Medicaid MCOs Make Efforts to Slow Overprescribing

From RADAR on Medicare Advantage

In states that have been hit hardest by the opioid epidemic, Medicaid managed care organizations are under enormous pressure to reduce opioid prescribing. AIS Health highlights the efforts of three MCOs serving states with the highest rates of death due to opioid overuse.

Dayton, Ohio-based CareSource reports that a prescriber outreach program implemented in 2016 resulted in a 40% decrease in the number of opioids prescribed to its members in the last 18 months.

Their "MED Letters" initiative involves notifying providers who are prescribing high amounts of opioids, as determined by their Morphine Milligram-Equivalent Dose (MED), as well as using claims data to identify members who are at risk for substance use disorder, diversion, overdose or other adverse events and then alerting their providers. CareSource sends letters to prescribers showing how their overall MED prescribing compares to their peers, then highlights strategies to reduce opioids in their practices.

Meanwhile, Pittsburgh-based not-for-profit MCO Gateway Health serves Medicaid and/or Medicare Advantage consumers in four of the five states with the highest opioid overdose death rates (Pennsylvania, Ohio, West Virginia and Kentucky) and has deployed a "whole-person" approach that integrates physical and behavioral health services.

Through partnerships with provider groups to support whole-person care, patients can "access services not traditionally covered under Medicaid," according to Steven Szebenyi, M.D., vice president and chief medical officer.

In addition to strengthening its lock-in program, Kentucky insurer Passport Health Plan says it is reducing the initial number of units of narcotics that may be prescribed and has programmed several safety edits within its systems to help limit overuse and opioid prescribing at high doses.

"Essentially, if a member has a prescription that exceeds a specific daily opioid dose, exceeds the number of days for drug therapy, or is an inappropriate opioid option based upon how long the member has been on therapy, the prescription will be rejected and will require a prior authorization," explains Passport Communications Director Michael Rabkin.

Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.