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Can We Fight Opioid Use Disorder by Filling Data and Policy Gaps?

Allison Inserro
Which data, policy, and information gaps exist throughout the healthcare system and need filling in order to combat opioid use disorder (OUD) through better prevention and treatment strategies? Two recent reports discuss how these gaps are worsening efforts to fight OUD.
Which data, policy and information gaps exist throughout the healthcare system and need filling in order to combat opioid use disorder (OUD) through better prevention and treatment strategies?
 
Two recent reports discuss how these gaps are worsening efforts to fight OUD. The Deloitte Center for Health Solutions and the Network for Excellence in Health Innovation (NEHI) interviewed their stakeholders, including health plans, pharmacy benefit managers (PBMs), healthcare systems, other healthcare associations, government officials, pharmaceutical companies, pharmaceutical distributors, and others to unearth possible strategies to improve prevention and treatment.
 
The Deloitte report focused on leveraging data and technology, expanding those methods away from their original focus of fighting fraud, waste, and abuse.1 By using data analytics and predictive modeling, health plans can reduce the chance of OUD developing in patients taking opioids who might have risk factors that could predispose them to developing dependence later, such as depression or a family history of the disease.

To highlight treatment access issues, Deloitte built an interactive map that zeroes in on the geographical distribution of medication-assisted therapy (MAT) facilities in the United States, opioid-prescription rates, and opioid-related death rates. The map shows that some areas of the country have no treatment for OUD available.

Deloitte wrote the report for 3 reasons, said George Van Antwerp, senior manager, strategy and operations, in an interview with The American Journal of Managed Care® (AJMC®).  

“Socially, this has become such a crisis in the United States that we felt it was important to shine some light on this issue,” he said. Second, he said, clients across all parts of healthcare were asking questions about the issue, and third, there are rapid changes happening in the way of legislation and utilization management when it comes to opioids.

As more health plans use predictive modeling, there’s a better likelihood that data can be used to drive results, Van Antwerp said.

“If we can use the data to risk score people, predict their risk, their likelihood of becoming addicted and intervene earlier, in many cases you have a better chance to help them get the right treatment, help them understand the risk,” he said.

Susan Dentzer, NEHI’s president and chief executive officer, said much the same thing.

“We have been alarmed about the growing toll of opioid use disorder epidemic and we have done some work over the past couple of years looking at the work that our membership organizations have done to address the issue,” said Dentzer. NEHI is a nonpartisan research nonprofit that counts payers, pharmaceutical firms, nonprofits, and other organizations among its members.

While she noted the obvious problems, like an insufficient supply of MAT facilities or addiction specialists trained to provide help to those seeking to recover, there are also what she called “second-order issues” that impede success.

There are obstacles in what she called the “healthcare information infrastructure architecture” as a result of information being blocked or siloed, and to illustrate it, NEHI outlined a multi-step process showing best- and worst-case scenarios for optimal opioid prescribing.2

The report makes 6 recommendations for a best practice in opioid prescribing
  • Evaluate the pain; determine effective treatments, including nonpharmacological ones and nonopioid medications.
  • Consult clinical decision guidelines that incorporate the CDC guidelines. (The NEHI report noted that the CDC guidelines are not intended for active cancer, palliative care, or end-of-life care, but some doctors are reporting that is an unintended consequence of the guidelines.)
  • Check prescription drug monitoring programs (PDMPs) for past use of opioids.
  • Use electronic prescribing.
  • Have patients sign a pain contract that acknowledges risk.
  • Take steps to offer help if dependence occurs.
However, efforts are impeded by data collection that isn’t streamlined, PDMPs that vary from state to state in terms of functionality, and a lack of interoperability with electronic health records, both reports noted.

“Everywhere you look there’s a problem of bad movement of information,” Dentzer said.

In addition, electronic prescribing of controlled substances is difficult and time-consuming for busy providers due to Drug Enforcement Agency regulations that require the usage of a different system for drugs that are not controlled, Dentzer said.

There’s also a need for evidence-based standards and quality metrics to define successful treatment, the Deloitte report noted.



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