Provider-owned plans have an edge in addiction treatment
Provider-owned health plans have a leg up over traditional insurers when it comes to tackling the opioid epidemic.
Integrated systems that own health plans are better able to directly address over-prescribing of opioid painkillers and expand access to addiction treatment.
“It really makes a difference when payers and providers sit down and attack the problem together,” said Dr. Perry Meadows, medical director of government programs at the not-for-profit Geisinger Health Plan, owned by Danville, Pa.-based Geisinger Health System.
Geisinger Health Plan’s special investigations unit analyzes claims data to pinpoint providers who are prescribing opioids inappropriately and removes them from the plan’s network.
Through a state center of excellence grant, Geisinger plans to open three clinics this year devoted solely to medication-assisted treatment, or MAT, which combines medication and behavioral health therapy to treat addiction. The plan will use case management to identify patients early and help them complete the treatment program.
Geisinger also holds community forums on opioid abuse, where Meadows speaks about his own family’s harrowing experience with his stepson’s long-term addiction problems. The stepson got hooked on opioid painkillers after suffering a workplace injury. He still uses heroin and cocaine even after experiencing a near-fatal overdose, during which Meadows had to perform CPR to save his life. “It can happen to anybody,” Meadows said. At Kaiser Permanente, providers, pharmacists and the health plan collaborate in addressing opioid abuse. The integrated system removed most of the high-potency opioids from its prescription drug formulary. Only Kaiser’s pain management specialists, oncologists, and hospice and palliative-care doctors are authorized to prescribe these drugs.
The health plan also put limits on the amount of opioid painkillers doctors could prescribe and built alerts into its electronic health record system to ensure doctors aren’t prescribing dangerous combinations of painkillers. The plan’s pharmacy mines data to monitor physicians’ prescribing patterns.
In addition, Kaiser doctors don’t face the disincentive of low reimbursement rates that discourage other doctors from providing needed medication-assisted treatment to addicted patients. That’s because Kaiser doctors are salaried.
“We don’t sit there and worry if the reimbursement for that treatment is too low to be worth our while,” said Dr. Michael Kanter, the system’s chief quality officer.