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    Four health programs successfully fight the opioid epidemic

     

    3. Inland Empire Health Plan’s Total Pain Care program

    Inland Empire Health Plan (IEHP) in California, a not-for-profit Medicaid and Medicare managed care plan, experiences high numbers of prior authorizations for opioids, and many  of its customer service calls, grievances, and complaints are pain-management related.

    IEHP’s Total Pain Care program focuses on a broad-spectrum pain management strategy. Instead of simply restricting the use of opioids, the health plan works with providers and community partners, says Bradley P. Gilbert, MD, chief executive officer.

    One example is IEHP’s partnership with a multidisciplinary pain program offered by the Desert Clinic Pain Institute (DCPI), which provides a focused, comprehensive approach for chronic pain sufferers who are on high doses of opioids.

    Approximately 1,000 IEHP members have been enrolled in the DCPI center of excellence program since 2015. In addition to chronic pain and opioid use, they often have a psychiatric illness or symptoms. Most are at high risk of hospitalizations and/or death from opioid overdose.

    “It’s a 12-month [fully covered by IEHP], evidence-based program that uses medical treatment, behavioral therapy, physical reconditioning, and education,” says Jennifer N. Sayles, MD, IEHP’s chief medical officer. “Patients may receive individual or group cognitive therapy, restorative medicine and conditioning, and alternative therapies such as yoga, mindfulness, massage, acupuncture, and other treatment modalities. The focus is promoting patient self-efficacy and functional restoration.”

    Patients report statistically significant decreases in perception of pain intensity and interference, significant improvement in their Pain Disability Index measures, and decreases in depression symptoms as measured by Patient Health Questionnaire scores, Sayles says. IEHP has also seen improved member satisfaction and reports of improved quality of life.

    The key to making an impact on the opioid crisis is coordinating with carve-out and community services, Gilbert says. “Health plans also need to engage with their members before and during treatment. Transitional support programs help ensure successful outcomes for members after they’ve completed the DCPI program.”  

    4. U.S. Department of Defense (DoD) opioid reduction program

    DoD’s opioid reduction program focuses on reducing demand, treatment, and overdoses. “Demand reduction is accomplished by a strong drug testing program, interdiction efforts with law enforcement, prescription drug monitoring programs, and policies that limit types and amounts of opiate drugs that may be dispensed,” says Capt. Michael Colston, USN, Office of Health Services Policy & Oversight, Department of Defense (DoD) Health Affairs.

    DoD requires all opioid providers to complete DoD-specific training that guides them to consider when it is most appropriate to use opioids for pain, and when other treatment approaches are best. “DoD embraces parity between substance abuse treatment and all other forms of medical treatment,” Colston says. “To that end, inpatient beds, medication-assisted treatment, and intensive outpatient treatment capability have been increased.” 

    DoD has a long-standing random urinalysis program for all uniformed service members, Colston says, noting that three years ago, its drug testing panel was expanded to cover additional opiate metabolites. “Positive screens remain well below 1%,” he says.

    DoD’s overdose death rate (2.7/100,000) is one fourth of the national rate (10.4/100,000), according to Colston. “Even after demographic corrections—DoD is younger and more male than the general population—the rate is less than half the civilian rate,” he says.

    Tracey Walker
    She is senior editor of Managed Healthcare Executive.

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