While Congress considers dozens of bills to bring much-needed resources to our nation’s opioid crisis, it is our communities, each unique and distinct, that form the core of the solution.
By working with community-based, nonprofit health plans that are on the frontlines, I have seen how their deeply rooted partnerships with community leaders — including clergy, law enforcement, schools and employers — helped them understand the magnitude of the opioid problem and compelled them to act long before the crisis hit the national consciousness.
The experience of local, nonprofit health plans is particularly useful to understand as Congress crafts policy and directs federal funds, because these plans have long been investing in opioid addiction prevention and treatment programs.
Looking across a diverse set of community-based plans and their approaches, there are four areas of focus that have consistently produced results: prevention, prescribing, treatment and community engagement.
Prevention. Recognizing that early intervention is critical in preventing each opioid prescription from becoming an addiction, community health plans have developed sophisticated screening techniques to identify individuals recently prescribed opioids who may present warning signs of addiction. UPMC Health Plan in Pittsburgh uses data tools that identify members at risk for opioid misuse or abuse. UPMC shares this information with its care management team, which assists clinicians in developing clinical interventions for these patients.
Prescribing. Our member health plans are provider-aligned, meaning we not only work closely with clinicians to ensure that they understand the full range of treatment options available, but we also set parameters for prescribing. HealthPartners of Minneapolis changed its electronic medical records’ automatic setting for opioid medications from 20 pills to 10, so by default its clinicians are prescribing fewer pills. In 2016, its dental clinics implemented new guidelines to limit opioid prescriptions to four days, from one week, for procedures such as root canals and wisdom teeth removal, reducing the number of opioid pills prescribed in a one-year period by more than 91,500.
Other plans that have implemented programs to limit the number of opioids prescribed include SelectHealth in Salt Lake City; Scott and White Health Plan in Temple, Texas, which limits the initial prescription for short-acting opioids to seven days; and Priority Health in Grand Rapids Mich., which reduced the number of pills prescribed for short-acting opioids for acute pain to 15 days.
Treatment. Community health plans believe that access to and coverage for non-pharmacological therapies is important, and their treatment and services for opioid use disorders include behavioral health, team-based care and case management services. HealthPartners has long been committed to “treating pain without pills.” Its pain management program includes holistic approaches to treating chronic pain, acknowledging the relationship among pain, mood and addiction, and a model of care that focuses on promoting activity, exercise and physical therapy, rather than simply writing a script for pain medication. Between 2009 and 2016, for example, the number of HealthPartners’ patients who received opioids after being diagnosed with chronic back pain decreased 51 percent.
At Group Health Cooperative of South Central Wisconsin in Madison, such non-pharmacologic approaches to pain management include acupuncture, massage and mindfulness. Presbyterian Health Plan members in Albuquerque, N.M. — a state that until recently had one of the highest overdose rates in the country — can receive support from Presbyterian Healthcare Services’ addiction consultation team while in the hospital, including a physician addiction specialist, nurse practitioner, physician assistant and peer support specialist.
Community Engagement. Community education and awareness initiatives abound in our organization. Our health plan employees live in the communities where they work, which strengthens the quality of their relationships and leads to better health.
In Buffalo, N.Y., medical and pharmacy representatives from Independent Health serve on a joint Erie County task force to address the opioid public health crisis. Independent Health actively collaborates with local law enforcement, political and public health leadership and other community organizations in drug takeback programs that encourage the safe use and disposal of opioid prescription medications.
Geisinger Health Plan in Danville, Pa., which runs the #HadEnough campaign to promote awareness and education about opioids, includes community panel discussions with experts as well as members of the community in recovery.
America’s community health plans recognize opioid overuse, abuse and addiction as a public health crisis that must be addressed through integrated, community-based solutions. Our plans will continue to work in partnership with clinicians and community leaders to develop multifaceted strategies to address the health of our communities and end this epidemic.
Ceci Connolly is president and CEO of the nonprofit Alliance of Community Health Plans, a national consortium of 22 nonprofit health organizations, and a former national health correspondent for The Washington Post.
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