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The opioid crisis in the United states of america continues to reverberate across lodge. While a holistic solution remains elusive, wellness plans and chemist's benefit managers are evolving their utilise of data analytics and technology to amend prevention and treatment among their members and in their communities.

Executive summary

The opioid crisis in the United States has had a widespread impact on all aspects of society. The epidemic extends across multiple delivery points in the health care ecosystem, with no single entity capable of implementing a consummate solution. While a holistic approach involving the entire ecosystem is likely required, health plans and pharmacy do good managers (PBMs) have an opportunity to curb opioid misuse among their members and in their communities—by leveraging data and engineering to improve prevention and handling. To help identify some potential strategies, the Deloitte

Center for Health Solutions interviewed 35 clinical, pharmacy, information analytics, and policy leaders from health plans and PBMs beyond the country. Nosotros found that a growing number of health plans and PBMs are taking a data-driven, evidence-based arroyo to help change patient and physician behavior. We expect emerging technologies to play an increasing office in supporting these endeavors in the boxing against the opioid epidemic.

According to our major findings, potential strategies for health plans and PBMs include:

Leveraging data and emerging technologies: Many wellness plans and PBMs are finding that information is a powerful tool in addressing opioid misuse. Building on traditional fraud, waste, and abuse (FWA) programs, health plans are leveraging new techniques to analyze their claims and utilization information to identify clinicians whose opioid-prescribing patterns might go against clinical guidelines. Many health plans are reaching out to these clinicians, providing feedback, and creating shared decision-making tools to assistance them more than effectively navigate treatment options with their patients. While it is still early, health plans and PBMs are also turning to technologies such as data analytics, hot-spotting (a data-driven procedure for the timely identification of outlier patterns), predictive modeling, and virtual care.
Working toward more streamlined data drove and sharing: Information is being used to design evidence-based approaches to changing benefits and incentives, every bit well as for utilization-direction programs such as prescription make full limits or prior authorizations. Nevertheless, at that place are limitations and barriers to using data to its full potential, according to our interviewees. Barriers include a lack of interoperability across the health intendance system, and silos that limit stakeholders from having a holistic view of the patient. Health plans and PBMs are reaching out beyond the ecosystem to collaborate and explore means to share data. Notwithstanding, stakeholders cite limitations in data-sharing, including challenges accessing existent-time data from prescription drug monitoring programs (PDMPs)—state databases used to track prescriptions for controlled substances that patients have filled. Some interviewees likewise noted that in circumstances where there is an opportunity to salve lives, privacy regulations need to exist modernized.
Supporting the development of evidence-based standards and quality metrics to define and encourage successful treatment: Respondents view their organizations as being integral to increasing members' access to medication-assisted treatment (MAT) for opioid use disorder (OUD). They are working to help members have access to long-term management and support, and identify strategies to better integrate behavioral and concrete health. They cited the need for accreditation and improved standards for treatment facilities and programs, likewise equally testify-based standards and robust quality metrics to define successful treatment. Quality metrics and standards could help advance value-based care payment models for prevention and treatment. For a look at the distribution of MAT facilities in the Us, visit Deloitte's interactive tool.
Advocating for policy changes at the federal level: Health plans and PBMs represent just 1 function of the wellness care organisation, and they cannot solve opioid misuse past themselves. Many are advocating for changes such as workforce development policies to encourage health care professionals to pursue behavioral health specialties and for mandating electronic prescribing of controlled substances (EPCS). Our interviewees also agreed that more research is needed on chronic pain, substance utilise disorder (SUD), and addiction. They cited the demand for more research on effective non-opioid hurting-management therapies and for developing leading practices to address factors outside the health intendance system that impact wellness and specifically SUD. These factors, specifically the social determinants of health, include unemployment, loneliness, and family members with SUD.

Despite limitations in the availability and completeness of data, many health plans and PBMs are using the information and evidence they do have to develop leading practices. Many of their programs focusing on educating consumers and clinicians about prescription guidelines have successfully curbed prescription rates. Although there are clear health care and societal savings associated with helping someone overcome an addiction, the best strategies for long-term success are not e'er clear.ⁱ For many wellness plans, addressing opioid misuse among their members and in their communities is a key strategy for improving wellness outcomes. PBM stakeholders told u.s.a. that taking on this challenge is a critical function of their mission and an important opportunity to mitigate future fiscal and reputational run a risk. Although prescription rates for opioids have decreased in recent years, many industry observers concur that the rates of habit, overdose, and death volition probable become worse in the coming years earlier they get-go to improve.²

This circuitous, multifaceted problem calls for systematic solutions across the health care organisation.

