Data Analytics

How often are members being exposed to opioids?

Before exploring prescription patterns, employers should start with a basic look at the prevalence of opioid prescribing for pain control. To understand prescribing patterns across different types of opioids, request Morphine Milligram Equivalents (MME) per opioid, length of prescription, and whether the opioid is long-acting versus short-acting.

Why are members being prescribed opioids?

It is important to understand which conditions are correlated to opioid prescribing in order to fully understand prescribing patterns. This includes the top conditions that opioid prescriptions are written for and the rate per condition. This information can help employers understand why their workforce is receiving opioids and evaluate alternative options for non-opioid treatment for these conditions.

Are members receiving appropriate care to manage their pain?

Pain is a symptom rather than a diagnosable condition. The condition for which a member is experiencing pain determines the best clinical pathway for them to receive care. For this reason, examining claims data to evaluate the quality of pain treatment is challenging.

To begin, employers can consider the top conditions for which opioids are prescribed. An evaluation of the IBM® MarketScan® database revealed that from 2016-2017, the top three conditions from which opioids are prescribed in Kentucky were back pain, arthritis and diabetes. Employers can also request this metric for their own members. Employers can ask for an evaluation of the types and sequences of pain management care that members are receiving to learn useful insights into whether or not comprehensive evidence-based pain treatment is the standard.

Additionally, employers can review claims data to learn if members using opioids long-term are receiving regular follow ups and assessment to monitor their condition, functional outcomes, and opioid use. Employers can also learn the rate of members who are receiving referrals for non-pharmacological therapies. Pharmacologic therapies can be clinically appropriate for treating pain, but should be supported by the use of nonpharmacologic therapies if appropriate.

Are members who are exposed to opioids at risk?

Prescription opioid use is not inherently dangerous. The risk lies in how, how much of, and how long the opioids are taken. Although health plan data cannot identify how members are taking opioids, it can provide insight into the other two factors. Key indicators can give insight into the questions employers may have around prescribing patterns within their health plan and how those patterns may support or deter opioid-related risks. Pharmacy and medical claims data can also give insight to patterns related to overdose or the risk of it.

Are members overdosing on opioids?

Although capturing definitive information on opioid overdose within a population is difficult, certain measures can help indicate the prevalence of overdose or situations related to it.