cl 1 anderson lamer

Clinical Track: Taking on Prescrip2on Drug Abuse

Across the Care Con2nuum

Daren Anderson, MD VP/Chief Quality Officer, Community Health Center, Inc.

Director, Weitzman Quality Ins?tute Associate Professor of Medicine, Quinnipiac University

Melissa Lamer, PharmD, BCPP Director of Behavioral Health Pharmacy Solu?ons

Magellan Rx Management

Disclosures

•  Daren Anderson has disclosed no relevant, real or apparent personal or professional financial rela6onships.

•  Melissa Lamer PharmD, BCPP wishes to disclose she is an employee and is paid a salary form Magellan. She will present this content in a fair and balanced manner.

Learning Objec6ves

1.  Iden6fy the specific provider educa6on interven6ons that can play a role in decreasing prescrip6on drug abuse.

2.  Evaluate how the applica6on of advanced health care data analy6cs enables the iden6fica6on and targe6ng of inappropriate behaviors related to prescrip6on drug abuse.

3.  Analyze preliminary results of CHCI’s randomized trial of ECHO Pain Management, discussing the impact of the interven6on on provider, pa6ent and administra6ve outcomes.

Strategies for Improving the Quality and Safety of Chronic Pain

Management in Primary Care

Daren Anderson, MD VP/Chief Quality Officer

Community Health Center, Inc. Director, Weitzman Quality

Institute Associate Professor of Medicine

Quinnipiac University

Goals of Presentation

•  To discuss current challenges in managing pain in primary care, particularly in medically underserved populations

•  To describe the Stepped Care Model for Pain Management

•  To describe primary care system interventions to improve quality of chronic pain management

•  To explore methods to measure quality in chronic pain management

•  To understand the Project ECHO model and how it can be used to improve the quality and safety of pain management in primary care

Community Health Center, Inc.

Our Vision: Since 1972, Community Health Center, Inc. has been building a world-class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes and building healthy communities.

CHC Inc. Profile: "   Founding Year - 1972

"   Primary Care Hubs–13

"   No. of Service Locations-218

"   Licensed SBHC locations–24

"   Organization Staff – 500

"   140,000 patients

"   400,000 visits

"   Medical, dental, behavioral health

Weitzman Quality Institute •  Established in 2013 by the

Community Health Center, Inc.

•  Named in honor of Gerald Weitzman, a community pharmacist, one of CHC’s founders, and a long-time board member

•  Research Institute based in a large FQHC

•  Promotes innovations in quality improvement science as well as critical investigation in primary care and systems redesign

Academic Partners

•  Chronic pain affects approximately 100 million Americans1

•  Annual cost of $635 billion in medical treatment and lost productivity1

•  Majority of patients with pain seek care in a primary care setting2

•  Primary Care Providers express low knowledge and confidence in pain management and receive little pain management education3

•  Opioids are heavily relied on for pain management in primary care4

•  Prescription opioid overdose is a major and growing public health concern5

Background

•  Increasing demand to identify and manage painful conditions

•  Increasing rates of opioid abuse and diversion •  Limited training in pain management •  Limited access to specialists •  Limited access to pain management specialty centers

The Challenge for the PCP

CHC’s Stepped Care Model for Pain Management

STEP 1

STEP 2

STEP 3

Primary Care Medical Home Routine screening for presence & intensity of pain

Comprehensive pain assessment and follow up Documentation of function status and goals Management of common painful conditions

Primary care team-care: MA, RN Care managers Systematic Opioid Risk Assessment/Refill/Monitoring

Complexity

Treatment Refractory

Comorbidities

RISK

Tertiary Interdisciplinary Pain Centers

Referrals to community partners

Chronic Pain in Primary Care: Baseline Data from a large health

system

Chart Review Data warehouse Provider/Staff surveys

Data sources:

Source: J Am Med Inform Assoc. 2013 Dec; 20(e2):e275-80. doi: 10.1136/amiajnl-2013-001856. Epub 2013 Jul 31.

EHR Data: Chronic Pain Algorithm

•  All patients age 18 and older with at least one medical visit in the past year who met any of the criteria below:

•  A visit with an ICD9 code specific for chronic pain (e.g. “chronic pain syndrome” 338.2X, 338.4)

•  Two or more visits separated by 30 days or more with an ICD9 code for a painful condition

•  Receipt of at least 90 days of opioid medication other than buprenorphine in one year

•  One visit with an ICD9 code for a painful condition AND two or more pain scores greater than or equal to 4.

