Feel­ing the pain, em­ploy­ers be­gin to take on the opi­oid epi­demic

Ed­u­ca­tion, ad­dic­tion ser­vices and al­ter­na­tive ther­apy cov­er­age to treat pain man­age­ment are among the strate­gies com­pa­nies are em­brac­ing

Employee Benefit News - - Contents - By Kathryn Mayer

Ed­u­ca­tion, ad­dic­tion ser­vices and al­ter­na­tive ther­apy cov­er­age to treat pain man­age­ment are among the strate­gies com­pa­nies are em­brac­ing.

It’s no se­cret that the opi­oid cri­sis has been a bur­den on so­ci­ety. But em­ploy­ers are fi­nally be­gin­ning to re­al­ize the im­pact it’s hav­ing on them. From the cost bur­den of abuse and ad­dic­tion treat­ments to ab­sen­teeism and lost pro­duc­tiv­ity, abuse, mis­use and ad­dic­tion of the drug is tak­ing its toll. In fact, more than half of em­ploy­ers (60%) say they’ve been af­fected by at least one case of opi­oid mis­use or abuse, ac­cord­ing to a re­cent sur­vey of 62 large em­ploy­ers by the Na­tional Busi­ness Group on Health.

All this is lead­ing to a big change: The days of em­ploy­ers view­ing the epi­demic as purely a so­ci­etal is­sue are over, ex­perts say. So what are em­ploy­ers do­ing to ad­dress the is­sue?

For an­swers, Em­ployee Ben­e­fit News spoke to Brian Mar­cotte, pres­i­dent and CEO of the Na­tional Busi­ness Group on Health, and Mike Thompson, pres­i­dent and CEO of the Na­tional Al­liance of Health­care Pur­chaser Coali­tions. The two in­dus­try ex­perts spoke about the need for changes in em­ploy­ers’ ed­u­ca­tion ef­forts, as well as more pain man­age­ment al­ter­na­tives — and how all that might change ben­e­fit plan of­fer­ings.

Em­ployee Ben­e­fit News: We are see­ing how big of a prob­lem opi­oids are in greater so­ci­ety, and how much it’s also cost­ing the econ­omy. But clearly it’s an is­sue that’s af­fect­ing em­ploy­ers and their work­force — how big of a prob­lem is this for them?

Brian Mar­cotte: This is a huge prob­lem for em­ploy­ers. I think ev­ery­one rec­og­nizes it is a big so­cial is­sue for the coun­try, but peo­ple don’t think it’s hap­pen­ing in their back­yard. We’re start­ing to work with em­ploy­ers and are start­ing to look at em­ployer data go­ing back sev­eral years to re­ally dig into this, and we are re­al­iz­ing it’s been a big is­sue for them.

Mike Thompson: Em­ploy­ers ini­tially looked at this [as] a so­ci­etal is­sue, not nec­es­sar­ily an em­ployer is­sue or ben­e­fits is­sue. But our coali­tion is work­ing to de­velop an agenda for what em­ploy­ers should do. I think there are mul­ti­ple parts to the agenda, and part of it is re­ally deal­ing with the epi­demic of ad­dic­tion and cre­at­ing an en­vi­ron­ment that al­lows peo­ple to get the help they need and help get them on a path to re­cov­ery. It’s not a sim­ple task at all; it’s prob­a­bly the fastest-grow­ing epi­demic we’ve seen in our gen­er­a­tion. It’s one we need to take very se­ri­ously, and one where ev­ery­one has to do their part.

What kinds of things should be on the agenda? What are em­ploy­ers be­gin­ning to do?

Mar­cotte: Em­ploy­ers are do­ing a num­ber of things: they are work­ing with their health plans and their phar­macy ben­e­fit man­agers to in­cor­po­rate CDC guide­lines — which are very good — [on] how opi­oids should be dis­pensed and man­aged. They’re also work­ing with their health plans to coach, ed­u­cate and work with providers [re­gard­ing their pre­scrip­tion pat­terns]. A num­ber of em­ploy­ers have im­ple­mented train­ing for man­agers and peers to iden­tify signs not only of opi­oid is­sues, but be­hav­ioral health is­sues, and help steer [em­ploy­ees] to ap­pro­pri­ate re­sources. There are a num­ber of things, but there are still a num­ber of gaps and chal­lenges.

What have been the bar­ri­ers to deal­ing with this is­sue, and how do you over­come those bar­ri­ers?

Thompson: Part of it is deal­ing with this from a cul­tural per­spec­tive, where his­tor­i­cally, much like men­tal health and obe­sity, there is a sense that peo­ple brought this on them­selves and they share in the blame for what has hap­pened here.

But of­ten peo­ple got here by no fault of their own — by treat­ments from their provider — and when peo­ple are af­fected by this, the path­way out is a very se­ri­ous one to take. The other part is deal­ing with de­liv­ery of care to try to stem the tide, and that’s start­ing to turn al­ready. I’m very en­cour­aged by opi­oid light treat­ments, for surgery, [which] don’t re­quire as much med­i­ca­tion as what was con­sid­ered stan­dard prac­tice.

So what are some of the al­ter­na­tives to opi­oids and those drugs? How are em­ploy­ers be­gin­ning to look at this?

Mar­cotte: One of the ar­eas we have been ex­plor­ing is phys­i­cal ther­apy as an al­ter­na­tive to pain man­age­ment. We are be­gin­ning to see the

emer­gence of vir­tual care so­lu­tions around phys­i­cal ther­apy. There are a num­ber of dif­fer­ent com­pa­nies that can do dig­i­tal coach­ing re­lated to phys­i­cal ther­apy, which helps break down bar­ri­ers to ac­cess and ad­dresses some stigma is­sues re­lated to treat­ment.

The con­ve­nience fac­tor helps, too. We are be­gin­ning to see some changes in provider pre­scrib­ing pat­terns when it comes to the num­ber of opi­oids or al­ter­na­tives to opi­oids, but it takes a long time to change be­hav­ior and ad­here to best prac­tice.

Thompson: What em­ploy­ers are more read­ily em­brac­ing that they should have a point of view on — and should take ac­tion on — is pain man­age­ment.

We know past prac­tices have con­trib­uted to this epi­demic, so ed­u­cat­ing peo­ple on what the risks [of opi­oids] are, and what are some of the al­ter­na­tives is key. We need to let peo­ple know these are con­trolled sub­stances for a rea­son, and we need to treat them as such. It’s a huge is­sue we’re just get­ting our hands around, and frankly, em­ploy­ers are play­ing a big role.

But as we look at al­ter­na­tives to ad­dic­tive med­i­ca­tions for pain man­age­ment, we re­ally need to look at our cov­er­age prac­tices for some of these al­ter­na­tives. Some­times we may not be cov­er­ing acupunc­ture, chi­ro­prac­tor care or other lim­ited ap­proaches to pain man­age­ment.

EBN: So the opi­oid epi­demic may lead to a big shift in de­liv­ery of care and ben­e­fits that are cov­ered in plans? Mar­cotte: It’s go­ing to have to. We need al­ter­na­tives. Some of these other so­lu­tions, the patient is go­ing to have to be con­vinced they don’t need opi­oids and there are al­ter­na­tives.

I think em­ploy­ers will have to take a hard look at their pBh:8y.s6i2c5a l ther­apy ben­e­fits and see how they’re struc­tured and ask if they’re an en­abler or a bar­rier to al­ter­na­tives to opi­oids.

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