Opioid Task Force Discusses Pew Recommendations, Insurance

The Governor’s Task Force on Opioid Abuse met at the state Capitol on July 13 to discuss the final recommendations from Pew Charitable Trusts and to hear from insurers about how they are addressing the opioid epidemic.

Pew presented several recommendations in three subject areas: treatment system transformation, workforce, and underserved populations. The recommendations included:

Treatment system transformation:

  • Permanently allow for integrated opioid treatment programs.
  • Redefine the definition of “recovery housing” to include patients using medication assisted treatment (MAT). Currently, patients on medication may be excluded from recovery housing programs. Pew offered New Jersey and Ohio as examples of states that redefined “recovery housing” to prevent this type of discrimination.
  • Develop a single patient placement tool for Medicaid patients.

Workforce:

  • Fund buprenorphine prescription training in residency programs for physician assistants, nurse practitioners, physicians, and other providers. (Pew included this recommendation in its previous report.)
  • Expand the scope of Wisconsin’s Behavioral Health Review Committee by allowing the committee to analyze need for providers, scope of practice, continuing education, and regulatory barriers to providing treatment.

Underserved populations:

  • Create a pilot in state prisons and/or county jails that provides MAT to inmates. Pew provided Rhode Island as an example of this program.
  • Expand provider capacity for MAT for pregnant women.
  • Increase post-partum programs for mothers with opioid abuse disorders. Pew provided Gundersen Health Systems’ GunderKids program as an example of a successful Wisconsin program. GunderKids is a home-based system that encourages a positive relationship between at-risk children, their parents, and Child Protective Services and provides families with education and training to address stressors.

Follow-up recommendations from Pew include Medicaid payment system changes, a provider referral tool, and uniform waitlist reporting requirements. Pew will subsequently release a full report of their research and recommendations for Wisconsin.

After Pew’s presentation, the task force heard from insurers Anthem and UnitedHealth Group on their efforts to curb opioid abuse. Anthem’s programs include requiring prior authorization for long-term opioid prescriptions and notifying providers when patients exhibit red-flag behaviors (e.g. excessive claims, visits to multiple pharmacies/prescribers, concurrent claims for opioids and MAT). Other Anthem efforts include covering MAT and a variety of alternative treatments, recruiting primary care providers in rural areas, using telemedicine, and providing online consumer resources.

UnitedHealth Group presented extensive data showing the cost effectiveness of preventing opioid abuse and using alternative treatments to address pain management. United shared their strategy of focusing on alternative treatments, appropriate prescribing, and using data to target at-risk patients.

Next, two community health plans presented their efforts and recommendations for addressing the opioid epidemic. Group Health Cooperative discussed their coverage and limited prior authorization for substance abuse treatment, MAT, and alternative pain management treatments. Group Health also detailed their efforts in provider education, Prescription Drug Monitoring Program utilization, and limitations on short-term opioid prescriptions for acute pain.

Security Health Plan described their prevention efforts that include a program of automatically sending educational pieces to first-time opioid users. Like other presenters at the meeting, Security uses data to flag at-risk patients and connect them with care management teams, requires prior authorization for long-term opioid prescriptions, covers alternative pain management treatments, and has eliminated many prior authorization requirements. Security also highlighted their community engagement efforts such as safe drug disposals at clinics, an internal Controlled Medication Workgroup, and their sharing of best practices with other health organizations. Security also recommended the legislature review Medicaid provider reimbursement and create a state-run narcotic treatment program.

Throughout the meeting, committee members asked extensively about coverage and prior authorization for alternative treatments. Co-chair Rep. John Nygren (R-Marinette) also emphasized the committee’s commitment to a collaborative relationship with insurers and providers.

More on legislative efforts to address the opioid epidemic in Wisconsin.





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