What can the rest of healthcare learn from Geisinger and Penn?
In 2016, leaders at Geisinger Health System noticed something disturbing: Drugs were killing their patients. That year alone, more than 4,600 people in Pennsylvania died from drug overdoses, 85 percent of whom had taken some kind of opioid. The numbers represented sharp increases from the prior year, underscoring the toll that the surging opioid crisis had begun to take.
But there was another intriguing statistic: A quarter of overdose deaths involved prescription opioids. That revelation indicated that healthcare organizations could do something about the problem. If providers were the ones doling out the drugs, couldn’t they prevent opioids from getting to users? The question was critical for Geisinger, which serves some of the hardest-hit counties in the state.
“We realized we had a problem, and we had to do something about it,” John Kravitz, Geisinger’s senior vice president and chief information officer, said.
So they did.
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Geisinger implemented a series of measures spanning the bleeding edge of health tech and good old-fashioned therapeutic alternatives, ultimately mounting a successful campaign. But it wasn’t alone. Its neighbor, Penn Medicine, had also turned to data to fight a public health disaster that had gripped Pennsylvania and much of the nation. Together, these respected institutions’ initiatives, described earlier this summer at the Health IT & Analytics Summit in Baltimore, Maryland, can serve as models for healthcare providers facing similar challenges.
Prior to undertaking this effort, Geisinger was writing roughly 60,000 prescriptions for opioids per month. Now, that number is down by nearly half, to 31,000. The health system has also cut the number of calls associated with prescription, its diversion control staff, the time providers spend on prescriptions and more than $1 million in costs.
Geisinger took a multipronged approach to the opioid crisis, but its first step was to analyze 10 years of health plan data, enabling leaders to understand trends among patients with opioid abuse disorder. The organization also leveraged its electronic health record (EHR) system and the state’s prescription drug monitoring program to track doctor shoppers. A provider dashboard, meanwhile, identified high-prescribing physicians, provided high-level views of the opioid crisis and kept a record of patient details. What’s more, prescribers began turning to exercise, cognitive behavioral therapies and even acupuncture and yoga to help treat patients with chronic pain.
Perhaps Geisinger’s most effective decision, however, was its move toward electronic prescribing. Across its 250 primary care sites, the health system centralized standards, largely ditching paper pads. As such, 74 percent of controlled medications are now prescribed electronically, with 126 clinics that are at 100 percent.
The migration also allowed for tighter controls. In the past, patients who received opioids for chronic pain might have been required to get a new prescription every six months or year. Geisinger since crunched that time down to every 30 days, Kravitz said.
Despite also calling the Keystone State home, Penn Medicine serves a different population than Geisinger — but it’s a group of patients still very much affected by the opioid crisis. Through six hospitals and several other facilities, Penn Medicine’s 35,000 employees serve Philadelphia and the surrounding area. In 2015, they saw opioid overdose numbers rise.
“For us in the city, this became a pretty big problem,” said Christine VanZandbergen, Penn Medicine’s associate vice president of IS applications.
When she and her colleagues dug into the data, they found that a “significant increase” in the number of prescribed opioids correlated with a rise in overdoses. Opioid abuse, it appeared, was related to the number of days accounted for in a prescription. Even so, the overwhelming majority of patients had unused pills after surgery, VanZandbergen noted.
So, Penn Medicine acted. It set up analytics dashboards, focused on provider and patient education and invested in data integration, in the form of decision support tools, EHR alignment and prescription drug monitoring program connections.
The health system’s opioid dashboard helped measure data regarding opioid use. For starters, leaders defined what chronic opioid use means and launched metrics, such as the total number of pills prescribed by the provider and the health system at large. The tool also provided insights into patients who abuse opioids — for example, by displaying whether someone failed a urine drug screen.
Further, the health system began encouraging alternatives to opioids, including intravenous acetaminophen and oral NSAIDs.
Penn Medicine mounted an ongoing educational campaign, online and in person, to arm providers and patients with resources. Even case managers and other staff members received modules to help them better manage the opioid crisis.
And then leaders again turned to tech.
“If we want to be successful in changing our prescribing behavior, it’s got to be integrated into our EHR,” VanZandbergen said.
Surprisingly, prescribers welcomed EHR-based solutions, which spanned prescription drug monitoring program, electronic prescribing and clinical decision support, alerting clinicians to what the guidance recommends.
The result: As of June, the total number of opioids prescribed has dropped by 15 percent.
From here, VanZandbergen added, Penn Medicine plans to double down on its analytics efforts, strengthen clinical leadership, engage operational teams and pursue greater funding. And when patients with opioid addiction come in, the health system — like many others — remains limited in what it can do for them. But in the future, it hopes to create a comprehensive program to help patients who are caught in perhaps the worst drug crisis in the country’s history. And, of course, any such program would be accompanied by means to measure its effects.
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