Data warehous

e


Demographics Pa2ents with Chronic Pain (20% of all

pa2ents)

Pa2ents without Chronic Pain (80%)

p-‐Value Two-‐Tail

Total Patients* 8152 % 32487 % Sex Male 2995 37% 13215 41% <0.0002

Female 5156 63% 19266 59% <0.0002 Age Age 18-‐29 856 11% 8679 27% <0.0002

Age 30-‐39 1483 18% 7163 22% <0.0002 Age 40-‐49 2319 28% 6758 21% <0.0002 Age 50-‐59 2243 28% 5644 17% <0.0002 Age 60-‐69 925 11% 2969 9% <0.0002 Age 69+ 326 4% 1274 4% 0.7482

Race Caucasian 3624 44% 12433 38% <0.0002 Black 1005 12% 4147 13% 0.2891 Hispanic 3138 38% 12866 40% 0.0667

Visits

Avg Visits/Yr 6.54 2.72 <0.0002 Opioids Any Opioid Rx 3280 40% 1870 6% <0.0002

90+ Days Opioid 1297 16% 0 0% <0.0002 Mental Hlth Pts w/ a CHCI BH Visit 1991 24% 3329 10% <0.0002 Pain Referrals Physical Therapy 1655 20% 953 3% <0.0002

Pain Management 573 7% 94 0% <0.0002 Physical Med and Rehab 700 9% 346 1% <0.0002 Orthopedic Surgery 1347 17% 677 2% <0.0002 Rheumatology 275 3% 159 0% <0.0002

Insurance Medicaid 5425 67% 15315 47% <0.0002 Medicare 1302 16% 3094 10% <0.0002 Uninsured 780 10% 7814 24% <0.0002

Data warehous

e •  >female •  Older •  More

visits •  More

opioids •  More BH

Dx •  More

referrals •  Less

uninsured

* All adult patients in 2011 with at least one medical visit


Data warehous

e 100%

37%

9%

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

All CHCI Chronic Pain Cohort Chronic Opioid Subset

Total Primary Care Medical Visits, 2012

.

Anderson D, Wang S, Zlateva I. Comprehensive Assessment of Chronic Pain Management in Primary Care- a First Phase of a Quality Improvement Initiative at a Multi-Site Community Health Center. Journal of Quality in Primary Care. , 2012, 20(6):421-433.

0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

0% 0% 0% 0% 0% 0%

1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%

1% 2% 2% 2% 2% 2% 2% 2% 2%

2% 2% 2% 2%

3% 3%

4% 4%

4% 5% 5% 5%

5% 5%

5% 5%

6% 7%

7% 7%

8% 10%

11% 11%

11% 11%

0% 2% 4% 6% 8% 10% 12%

Dudley MD, Robert-PD

Farb MD, Alan-PD

Kennedy APRN, Michelle

Moemeka MD, Angela

Seagriff APRN, Nicole

Ayubcha MD, Soussan- FP

Mohammadu MD, Fusaini

Bravo MD, Teresa-FP

Kobel PA, Cela

Martin MD, Monique

Quarles APRN, Kristie

Wessling MD, Kathleen

DeMarco APRN, Rachel-FP

Weir MD, Lori

Knoeckel APRN, Sarah

Weischedel MD, Anne-Katrin

Dresden APRN, Debra

Gellrich MD, Gabriella-FP

Doerwaldt MD, Hartmut-FP

Wilson APRN, Laura

Carden APRN, Pamela LOCUM

Lau MD, Wai Lang- IM

Barrow MD, Alvin

Butler MD, Danielle-FP

Lecce MD, Carl-FP

Swan APRN, Amanda

Kamat MD, Leena

Manning DO, Lynne

Rivera Godreau MD, Ivelisse--FP

Patel DO, Dipak--FP

Decker APRN, Patricia-FP

Percent of Panel Prescribed 90 Days of Opioids by PCP

Provider Names

Data warehous

e


Chart Review Results Baseline

2011

Chronic Opioid

Cohort

Presence of pain documented 65.3%

Provider's func6onal assessment documenta6on 6.7%

Provider's cause/source documenta6on 64.0%

Diagnos6c test reviewed 4.7%

Pain medica6on ordered 100%

Pain consult 10.7%

Documenta6on of treatment plan 96%

Pa6ent educa6on provided 16.0%

Diagnos6c Imaging ordered 22.0%

Pain reassessed 20.0%

Chart review

.

