Actuarial Outpost

Actuarial Outpost (http://www.actuarialoutpost.com/actuarial_discussion_forum/index.php)
-   Health - Disability (http://www.actuarialoutpost.com/actuarial_discussion_forum/forumdisplay.php?f=13)
-   -   Can actuaries help solve the opioid crisis? (http://www.actuarialoutpost.com/actuarial_discussion_forum/showthread.php?t=323884)

Stephen Camilli 07-06-2017 11:56 PM

Can actuaries help solve the opioid crisis?
 
I was quite intrigued by this article in the March SOA health section newsletter on the opioid crisis, a public health issue that has weighed heavily on my mind and heart:

http://healthwatch.soa.org/?issueID=3&pageID=23

Based on this article, it seems that we, as a profession could do more to contribute to the solution of this crisis, working together with appropriate groups and individuals, perhaps through building models to identify high-risk individuals, high-risk prescribers, identify effective alternative treatments, etc.

I am far outside my personal area of expertise, but would love to see more actuaries get involved in thinking about solutions to the current crisis.

Dr T Non-Fan 07-07-2017 12:45 PM

Fixed!

http://www.chicagotribune.com/lifest...707-story.html

I think (with no reason) actuaries were behind this. So, you're welcome!

Dr T Non-Fan 07-07-2017 12:49 PM

Interesting section of that article:

Quote:

The study also found a continued increase in long-term prescribing of opioids. The average length of prescriptions rose steadily from about 13 in 2006 to about 18 in 2015, the data show.
"13" what? It is some length, but they don't say if it's days, weeks, months.

Perhaps there is some way to wean people off dosages. Instead of a bottle of same-strength pills, maybe they should be packaged sequentially, like birth control?

JMO 07-08-2017 10:05 AM

Quote:

Originally Posted by Dr T Non-Fan (Post 9021625)
Interesting section of that article:


"13" what? It is some length, but they don't say if it's days, weeks, months.

Perhaps there is some way to wean people off dosages. Instead of a bottle of same-strength pills, maybe they should be packaged sequentially, like birth control?

http://www.npr.org/sections/health-s...-high-cdc-says

Zap 'em for 13 days, it says here. Or 18 days.
Other statistics at the link.

FormLetter 07-10-2017 12:01 AM

Quote:

Originally Posted by Dr T Non-Fan (Post 9021625)
Interesting section of that article:


"13" what? It is some length, but they don't say if it's days, weeks, months.

Perhaps there is some way to wean people off dosages. Instead of a bottle of same-strength pills, maybe they should be packaged sequentially, like birth control?

WRT bolded, underlined part: That is actually what a pain doctor will do if a patient violates their patient-doctor prescribing contract and gets cut from their prescription.

Say they are prescribed 20mg. They will get a taper pack with a few days of 15mg, a few of 10mg, a few of 7.5mg, some 5 mg, and then empty cells after that.

JMO 07-10-2017 09:08 AM

Quote:

Originally Posted by FormLetter (Post 9022904)
WRT bolded, underlined part: That is actually what a pain doctor will do if a patient violates their patient-doctor prescribing contract and gets cut from their prescription.

Say they are prescribed 20mg. They will get a taper pack with a few days of 15mg, a few of 10mg, a few of 7.5mg, some 5 mg, and then empty cells after that.

Seems like too little to late. It the patient has already acted badly, why wouldn't they just rip open all the cells to get the dose they want??

Marcie 07-10-2017 09:15 AM

Quote:

Originally Posted by Dr T Non-Fan (Post 9021625)
Interesting section of that article:


"13" what? It is some length, but they don't say if it's days, weeks, months.

My opioid prescription was in danger of being crushed by a dwarf!

lookingon1 07-10-2017 11:51 AM

Quote:

Originally Posted by Stephen Camilli (Post 9021177)
I was quite intrigued by this article in the March SOA health section newsletter on the opioid crisis, a public health issue that has weighed heavily on my mind and heart:

http://healthwatch.soa.org/?issueID=3&pageID=23

Based on this article, it seems that we, as a profession could do more to contribute to the solution of this crisis, working together with appropriate groups and individuals, perhaps through building models to identify high-risk individuals, high-risk prescribers, identify effective alternative treatments, etc.

I am far outside my personal area of expertise, but would love to see more actuaries get involved in thinking about solutions to the current crisis.


Great to bring this up. It's amazing to me that they would write this article and not think of ways to solve the issue with their plethora of skills. Actuaries are the MOST trained public health professionals and are in best position to make a difference but they are satisfied sitting on the sideline and reporting the problems. I congratulate you personally for this excellent observation and post-probably the best one I've ever come across...

