Opioid Use Disorder and the Medicare/Medicaid Population

Opioid Use Disorder and the Medicare/Medicaid Population

The United States has long been engulfed in an opioid epidemic that stemmed from increased prescribing of opioids in the 1990s and is characterized today by use of synthetic opioids, like fentanyl, as well as illicit opioids such as heroin.[1] By 2017, there were 58 opioid prescriptions written for every 100 Americans.[2] This rise in opioid use has led to an increased prevalence of Opioid Use Disorder (OUD) in a variety of populations.

OUD—which may involve the misuse of prescribed opioid medications, diverted opioid medications, or illicitly obtained heroin—is typically a chronic, relapsing illness associated with significant rates of morbidity and mortality.[3] The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, describes OUD as a “pattern of opioid use leading to problems or distress,” with at least two of the following occurring within a 12-month period:[4]

  1. Taking larger amounts or taking drugs over a longer period than intended.
  2. Persistent desire or unsuccessful effort to cut down or control opioid use.
  3. Spending a great deal of time obtaining or using the opioid or recovering from its effects.
  4. Craving, or a strong desire or urge to use opioids.
  5. Problems fulfilling obligations at work, school, or home.
  6. Continued opioid use despite having recurring social or interpersonal problems.
  7. Giving up or reducing activities because of opioid use.
  8. Using opioids in physically hazardous situations.
  9. Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids.
  10. Increased tolerance (i.e., need for increased amounts, or diminished effect with continued use of the same amount).
  11. Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Although OUD is similar to other substance use disorders, there are many unique features, including risk of physical dependence in as little as 4 to 8 weeks and severe symptoms such as chills, cramps, vomiting, and insomnia during withdrawal.[3] Despite its unique features, the factors contributing to OUD are very general and can include ease of access, environmental and genetic factors, social support system, addictivity of the drug, and early use.

Looking at the rate of opioid prescribing among Medicare and Medicaid beneficiaries can help us gain an understanding of the development of OUD in America. In 2018, the Centers for Medicare & Medicaid Services (CMS) analyzed the prevalence of OUD among beneficiaries and reported that 6 out of every 1,000 Medicare beneficiaries and 8.7 of every 1,000 Medicaid beneficiaries suffer from OUD.[5] Using data from 2006 to 2015, another CMS study found that 23.5 percent of dual-eligible beneficiaries in 2015 had a substance use disorder.[6] For the Medicaid-only population, there were 31 million opioid claims in 2017, and opioid prescriptions represented 4.57 percent of all Medicaid prescription claims.[7] One year earlier, in 2016, 14.4 million of the 43.6 million Medicare-only beneficiaries enrolled in Part D received opioids.[8]

The national data for OUD and opioid prescriptions is presented here to provide the foundation for a larger discussion around OUD in the United States. Over the course of this series of newsletters, we will dive into topics such as OUD treatment options, how COVID-19 is impacting treatment centers across the country, and much more. To read more of our OUD coverage, please click here.

 

[1] Centers for Disease Control and Prevention (CDC). (2020). Opioid overdose: Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.

[2] CDC. (2020). Opioid overdose: Prescribing practices. Retrieved from https://www.cdc.gov/drugoverdose/data/prescribing/ prescribing-practices.html.

[3] Strain, E. (2020). Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis.

[4] American Psychiatric Association. (2018). Opioid use disorder. Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder.

[5] CMS. (2018, June 11). CMS opioids roadmap. CMS.gov Blog. Retrieved from https://www.cms.gov/blog/cms-opioids-roadmap.

[6] Anderson, K. K., Hendrick, F., & McClair, V. (2018, October). Data analysis brief: National trends in high-dose chronic opioid utilization among dually eligible and Medicare-only beneficiaries (2006-2015). Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Downloads/OpioidsDataBrief_2006-2015_10242018.pdf.

[7] CMS. (2019). Medicaid State Opioid Prescribing Mapping Tool. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap_Medicaid_State.

[8] Office of Inspector General. (2017, July). Opioids in Medicare Part D: Concerns about extreme use and questionable prescribing [OEI-02-17-00250]. U.S. Department of Health & Human Services. Retrieved from https://oig.hhs.gov/oei/reports/oei-02-17-00250.pdf.