Introduction

Prescription opioids can exist effective in treating pain. However, sometimes, whether taken alone or in combination with other drugs, they tin can lead to corruption, habit, and in some instances, life-threatening adverse events.^³Opioid misuse is frequently front-page news, and overdoses and opioid-related bloodshed rates have been increasing for more than a decade. In that location are many reasons for this, but they go beyond the scope of this report. Briefly, they include an intense focus on hurting direction, marketing campaigns, quality metrics that are built around pain management, a gap in the understanding of chronic pain and habit pathways, and (until recently) a lack of clear guidance on the appropriate use of opioids.⁴ Health plans and PBMs, like other stakeholders in the health care ecosystem, are working to accost this crisis.

How big is the opioid crisis?

The opioid epidemic is affecting employers and emergency rooms

Although the United States has simply 5 pct of the world'south population, we consume 99 percent of the world's hydrocodone and 81 percent of its oxycodone. According to some estimates, opioid apply in the Usa is 30 times higher than is medically necessary given the size of the population.⁵ Hither's how the opioid epidemic is affecting employers and hospitals:

Employer costs: A large, self-insured employer could spend an boosted $xiv,810 for each covered employee who abuses opioids.⁶ While prescription opioid use has declined to its lowest level since 2009, the cost of treating habit and overdoses has increased substantially, according to the Kaiser Family Foundation. In 2016, large, self-insured employers collectively spent $2.6 billion to treat opioid addiction and overdoses—up from $300 meg 12 years earlier.
Burden on the emergency room (ER): The rate of ER visits for suspected opioid overdoses increased by an average of thirty percent among 45 states from July 2016 to September 2017, according to the Centers for Disease Control and Prevention (CDC).⁷

Potential health program and PBM strategies to gainsay the opioid crunch

Substance corruption is not new to the US health care landscape, just the demographics for opioid misuse are different. In addition to urban areas, the opioid crisis is affecting many suburban and rural communities. Workers' compensation claims were an early indicator of the emerging opioid crunch, more than so than health insurance claims or other signals. A 2012 report by Lockton Companies concluded that prescription opioids were the top driver of indemnity losses related to workers' bounty claims.⁸ The report noted that prescription opioid corruption stemming from the direction of chronic pain had the most damaging touch on on claims.

Data analytics helps bring the upshot into focus

Many of our health plan and PBM interviewees said that in the early years of the epidemic, their organizations had focused on monitoring prescribing information to avoid FWA. From this data, they began to realize over the past five years that patients were often treated with also much pain medication or for longer than recommended. This typically happened after routine surgery or dental procedures. As a result, ER admissions for opioid overdoses and opioid-related deaths were rising. Wellness plans and PBMs realized that the health care system needed to reframe the issue. The substance abuse and addiction models of the past need to be rethought. They also knew they had to look at a broader data gear up beyond what is traditionally used to target FWA.

As health plans began to review their data, descriptive analytics helped them bring the issues into sharper focus. They started to identify some of the metrics they wanted to target, such as prescription rates, total morphine milligram equivalents (MME), and duration of therapy. Wellness plans besides began to await at which diagnoses were beingness treated with opioids (where the medical and chemist's data could exist linked). They were then able to place certain clinicians who had higher opioid prescribing rates than their peers. The CDC's 2016 guidelines on opioid prescribing were helpful in directing clinicians to appropriate, evidence-based opioid-prescribing guidelines.⁹

The substance corruption and addiction models of the past need to be rethought.

OUD is difficult to generalize and can touch on anyone regardless of geography, age, income, education, and other factors. Yet, many wellness plans and PBMs began to meet patterns emerge in the data that could help identify certain factors that might increase a patient's take a chance of becoming dependent on or addicted to opioids.