Woodrow 07-10-2017 12:44 PM

Quote:

Originally Posted by lookingon1 (Post 9023097)
Great to bring this up. It's amazing to me that they would write this article and not think of ways to solve the issue with their plethora of skills. Actuaries are the MOST trained public health professionals and are in best position to make a difference

I'm not sure what you mean by this.

I have quite a few friends who work in public health, some have public health PhDs or biostatistics PhDs, others just have lots of experience in their field, working at the CDC or university schools of public health.

I think actuaries could bring something different to the table, but I don't see how we are the most trained.

lookingon1 07-10-2017 01:17 PM

Seems you have a lot of friends...

You have as much training as your friends, and they are all contributing to solving this problem. What are actuaries doing, reporting their works?

lookingon1 07-10-2017 06:12 PM

So what exactly is your specialty-you can't solve the public health problems (the biostats and your other friends' jobs). There are many people working on policy for new health care proposals, you can't do that because the med economists' jobs. You can't do data science because it's their job. What job do you do?

From reading few things, I sometimes get the feeling you guys want to do all the above with some slight edge (like we are risk experts etc and we can do better). Is that what you really are? Because this problem should have been tackled by actuaries without a call from the OP.

And you claim maybe you set premiums-all you did was discover that the premiums are too high in obamacare and caused your companies to run out of the business. What did you do to propose solutions? Pay millions to milliman like the blind leading the blind.

redearedslider 07-10-2017 06:43 PM

:popcorn:

Dr T Non-Fan 07-10-2017 06:48 PM

I've been a part of most of those ideas in the OP.

But, we can't tell hospitals and physicians to stop charging so damn much.
We can't tell hospitals and physicians to stop treating nearly dead patients.
We can't tell hospitals and physicians to stop using/prescribing the most expensive drugs and to stop buying the latest fancy equipment.

'cause, those are the problems.

redearedslider 07-10-2017 08:16 PM

If health insurers would stop cutting reimbursement rates then doctors wouldn't have to run so many procedures to keep food on the table for their families.

lookingon1 07-10-2017 09:34 PM

Quote:

Originally Posted by Dr T Non-Fan (Post 9023748)
I've been a part of most of those ideas in the OP.

But, we can't tell hospitals and physicians to stop charging so damn much.
We can't tell hospitals and physicians to stop treating nearly dead patients.
We can't tell hospitals and physicians to stop using/prescribing the most expensive drugs and to stop buying the latest fancy equipment.

'cause, those are the problems.

NO you can't but you come up with convincing analysis that demonstrates the issue that will force the change.

Eventually, they WILL have to stop these things and they will. The problem will be solved, whether by actuaries or whomever.

Dr T Non-Fan 07-10-2017 10:22 PM

Analysis has already been done. You think those are conjectures?

redearedslider 07-10-2017 11:07 PM

Public analysis?

lookingon1 07-11-2017 01:33 AM

Quote:

Originally Posted by Dr T Non-Fan (Post 9023847)
Analysis has already been done. You think those are conjectures?

Done?? Nothing is done, the problems are persisting. There is lots more room for analysis. Actuaries have so many opportunities to step in and solve these problems, before the others do.

The last real work by a health actuary, as far as I can see, was Bluhm's stuff---which was in the 1980's NOTHING has come since (which is still important analysis). The disease management was all blown air and didn't amount to anything. And the rest was conjectures about the ACA and our health system. But no real solutions.

I am saying we need someone to tackle the problems we have and devout actuarial talent on that. This OP's call is so important which is why I was shocked and amazed to see this today.

lookingon1 07-11-2017 01:39 AM

Quote:

Originally Posted by redearedslider (Post 9023881)
Public analysis?

what do you mean public analysis...

redearedslider 07-11-2017 04:14 AM

Publicly available analyses that support the conclusions DTNF posted. DTNF said the analysis has been done so I want to know where it is so I can read it.

lookingon1 07-11-2017 08:41 AM

There are of course none. He is just trying to sound semi intelligent (have you seen any of his work by any chance...)

You can find Bluhm's paper on the SOA syllabus through the 90's and 2000's up until he wrote a book around it (it was related to indiv insurance)-now in 2nd edition, and they got this new young guy-what has he done? survived phd in Madison but not clear what anyone from that group has really done.

Trust me if there is anything new it would appear on the syllabus. There have been rehashes on DM that amounted to very little (to be polite). Now lots of treatises on ACA. That's it in nutshell!

