Health Insurance Companies Take On The Opioid Crisis

Health Insurance Companies fight the opioid crisis

With the CDC reporting over 47,000 U.S. deaths due to opioid overdoses in 2017, opioid addiction has become a crisis. It can only be tackled if all stakeholders adopt plans to combat the problem – and that includes health insurance companies.

Withholding Drugs and Providing Treatment

Much of the focus of health insurance companies’ responsibility in stopping opioid abuse has been on their role as gatekeepers. Insurers are increasingly pressured to make certain that patients aren’t able to keep getting access to these highly addictive drugs. This can be done by looking over claims and flagging ones that appear to show evidence of opioid misuse. At that point, the insurance company can either get in touch with the prescribing physician or start denying the claims.

In an article in Medical Xpress, Theresa Kreif explains that insurance coverage for addiction treatment is key to stopping opioid deaths and that a lack of insurance coverage is the main determining factor for people who want treatment but don’t get it.

How Health Insurers Are Helping Their Members

Nerd Wallet published an overview of which steps some of the major health insurance companies are taking to do their part in the fight against opioid abuse, and they found that Aetna, Anthem, Cigna, Humana, Kaiser Permanente, and UnitedHealth Group were all reviewing claims for signs of misuse. All but one (Humana) had also stopped requiring a prior authorization for addiction treatment. Some companies are also requiring prior authorization for opioid prescriptions as a way of monitoring potential abuse.

Last year, Blue Cross Blue Shield (BCBS) issued a report finding that 241,900 of its members suffered from opioid use disorder. The company has been working to reduce opioid abuse by following CDC guidelines and curbing inappropriate opioid prescriptions.

Medicaid has a significant role in the battle against opioid addiction in the U.S. A Kaiser Family Foundation report notes that, “Medicaid facilitates access to treatment by covering numerous inpatient and outpatient treatment services, as well as medications prescribed as part of medication-assisted treatment.” And the expansion of Medicaid, due to the Affordable Care Act, has also helped bring treatment to more opioid users.

Insurance Companies Working Together to Fight Addiction

The Substance Use Disorder Treatment Task Force was able to bring 16 healthcare payers together to adopt “National Principles of Care” in the treatment of addiction. The list of companies includes Aetna, AmeriHealth Caritas Family of Companies, Anthem, Inc., Beacon Health Options, Blue Cross Blue Shield of Massachusetts, CareOregon, CareSource, Centene Corporation, Cigna, Commonwealth Care Alliance, Envolve Health, Horizon Blue Cross Blue Shield of New Jersey, Magellan Health, UnitedHealth Group, UPMC Insurance Division, and WellCare.

The agreed-to principles (explained in greater detail here) are:

*Universal screening for substance use disorders across medical care settings

*Personalized diagnosis, assessment, and treatment planning

*Rapid access to appropriate Substance Use Disorder care

*Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment

*Concurrent, coordinated care for physical and mental illness

*Access to fully trained and accredited behavioral health professionals

*Access to FDA-approved medications

*Access to non-medical recovery support services

In a statement, the founder of the task force and CEO of Shatterproof, Gary Mendell, said, “For the first time in history, leading healthcare insurers and other third-party payers from across our nation have come together and agreed to identify, promote, and reward one core set of evidence-based principles for addiction treatment.

Innovating and Discovering New Ways to Reach Out

As a part of its commitment to combating addiction, one of the members of that alliance, Centene Corporation, announced that its clinical leadership team developed the OpiEnd™ program. “OpiEnd utilizes Centene’s proprietary business intelligence tools to identify at-risk members for potential opioid misuse,” the company stated. “This proactive approach employs early intervention to prevent opioid misuse and, ultimately, to save lives, one member at a time.”

Telehealth services are a promising avenue for fighting the widespread opioid crisis as well, and they recently signed into law. Eric Wicklund of mHealth Intelligence reports that the legislation includes “provisions to improve Medicare reimbursement for telehealth programs and support an innovative telemedicine-based program that trains rural and remote healthcare providers on how to treat patients with substance abuse and mental health issues.” He also notes that the bill includes other provisions that will utilize connected care platforms to bring treatment to underserved populations.

Tackling a Complex Problem

The opioid crisis undoubtedly represents one of the greatest healthcare challenges of our time. But health insurers are recognizing the breadth and depth of the tragedy and taking steps to reduce its damage.

As health insurance companies continue to develop their efforts to reduce opioid abuse, it will be important to, work on innovative solutions. Also continue improving policies and measures designed to help bring this deadly crisis to an end.

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