Pain Survey Questions Item Statement Mean

Baseline 2011

Skilled chronic pain management is a high priority for me. 3.74*

My management of chronic pain is influenced by experience with addicted patients.

1.15

My management of chronic pain is influenced by fear of contributing to dependence.

1.36

I have adequate time to manage most patients with chronic pain. 1.81

Fear of narcotic regulatory agencies/administration influences my decisions regarding chronic pain management.

2.04

Analgesic side effects hinder my efforts to treat patients with chronic pain.

2.17

Patients I treat become addicted to opioids. 2.55

I use an opioid agreement with my patients. 4.45

I use a pain assessment or monitoring tool. 3.77

I am confident in my ability to manage chronic pain. 2.77

I am satisfied with the quality of resources available to help me manage patients with chronic pain.

1.53

Provider/ Staff

surveys


152.49

138

178

150

0.00

50.00

100.00

150.00

200.00

250.00

CHCI Providers (n=47) Davis et al. Valida6on Cohort: Internists (n=84)

Davis et al. Valida6on Cohort: Pain Experts (n=22)

Davis et al. Valida6on Cohort: Academic Physicians (n=27)

Avg CHCI KP50 Baseline Score Comparison Provider/

Staff surveys

.


Key Findings •  Chronic pain is extremely common (up to 37% of visits) •  Patients using opioids have >10 visits per year •  Documentation of pain care is poor •  Functional assessments are rarely documented •  Pain care knowledge is low •  Providers have low confidence in their pain

management skills •  Providers feel that pain care is an important skill for

them

. Anderson D, Wang S, Zlateva I. Comprehensive Assessment of Chronic Pain Management in Primary Care- a First Phase of a Quality Improvement Initiative at a Multi-Site Community Health Center. Journal of Quality in Primary Care. , 2012, 20(6):421-433.

Problem Goal Interven2on

Low pain knowledge/self efficacy

Increase knowledge and self efficacy

Online, team-‐based CME

Poor documenta6on of pain and func6onal status Poor documenta6on of pain reassessment

Improve documenta6on of pain care/func6onal status

•  EHR templates for pain management visits

•  SF8 Pain interference form (PROMIS tool)

•  Opioid Risk Tool •  COMM® form

Low rates of opioid monitoring/high varia6on in prescribing paherns

Reduce opioid prescrip6on varia6on and increase use of opioid agreements and u-‐tox monitoring

•  Standard policy for opioid agreements

•  Standard policy/procedure for utox

•  Opioid dashboard •  Opioid review

commihee

Limited behavioral health co-‐management

Increase BH-‐Primary care co-‐management

•  Behavioral health co-‐loca6on

•  Pain group therapy •  Project ECHO

Low use of CAM Increase access to CAM Improved access/Co-‐loca6on of chiroprac6c, mindfulness program

Limited access to specialty consulta6on

Increase PCP access to specialty advice

Project ECHO

Pain CME Options

•  Conferences •  REMS training

CHCI Biannual Pain Management CME

•  All PCP’s •  2 hours, biannually •  Virtual Lecture

Hall® •  Group format: PCP,

RN, BHP, PharmD

Action Plan Problem Goal Interven2on




Poor documenta6on of pain and func6onal status

Poor documenta6on of pain reassessment










commihee








Project ECHO

Chronic Pain Follow-Up Templates •  Click the HPI link and select the category Chronic Pain Follow

Up to document the necessary information:

Pain Follow Up Assessment Forms















commihee








Project ECHO

CHCI standard policy for chronic opioid therapy:

•  All patients receiving COT* must have: –  Signed opioid agreement scanned and

saved in the EHR –  Utox at least once every 6 months –  Follow up visit every 3 months

*COT defined as receipt of 90 days or more of prescription opioid analgesic medication

Opioid Management Dashboard

Provider Names

Opioid Review Committee

•  Committee with oversight over opioid prescribing –  Formulary –  High dose opioid oversight –  Can require review before Rx –  Can review outliers –  Establish internal guidelines















commihee








Project ECHO

•  University of Bridgeport •  Six CHC sites: 4 Chiropractors + students •  1-2 days per week •  Internal referral in ECW •  ECW custom HPI folders •  Collaborative management for pain/

musculoskeletal problems Results •  Number of Unique Patients Seen – 77 •  98.7% completely satisfied •  98% stated their condition was improved after

treatment

CHC-University of Bridgeport Integrated Chiropractic Care

Expanded Access to Chiropractic

Photo of acupuncture















commihee








Project ECHO

Behavioral Health Integration for Pain Management

•  Co-location of Behavioral health and primary care

•  Warm handoffs •  Group therapy •  BH participation in Project ECHO

COGNITIVE-BEHAVIORAL THERAPY (CBT)