Hey, good news is it can change and the new generation have their new chance. I hear the millennials are so smart.

Stephen Camilli 07-11-2017 11:11 AM

I think that this thread is going off in a different direction than what I had intended. It certainly helps no one to talk about what actuaries did or did not do in the past, unless it is constructively seeking what to potentially do better in the future. I think there is a place for actuaries both individually and as a profession to be more proactive in trying to implement change. The opioid crisis is one such possibility. I certainly do not think that actuaries are the only professionals that can contribute to this; however, I think that actuaries could contribute a unique perspective, working together with other public health professionals.

We often talk of what "the profession" does, but ultimately, it depends mostly on what individual actuaries do. So, one purpose in posting this was to try and inspire action from actuaries who are in a position to contribute. I think that there are many ways that actuaries could contribute to solving this either through working together with existing research projects, coming up with new ideas about how to solve this problem, and then seeking to use this information to implement change. The last step is likely the hardest, and involves different "inexact" ways of trying to implement change, through writing letters, publishing articles, seeking to share the right information with the right people who can influence these processes.

As a couple resources that I found interesting:

Here is a for-profit program with Oliver Wyman: http://www.oliverwyman.com/our-exper...ng-wisely.html

that works to identify extreme outliers in practice. Perhaps something similar could be implemented for opioid prescriptions to identify abuse more quickly.

Here is a great Linked In post that I saw the other day about using actuarial science for social good in Malaysia: https://www.linkedin.com/pulse/using...sb4z0bag%3D%3D

I would encourage anyone interested in getting involved in some way with this program to reach out to Rebecca Owen, the author of the article, and to the public health subgroup of the soa health section to see if there is some way of contributing.

bluecup129 07-11-2017 11:19 AM

Honest question- what percentage of people who abuse opioids do so via their own prescription as opposed to obtaining the drug via illicit methods? The first person represents someone I could track with my company-specific data. The second person I probably could not.

It would be like trying to determine if an individual is having unnecessary services performed by a doctor that they pay under the table.

There is potential for this at the provider level (i.e. calling to the carpet providers who systematically prescribe more or stronger doses of opioids than are warranted), but I'm only scratching the surface of the problem.

lookingon1 07-11-2017 11:36 AM

Quote:

Originally Posted by Stephen Camilli (Post 9024150)
I think that this thread is going off in a different direction than what I had intended. It certainly helps no one to talk about what actuaries did or did not do in the past, unless it is constructively seeking what to potentially do better in the future. I think there is a place for actuaries both individually and as a profession to be more proactive in trying to implement change. The opioid crisis is one such possibility. I certainly do not think that actuaries are the only professionals that can contribute to this; however, I think that actuaries could contribute a unique perspective, working together with other public health professionals.

We often talk of what "the profession" does, but ultimately, it depends mostly on what individual actuaries do. So, one purpose in posting this was to try and inspire action from actuaries who are in a position to contribute. I think that there are many ways that actuaries could contribute to solving this either through working together with existing research projects, coming up with new ideas about how to solve this problem, and then seeking to use this information to implement change. The last step is likely the hardest, and involves different "inexact" ways of trying to implement change, through writing letters, publishing articles, seeking to share the right information with the right people who can influence these processes.

As a couple resources that I found interesting:

Here is a for-profit program with Oliver Wyman: http://www.oliverwyman.com/our-exper...ng-wisely.html

that works to identify extreme outliers in practice. Perhaps something similar could be implemented for opioid prescriptions to identify abuse more quickly.

Here is a great Linked In post that I saw the other day about using actuarial science for social good in Malaysia: https://www.linkedin.com/pulse/using...sb4z0bag%3D%3D

I would encourage anyone interested in getting involved in some way with this program to reach out to Rebecca Owen, the author of the article, and to the public health subgroup of the soa health section to see if there is some way of contributing.

Great responses Stephen. Like the way you handled this and your responses. And I like the overall approach you are suggesting and I believe that this is the best way to make something happen in this field and move ahead. Great thoughts and thank you for sharing. Impressive really, hope others will read this important thread.

WhosOnFirst 07-12-2017 09:33 AM

Quote:

Originally Posted by Stephen Camilli (Post 9024150)
I think that this thread is going off in a different direction than what I had intended. It certainly helps no one to talk about what actuaries did or did not do in the past, unless it is constructively seeking what to potentially do better in the future. I think there is a place for actuaries both individually and as a profession to be more proactive in trying to implement change. The opioid crisis is one such possibility. I certainly do not think that actuaries are the only professionals that can contribute to this; however, I think that actuaries could contribute a unique perspective, working together with other public health professionals.

