Finding Signs of Opioid Abuse in Your Benefits Data

How do employers find those whose care needs aren’t being met? In this case study, we’ll take a look at how one employer used the Artemis Platform to find and support those suffering from opioid abuse.

Artemis Health helped one customer identify signs of opioid abuse in their population. They wanted to see how many members might be “ doctor shopping,” or seeking prescriptions from multiple providers. They also wanted to see if some office locations were more prone to opioid abuse than others.

Opioid abuse affects an estimated 2M Americans. Over 20k people died from prescription pain killer overdoses in 2015.

The challenge.

Patients use opioids safely and legitimately for pain management, but how do you track opioid abuse, not just normal use?

This is where experts weigh in. Artemis Health Chief Clinical Officer Rance Hutchings, Pharm.D., helped our team analyze the “morphine milligram equivalent” dosages of patients being prescribed opioids. This helps us determine which de-identified members are at risk for addiction and overdose.

2x the risk: The Centers of Disease Control and Prevention has identified 50 morphine milligram equivalents (MME) per day as a threshold for concern. Dosages at or above 50 MME per day increase the risk for overdose by 2x the risk at dosages under 20 MME per day.

The solution.

The Artemis Platform integrates data from multiple feeds and allows users to see results with clear visualizations. This is unique in the industry. For this client, we looked at prescription claims data from multiple angles to get a sense for the scope of opioid abuse in their population.

01  Artemis identified “doctor-shopping” behavior. We looked at “polyprovider” members, those who received opioid prescriptions from 7 or more different prescribers. We compared this against these members’ health plans and the employer’s office locations.

02   Artemis explored pharmacy shopping. Next, we analyzed members who received prescriptions from multiple pharmacies (3 or more). Again, we aligned this information with health plans and office locations.

03   Artemis calculated MMEs. Using the CDC’s 50 MME or above metric, we found which members were taking dangerous doses of opioids. In this population, nearly 600 members were exceeding this dosage.

The results?

The findings showed that this employee population includes hundreds of people (daily average over 90 MME) who could benefit from a pain management program or doctor. While only 15 members in this data were shown to be doctor shopping or pharmacy shopping, the vast majority are using just one of the company’s health plan options.

Tip: Artemis customers are very concerned with patient privacy, and all our data is de-identified. We track office locations and health plans so benefit teams can target and deliver communications about pain management programs or drug abuse benefits through the carrier.

Armed with this information, the employer is changing their plan design. They are looking at three main changes:

01   Implementing a new program that caps fill days for opioid prescriptions

02   Considering capping morphine equivalents

03   Rolling out a richer pain management benefit