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Make Me Smart with Kai and Molly

Insurance executives are using data to help curb opioid abuse

Dan Gorenstein Jun 7, 2016
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Jackson, 27, who said he is addicted to prescription medication, lies passed out in a public library in New London, Connecticut. 
John Moore/Getty Images

Nearly 19,000 people. That’s how many Americans died in 2014 due to overdosing on prescription pain medication, the Centers for Disease Control and Prevention reported.

The Food and Drug Administration, states and health insurance companies are all tackling this public health epidemic.

As a new report from this month’s edition of the journal Health Affairs points out, a key tool in the fight is data. Consider that one reason prescription painkiller abuse has gotten out of hand is that it’s super easy to get a prescription.

Cornell Health Policy Professor Yuhua Bao, lead author of the report, found one way to stop that is when doctors sign up for systems that track the pharmacies where people are buying these drugs. 

Without such a kind of system-wide database, it would be hard for individual doctors to really see the complete picture,” she said.

Bao said when physicians can see that complete picture, these programs lead to a 30 percent drop in prescribing certain opioids.

Health insurers are also betting on data.

For example, Anthem uses claims data to see its members who go to multiple pharmacies and use prescriptions from multiple doctors.

“They are in panic often,” said Anthem case manager Emily McKay. McKay fields calls from privately insured consumers who wrestle with opioid addiction.

The desperation is palpable.

Members will tell McCay things like, “You know, ‘I’ve got to get in somewhere. I’ve got to get medications.’”

“Or it may be, ‘Can you help me, can you talk to my doctor and let them know I’m really in pain?’” McKay said.

This month, Anthem launched a program to funnel people to one pharmacy. Anthem has sent letters to thousands of its commercially insured members who are considered at high-risk for opioid abuse.

The company is just one of several insurers trying to get its  hands around this public health epidemic.

Cigna’s Dr. Doug Nemecek said his company is sharing de-identified patient data in hopes it can figure out what sort of treatment programs work best to break these addictions. Up until now, he said, that’s a code that hasn’t been cracked.

The biggest issue we have is that we don’t know how to help people choose the best program. And we don’t know how to measure quality for the programs that are providing care today,” he said.

Add Nemecek to the long list of health care people who are putting their faith in data to help us pull through this crisis.

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