September 6, 2018
As a leader in managing complex population health, concentrating across health care and pharmaceutical management, Magellan Health is making a difference in the opioid crisis. Magellan offers solutions across the care continuum for treatments of opioid dependence and addiction.
We recently spoke with Magellan’s Dr. Caroline Carney, chief medical officer for Behavioral and Specialty Health, and Dr. Seth Feuerstein, chief innovation officer, to discuss their work in addressing the opioid crisis.
Dr. Caroline Carney: We are using a data-based approach, where we look at analytics of patients who may be abusing and/or dependent on opioids or who may be at high risk to do so. We look to identify those who are going to multiple prescribers, using high amounts of opioids, or are prescribed dangerous combinations of medications. We evaluate patterns to identify those who may be at risk for developing dependence. Using analytics to identify outlier prescribers, we can enhance quality and safety for our members.
We also encourage providers to follow best practices on dosing limits to prevent misuse of opioids. It is important to ensure the morphine milligram equivalent dose and duration of treatment prescribed follow Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and/or state-required best practices. Providers can also consider non-opiate alternatives before prescribing opioids, and carefully evaluate whether long- or short-acting opioids should be used based on CDC and evidence-based guidance.
Dr. Seth Feuerstein: As health insurance providers, we work through primary care and digital platforms to streamline access to care for our members. We can screen for substance use disorders via email, via a portal, or at a primary care visit. The results of the screening are available to individual members in their electronic health record to share with their providers if they would like, and alongside the results are recommendations for next steps, including referrals to doctors. We can connect patients to clinics via a digital entry point (via portal and telehealth). We need to engage with patients if we intend to best serve them.
Dr. Carney: We use several approaches to care: a Chronic Pain and Musculoskeletal program, a population health approach, and a Prescription Drug Abuse solution.
The Chronic Pain/Musculoskeletal approach focuses on intensive treatment of pain. We find members through identification of chronic pain and conditions associated with pain in claims utilization data, pharmacy claims for opioids and morphine-equivalent doses (MED), and real-time referrals from utilization management and case management teams. We reach out to members and offer a pain assessment, which evaluates how they feel physically, and an assessment of willingness to change behavior. We also ask members to assess the impact of pain on their lives. These assessments indicate someone’s risk, willingness to change, and which solutions may be useful. This leads to individualized plans of care.
Members are enrolled in case management and with a care team consisting of a pain management physician, a psychiatrist, a psychologist, and a pharmacist who all work together. We have seen too many instances of people getting the wrong kind of care—many people with chronic pain need to be seen in the specialty setting and we hope that this approach helps provide that right kind of care. The results have shown that depression, pain, and functionality have all improved in members.
From a Population Health perspective, we use data to find those who may be at risk of abusing opioids and manage our members throughout their care in outpatient and inpatient settings. This is where our behavioral health work comes into play—we focus on getting people to transition into sustainable care. We use motivational interviewing, case management, provider outreach, and other approaches to identify and work with those who may be at risk.
Through Magellan Rx’s Live Vibrantly Program, we enhance traditional pharmacy solutions (including analytics) and drug utilization reviews with innovative interventions. This includes an Opioid New Start program to educate members who have been prescribed opiates for the first time; a toll-free opioid hotline for members who need help understanding their opiate prescription or feel like they have a problem; and enhanced utilization management. In one program, we’ve already seen an overall 11 percent decrease in opioid claims, and 280 percent increase in naloxone prescribing. Through analytics, we can identify when members are receiving prescription narcotics from more than one prescriber, identifying potentially fatal combinations of medications such as opioids and benzodiazepines or muscle relaxants.
Dr. Feuerstein: Magellan has been innovating with our digital cognitive behavioral therapy (DCBT) products for nearly a decade. It is the only program of its kind to receive the highest rating available by the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices, and collectively, the DCBT programs matched or exceeded results reached by conventionally delivered cognitive behavioral therapy.
For example, our SHADE program was first published in the Journal Addiction in 2009. SHADE is a virtual delivery model with telehealth and supports designed to help those with substance use disorders. SHADE helps participants manage their substance use disorder and potential co-occurring mood disorders by promoting long-lasting, skill-based changes in behavior and thinking.
In addition to the SHADE program, we have also recently launched ComfortAble, an app designed to help those with chronic pain reduce pain and improve functioning. We also have developed a platform that screens people for alcohol or substance use disorders and incorporates information on providers and health systems to connect those in need with services. We have been testing these products in federally-qualified health centers and accountable care organizations for six years.
Dr. Carney: The key is to have a multi-modal approach. A one-size-fits-all approach is never going to work.
Dr. Feuerstein: Data, data, data! Data-driven strategies yield the best results and set the path forward.