Payor Strategies to Reduce the Harm of Opiods

By: Karina Gonzalez

CMS recently published a white paper entitled “Healthcare Payer Strategies to Reduce the Harms of Opioids.” The white paper was prepared by the Healthcare Fraud Prevention Partnership (“HFPP”), which is a voluntary public-private partnership between the federal government, state agencies, law enforcement, private health insurers, employer organizations and fraud units to reduce fraud, waste and abuse.  The white paper gives information and provides insight on the way payors view addiction treatment.

HFPP identified five actions that should be considered for implementation by all payors as quickly as possible.

  • Train providers on Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain;
  • Promote access to and usage of Medication Assisted Treatment (MAT);
  • Promote the availability of Naloxone;
  • Encourage use of cross-payor data to identify fraudulent, wasteful or abusive practices associated with opioids in order to target corrective actions; and
  • Identify and disseminate effective practices across the healthcare sector.

The HFPP strongly encouraged MAT services as part of treatment programs and felt it was more effective in combination with behavioral therapy in treating opioid use disorders than behavioral therapy alone. The HFPP believes that payors should promote the use of MAT through reimbursement policy, provider recruitment and patient education.

Promotion of Naloxone was supported through a policy of reduction in unnecessary barriers and prioritized reimbursement.

The HFPP noted that payors are in a unique position to hold and share large quantities of data about Opioid use and treatment. They can identify and share strategies such as reimbursement and coverage policies and practices that connect patients to care best suited to their needs. They can disseminate information to a wide audience about the issues and practices that lead to fraud, waste and abuse in the healthcare system.

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