October 15, 2018 at 5:00 am ET
In response to pressure from the White House and the growing number of opioid-related deaths in the United States, the Senate recently passed sweeping legislation with the goal of combating the opioid crisis.
Senators voted 99-1 for a comprehensive bipartisan package that looks to provide more access to treatment and prevention programs as well as measures to prevent and detect illegal opioids from entering the country. This may be the largest bipartisan success this Congress has achieved thus far — a true indication of our nation’s capacity to come together and arrest the opioid crisis.
The most recent iteration of this bill also eliminates the IMD exclusion, a move that will facilitate access to care and funding for those who are struggling to afford treatment. This is a big step forward — and now, we can get to work on tackling the systemic causes of the opioid crisis.
The truth is that without these upstream fixes, we can neither fully nor permanently resolve the downstream effects of the opioid crisis. That means combatting the waste and abuse that pervade all corners of the health care industry, the misaligned incentives that result in a system where prescribing more treatments means deriving more profits, and our backwards model that rewards physicians for spending less time on individual appointments. Less time per patient means more patients; more patients mean more treatments; and more treatments mean more money. “Treatment” that often leads to referrals for unnecessary, expensive and painful surgeries, which — you guessed it — mean more opioid prescriptions.
Which means: Without bigger fixes for health care, we can’t fix the opioid crisis.
And these are the sorts of changes that aren’t going to come from Washington, either. The real solutions are going to come from the bottom up. And they’ll have to target more than just opioids.
But here’s the good news: As I lay out in my latest book, “The Opioid Crisis Wake-Up Call,” those solutions have already arrived. And they aren’t coming from a piece of ephemeral legislation spirited in from on high. Instead, they’re coming from business executives structuring better health care compensation packages and from medical professionals fighting the status quo within the system. They’re coming from local officials using their bully pulpit to address opioid overuse in their communities. And it’s those solutions to which we should be turning as we look to lead ourselves out of the opioid crisis.
The crisis is a self-inflicted wound. That means that the greatest drivers of the epidemic all circle back to the way we structure, pay for and deliver health care. So it stands to reason that if we’re looking for ways to eradicate the opioid epidemic, we should be looking to health care purchasers, providers and health care businesses.
Here’s the catch: All businesses are health care businesses. As the chief benefits purchasers for the largest proportion of working-age Americans and their families, employers effectively run a health care business – whether they like it or not.
Yet, world-wise employers are already using this to their advantage. Wielding their leverage as health care purchasers, companies all across the country have restructured their employee health plans by focusing on the relationship between cost and quality, rewarding intelligent provider choices and putting money back into their employees’ pockets and their businesses’ value.
I was struck, for example, by the “little engine that could” story out of Allegheny County. There, teachers and school board leaders cut annual health care costs to $199 million less than those of neighboring school districts, just by creating a simple, tiered system that allowed employees to select their own hospitals — but charged a higher premium for hospitals that had measurably lower quality and value. The subsequent $7.36 million reduction in employee hospital spending allowed the schools to cut class sizes, hire more staff and simultaneously increase teachers’ benefits and pay. Not only were employees rewarded for wise decisions, so were physicians: After the new plan went into effect, the area’s highest-quality hospital saw a 45 percent surge in revenue, while the lowest quality hospital saw a 63 percent drop.
Elected officials still have a critical role to play, especially given the breaking news that the Centers for Disease Control and Prevention’s opioid prescribing guidelines could be linked to the recent, and much welcome, decline in opioid prescriptions. Armed with new proof of the effectiveness of the CDC’s strategies — and augmented by an even newer, more comprehensive set of prescribing guidelines for 2018 — states can now mandate that prescribers wishing to participate in their state’s health plans (for state employees) must adhere to these guidelines and maintain accountability by joining the state and national prescriber databases. Because these prescribers also treated private sector employees, the benefit of this wise approach extends beyond just the public sector workforce.
Tomorrow’s solutions for today’s opioid epidemic aren’t coming from Washington’s elites. Nor have any of the catalysts for our most watershed social issues, from civil rights, to energy independence, to climate change, to better food. While the government has played a role in maintaining each of these initiatives’ momentum, any critical legislation they issued came in response to, not advance of, business and grassroots-fueled movements all around the country. The movements themselves were the work of everyday citizens clamoring for change.
That work can start today. And for the heroes of The Opioid Crisis Wake-Up Call, that work has already begun. It’s our turn to keep it going.
Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our health care system, and he is also the author of “The Opioid Crisis Wake-up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back.”
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