By Rachael Jones, Senior Vice President, Performance Analytics and Quality for Cotiviti
One of the biggest health issues stemming from the COVID-19 pandemic is also largely unseen: the rise in opioid use disorder complications. The stress of self-isolation appears to have triggered a relapse in some who struggle with opioid use disorder. The pandemic also significantly reduced capacity for in-person treatment and peer counseling, disrupting care for those receiving treatment prior to the pandemic. As a result, communities across the nation are experiencing a surge in opioid overdoses—both fatal and nonfatal. In Niagara County, N.Y., alone, officials reported a 35 percent increase in drug overdoses from Jan. 1 to April 6 compared with 2019 figures.
Increased prevalence of opioid use disorder presents concerns not just for healthcare providers and communities, but also employers. Those suffering from opioid use disorder frequently demonstrate increased absenteeism and declines in productivity, and pose a hazard to themselves, their coworkers, and their environment. One recent study showed the opioid epidemic cost employers $96 billion in lost productivity from 2015 to 2018. Meanwhile, 75 percent of employers believe they are directly affected by misuse of prescription drugs in the workplace, whether through absenteeism, on-the-job injuries, increased costs or other issues, according to a survey released by the National Safety Council.
How can employers leverage data to develop thoughtful interventions for opioid use disorder? Three approaches stand out.
Use pharmacy claims data to identify the types of conditions for which opioids are most frequently prescribed. For example, suppose a company performs a deep dive into pharmacy claims data that reveals 15 conditions accounted for 46 percent of opioid claims, and members received opioid prescriptions for osteoarthritis, musculoskeletal disorders, and back pain most frequently. With access to this data, employers can partner with their health plans to provide alternatives to opioid treatment, such as pain management therapies, for specific conditions.
They can also develop employee education programs that help employees reduce their risk for certain conditions on the job, such as back injury. Employers can also help ensure employees understand that opioids are highly addictive—even after just five days of use. Research points to the value of employer intervention: When employers initiate and monitor substance use disorder treatment plans, employees demonstrate better sustained recovery rates.
Pharmacy claims data also is an essential tool in changing prescribing patterns to match evidence-based treatment protocols. For example, the data can help pinpoint which physicians most often prescribe opioids. From there, employers can help prevent opioid use disorder by making providers aware of their prescribing patterns in relation to their peers and aligning payment incentives with evidence-based protocols.
Analyze medical claims data to gain insight into opioid dependency risk factors. There are many factors that make employees prone to opioid use disorder, from gender to tobacco use to existing conditions such as mood disorders or those that cause musculoskeletal pain, like fibromyalgia. For example, research shows women are more susceptible to opioid addiction than men, although it is unclear why women’s bodies respond differently to opioids. Women also are more likely to be prescribed opioids—and at higher doses—and take opioids longer, on average, than men.
With advanced analytics and artificial intelligence (AI), employers can analyze claims data as well as other data types, such as social determinants of health, labs, and pharmacy information, to determine which employees are most prone to opioid use disorder. Leveraging this approach, employers are more empowered to look for potential indicators—such as concurrent use of opioids and benzodiazepines, use of opioids at high dosage, and use of opioids from multiple providers—and then develop digital tools that send personalized alerts to employees prior to filling a prescription for opioids. This method raises awareness of employees’ potential for opioid dependency and offers alternatives for treatment. By combing medical claims data for opioid risk factors, employers are better able to detect highly susceptible populations and deploy targeted interventions to help prevent or break the cycle of addiction.
Develop opioid-dependent member profiles using demographic, financial, and clinical information. Using predictive analytics, employers can gain a big-picture view into employees who are most likely to be suffering from opioid use disorder based on their health conditions, the types of care they receive, their gender, and more. These analyses, performed at the population-level rather than by identifying specific individuals, enable employers to assign a risk score to employee groups, categorizing them as low, moderate, or high risk for opioid use. Employers can then examine areas of highest risk by cohort—including employees’ role within the organization, health conditions, and those with opioid remission diagnoses—and explore opportunities for programs that could decrease the potential for addiction or relapse.
For example, if the data point to high incidence of opioid use among men with musculoskeletal conditions, an employer could adopt programs that help prevent on-the-job musculoskeletal injuries, with marketing of such programs geared toward men. If the data show that female employees most often access prescriptions for oxycodone in the emergency department (ED), tailoring messaging designed to reduce ED visits to a company’s female employees—such as by emphasizing the convenience of telehealth after hours—could be a vital step to managing opioid dependence and addiction.
Going Beyond “One-Size-Fits-All”
While statistics around the rise of opioid use disorder during the COVID-19 pandemic are harrowing, stories from healthcare’s frontlines suggest the problem may be bigger than we can see—and tragically, the problem may worsen as the U.S. experiences a widespread COVID-19 resurgence, requiring even more vigilance. Some researchers call the suspected link between opioid use disorder and COVID-19 “the epidemic within the pandemic.” That’s why it’s important for employers to develop a culture of health and wellness that engages employees in lowering their risk for addiction, reduces the stigma of opioid use disorder, and supports recovery. Leveraging data to develop a highly informed, highly targeted approach to combatting opioid use disorder enables a return to health for vulnerable employees while creating a safer work environment for all.
Rachael Jones is Senior Vice President, Performance Analytics and Quality for Cotiviti, a leading solutions and analytics company that leverages clinical and financial datasets to deliver deep insight into health system performance.
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