Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

BCBSA Tackles Opioids with Big Data, Accreditations, Member Hotline

The Blue Cross Blue Shield Association is planning to further reduce opioid abuse by adding new features to its population health management toolkit.

Opioid abuse and population health

Source: Thinkstock

By Jennifer Bresnick

- The Blue Cross Blue Shield Association (BCBSA) is taking additional steps to combat opioid abuse by leveraging big data analytics and offering more resources to patients and providers seeking to prevent or treat opioid dependence.

In 2017, close to a quarter of a million BCBS plan members had an opioid use disorder diagnosis, according to a new report from BCBSA and Blue Health Intelligence, highlighting the prevalence of the nation’s most widespread population health crises.

While the number of opioid prescriptions filled by BCBS members has dropped by 29 percent since 2013, hotspots of abuse and dependence remain a matter of significant concern for patients, regulators, payers, and public health officials.

"BCBS companies are deeply committed to improving how we care for those currently suffering from opioid use disorder," said Scott Serota, president and CEO of BCBSA.

To better address the needs of members attempting to access treatment, BCBSA will establish a new accreditation program called the Blue Distinction® Centers for Substance Use Treatment and Recovery.

READ MORE: Opioid Prescriptions Dropped 12% in 2017 as Guidelines Change

The initiative will fill an important gap in the assessment of treatment centers, which have historically lacked a strong review process.

A 2013 survey of the treatment center landscape found that only 22 percent of facilities had been accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), and just 19 percent had received a nod from the Joint Commission, BCBSA says.

More than half of centers have neither certification, leaving patients and providers unable to be confident that they are accessing high quality, effective substance abuse care.

By the year 2020, BCBSA will be vetting treatment centers through its new program.

BCBS customers and the general public will also be able to call a new hotline that will connect them with appropriate high-value treatment centers approved by the consortium of payer organizations.

READ MORE: For Opioids and Substance Abuse, Big Data Analytics Is Just the Beginning

"Our goal is to assess the effectiveness of treatment options and close the gap in care to make a difference in not just our members' lives, but the lives of all Americans," said Serota.

The new tools will hopefully help healthcare stakeholders continue to reduce the misuse of opioids. 

Ongoing efforts to curb high prescription rates have been positive, BCBSA said, and the number of opioid use disorder diagnoses actually declined slightly in 2017.

Since 2013, the number of BCBS members who have filled at least one opioid prescription per year has dropped by 25 percent. 

Opioid use disorder diagnoses per 1000 Blue Cross Blue Shield members

Source: BCBSA

READ MORE: Addressing Opioid Abuse with Analytics, Population Health Strategies

Thirty-four states across the nation reduced their opioid prescription rates by 30 percent or more, with Massachusetts seeing a 51 percent decline in filled prescriptions.

"Our Prescription Pain Medication Safety Program has had a substantial impact on opioid prescribing habits in the Commonwealth, helping to reduce the risk of misuse of these powerful narcotics," said Bruce Nash, MD, Chief Physician Executive at Blue Cross Blue Shield of Massachusetts.

The program, launched in 2012, combined industry best practices with care coordination and data analytics strategies to develop guidelines for new and continuing opioid prescriptions. 

By 2014, the initiative contributed to a 20 percent decrease in claims for short-acting opioids such as Vicodin and Percocet and a 50 percent drop in claims for longer-acting drugs, such as OxyContin and its equivalents.

"Solving the nation's opioid epidemic takes strong partnerships among the medical community, health insurers and government. Programs such as Blue Cross' Prescription Pain Medication Safety Program are leading the way in addressing this health crisis," said Massachusetts Secretary of Health and Human Services Marylou Sudders.

"We are encouraged to see opioid-related deaths declining and prescriptions for Schedule II drugs significantly decreasing in Massachusetts, but we know that there is significant work ahead to increase access to treatment and to help individuals find the path to recovery across the state."

Despite dramatic declines in prescribing, New England remains among the regions with the highest rate of opioid use disorder, says BCBSA.  New Hampshire has the highest rate of new diagnoses, with 12.3 out of every 1000 BCBS members suffering from opioid use disorder.

In contrast, just 2.2 per 1000 members in South Dakota are being diagnosed with the condition.  The majority of states hover between 3 and 6 diagnoses per 1000 members, but rates are significantly higher in the Appalachian region, the Deep South, and in Alaska.

The data supports what national BCBSA leaders already acknowledge: that payers and providers still have a challenging road ahead.

"We are encouraged by these findings, but we remain vigilant," said Dr. Trent Haywood, senior vice president and chief medical officer for BCBSA. "More work is needed to better evaluate the effectiveness of treatment options and ensure access to care for those suffering from opioid use disorder. BCBS companies are committed to doing both."


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