Spotlight: How providers and payers are combating the opioid epidemic in different parts of the US

Hospitals, health systems, and physicians are leading their own charge, in tandem with law enforcement and government, when it comes to combating the opioid crisis that is gripping the country.

There are numerous ways that states, providers, and even payers, are choosing to attack the issue. According to a new study from the Blue Cross and Blue Shield Association, Massachusetts is leading the nation when it comes to cutting down on opioid prescribing and abuse treatment.

The study looked at claims data from BCBS members across the country, and weighed it against national benchmarks. In 2015, 14 percent of Massachusetts members in Massachusetts filled an opioid prescription, well below the national benchmark of 21.4 percent.

Nationally, treatment numbers are disheartening. While opioid use disorder diagnoses skyrocketed  nearly 500 percent between 2010 and 2016, medication-assisted treatment increased by only 65 percent. However in Massachusetts, 84 percent of members who were diagnosed received medication-assisted treatment. The treatment method employs both counseling and drug therapy.

The report also said that prescriptions for "high-dose, long-duration" opioid-based medications, which have been linked to higher rates of opioid abuse, were fewer by far in Massachusetts, with just 2 percent of members receiving such prescriptions. The national average is 8.3 percent.

BCBS is one payer taking specific aim at the opioid crisis with its Blue Cross Blue Shield of Massachusetts Prescription Pain Medication Safety Program, which was introduced in 2012. It required several measures including: prior authorization for all new short-acting opioid prescriptions for more than 30 days; prior authorization for all new long-acting opioid prescriptions; treatment plans that consider non-narcotic options; risk assessment for addiction signed by the patient; an opioid agreement between the patient and prescriber outlining expected behavior of both parties.

"In its first three years, the Prescription Pain Medication Safety Program eliminated more than 21 million doses of opioid-based medications. Additionally, the program became the model for legislative action by the Commonwealth of Massachusetts," BCBS said in a statement.

For some systems it's new prescribing policies and protocols surrounding opioid administration. Some are utilizing technology and a means to track patients use, and some states are even mandating such measures. 

As of January, Nebraska became the first state to require that all drugs b reported to its Prescription Drug Monitoring Program, or PDMP. 

To Nebraska's south, New Orleans' Oschner Health System has made opioid monitoring a function its EHR, Epic. In Indiana, as of 2017 the state said it would integrate EHR software with its Inspect program to better track controlled substance prescribing.

Finally, University of Carolina Health Care at Chapel Hill just this week announced their own plans to integrate its Epic EHR with the states controlled substance reporting platform, a move tha allows clinicians to access the database when they order medicine, simplifying a once-complicated process that required juggling the two systems simultaneously, into one that takes just a few steps for a provider to confirm a patient's prescription history. This helps make sure a patient is no prescribed any inappropriate medication.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com