A Lifelong Struggle, a Tearful Reconciliation

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In the year since Jeff Balek began working for the Guardian Angels program, where he reaches out to Aetna members who have survived an opioid-related overdose to connect them with support and resources, Balek estimates he has spoken to hundreds of people who nearly died from an opioid overdose, and he has heard hundreds of heart-wrenching stories.

A counselor talking on the phone.
Jeff Balek, a Guardian Angels program clinical lead, works one-on-one with members recently released from the ER following an overdose.

But one story stands seared in his memory above the others: A man in his 40s named Kevin, who struggled with addiction for most his life and was now sober for the first time in decades, whose greatest wish was to try to rectify his greatest regret — his estranged relationship with his mother.

The problem was that he had no idea how to find her. Or whether she even wanted to see him. He searched desperately for six months to locate her, and when he did, the news was staggering. She was living out her final days in hospice care, more than a thousand miles away in Florida.

Could he find the money to arrange the trip? Could he get there in time? And, most importantly: Would she welcome him if he did?

“All I want is to at least have a chance to make things right,” he told Jeff.

Closing the Gap Between Overdose and Much-Needed Treatment and Support

Kevin’s story is a poignant example of the devastation that opioids can wreak on a family, but also of the redemptive opportunities for people who seek and receive help.

Those opportunities are why Aetna launched the Guardian Angels program as pilot in 2018. The company’s data showed hundreds of people were visiting emergency rooms each month with opioid-related overdoses. They all had complex needs for treatment and recovery, but the ER doctors’ job was limited to helping them survive an overdose. Once they survived, they were on their own again. It was like being treated for frostbite but then sent back outside into frigid temperatures. Without a coat.

Guardian Angels is part of our company-wide commitment to help address the abuse and misuse of prescription opioids, which includes everything from a safe medication disposal program in Ohio to Pharmacists Teach, an outreach program that’s reached more than 450,000 students and parents since 2015.

“We noticed patients would be discharged with minimal ongoing support,” says Daniel Knecht, MD, Aetna’s vice president of health strategy and innovation.

The Guardian Angels program was designed to close that gap. Clinicians who specialize in addiction recovery call members after they’ve been discharged to lend support, to offer education, and to connect them to community resources.

To date, the program has helped more than 600 members and their families, and the Guardian Angels staff has gone from a single person to two — Balek works alongside clinician Ramona Zarate — and is looking to expand again.

“We reach out when the individual is most needing help and most susceptible to intervention,” Balek says. “They had a near-death experience. Their defenses are broken down. They’re on the brink of emotional deterioration.”

“Talking about substance use is difficult,” Zarate says. “It’s important to give the person a safe space to discuss their experiences, their fears and their hopes for the future.”

There is no shortage of need. More than 70,000 people in the United States in 2017 died from drug overdoses, and that number continues to grow. Balek estimates that he and Zarate each talk to as many as 10 people a day. Outreach and perseverance are key; it sometimes takes up to eight calls just to reach someone.

Once the connection is made, the angels’ conversations with the members can stretch for months. The idea is to continue providing support until the patient reaches what they call “early remission,” which usually takes about three months. But Balek says he never cuts anyone off. As long as they’re willing to talk, he’s willing to listen. There’s always a goodbye, eventually, but Balek wants to make sure it’s “goodbye for a good reason.”

A Second Chance

In Kevin’s case, Balek stayed in touch for almost a year, as he struggled with facing the pain of his estrangement, as he searched for his mother, and as he wrestled with doubts about whether to approach her.

In the end, with Balek’s help and support, Kevin took the leap of faith and visited. To his relief, she welcomed him with open arms, glad to see him, and thrilled that he had shed his demons, at least for now. They shared the few good memories they had, back before addiction dug its claws into his life. They shared tears.

“The joy in his voice was incredible,” Balek says.

A few weeks later, Kevin’s mother died.

