Despite national efforts to combat the opioid crisis, it remains a widespread health issue in America. In its most recent Health of America report – The Opioid Epidemic in America: An Update – the Blue Cross Blue Shield Association (BCBSA) found that while progress has been made – the total number of opioid medications filled by commercially insured Blue Cross  Blue Shield (BCBS) members across the country has declined by 29 percent since 2013 – there were still 241,900 BCBS members diagnosed with an opioid use disorder (OUD)  in 2017.

The report also highlights individual findings from each state, and Rhode Island has been particularly hit hard by the opioid crisis. In fact, Rhode Island is tied with Connecticut for the 8th highest opioid use disorder diagnosis rate nationally (nine per 1,000 members). However, the report does have some promising data demonstrating the positive impact of work already underway:

• Rhode Island has the second highest reduction rate (46 percent) in opioid prescriptions per 1,000 members from 2013-2017.
• Rhode Island is tied with Massachusetts for having the highest percentage of members (57 percent) with prescriptions lasting fewer than eight days’ duration.
  • This marker is especially important as doses longer than seven days are considered high dose and high duration by the CDC and may lead to a higher likelihood of patients being diagnosed with OUD in the future.
• In 2017, 67 percent of BCBS members filled their first opioid prescription within the CDC-recommended guidelines for both dose and duration. Rhode Island led the way at 80 percent.

Nevertheless, there’s still a lot of work to be done.  BCBS plans across the country are collaborating to find reliable support for members – and all Americans suffering from opioid use disorders – and are collaborating with clinical and program experts to assess the effectiveness of treatment options and improve access to quality treatment services.

Complementing local efforts, the BCBSA board of directors has committed to advancing the safety and effectiveness of treatment for opioid use disorders. As part of that commitment, BCBSA will launch Blue Distinction® Centers for Substance Use Disorder Treatment and Recovery to ensure members have access to the best evidenced-based approaches in addressing the long-term issues associated with opioid use disorders. The BCBSA also agreed to establish a national hotline to connect those in need with treatment centers. The hotline is slated to be available in 2020 to both BCBS members and non-members alike.

Here in Rhode Island, BCBSRI has supported the efforts of the Governor’s Opioid Overdose Task Force to develop and implement strategies aimed at prevention, treatment, rescue and recovery. BCBSRI has embedded pharmacists in our patient-centered medical homes to help manage opioid use and provide alternative, non-opioid solutions for patients with acute and chronic pain. We have reduced opioid prescriptions and are collaborating with medical professionals, employers and communities to address gaps in the continuum of care.

BCBSRI recently partnered with the Addiction Services Center at Roger Williams Medical Center to deliver medication-assisted treatment to Rhode Islanders struggling with opioid use disorders. We also bundled all services so that members only have to make one copay per month - an important step to encourage more people into care management and treatment programs. We have also partnered with Beacon Health Services, whose case management programs assist members in accessing and engaging in treatment and recovery. And, we’ve partnered with Anchor Recovery, whose peer support program has enrolled 300 members since January.

BCBSRI is also implementing policy changes. Effective 1 de enero de 2019, copayments for behavioral health office visits will be consistent with primary care office visits. As of 1 de agosto de 2018, BCBSRI also removed approval requirements (also known as utilization review) for in-network behavioral health services. Concurrent with this change, BCBSRI is shifting to a care management model that is focused on developing quality measures to ensure our members get the best care.  And, we are providing education support and advocacy for members navigating both an illness and the healthcare system. 

In 2018, the Governor’s Opioid Overdose Task Force focused on the theme of communities coming together and highlighted the role of connections. The epidemic calls upon all of us to work together to combat this critical health issue.  It’s up to us as Rhode Islanders to help tackle this crisis from the grassroots level in our own communities.

As the healthcare partner to one in three Americans, Blue Cross and Blue Shield companies stand committed to our communities and to fighting America’s opioid crisis through several national initiatives. Here in Rhode Island, BCBSRI is collaborating with state leaders, providers and community partners to help improve access to quality, affordable behavioral healthcare, especially care that addresses substance use disorders.

Matthew Collins, M.D., MBA, is the vice president of clinical integration at BCBSRI.