Community Health Plans’ Roles in Addressing Safe and Effective Opioid Use

ACHP released its newest report, Ensuring Safe and Appropriate Prescription Drug Use, on Tuesday before a standing-room only crowd of reporters and experts from a wide variety of stakeholder organizations at the National Press Club in Washington, D.C.

Prescription drug misuse, particularly of opioid painkillers, is a growing public health problem, with opioid overdose deaths tripling over the past decade and the number of opioid prescriptions doubling during this same time period to over 200 million a year.

ACHP President and CEO Patricia Smith and an expert panel comprising physicians from three ACHP member health plans discussed strategies to engage providers, patients, pharmacists, community-based organizations and public agencies to address opioid misuse and fielded questions from the audience.


“Opioids are highly potent, controlled medications that relieve pain. Patients deserve the best quality care to help alleviate their pain and enable them to address their underlying health conditions. But the powerful drugs now available to us create a real challenge in balancing that care with the need to guard against the damage misuse can inflict. In particular, there is great concern about the use of very high doses of prescription painkillers. The nation’s leading health plans see this problem in their own communities and are taking action to protect patients from both pain and the danger of misuse of opiates.  Today the Alliance of Community Health Plans is releasing a report that profiles the important work being done across the country by our members.”

Patricia Smith, President and CEO, Alliance of Community Health Plans


“One of the things I want to highlight as a physician: You know we take a Hippocratic Oath. And our job is really to try to help relieve pain and suffering—but also to do no harm. I’m fortunate to be part of an organization, Kaiser Permanente, that is the largest integrated not-for-profit health care system in the United States that brings together physicians, pharmacists, hospitals, and health plans to focus on quality improvement.
Coming from Kaiser Permanente in Southern California—we’re the largest region of Kaiser Permanente; we have 3.5 million members and I work with more than 5000 physicians, and this issue has caught their attention.

A lot of the work that I’m going to describe to you really has been physician driven. We want to be part of the solution, not part of the problem.”

Joel Hyatt, M.D., Assistant Medical Director, Regional Quality and Clinical Analysis, Kaiser Permanente, Los Angeles, California


“In 2010…Group Health achieved system-wide consensus on an updated guideline and made it into a working document. Physicians, care team members and researchers worked to develop common approaches to patient-centered care. We implemented standard practices, protocols and educational tools to provide consistent systematic care and improve safety in all of our twenty-five clinics. Instituting best practices resulted in major improvements in work flow in care and in patient, prescriber and team satisfaction.

We came to a consensus on roles and standard work processes for care team members from medical assistants to consulting nurses, pharmacists and physicians, and provided trainings so the entire team gave the same message. Most primary care physicians completed an online class about chronic pain and opioid prescription…that was funded by a Group Health foundation grant. This improved physician confidence in managing opioids and in managing chronic pain. All patients participate in their chronic pain care. This includes setting functional goals associated with opioid use. The goal in treating chronic pain is improving quality of life…”

Randi Beck, M.D., Service Line Chief of Physical Medicine and Rehabilitation, Group Health Cooperative, Seattle, Washington


“As part of the new initiative focusing on primary care physicians in collaboration with this work group that I just mentioned, the health plan created an algorithm to identify patients with abnormal opioid utilizations position patterns…Along with these patient lists the health plan provided a comprehensive pain management tool kit which was developed in conjunction with this group of providers.

…The toolkit included information regarding appropriate narcotic prescribing, patient assessments and screening tools for early identification of misuse issues, strategies for acute and chronic pain management, templates for care plan development, patient pain agreements, formulary and drug information and also charts to help providers compare different dosages of analgesic preparations.

The toolkit recommended non-pharmacological treatment when that was appropriate and had initiatives regarding the identification of physical, emotional, psychological, social and also vocational issues that may have been exacerbating the pain symptoms. In the first year of this study and of our program that we put into place, our pain management program had a decrease of about thirteen percent in opioid claims for the members that we targeted for this initiative.

.…[T]hey were starting to see that the costs have slowly started diminishing but what we are seeing is that where the costs are diminishing are in the inpatient and outpatient costs, except for behavior of health, for inpatient behavior health, inpatient substance abuse in detoxification. Also psychology referrals, psychiatric referrals and primary care physician and pain management specialty referrals all had increased and the costs of all those services have gone up.

Overall we think we’re seeing a diminishing cost, because we’re getting better quality treatment for our members.

Stephen E. Perkins, M.D., Vice President of Medical Affairs, UPMC Health Plan, Pittsburgh, Pennsylvania



Rachel Schwartz