As he does with most of his patients, Balek eventually lost touch with Kevin. Last he heard, Kevin had found a job and a girlfriend, and had moved to Florida — almost as if he wanted a way to feel closer to his mother, as if her love and acceptance before she died made Florida feel like a safe, welcoming place.

Last Balek heard, Kevin was still sober.

Recently, Balek found notes from his last conversation with Kevin. These were what turned out to be the final words Kevin said to him: “I really didn’t think my Mom would see me doing well again. She got to see me looking good and clear-eyed and smiling. She got to see the real me, who always loved and cared for her.”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Safe Medication Disposal Program Expands in Ohio

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Our new Ohio disposal units were rolled out at a recent event at a CVS Pharmacy in Toledo, which was attended by city officials, including Toledo Mayor Wade Kapszukiewicz (far left) and Police Chief George Kral (far right).

Our enterprise-wide efforts to help prevent the misuse and abuse of opioids nationwide include making safe disposal options for unused or unwanted medications readily accessible to all of our CVS Pharmacy customers.

That’s why we’re working to expand our safe medication disposal program to more locations nationwide, include, most recently, in Ohio, where we added disposal units in 53 CVS Pharmacy stores in communities across the state, including Cincinnati, Cleveland, Columbus, Dayton, Toledo and Youngstown.

“When patients leave unused medications, especially opioids, in a medicine cabinet, there is a risk that those medications might be misused or diverted, which is why we have worked to help increase access to and awareness of safe medication disposal options in the communities we serve,” said William Cuffari, R.Ph., and District Leader for CVS Pharmacy. “Providing more options for the proper disposal of unused medications is just one of the ways that CVS Health is working to help combat opioid misuse, in Ohio and across the country.”

This most recent expansion brings the total disposal units in CVS Pharmacy stores in Ohio to 82. Nationwide, we’ve installed more than 1,300 in-store safe medication disposal units, and donated more than 970 units to community organizations like police departments.

We will continue to roll out additional safe medication disposal units across the country through the end of 2019, as part of a commitment announced at the end of last year to help provide more disposal options in our communities. We’ve also partnered with Google Maps to make it easier for consumers to find year-round medication disposal options.

Our safe medication disposal program is just one of many ways we’re working with local communities to help prevent and address prescription misuse. Our Pharmacists Teach program brings CVS pharmacists to schools across the country to talk to students and parents about the dangers of prescription drug abuse. More than 500,000 students across the country, including over 19,000 in Ohio, have participated in the program.

We’ve worked with 48 states including Ohio and Washington, DC to increase access to the opioid overdose-reversal drug naloxone, also known as Narcan. Patients can obtain this potentially life-saving medication, which can reverse the effects of an opioid overdose, without an individual prescription in these states.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Aetna Empowering Physicians to Fight Opioid Crisis via Best Practices

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Although doctors and other prescribers play a key role in fighting opioid use disorder (OUD), they often don’t have the latest clinical information about the risks associated with opioids. To close that knowledge gap, Aetna is collaborating with Alosa Health and clinical experts to educate primary care doctors in their own offices on best practices for the appropriate use of opioids as well as how to screen and treat for opioid addiction.

The goal? To reduce the number of new opioid users and lower risks for patients who are currently on opioid therapy.

Battling Misconceptions about Opioid Prescribing

“More cautious prescribing can help prevent people from getting addicted to opioids and help those who are addicted to find alternative methods for    managing their pain,” said Andrew Kolodny, M.D., co-director of opioid policy research, Brandeis University, and a nationally recognized expert on OUD.

The “academic detailing” pilot is deploying about 30 trained health care educators  to doctor’s offices in Pennsylvania, Illinois, Maine, West Virginia and Ohio, some of the states hit hardest by OUD. These detailers—comprising physicians, nurses and pharmacists — develop individualized education plans with each prescriber and highlight opportunities to improve their clinical practices.

The program is providing physicians with the best peer-reviewed evidence on treating acute and chronic pain and recognizing and caring for patients with OUD utilizing medication-assisted treatments (MAT).