Risk varies by age and gender: OUD diagnoses increased 493 percent from 2010 to 2016, according to a 2017 study published past the Blue Cross Blueish Shield Clan (BCBSA).¹⁰ The study shed light on sure populations that might be at higher hazard under sure circumstances. For example, information technology showed that women over the historic period of 45 tend to have a higher risk for OUD compared to men in that age group. The pattern is reversed for people younger than 45, with men being at higher gamble than women.
Drug combinations could increase hazard: In an effort to identify the characteristics of patients who are likely to overdose, a squad of addiction researchers and epidemiologists at Geisinger Health System examined the medical records of more 2,000 patients, including those who had experienced an overdose. The study found that patients who have high doses of prescription opioids, combined with psychotropic medicines, might need closer monitoring. Other risk factors include beingness unmarried, uninsured, or publicly insured; having a history of previous habit, mental illness, or chronic disease; and a diagnosis of hepatitis or lower back pain.¹¹

As health plans analyzed their information, they could see who was on a long-acting opioid (not recommended as a beginning-line drug for acute conditions) versus a short-acting opioid, which might be more appropriate. In 2018, a large report showed that patients who were prescribed long-acting opioids were 2.five times more likely to suffer an accidental overdose than those who were prescribed short-acting formulations.¹² Given the amount of inappropriate prescribing, many health plans added an edit to their claims systems, which directs physicians to prescribe certain medications as a first-line therapy, with certain quantity limitations.

Placing limits on the elapsing of prescriptions was one of the well-nigh mutual early intervention strategies used by health plans to curtail opioid abuse. The 2016 CDC guidelines were helpful in creating their messaging. Just our interviewees emphasized that it is not enough to limit supply. In some cases, that strategy could pb to unintended consequences. Research shows that limiting opioid prescriptions for those already taking opioids can sometimes open the door to heroin use. Heroin can be cheaper than prescription opioids.¹³

Enquiry shows that limiting opioid prescriptions for those already taking opioids can sometimes open the door to heroin use.

Our respondents recognized that some physicians take circuitous patients who are dealing with chronic hurting, multiple comorbidities, possibly mental wellness issues, and other complicating factors. Interviewees cited a need for more effective risk-assessment and conclusion-support tools that are either online or integrated into electronic medical records (EMRs) to guide clinicians trying to manage these more complex patients. The number of technology-based tools that can help clinicians is increasing. Table 1 provides examples and apply cases that are starting to hit the market place and could be deployed more widely in the future. The challenge is integrating these technologies into the clinical workflow, having dynamic tools that tin can be updated as patients' weather condition evolve, and integrating the technology with the practice of other clinicians treating the patient.

Nosotros knew nosotros could non but put a quantity limit on prescribing across the lath. It'southward non just nigh setting rules and changing coverage. There are patients out there who are dealing with complex chronic pain issues, and nosotros need to make sure those patients with both substance utilise disorder and chronic pain are getting effective treatment. We accept invested in a number of web-based tools and supports for the care team and the patient. And we are piloting many different comprehensive approaches to pain management. We are also working to go data on effective MAT programs and providers to our main care physicians.
-Doug Nemecek, Md, primary medical officeholder, Behavioral Health, Cigna Corporation

From retrospective data analysis to predictive modeling

Novel analytic techniques tin help health plans and PBMs leverage their information to identify people at high adventure for opioid misuse. Many health plans and other health intendance stakeholders are in the early on stages of creating predictive-modeling tools. As they learn more than nigh the drivers and predictors of opioid misuse and overuse, they are likely to strengthen these efforts.

The duration of opioid treatment following surgery was the strongest predictor of opioid abuse among commercial health plan enrollees with no history of misuse or ongoing opioid use, according to a 2018 British Medical Journal study.¹⁴ Each additional week of opioid treatment increased the risk of dependence or overdose past virtually xx percent. Each boosted refill increased the take a chance by 44 percent.

Some health plans are segmenting their populations into different risk categories, and are studying how people move in and out of the categories. This can meliorate a health plan's power to identify people who might exist at risk early on, and offer interventions at the appropriate time. For example, the lowest-risk groups might include members who have no SUD claims and no utilise of nicotine or other substances. The highest-risk categories might exist members who have SUD diagnoses from ER visits or other hospital visits, only are not currently seeking handling. Wellness plans and other stakeholders that employ predictive modeling can keep to refine their models and examination out unlike interventions to keep to learn what works.

