Cigna’s 25% reduction in opioid use among its commercial book of business nearly a year ahead of schedule has set a new hopeful tone for curbing this national crisis. An estimated 2.5 million Americans suffer from substance use disorders related to prescription opioid pain relievers, according to the insurance carrier.
One leading employee benefits authority with a major brokerage is taking notice of Cigna’s approach and accomplishment, which he believes will resonate with brokers and advisers whose clientele is struggling with this issue.
Ron Leopold, M.D., chief medical officer for Lockton Benefit Group, describes the accelerated reduction in opioid use as an “impressive result,” adding that “the industry should take a good, hard look at all of the different strategies that were employed by the Cigna program.” He says Lockton has been addressing the opioids issue with employers in all industry sectors to not only reduce spending, but also improve health outcomes and productivity.
In May 2016, Cigna sought to harness its physician-partnership model in hopes of breaking the vicious cycle of addiction that it noticed had been ravaging employer clients. That effort also included assuring access to clinically appropriate remedies prescribed by a doctor for patients who had no alternatives to manage their pain.
The insurance carrier’s comprehensive program, done in partnership with more than 1.1 million prescribing clinicians, includes both preventive measures and assistance to patients involving evidence-based care for pain.
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Cigna solicited input from across the benefits spectrum — medical, dental, behavioral health, pharmacy and disability — as well as governmental affairs, to identify immediate and longer-term approaches. Key objectives included stronger safeguards in the opioid prescribing process, enhanced support and counseling, and easier access to treatments for substance use disorders.
Along the road to curtailing opioid use by 25%, Cigna measured the total volume of opioids prescribed based on morphine milligram equivalent doses. It also took into account the number of pills and dosing, as well as the relative strengths of different opioid medications.
Duration and dosage measures
This summer, Cigna plans to initiate additional safety measures aligned with national and regional guidelines to minimize the risk of medications that are more likely to cause an opioid overdose. They include limiting the duration of certain opioid scripts and ensuring daily dosage measurements do not exceed safe and appropriate quantities. Plans also are in the works for a consumer-focused initiative focused on prevention.
So far more than 2,000 medical groups representing more than 65,000 physicians have pledged to work with Cigna to address the opioid epidemic. A major focus of the initiative is to align these physicians with education stemming from guidelines the Centers for Disease Control and Prevention (CDC) released in early 2016.
“We provide them with more information about their patients, as well as their own prescribing patterns around opioids, comparing them to peers in the community, as well as to those CDC guidelines,” says Doug Nemecek, M.D., chief medical officer of Cigna Behavioral Health.
Various reports have been created at the practice level for larger primary care-based accountable care organizations that share the data with their leadership. They help identify outlier physicians and innovative best practices alike for improving opioid prescribing.
“We also spent a lot of time listening to physicians to understand what different efforts and best practices had they been putting in place in their practice, in hospitals and communities,” Nemecek reports.
As a clinician, Leopold likes the focus on physicians because it lets healthcare payers get to the source of control over prescribing habits. He thinks it’s also extremely helpful to offer treating physicians benchmarks against CDC standards, which “can be a powerful influencer of prescriber habits.”
By analyzing both medical and pharmacy data, Lockton is able to get a clear picture of overall prescription use, including types of medication, frequency of use, supply and the number of prescribing physicians and pharmacies per member involved.
Such information is able to uncover abuses involving doctor shopping. “We’re able to see members that have gone to two, three, four or five different pharmacies in order to get their medicines,” he explains.
Despite the Cigna initiative’s early success, Nemecek says there’s much more work to be done. “We are continuing to look for additional ways to partner with physicians and communities to identify more ways to further address the opioid crisis,” he says.
Benefit brokers can play a critical role in helping eliminate the stigma associated with opioids for a more constructive and holistic view, according to Nemecek. He says, they can “change the conversation with clients, and ultimately in their communities, that addiction should be treated like other chronic diseases the same way we look at diabetes and heart disease.”