“From 1999 to 2013, prescribers quadrupled the number of opioid prescriptions, and although we’ve reduced it dramatically since 2013, we’re still at three times the level we saw in 1999,” said Elisabeth Fowlie Mock, M.D., M.P.H., an academic detailer based in Maine. “These days, we are seeing a lot of providers who are inheriting patients on high doses of opioids and are not sure what to do  regarding the best next steps.”

Mock noted that the vast majority of patients on long-term opioid therapy who are tiered off appropriately and provided with other, better pain management options report less pain, fewer side effects and more functionality once they are off of the opioids.

“They say that they’ve gotten their lives back,” she said, adding that the program is needed because only 20 percent of people with OUD are receiving treatment for the disorder.

For the AdvocateCare Center, a busy multidisciplinary practice in Chicago that provides team-based care for patients with multiple chronic and acute conditions such as diabetes, heart failure and kidney disease, the opioid education provided helpful insights into the best solutions for pain management.

“It was great to have the training right in our office and be able to easily work it into the workflow of the day,” said Michael A. Richman, M.D.The entire team of social workers, nurses, behavioral health specialists and support staff participated in the training because they all encounter patients daily who are struggling with pain and/or addiction to opioids.

“Our detailer did a great job of laying out options for appropriate pain management,” he said, adding that evidence supports the use of multi-modal approaches such as movement and cognitive therapies, many of which are offered by the AdvocateCare Center. “The materials were easy to understand, and the evidence-backed background she presented was very valuable. The training was really helpful and appreciated.”

Daniel Knecht, M.D., vice president of clinical strategy and policy at Aetna, a CVS Health company, said that the program is helping to deepen Aetna provider partners’ knowledge base and comfort with treating OUD by providing insights around screening and treatment. He noted that many providers haven’t received formal training in pain management or addiction medicine.

Susan Reeves, R.N., a detailer who is working with providers in the Philadelphia area, said many of the physicians she is working with are excited to have access to the latest clinical information on opioids and other pain medications.

“One of their biggest concerns is, ‘What are my options?’ ‘What else can I do?’ ” she noted. “Luckily, evidence-based alternatives like physical therapy, chiropractic care, etc., offer great options. Doctors are relieved to hear the studies about these and other options because they really don’t have time to conduct their own research.”

Focusing on Proven Pain Management Alternatives

Studies of academic detailing have found that clinicians welcome the practice as it improves decision making and reduces health care costs.Academic Detailing: “Marketing” the Best Evidence to Clinicians; https://jamanetwork.com/journals/jama/article-abstract/2598775 It has successfully been used to educate physicians on a variety of health issues, such as atrial fibrillation, chronic obstructive pulmonary disease and appropriate antibiotic use, among others.Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial; https://www.ncbi.nlm.nih.gov/pubmed/15282232 Educational Outreach to Opioid Prescribers: The Case for Academic Detailing; https://www.ncbi.nlm.nih.gov/pubmed/28226336

“Evidence-based detailing programs are important because they provide direct, often in-person support to busy clinicians to help them screen, treat and manage patients with acute and chronic pain as well as substance misuse and addiction,” said Wilson Compton, M.D., deputy director of the National Institute on Drug Abuse (NIDA).

Stakeholders from across the health care system, including payers, can make a difference in guiding the safe and appropriate use of pain medication now and in the future, according to Dr. Kolodny.

“Aetna can have a very positive impact on opioid addiction, both through advocating for prescribing caution and by helping opioid-addicted people to have better access to treatment,” he said, adding that he’s “impressed with Aetna’s response to the epidemic by developing innovative solutions like the detailing program.”

The year-long pilot program is being guided by a national group of leading experts in pain management and the national opioid situation, drawn from universities across the country as well as NIDA and the Centers for Disease Control and Prevention.

