Addressing opioid abuse? Payer-provider collaboration is key, says this Cigna CMO

The opioid epidemic is a complex issue that will require a multipronged approach to address, according to Doug Nemecek, MD, MBA, CMO of behavioral health for Bloomfield, Conn.–based Cigna.

Cigna is one of several payers collaborating with clinicians to limit opioid prescriptions, develop safer pain management strategies and improve treatment for substance use disorders. In November 2016, the payer invited providers to join its pledge of reducing plan members' opioid use by 25 percent in three years. Since then, Cigna has launched numerous initiatives aimed at curbing the opioid epidemic, according to Dr. Nemecek.

He recently spoke with Becker's Hospital Review about Cigna's initiatives and how physicians and payers can work together to address the opioid epidemic.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What steps can providers take to prevent opioid addiction? What alternative pain management strategies have proven effective?

Dr. Doug Nemecek: First and foremost, providers should become familiar with and follow the prescribing guidelines the CDC issued last year. Far too many people have become dependent on opioids because they were prescribed too many pills at too high a dose following an injury or surgery. Second, before writing an opioid prescription, providers should check their state's Prescription Drug Monitoring Program online database to see if their patient has been identified as a "frequent flyer" — someone who seeks opioids often and from many sources. Third, providers should carefully consider information from a patient's health plan that may suggest the individual might be at risk for addiction. Based on claims, health plans can see if a customer is filling multiple prescriptions at multiple pharmacies, or is taking a combination of medications that could be dangerous. Those are red flags that require action.

Regarding pain strategies, providers should recognize that non-narcotic pain medicines often provide sufficient relief for acute pain following an injury or surgery. For chronic pain, many people find relief through acupuncture, massage therapy, yoga, meditation and cognitive behavioral therapy. More research is needed to identify which strategies work best for different types of pain.

Q: How can physicians and payers collaborate to better prevent or treat opioid addiction?

DM: We need to start with the premise that providers and payers alike want to solve this enormous societal problem and do what's best for the patient. There should then be a two-way flow of information. Cigna shares information with our network providers about their prescribing patterns. We're able to show them how their prescribing pattern compares to that of their peers and to the CDC guidelines. Likewise, we want to hear from providers. What's working for them and their patients? Have they adopted a strategy or an intervention that's been successful? We want to know this information so we can add it to our opioid quality improvement playbook that's available on our website.

Q: What initiatives has Cigna implemented to help combat the opioid epidemic?

DM: In 2016, Cigna's president and CEO David Cordani made a commitment that Cigna would reduce opioid use among our customers by 25 percent by 2019. We've had great early success with a 12 percent reduction so far. So we're about halfway there, but there's still much to do. We have encouraged the medical groups that participate in Cigna Collaborative Care to sign our opioid pledge to follow the CDC prescribing guidelines and treat opioid use as a chronic disease. We are working with organizations like Shatterproof and the Association for Behavioral Health and Wellness on programs to overcome the stigma associated with substance use disorders. We're working with the American Society of Addiction Medicine to develop evidence-based outcome measures for treating substance use disorders. In 2017, we're focusing specifically on how this crisis affects veterans, and we will start a Veterans Support Line this fall.

Q: What is most important for healthcare leaders to understand about the opioid epidemic?

DM: I think there are two things. First, healthcare leaders should understand substance use disorder is a chronic disease that needs to be managed throughout a patient's lifetime. We know how to manage diabetes and other chronic conditions. We need to adopt a chronic disease approach to treating substance use disorders. Second, the opioid crisis is complex. There is no silver bullet. It's not possible for one individual or one organization to solve it alone. It will take the efforts of many people, working from many angles, to get the job done.

More articles on opioids:

1k more Ohioans died of drug overdoses in 2016 than 2015: 5 things to know
'Out in front' — how healthcare leaders can help solve the opioid crisis}
7-day opioid prescription limits take effect in Ohio

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