Blue plans collaborate on opioid protocols

There are 36 health insurers that comprise the national Blue Cross Blue Shield Assn., and every one of them has encountered the costs of today’s opioid crisis. To respond, the Blue plans have created a new executive committee to identify best practices in prevention and risk reduction.

According to Kim Holland, vice president of state affairs for the association, the committee includes clinicians, chief medical officers, fraud experts, governmental affairs leaders and pharmacy leaders from the Blue plans. The insurers are implementing programs in their respective territories to manage members with addictions.

“What this committee is going to do is bring together those people who have knowledge about those programs to talk about them and explore ways that they collectively can establish best practices for our systems, which can be executed by every plan,” says Holland.

For example, Blue Cross Blue Shield of Massachusetts (BCBSMA) tracks prescriptions filled by its members and identifies when a single member is obtaining multiple opioid prescriptions. As part of the process, the BCBSMA medical director initiates phone calls to the members’ prescribing physicians to alert them to the red flags and to reinforce prescriber education.

“Our objective is to prevent addiction from prescription opioids,” Holland says. “We know this is a complicated issue, and there are many moving parts to it.”

She says the Blue plans can provide resources to consumers and healthcare providers to help them take preventive action, but “Blue plans have no illusion that they can stop opioid addiction.” Likewise, the committee is not going to examine or establish any standards for treatment of addiction specifically.

Case management

Sarahlee Browning, LICSW, the behavioral health operations leader for BCBSMA, says some of the local detox facilities in Massachusetts can refer their patients, who are members of the health plan, to BCBSMA’s case management services.

“Together the member, the facility social worker and the Blue Cross case manager work to identify barriers, set up provider appointments and identify community resources, all before the member discharges,” Browning says.  “Then we continue to follow the member for up to 45 days after discharge to make sure they went to the appointments and that they like the provider.”

BCBSMA case managers will reach out by phone about twice a week, following up with patients from detox to partial hospitalization to outpatient, or in some cases, following up after residential services. The hope is also to track members for outcomes data, but Browning says the plan doesn’t have the data just yet.

In 2015, BCBSMA identified 907 plan members who were eligible for the case management services, and 335 agreed to participate, Browning says. Of those, 98% reached at least one of their self-identified engagement goals, such as making an appointment with a counselor or a primary care physician.

The plan also covers medication-assisted treatment (MAT).

“We have an addictionologist on staff to review cases—and speak to prescribers of very high doses of buprenorphine, for example, to understand how the clinician got there—and to encourage use of MAT in general,” says Ken Duckworth, MD, medical director for behavioral health for BCBSMA. “We make sure people on high doses have talked to an addiction specialist. We are trying to reduce the risk of diversion or abuse.”

The addictionologist, the two case managers and the two utilization managers meet regularly to coordinate their efforts around members with addiction, he says.