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Aetna Sponsors Third Annual Opioid Forum in DeKalb County

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Larry Johnson, National Association of Counties Chairman of the Large Urban County Caucus, speaking during the recent opioid summit in Georgia.
Larry Johnson, National Association of Counties Chairman of the Large Urban County Caucus, speaking during the recent opioid summit in Georgia.
Frank Ulibarri, Georgia and Gulf States market president, spoke at the event.
Frank Ulibarri, Georgia and Gulf States market president, spoke at the event.

As national efforts continue to combat opioid use disorder (OUD), the Aetna Georgia Markets team is committed to supporting their local community.

These efforts were showcased in the third annual DeKalb County Opioid Summit – where the focus was on ways to help youth and families in the county overcome the challenges of OUD.

Aetna, a CVS Health company, sponsored the May 2 summit. The event highlighted the local impacts of this health issue and Aetna’s commitment to help at the local level. The event featured youth from local high schools, stakeho­­­­lders and community leaders.

This diverse group of stakeholders discussed the opioid epidemic from their perspective, bringing to light the negative aspects they see daily and the opportunities to improve the situation in DeKalb and for the state. Frank Ulibarri, Georgia and Gulf States market president, represented Aetna.

The local impacts of the crisis

In 2013, Antoinette Tuff found herself held hostage as a bookkeeper in a local school in Georgia but was able to disarm the gunman by talking him into surrendering to the police. After that experience, Tuff founded Kids on the Move for Success, which is an organization dedicated to helping children see the positive in life.

“No matter what it looks like today, it will be better tomorrow,” said Huff, who spoke at the summit. “Kids today face so much and are more likely to turn to drugs to feel better or to escape. This epidemic is not in some distant land, it’s in our front yards and we need to deal with it.”

For panelist Robin Elliot, working to solve the abuse of opioids is her life’s mission.

The death of Elliott’s son from a heroin overdose has made her become an advocate in Georgia. Elliott’s organization GA Overdose Prevention has dispensed over 1,000 Narcan kits across Georgia to help those who may experience an overdose. She’s also worked to pass a Georgia law that prohibits any legal action against someone who may have overdosed (from any substance).

Hyancinth Douglas, a juvenile probation supervisor and youth advocate, talked about how teenagers need to find positive support in their teachers, mentors and family members and reach out to them.

“Educate yourself about drugs,” said Douglas. “Try to determine what triggers you, and use your support system to help. There is no shame here.”

In a workshop hosted by CVS Health, two pharmacists outlined the real threat that opioids pose to the community and the entire country.

In a packed classroom, the pharmacists cautioned that adolescents are at an increased risk for addiction since their brains are still developing.

Ulibarri said he was proud to again be a part of this meaningful event.

“We are honored to once again collaborate on the third annual forum of this kind in DeKalb County,” said Ulibarri. “As a fellow Georgian, I’m proud of Aetna’s mission to help people on their path to better health – including the time and resources that have been dedicated to tackling the most-pressing issues facing the communities where we live and work. Working together with DeKalb County and other local stakeholders, we’re able to explore the impact of OUD on our youth and families and to discuss how to best combat it. It is ultimately on all of us to act.”

Aetna is committed to combatting OUD with a multifaceted strategy focused on preventing prescription opioid misuse and addiction, intervening in at-risk behavior, and supporting members with access to treatment for addiction. For more information on our efforts, click here. Similarly, CVS Health has made an enterprise-wide commitment to help address prescription opioid use disorder by designing programs to increase access to safe medication disposal, encourage appropriate utilization, educate patients and communities, expand access to life-saving overdose reversal agents, and support local recovery programs. For more information on those efforts, click here.

