How Anthem Blue Cross Reduces Dental Opioid Prescriptions

BY SCOTT TOWERS

SINCE THE AMERICAN opioidcrisis began in the 1990s, it has continued to have a devastating impact on human lives and oureconomy. In 2017, the crisis was officially declared a public health emergency and since then,  U.S. health care institutions and providers have worked to fight this epidemic, but they need help. This effort requires collaboration from all parties involved in our country’s  healthcare system, including employers and insurance companies.

The need to stop this epidemic has become even more urgent due to the COVID-19 pandemic, which has led to significant increases in opioid-related deaths in 35 states in just the last few months. Additionally, according to the National Institute on Drug Abuse, people who take high-doses of opioids may be more at risk for COVID-19 due to the negative effect opioids have on the lungs and heart, making them more susceptible to respiratory health challenges.

With America’s healthcare system driven by employer-provided insurance, employers have a responsibility to understand the epidemic, its associated costs and how they can help their employees through this crisis. In turn, their insurance providers have a duty to provide them with the proper resources, education and support.

Anthem Blue Cross has taken steps to do so with a program that has resulted in significant reductions in dental opioid prescriptions. By applying our whole health approach to opioid prescribing in dentistry and rolling out our Dental Patient Health History tool last year, Anthem has seen a greater than 50% reduction in opioids prescribed by dentists since 2016. In that same time period, the number of opioid prescriptions by dentists exceeding a seven-day supply has dropped by more than 90%. Since the first exposure to opioids for many people, including 31% of adolescents (aged 10 to 19), occurs following dental procedures, we know that reducing dental opioid prescriptions in particular is critical.

COSTS OF THE CRISIS

According to the latest available  figures from the U.S. Centers for Disease Control and Prevention (CDC), opioids were responsible for 46,802, or 69.5%, of drug overdose deaths in the U.S. in 2018. The opioid crisis claims more lives from the 25 to 34-year-old age group than it does from any other, making it particularly horrifying.

On top of the human cost, there is a staggering financial cost. According to the Society of Actuaries (SOA), the opioid epidemic cost the U.S. economy more than $630 billion between 2015 and 2018 in expenses related to premature mortality, criminal justice activity, child and family assistance and education programs. Of that total economic loss, lost productivity in the form of absenteeism, educed labor force participation, and  employer  costs for disability and workers’ compensation accounted for $96 billion.

To address this nationwide problem, the CDC released updated opioid prescription guidelines in 2016. While guidelines and advisories from national health care institutions and leaders are important, they are ineffective without buy-in from stakeholders up and down the chain of care—including Anthem.

THE WHOLE PERSON HEALTH APPROACH

Recognizing the gravity of the situation and our responsibility to act, Anthem aligned with the CDC’s recommendations shortly after their release and immediately applied our whole person health approach to reduce opioid prescriptions. In the traditional American healthcare model, information can travel very slowly or not at all between practice areas, which  can potentially hinder a patient’s  health journey. Our whole person health approach connects dental, vision,  pharmacy, disability and other medical claims data in real time to provide a holistic view of the patient’s health.

With more information about their patients’ medical and prescription histories, providers can see what patients are taking and why, to make better and more informed decisions and recommendations, and ultimately improve patient outcomes while reducing medical costs.

The solution to such a widespread problem needs to be bold, so our integrated approach to whole  person health has enabled us to put our combined healthcare expertise toward developing a comprehensive and effective plan of action.

REDUCING DENTAL OPIOID PRESCRIPTIONS

Through our whole person health approach, we initiated a multi-year effort to create more targeted communications for network dentists who had higher volumes or longer durations of opioid prescriptions. We implemented stronger quantity limits on short-term and long- term acting opioids, while proactively recommending alternative, non-addictive pain management options such as acetaminophen or ibuprofen.

Additionally, our secure and HIPAA compliant Dental Patient Health History Tool allows network dentists to see integrated patient health histories across products including medical, dental, vision, behavioral health, and prescription drug coverage. The tool also includes opioid prescription data from other providers, helping to solve a major issue in single patients who possess multiple opioid prescriptions from different providers, and helping those providers avoid potential over prescribing.

On top of reducing opioid  prescriptions by fighting over-prescription, prescription shopping and abuse, whole person health helps dentists recognize and manage systemic or chronic conditions.

This can improve patients’ overall oral health and prevent emergent events, such as infections, that can require support in the form of pharmaceuticals or opioids.

When opioids are absolutely necessary, dentists can recommend three-day prescriptions instead of five, seven or 10, reducing the amount of time a patient takes opioids, the likelihood that they will become addicted and lastly, the cost of each prescription.

HOW THIS BENEFITS ALL PARTIES

Since this crisis began, American families have seen how devastating and harmful opioids can be. So, any solution to reducing prescriptions and usage of these medications needs to include a focus on the patient. By better educating patients about the risk of opioids, helping them to manage any underlying health conditions, and encouraging them to improve their overall health, it’s possible to reduce the likelihood that they will need opioids in the first place, and potentially fall victim to addiction.

For providers, having access to the whole person health view of their patients’ medical care and opioid prescription histories reduces the time spent gathering patient history and background. Making this information readily available to all care providers involved gives them more confidence in their decisions and recommendations and makes care more efficient from start to finish.

Employers obviously depend heavily on their employees, so it is in their best interest to ensure they are healthy and to provide them with the tools necessary to get the best possible care. Reduced opioid prescriptions can help reclaim the billions of dollars lost to health care spending and lost productivity and lost work days created by the opioid crisis, while also reducing the cost associated with managing and treating addiction.

The American people need to be freed from the grasp of this crisis, especially in the midst of a pandemic. So, for brokers, I encourage you to seize this opportunity to work with insurance providers that offer a whole person health approach and be the partner that employers can count on to help combat this public health emergency.

 

 

SCOTT TOWERS is president of  Anthem Blue Cross’s Dental and Vision businesses. In this role, he is  responsible for setting the strategic direction with accountability for product development, operations, underwriting, network development and strategy, as well as managing membership across the enterprise.