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Healthy Eating and Kids: A Q&A With a Pediatrics Registered Dietitian

Healthy Eating and Kids: A Q&A With a Pediatrics Registered Dietitian

Healthy Eating and Kids: A Q&A With a Pediatrics Registered Dietitian

Bethesda, MD, April 2020

To celebrate today’s Tasty Tuesday for Every Kid Healthy Week, we interviewed a pediatric Registered Dietitian. Carol Henderson, a member of Econometrica’s Health Group, is a pediatrics Registered Dietitian who has worked with children and teens and their families for dozens of years. In particular, she worked with infants and children with feeding and growth issues and children diagnosed with chronic conditions and diseases, such as cystic fibrosis, diabetes, juvenile arthritis, gastrointestinal disorders, and severe food allergies.

Interviewer: I wonder if you could tell us a little bit about what it is like working as a pediatric dietitian and what you want to accomplish when working with children and their families?

Carol: The primary goal when working as a dietitian with pediatric patients who are sick is to ensure adequate, proportional growth throughout childhood. Some children need to grow bigger and become stronger and some need to minimize their growth over time. Pediatric dietitians also evaluate a child’s activity level, daily schedule, parent/caregiver roles, timing of meals and mealtime environment, food availability, meal preparation, and sleep patterns to gauge an individual’s nutritional needs. These actions align with each of the daily themes we are celebrating during Every Kid Healthy Week:

  • Mindfulness Monday. Preparing healthy meals for a family is an investment that not only requires time, commitment, but also a state of mindfulness—a sense of calm that is needed to prepare meals, even during chaotic family times. Taking time out once a week to inventory foods on hand and create a shopping list may make it easier to put meals on the table.
  • Tasty Tuesday. Today, which is Nutrition and Healthy Eating day, is a good time to assess the nutritional quality of the snacks your child/children are eating and how often they snack throughout the day. It is important to develop healthy feeding habits (have set times for meal and snack intervals—especially for young children) so they can achieve their nutritional intake goals every day.
  • Earth Day Wellness Wednesday. Have you every quizzed your child to see where they think different food ingredients come from? This activity can turn into a project. You can select an ingredient in a dish you are preparing and ask if it comes from an animal, plant, or is it a mineral and go from there!
  • Thoughtful Thursday. Kids react to their environment and learn from others. Therefore, creating a pleasant environment where your child can sit and eat meals at regular intervals and interact with other family members contributes to their social and physical well-being.
  • Fitness Friday. Kids wiggle, squirm, run, and love to play—all things that contribute to their development. It is your job as parents/caregivers to find outlets for children to keep them active.

Interviewer: How did you pick dietetics as a profession?

Carol: Dietetics found me! I was going to become a high school chemistry teacher. In college, I conducted my junior year teaching practicum in a local high school. A small group of students in one chemistry class thought it would be hilarious to capitalize on my untested teaching skills, so they combined all the reagents (acids and bases) that lined the lab benches and blew up the chem lab. Everyone evacuated safely and I stood in the middle of the chem lab while the sprinklers were raining down on me and said, “I don’t ever want to be a chemistry teacher!” Because chemistry is such an integral part of food science and dietetics, I found a new calling.

Interviewer: There are so many different paths you could have undertaken with a dietetics degree, why pediatrics?

Carol: My oldest sister had just completed medical school and she received her residency “match” at Cincinnati Children’s Hospital. At the same time, I completed my Dietetic Internship at the Mayo Clinic in Minnesota, so we moved in together. A dietitian position opened at Cincinnati Children’s and I became one of two dietitians for a 750-bed hospital. That would not happen today. Nowadays, a children’s hospital of the same size would have more than 35 dietetic staff members. It has been a great blessing to have worked with children, teens, and their families as a pediatric dietitian and patient advocate for many decades.

Interviewer: Carol, do you have any parting thoughts you would like to share today?

Carol: The greatest gift I have received from working as a pediatric dietitian is the importance of play. Play consumes all children. I think as adults we should consume more play in our lives!

 

Interview edited for length and clarity. Thanks to Emma Wellington for conducting this interview.

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Econometrica Launches New Course

Econometrica Launches New Course

Econometrica Launches New Course

Bethesda, MD, April 2020

Econometrica launched a new course about handwashing during the COVID-19 pandemic. Washing your hands regularly and thoroughly is the best thing, aside from social distancing, that you can do to protect yourself and your community from the spread of COVID-19. Adapted from guidance from the Centers for Disease Control and Prevention, the new course will focus on when and how you should wash your hands to stay healthy – a simple task, yet often misunderstood and performed poorly.

The new course is available at https://econometricainc.com/training/.

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Looking Ahead in Quality Improvement

Looking Ahead in Quality Improvement

Looking Ahead in Quality Improvement

Bethesda, MD, April 2020

In February, the Centers for Medicare & Medicaid Services (CMS) sponsored the CMS Quality Conference, an annual meeting of leaders and stakeholders dedicated to improving the quality, safety, and value of modern healthcare. Econometrica employees participated in this 3-day conference, which gathers the brightest in the field (including Government employees, providers, researchers, policymakers, professional society members, and others) to discuss several existing and future quality improvement initiatives. As the Affordable Care Act, the legislation that created many of these quality programs, celebrated its 10-year anniversary this March, the conference emphasized current and upcoming quality improvement programs. Econometrica has engaged with many of these models in the past; in this article, we highlight and look ahead to several key innovations discussed at the conference.

 

The Quality Payment Program (QPP) was the focus of many conference sessions. Created under the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015, the QPP aims to improve care and reduce costs while also easing provider burden. Clinicians may choose to participate via two tracks: the Merit-Based Incentive Payment System (MIPS), or Advanced Alternative Payment Models (APM). Through MIPS, clinicians are reimbursed based on quality of care as measured by performance in four domains: quality, cost, improvement activities, and promoting interoperability. Scores on measures in these domains are aggregated into a final score that determines a payment adjustment. Clinicians may also receive incentive payments for participating in an Advanced APM. APMs are payment frameworks that offer incentive payments for the provision of high-quality, cost-efficient care. Under the QPP’s Advanced APM option, a 5-percent incentive is available for clinicians who meet threshold levels of payments or patients through an Advanced APM.


Conference sessions highlighted CMS’ plans for implementation of the new MIPS Value Pathways (MVP) framework for participation in QPP beginning in the 2021 performance period. The goal of MVPs is to simplify and lower reporting burden. MVPs allow clinicians to report on measures and activities that are specialty- or practice-specific with a base of interoperability measures and population health measures derived from administrative claims data.

 

Other innovative models highlighted at the conference include the Integrated Care for Kids model and the Maternal Opioid Misuse model. The Integrated Care for Kids model aims to address challenges in children’s health through early identification and treatment of health issues and improved quality of care for children. It promotes care coordination across providers and creates State-specific APMs to enhance payment for quality of care and outcomes. Model participants include Lead Organizations, which are made up of community partners; State Medicaid Agencies; and Partnership Councils. The Maternal Opioid Misuse model is one of CMS’ models designed to respond to the opioid crisis by targeting the lack of coordination of care for pregnant and postpartum patients with Opioid Use Disorder. It further looks to increase access to necessary services and the availability of care providers for pregnant and postpartum women with Opioid Use Disorder.

 

Econometrica is excited to be part of such a vibrant conversation about the future of quality improvement! We look forward to continuing to work with CMS and other leaders in the field to drive healthcare innovations that promote the provision of high-quality care at efficient cost.

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Reflecting on 10 Years of Healthcare Innovation

Reflecting on 10 Years of Healthcare Innovation

Reflecting on 10 Years of Healthcare Innovation

The Econometrica Team celebrates the 10-year anniversary of the Affordable Care Act and the many innovations it created.

Bethesda, MD, March 2020

On March 23, the Patient Protection and Affordable Care Act (ACA) celebrates its 10-year anniversary. A landmark body of legislation, the ACA has left a lasting impact on healthcare in the United States. One of the key tenets of the legislation highlights its dedication to original and novel solutions to healthcare challenges: the creation of the Center for Medicare and Medicaid Innovation (CMMI), also known as the Innovation Center within the Centers for Medicare & Medicaid Services (CMS). In the past decade, the Econometrica Team has engaged with several CMMI programs designed to improve quality of care while reducing costs. We mark this milestone by reflecting on the past 10 years of work in this space and looking forward to future innovations.

Since its inception through CMMI, Econometrica has been influential in the success of the Hospital Innovation and Improvement Network initiative, formerly known as the Partnership for Patients initiative. This initiative seeks to improve healthcare safety and quality by reducing harm in hospitals and reducing readmissions through public–private partnerships. In the first iteration of the initiative, Econometrica served as the National Content Developer. In this role, Econometrica supported Hospital Engagement Networks in identifying, sharing, and celebrating innovations in care redesign that improved patient outcomes and reduced readmissions in key areas (e.g., adverse drug events, early elective deliveries). Econometrica served as the evaluator for the initiative and investigated the savings and improved patient outcomes for the first and second iteration of the model. We have supported the third iteration of the model through our work monitoring Patient and Family Engagement activities and providing evidence-based resources on how to expand the innovation.