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Giving the Gift of Healthy Moms and Babies

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Pictured above (L-R) during a check presentation in the rotunda of the Kentucky State Capitol: Scott Brinkman (KY Gov Executive Cabinet Sect.), Kristi Putnam (KY Cab for Health and Family Services (CHFS) Dep. Sect.), Fran Soistman (Aetna EVP), Jon Copley (ABH-KY CEO), Jennifer Hancock (VOA President), Nicole Collins (VOA recipient), Robert Stivers (KY Senate President), John Tilley (KY Sect. of Justice), Adam Meier (KY Sect. of CHFS)

Aetna Better Health of Kentucky donates $150,000 for Freedom House addiction treatment facility

Delivering healthy babies is not only a goal of Freedom House — a program committed to providing customized addiction treatment to pregnant Kentucky mothers working to overcome substance abuse disorder — it’s also a goal of Aetna Better Health of Kentucky.

With a shortage of treatment and recovery programs, the opioid and addiction crisis has hit Southeastern Kentucky hard. To support the need, the health plan recently donated a $150,000 to help cover the cost of a new addiction treatment facility in the Appalachia region of Clay County, KY. Expected to open in July or August with space for 20 women and their children, the new Freedom House will be the fourth operated by Volunteers of America (VOA) Mid-States.

“Aetna’s gift will support the critical funding Freedom House requires to provide comprehensive care and addiction services to pregnant and parenting mothers,” said Aetna Better Health of Kentucky CEO Jon Copley. “Helping to underwrite this program on the front end will save hundreds of thousands of dollars on very expensive care for neonatal abstinence syndrome on the back end.”

“We are so grateful to Aetna for their support and their amazing generosity that will make this truly innovative and important project possible,” added Jennifer Hancock, President and CEO of Volunteers of America.

During the check presentation, Nicole Collins, a graduate of the program discussed how she got clean and delivered a healthy baby boy at one of the Freedom House locations in Louisville. And Kentucky State Senate President Robert Stivers said he hopes the new location will expand the program’s reach and make addiction services more accessible across Kentucky.

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Removing barriers to prevent and treat opioid abuse and dependence in Medicare

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America’s addiction crisis has led to the first two-year consecutive decline in our country’s life expectancy since the 1960s, Aetna’s Executive Vice President and Chief Medical Officer Hal Paz told the House Ways and Means Committee yesterday during a hearing entitled “Removing Barriers to Prevent and Treat Opioid Abuse and Dependence in Medicare.”

House leaders are asking Aetna and other health care stakeholders for help in combatting the opioid crisis and, specifically, about any opportunities to improve Medicare’s coverage of treatment.

In his testimony, Paz outlined the holistic approach Aetna is taking to address the opioid epidemic, including enhancing programs to reduce inappropriate opioid prescribing, encouraging the use of non-opioid pain treatment modalities, and promoting evidence-based treatment for members struggling with opioid use disorder.

For example, as of Jan. 1, Aetna is limiting initial opioid prescriptions for acute pain to a seven-day supply in its commercial business.  These stricter daily and dosage limits are in alignment with CDC guidelines, and will help reduce the potential for abuse and addiction. Aetna also became the first and only national payer to waive copays for Narcan— a lifesaving, highly effective opioid overdose reversal agent—for fully-insured commercial members once their deductible is met.

“Our important efforts in our Commercial lines of business, for example, can inform how the Centers for Medicare and Medicaid Services (CMS) regulate Medicare Advantage (MA) and Part D plans to allow for similar programs in the Medicare space,” he said.

In addition, in Medicare, Aetna has also taken steps to promote appropriate prescribing and coordination of care for its members who use opioids. With CMS approval, Paz noted that Aetna has instituted utilization management tools in its Medicare formularies to support appropriate and safe prescribing and dispensing of opioids and identify potential inappropriate use.

Paz suggested that Congress and CMS can take additional steps to help Medicare plans improve coverage of treatment, specifically:

  • Finalizing provisions that would limit initial opioid prescriptions to a seven-day supply, in alignment with CDC guidelines
  • Ensuring success of Medicare Part D lock-in mechanism (by which a member can be “locked in” to one pharmacy to prevent “pharmacy shopping”) and providing greater flexibility to Medicare Advantage and Part D plans
  • Modernizing privacy regulations to ensure that providers and organizations have all the information necessary to provide safe, effective, high quality care

“Aetna is deeply committed to doing its part to reverse the trend of opioid misuse, abuse, and overdoses across the nation,” Paz said. “We look forward to continuing to play a productive role in the dialogue with the Committee and with other policymakers to help find solutions to this epidemic.”

