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How a Pennsylvania Insurer Aims to Use Big Data Against Opioids


Highmark Inc. wants to leverage claims data to identify and intervene with patients at risk of opioid dependence.

Image has been resized. (U.S. Air Force photo illustration/Tech. Sgt. Mark R. W. Orders-Woempner)

A major health insurer in Pennsylvania, Delaware, and West Virginia says it will ramp up efforts to use big data to crack down on the opioid crisis.

Highmark Inc., the fourth-largest Blue Cross Blue Shield affiliate, this month announced an expansion of its broad initiative to identify and intervene with patients at risk of opioid addiction. Highmark and its affiliates have more than 5 million members.

Under the new initiative, Highmark will leverage patient claims data in partnership with axialHealthcare, a Nashville, Tennessee-based health analytics firm that focuses on pain and opioid management. Software tools from axialHealthcare will be used to identify patients who meet a set of risk factors, allowing physicians the opportunity to alter treatment plans or refer the patient to services to help curb opioid addiction. The program was initially launched in West Virginia, but will now expand to Pennsylvania.

In an email, Charles DeShazer, MD, told Healthcare Analytics News™ that the new initiative builds on data-driven strategies already in use by Highmark.

“For example, we may proactively reach out to those identified with specific chronic conditions, such as diabetes,” he said. “Our system may ‘flag’ a diabetic who needs to receive certain services to keep them healthy and well, and one of our nurses can reach out to them to make sure they are getting the care they need.”

Highmark has already been using axialHealthcare’s tools to identify physicians whose pain medication prescribing habits don’t appear to align with best practices. Now, those insights will extend to the individual patient level.

“What’s new now is that providers are receiving patient alerts during benefit and eligibility checks,” DeShazer said. “This is meant to identify those specific patients who may be at high risk and enable the physician to intervene at the point of care if necessary.”

The system, which is based on data from more than 100 million patients, is designed to catch things like drug interactions, such as when a patient has gotten prescriptions for both opioids and certain sedatives. Patients will also be flagged if the database finds they are receiving opioid prescriptions from multiple physicians.

The pilot version of the program, deployed in West Virginia in the fall of 2016, resulted in a 28% reduction in the number of patients receiving opioids from multiple providers.

Physicians who are flagged by the system can receive targeted consultations from axialHealthcare. When a physician’s patient is identified as at-risk, the physician can access comprehensive information on the patient and their associated risks, as well as a suite of tools designed to aid that patient. AxialHealthcare also makes staff pharmacists available to physicians to help guide pain management decisions.

“If a patient is identified as at-risk for opioid use disorder, a provider can use proprietary care pathways to definitively diagnose opioid use disorder or taper opioids,” DeShazer said. “The provider can also refer patients to the best available care by accessing axialHealthcare’s directory of quality advanced pain specialists or medication-assisted treatment centers.”

In addition to the use of data to target at-risk patients, Highmark said it will institute new limits for patients who are newly prescribed opioids after March 1. Patients in the company’s commercial plans will be allowed to only get a 7-day supply, a cap that experts have found effective in lowering the chance of addiction.


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