Gateway Health

Nationwide
Health and Human Services

The OPI Solution

“Designed to balance the need to maintain and improve access to all evidence-based analgesic therapies for medically ill patients who suffer from chronic pain.”

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How Relias Helped Gateway Health Reduce Opioid Over-Prescribing

The Problem: Overprescribing Opioids for First Line Pain Relief

In 2011, Gateway Health saw a need to reduce the use of opioids as first line pain relief and, in 2013, the need to perform an opioid over-utilization review (OOR) activity, per CMS guidelines.

The Solution: Use Their Data for Better Population Health Management

In January 2011, Gateway Health implemented an Opioid Prescription Intervention (OPI) Solution in partnership with Care Management Technologies (CMT), now part of the Performance Management Solution by Relias. In a controlled trial study, Gateway Health compared changes in triggering rates of four opioid Quality Indicators™ (QIs) from the Relias OPI Solution between two groups of prescribers over a six-month period. The intervention group received a mailed letter alerting providers when their prescription practices triggered a flag on one or more QIs. The control group received no intervention.

“Designed to balance the need to maintain and improve access to all evidence-based analgesic therapies for medically ill patients who suffer from chronic pain.”

Taking all four QIs together, triggering rates for the intervention group decreased more than 27 percent compared to the control group (p=0.00).

Two QIs identified greater decreases for the intervention group:

  • Use of Opioids for 60+ Days in the Absence of a Diagnosis Supporting Chronic Use in Adults (p=0.00)
  • Use of Opioids for 60+ Days in the Absence of a Diagnosis Supporting Chronic Use in Elderly Adults (p=0.03)

A third QI showed a strong trend:

  • Multiple Prescribers of Opioids Without a Malignant Cancer Diagnosis (p=0.07)

The fourth QI indicated a weaker trend:

  • Use of Opioids for 30+ Days with Diagnosis Suggesting Opioid, Alcohol, or Other Substance Abuse in the Past Year (p=0.15)

The Relias Population Health Management’s OPI solution was designed to balance the need to maintain and improve access to all evidence-based analgesic therapies for medically ill patients who suffer from chronic pain with the equally important and urgent need to enlist physicians and other prescribers in the effort to stem the alarming tide of narcotic analgesic misuse and adverse events.

“The average number of opioid prescriptions dropped by 16% per adult patient and by 18% per elderly patient from July 2013 to December 2014.”

As part of the effort to reduce the use of opioids as first line pain prescriptions, proprietary algorithms were applied in the review of pharmacy claims data for the purposes of evaluating the quality and appropriateness of prescription and administration of opioid medications to Gateway’s Medicare Advantage Prescription Drug (MAPD) members. When a pattern of practice inconsistent with an OPI Quality Indicator™ (QI) was identified, a mailed intervention letter was sent to the treatment provider to alert the provider to concerns such as polypharmacy and dosages outside of therapeutic ranges. The health care provider remained responsible for treatment decisions.

The Outcome: Reductions in Opioid Prescribing and Associated Costs

Relias Population Health Management’s Impact on Gateway’s Opioid Outcomes

  • While the effort for the initiative was a quality focus, the adult combined estimated 12-month savings (hospital/ER/opioid pharmacy) was $324 PUPM, reflecting a total savings of $8,019,179 associated with the quality intervention.
  • Over the same 12-month period, the elderly combined estimated savings (hospital/ER/ opioid pharmacy) was $285 PUPM, reflecting a total savings of $3,320,023.
  • The OPI analysis continues to show statistically significant cost savings impact in the areas of ER Visits (12 percent decrease), Medical Costs (6.8 percent decrease) and Pharmacy Costs (12.2 percent decrease).
  • A 42.8 percent decline in the average number of adult OPI QIs triggered per prescriber was found in 2014 compared to the July 2013 trigger rates.
  • The average number of opioid prescriptions dropped by 16 percent per adult patient and by 18 percent per elderly patient from July 2013 to December 2014.
  • In the intervened OPI population, the average number of pharmacies per patient decreased by almost 45 percent and the average number of prescribers per patient decreased by over 37 percent.
  • For the intervened population, the average number of days per month a patient had an active opioid prescription decreased by 14 percent, comparing the rate immediately prior to each patient’s first intervention date to the rate 120 days after the intervention.
  • For the intervened population, the average daily high dose morphine-equivalent dose decreased by 12 percent, comparing the rate immediately prior to each patient’s first intervention date to the rate 120 days after the intervention.