By Velvet Thorne, LPN, CLNC, Population Management Trainer, HealthEC
As physician practices transition to value-based care and incorporate population health management (PHM) solutions into their day-to-day workflows, there are opportunities to close the communication gaps that can lead to opioid abuse. By aggregating and analyzing data across the care continuum, healthcare organizations can proactively recognize patients with conditions that put them at risk for abuse (e.g., cancer, COPD, and muscular skeletal disorders), flag specialists that are overprescribing, and note which pharmacies are dispensing the most opioid prescriptions.
These analytics-driven technologies and the evolving role of care coordinators have an important part to play in addressing the opioid epidemic. When used together, these resources enable healthcare providers to quickly identify and proactively care for patients at risk of opioid abuse. This article illustrates how holistic solutions that account for social determinants of health and rely on technology, personal intervention, and education, can be adopted to help healthcare organizations stem the tide of opioid addiction.
The origins of opioid abuse
Many patients develop opioid dependence after taking pain medications for an extended period of time. A simple patient case example demonstrates how easy it is for patients to end up with multiple pain prescriptions that they may become dependent on or addicted to later:
A patient is seen by an orthopedic surgeon after a motor vehicle accident. The patient is prescribed a 30-day supply of Percocet, MRIs are performed, and the patient is referred to a neurologist for pain management. The neurologist administers three steroid injections and prescribes a 30-day supply of Vicodin with one refill. The patient then sees their primary care physician, where more Percocet is prescribed.
In this scenario, communication gaps in care management contributed to the threat of opioid abuse. Without proper care coordination protocol in place, multiple physicians assumed responsibility for the patient, resulting in three separate pain medication prescriptions filled at three different pharmacies. In the absence of aggregated insight into the patient’s health record, providers overlooked the patient’s history of illicit drug use. Many patients find themselves with pain medication addictions due to simple scenarios like this one.
In response to the recent spike in overdoses, many physicians have pulled back on prescribing opioids. Without referrals in place for managing pain as prescriptions are scaled back, many patients experience adverse effects related to withdrawal and end up in the emergency department (ED). Some patients end up bypassing healthcare to get pain medications off the street. This trend highlights physician challenges in pain management and underscores the importance of slowing tapering patients off of opioids to reduce the potential for long-term dependency.
Overcoming challenges in the opioid epidemic
New regulations and guidelines are emerging to help providers better address opioid issues. Prescription drug monitoring programs (PDMP) are being used to aggregate patient data portals and monitor drug use. This enables providers to see all controlled substance prescriptions across neighboring states. The Centers for Disease Control and Prevention require providers to check PDMPs every three months and before every opioid prescription. The New York State Department of Health now requires that drug treatment plans include patient goals, tapering plans, treatment alternatives, and a risk factor evaluation that must be reviewed annually with patients.
The objective is to streamline processes and reduce drug utilization and the associated costs of abuse. Overarching goals for physicians and clinical teams addressing the opioid epidemic include:
- Identification of patients at risk
- Closing gaps in communication across primary care, specialists, pharmacy and others
- Shifting to alternative first lines of addiction treatment
- Establishing goals for pain and function
- Discussing the benefits, risks and availability of alternative addiction treatments
New medication-assisted treatment options, addiction treatment mentor programs, and increased drug risk evaluation training for medical professionals represent some of the strategies that healthcare organizations are employing to address the opioid crisis. Technology and care coordinators have emerged to play a pivotal role, as well.
Role of technology
Consensus is building on the importance of understanding the patient profile for opioid addiction risk. Several factors influence the profile for opioid abuse risk, including:
- Family history of substance abuse (alcohol, illegal drugs, and/or prescriptions)
- Personal history of substance abuse (alcohol, illegal drugs, and/or prescriptions)
- History of preadolescent sexual abuse
- Psychological disease (ADD, OCD, bipolar, schizophrenia, and/or depression)
Technology attacks the opioid epidemic head-on by applying complex algorithms to aggregated data sets to help providers identify patients who are at high risk. This may include looking for patients with multiple providers, high ED visit tallies, and the presence of co-morbidities that might warrant high prescription volumes. Veterans, for example, often have higher addiction rates where dual physicians are seen (typically at Veterans Affairs and Medicaid facilities) due to lack of care coordination between providers.
Technology solutions like PDMPs and PHM platforms are helping healthcare organizations remove data barriers so providers have a more comprehensive view into patient health records. Many electronic medical record systems are customizable, allowing providers to implement an alert system to notify providers of at-risk alcohol and drug abuse patients. Once a detection system is in place to flag instances of potential drug abuse, care coordinators can then step in to help these at-risk patients with appropriate next steps in their care journey.
Role of care coordination
Care coordinators are a vital asset in healthcare organizations’ efforts to address opioid addiction. These caregivers are often able to identify patterns of abuse that may inform patient risk factor algorithms. Common red flags for opioid abuse reported by care coordinators include:
- Frequently lost or stolen scripts
- Frequently cancelled appointments
- Use of other drugs and/or alcohol
- Seeking drugs from multiple providers
- Using prescriptions for euphoria and anxiety relief
- History of prescription forgery
- Selling or sharing prescription drugs
- Repeated increase of prescription dosage
- History of drug or prescription overdose
- Aggressive demands to increase prescription dose
- Altering the route of administration
- Arrest for DUI or other drug-related activities
When identifying at-risk patients for targeted care follow-up, care coordinators can leverage data analytics platforms to ensure that key steps are taken help the healthcare organization better manage opioid-dependent patients. Analytics resources enable care coordinators to:
- Stratify patient data using multiple data sources
- Apply risk scores
- Focus on the top 5% of patients to make the greatest impact
- Decrease the amount of high ED users
- Increase annual wellness and preventive care appointments
- Monitor and track chronic disease patients
- Coordinate care to close communication gaps between providers
- Improve discharge planning
- Ensure primary care physician follow-up within five to seven business days
Care coordinators act as the liaison between patients and disparate providers and care settings, bridging gaps where common communication failures typically occur. This may include verifying claims data with real-time prescription information, calling the patient to discuss or arrange drug treatment options, or documenting data for case escalation with a medical director.
As the opioid crisis continues, the healthcare industry must address the problem head on. And while there is no simple solution, data analytics and new care coordination protocols can certainly be significant agents of change.
About the Author
Velvet Thorne has been in the business of healthcare for more than 30 years and holds a non-restricted license in New Jersey, New York and Pennsylvania. She is the subject matter expert for care coordination at HealthEC. She has several certifications including Business Management, Legal Nurse Consultant and is a certified Six Sigma Green Belt. She led the care coordination program for Alliance for Integrated Care of New York (AICNY) and recently started a new role as Population Management Trainer.