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Aetna Foundation launches funding initiative to help fight opioid epidemic

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The Aetna Foundation is launching a funding initiative to fight the ongoing opioid epidemic in the U.S. and help communities and states that have been particularly hard hit. Grants totaling $6 million will fund state and local projects with the potential to make a real difference in addressing opioid-related challenges.

North Carolina will be the first state to receive a grant through the Aetna Foundation’s initiative. The North Carolina Harm Reduction Coalition will receive $1 million to help fund its “Rural Opioid Overdose Prevention Project.”

“While this is a national health crisis, there is no single solution that can be applied across the country,” said Harold L. Paz, M.D., M.S., Aetna’s executive vice president and chief medical officer and member of the Aetna Foundation Board of Directors. “These grants will provide important resources to empower local communities to address the unique characteristics of the opioid-related problems they are facing.”

In a survey conducted by Morning Consult, 77 percent of respondents said the role of local communities and community organizations are important in fighting the opioid epidemic. The survey was conducted from Feb. 8 through Feb. 12, 2018, and 2,201 adults participated.

With one of the highest rates of opioid overdose deaths nationwide, the funding will help provide community-level risk education in five rural counties in North Carolina; distribute naloxone kits to rural, high-risk opioid users; and increase adoption of best practice policies on overdose prevention.

More than 12 million people in the U.S. misuse prescription opioids, according to the most recent data from the United States Department of Health and Human Services. The number of overdose deaths involving opioids in 2016 was five times higher than in 1999, according to the Centers for Disease Control and Prevention.

In 2010, drug overdoses overtook motor vehicle crashes to become the leading cause of injury death in North Carolina. An average of five people a day died from drug overdoses in North Carolina in 2016, according to the North Carolina State Center for Health Statistics.

“There’s no question that rural communities in North Carolina have been especially hit hard by this epidemic. There are far too many tragic stories of lives being lost and families bearing the burden,” said North Carolina Attorney General Josh Stein. “North Carolina Harm Reduction has been doing excellent work to confront these challenges. I am grateful to Aetna for supporting North Carolina Harm Reduction to save lives in North Carolina communities.”

The Aetna Foundation will be announcing grants to other organizations in additional states over the next several months as part of its mission of Building Healthy Communities by supporting locally-based programs, dynamic partnerships, and proven models that can help accelerate progress everywhere.

“For the first time in our history, our children’s generation is not expected to live as long as our own. That is due in large part to the epidemic of opioid abuse, which presents a clear and present threat to our communities and health care resources,” said Garth Graham, M.D., M.P.H, president of the Aetna Foundation and vice president of Community Health for Aetna. “The innovative work that the North Carolina Harm Reduction Coalition is doing on the ground is promising, and it’s our hope that it can also offer a road map for outreach in other rural communities.”

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Aetna Foundation Announces Latest Grant to Help Battle the Opioid Epidemic: Pennsylvania

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Aetna Executive Vice President and Chief Medical Officer Harold L. Paz, M.D., M.S., speaks at the Pennsylvania announcement.
Aetna Executive Vice President and Chief Medical Officer Harold L. Paz, M.D., M.S., speaks at the Pennsylvania announcement.

The Aetna Foundation announced the next step in its funding initiative to fight the ongoing opioid epidemic with a $1 million grant to the Pennsylvania Department of Health.

The grant is part of a $6 million commitment by the Aetna Foundation to combat the epidemic in states hardest hit by the crisis by funding state and local projects with the potential to make a real difference in addressing opioid-related challenges.

