Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Substance Abuse Help Cuts Population Health Management Costs

By Jennifer Bresnick

- Integrating substance abuse care into a population health management program can help raise patient retention numbers, reduce emergency department visits, and cut healthcare costs by an average of 46 percent, says a study from Humana and Catasys Inc., presented at the American Society of Addition Medicine’s annual conference.  Using clinical analytics based on claims data that flagged patients who may have had their substance abuse problems overlooked in the past, Humana was able to provide more comprehensive, proactive treatment for some of the 23 million Americans who may benefit from better management in this area.

Population health management and substance abuse

The study involved more than 2300 Humana patients, 151 of whom were selected for participation in a substance abuse management program.  These patients were identified through their claims history and paired with a control group with a predictive analytics algorithm that identified metrics including average number of emergency department visits and inpatient hospital admissions.

The patients who were enrolled in a population health management program that integrated proactive help and treatment for substance abuse had 16 percent fewer emergency department visits and 67 percent fewer hospital admissions than the control group.  Their enrollment rate also remained more than six percent higher than the national average of 10.9 percent.

Substance abuse, particularly when it comes to controlled prescriptions such as opioids, has received intense scrutiny from healthcare providers and lawmakers who are attempting to leverage healthcare data analytics for better monitoring and the reduction of doctor shopping and other types of fraud.  With expanded state-level databases and a more real-time look into patient behaviors, government officials and the healthcare industry are partnering to prevent adverse events, crimes related to substance abuse, and overdose deaths.

The Humana study contributes to a growing consensus within the healthcare industry that better population health management and patient-centered care can make a significant impact on the way patients cope with difficult long-term issues like chronic pain, which may lead to opioid addiction. 

In January, the Institute of Medicine (IOM) recommended that healthcare providers make better use of their data analytics infrastructure to identify chronic pain sooner and manage it more effectively to prevent patients from joining the 60 percent of prescription opioid users who are at risk for adverse events due to poor medication reconciliation and insufficient monitoring.

“We have inadequate knowledge about treating various types of pain and how to balance effectiveness with potential harms," said Dr. David B. Reuben, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. "We also have a dysfunctional health care delivery system that promotes the easiest rather than the best approach to addressing pain."

Participants in the Humana program not only received better care that helped them avoid crisis events, but also significantly reduced their healthcare costs, which dropped an average of 46 percent.  At the same time, the control group’s costs increased by 14 percent, the study found.  The costs were calculated by measuring the changes in average allowable claim costs per member per month.

“The improved health outcomes results clearly reflect the benefits that population health can achieve by integrating substance abuse programs,” said Dr. Larry Weinstein, Chief Medical Officer for LifeSynch, a wholly owned subsidiary of Humana that provides behavioral health services. “By taking a proactive approach, as opposed to a reactive one, we were able to reach people at risk for medical and psychiatric complications from substance use disorders. This enabled us to take the necessary steps to help people improve their health.”

“We are pleased to help members with substance use disorders engage the type of support needed to improve their health and well-being,” added Omar Manejwala, MD, Chief Medical Officer for Catasys. “Treated members are proactively managing their conditions, and their improved health results in fewer trips to the emergency room and fewer inpatient admissions.”

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