What tools are wellness plans and PBMs using to target opioid misuse and abuse?

Pharmacy lock-in programs: These programs aim to prevent patients from getting multiple prescriptions and/or using multiple pharmacies for controlled substances.
Utilization-management tools: Health plans utilise utilization-management tools to blueprint and develop value-based approaches that provide access to necessary treatments. These tools tin can assist encourage safe, effective intendance at affordable costs. Tools might include prior say-so for prescription hurting medication, step-therapy (which promotes an evidence-based, systematic approach to therapy), and prescription tiering (in which certain drugs or drug classes are preferred over others). Studies have shown that utilization-management techniques can be successful in curbing opioid misuse.¹⁵
Medication-assisted treatment (MAT): MAT is defined by the Substance Abuse and Mental Wellness Services Administration (SAMHSA) equally the apply of medications in combination with counseling and behavioral therapies for the treatment of SUD. The medications used in MAT may help block other narcotics or assist with withdrawal symptoms, and they exercise not cause the euphoric loftier associated with opioid misuse. A meta-analysis of 50 studies showed the retentiveness rate for methadone ranged from 70 percent to 84 percent at i year. The retention rate for buprenorphine ranged from 60 pct to ninety percent at one year. Both of these OUD treatments resulted in significantly fewer overdose deaths, likewise every bit reductions in illicit drug use, criminal activity, arrests, high-risk behaviors, HIV and hepatitis C incidence, equally well as improvements in health condition, functionality, and quality of life.^sixteen Nigh half of those who accept an opioid addiction, who took either a monthly shot of naltrexone or a daily pill of buprenorphine and naxolone, remained gratis from relapse six months later, according to a 2017 research.¹⁷
Virtual and digital care: Health plans and PBMs can use emerging technologies to bargain with opioid dependence and addiction. For instance, telehealth tin assistance bring together multidisciplinary experts to treat SUD. For more data on how applied science can help, see table 1.

Emerging technologies are playing a role in supporting strategies to reduce opioid misuse

In improver to information analytics and predictive modeling, emerging technologies tin can as well be used to help fight opioid dependency and addiction. As seen in table 1, many wellness plans and PBMs are already leveraging some technologies, and could begin using others to reduce opioid misuse in their populations and communities.

In ten years, I believe in-person office visits for behavioral health will exist the exception, and telehealth visits will exist the rule. Information technology will be the standard of care as the technology continues to improve and people become more than at ease with it. For the patient, information technology is often more convenient, private, and they may exist more comfortable in their abode or in a familiar setting.
— James Schuster, MD, chief medical officeholder, Medicaid, Special Needs and Behavioral Services and VP, Behavioral Integration, UPMC Insurance Segmentation

Working toward more streamlined data drove and sharing

Although data analytics is typically an essential part of health plan and PBM strategies to target opioid misuse, our interviewees cited many limitations and barriers to using it to its full potential. These include lack of interoperability and siloed systems, limitations of PDMPs, and privacy regulations that need to be modernized. Increased collaboration beyond the ecosystem could aid resolve some of these challenges, but policy changes may also exist necessary.

Benefits and limitations of PDMPs

PDMPs collect information from pharmacies to track the prescriptions for controlled substances that patients have filled. When physicians or dentists cheque their state's PDMP database, they can look for worrisome patterns of opioid prescriptions. From there, they tin can deny or change a prescription or educate the patient about other options or addiction treatment.

Studies prove that PDMPs can help change prescribing patterns and reduce possible harm from opioids.²⁶ Only PDMPs accept limitations:

PDMP use is voluntary in many states and in many circumstances. Dispensers, such every bit pharmacies, are required to upload the information into the database afterwards dispensing a prescription, but just 29 states mandate that prescribers and/or pharmacists use the PDMP. A state tin can outline only sure situations that require a physician or pharmacist to obtain a PDMP report, such as prior to a patient's initial opioid prescription. Only 26 states require all prescribers and/or dispensers to register for PDMP access.²⁷
Often, information is not shared across country lines. To date, 34 states are actively participating in the National Association of Boards of Chemist's shop PMP InterConnect^®, which transmits information to each contributing state. Several other states will be added to the program in the coming months.²⁸
PDMPs will likely not exist constructive when patients use false identities, or when controlled substances are obtained from illegal diversionary markets.

