A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations

Hartung, Daniel; Alley, Lindsey; Leichtling, Gillian; Korthuis, P. Todd; Hildebran, Christi

doi:10.1016/j.addbeh.2018.04.020

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…Numerous efforts have been reported to reduce the prescribing of opioids and/or incidence of OUD/SUD. These include the implementation of prescription drug monitoring programs [ 54 , 55 ], statewide Medicaid program initiatives such as coordinated care organizations [ 56 , 57 , 58 ], educational outreach and academic detailing for providers [ 59 , 60 , 61 ], advances in medicine/surgery that lower post-surgical dependence on narcotics [ 62 , 63 ], the fentanyl patch-for-patch program [ 64 ], pharmacy consult intervention [ 65 ], quality measure development and/or quality improvement [ 66 ], using data analytics to predict the risk of overdose [ 67 ], and schedule change of opioid analgesics [ 68 ]. Other initiatives have been reported to be less successful in this regard; for example, the adoption of controlled substance laws, which are reported to not be associated with lowering the prescription of opioids or overdose incidence among disabled Medicare beneficiaries [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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“…Prescription opioids were identified using National Drug Code identifiers derived from FirstDataBank’s Drug File. Consistent with CDC Guideline for Prescribing Opioids for Chronic Pain and the threshold selected for most CCOs, we defined high dose as any prescription exceeding 90 MME per day [ 13 , 15 ]. We calculated daily MME for each prescription by multiplying the formulation strength by the quantity dispensed and the CDC endorsed conversion factor [ 16 ] and then dividing by each prescription’s day supply.…”

Section: Methodsmentioning

confidence: 99%

“…quantity limits and prior authorizations on long-acting opioids), provider directed interventions (e.g. training programs and targeted letters), and patient facing education [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

Hartung

Geddes

Hallvik³

et al. 2022

BMC Health Serv Res

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Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

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“…While the initiative targeted health care settings across the state, particular guidelines were specific to the Medicaid program. Mainly, the initiative required Coordinated Care Organizations (CCOs) to engage in Performance Improvement Projects (PIP) to decrease risky opioid prescribing to Medicaid recipients 14 . Preliminary reports show a positive downward trend in both risky opioid prescribing (ie, prescriptions for ≥90 and ≥120 mg morphine equivalent dose [MED] per day) and fatal opioid overdoses in the period after the initiative (2017) 12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…Mainly, the initiative required Coordinated Care Organizations (CCOs) to engage in Performance Improvement Projects (PIP) to decrease risky opioid prescribing to Medicaid recipients. 14 Preliminary reports show a positive downward trend in both risky opioid prescribing (ie, prescriptions for ≥90 and ≥120 mg morphine equivalent dose [MED] per day) and fatal opioid overdoses in the period after the initiative (2017). 12,13 Prior to the OHA Opioid Initiative, the Oregon Medicaid program implemented a prior authorization policy, which also contributed to a significant decline in high dose of opioid prescriptions.…”

Section: Introductionmentioning

confidence: 99%

A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data

Ibrahimi

Hallvik²,

Johnston

et al. 2020

Pharmacoepidemiology and Drug

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Purpose Public and private payers have implemented benefit limitations to reduce high‐risk opioid prescriptions. The effect of these policies on the increase of out‐pocket payment is unclear. To understand this gap, we compared the discrepancies in trends between opioid prescription fills vs claims among Medicaid beneficiaries. Methods Data from the Oregon Prescription Drug Monitoring Program (PDMP) and Oregon Medicaid administrative claims were used to identify Medicaid beneficiaries 18 years and older enrolled at least one full month from 2015 to 2017. Generalized linear models assessed the trends in the monthly rates of opioid PDMP prescription fills and pharmacy claims per 1000 eligible members. Rates by morphine equivalent dose (MED) tier (<50, 50‐89, 90‐120, >120 MED) and co‐prescribed opioid and benzodiazepine were also assessed. Results During the study period, an average of 495 355 Medicaid members had 2 797 054 opioid PDMP fills and 2 472 155 opioid Medicaid pharmacy claims. Study participants had 15.4 (95% confidence interval [CI] 13.6 to 17.0; P < .001) more prescriptions per 1000 member per month in the PDMP data (114.1 [SD 7.4]) compared with the Medicaid claims data (98.7 [SD 7.9]). Similarly, there were 1.9 more co‐occurring opioid/benzodiazepine prescriptions per 1000 members per month observed in the PDMP data than the Medicaid claims data (95% CI 1.7 to 2.1; P < .001). At each MED tier, the PDMP fills were consistently higher than the claims (P < .001). Conclusions Higher rate of fills in the PDMP compared to pharmacy claims suggests that there may be an increasing trend of out‐of‐pocket payment among Medicaid beneficiaries.

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A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations

Cited by 6 publications

References 19 publications

Misalignment of Stakeholder Incentives in the Opioid Crisis

Misalignment of Stakeholder Incentives in the Opioid Crisis

Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data

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