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Health insurers tackling the opioid epidemic

Companies hiring social workers, limiting prescription supply

Several health insurance companies in Massachusetts are taking steps to counter the growing opioid epidemic, including hiring social workers to help support patients who are in recovery, according to a NPR report.

Massachusetts-based CeltiCare Health Plan, which has about 50,000 members and primarily manages care for patients on Medicaid, has hired social workers it assigns to some patients. While insurers typically cover some inpatient substance use treatment and detox, patients are likely to relapse and need readmission without follow-up support, Jay Gonzalez, CeltiCare's president and CEO, told NPR.

Providing that support may save the insurer substantial amounts of money. Nearly a quarter of CeltiCare's hospital admissions are related to substance use and the company spent more than 10 percent of its budget last year on Suboxone, a medication to treat addiction, Gonzalez said. Some of its members make 50 to 100 emergency room visits a year.

CeltiCare is also training some members and their families on how to use Narcan, a drug that saves lives by reversing opioid overdoses. It is also limiting the initial prescription of opioid painkillers it permits for each patient.

Blue Cross Blue Shield of Massachusetts has also been limiting the supply of opioids, such as Vicoden and OxyContin, it allows patients in an initial prescription. It's an important step given that many people get into trouble with opioid use beginning with a legal prescription for painkillers. Blue Cross also contacts its members who are in detox programs in an effort to prevent relapses and coordinate their care, FierceHealthPayer previously reported.

Several members of the Association of Community Affiliated Plans, a group of 60 not-for-profit health plans in two-dozen states, are also taking steps to fight opioid abuse that include screening patients they insure for substance abuse, using social workers to help keep them in treatment, and using medications such as Suboxone to prevent relapse. One of those plans is Neighborhood Health Plan in Boston, which has developed algorithms to identify patients at risk for relapsing after treatment and hired social workers to provide support to them, according to the NPR report.

By addressing opioid abuse, insurers can not only save money in the long run, but also improve overall health in the general populationFierceHealthPayer previously reported. Yet because drug addiction isn't treated like a chronic disease, insurers often don't fully cover treatment options.

To learn more:
- read the NPR report

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Treating and preventing opioid abuse saves money in the long run
Humana study shows success of linking population health, substance abuse treatment
Insurers fall short when it comes to covering substance abuse treatment