Efforts are under way to improve PDMPs. The Prescription Monitoring Program Training and Technical Aid Center at Brandeis Academy, for example, provides a broad range of services and supports to PDMPs, federal partners, and other stakeholders to build on and meliorate the effectiveness of PDMPs.²⁹

Our interviewees, all of whom rely on data to shape their strategies, expressed a desire for boosted data, from a variety of sources beyond their purview. For instance, some organizations have only medical data. Pharmacists and PBMs are oft express to pharmacy information. Some organizations have both, but lack behavioral health data, toxicology data, or data from EMRs. This data could assist them refine and amend their data analytics and predictive-modeling tools. It could also help them develop better tools to help clinicians deal with circuitous patients.

Wellness plans and health systems are also starting to collect more information around the social determinants of health (SDOH)—factors outside the wellness care system that influence health and may drive addiction and OUD. Such SDOH data may include data on a person's environment, income, access to salubrious food, or transportation barriers that make it difficult to access intendance. Our interviewees agreed that SDOH data is sparse and not hands accessible at the point of intendance. A contempo Deloitte report shows that only one-third of hospitals are integrating any kind of SDOH information in the EMR. And, just considering the data is at that place, it does not mean that the care team is accessing information technology. Another finding of the report was that the SDOH data residing in the EMR often gets buried in unstructured data such as social work notes, and is non accessed or used by the clinician.³⁰

As discussed before, fifty-fifty if clinicians have admission to these boosted data sources, there are oft challenges with integrating them in the workflow, ensuring that the data is updated, and integrating the information with the practices of other clinicians treating the patient (see table one for early solutions that may be more than widely deployed). This was reinforced past speakers at a March 2018 hearing held by the United states of america Senate Wellness, Educational activity, Labor, and Pensions Commission on the opioid crisis, who highlighted challenges with data-sharing.³¹ Some of the skilful witnesses stressed the importance of having a holistic view of the fellow member, patient, or person in the customs. Sanket Shah, a wellness informatics professor at the Academy of Illinois, recommended ways in which federal agencies could integrate multiple information sources at the local and state level. Having a centralized data repository could assist further advance predictive analytics and identify loftier-hazard individuals earlier. He also asked the committee to consider supporting the Prescription Drug Monitoring Human action of 2017, which would require states that receive federal grant funding to establish a PDMP to enable data-sharing with other states. The human activity would likewise fund a data-sharing hub to serve as a central repository.

Having a centralized data repository could help further advance predictive analytics and place high-risk individuals earlier.

Some of our interviewees noted that the lack of data-sharing was not solely a technical trouble. There are also cultural issues related to information-sharing, as well as an inherent risk. Any entity that handles health intendance data needs to ensure that it has systems in place to secure it and keep information technology private. Additionally, a 46-year-old privacy police force (42 CFR Role two) protects the disclosure of SUD diagnosis or treatment data to avoid deterring patients from seeking intendance and and then potentially facing stigma from employers, insurers, housing, child custody, and other situations. The constabulary requires the patient's consent whenever this information is disclosed. Many stakeholders view some elements of this law to be a barrier to improving behavioral and physical wellness care integration.³²

To encourage more data-sharing, the federal government and states demand to accept appropriate regulations in place to navigate security and patient privacy concerns and the catchy upshot of who owns the data.

Multiple data sources could help, but they are spread over many stakeholders

Interviewees expressed a want for more data to help them accelerate their analytics and predictive-modeling tools. With diverse stakeholders having dissimilar data about a member, patient, or person in the community, it is hard for any stakeholder to get a holistic view of the person and intervene early.

