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Sober Nation

Putting Recovery On The Map

03-03-16 | By

How Insurers Plan to Curb The Opioid Epidemic

Health Insurance

It has become a broken record–America has a rampant prescription painkiller addiction problem. The widespread abuse and deaths associated with painkillers and other prescribed medications have reached crisis levels in our country. This drug epidemic has not only become a major platform issue for Presidential candidates, it has brought legislators, law enforcement, addiction professionals and concerned citizens across the country together in hopes of finding solutions to an epidemic that is showing little signs of slowing down.

As this crisis is reaching fever pitch, insurance companies have started to offer their own solutions in an attempt to slow the destructive progress of prescription painkiller addiction. Feeling the pinch of high costs of the after effects of treating painkiller addiction, there are some smaller non-for-profit insurers who are starting to put into place solutions in order to curb the opioid epidemic.

Instituting Interventions on the Front Lines

The ways insurers plan to curb the opioid epidemic start by providing the necessary interventions when those who are addicted enter a care facility. The Association for Community Affiliated Plans (ACAP)–which represents about 60 safety-net health plans in 24 states–gathered its members together in order  to come up with beneficial ways that payers can help the delivery system trim those costs and cut down on unneeded visits to the emergency rooms.

Some of the solutions these members came up with included locking patients into one pharmacy provider to keep them from bouncing between locations looking for drugs and to having plan-employed health navigators reach out to the primary care doctors when their patients visit an emergency room which is not in their provider network.

Children’s Community Health Plan of Wisconsin–which is a member of the ACAP network–has seen ongoing issues with mothers who are hooked on prescription painkillers while pregnant, and then giving birth to babies who are also addicted. The healthcare provider went through their data screening for pregnant women that were showing tell-tale signs of opioid addiction. When the timing was right in the pregnancy, the provider discreetly reached out to the pregnant women that were affects as well as their providers to make sure the doctor is aware of the addiction, allowing them time to put measures in place to wean newborns off of opioids.

Another example of an insurer reaching instituting preventative measures is Texas Children’s Health Plan, and they were noticing a dramatic increase in the number of children who were suffering from opioid poisoning. When representatives investigated further into the claims data, they had found that many parents of these children were obtaining drugs through their dentists or orthopedists, rather than their primary care provider–and often without using their benefits. As a result, Texas Children’s Health Plan has worked with physicians to learn how to screen, spot and refer teens who are abusing drugs to the appropriate behavioral health services.

Working Together to Curb Opioid Addiction

There are other ways that insurers plan to curb the opioid epidemic is by forming partnerships with organizations outside the immediate medical care field. For example, Massachusetts-based providers such as Neighborhood Health Plan and CeltiCare have created programs that connect their members with social workers.

This measure was put into place to help members with a history of painkiller abuse and may be more vulnerable to addiction from overdosing. The approaches these insurers are taking are more hands-on. By connecting those who abuse painkillers with experts who can actively help prevent them from overdosing, it helps those addicted find the appropriate help they need and it helps insurance companies trying to avoid big hospital bills.

While the measure that insurers are using to curb opioid addiction are innovative and can a precedent for other insurers, it is too early to tell whether these new programs are providing significant impact. However, the approach these smaller insurers are taking may get the notice of larger health insurance companies and they may follow suit with similarly structured intervention programs.

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