Econometrica supported CMS on the Medicaid Incentives for Prevention of Chronic Diseases program by monitoring the program’s effectiveness and providing technical support to participants. The demonstration program tested the effectiveness of offering incentives to Medicaid beneficiaries who took part in prevention programs to address one of the following health behaviors or outcomes: curbing tobacco use, controlling or losing weight, lowering cholesterol or blood pressure, and avoiding the onset of diabetes or improving diabetes management. Econometrica supported the 10 States that received grants in implementing the program, created and put into action a learning system, collected performance data, and organized meetings for grantees.

Another of Econometrica’s early CMMI initiative-related evaluation projects was the Evaluation and Monitoring of the Bundled Payments for Care Improvement Model 1 Initiative, which connected payments for services provided to beneficiaries during an episode of care. Econometrica evaluated changes in service utilization patterns, patient case mix, incidence of harm, quality of care, changes in key health outcomes of patients, and Medicare expenditures, and collected primary qualitative data by interviewing participants. We designed and administered a Patient Health and Experience Survey to certain beneficiaries to understand their care experience. We are currently building on this work under our Learning System for Bundled Payments for Care Improvement Advanced Model contract, in which we are researching and recommending which quality measures to use to evaluate participant performance in the model, responding to help desk tickets, and assisting with a data feedback dashboard that monitors model performance.

Our other current work on CMMI initiatives includes engagements with the Million Hearts® and Comprehensive Primary Care Plus (CPC+) models. Million Hearts® aims to reduce the risk of cardiovascular disease and improve outcomes for people at risk of heart attacks and stroke. Econometrica assists with the program implementation by validating beneficiary eligibility for the program, tracking provider use, and creating payment files for claims processing for each beneficiary.

Our work on CPC+ falls into two projects that support the model, which seeks to improve primary care through regional transformations of care delivery and multi-payer reform. Econometrica produces a series of data extracts consisting of claims and administrative data, which are sent to more than 300 individual practices participating in CPC+. We also aggregate data extracts that are provided to four regional aggregators participating in CPC+.

We look forward to continuing to support CMS’ dedication to innovative models that promote the delivery of high-quality healthcare at reduced cost. Happy birthday, CMMI!

Read more about CMMI here.

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Econometrica Maintains Continued Operations During Coronavirus Pandemic

Econometrica Maintains Continued Operations During Coronavirus Pandemic

Econometrica Maintains Continued Operations During Coronavirus Pandemic

Bethesda, MD, March 2020

BETHESDA, MD – On March 13, President Trump declared a national emergency in response to the outbreak of coronavirus (COVID-19) nationwide. Econometrica, Inc., continues to monitor developments related to the coronavirus pandemic to ensure the safety of our staff, their families, and communities. We also are taking steps toward meeting our commitments to clients and partners and continue to provide the high-quality and timely services expected from Econometrica

The following summarizes steps we have taken to date:

  • Econometrica has mandated that all employees work full time from home for the foreseeable future. We are complying with guidelines from the Centers for Disease Control and Prevention (CDC) to halt gatherings of more than 50 people and to encourage social distancing.
  • Employees working remotely have full access, using secure configurations, to Econometrica’s network resources, applications, and support, including communication tools to support telework. No project work will be interrupted by this move to a remote setup.
  • Project teams in our Health, Housing and Community Development, General Services, Capital Markets, and Data Analytics groups are moving toward scheduling all meetings virtually and limiting travel. All business travel is temporarily suspended during this time.
  • Staff members who work onsite at our clients’ offices continue to report to their respective agencies unless directed otherwise. We have been in contact with each client to develop contingency plans to address remote work should access to the client site is limited or an employee shows symptoms of COVID-19.
  • We have regularly communicated prevention strategies and tips from CDC and the American Red Cross for keeping homes and workplaces safe. Everyone has been advised to call their doctors and follow CDC recommendations for self-quarantine should they show any symptoms related to COVID-19.

Coronavirus infections increase at an exponential rate, with symptoms including fever, cough, and shortness of breath. Social distancing seems to be effective in reducing the spread, and Econometrica wants its employees to feel safe and remain healthy. As this outbreak unfolds, Econometrica will continue to provide its high-quality services with no reduction in availability or commitment.

Please contact us at (301) 657-9883 or Administration@EconometricaInc.com if you have any questions or concerns.

Read more about Econometrica’s News.

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