Opioid-related treatment approaches vary by region

Research published this week by FAIR Health, a national, independent not-for-profit that analyzes commercial insurance claims, indicates treatment approaches for opioid-related diagnoses widely vary by geographic location.

In is third whitepaper on the nation’s opioid epidemic, FAIR Health analyzed privately billed healthcare claims to study the nation’s top five cities by population (Chicago, Houston, Los Angeles, New York and Philadelphia) and their respective states over the period from 2007 to 2016.

Data shows that drug testing is one of the most commonly used procedures. Among the procedure codes associated with opioid-related diagnoses in 2016, the drug testing code appeared in the top five for all the states studied.

In California, the most common procedure codes were for outpatient services and drug tests. Illinois’ top five codes included office visits, administration of naltrexone injection and group counseling. Methadone topped New York’s procedure codes, while laboratory tests made up all of the top five procedure codes in Pennsylvania and Texas.

“It’s significant because we’re in the middle of this crisis and there are interventions and protocols being designed to counter it,” says Robin Gelburd, president of FAIR Health. “It’s important to understand what types of services are being done where and to study patients longitudinally to see what is having the most impact and what are the most effective interventions that could bring value to this crisis.”

For insurers, data on the disparate approaches to treatment across various regions could impact benefit designs, reimbursement protocols and the way they design their provider networks, Gelburd tells Behavior Healthcare Executive. Public health officials, meanwhile, can “start evaluating what type of access is available to these different interventions and [determine whether that] is driving disproportionate utilization of certain treatments and procedures,” she adds.

Other findings from the latest FAIR Health whitepaper:

• In both rural and urban settings, 51- to 60-year-olds represented the largest concentration of opioid-related insurance claims. “Oftentimes, this is considered a younger person’s epidemic, but at least in the private health sector, that is not what is being demonstrated,” Gelburd says.
• Despite constituting 43% of New York state’s population, New York City accounted for 13% of the distribution of insurance claim lines with opioid-related diagnoses. Conversely, San Antonio and its immediate surrounding area accounted for 66% of the distribution of such claim lines in Texas, despite constituting just 5% of the state’s population. Moreover, claim lines with opioid-related diagnoses increased by 141,022% in the San Antonio area from 2007 to 2016, the largest increase in Texas.

Protocols for a fourth whitepaper in the series are currently being designed by FAIR Health, Gelburd says. The paper, which will broaden the lens of the third installment and cover the rest of the country, is tentatively scheduled to be released in late 2017 or early 2018.

Join Us

Donna Smith, executive director of business development at FAIR Health, will speak during a session titled “How Private Claims Data Provide a Window onto the Opioid Crisis” during the National Conference on Addiction Disorders, which will be held Aug. 16-20 in Baltimore.