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Health Plan Takes On Opioid Overutilization for Medicare Patients

By Gregory A. Freeman  
   November 15, 2017

A nonprofit health plan provides beneficiaries low-cost access to medication-assisted treatment. The insurer also implements prescription restrictions and physician education.

With six of every 1,000 Medicare beneficiaries and almost nine of every Medicaid beneficiaries abusing prescription opioids, health plans have a strong incentive to help their members address this problem. Getting people off opioids yields tremendous benefits for the individual but also for the health plan that can be stuck paying for all the health effects of addiction.

That improvement may require an upfront investment by the health plan, and a California insurer is finding that its nonpfit status gives it more leeway to address the issue proactively.

Opioid treatment spending increased 1,000% over the five years from 2011 to 2015, according to a study from FAIR Health, an independent nonprofit that manages the database of privately billed health insurance claims. That was one impetus for SCAN Health Plan to address the opioid crisis with a multipronged approach that is showing good results.

SCAN is a nonprofit organization that operates a Medicare Advantage plan with 185,000 members in California. The devastating effect of opioid addiction prompted SCAN to develop holistic, proactive measures to reduce opioid overutilization and increase awareness among members and physicians in its network, says CEO Chris Wing.

'Good numbers'

The percentage of SCAN beneficiaries using opioids dropped 16% from the first quarter of 2014 to the second quarter of 2017, going from 18.6% of all plan beneficiaries to 15.7%. SCAN also got its opioid prescribing rate to 5%, below the national average of 5.74% and the California average of 5.46%.

The effort also reduced the percentage of members utilizing concurrent opioids and benzodiazepines from 1.9% to 1.37%—a 27% reduction.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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