If you haven’t had a chance to read that piece yet, we delved into how pain is a prevalent problem in the U.S., with the Institute of Medicine estimating that about 100 million Americans battle chronic pain conditions. Fueled by everything from misaligned payment systems and incentives, to aggressive pharmaceutical reps and patient satisfaction surveys that indirectly encouraged overprescribing, opioid painkillers have long been the first line of defense in addressing pain.
But given the nation’s ongoing opioid epidemic that killed nearly 30,000 Americans in 2014, however, hospitals are shifting the pain treatment paradigm in a new direction and expanding the toolbox of options for providers. Hospitals like Duke University Health System and St. Joseph’s Regional Medical Center are conducting systemwide opioid safety initiatives and cultural transformation efforts to treat pain in this new reality of death and addiction.
The insurance industry also recognizes that it played a part in creating the nation’s corresponding epidemics of pain and opioid addiction. And just as America’s hospitals are working to shift the pain paradigm away from prescription painkillers, so, too, are payers across the country. If the health care field is going to solve these crises, it must move past the blame game and find ways to collaborate across sectors, says Kate Berry, senior vice president of clinical affairs and strategic partnerships for America’s Health Insurance Plans, a payer trade group.
“This is a big challenge and we need to collaborate across the entire health care system to make a difference,” Berry says. “Everybody has something to contribute and the idea is not to point fingers but, rather, think about how we can collaborate to provide the full spectrum of prevention, effective pain management and then also treatment, and continuing to improve the evidence base, as well.”
After hearing concerns about opioids and pain management from its members, AHIP convened an engaged group of its members to come up with solutions earlier this year. They’re meeting monthly now, sharing best practices, thinking about broader strategies to address the crises and letting payers sound off about policy issues.
There’s a dire need for further research on effective methods of pain management, and Berry was excited to see that in July, the Patient-Centered Outcomes Research Institute, or PCORI, approved some $21 million in funding to fuel that investigation. Payers — alongside hospitals and patient stakeholder groups — are one of the key groups of participants in those efforts to address the evidence gaps.
This past summer, Berry shared some early findings from AHIP’s work group, including what several health plans are doing to treat pain better and curb opioid use. For one, Harvard Pilgrim Health Care, a nonprofit plan serving more than 1.3 million members in New England, advocates for such non-opioid pain treatments as the use of alternative drugs, physical and occupational therapy, massage, chiropractic care and acupuncture, among other interventions.
Also in the commonwealth, Blue Cross Blue Shield of Massachusetts, a health plan headquartered in Boston with 2.8 million members, has rolled out tools to help manage medications and avoid unneeded increases in dosage. A few years ago, they implemented an Opioid Safety Management Program that requires prior approval for some refills and, in just three years, it’s dropped opioid prescriptions by about 21 million.
Berry also shared five recommended steps the field can take to address the opioid epidemic: (1) establishing centers of excellence in pain management and substance-use disorder treatment, (2) bolstering education for providers and consumers on managing pain and the risks of opioids, (3) sharing information through prescription drug monitoring programs, (4) expanding capacity to treat opioid addiction, and (5) strengthening communication and coordination across the care team.
Health care must be careful not to swing the pendulum too far in the other direction, Berry says, to the point that pain goes undertreated.
“We don’t want people suffering in pain,” she says. “At the same time, we went too far. Those statistics are out there to say how dramatically the volume of opioid prescriptions has escalated in the past couple of decades, and the impact on people's lives. All that is well-documented, but I think the key is to strike the right balance between ensuring access to the most evidence-based care that manages people's pain and minimizes the risk of this huge crisis.”
For more on this topic, make sure to check out H&HN’s previous coverage of the epidemic — including a story we wrote in March about how health plans are curbing opioid addiction — along with the American Hospital Association’s resource page.