Illinois Makes Aggressive Move on Opioids. What Did They Get Right/Wrong?
Dave Chase, Health Rosetta-discovering archaeologist
Healthcare Transformation Author & Speaker | Chief Archaeologist at Health Rosetta
States are responding to a massive public health crisis. We continue to crowdsource what is/isn't working. For example, The Opioid Crisis Wake-up Call has a case study of a rural California county went from the highest rate of opioid overdose deaths in the state (4x the state average) to literally zero opioid OD deaths last year. At the employer level, early analysis demonstrates that Health Rosetta-based plans have dramatically lower rates of opioid prescriptions and addiction. Having said that, we're not out of the woods by any means. What do you think the Illinois leaders got right/wrong? Please add your comments below. The following is the release from the state:
Illinois Department of Insurance Becomes Nation’s First Regulator to Address Opioid Crisis Through Benchmark Plan
Determined to Curb Growing Epidemic, Rauner Administration Announces Bold Strategy
SPRINGFIELD – Gov. Bruce Rauner and the Illinois Department of Insurance (DOI) announced today that the state is taking additional steps to curb the growing opioid crisis in Illinois. The DOI is asking the federal government to approve five critical changes to its Health Care Benchmark Plan, ensuring that people who struggle with substance use disorder have access to the most effective forms of treatment.
The Benchmark plan serves as a minimum scope of benefits that most health plans sold in Illinois must cover. The Illinois DOI hosted an electronic public notice and comment period to solicit recommendations from the public this past Spring. Based on the analysis of the comments and the expertise of the providers and researchers, DOI revised the Benchmark Plan with the aim of reducing addiction and overdose by:
? Covering alternative therapies for chronic pain,
? Improving the way opioids are prescribed, AND
? Expanding access to mental health and substance use disorder treatment and services.
“This epidemic is affecting every community and every demographic with tragic outcomes across the country. We’re committed to helping people get the treatment they need, regardless of their socio-economic status” Gov. Rauner said. “These changes to the Benchmark Plan will give people who carry private insurance access to medications that will help them deal with the pain from an injury while reducing the odds that they become addicted to dangerous medications.”
DOI submitted its revisions to the Federal Centers for Medicare & Medicaid Services on Sunday, July 1st, making Illinois the first state in the nation to address the opioid crisis through its Benchmark plan.
“We are thrilled to announce revisions to the Benchmark plan, that focus on addressing the opioid crisis. We continually strive to fulfill our mission of protecting and educating Illinois consumers,” said DOI Director Jennifer Hammer. “I can think of no better way to protect consumers than to implement evidence based, systematic changes to coverage and access to mental health and substance use disorder treatments and services.”
If approved, private health care insurers in Illinois would be required to cover alternative therapies for chronic pain, issue short-term prescriptions for chronic pain, remove barriers to prescribing Buprenorphine products for medically assisted treatment (MAT) of opioid use disorder, cover prescriptions for at least one intranasal spray opioid reversal agent when initial prescriptions of opioids are dosages of 50MME or higher, and expand access to mental health and substance use disorder through tele-psychiatry care. The changes would go into effect for plan year 2020.
Changes to the Benchmark Plan will compliment steps that have already been taken to tackle the opioid epidemic in Illinois. Members of the Governor’s Opioid Overdose Prevention and Intervention Task Force, created through Executive Order 17-05, have toured the state listening to people who are impacted by the crisis and has made recommendations on how the state can intervene. Our teams at the Department of Human Services have connected more than 5k people to critical resources through the Opioid Helpline. The Prescription Monitoring Program has helped scale back people’s ability to doctor shop for dangerous opioid medications and, through the issuance of standing order, we continue to put life-saving medications in the hands of people whose loved ones are struggling with opioid use. Nearly 2,000 overdose reversals have been reported over the past year.
Background: In April 2018, the Federal Centers for Medicare & Medicaid Services (CMS) announced that states have until July 2, 2018 to change their Benchmark plan effective in plan year 2020 (including three options that weren’t previously available). The Illinois Department of Insurance (DOI) anticipated these changes in February 2018 and secured approval from the Governor’s Office to pursue changing the Benchmark plan to address the opioid crisis. Since February 2018, DOI has contracted with three external groups to assist in the drafting of the new plan (SIU School of Medicine (researcher and provider experts), PCG (subject matter experts), and Oliver Wyman (actuaries)). As of Monday, Illinois becomes the only state in the nation that met the extremely short timeline.
For more on how Illinois is battling the opioid crisis visit State of Illinois Opioid Action Plan.
For more information on the Illinois Benchmark plan visit https://go.cms.gov/2KE5A7i
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Dave Chase is the co-founder of the Health Rosetta (a LEED-like organization for healthcare), Managing Director of the Quad Aim Fund, Executive Producer of The Big Heist, and author of the book, “The Opioid Crisis Wake-up Call: Health Care is Stealing the American Dream. Here's How We Take it Back.” Follow the link to the book for a free download of the book. Chase's TEDx talk was entitled "Healthcare stole the American Dream -- here's how we take it back." See the Health Rosetta Institute website for how to get involved, resources and how to join others to support its mission.
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Chief, Surgical Services | Diplomate, American Board of Anesthesiology & Obesity Medicine
6 年Pain , as a presenting complaint , is very subjective and is not unique to the US population. Look at how Pain is treated in other countries. Pharma did an amazing job marketing opioids to the masses. State prescription drug monitoring programs have shown a decrease in the number of opioids being prescribed. Unfortunately back yard chemists are synthesizing opioids (fentanyl ) and incorporating them into street heroin -leading to addiction and death. Physicians/PAs/NPs who prescribe opioids in this country usually have time constraints to chart and move on to the next patient instead of coordinating a treatment plan which may include other options (PT,OT,massage,rest,acupuncture, acupressure, NSAIDS, TENS). A treatment plan requires time to educate the patient, it’s more than a tear off sheet of paper. Let’s look beyond our borders and see what we can learn from other countries before we recreate the proverbial wheel.
Physician
6 年I wonder what are these "alternative treatments" that insurance will have to cover.
Technology Professional
6 年Keep in mind that prescription opioids are only a portion of the problem. There should be actions taken to alleciate opiate addiction before (while) access is being restricted. Most heroin users in the US became addicted via prescription opiates. If our goal is to save our people we need to stop looking at this as an access problem and approach this as the addiction problem it is. Cutting off legal access pushes the problem to black market opiates, fake pills, stolen pills, heroin and fentanyl. As insurance professionals we focus on what we know; insurance. We need to be using our knowledge to help build up addiction and rehab benefits and focus on our ability as administrators of the plans paying for treatment to help get people the care they need. We should use our healthcare management teams to help get people into treatment. We should use our underwriters and pbms to help identify plan members that exhibit known factors of addicts. We can partner with quality treatment centers to keep the body brokers away from our clients. We can do more. Stop putting so much focus and pressure on taking opiates away as a legitimate pain management option. We need use our knowledge and resources to make opiates a better and safer option.
Your Partner in Building Transformative Healthcare Solutions | Health Rosetta Charter Advisor | Chief Member
6 年I am so happy to see that you shared this. Its quite a robust action plan. I passed it on during our Health Rosetta Chicago Chapter call last week. I'd like to get Rauner and members of the IL opioid task force part of the the Chicago roadshow. Kane county recently received recognition from the Surgeon General that they are on the "right track" in combatting the opioid crisis. https://kanecountyconnects.com/2018/05/surgeon-general-to-kane-county-youre-on-the-right-track-in-fight-against-opioids/