Impact of a Health System's Three-Pronged Strategy to Address the Opioid Epidemic in DE, PA, and WV, 2013-2017

In the past two decades, from 1999-2017, more than 700,000 people have died from a drug overdose in the United States. In 2017, more than 68% of the drug overdose deaths involved an opioid, and the opioid death rate was six times higher than in 1999. Although treatable, opioid addiction has significant health consequences; and evidence-based, data-driven models addressing these opioid-related factors remain sparse.

To help stem this epidemic, Highmark Inc., a national health plan as well as the second largest integrated delivery and financing system in America, developed, implemented and evaluated a series of quality management-focused opioid interventions utilizing a three-pronged public health approach. We focused on more effectively managing pain to reduce the need for opioids (primary prevention); when needed, prescribing opioids according to safe prescribing guidelines (secondary prevention); and for those with Opioid Use Disorder (OUD), ensuring access to effective treatment to reduce morbidity/mortality (tertiary prevention) for our members.

We deployed a series of evidence-based and data-driven interventions utilizing clinical guidelines, integrated and coordinated infrastructures, and community-based participatory research frameworks within our service areas of Delaware, Pennsylvania, and West Virginia. We examined medical and pharmacy claims for combined data years 2013-2017 by age, product (commercial, diagnosis with OUD), total Opioid prescription (RX) fill rate (per 1,000 members), opioid use by dose (dosage level by Morphine Milligram Equivalents), opioid use by duration (number days of opioid use), rate per 1,000 members diagnosed with OUD, and geography.

Improvements in total Opioid RX fills, opioid use by dose and duration for members diagnosed with OUD. Over these years, a decrease of 19% of total Opioid RX fills; shorter durations and the majority of these members switched to 7 days or less of opioid use; and a reduction by 13 percentage point of the number of members on higher strength 20+ MMEs opioids resulted.

These findings may help inform nationwide opioid-focused efforts and set priorities.