It’s hard to follow the news today without reading an article about the opioid epidemic. It truly is a crisis — one that Independence Blue Cross is committed to preventing and treating any way we can. That’s why when Mercer recently approached us and asked if we’d join forces with them to help one of our shared, national clients protect their employees from the risk of opioid misuse and abuse, we were eager to help. Since we have such a strong presence in the community, and the opioid epidemic is one of our top priorities, this was a great opportunity to brainstorm tangible ways that we can protect our members from this devastating epidemic.
Specific Steps Lead to a Pilot Program
Our brainstorm resulted in the idea to develop a pilot program designed to provide educational resources and clinical support to help prevent opioid misuse and abuse, along with ensuring there is an adequate network of providers for those who need treatment.
Finding the Area of Maximum Impact
Our first step was to look at medical and pharmacy utilization trends specific to the client’s employee population in order to see what conditions/episodes in care resulted in members being prescribed opioids.
We found that members who have spine, knee, and hip procedures, as well as C-sections, were most likely to be prescribed opioids. We fed this information through the BlueCross BlueShield Institute’s Community Health Management Hub to find out which areas of the country these episodes of care were most prevalent, in order to focus our pilot program on the area of maximum impact. From this information, we decided to focus on the client’s membership in Texas.
Implementing the Pilot Program
On July 1, 2018, we implemented a process-based plan design where members’ out-of-pocket expenses (deductible/co-insurance) would be reduced if they spoke with one of our registered nurse Health Coaches prior to having a spine, knee, and/or hip procedures, or a C-section. Members could also speak to the Health Coach after a procedure/surgery, if any of these episodes of care were performed in an emergency. If a Health Coach spoke to a member prior to a procedure, he/she would follow up with the member post-procedure.
The client also increased their limit on chiropractor and acupuncture visits.
Insight from Health Coaches
Through this pilot program, Health Coaches provide clinical and evidence-based educational support to educate members on the risks of taking opioids, alternatives for pain management, and services their employee assistance program offers. They also educate members on the quality and financial benefits of having their procedure done at a Blue Distinction facility.
Prior to the July 1 launch date of the new plan design, we sent communications to our client’s members educating them about this new benefit, and we continue to educate them through avenues like open enrollment meetings.
Looking Ahead
Members are already benefitting from the new plan design as they are actively engaging with our Health Coaches and learning about the risks of opioid misuse and abuse. Today, we’re handling this new process manually, but in the future, we’re looking to create a more automated process and include additional episodes of care to engage more members.
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