In Pennsylvania, the funds will turbo-charge the state’s innovative opioid dashboard, a collaborative project between the Pennsylvania Department of Health and the University of Pittsburgh. The dashboard is a comprehensive tool that will:

  • Offer responders across the state new evidence to make key decisions to best change the trajectory of the opioid epidemic.

  • Serve as a cross-sector bridge from experts across academia, the public and private sectors, and government agencies to provide real-time contextualized data.

  • Better facilitate a collaborative response to the opioid crisis in Pennsylvania and save more lives.

The official announcement took place on Tuesday, March 27 at the Capitol Media Center in Harrisburg. The event will include Hal Paz, M.D., Aetna’s executive vice president and chief medical officer and member of the Aetna Foundation Board of Directors, Pennsylvania Health Secretary Rachel Levine, M.D. and Department of Drug and Alcohol Programs Deputy Secretary Ellen DiDomenico, and Donald Burke, M.D., dean of the University of Pittsburgh Graduate School of Public Health.

“Solving the opioid crisis will take a collaborative, cross-sector effort. This data dashboard will fuel the work being done in Pennsylvania by bridging the strengths of the private, public and academic sectors to save more lives,” said Dr. Paz. “At Aetna, we’re encouraged by the work of the state of Pennsylvania to build a dashboard that will help inform decision making that will not only serve as a vital tool for Pennsylvanians, but can be replicated in other states deeply impacted by this epidemic.”

For more information on the announcement, visit the Department of Health media site.

In the United States, more than 42,000 individuals die every year from overdoses. That’s 116 people per day. In Pennsylvania alone, opioids claimed more than 27 lives for every 100,000 individuals in 2017. Pennsylvania Governor Tom Wolf has declared a statewide emergency, a declaration that accelerates access to information, including allowing the Commonwealth to collect more data on overdoses, neonatal abstinence syndrome and opioid prescriptions.

The grants complement Aetna’s efforts to fight the opioid crisis through integrated pharmacy, behavioral health and medical programs.

The Pennsylvania grant follows the initial grant which benefitted the North Carolina Harm Reduction Coalition and its “Rural Opioid Overdose Prevention Project.”

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Study Shows Longer Duration Predicts Higher Risk of Opioid Misuse and Abuse

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Aetna’s continuing work on helping combat the opioid epidemic includes a study suggesting the strength of the drug might not be the best predictor of misuse.

In a study coauthored with Harvard Bioinformatics, findings show that among surgery patients with no history of recent or chronic opioid use, there was a higher risk of misuse and abuse if they were taking the opioids for a longer duration. The study appeared in the January 2018 edition of BMJ and the research relied on insights derived from Aetna’s pharmacy and medical claims data.

“We hope this paper facilitates a change in culture among surgeons in how they manage post-operative pain,” said Dan Knecht, M.D., M.B.A, vice president and head of Clinical Strategy and Policy at Aetna.

The study is part of Aetna’s commitment to battling opioid misuse, which includes initiatives targeting super-prescribing clinicians and changing its policies to limit overprescribing and increase access to addiction treatment.

Hal L. Paz, M.D., M.S., executive vice president and chief medical officer at Aetna, recently discussed Aetna’s efforts in a PBS documentary called, “Understanding the Opioid Epidemic.” The documentary looks at the factors that led to the epidemic, its impact on the country and how it can be addressed.

Inappropriate prescribing and misuse and abuse of prescription drugs is a contributing factor to the epidemic. In a well-intentioned effort to more aggressively treat their patients’ pain, some physicians may have underestimated the dangers of dependence and abuse.

“Because of the addictive properties of these drugs and the fact that they are very effective in eliminating pain, the pendulum swung way out, but at a tremendous cost and in tragic ways,” Paz said. “We have to bring it back to the middle.”

Paz appears in Chapter 4 of the documentary, which you can watch below:

Empowering physicians to prescribe more responsibly

Paz emphasized Aetna’s role is not to “second-guess” physicians when they write a prescription for a narcotic. Instead, the health company analyzed data to identify prescribing patterns and shared this information to better inform physicians about their outlier status and empower them to prescribe more responsibly.