Supporting the development of bear witness-based standards and quality metrics to define and encourage successful treatment

Our interviewees discussed the stigma around OUD and the role wellness plans and PBMs can play in fostering the acceptance of OUD as a chronic status. Comparing the use of medication for OUD with treatments for blazon 2 diabetes, many of our interviewees illustrated how attitudes toward OUD were different. While most health care professionals accept that a patient diagnosed with type 2 diabetes should go along with a medication therapy that works, this is not always the case with OUD. As discussed in the sidebar "What tools are health plans and PBMs using to target opioid misuse and abuse?" in that location is substantial evidence that MAT can reduce overdose deaths, illicit drug employ, criminal activity, and risky behaviors, and assistance better health condition, functionality, and quality of life. Despite the show, some people believe that at a certain point, a person should not be treated with medication for OUD. Instead, the goal is abstention from any opioid. Many of our interviewees said they felt the need to educate their ain staff on the evidence, as well every bit their network providers and community. Other suggested strategies include increasing admission to MAT through benefit blueprint and improving the integration of behavioral and physical health.

Another claiming in efforts to support treatment is the shortage of supply of SUD treatment facilities and staff. Waitlists persist in almost every state.³³ A 2017 Health Affairs assay reveals pregnant gaps in access to MAT across the United States³⁴ (encounter Deloitte's interactive tool for more information). During his first few weeks as secretary of the The states Department of Health and Human Services (HHS), Alex Azar, touting MAT as a critical tool in the fight against opioid misuse, stated that but i-3rd of SUD treatment programs offering MAT. In response, the administration aims to raise this number through initiatives, such as new guidance from the US Nutrient and Drug Assistants, and by encouraging new studies around MAT.³⁵

MAT handling gaps, demographics, and opioid-related deaths

Deloitte developed an interactive map using data to highlight where MAT treatment gaps persist in the United States. The map shows the distribution of facilities that offer various medications for MAT at the county and state levels, and how that distribution corresponds to some measures of the opioid crisis, such equally opioid prescription rates, age-adapted death rates of people aged 15 years and older, and key demographic information. Key findings from the tool include:

60 pct of all SUD treatment facilities exercise not offer any form of MAT, while 54 pct of facilities that treat opioid addiction practice not offering whatever class of MAT. Interviewees emphasized the importance of patients with OUD having admission to some course of MAT.
Only 7 percent of all MAT facilities offering all three recommended medications (some course of methadone, buprenorphine, and naltrexone). These facilities offer mental wellness services likewise. Our interviewees stressed the importance of treating OUD and mental health concurrently.
The 100 counties with the highest opioid-related death rates (3 percent of all counties in the country) accept 7 percentage of the overall US population, but 27 pct of the total opioid-related deaths. These counties have 10 percentage of all SUD facilities, and 10 percent of all opioid prescriptions.

Other efforts past wellness plans to increment admission to MAT include:

Reducing barriers to buprenorphine initiation and maintenance
Encouraging physicians to employ a multidisciplinary squad-based model of care that includes licensed clinical social workers, nurses, or medical assistants to handle some of the administrative, educational, and care-coordination functions that are required to offer MAT
Simplifying administration and reporting between main intendance clinicians and the health plan
Expanding the use of telehealth for MAT to increase access

Many interviewees also said that the lack of standardized quality outcome measures for SUD and opioid treatment can brand it challenging to secure high-quality treatment for members. Cigna is working with the American Society of Habit Medicine in partnership with researchers to validate treatment outcome measures. Every bit part of the collaborative, a team from Cigna shared 2 years of medical, pharmacy, and behavioral health data. Many health plans are also working with Shatterproof, a nonprofit organization focused on habit, to develop treatment quality measures.³⁶

Moving forward, wellness plans and PBMs desire to evolve value-based payment models along with the rest of the wellness care system. Value-based payments for behavioral wellness issues, including opioid disorders and SUDs in general, have traditionally lagged backside medical and surgical conditions. One major challenge is the lack of standardized quality measures. Some wellness plans are piloting programs around prevention and treatment, and are advocating for policy changes to address the limitations in information.

Value-based care and opioid use

Despite the lack of standardized quality measures, some health plans are developing value-based care payment models effectually opioid employ. California, Rhode Island, and Vermont accept different programs for opioid dependency in their Medicaid programs.³⁷

The San Francisco Medicaid Health Plan has pay-for-performance incentives for leading practices using pain-direction guidelines, opioid-review committees, and limiting the apply of short-interim opioids. The Medicaid Partnership Health Plan of California provides an incentive to clinicians who complete didactics and preparation on buprenorphine prescribing, obtain a Drug Enforcement Assistants waiver, and accept new patients for treatment.
In Rhode Island, more than 2,600 Medicaid members who have an opioid-use disorder have been machine-assigned to a handling program. The state pays a weekly bundled charge per unit for both fee-for-service members and managed care members.
Vermont has a hub-and-spoke model. Hubs are highly regulated specialty treatment centers run past opioid treatment program-licensed providers. The centers provide methadone treatment and receive a monthly bundled rate per fellow member. Spokes are office-based treatment programs that as well offer primary care, ob-gyns, and psychiatry that include buprenorphine treatment.