•  GOAL: Move person from passivity, stress- reactivity and hopelessness to hopefulness, resourcefulness, and action

METHODS FOR IMPROVED COPING WITH PAIN

–  Cognitive Restructuring –  Acceptance and Adaptation –  Reframing –  Distraction –  Repetitive movement –  Relaxation –  Imagery –  Motivation –  Planning and Pacing Daily Activities –  Goal Setting –  Medication Management


Low pain knowledge/self efficacy Increase knowledge and self efficacy











•  Opioid dashboard •  Opioid review commihee



•  Behavioral health co-‐loca6on •  Pain group therapy •  Project ECHO




Project ECHO

NEJM 6/2011 •  Prospective cohort study

comparing HCV Rx at UNM with Rx by primary care clinicians at 21 ECHO sites in rural areas and prisons in NM.

•  407 patients with no previous treatment

•  Primary endpoint was SVR. •  57.5% at UNM and 58.2%

at ECHO sites achieved SVR.

•  Serious adverse events occurred in 13.7% at UNM and 6.9% at ECHO sites.

Project ECHO University of New Mexico

“The mission of Project ECHO is to develop the capacity to safely and

effectively treat chronic, common and complex diseases in rural and

underserved areas and to monitor outcomes.”

Dr. Sanjeev Arora, University of New

Mexico

Technological Infrastructure

•  Video conferencing system for ECHO team

•  Mobile teleconferencing platform (Vidyo©)

•  Webcam/iPad/ smart phone for end-users

•  EHR

60

•  2 hour weekly sessions •  Case submission form •  Expert specialty team •  ECHO Project

Coordinator •  15-20 min didactic

presentation •  Case presentations

(2-10) •  Primary care providers

join from anywhere

Structural Features

Unique Features of CHCI Project ECHO

•  Google Sites project page

•  ECHO blog •  Twitter for questions/

comments from participants and observers

•  Integration of behavioral health and primary care through co-presentation

•  National participation

Project ECHO Pain Management

Project ECHO Buprenorphine

Primary Care Marwan Haddad, MD, MPH

Psychiatry Richard Feuer, MD

Behavioral Health Cliff Briggie Psy.D, LADC, LCSW

Nursing Jonathan Arocho, LPN

Medical Assistance Omar Perez

65

Bup Case Presentation Form

66

Page 1 Page 2

Provider Comments

•  The sessions are “fascinating”, with “great didactic” presentations and a “collegial feel” that provides “the opportunity to…inspect my own clinical reflexes”. -- ECHO Medical Provider

•  Sessions are “informative and feature helpful information on the types of patients I see in everyday practice”. -- ECHO Medical Provider

•  “I have learned a lot and want to find a way to share this knowledge with the other providers at my site.” -- ECHO Medical Provider

Connecticut Community

Health Center, Inc.

13 primary care health

centers across the

state

Over 130,000 medically

underserved patients

Arizona El Rio

Community Health Center

16 practice locations in Tucson, AZ

73,000 patients

280,000 visits per year

Delaware Westside

Community Health Center

9 practices in Delaware

23,000 patients

Affiliation with University of

Delaware

California

Open Door Community

Health Center

2 primary care sites

Northern CA region

Coming soon: 10 additional sites from Maine 7 additional sites from New Jersey

Study Findings

Improvements in Opioid Agreements and uTox Screening

2.7

2.7

2.7

2.7

5.4

14.6

14.6

2.7

13.5

5.4

5.4

10.8

10.8

20.6

20.6

18.9

83.8

91.9

91.9

86.5

83.8

64.7

64.7

78.4

0 20 40 60 80 100

spent enough time with me

thoroughly explains the treatment(s) I receive

treats me respectfully

listens to my concerns

answered all my questions

advises me on ways to avoid future problems

gives me detailed instructions regarding my home program

Overall, I am completely satisfied with the services I receive

Percent of Patients

My chiropractor:

Pt satisfaction with chiropractic services assessment tool

Disagree Agree

92.1%

50.0%

21.1% 18.4% 18.4% 13.2%

7.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Back Neck Leg Arm Hand/ Wrist Other Foot/ Ankle

