CMS Roadmap Fighting the Opioid Crisis

Transcript

1 March 2019 CMS Roadmap FIGHTING THE OPIOID CRISIS % of all 36 opioid o verdose 47,000 deaths involve a 1 in 2017, or 130 people per day. 1 prescription opioid. PRESCRIPTION OPIOID MISUSE When used correctly, The CDC issued 3 out of 4 people 11.4 million An estimated prescription opioids guidelines for people misused prescription oin who used her 2 for helpful are e prescribing saf opioids misused prescription —putting them at risk 3 treating pain. of opioids in for dependence and addiction. opioids first. e. primary car OPIOID USE DISORDER Learn more about prescription opioid misuse % Treatment Over exist, two million options Only 20 of people Learn more about with opioid use disor der including medication- people ha ve an opioid use disorder 3 receive treatment. opioid use disorder. assisted treatment (MAT). and treatment OF CMS FOCUS KEY AREAS As one of the largest payers of healthcare services, CMS has a vital role in addressing the opioid epidemic and is focused on three key areas: TREATMENT PREVENTION DATA Expand access to treatment Use data to target Manage pain using a safe or opioid use disorder prevention and treatment f and effective range of efforts and to identify fraud treatment options that rely less on prescription opioids and abuse

2 SUCCESSES SO FAR DATA COVERAGE AWARENESS CMS coverage policies now CMS sent 24,000 letters in 2017 to show where CMS released data ensure some form of medication- Medicare and Medicaid opioid and 2018 to Medicare physicians assisted treatment across all to highlight that they were prescribing is high to help identify —Medicare, CMS programs prescribing higher levels of opioids areas for additional interventions. Medicaid, and Exchanges. than their peers to incentivize safe prescribing practices. TRACKING BEST PRACTICES ACCESS CMS activated over 4,000 Due to safe prescribing policies, As of January 2019, CMS hospitals, 120,000 clinicians, the number of Medicare approved 21 state Medicaid and 5,000 outpatient settings beneficiaries receiving higher than to improve 1115 demonstrations through national quality recommended doses from multiple access to opioid use disorder improvement networks to rapidly declined by 40% in 2017. doctors treatment, including new generate results in reducing flexibility to cover inpatient opioid-related events. and residential treatment. MOVING FORWARD PREVENTION TREATMENT DATA ata provides insight D Significant progress Medicare, Medicaid, has been made in into doctor, pharmacy, and private health and patient use of prescription plans provide some identifying inappropriate opioids and effectiveness prescribing patterns coverage for pain and opioid of treatment use disorder treatments CMS CAN BUILD ON THESE EFFORTS TO FURTHER: Identify and stop 1. access to Ensure 1. 1. opioid use Understand inappropriate prescribing treatment across CMS patterns across populations programs and geography of opioids sharing of omote 2. Pr patients options for a 2. Enhance diagnosis of 2. Give cti across onable data a OUD to get people the broader range of treatments continuum of care support they need earlier Support innovation 3. 3. Monitor trends to assess through new models effective, Promote 3. impact of prevention non-opioid pain treatments and best practices and treatment efforts IMPLEMENTING THE SUPPORT ACT The SUPPORT for Patients and Communities Act was enacted on October 24, 2018. CMS is implementing a number of new initiatives under that law that aim to increase options for treating beneficiaries with opioid use disorder, ensure prescriber accountability and improved safety for patients across CMS programs, and illuminate Medicaid prescribing data.

