Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Custom Media Event: ESG Summit
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Virtual Health
    • - Future of Healthcare Staffing
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Transformation Hub

Where healthcare challenges find solutions

  • Patients
  • Operations
  • Care Delivery
  • Payment
Care Delivery
March 29, 2018 01:00 AM

Blue Cross and Blue Shield discourages using opioids as primary pain treatment

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    The Blue Cross and Blue Shield Association has adopted a new standard that opioids should not be the first or second treatment options to manage pain, mirroring guidelines set by the Centers for Disease Control and Prevention.

    In most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for the Blues association, which has about 106 million members.

    It's not an absolute decree. In many cases, particularly related to cancer treatment or end-of-life care, opioids may be the best remedy, said Haywood, adding that the association will aid physicians in making the best clinical decision.

    "The opioids are half as effective but two to four times more harmful," he said. "But because of how they are marketed, physicians might think that is not the case."

    Opioid marketing campaigns and payment models were partly to blame. Purdue Pharma, which produces OxyContin, reached a $635 million settlement with the federal government in 2007 related to alleged misbranding of OxyContin. South Carolina and other states have made similar claims that Purdue downplayed the addictive nature of the painkillers.

    Physicians used to have performance incentives linked to subjective pain measures that patients indicated on a sliding scale, said John Hamilton, chief clinical outreach officer at Mountainside Treatment Center. There was a lot of pressure to do business as usual, he said.

    "So, they changed the system and looked at things differently," said Hamilton, adding that evidence supports that anti-inflammatories are often more effective than opioids. "The whole subjective measure of pain from sad face to happy face is ludicrous."

    Insurers, pharmacies, distributors and providers have restricted the number and size of opioid prescriptions they dole out. Blue Cross and Blue Shield of Michigan recently implemented a new policy that limits opioid prescriptions to 30-day or five-day supplies. Blue Cross and Blue Shield of Massachusetts requires prior authorization for opioid prescriptions for more than 30 days and that doctors and patients co-sign an agreement. Prior to these changes, an analysis from America's Health Insurance Plans revealed that many opioid prescriptions exceeded maximum dosage levels and recommended supply.

    Salt Lake City-based Intermountain Healthcare is looking to cut the number of opioids prescribed for acute pain across its entire system by 40% by the end of this year. Some states are also requiring that physicians participate in training related to opioid prescriptions.

    But physicians worry that reducing the supply could cut off access to patients who need the potent drugs. Also, insurers have been slow to cover alternatives to opioids. Prior authorization for medication-assisted treatment is another big roadblock.

    Experts like Sebastian Seiguer, CEO of emocha Mobile Health, software that helps track medication adherence through video, supported the guidelines implemented by the CDC and the Blues.

    "All these types of remedies are all trying to cover for one major problem we have—prescribers are hesitant to prescribe replacement treatments for opioids because they don't know what is happening to the patient when they leave the office," he said. "We need ways to monitor and support the patient between visits."

    The epidemic has reached unprecedented heights. Twenty-one percent of commercially insured Blues members filled at least one opioid prescription in 2015, according to a Blues study. The report also showed members with an opioid use disorder spiked 493% over seven years.

    Research from FAIR Health, an independent not-for-profit that manages the database of privately billed health insurance claims, found that opioid treatment spending increased 1,000% from 2011 to 2015. That was one impetus for Scan Health Plan, which offers a Medicare Advantage plan to about 185,000 members in California, to offer buprenorphine for a $5 copay and boost access to Naloxone. The health plan also has quantity limits and prior authorization requirements for long-term prescriptions as well as a prescriber education program.

    But there is room for improvement and more analysis is necessary, the Blues' Haywood said. For instance, providers in the Southeast don't prescribe as much medication-assisted treatment than the their peers in the Northeast, despite higher rates of opioid abuse, he said.

    "We want to resolve those particular issues," Haywood said.

    Want to continue the conversation about opioids? Join Modern Healthcare on April 25-26 at its Opioid Crisis Symposium.

    An edited version of this story can also be found in Modern Healthcare's April 2 print edition.

    Tags: Care Delivery, Insurers, Insurance, Blue Cross and Blue Shield, Private Plans, Opioid abuse, Transformation, Transformation Hub
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Amazon_sized_getty_i_i_i.jpg
    Amazon expanding Amazon Care with behavioral health
    woman stressed calling
    States prep for 988 mental health hotline's national debut
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Transformation Summit
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Virtual Health
        • - Future of Healthcare Staffing
      • Custom Media Event: ESG Summit
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing