States have broad authority to influence and regulate the prescribing and dispensing of prescription drugs and do so in a variety of ways. CDC provides data and resources to equip and inform states about putting into practice strategies that help prevent high-risk prescribing and improve treatment for battles against opioid addiction and overdose.
The extent of the opioid crisis means years of work, resources, and programming from payers, providers, and patients. A recent effort, funded by the Robert Wood Johnson Foundation, conducted a literature review and interviewed insurers, providers, and patient advocates looking for the most current efforts, data, and experiences from the frontlines of the opioid crisis.
This week and in separate press releases, Anthem and OptumRx announced significant improvements through their opioid programs. These successes mark new options for the battle in, what the President declared, the opioid "national emergency". The following are important points from their separate announcements.
For payers, identifying doctors who write more opioid prescriptions can be key for any successful opioid management program. Using the one factor influencing opioid prescription habits, payers can target education improving the overall provider network performance. Physicians trained at the United States’ lowest-ranked medical schools write more opioid prescriptions than physicians trained at the highest-ranked schools, according to a study by Princeton University.
Behavioral health claims skyrocket for any number and combination of factors. Behavioral health care will increase in cost and utilization with a number of factors driving this, including the:
Workers compensation treatment guidelines can help prevent unnecessary medical procedures and the prescribing of potentially harmful medications. However, they are not all the same, nor are they without challenges. Understanding a jurisdiction's strengths/weaknesses, taking a strategic approach to developing guidelines, and using common sense can lead to better outcomes for injured workers—and, ultimately, lower costs for payers.
According to the CDC, drug overdoses are the leading cause of accidental death in the United States. Of the overdose deaths that occurred in 2015, 63 percent involved an opioid. Payer options for managing efforts against opioid overuse range from monitoring population data to working with provider networks.
Athena Health recently published the 2016 edition of PayerView, a in-depth review of the biggest payers in their network. Athena Health identifies the shift to value based care and healthcare reform as the biggest challenges to everyone for payers to providers.
Hospital Readmissions penalties run high as the government plans to penalize more than half of the nation’s hospitals. Over the next year Medicare plans to withhold more than a half a billion dollars in payments, reports Kaiser Health news. In 2015 alone hospital readmissions penalties hit a total of $420 million¹.
The specialty pharmacy industry is booming and as many pharmacies opt for moving down the specialty pharmacy accreditation path, many hospitals and healthcare systems are starting to realize opening their own specialty pharmacies (or partnership with one) could be a good idea. The jump to specialty pharmacy for a health system or hospital, isn’t only a revenue driver as it gives them access but could also help with re-admissions, quality of care, and data collection. And as specialty pharmacies crop up all over the country, with an estimated 250 to be accredited by the end of 2015, it is the perfect opportunity for health systems to take fate into their own hands. From driving revenue, to increasing quality of care here are three main areas a hospital or health system can benefit in an in-house specialty pharmacy.