LDI Awarded Grant to Study Payment Policies for Opioid Use Disorder

A Penn LDI-Shatterproof Collaboration

The University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) has received a grant from the Laura and John Arnold Foundation (LJAF), in partnership with Shatterproof, to study the logistics and policies related to the public and private insurance industry’s coverage of opioid use disorder treatment.

LDI is Penn’s hub of health services research collaboration, with many of its senior fellows engaged in a wide range of studies related to addressing the opioid epidemic. Shatterproof is a non-profit advocacy organization whose Substance Use Disorder Treatment Task Force is working to create a national universal standard of care for opioid use disorder. LJAF funds research in a number of areas, including public health, to help support evidence-based public policy.

Sixteen insurers

Last November Shatterproof announced it has signed 16 major health insurers to an agreement endorsing the National Principles of Care for Substance Use Disorder Treatment, which are based on evidence presented in the 2016 Surgeon General’s Report on Alcohol, Drugs, and Health.

Daniel Polsky, PhD, Executive Director of LDI

The new award from LJAF is a six-month project focused on establishing the groundwork for the Shatterproof Task Force’s larger effort to transform the country’s addiction treatment system with payer policies and incentives that foster high-quality evidence-based treatment practices.

Monitoring policy changes

“The plan is to develop an assessment strategy that could be applied systematically across cooperating private payers and state Medicaid directors,” said LDI Executive Director Daniel Polsky, PhD, who is the research project’s primary investigator. “The goal is to eventually create a system that could monitor changes in policies over time, evaluate those policies, and track progress in adopting best practices.”“This project will inform our work with payers to implement changes that increase availability of, and incentivize, higher quality addiction treatment,” said Samantha Arsenault, Director of National Treatment Quality Initiatives at Shatterproof. “We look forward to working with LDI to understand and track how insurance providers are optimizing efforts to curb the opioid crisis.”

As the opioid epidemic has evolved into a national crisis, insurers have established widely varying coverage policies for substance use treatment at the same time researchers and advocates have documented that treatment remains beyond the reach of large numbers of people who need it most.

Payment models

Insurers operate according to several categories of strategy including benefit design, coverage, utilization management, reimbursement and alternative payment models that directly effect what treatments are available and to whom.

Samantha Arsenault, Director of National Treatment Quality Initiatives at Shatterproof

The current body of evidence-based treatment strategies for opioid use disorder include three medications approved by the Food and Drug Administration — buprenorphine, methadone, and naltrexone. But researchers have found that these effective medications are often not used in mainstream healthcare and specialty addiction treatment facilities.For instance, roughly a third of these facilities offer even one of the medications and only two percent offer all three. Even then, the delivery of these medicinal therapies was found to often be inadequate and of poor quality.

115 deaths a day
According to the Substance Abuse and Mental Health Services Administration, over 2 million Americans are addicted to opioids, including prescription and illicit versions. The National Institute on Drug Abuse estimates that 115 of those people die every day — or about five deaths every hour around the clock.

This post cross posted from the University of Pennsylvania Leonard Davis Institute EMagazine.

From C-Section and Knee Arthroscopy to Opioid Dependency: How Big A Problem?

Is it possible that the widespread prescribing of excessive amounts of opioids for C-section and knee arthroscopy patients is responsible for producing a significant number of opioid dependencies?

That question is the subject of Perelman School of Medicine postdoctoral researcher Benjamin Ukert‘s new pilot project funded by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH).

Launched in 2015 and funded by the National Institute on Drug Abuse, CHERISH is a collaborative effort of Penn LDI, Weill Cornell Medical College, Boston Medical Center and the University of Miami Medical School. Its researchers are involved in a broad range of studies related to opioids, HIV/AIDS and HCV.

Early stage funding
In some of its previous pilot grants, CHERISH has funded early-stage work that analyzed how HCV treatment can be more effectively integrated into primary care; how state prescription drug monitor (PDMP) programs impact prescribing levels; the variability and excesses of opioid prescribing practices for six specific diagnoses; and the impact of e-cigarette and marijuana policies on cigarette use and birth outcomes.

Supported by his new CHERISH pilot grant, Ukert, PhD, an Associate Fellow at Penn’s Leonard Davis Institute of Health Economics (LDI), is analyzing private insurance patient data from 2012 to 2015 to find opioid prescriptions given to surgical patients who have no previous history with opioids. Then, he is tracking their prescriptions over the next year to see how many patients were subsequently given a second and third refill in a period when many physicians routinely prescribed 30 or 40 pills at a time.

Critical quantity of pills
“Current medical guideline say that if you get more than 20 pills the first time, there’s a higher risk of becoming addicted,” said Ukert at a day-long CHERISH research dissemination and policy mentoring session at LDI. He hopes to quantify if, in fact, that has happened to any significant degree in two areas of surgery that normally do not involve long-term pain management.

