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Insurers track adherence to CDC opioid guidelines

October 23, 2017
by Julie Miller, Editor in Chief
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Data is the one thing that managed care has in spades. And now the health plan industry is using that data to help prevent opioid misuse.

America’s Health Insurance Plans (AHIP) has launched its Safe, Transparent Opioid Prescribing (STOP) initiative, which includes a data analysis tool to compare doctors’ prescribing patterns against the Centers for Disease Control and Prevention (CDC) guidelines. From there, individual health plans will be able to identify prescribers who aren’t adhering to guidelines and ask them to revise their practices.

“Plans are in a unique position because they have a 360 degree view of the data and are trying to do what they can to offset the opioid epidemic,” Richard Bankowitz, MD, the association’s chief medical officer, tells Addiction Professional.

Bankowitz says the data currently in house predates AHIP’s adoption of this new standard to measure daily practice against the CDC guidelines, so it will serve as a baseline going forward to evaluate progress. Findings on the initiative’s effectiveness could be available within a year, he says.

AHIP member health plans will track claims data for dosage and duration of prescribed opioids as well as how often they are prescribed for patients also using benzodiazepines. Measures will look for use of extended-release or long-acting opioids and how often urine drug screening is used.

Leveraging data to improve care isn’t new for health insurers. Bankowitz says plans historically have mined their pharmacy claims data to help identify patients who are receiving multiple prescriptions for opioids from multiple providers, for example.

While the STOP initiative is centered on driving CDC guidelines into everyday prescriber practice, plans are also beginning to develop policies to reduce barriers to addiction treatment, says Kate Berry, senior vice president of clinical affairs for AHIP.

“Plans are trying to allow access to medication assisted treatment, but also to ensure availability of behavioral health counseling and other support,” she says.