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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Fighting the Opioid Epidemic in Human Terms

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The opioid epidemic is affecting people in all walks of life and in every community across the nation. Learn how CVS Health–Aetna is helping to support its members by increasing access to non-opioid pain treatment, reducing inappropriate opioid prescribing, and increasing the use of effective medications to treat opioid use disorder.

Read more about our progress in fight against opioid misuse and abuse.

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Aetna Sees Progress on Its Five-Year Plan to Fight Opioid Addiction

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Aetna’s ambitious five-year plan to fight opioid addiction through a three-pronged strategy of prevention, intervention and support is making an impact for members who struggle with opioid use disorder (OUD) as well as those who are seeking better ways to manage chronic and acute pain.

“We are committed to finding innovative solutions that address the impact of OUD for our members and their loved ones,” said Daniel Knecht, M.D., M.B.A., VP of Clinical Strategy and Policy at Aetna, a CVS Health business. “And that means developing programs and approaches that help our members manage pain with safe, appropriate treatment.”

Aetna’s five-year goals, aimed for achievement by 2022, include:

  1. Reducing inappropriate opioid prescribing to members by 50 percent,

  2. Increasing the rate of Aetna members with chronic pain who are treated by an evidence-based, multi-modal approach by 50 percent, and

  3. Increasing the rate of members with opioid use disorder (OUD) who are treated with medication-assisted therapy (MAT) and other evidence-based treatments by 50 percent

Guardian Angel Program Offers a Lifeline

While it’s important to track data, Aetna is committed to combatting opioid addiction on human terms by creating a support system for people stricken by this condition. Aetna launched a first-of-its-kind Guardian Angel program in 2018 to offer support to people who have recently suffered an opioid overdose.

“When a person survives an overdose, they are especially susceptible to a subsequent overdose. But they’re also very open to healthy change at the same time,” said Jeff Balek, LCPC, CADC, Guardian Angel Team Clinical Team Lead. “That creates an opening for a clinician to reach out, allowing the person to take their first step toward recovery.”

Balek noted that the people he’s worked with appreciate having a support system to navigate tasks like finding appropriate treatment and community resources and making appointments.

“These members are usually feeling scared, alone and discouraged,” he said. “Just like any other disease with high rates of mortality, the focus needs to be on promoting and assisting these individuals into lifesaving treatment.”

Aetna Foundation Grants Reach into Communities

The Aetna Foundation’s pledge of $6 million in state-based grants provides support for state government agencies, hospital associations and grassroots organizations in North Carolina, Pennsylvania and Florida in their efforts to combat addiction in local communities. Additional grants are planned for 2019.

“One thing that is abundantly clear is that there is no one singular playbook for combatting opioid addiction,” said Garth Graham, M.D., President of the Aetna Foundation. “We have to look at every constituency as a valuable asset in the fight.”

Support for first responders—through the donation of thousands of Narcan kits in several communities especially hard-hit by addiction—was an important part of Aetna’s strategy in 2018. Aetna’s Office of the Chief Medical Officer also provided education for these groups on the front-lines in identifying and treating an overdose. Narcan nasal spray, a formulation of the life-saving drug naloxone, reverses the effects of an opioid overdose and is administered easily by first responders in the field.

Leveraging the Strengths of CVS Health-Aetna

Looking forward, the combined resources and capabilities of Aetna and CVS Health will be brought to bear on this critical issue, building on the progress already made. CVS Health has been recognized for its work to address OUD with comprehensive pharmacy care, including:

  • Increasing access to safe medication disposal by installing thousands of disposal units in CVS Pharmacy locations and community-based law enforcement offices across the country,

  • Establishing a standing order to dispense naloxone to CVS Pharmacy patients without an individual prescription in 48 states, and

  • Educating hundreds of thousands of students and parents across the U.S. about the safe use of opioids through its Pharmacists Teach program.

Click here to read more about how Aetna is tackling opioid addiction, and stay tuned for more on Aetna and CVS Health’s combined strategy to continue the fight against opioid addiction.

Goal progress shown represents percent change between June 2017 and June 2018.

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Innovative, meaningful solutions to the national opioid epidemic

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Aetna is highlighting National Patient Safety Awareness Week (March 10 to 16) to support our goal of keeping members healthy, which includes our clinical and behavioral health teams working together to combat the opioid epidemic.