Ukert was one of two recent recipients of CHERISH pilot project grants. The second was Czarina Behrends, PhD, an instructor at Weill Cornell Medical College whose research focuses on harm reduction strategies, program evaluation and research related to HIV and Hepatitis C testing and care, with a special focus on people who inject drugs.

Expanding Naloxone distribution
Funded by her new CHERISH grant, Behrends is working with the New York City Department of Health to assess citywide Naloxone (Narcan) distribution patterns, outcomes and requirements for new resources. She is currently interviewing managers at homeless shelters, substance abuse programs, emergency departments and other settings that have an ongoing association with opioid users. As New York shifts more funding into its Naloxone program it needs to know how to best expand it. Behrends’ findings will help to map out new distribution points for the overdose-reversing drug and identify barriers that may impede its broader availability.

“So far,” said Behrends, “the barriers seem different for different types of organizations. The larger ones face challenges in managing their Naloxone supply because when they order from New York City, the Naloxone is shipped to a single place and they have to redistribute it to elsewhere in the city, which is really complicated. Smaller programs have more trouble keeping up with community demand for Naloxone training. They try the best they can, but money is an issue.”

“Overall,” Behrends continued, “the administrative red tape around how Naloxone is distributed is challenging and that is the basis of the question for us: how to get it to the people who need it most?”

 

This post was cross-posted from University of Pennsylvania Leonard Davis Institute (LDI) EMagazine.

A Computer Tool to Address Epidemic of Opioid Overdose Deaths

PA Governor Tom Wolf Urges Medical Professionals to Sign Up

 
Photo: Hoag Levins
Pennsylvania Governor Tom Wolf speaks at a University of Pennsylvania press conference where he announced the launch of a new state prescription drug monitoring system designed to tighten access to prescription opioid drugs and other controlled substances.

Pennsylvania Governor Tom Wolf on Thursday announced the launch of a new Prescription Drug Monitoring Program (PDMP) designed to log and analyze every prescription for opioids and other controlled substances dispensed anywhere in the state.

The new web-based computer program is Pennsylvania’s latest tool in the battle to lower the body count of prescription drug overdose deaths that has become the state’s most pressing health challenge.

Wolf made the announcement at a press conference in the University of Pennsylvania’s Perelman School of Medicine where he was accompanied by Secretary of Health Karen Murphy, RN, PhD, and Deputy Secretary for Health Innovation at the Pennsylvania Department of Health Lauren Hughes, MD, MPH.

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All three emphasized the severity of the state’s prescription opioid overdose crisis, noting that 3,500 Pennsylvanians are dying annually and that number continues to rise. Hughes, who oversees the new PDMP program called the situation “the worst public health crisis Pennsylvania has experienced in recent history.”

‘Doctor shopping’
A Prescription Drug Monitoring Program (PDMP) is a statewide database into which pharmacists and clinicians who dispense drugs are required to record the individual sales of controlled substances. The system can automatically monitor and analyze the incoming data to identify patients who are involved in “doctor shopping” — practice of simultaneously receiving opioid prescriptions from different doctors.

The Pennsylvania PDMP law requires pharmacists to enter dispensing data into the PDMP system within 72 hours after the patient gets the prescription. The stored data for each prescription includes the prescribing doctor, patient and drug’s name, dosage, date, pharmacy and payment method.

The PDMP data can also be used in a variety of other ways to more effectively support drug abuse-related education, research and enforcement efforts. Pennsylvania’s PDMP office is currently most focused on encouraging physicians to routinely query the system before prescribing an opioid medication for a patient.

A  new website has been launched by the Health Department to support PDMP registration and technical support for the state’s physicians and pharmacists.

‘Immediate and sustainable reductions’
“As a practicing Pennsylvania physician, I can tell you that my colleagues and I have been eagerly awaiting a usable PDMP,” said Penn emergency physician Zachary Meisel. “We know that states that implemended PDMPs have seen immediate and sustainable reductions in opioid prescribing.”

Meisel, a health services researcher and Senior Fellow at the Leonard Davis Institute of Health Economics (LDI), is also a member of the research team at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH). That collaborative project of Weill Cornell Medicine, Boston Medical Center, LDI and the University of Florida is heavily involved in opioid addiction research.

Meisel is also the co-author of a recent study of PDMP use by emergency room physicians that details the successes and unresolved issues of such systems.

“A usable PDMP should help Pennsylvania doctors not only make better decisions to limit opioid prescriptions for patients who are getting too much,” Meisel said, “but it can also help patients with pain get appropriate treatment.”

‘Key first step’
However, Meisel also noted that PDMP availability alone isn’t an instant solution. “Physicians will have to be able to find it easy to use and integrate it into their daily practice but having this new working system is a key first step.”

In June, a team led by CHERISH researchers Yuhau Bao and Bruce Schackman, both of Weill Cornell Medical College, published the findings of a study of the results achieved in 24 states that operated PDMPs from 2001 to 2010.

That Health Affairs article reported that “the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward.”

This article originally appeared on the University of Pennsylvania Leonard Davis Institute website.