3 DETAILED ACTIVITIES ON THE 2019 ROADMAP A CLOSER LOOK: TREATMENT PREVENTION Continue reducing inappropriate opioid Identify and develop solutions for treatment barriers for pain and opioid use disorders across Medicare, Medicaid, and private prescribing by: health plans, including: • Implementing a new authority to • limit Medicare beneficiaries to certain Access to non-opioid pain treatments, pharmacies and doctors (or “lock-in”). • Access to medication-assisted treatments (MAT), and • Strengthening real-time prescription • Access to providers in rural and other low-access communities. c ontrols with the use of prescription tabases and point of sale drug da y edits. pharmac MEDICAID 1115 MEDICAID S U B STAN CE I N N OVATION Incorporate incentives for appropriate USE DISORDER ACCELERATOR into future Medicare Quality prescribing WAIVERS PROGRAM (IAP) Star Ratings and the Quality Payment LEARN MORE LEARN MORE Program. Foster innovation Align monitoring of systemic and expand inappropriate prescribing to the CDC opportunities to Guideline for primary care practitioners support on-the- and partner with law enforcement to stop ground initiatives egregious prescribers. through: M EDICARE MEDICARE QUALITY Outline options and share best practices AND MEDICAID IMPROVEMENT for state Medicaid agencies and other I N N OVATION ORGANIZATIONS MODELS payers on non-opioid treatments and other ) (QIO s tactics to help address pain and the opioid LEARN MORE L EARN MORE crisis. DATA & ANALYTIC TOOLS CMS will focus our data efforts and provide tools for states, plans and providers to: • • prescription opioid use patterns across Analyze Monitor success of prevention measures related to reducing overuse and misuse of prescription opioids. ams and in special populations such as CMS progr individuals in rural areas, with dual Medicare/Medicaid • transparency tools and interoperability, and Improve eligibility, and with certain health conditions. expand data tools like the “heat map” of prescribing • r ates in Medicare and Medicaid that help determine Support state Medicaid program capacity to track and r eport data. where to target safe prescribing efforts (see maps below). 4 5 2016 MEDICARE PRESCRIBING RATES 2016 MEDICAID PRESCRIBING RATES

4 HIGHLIGHTING INNOVATION MEDICAID DEMONSTRATION COLLABORATIVE LEARNING PROJECT CMS approved an 1115 Medicaid CMS’s Transforming Clinician Practice Initiative is a collaborative learning initiative that demonstration project (TCPI) for Virginia and facilitates information sharing and practice reform on worked with the state to strengthen the a large scale, with over 90% of clinicians operating in delivery system for treatment of substance use small, rural, or underserved areas participating. One disorders, including opioid use disorder. ted Pain Care program TCPI member —the Integra Virginia’s Medicaid demonstration project has at Community Care of West Virginia—achieved significantly improved access to treatment promising results, including: by increasing reimbursement, which led to increased provider capacity and a 49% Zero opioid-related deaths among the 1. 2,628 patients over the past 2 years increase in number of members accessing opioid use disorder treatment. It also resulted A reduction in opioid 2. 7 in a 39% decrease in opioid-related emergency pr escriptions by 86% in 4 years. 6 department visits in the first 5 months. ADVANCED ANALYTICS HUB AND SPOKE MAT CMS’s Quality Improvement Organizations CMS approved and provided technical assistance to Vermont on its Hub and Spoke MAT program to provided advanced data analytic support and add the Health Home optional Medicaid state clinical expertise to a network of 10 hospitals plan benefit to promote coordinated care for and partners across Colorado to change pain chronic conditions, which has led to dramatic management practices and improve care. Over a reductions in opioid use, overdoses and emergency 6-month timeframe, CMS data showed that these hospitals achieved a 36% reduction in the use of department visits related to opioid use. opioids— about 35,000 fewer administrations of opioids in the emergency department—and an increase in non-opioid pain medications by 31%. INNOVATIVE MODELS focused on particularly vulnerable populations. The models CMS introduced 2 innovative opioid Integrated Care health care, for Kids (InCK) Model focuses on integrating physical and behavioral for children affected by family opioid abuse. The preventing opioid abuse, and improving outcomes Maternal Opioid care of pregnant women with opioid Misuse (MOM) Model supports transformation in the use disorder. By clinical care and the integration of other services critical supporting the coordination of eing, and recovery, the model ha s the potential to improve quali for health, wellb f care and red uce ty o costs for mothers d infants. Stat es and care deli an ll begin imple menting changes in 2020. very partners wi SOURCES: 1 CDC: https://www.cdc.gov/drugoverdose/data/index.html https://www.macpac.gov/wp-content/uploads/2018/01/ Virginia: 6 Examining-Residential-Substance-Use-Disorder-and-the-IMD- 2 HHS: https://www.hhs.gov/opioids/about-the-epidemic/index.html Exclusion.pdf 3 SAMHSA: https://www.samhsa.gov/sites/default/files/aatod_2018_final.pdf WV results: https://www.medicaid.gov/medicaid/section-1115-demo/ 7 https://www.cms.gov/Research-Statistics-Data-and-Systems/ 4 demonstration-and-waiver-list/?entry=40604 Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ OpioidMap_Medicare_PartD.html https://www.cms.gov/Research-Statistics-Data-and-Systems/ 5 Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ OpioidMap_Medicaid_State.html

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