Can actuaries help solve the opioid crisis?

[lookingon1]

ps I can't believe I've been here since Sep 2013????wtf that's probably a record for moi (4 years friends...)

[bigb]

How exactly is it that "actuaries" can solve an opioid crisis? How many other crisis' exist in the health sector that "actuaries" have been exposed to now for decades? Clinician's seem to be in an infinitely better position to address this issue. Its like asking us why doctors are writing scripts.

[WhosOnFirst]

Originally Posted by bigb

How exactly is it that "actuaries" can solve an opioid crisis? How many other crisis' exist in the health sector that "actuaries" have been exposed to now for decades? Clinician's seem to be in an infinitely better position to address this issue. Its like asking us why doctors are writing scripts.

I think the OP was trying to show that the risk prediction methodologies that actuaries are very familiar with could help with opioid addiction. I inferred that that he believes that being able to predict who might get addicted in the first place could be of use to prevent future addiction. That would appear to be a realm where actuaries are better suite then clinicians.

I'm not positive I buy into the idea of being able to reduce addiction by predicting who might become an addict. My bias is towards viewing addiction as a medical condition which means my preference for solving any addiction would be through a better understanding of the biological processes that create addiction. I don't think actuaries are of much use in that realm.

[Stephen Camilli]

Thanks for your notes. I think there are a few different ways we can help, based on conversations with some fellow actuaries; however, not all of them are unique to actuaries. I also think other people out there have multiple more ideas on what we could do to help.

Help build models to identify people who are at risk, through both prescription use and medical care that indicates an issue, and convey this to care management teams.

Identify providers whose prescription patterns may indicate an issue.

Cooperate with public health programs that intend to mitigate the crisis.

Evaluate benefits of non-traditional treatment options

Evaluate cost savings that would result from expanded network or expanded resources for treatment of opioid addiction -- this could be shared w/ private insurers or governments for resource allocation.

Construct methods to quickly identify regions or providers that are oversubscribing, and an appropriate response

Just a few thoughts.

There are more actuaries now interested in getting involved with public health, and the SOA Health section has created a public health subgroup. If you're interested - here is some more info: http://healthwatch.soa.org/?issueID=4&pageID=18

[dgtatum]

Originally Posted by JMO

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

I have read stats that say Medicaid recipients are like 5 times more likely to abuse opioids than a non-Medicaid recipient.

This article shows that a lot of the states that took the Medicaid expansion have had increases in opioid deaths and abuse that are greater than increases in other areas holding a lot of things constant. While Medicaid has increased access to treatment options it has also increased access to the pain killers themselves. In my estimation it is much easier to become addicted than it is to overcome addiction so the increase in the amount of treatment and the effectiveness of the treatment would have to be substantially larger than the increase in the access to prescription of these drugs to actually lower addiction rates. This data would seem to show that this is not the case. So sighting increases in treatment options offered by Medicaid without discussing increases in access to the addictive drugs themselves is not helpful or actuarial imo. That said I understand discussing Medicaid's role in starting, sustaining, and expanding the opioid crisis is going to be a very unpopular discussion to have.


https://spottedtoad.wordpress.com/20...opioid-crisis/

[lookingon1]

Originally Posted by WhosOnFirst

I think the OP was trying to show that the risk prediction methodologies that actuaries are very familiar with could help with opioid addiction. I inferred that that he believes that being able to predict who might get addicted in the first place could be of use to prevent future addiction. That would appear to be a realm where actuaries are better suite then clinicians.

I'm not positive I buy into the idea of being able to reduce addiction by predicting who might become an addict. My bias is towards viewing addiction as a medical condition which means my preference for solving any addiction would be through a better understanding of the biological processes that create addiction. I don't think actuaries are of much use in that realm.

This can be said about many different works being done in health actuarial. We don't solve the medical problem, we can create guidance to those professionals. We may see things they don't and provide assistance. Plus we study the financial risk in addition.

[JMO]

I believe that people in pain shouldn't be punished because some folks misuse opioids.
AMA protests limitations recently proposed by a PBM.
http://hosted.ap.org/dynamic/stories...08-16-14-14-23

Express Scripts launched a yearlong pilot program in 2016 aimed at reducing patients' dependency on opioids and the risk of addiction, said Snezana Mahon, the Missouri-based company's vice president of clinical product development.

Mahon said analysis of 106,000 patients in the pilot program showed a 38 percent reduction in hospitalizations and a 40 percent reduction in emergency room visits, compared to a control group. The program is scheduled to take effect nationwide on Sept. 1 for Express Scripts members whose employer or health insurer has enrolled to participate.

Under the program, new opioid users are limited to seven-day prescriptions, even if the doctor orders scripts for much longer. Mahon said the average prescription is for 22 days.

The program also requires short-acting drugs for first-time opioid prescriptions, even though many doctors prescribe long-acting opioids. Dosage is also limited, and the company will monitor and try to prevent for patterns of potential "pill shopping," where a patient goes from doctor to doctor to collect prescriptions.

The program does not apply to patients in hospice or palliative care, or to cancer patients.

A competitor, CVS Caremark, has a similar program.

ETA: I'm not saying misuse is not a problem. I'm not yet convinced that it's a CRISIS*. I just find it hard to believe that a one-size-fits-all solution is what we need.

Disclosure - Not an actuary, never worked on health care when I was an actuary.

*Al Gore still insists that the only crisis worth caring about is global warming. Be that as it may. . .

[lookingon1]

this is apparently not just a boring public health problem for those with nothing better to do. Express scripts and likely health carriers will be getting involved with this. Timely to have the OP bring this up-maybe we can be ahead of the game on this

https://www.yahoo.com/news/express-s...175222599.html

[Patriot]

When I had a kidney stone blasted I was given a 90 day (@ 6 pills per day) script for vicodin. Someone told me the street value for 540 vicodin tablets was several K.

[JMO]

News item about opioid addiction and insurance fraud.
http://hosted.ap.org/dynamic/stories...08-24-04-10-35

The Reflections treatment center looked like just the place for Michelle Holley's youngest daughter to kick heroin. Instead, as with dozens of other Florida substance abuse treatment facilities, the owner was more interested in defrauding insurance companies by keeping addicts hooked, her family says.