In our last post on the opioid crisis, we covered conducting a current state assessment to address opioid risk and misuse for your covered members. Here we’ll cover key strategies employers can take to help prevent opioid misuse, especially among members with chronic conditions or those who require pain medication for injuries or health conditions.
Opioid addiction risk often begins as (1) an often affiliated comorbidity to common physical (e.g., musculoskeletal) conditions or (2) as a byproduct of legally prescribed opioids to family members and friends — 70% of abused medicine is provided by or stolen from friends and family.1
As such, employers can help reduce the risk of opioid misuse by implementing strategies to minimize and even prevent the need to prescribe opioids for pain management in the first place.
Lifestyle, wellness and prevention programs targeted at conditions that commonly result in chronic pain will help reduce opioid use in the long term. Prevention programs to consider include:
- Weight management programs
- Ergonomic assessments and occupational safety strategies
- Lifestyle and wellness coaching
2. Education and alternative care options
Education and alternatives to pain medication can help reduce opioid use.
- Providing member education and access to alternatives through your health plan, which can steer members toward evidence-based alternative treatments for conditions that bring chronic pain. They can also suggest non-surgical treatment options that are less likely to promote opioid prescriptions, including physical therapy, occupational therapy and acupuncture.
- Promoting second-opinion programs within the care management program if the plan has one. If not, consider partnering with an expert medical opinion or second-opinion vendor such as Best Doctors, Consumer Medical and Grand Rounds to support members in their decision-making processes and direct members to less invasive treatment options where possible.
- Addressing chronic pain conditions with point solutions such as Hinge Health, a 12-week, coach-led remote program designed to target common musculoskeletal conditions. It can help prevent the need for opioids. Hinge Health has an embedded behavioral health component based on cognitive behavioral therapy (CBT) that helps members avoid opioids for pain.
- Delivering and promoting near-site or onsite preventive health services that can improve the quality and consistency of care, support chronic-condition care and help employees manage lifestyle, health and social determinant risks.
- Promoting employee assistance program consultations and referrals to local resources and treatment options.
3. Steerage and plan management
Steering members to quality care and ensuring effective plan design will help manage opioid misuse.
- Offering cost and quality transparency tools to employees to support them in seeking quality providers
- Incentivizing the use of centers of excellence (musculoskeletal, mental health/substance abuse) through plan design
- Reviewing medical plan prior authorization and utilization management approaches
- Modifying health plan design to increase the number of allowed annual visits for alternative treatments
4. Opioid prescription management
How opioids are prescribed can also have a significant impact on misuse and addiction. Ensuring opioid prescription utilization management and prior authorization methods help minimize addiction risk for conditions where it is medically appropriate to minimize opioid use such as musculoskeletal conditions and combined behavioral health issues. That said, some conditions are more appropriate for opioid use (like hospice care) and less strict opioid management is warranted.
Consider these utilization management, prior authorization and prescription management tactics:
- Initial fill should be for a seven-day supply or less, before a follow-up appointment with the treating physician
- Ensure dosage quantity limits apply to prescriptions
- Increase patient understanding of prescriptions and risks and provide additional education for the employee to take home, including proper prescription disposal instructions and disposal bags
- Use pharmacy benefit management (PBM) and/or medical plan outreach to treating providers to address any addiction risks for particular individuals
Build a culture of healthy return-to-work policies and communicate to employees the availability of preventive benefits, pain management and behavioral health support to reduce further injuries and chronic conditions that could yield opioid use. Consider ways to support employees returning to work following a surgery or disability that may require them coming back in a different capacity.
Think about how to modify employees’ workplace environment and/or daily job functions to support them in their recovery and reduce potential pain related to their condition. This will not only support employee recovery but also resonate with your larger employee population. Such practices help create a work culture that promotes attraction and retention and helps you become recognized as an employer offering positive return-to-work support and flexibility for employees.
A holistic strategy to prevent misuse
To create a holistic opioid management strategy it is important to employ methods to combat opioid use before it becomes misuse. Focus on prevention, workplace education and alternative pain management options that can help keep employees off of opioid medication in the first place and prioritize return-to-work programs to help get employees back to their regular activities and habits following an injury and keep them off of ongoing opioid medication.
1 ONDCP findings from the Substance Abuse and Mental Health Service Administration’s NSDUH averaged for 2009 and 2010 show that 55% of persons who used pain relievers non-medically obtained the pain relievers from a friend or relative for free, another 11% bought them from a friend or relative, and 5% got them from a friend or relative without asking. https://nsduhweb.rti.org/respweb/homepage.cfm