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January – February 2019
A message from Dr. Duane DiFranco
Here's an overview of Blue Cross’ efforts to address opioid epidemic
 More than 2,600 Michigan residents died in 2017 from drug overdoses, exceeding the number of traffic and firearm fatalities reported that year. As the opioid epidemic continues to capture the attention of public health officials and decision-makers across the country, Blue Cross Blue Shield of Michigan and Blue Care Network are continuing efforts to address the issue through public awareness, collaboration and improvements to clinical care delivery.
A multifaceted approach
Prevention, treatment, advocacy and collaboration have been the foundation of Blue Cross’ efforts to address the opioid epidemic. What began as an internal, cross-functional task force among company representatives has extended to working with physician groups, forging partnerships with other health plans and supporting community groups across the state.
A few of our key focuses have been:
- Raising awareness: Educating the health care community and public about opioid and prescription drug misuse has been crucial. Whether it’s sharing information about safe disposal or ways to identify or treat substance use disorder, Blue Cross’ goal is to advocate for prevention and awareness around all aspects of the opioid epidemic.
- Removing barriers to treatment: Blue Cross and Blue Care Network have removed barriers to addiction treatment by providing access to medication-assisted treatment, which reduces cravings and keeps those in recovery stable. Prior authorizations aren’t necessary for most buprenorphine-based treatment regimens such as Suboxone®, Vivitrol® or methadone. By using real-time hospital discharge data, our pharmacy team works with our behavioral health experts to engage members in treatment following an opioid or heroin overdose.
- Supporting community coalitions: In 2018, the Blue Cross Blue Shield of Michigan Foundation joined forces with the Michigan Health Endowment Fund and the Community Foundation for Southeast Michigan to award more than $500,000 in grants to nine community coalitions across the state working to fight opioid abuse. The funding is helping communities start sustainable, evidence-based practices that include education, law enforcement and clinical interventions addressing opioid and prescription drug abuse in Michigan.
Treating chronic pain
As the conversation around pain management evolves, Blue Cross remains focused on working directly with doctors to coordinate care and reduce opioid and prescription drug misuse. A proper balance needs to be struck as I wrote in a column in the November – December issue of this newsletter. People with — or at risk of — opioid use disorder need assistance and so do people with significant pain syndromes. Some of the strategic approaches we’ve taken to encourage balanced and appropriate opioid prescribing practices, include:
- Enforcing policy change: As of Feb. 1, 2018, we’ve been working with doctors to limit the quantity and day supply of addictive substances. This common-sense step helps members get the pain management medication doctors believe is needed, while taking positive steps to address a growing epidemic of addiction and overdose deaths. For example, for our commercial members, an initial fill of a prescription for an addictive medication is limited to a five-day supply. And additional fills are limited to a 30-day supply. (This doesn’t apply to members with a cancer diagnosis or who are terminally ill.) Blue Cross also uses system edits, such as refill-too-soon logic, to limit early refills and help prevent the stockpiling of controlled substances.
- Forging partnerships: Blue Cross and the Michigan Opioid Prescribing Engagement Network work with our physician groups to improve statewide prescribing practices and utilization. Michigan OPEN works with doctors and hospitals to decrease new opioid prescriptions to surgical patients and raise awareness of the danger of opioids. Blue Cross is also a member of America’s Health Insurance Plans’ and the Blue Cross and Blue Shield Association’s opioid prevention and abuse workgroups. These groups are focused on developing recommendations on how health plans can work with others in the health care community to ensure safe opioid prescribing.
- Identifying at-risk members: Blue Cross has worked to monitor who's obtaining controlled substances from multiple prescribers and analyze claims for larger-than-average amounts. In addition to this, our Controlled Substance Workgroup of doctors, behavioral health specialists, case managers, pharmacists and corporate investigators review claims of members with behavior reflecting opioid misuse or abuse to then coordinate treatment referrals and ongoing case management.
- Providing resources on appropriate treatment of pain: Blue Cross has worked with the state of Michigan and with our providers to develop clinical care guidelines for the prescription of opioid medication in primary care. We’ve also sponsored, in collaboration with provider partners, continuing medical education across the state to better equip providers to treat those with significant pain.
Promising results
While there’s still much work to be done to address the opioid epidemic, Blue Cross has seen notable results from our efforts. Here are some significant statistics:
- Since 2014, the number of members receiving the dangerous “triple threat” drug (a combination of opioids, benzodiazepines and Soma®) has decreased 84 percent.
- By incentivizing physician groups through Value Partnership programs, Blue Cross has been able to increase electronic prescribing of controlled substances by nearly 30 percent since 2015.
- From 2012 through 2017, the number of opioid prescriptions went down 32 percent.
- About 850,000 fewer opioid pills have been dispensed since 2014 due to our “triple threat” and “doctor shopper” initiatives.
For more information, visit Blue Cross’ Opioids 101 online resource page at mibluesperspectives.com/opioids101.
Duane J. DiFranco, M.D., is Blue Cross Blue Shield of Michigan’s vice president of clinical programs and our Medicare star ratings program. |
