Healthcare Analytics, Population Health Management, Healthcare Big Data

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Optum Risk Management Analytics Cut Opioid Use by 14%

Payers are leveraging all the analytics tools at their disposal to reduce opioid use and manage high-risk individuals.

Opioid use and risk management analytics

Source: Thinkstock

By Jennifer Bresnick

- UnitedHealth Group’s Optum analytics services are helping to significantly reduce improper usage of opioids and bring providers in step with recognized clinical guidelines. 

By placing limits on the amount and duration of opioid prescriptions for certain patient populations, the OptumRx Opioid Risk Management program has reduced overall opioid use by 14 percent in a pilot with 400 healthcare clients.

The tool allows providers and pharmacists to take a data-driven approach to managing the risks developing opioid dependence as a result of inappropriate use of legal prescriptions. 

By combining educational efforts with stricter limitations on the duration and dosages of opioid prescriptions, providers can better control how patients benefit from pain management drugs without unintentionally getting hooked on the medication.

“Recognizing this is an issue that can affect any segment of our population at any point in time, successful opioid management programs must tailor engagement based on the needs of an individual,” said David Calabrese, chief pharmacy officer at OptumRx.

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

“The right level of prevention and care must be delivered, at the right time, to the right stakeholder – using multiple channels and touchpoints – before a member even receives a first opioid prescription through to the effective support and management of those well entrenched in battles to fight this devastating epidemic.”

The program’s multifaceted efforts to control opioid use include applying evidence-based utilization management protocols to refill requests and prescriptions that may lead to excessive dosing, as well as using big data analytics to identify potentially high-risk individuals.

OptumRx uses CDC guidelines to ensure that pharmacists and providers can successfully limit patients to recommended dosages of these powerful drugs.  As a result, the company has seen an 82 percent reduction in the number of prescriptions above the CDC guidelines for recommended doses of 50mg morphine equivalent dose (MED) per day for first-time acute prescriptions.

The pilot has also produced a 65 percent drop in the number of prescriptions written above the maximum 7-day supply for first fills and a 68 percent decrease in prescriptions of more than 90mg MED for known current chronic opioid utilizers.

“OptumRx’s program is showing early but meaningful potential to begin curbing the opioid epidemic in America,” said Dr. Sumit Dutta, chief medical officer of OptumRx. “We expect these improvements to continue as the program gains momentum and we implement with more clients.”

READ MORE: Surgeon General, Healthcare Orgs Pledge to Tackle Opioid Abuse

UnitedHealth Group is just one of many insurance payers attempting to curb the raging opioid epidemic from their side of the equation.  With a complete view of patient activities across the vast majority of their providers, payers are uniquely positioned to access valuable insights into potential overutilization of high-risk medications prescribed by multiple entities.

Cigna recently announced similar success with its opioid reduction efforts, citing a 12 percent drop in prescription rates between 2016 and 2017.  The payer’s Cigna Collaborative Care program, involving more than 62,000 physicians across the country, leverages big data analytics and provider alerts to ensure that clinicians are monitoring how their prescribing habits are impacting patients.

“As a country, we have developed an overreliance on opioids to manage pain. If we’re going to break the opioid epidemic, we need to change that culture,” Cigna President and CEO David Cordani.

“Helping doctors become more aware of their own prescribing patterns and the effectiveness of non-narcotic alternatives for pain management is key to helping our customers have better health outcomes. For those who have become dependent on opioids, we need to treat them as compassionately as we would someone suffering from any other chronic disease and help them with recovery.”

Anthem has also seen promising results with its opioid management strategies.  The company has reached its goal of reducing filled opioid prescriptions by 30 percent ahead of schedule.

READ MORE: ICU Admissions from Opioid Overdoses Increase 34% Since 2009

In the past year, several states have seen drastic reductions in opioid prescriptions through Medicaid, including a 29 percent decrease in Virginia, 22 percent in Maryland, and 9 percent in Georgia.

Employer-sponsored and individual plans decreased their opioid prescription rates by 23 percent in Nevada, 17 percent in Connecticut, and 17 percent in Wisconsin.

“Anthem believes all insurers have a responsibility to do what we can to address this health epidemic, and we are committed to making a significant difference to our health plan members,” said Dr. Sherry Dubester, Anthem vice president of behavioral health.

“We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, reduce and more effectively treat opioid use disorder among our members.”

Like OptumRx, Anthem relies on enforcing stricter prescribing guidelines and duration limitations for opioid use.  Provider alerts and coordination with pharmacists also help to reinforce adherence to guidelines and reduce the risk of dependence for patients.

Collaboration across the care continuum is essential for success, say representatives from Anthem and Cigna, as well as OptumRx’s Calabrese.

“The results of Opioid Risk Management show that through coordinated efforts across the entire spectrum of patient treatment, we can make changes that help provide better health outcomes for patients and for society as a whole,” he said.


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