Provider-owned plans have an edge in ad­dic­tion treat­ment

Modern Healthcare - - NEWS - By Shelby Liv­ingston

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.

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