Paduda: State Fund Is Solving Opioids

Tuesday, May 1, 2018 | 0

I’ve lauded the Ohio Bureau of Workers’ Comp for its great successes reducing opioid usage. But, I’ve heard from many stakeholders that Ohio’s got a unique advantage.

Joe Paduda

The BWC is both the regulator AND the payer, so it gets to do whatever it thinks makes sense, and providers, patients and pharmacies have to do what they’re told.

Fair point.

The implication is this: It’s way harder when you’re:

• Not a monopolistic state fund.
• You don’t have the power to implement formularies, utilization review, pre-cert, and other care controls.
• You don’t have the full focus and influence of a state’s governor behind you.

Well, the State Fund of California is delivering stellar results without any of the inherent advantages listed above — in a state that is highly litigious, without a formulary (until this year), and where a subset of providers spends every waking hour thinking up new ways to screw State Fund, insurers, employers and taxpayers by gaming the system.

Gov. Jerry Brown is fully supportive of State Fund.

From 2014 to 2017, the State Fund delivered:

• A 60% reduction in total opioid prescriptions to injured workers covered by State Fund.
• A 74% reduction in opioid spend.
• Across-the-board morphine equivalency dosage reductions (80% reduction in the number people above 50 MEDs; 83% reduction in the number people above 80 MEDs; and 87% percent reduction in the number people above 120 MEDs).

As a result, opioids now represent 16.9% of the State Fund’s total prescriptions, down 31% since 2014.

A couple of more data points, then we’ll dig into how State Fund did this. There were 1,458 patients who were prescribed 120 or more MED in 2014. Today there are 186 cases.

Results for those patients prescribed 50 or more MEDs were almost as good; the number of patients declined by more than 80%, from 5,000 to 994.

How’d State Fund do this?

There are two primary foci: reduce initial opioid usage, and help long-term patients wean off opioids. We’ll focus on the latter in this post.

Recall that these results occurred before the new formulary was implemented, so that did not have an effect on these statistics.

State Fund’s long-term opioid reduction program begins with the adjuster, who remains involved in the claim throughout the process. The program involves multiple vendors, a variety of approaches, an openness to innovative treatment and a lot of communication.

There is no “canned” approach: Cognitive behavioral therapy, acupuncture, counseling, physical therapy, exercise programs and functional restoration programs have all been employed. Medication-assisted therapy, or MAT, has been used in selected cases, but for the most part State Fund is trying to stay away from using opioids to solve opioid problems.

Key to the long-term issue has been using vendors to conduct peer-to-peer conversations with the prescribing physicians. According to State Fund Medical Director Dinesh Govindarao, this peer-to-peer education of prescribing physicians has been instrumental in the success of the program, as many treating providers don’t have adequate training on pain management and opioid prescribing.

For patients with significant chronic pain, State Fund developed a program specifically aimed at helping them cope with their condition. Patients willing to participate were enrolled in this program.

Going forward, State Fund and Dr. Govindarao are working to set up a more defined process to triage patients, one that will have different approaches and process flows for different types of patients. They will be looking at commonalities in patient groups to see if they can flow them through consistent treatment approaches.

What does this mean for you?

You can dramatically reduce long-term opioid usage through a well-designed, carefully managed, patient-centric approach overseen by a very competent medical director.

And when you do, you can save scores of lives, hundreds of families, and millions of dollars for policyholders and taxpayers.

One last comment: These results were produced by a state entity and state workers focused on doing the right thing, the right way.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.