Perc

enta

ge

of

Pat

ients

CHCI Chiropractic Services General Area of Treatment

Decrease in average # of visits for patients with chronic pain

Decrease in severe pain

Chronic Pain Cohort

Prescription of any opioid medication in patients with and without chronic pain

Decrease in Chronic Opioid Prescribing

Prescription of 90+ days of any opioid medication in patients with and without chronic pain

Chronic Pain Cohort

Next Steps •  Combine system redesign work with Project ECHO

–  QI Training –  IHI “Breakthrough Series Collaborative”

•  Population level data •  Complete controlled trial of Project ECHO •  Expand access to ECHO

Summary of Pain Management Best Practices

•  Required pain CME for all PCPs •  Structured Opioid Risk Assessment •  Pain management follow up and monitoring frequency

based on risk assessment •  Routine review of state prescription drug monitoring

website •  Standard opioid agreement for all patients receiving

chronic opioids •  uTox q6 months minimum •  Multimodal care, onsite when possible:

–  Co-management with Behavioral health –  Chiropractic –  Acupuncture –  Mindfulness

Conclusions •  Chronic pain is highly prevalent in primary care •  Knowledge and adherence to guidelines for

management of pain is variable •  Health IT can be used to identify patients with chronic

pain •  Use of an opioid management dashboard can improve

safety and monitoring •  A multifaceted QI initiative aimed at improving pain

management in primary care is improving quality at CHC

Comments or Questions?

_________________________

Daren Anderson, MD

VP/ Chief Quality Officer

Community Health Center, Inc.,

Director

Weitzman Quality Ins?tute

[email protected]

860.347.6971 ext.3740

_________________________

References References: 1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academy Press, 2011. 2. Breuer B, Cruciani R, Portenoy R. Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey. South Med J 2010;103:738-747. 3. Ponte C, Johnson-Tribino J. Attitudes and Knowledge About Pain: An Assessment of West Virginia Family Physicians. Fam Med 2005;37:477-480 4. Okie, S. 2010. "A Flood of Opioids, A Rising Tide of Deaths." The New England journal of medicine 363 (21): 1981-5. 5. Centers for Disease Control and Prevention. 2010. Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs - United States, 2004–2008. Washington, DC: DHHS. Anderson D, Wang S, Zlateva I. Comprehensive Assessment of Chronic Pain Management in Primary Care- a First Phase of a Quality Improvement Initiative at a Multi-Site Community Health Center. Journal of Quality in Primary Care. , 2012, 20(6):421-433.

Taking on Prescrip6on Drug Abuse Across the Care Con6nuum

Melissa Lamer, PharmD, BCPP Director of Behavioral Health Pharmacy Solu?ons Magellan Rx Management

Financial Disclosures

•  Melissa Lamer PharmD, BCPP wishes to disclose she is an employee and is paid a salary form Magellan. She will present this content in a fair and balanced manner.

Learning Objec6ves

•  Iden6fy the specific provider educa6on interven6ons that can play a role in decreasing prescrip6on drug abuse.

•  Evaluate how the applica6on of advanced health care data analy6cs enables the iden6fica6on and targe6ng of inappropriate behaviors related to prescrip6on drug abuse.

Startling Trends in Substance Use and Abuse

Prescrip2on drug abuse is the fastest growing drug problem

•  From 2004-‐2011 emergency room visits due to the use of non medical use of opioids has increased 183%1

•  Over 54% of pa6ents were sent home; only 2.4% who were referred to detox or treatment programs2

11th consecu2ve year of increasing drug overdose deaths2

•  Higher morphine equivalent dosing greatly increases risk

• Many deaths involve combined mental health medica6ons use such as benzodiazepines, an6depressants, and an6psycho6cs2

1 Drug Abuse Warning Network, 2011. 2 Pharmaceu?cal Overdose Deaths, United States, 2010.” Journal of the American Medical Associa?on. 2012.

