Using Membership Data to Solve Michigan’s Opioid Crisis

Using Membership Data to Solve Michigan’s Opioid Crisis

Nov 19 2017

America's opioid epidemic is a major health crisis.

By: Dr. James Forshee, Chief Medical Officer and Senior Vice President of Medical Affairs

Drug overdose is the leading cause of accidental death in the United States, killing more people than guns or car accidents.

Opioids were involved in nearly 50,000 deaths in 2016, with almost 2,000 of those deaths happening in Michigan. According to the U.S. Centers for Disease Control and Prevention, the state is facing an opioid epidemic.

Priority Health is committed to tackling this issue with a goal to reduce opioid use among its members by 25 percent within the next two years.

We all, health providers and insurers included, need to be a part of the solution to reverse the opioid use and abuse trend.

The first step is to have empathy for this crisis.

When people with historic dependence on drugs get seriously hurt or need surgery, it’s often not clear, even to many doctors, how to safely manage their pain. For some people recovering from addiction, what begins as pain relief ends in tragedy. Opioid dependency has direct medical and social implications, as opioids limit a person’s ability to live a normal, healthy life.

Priority Health has taken a closer look at how we can protect our members from further harm by leveraging our members’ data to identify any underlying indicators. Specifically, we reviewed the prescription process for opioids, finding the drugs tend to be over-prescribed. We also found that if a person takes these prescriptions for more than seven days, their likelihood of becoming dependent increases.

Potential solutions/next steps

Priority Health is committed to tackling this issue with a goal to reduce opioid use among its members by 25 percent within the next two years. To do so, we’re investigating the following changes:

  • Limit the types and amounts of opioids that are available through prescription coverage
  • Drive our physician partners to prescribe the opioid antidote along with an opioid prescription
    • This antidote has the ability to counteract the opioid in three to five minutes, helping to prevent death from an overdose
  • Alert high risk opioid members on the severity of inappropriate drug use and what they can do to combat the risk of overdosing
  • Eliminate 90 day fills of opioids
  • Limit prescription coverage to 30 days for long acting opioids and 15 days for short acting opioids, and two scripts in a three month period
  • Increase the number of members in dependency/addiction and substance-abuse treatment programs

Priority Health has already expanded its provider network to include more residential treatment and medication assisted treatment providers. We have also expanded our care management program staff to serve more members.

To truly impact the epidemic, however, advocating for changes to state policy is a must, such as improving access to evidence-based therapies for addiction. Additionally, investing in Prescription Drug Monitoring Programs (PDMPs) and state-run electronic databases used to track opioid prescriptions will help identify best practices. This information should be immediately available in the electronic medical record.

It’s time we end the stigma that surrounds those who have become dependent on opioids and instead help them recover and stay healthy. Take the time to learn more about opioid dependency to protect yourself and loved ones from opioid abuse, addiction and overdose.

About the Author: James Forshee, MD is chief medical officer and senior vice president of medical affairs at Priority Health. With more than 25 years of experience, he oversees medical policy and programming, as well as clinical strategies for the organizations. He is responsible for leading the clinical and pharmacy departments and programs, the development and coordination of population health programs and chronic disease management strategies. 

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