Opioid Performance Improvement Project

Project Goals

To decrease the rate/number of Prepaid Medical Assistance Program (PMAP), MinnesotaCare (MNCare) and Special Needs Basic Care (SNBC) enrollees that are New Chronic Users (NCUs) of opioid pain relievers from the baseline year of 2017 to the final project year of 2020. DHS has identified 45 days of opioid use as a critical timeline for patients, as continued use beyond that time can result in long-term/chronic use or addiction. Developed by the Minnesota Department of Human Services, the NCU measure supports quality improvement efforts in preventing chronic opioid use.

Project Description

The surge in opioid use and misuse in the U.S. is well known and highly publicized. Since 2010, as the opioid problem has come to the attention of the medical community and the public, clinical guidance has been slowly disseminated from a variety of sources, including the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC). In addition, state legislatures have issued directives to address the issue. Much of the early guidance was focused on managing chronic opioid use. Minnesota published Opioid Prescribing Guidelines in March of 2018, which addressed acute, post-acute and chronic use.

The interventions leverage the various tools managed care organizations have to impact population. The specific interventions for this project include outreach to Minnesota Health Care members, as well as offering tools for providers to support improved prescribing practices.

Member interventions include:

identification of and outreach to members who are potential new users;
increased engagement with Medication Therapy Management (MTM) pharmacists;
consistent messaging across health plans through shared materials; and
safe disposal of unused and unwanted medications.

Provider interventions include:

a provider toolkit that includes opioid prescribing guidelines, screening for risk factors, shared decision-making tools and educational tools and resources;
a series of webinars for providers covering how to support members who are prescribed opioids (MN Opioid Prescribing Guidelines, Tools and Information for Care Coordinators, Opioids and Behavioral Health – Dual Diagnosis Webinar); and
UPPW-adopted uniform prescribing limits for new opioid users.

Entities Involved

Medica, Blue Plus, HealthPartners, Hennepin Health, South Country Health Alliance, UCare. The group has collaborated with Stratis Health, ICSI, the Minnesota Farm Bureau, PICA Head Start, Minnesota State High School League and the Hennepin County Sheriff’s office.

How Health Plans Support the Project

The nonprofit Minnesota health plans serving Minnesota Health Care Program members are leading this work. This collaboration enables us to bring resources and education to the provider community, which increases buy-in by diminishing duplicative messaging to providers.

Additional Information

Visit the Collaboratives website at http://www.stratishealth.org/pip/opioids.html for more detailed information.

HealthPartners Specific Information

Public awareness campaign about opioid use and what health plans are doing.
The “Treating Pain Without Pills” report provides a comprehensive overview of the work HealthPartners has done around the opioid epidemic.
Promotion of opioid education on health plan websites and social media channels.

Hennepin Health Specific Information

Starting in January 2019 Hennepin Health refers members who are non-compliant with the Restricted Recipient Program to Social Workers through a delegate agency with specialization in Substance Use Disorder. The agency can monitor individual member care and prescriptions through the EPIC ® Electronic Health Records and communicate directly with prescribers and primary care physicians in the community to support services needed to increase engagement in treatment services.

Hennepin Health has access to Rule 25 LADC Assessors through Hennepin County Public Health/ Healthcare for the Homeless who will seek out the hard to reach members experiencing homelessness when they express interest in treatment.

Hennepin Health supports via innovation funding a Pharmacy Resident Program in collaboration with Hennepin Healthcare Systems. Pharmacy Residents are an extension of the pharmacy team at Hennepin Healthcare and are part of the discharge planning team for Hennepin Health members in the inpatient setting. Prior to discharge, members who are identified as receiving new medications, high risk, medications (i.e. opioids, including opiate naïve members), a change in previous medications, or history of non-compliance meet with a Hennepin Healthcare Pharmacy Resident. The Pharmacy resident will complete a comprehensive medication assessment and provide education and resources to improve appropriate and identify risks and barriers.

Hennepin Health in collaboration with Hennepin County Public Health Opioid Coordinator identified a barrier to Suboxone treatment based on prior authorization requirements for providers outside the Hennepin Healthcare System. Hennepin Health subsequently removed this perceived barrier to engaging in medication assisted treatment solutions in July 2018. The result is increased access immediately upon the identified need.

Medica Specific Information

Beginning January 1, 2018, Medica implemented the “Reducing Chronic Opioid Use in the MSHO Population PIP.” These Medica-specific interventions included:

an enhanced safety and monitoring program;
high opioid provider clinical quality review;
medication disposal opportunities;
care coordination and the use of alternative therapies; and
the Pharmacy Educational Initiative.

Internal data reports allow Medica to gauge progress in reducing the number of new opioid users among MSHO members.