Scroll down for an interactive infographic highlighting Aetna’s commitment to fighting the opioid epidemic:

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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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A Lifeline for Members Who Recently Survived an Overdose

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The statistics are staggering: More than 70,000 people died in the U.S. in 2017 from drug overdoses, and emergency department (ED) visits for opioid overdoses rose 30 percent in all parts of the U.S. from July 2016 to September 2017.https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#one

The lesser-known story is what happens to those who survive an overdose… the individuals who are at highest risk for a subsequent fatal overdose.

The emotional aftereffects of an overdose—guilt, anger and anxiety—are often compounded by the lack of resources and assistance survivors may find upon returning to the responsibilities of daily life.

Aetna’s Guardian Angel program works to close this gap, using claims data to identify members who have recently been admitted to the ED following a non-fatal opioid-related overdose. Once a member is identified, a clinician who specializes in addiction recovery calls the member to connect him or her with evidence-based treatment and provide education on community support and resources.

Guardian Angel Clinical Lead Jeff Balek, LCPC, CADC, focuses on connection and empathy in his outreach to members who have suffered an opioid-related overdose.

Finding a Path to Recovery

“The care delivered in an ED is really focused on ensuring that you remain alive,” said Jeff Balek, LCPC, CADC, clinical team lead for the program, noting that most post-revival ED stays only last about four to six hours. “Patients who survive an overdose then often receive messages from providers asking why they’re harming themselves in this way and urging them to stop. However, they aren’t typically given actionable information about obtaining treatment. Having a near-death experience is incredibly traumatic, and survivors and their families need help.”

That’s where the Guardian Angels come in. Launched in 2018 as a pilot, the program grew out of a call-to-action after Aetna claims data revealed hundreds of ED visits each month related to opioid-related overdoses. Today, this unique program has connected with and helped more than 600 members and their families to find a pathway out of opioid addiction and toward lasting recovery.

“Our data revealed that there were significant gaps in care for many members who had survived an overdose. We noticed patients would be treated in the ED and discharged with minimal ongoing support,” said Daniel Knecht, M.D., vice president of health strategy and innovation for Aetna, a CVS Health company. “We felt this was a critical opportunity to step in with support to help our members heal at a vulnerable time during which they may be most receptive to accepting help.”

Although first responders and ED personnel often use Narcan (naloxone) to reverse an overdose, the antidote is just the first step of a long journey to recovery, Knecht noted. Through the Guardian Angel program, Aetna works with its provider partners to ensure members have access to coordinated, longitudinal care as well.

The program is part of a three-pronged strategy Aetna launched in 2016 to provide better prevention, intervention and support for members struggling with opioid use disorder (OUD). The Angels’ clinical expertise in substance use dependency and the personal connections they make with members differentiate the program.

A Safe Space to Connect

“A key piece of our success is the active outreach Angels do. Often, they make up to eight calls just to be able to connect with the member,” said Jennifer Johnson, senior director of program management, adding that the program has a high engagement rate of around 50 percent. “This program is designed to allow us to build trust and let members know we’re supporting them.”

Guardian Angel Ramona Zarate, LCPC, CADC, shared that she uses her clinical judgment to assess how ready a member is to begin the process of recovery. “Talking about substance use is difficult,” she said. “It’s important to give the person a safe space to discuss their experiences, their fears and their hopes for the future.”

Zarate added that if a member is willing and motivated to get treatment, the Guardian Angels then focus on finding in-network providers who offer medication-assisted treatment (MAT), educating on appropriate alternatives to opioids for pain management and even scheduling provider appointments.

The success of the Guardian Angel program hinges on meeting members where they are in their battle with addiction and readiness for recovery, according to Balek.

“I am interested in establishing a relationship with this person and humanizing his or her experience,” he said. “If someone is in distress, I’m going to be right there to empathize with what’s causing stress. Eventually, we’ll get to the ‘why’ behind the opioid use. And that’s where the real healing can begin.”

The outreaches have helped hundreds of members to be treated with MAT, reconnect with family members, get jobs, live independently and reclaim their lives.

Despite the successes, Balek notes that tremendous progress remains in tackling the stigma people with OUD often face. “When I reach out to someone, my focus is on finding a way to connect with the person behind the label,” he said. “As a society, we need to remember that these are good people who just need a helping hand… and this program will go a long way toward chipping away at this mountain of a problem our country is facing.”

Editor’s note: Aetna’s parent company CVS Health also has made an enterprise-wide commitment to help address prescription OUD 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, 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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