Next generation opioid strategy resulted in 27% drop in prescriptions
With data and analytics guiding efforts, UnitedHealthcare works with care providers and employers to prevent opioid misuse and deliver tailored treatment.
- All states
- Employee experience
Someone dies from an opioid-related overdose every 13 minutes.1 Prescription opioid overdose is now the leading cause of accidental death in the United States.2 The scourge of opioid misuse is taking a devastating toll on the social and economic welfare of individuals, families and communities. Opioid abuse now accounts for $15,000 in per-patient incremental annual health care costs and 25 percent of all workers’ compensation costs, affecting employee health and productivity.3, 4
The UnitedHealthcare opioid management strategy is demonstrating positive results. With powerful data and analytics guiding their efforts, the company is joining with care providers and employers to prevent opioid misuse and deliver tailored treatment and recovery support to those who are struggling.
Preventing abuse before it starts
“The root cause of our nation’s opioid epidemic is not unethical or illegal medical practice, but the well-intentioned yet tragically misguided practice of over-prescribing opioids for common conditions." 5
Opioid dependence can begin in a matter of days and 30 percent of patients with first-use opioid exposure after 30 days will remain on therapy for over a year.6
Yet, 99% of physicians prescribe opioids beyond the dosage limit of 3 days recommended by the U.S. Centers for Disease Control and Prevention (CDC), according to a 2016 survey by the nonprofit National Safety Council.7
UnitedHealthcare leverages its broad provider relationships to promote appropriate use. Through utilization management, it limits the dose and length of therapy starting with the very first fill through prior authorizations and dosing limits that are based on the CDC guidelines. Through innovative resources and technology, action is applied at both the micro and macro level in real time to prevent overprescribing.
Treating addiction as a chronic disease
Addiction is a disease and should be acknowledged as such. UnitedHealthcare applies treatment for at-risk and high-risk members as they would any other chronic condition – such as diabetes or heart failure.
With its expanded Retrospective Opioid High Utilization program, the company identifies members who are at increased risk of opioid misuse or inappropriate use due to a high number of prescriptions from multiple doctors and pharmacies. Proactive outreach to providers assists in guiding these people to the appropriate resources and support programs.
Supporting long-term recovery from addiction
2.1 million Americans are estimated to have a prescription painkiller abuse disorder, and the relapse rate for opioid abusers is 40-60 percent. Like other chronic conditions, addiction must be managed over a lifetime.
Stress, mental illness, alcohol abuse and long-term post-surgical recovery can contribute to patients becoming dependent on prescription painkillers. To support long-term recovery, UnitedHealthcare connects employees with certified peer support specialists who are uniquely qualified to support others because they have made the journey from substance abuse to recovery themselves. They continue to monitor claims data and work with providers to connect members to available behavioral health support such as counseling and rehabilitation.
The National Alliance of Healthcare Purchaser Coalitions recently honored UnitedHealth Group – parent company of UnitedHealthcare – with the 2018 eValue8™ Innovation Award for its successful opioid strategy, which brings together the UnitedHealthcare opioid management strategy with partnered analytics work from their sister company, Optum.
- 95% of “first fill” opioid scripts ≤ 7 days’ supply8
- 27% reduction in total opioid prescriptions9
- 21% reduction in average dose10
Implementing an opioid plan in your workplace
“It’s important for employees to be aware of and understand the safety concerns associated with opioids,” said UnitedHealthcare’s chief pharmacy officer, Susan Maddux. “That means communicating the risks of over-prescribing, overlapping treatments, abuse and side effects.”
Educational resources include Consumer Reports’ 5 Surprising Facts on Prescription Painkillers; Avoid Opioids for Most Long-Term Pain; and Pain Relief: What You Need to Know. Some other solutions are alternative pain management and lifestyle adjustments which include behavioral therapy, exercise, acupuncture and massage. Evaluating benefit coverage and cost sharing for these alternate treatment options may help reduce pain without the risks associated with opioid medications.
The National Safety Council offers guidance for re-evaluating policies and testing for prescription drugs. Their recommendations expand on education to include supervisor training and robust employee assistance programs.
With an epidemic of this proportion, there is no simple solution, but there is hope. UnitedHealthcare is combining their efforts with the work of the nation at large to lower the risk of opioid misuse one employee at a time. To see how UnitedHealthcare is approaching patient-centered care in regards to the opioid epidemic, find Randy’s story at https://newsroom.uhc.com/opioids/randys-story.html.
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- National Institute on Drug Abuse. Overdose Death Rates – United States. August 2018. Available at: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
- Rosengren J. Opioid Pain Pills, Drug Addiction And Overdose. AARP. June 1, 2017. http://www.aarp.org/health/drugs-supplements/info-2017/opioid-drug-addiction-pain-pills.html.
- Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC. The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 2015; 36:559-574.)
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. Accessed July 2017
- Shatterproof. Prescription Drug Monitoring Programs: Critical Elements of Effective State Legislation. March 2016: 9.
- OptumLabs: CY’16 Commercial Managed Care Medical and Pharmacy Claims Data
- Results are based on 3/4th quarter 2016 vs. July 2018 client data and short-acting opioid script volume and do not represent a guarantee of results.