We often talk of what "the profession" does, but ultimately, it depends mostly on what individual actuaries do. So, one purpose in posting this was to try and inspire action from actuaries who are in a position to contribute. I think that there are many ways that actuaries could contribute to solving this either through working together with existing research projects, coming up with new ideas about how to solve this problem, and then seeking to use this information to implement change. The last step is likely the hardest, and involves different "inexact" ways of trying to implement change, through writing letters, publishing articles, seeking to share the right information with the right people who can influence these processes.

As a couple resources that I found interesting:

Here is a for-profit program with Oliver Wyman: http://www.oliverwyman.com/our-exper...ng-wisely.html

that works to identify extreme outliers in practice. Perhaps something similar could be implemented for opioid prescriptions to identify abuse more quickly.

Here is a great Linked In post that I saw the other day about using actuarial science for social good in Malaysia: https://www.linkedin.com/pulse/using...sb4z0bag%3D%3D

I would encourage anyone interested in getting involved in some way with this program to reach out to Rebecca Owen, the author of the article, and to the public health subgroup of the soa health section to see if there is some way of contributing.

I like your enthusiasm but actuaries have been trying to convince people for years about the problems with funding for social security to no avail. I find it unlikely that anyone would pay attention to the suggestions of actuaries for the much more complex problem of opioid addiction.

campbell 07-12-2017 10:27 AM

Quote:

Originally Posted by WhosOnFirst (Post 9025666)
I like your enthusiasm but actuaries have been trying to convince people for years about the problems with funding for social security to no avail. I find it unlikely that anyone would pay attention to the suggestions of actuaries for the much more complex problem of opioid addiction.

This is a good point.

We've not had much in the way of "wins" as a professional group with regards to Social Security or public pensions.

It's great for us to support research/analysis that's relevant, but we need to think about being more effective in communication & persuasion.

It may be that opioid abuse may actually have solutions less controversial than SocSec or public pensions... but it may have similar problems in that the analysis/research produces very unwelcome solutions. We've not been very successful in such situations.

JMO 07-12-2017 11:17 AM

Quote:

Originally Posted by WhosOnFirst (Post 9025666)
I like your enthusiasm but actuaries have been trying to convince people for years about the problems with funding for social security to no avail. I find it unlikely that anyone would pay attention to the suggestions of actuaries for the much more complex problem of opioid addiction.

:iatp:

Actually, it seemed to me that the article that inspired this thread was doing a task that is also much needed - raising awareness.

Sredni Vashtar 07-12-2017 11:33 AM

Quote:

Originally Posted by campbell (Post 9025720)
We've not had much in the way of "wins" as a professional group with regards to Social Security or public pensions.

Same with healthcare. Every ACA thread is 99% about actuaries bemoaning the public understanding.

I think it would be neat if the AO organized a political arm-- like a subforum where we wrote letters to the editor and the like. I'm doubtful we could actually get away with much though. Presumably our Society, our employers, and our recruiters would all prefer silence over pot-stirring.

lookingon1 07-12-2017 05:50 PM

Quote:

Originally Posted by Sredni Vashtar (Post 9025828)
Same with healthcare. Every ACA thread is 99% about actuaries bemoaning the public understanding.

I think it would be neat if the AO organized a political arm-- like a subforum where we wrote letters to the editor and the like. I'm doubtful we could actually get away with much though. Presumably our Society, our employers, and our recruiters would all prefer silence over pot-stirring.

Isnt' the MAAA involved with a lot of that? I'm sorry am not a member of MAAA but I know some things and seem that they are the group most suitable?

lookingon1 07-12-2017 05:51 PM

Quote:

Originally Posted by WhosOnFirst (Post 9025666)
I like your enthusiasm but actuaries have been trying to convince people for years about the problems with funding for social security to no avail. I find it unlikely that anyone would pay attention to the suggestions of actuaries for the much more complex problem of opioid addiction.

What was the issue about social security? Sorry I'm not aware of this, would love to learn what happened. Would appreciate brief summary please...

campbell 07-12-2017 06:36 PM

Quote:

Originally Posted by lookingon1 (Post 9027097)
What was the issue about social security? Sorry I'm not aware of this, would love to learn what happened. Would appreciate brief summary please...