The path forrard for stakeholders across the health care system

This epidemic is multifactorial. Segments of the Usa are experiencing sixfold greater levels of opioid prescribing, leading to increased rates of habit. We know at that place are pockets of the country where the overdose and decease rates are profound. And we know there are other, complex problems at play, including social determinants of health, hopelessness in the face of loftier rates of unemployment, and the emotional and financial stress people who accept family unit members struggling with opioid utilize disorder often face. We need more research to understand and accost all of these issues.
— Hal Paz, Medico, MS, executive vice president and CMO, Aetna

The health care ecosystem has several stakeholders that engage individuals at diverse points in the intendance delivery chain. These include prescribing clinicians, PBMs, retail pharmacies, health plans, behavioral health providers, employer program sponsors, and policymakers. Previous Deloitte enquiry "Fighting the opioid crisis: An ecosystem approach to a wicked problem," has framed an ecosystem approach to address the opioid problem that includes public health stakeholders, economical and workforce evolution, the criminal justice organization, and kid welfare and other social services, in addition to the health care system.

Traditionally, as each of these stakeholders has wrestled with how to foreclose and manage OUDs, they take adult a serial of solutions at different points along the chain. Health plans recognize that a more comprehensive approach is required to address the opioid epidemic. This involves different types of interventions across the three chief pillars of the prescription life cycle: identification, prevention, and treatment and recovery (see figure iii).

Solutions can address stakeholder intervention opportunities along the patient journey

Ecosystemwide approaches might also require policy considerations. Our interviewees noted that their organizations are supporting policy changes, including modernizing privacy regulations, developing policies that aim to increment the number of mental health and behavioral specialists, and mandating electronic prescribing of controlled substances.

Interviewees also discussed the demand for more than inquiry on chronic hurting every bit well as effective not-opioid pain-management therapies. A 2018 written report showed that prescription opioids were not more effective than over-the-counter drugs or other non-opioids in treating chronic hip or knee joint pain, for example.³⁸ To engagement, there is limited evidence about the use of acupuncture, spinal manipulation, and yoga to care for different kinds of pain.³⁹ Because they practice not involve potentially addictive medications, stakeholders are interested in exploring these culling methods. In 2018, Ohio'south Medicaid program became the first in the Midwest to cover acupuncture for the management of depression-back pain and migraines.^forty

In improver to understanding pain and pain relief better, interviewees also called for more research on SUD and addiction. They want to know more than nearly the factors and comorbidities that put people at take chances. They also discussed the importance of creating a deeper understanding of the SDOH, specifically factors related to the opioid crunch, some of which include unemployment and corresponding feelings of isolation, and family members with addiction.⁴¹

Then many people and organizations are addressing the opioid trouble with dissimilar strategies. It's a fragmented approach, and we risk competing amongst ourselves for attending and resources. What nosotros need is more collaboration between the health plans, health systems, and customs partners. At Geisinger, we are working with several different community nonprofits in Pennsylvania and in a few other states. Nosotros are working with pharmacy schools at universities. We are sharing data from multiple sources and developing a coordinated strategic plan for the county.
— Perry Meadows, MD, medical director for government programs, Geisinger Wellness Plan

The common thread weaving together the diverse interventions for health plans and PBMs is the sophisticated application of analytics to unlock powerful insights from the data. Reducing barriers that preclude data-sharing across stakeholders can permit various players to utilise more holistic solutions. While policy levers tin can play a role in the future of the opioid crunch, the organizations we interviewed understand the critical demand for more collaboration across the ecosystem. They recognize the need to join forces with other health plans, the clinician community, and local community partners. They are reaching across the health care sector, creating and joining coalitions and collaborations in their communities to intermission through the silos. By combining efforts, they tin work through these complex problems, move the research agenda forrad, and bridge the gaps in data.

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