March 1, 2017
For the full report see: Program Interventions to Address Substance Use Disorder and Save Public Healthcare Funds
In an earlier report, the Office of the Inspector General (“Office”) examined how the Massachusetts Medicaid (“Medicaid”) and the Health Safety Net (“HSN”) programs managed over 800,000 fee-for-service claims for certain prescription drugs, with a focus on drugs that have a high potential for abuse. The Office used data analytics to evaluate utilization patterns; identify ways for the Medicaid and HSN programs to detect fraud, waste, and abuse; and observe what policies and practices the two programs had in place relating to the prescribing and dispensing of these drugs. The report was fueled, in part, by the growing problem of opioid use and abuse. Massachusetts in particular has one of the highest rates of drug overdose deaths in the United States; since 2000, opioid-related deaths have increased in Massachusetts by 350%.
The Office’s earlier report found that the Office of Medicaid (“MassHealth”), the state entity that runs both the Medicaid and HSN programs, could better use claims data to target fraud, waste, and abuse relating to prescription drugs in both programs. The report noted that using data analytics is an effective way to focus on subsets of MassHealth members or HSN users who may be at risk of addiction. MassHealth could, for example, use data analytics to identify MassHealth members or HSN users who are using a particular drug or drug combination, and then determine whether the treatment is clinically appropriate. The report also noted that data analytics can identify patterns of prescribing and dispensing controlled substances that may indicate fraud or abuse. The Office further found that MassHealth could take additional steps to more effectively manage claims for prescription drugs that have a high potential for abuse. Specifically, the Office recommended that MassHealth focus on how it reviews claims, uses prior authorizations, and monitors and addresses its members’ use of Schedule II drugs.
To follow up on that report, the Office has now examined 12 programs from across the country – public and private health insurers, a worker’s compensation program, a hospital-based program, and a health system – to identify interventions to address substance use disorder with the aim of identifying promising practices that MassHealth might replicate. To the extent possible, this examination includes the health outcomes of these practices in an effort to determine what interventions have the potential to prevent substance misuse and abuse in the first instance. Effective prevention would, in turn, reduce the need to treat substance use disorder; reduce the overall healthcare costs for people with substance use disorder; and lessen fraud, waste, and abuse in healthcare spending. This review also examines the available data regarding the fiscal impacts of these interventions in order to identify effective practices that also could save public healthcare dollars.
The interventions the Office reviewed include alternate treatment for pain, revised prescription policies, creative uses of data analytics, outreach and education to providers and patients, reduction in barriers to treatment for substance use disorder, integration of physical and behavioral health services, and tailoring interventions to specific populations.
Measuring the impact of these interventions is a challenge for a number of reasons. For instance, the majority of the programs the Office examined are implementing more than one intervention at a time. Therefore, it is difficult to attribute an outcome to one particular intervention. In addition, data is limited because of the short length of time that many of these programs have used these interventions. In spite of the difficulty in documenting the impact of specific interventions, some of these programs are seeing positive healthcare and fiscal results. Accordingly, the Office recommends that public and private insurance programs, healthcare providers, hospitals, and health systems consider adopting the interventions described in this report.