Partnership HealthPlan of California s Managing Pain Safely Program Robert Moore, MD MPH Chief Medical officer Partnership HealthPlan of California

Transcription

1 Session L6 This presenter has nothing to disclose It Takes a Village to Curb the Prescription Opioid Epidemic: Partnership HealthPlan of California s Managing Pain Safely Program Robert Moore, MD MPH Chief Medical officer Partnership HealthPlan of California December 4, :00 pm 28thIHIFORUM Outline P2 The Challenge Outcomes What we did How we did it 28thIHIFORUM 1

2 Partnership HealthPlan of California (PHC) P3 Mission: To help our members and the communities we serve, be healthy Plan Type: County Organized Health System Enrollment: 580,000 Medi-Cal members in 14 Northern California counties California Opioid Use Related to Overdoses P4 Prescription Opioid Use: 2008 Pharmacy Data Opioid Overdoses Red= Above Ave Blue = Below Ave Pink = US Ave Sources: 2008 Data: The Journal of Pain Data: The Journal of Pain 4 2

3 California Opioid Use Related to Overdoses P5 What have others achieved? Multnomah County, Oregon 75% decrease in opioid use 40% decrease in opioid overdose deaths over a 3-year period Kaiser 91% decrease in high dose opioids for non-cancer, non-terminal pain over 3 years Other possible outcomes Reduction in neonatal abstinence syndrome Decrease drug diversion 5 P6 Managing Pain Safely: Outcomes 3

4 Opioid Fills PMPM 7 59% Decrease Unsafe Dose (>120 MED) 8 74% Decrease 4

5 MPS Technical Support MPS Steering Committee 11/29/2016 P9 Managing Pain Safely: Program Structure Health Plan Internal Workgroups Data Management Pharmacy Provider Network Care Coordination/Utilization Management/ Member Services Legislative Policy/Regulation/Communication Community Support 10 5

6 P11 Managing Pain Safely: Interventions Interventions Education Pharmacy prior authorization changes Additional options for treating pain Community activation 12 6

7 Education Targeted Audience: Prescribers (PCP, Pain Specialists, EDs) Other members of the community PHC Board and leadership team PHC Staff Members (Outreach and Understanding Can Help [OUCH]) Public Elected representatives 13 Education Early topics: Change the former understanding of no maximum dose Hyperalgesia Decreased functioning Prescribing recommendations/best Practices Outpatient primary care and specialists Emergency Departments Dentists Pharmacies Later Topics Benzodiazepine co-prescribing Prescribing opioid reversal medication (Naloxone) Medication Assisted Therapy with Buprenorphine 14 7

8 Education Vehicles: Blog postings distributions Webinars CME in-person events Recordings of trainings Physician-to-Physician review of prescribing patterns Project ECHO (Extension for Community Health Outcomes) 15 Initial Focus: Stop Escalation, New Starts and Diversion 16 8

9 Pharmacy Prior Authorization Changes 1. Require justification for high doses of expensive opioids 2. Required justification for escalation of high-dose opioids (no matter what the price) 3. Request justification for all prescriptions for all stable high doses of opioids Request explanation for stable high dose Difficult cases may require supporting documentation of mental health, pain specialist, or pain medication oversight committee Track responses with PHC-level registry of patients on high dose opioids 4. Set a maximum 30 tablets of short acting opioids (per 90 days) without prior authorization for new onset acute pain. 17 Additional Options for Treating Pain Expanded benefits Podiatry Chiropractic Acupuncture Osteopathic Manipulation Therapy Formulary changes Duloxetine made formulary Other adjunctive non-opioid treatments covered Behavioral Health Smooth access to supportive behavioral treatment Mindfulness/relaxation self-help tools 18 9

10 PHC Counties Participating in CHCF Regional Opioid Safety Coalition Grant Program 11 PHC Counties are participating in CHCF s Regional Opioid Safety Coalition Grant Program CHCF Opioid Safety Coalition County 2 PHC Counties have new coalitions starting to form New County Coalitions 19 P20 Managing Pain Safely: New Starts and Drug Costs 10

11 Initial Opioid Prescriptions 21 52% Decrease Savings in Opioid Drug Costs 22 60% Decrease 11

12 Additional Sources of Savings and Efficiency For health plan Direct Drug Costs (rapid feedback on progress) Hospital Costs Emergency Room visit Costs For primary care Opens up appointments for other conditions Improved job satisfaction for clinicians leads to decreased turnover For community Criminal justice system Improved social stability Increased workforce productivity 23 Contact Information: Robert Moore, MD, MPH Chief Medical Officer, Partnership HealthPlan of 24 12