This led to an initiative in 2016, where Paz sent signed letters to nearly 1,000 doctors, who were identified as super-prescribers and were in the top 1 percent when it comes to refilling opioid prescriptions. The letters included guidelines and additional resources on appropriate prescribing.

“We expect that our physicians are going to be well-trained and they’re going to practice appropriately, professionally and ethically,” Paz said.

Aetna continued the super-prescriber initiative in 2017 by identifying 480 super-prescribing dentists and 249 super-prescribing oral surgeons in the U.S.

And the company also made changes to increase access to treatment. Aetna was the first national payer to waive copays for Narcan for its fully-insured commercial members after their deductible is met. The health company also limited the quantity of opioids prescribed for acute pain and post-surgery to a seven-day supply for its commercial pharmacy members, which aligns with the CDC guidelines as well as the above study.

Aetna also eliminated the pre-authorization requirements on all buprenorphine products, which are used to treat opioid addiction, in March.

Read more about Aetna’s five-year goals and its commitment to fighting the opioid epidemic.

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Medication-assisted treatment improving care for members with opioid use disorder

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As part of Aetna’s commitment to enhancing access to evidence-based addiction treatment options for its members, medication-assisted treatment (MAT) is available for those with opioid use disorder. MAT includes medications designed to help suppress cravings and lessen withdrawal symptoms, along with opportunities to seek additional support and help in the community.

According to a study published in the American Journal of Managed Care, people who don’t follow medication-assisted treatment are more likely to relapse. The June 2017 study, which Aetna participated in, was spurred by a separate study Aetna conducted in the 2010 that looked at 2,135 members and found medication-assisted treatment associated with lower utilization of services.

“For those individuals with opioid use disorder, the risk of dying has been shown to drop by more than half when treated with medication-assisted therapy,” said Dan Knecht, M.D., M.B.A, vice president and head of Clinical Strategy and Policy at Aetna. “This is the rationale behind why we are promoting its appropriate use in our opioid strategy.”

In 2017, Aetna announced its commitment to increase the percentage of Aetna members with opioid use disorder treated with medication-assisted therapy or other evidence-based treatment by 50 percent by 2022. Aetna also was one of the first insurers to end preauthorization requirements on all buprenorphine products, which is used to treat opioid addiction. The move (marked by the purple dotted line below) helped significantly increase access to these important treatments:

A graphic displaying how access to medication-assisted treatment (MAT) has increased for patients significantly since March 2017.

“We’re working to prevent misuse and abuse, intervene when we identify at-risk behavior and support those who are addicted through evidence-based treatments,” said Hal L. Paz, M.D., M.S., executive vice president and chief medical officer for Aetna. “Medication-assisted treatment can be extremely beneficial for individuals with opioid use disorder.”

Despite compelling evidence that MAT supports patients’ journeys to recovery, stigma exists. Additionally, the need for prescribers to obtain specific training and licensure before prescribing MAT has resulted in significant access challenges for many patients.

“We are working with various stakeholders in the health care ecosystem, including the  National Institutes of Drug Abuse, to educate providers about this program,” said Knecht.

Aetna’s Chief Medical Officer of Behavioral Health, Mark Friedlander, M.D., M.B.A., added that medication-assisted treatment is designed specifically to reduce cravings and the severity of withdrawal symptoms.

“People that use medication-assisted treatment as prescribed are not getting high and they’re not using it recreationally,” he explained.

The medication, Friedlander added, is just one component to medication-assisted treatment. Prescriptions are also paired with counseling and therapies, as well as access to support services personalized to each person.

Paz, Knecht and Friedlander agreed that if everyone works together they’re hopeful stakeholders can collectively help combat the ongoing crisis in the country, with MAT a cornerstone treatment for many with opioid use disorder.

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