Top health industry issues of 2018

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The health industry tackles the opioid crisis

Opioids are the leading cause of death for US adults younger than 50, with roughly 64,000 overdose deaths in 2016, up from 52,000 in 2015.1  Nearly half of those deaths involved a prescription opioid.2  Despite the ongoing drumbeat of concern—from policymakers, healthcare organizations and consumer advocates—the crisis has proven complex, with no quick fixes.

In 2018, healthcare industry organizations will build on their strengths and collaborate to prevent opioid misuse, improve treatments for chronic pain, and support patients struggling to recover from opioid addiction.

Identifying behavioral markers and social health determinants are critical to prevention. Healthcare leaders must work together on population health and community programs to fight addiction and overdose. States facing the highest numbers of overdose deaths—the most tangible and acute measure of the crisis—are working with first responders and law enforcement to expand access to drugs such as naloxone, which can reverse an opioid overdose if administered quickly.

Working with state and local health officials is one part of Aetna’s Enterprise-Wide Opioid Task Force, as is increasing communication between prescribing physicians and patients at risk for opioid misuse or abuse. Aetna is proceeding with a five-year plan to improve how chronic pain is treated, reduce inappropriate opioid prescribing, and increase medication-assisted therapy for members with opioid use disorder.3 The organization is preparing to launch an interactive dashboard so that consumers can track Aetna’s progress toward its goals, said Daniel Knecht, MD, MBA, Aetna’s head of clinical strategy and policy.

Aetna also has changed its prescription drug formulary to align coverage decisions with the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids.4 In states hit hardest by the opioid crisis, such as Kentucky and West Virginia, Aetna is using claims and pharmacy data to identify pregnant mothers and babies at risk for neonatal abstinence syndrome, or babies born with opioid dependence. “Based on signals in the data, our care managers will reach out to the member to engage them and discuss their options,” Knecht said. “A case manager is assigned to that pregnant member throughout the pregnancy and up to a year after birth, to make sure there is adequate support.”

Reducing the sheer volume of prescription opioids in circulation may require new rules for prescribers (see Figure). Even patients who use opioids correctly for chronic pain are at risk; 1 in 4 patients treated with opioids for long-term chronic pain struggle with addiction.5 “We are using higher-level analytics in our retail pharmacies to understand if a doctor has a high level of inappropriate prescriptions,” said Troy Brennan, executive vice president and chief medical officer at CVS Health. CVS Caremark is limiting opioid prescriptions for acute pain to seven days, a restriction supported by PhRMA, a biopharmaceutical trade organization. And the PBM has placed a daily dosage limit of 90 morphine milligram equivalents per patient, in keeping with the CDC guidelines, Brennan said.6

 

Implications

Improve patient management to bridge gaps in care

Consistent engagement with patients may help prevent new opioid addictions by identifying social factors that influence patient behavior. Care management programs, such as cancer care management, may be used to help manage at-risk opioid patients. “We are ramping up patient counseling in [CVS] retail pharmacies,” Brennan said.

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Use technology and data sharing to improve healthcare business collaborations

Combining public and private health data may reveal new insights and areas of focus. In Massachusetts, data sharing across many government agencies has made it easier to find at-risk opioid patients. Partners Healthcare has also contributed clinical health data to the Massachusetts Department of Public Health-led effort, said Tom Land, director of the department’s Office of Special Analytic Projects. Third-party organizations also may participate in compiling and analyzing health data to inform multi-organization strategies for reducing opioid misuse, dependence and overdose.

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Make safer treatments for chronic pain available

Some of the most dangerous opioids are the least expensive. Insurers, PBMs and pharmacies should consider the total cost of opioid addiction and overdose. Aetna is partnering with Pacira Pharmaceuticals Inc. and the American Association of Oral and Maxillofacial Surgeons to find oral surgeons with high opioid prescription rates and offer to enroll them in a program that provides free samples of Pacira’s Exparel, a non-opioid local analgesic. It then teaches the doctors how to use it with patients undergoing wisdom tooth extraction [7].

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1 Josh Katz, “Drug deaths in America are rising faster than ever,” New York Times, June 5, 2017,
https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

Centers for Disease Control and Prevention (CDC), “Provisional Counts of Drug Overdose Deaths, as of 8/6/2017,” September 2017,
https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf

2 CDC Prescription Opioid Overdose Data, August 2017,
https://www.cdc.gov/drugoverdose/data/overdose.html

3 Harold Paz, “Finding Solutions: Aetna’s Comprehensive Strategy to Combat the Opioid Epidemic,” July 2017,
https://news.aetna.com/wp-content/uploads/2017/06/Finding-Solutions-Aetna-on-Opioids-FINAL.pdf

4 CDC Guideline for Prescribing Opioids for Chronic Pain, March 2016,
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

5 Joseph A. Boscarino et al, “Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system,” October 2010,
https://www.ncbi.nlm.nih.gov/pubmed/20712819

6 PhRMA press release, “PhRMA Announces Support for Seven-Day Script Limit on Opioid Medicines for Acute Pain,” Sept. 27, 2017,
http://www.phrma.org/press-release/phrma-announces-support-for-seven-day-script-limit-on-opioid-medicines-for-acute-pain

7 Pacira press release, “Pacira Pharmaceuticals, Aetna, and the American Association of Oral and Maxillofacial Surgeons Join Together in a Program to Reduce Opioid Exposure for Patients Undergoing Wisdom Tooth Extraction,” https://globenewswire.com/news-release/2017/09/13/1120237/0/en/Pacira-Pharmaceuticals-Aetna-and-the-American-Association-of-Oral-and-Maxillofacial-Surgeons-Join-Together-in-a-Program-to-Reduce-Opioid-Exposure-for-Patients-Undergoing-Wisdom-Too.html

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Kelly Barnes
US Health Industries and Global Health Industries Consulting Leader, PwC US
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Gurpreet Singh
Health Services Leader, PwC US
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Karen C. Young
US Pharmaceutical and Life Sciences Leader, PwC US
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