Medicaid is One of the Most Vulnerable Popula6ons for Abuse

•  Medicaid recipients are prescribed pain killers at twice the rate of non-‐Medicaid recipients and are at six 6mes the risk of overdose1

•  Washington study iden6fied that 45% of people who died were enrolled in Medicaid2

•  A combina6on of 4 variables have been found to predict increase risk for opioid dependence3

-‐  Age -‐  Depression -‐  Psychotropic Medica6ons

-‐  Pain Impairment

•  Medicaid is the largest payor for mental health services4

-‐  This will con6nue to be of greater importance with Medicaid Expansion

1 CDC, 2011 2 Interagency Guideline on Opioid Dosing for Chronic Non-‐Cancer Pain 3Pain Physician, 2012 4CMS Bulle?n, 2012 hXp://medicaid.gov/Federal-‐Policy-‐Guidance/Downloads/CIB-‐12-‐03-‐12.pdf

Tradi6onal Management Methods

•  Controlled substance monitoring to increase awareness of pa6ent u6liza6on paherns

•  Leverages a pharmacist driven educa6onal campaign and requiring provider registra6on and checking for certain pa6ents

•  6 months aper implementa6on -  Registra6on up from 4.4% to

86.5% -  Database access up from 15.8% to

58.9% -  Last quarter 247 unique provider

ran a query (45.2%)

•  Audits iden6fy pharmacies and providers dispensing/prescribing higher quan66es of controlled substances than peers

•  Medica6on use evalua6ons iden6fy use of medica6ons with addi6ve effects -‐  Narco6cs + muscle relaxants +

psychotropic medica6ons •  Lock-‐in high risk individuals to one

prescriber or pharmacy for all controlled substances -‐  Prescrip6ons/pa6ent/month dropped

15% during the lock and 38% post-‐lock -‐  Average # of drugs/pa6ent dropped

15% during and 36% post-‐lock

Prescrip2on Drug Monitoring Program Ini2a2ve (PDMP)

Retrospec2ve Medica2on Reviews

Ques6on

While Tradi6onal Methods Are Needed They Are Not Enough

•  Despite the release many community providers are not accessing these important databases

•  There is addi6onal administra6ve burden on the providers by requiring them to go online, register and frequently revisit the site

•  Open it does not account for prescrip6on in other states

To Best Manage Opioid Abuse We Need a Smarter Solu6on

•  Maximizes knowledge by leveraging evidence-‐based guidelines to create ac6onable recommenda6ons

•  Works with mul6disciplinary teams and industry leaders to iden6fy high profile targets

•  Engages providers through mul6-‐modal communica6ons techniques including face-‐to-‐face, telephonic, virtual and email

•  Push data out to providers instead of pulling them in to get it saving 6me, resources and increasing ease

Receipt of Medical, Behavioral, &

Rx Data

Evidence-‐Based Algorithms Clinical Outreach Outcomes

• Medical, behavioral, lab, and/or pharmacy data received by our data warehouse

• Extract created, data scrubbed

• Leverages expert clinicians to create ac6onable informa6on

• Algorithms iden6fy non-‐compliant prescribing paherns and stra6fy others

• PCP & BH Providers - Mul6-‐channel consulta6on - Educa6onal materials

• Quality indicator monitoring

•  Impact analysis • Ac6vity tracking

Advanced proprietary clinical algorithms iden6fy prescribing paherns that are inconsistent with evidence-‐based guidelines resul6ng in

personalized provider consulta6ons

Whole Health RxSM Integrated Solu6on for Whole Member Health Management

To See the Whole Pa6ent, Pharmacy and Medical Claims Systems Must be Integrated

•  Mul6ple opioid prescrip6ons from mul6ple doctors and pharmacies

•  High dose medica6ons •  Over use of short ac6ng

analgesics without long-‐ac6ng medica6ons

•  Early refills

•  Hospital admissions for overdoses admissions

•  Diagnosis claims to iden6fy substance abuse

• Methadone opioid maintenance claims are not in pharmacy data

•  Cancer diagnosis requiring higher dosing

Pharmacy Data Medical Data

Whole Pa2ent Management

•  Suboxone® u6liza6on in combina6on with other opioid medica6ons

• High cumula6ve diazepam equivalent daily doses

•  Concomitant benzodiazepine and opioid therapy

• High cumula6ve morphine equivalent daily dosing

• Opioids from mul6ple prescribers and pharmacies

• Methadone and concomitant medica6on monitoring

•  Cumula6ve early refills

Repor2ng and Profiling

Early Pa6ent Iden6fica6on and Provider Outreach is Cri6cal to Improving Outcomes

Cumula6ve High Risk Report Combining mul6ple ini6a6ves is key to addressing

poten6al dangerous behavior

cl 1 anderson lamer

Health & Medicine

pain management step

safety of pain management

pain management specialty

primary care hubs13

chronic pain algorithm

chronic pain syndrome

pain management limited

primary care daren anderson