Obviously this is not a brief summary, but read the first two items in this thread:
http://www.actuarialoutpost.com/actu...d.php?t=228740

[and then read the rest of the thread... that's 6 years old and I'm just about to add more posts to]

Stephen Camilli 07-12-2017 07:30 PM

I think it is a bit different than social security and public pensions, in that the solution to those issues requires some kind of sacrifice, i.e. greater contributions, higher retirement age, lower benefit, etc. With the opioid crisis, there is currently a dearth of treatment centers and options. If analysis showed that investment in treatment options resulted in a greater decrease in costs to medicare/medicaid (a likely scenario based on most data, but without specific hard evidence to back up), a stronger political argument could be made for investment in treatment.

Similar economic analysis about the public costs of homeless people led to some states and cities offering free housing to high-risk individuals. See
http://www.newyorker.com/magazine/2014/09/22/home-free for one example. I can't recall where the original study about this came up, but it seems a similar economic argument could be made for certain solutions or remedies here. It is true that it seems like no-one is listening to us; however, delays, frustrations, etc., are the nature of trying to implement solutions that require political actions - they don't always follow a logical train of thought. Nevertheless, I still think that it is worthwhile, and that actuaries could do a lot to translate the desire to do something into specific action suggestions, with price tags and expected benefits attached to each action.

FormLetter 07-13-2017 08:04 PM

Quote:

Originally Posted by JMO (Post 9022938)
Seems like too little to late. It the patient has already acted badly, why wouldn't they just rip open all the cells to get the dose they want??

Depends whether they want to deal with withdrawals or not. There is a reason they give a taper prescription.

JMO 07-14-2017 09:59 AM

http://www.nbcnews.com/storyline/ame...ts-say-n782721
Senate Health Care Bill No Fix for Opioid Epidemic, Experts Say

lookingon1 07-14-2017 04:35 PM

Quote:

Originally Posted by JMO (Post 9029403)
http://www.nbcnews.com/storyline/ame...ts-say-n782721
Senate Health Care Bill No Fix for Opioid Epidemic, Experts Say

I think that's a given. They have much bigger problems with that bill...beside the opioid crisis. They need to figure out the basics still...

Fish Actuary 07-14-2017 06:16 PM

Quote:

Originally Posted by lookingon1 (Post 9023918)
Done?? Nothing is done, the problems are persisting. There is lots more room for analysis. Actuaries have so many opportunities to step in and solve these problems, before the others do.

The last real work by a health actuary, as far as I can see, was Bluhm's stuff---which was in the 1980's NOTHING has come since (which is still important analysis). The disease management was all blown air and didn't amount to anything. And the rest was conjectures about the ACA and our health system. But no real solutions.

I am saying we need someone to tackle the problems we have and devout actuarial talent on that. This OP's call is so important which is why I was shocked and amazed to see this today.

I kind of get the impression you're being a bit naive about the research that is being done on predicting/managing opioid addiction. Here's a link to all the research in Google Scholar that's been published since 2013 and pops up when you search for the "predicting opioid abuse" :link:

FormLetter 07-14-2017 09:11 PM

Predicting opioid use, some variable's I'd expect:
1) current prescription to an opiate/opioid
2) prior addiction to opiates/opioids
3) close proximity to other people use them
4) having prescribing privileges
5) having relationships with those under 4)

lookingon1 07-18-2017 12:51 AM

Quote:

Originally Posted by FormLetter (Post 9030786)
Predicting opioid use, some variable's I'd expect:
1) current prescription to an opiate/opioid
2) prior addiction to opiates/opioids
3) close proximity to other people use them
4) having prescribing privileges
5) having relationships with those under 4)

good start

lookingon1 07-18-2017 12:56 AM

Quote:

Originally Posted by Fish Actuary (Post 9030642)
I kind of get the impression you're being a bit naive about the research that is being done on predicting/managing opioid addiction. Here's a link to all the research in Google Scholar that's been published since 2013 and pops up when you search for the "predicting opioid abuse" :link:

it's not me you have to show off and flex your muscles to, there are real problems and you have to find solutions or no one will notice you. So you should figure out a way to do it and if google search is what you think is going to help then start doing it. As you can see lots of poeple have already started doing work on this. Maybe follow example of formletter and find more variables to build on.

bluecup129 07-18-2017 03:44 PM

I'm just trying to set adequate 2018 premium rates for my employer :shrug:


All times are GMT -4. The time now is 02:01 PM.

Powered by vBulletin®
Copyright ©2000 - 2020, Jelsoft Enterprises Ltd.

Page generated in 0.24715 seconds with 9 queries