To calculate trends in adult average days' supply for six commonly prescribed opioids: hydrocodone, hydromorphone, morphine, oxycodone, oxymorphone, and tapentadol to assess whether physicians ...changed prescribing practices at the time of the intensifying epidemic.
We used 2005–2015 Truven Health MarketScan Commercial Claims and Encounters data to measure trends in opioid average days' supply among commercially insured individuals and 2005–2014 MarketScan Multi-State Medicaid data to measure trends in opioid average days' supply among Medicaid beneficiaries.
For Medicaid, we found an increase in days' supply for all drugs except morphine. The largest percentage increase was for oxycodone, which increased 4.5days (37%). Opioid days' supply for individuals with commercial insurance exhibited similar but steeper trends. The largest increase was also for oxycodone, which increased 6days (56%). Between 2013 and 2015, when the opioid epidemic had begun to be widely publicized, there was no decline in the median days supplied for any of the opioids.
Our results find that days' supply of opioids are increasing despite public health campaigns and media attention on the risks of opioid prescribing. More effective interventions to curb opioid prescribing are needed to reverse these trends.
•We examined trends in average days' supply of opioid medications for Medicaid and commercially insured population.•Average days' supply for all drugs except morphine increased for both Medicaid and commercially insured population.•More outreach education is needed to convince providers that opioids should be prescribed cautiously.
If opioid analgesics are prescribed and used inappropriately, they can lead to addiction and other adverse effects. In this study, we (1) examine factors associated with potentially problematic ...opioid prescriptions and (2) quantify the link between potentially problematic prescriptions and the development of opioid use disorder. We found that older age; female sex; having back pain, arthritis, or migraine; hydrocodone prescription; previous pharmacotherapy for opioid use disorder; and frequent emergency department use were associated with problematic prescriptions among individuals with Medicaid and private insurance. Patients with commercial insurance and Medicaid who had potentially problematic opioid prescriptions were eight and three times more likely, respectively, to develop an opioid use disorder than patients without potentially problematic opioid prescriptions. Our findings help identify factors associated with problematic prescriptions and underscore the importance of targeted public health interventions.
•Private insurance enrollees with problematic opioid prescription were eight times more likely to develop OUD.•Medicaid enrollees with problematic opioid prescription were three times more likely to develop OUD.•Health plan, ED visits, mental health diagnosis associated with problematic opioid prescription: private insurance enrollees.•Non-Hispanic White, ED visits, mental health diagnosis associated with problematic opioid prescription: Medicaid enrollees.
Some states have adopted Accountable Care Organization (ACO) models to transform their Medicaid programs, but little is known about their impact on health care outcomes and costs. Medicaid ACOs are ...uniquely positioned to improve childbirth outcomes because of the number of births covered by Medicaid. Using Healthcare Cost and Utilization Project hospital data, we examined the relationship between ACO adoption and (a) neonatal and maternal outcomes, and (b) cost per birth. We compared outcomes in states that have adopted ACO models in their Medicaid programs with adjacent states without ACO models. Implementation of Medicaid ACOs was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates. Results varied by state. We found no association between Medicaid ACOs and several birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization, and severe maternal morbidity. Improving these outcomes may require more time or targeted interventions.
Objective:Opioid analgesics can be safe and effective when used properly. Reducing prescriptions that increase adverse outcomes is a focus for addressing the opioid crisis. In this study, the rate of ...potentially problematic opioid prescriptions was examined over 11 years in a large sample of U.S. patients.Methods:Claims from the IBM MarketScan commercial database (about 45 million) and multistate Medicaid database (about 7 million) from 2005 to 2015 were used to calculate rates of the following potentially problematic prescription practices: prescriptions for high-dose opioids for 90 days or more, prescriptions from multiple providers, prescriptions of long-acting or extended-release opioids for acute pain, overlap between prescriptions for opioids, and overlap between prescriptions for opioids and benzodiazepines.Results:Among patients with an opioid prescription, about 8% of those with private insurance and about 14% of those with Medicaid coverage had at least two incidents of potentially problematic prescriptions per year. Over the study period, rates increased for some practices (opioid-benzodiazepine overlap) and decreased for others (prescriptions from multiple providers). Receipt of potentially problematic prescriptions was higher among older patients, female patients with private insurance, and whites and male patients covered by Medicaid.Conclusions:A significant percentage of patients who are prescribed opioids experience problematic prescription practices. Targeted policy and clinical interventions that reduce potentially problematic prescription could be a focus for addressing the U.S. opioid crisis.
The aim of the study was to develop tools that quantify employers' investment in building cultures of health (COH)-inside and outside company walls.
Two COH instruments were developed through ...literature reviews and expert consultation. The first focused on internal culture of health (COH-INT), that is, programs, policies, and attributes of the physical and social environments that support employees' health and well-being. The second focused on external culture of health (COH-EXT), that is, programs, policies, and environmental supports that promote communities' health. We administered these tools to 32 employers and examined instrument reliability, distribution of scores, and correlation between the two instruments.
Both tools demonstrated adequate reliability. COH-EXT scores changed minimally over the 3-year study timeframe. There was little correlation between the COH-INT and COH-EXT scores.
More research is needed to further develop and validate COH-EXT instruments.
Objective: To evaluate the relationship between critical factors for successful worksite health promotion programs such as management support and program implementation and health care costs at PPG ...Industries. Methods: We analyzed survey data from 37 PPG worksites measuring management support and program implementation. We estimated the relationship between management and implementation scores in 2007 and subsequent health care costs in 2008 using ordinary least squares regression. Results: High program implementation scores were associated with higher health care costs (P < 0.01) as were high management scores (P < 0.05). However, sites with a combination of high management and implementation scores had lower health care costs, while sites with low scores on these dimensions had higher cost trends. Conclusions: Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.
BACKGROUND:Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover ...effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth.
OBJECTIVE:This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA.
METHODS:Primary data sources were 2005–2014 Health Care Cost and Utilization Project hospital data and 2004–2013 Centers for Medicare & Medicaid Services enrollment data. County-year-level regression analysis with fixed effects examined the relationship between Medicare managed care penetration and hospital cost per enrollee. We decomposed results into changes in utilization, severity, and severity-adjusted inpatient resource use. Analyses were stratified by whether the admission was urgent or nonurgent.
PRINCIPAL FINDINGS:A 10% increase in MA penetration was associated with a 3-percentage point decrease in inpatient cost per Medicare enrollee before the ACA. This effect was more prominent in nonurgent admissions and diminished after the ACA.
CONCLUSIONS:Results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. We did not observe a strong relationship between MA enrollment and inpatient days per enrollee. Future research should examine whether spillover effects still are observed in outpatient settings.
It is recognized that family members are a major source of diverted opioids. Yet it is not known how family member opioid prescriptions predict the development of an opioid use disorder (OUD).We ...conducted an observational study using commercial health care claims to investigate the association between a family member opioid prescription and an individual having an OUD-related claim in a large sample of patients with commercial insurance. We found that individuals had higher odds of having an OUD when a family member had an opioid prescription. This effect was magnified in spouses and employees compared with adolescents and young adult dependents. In addition, adult dependents with a pre-existing non-OUD substance use disorder had higher odds of having an OUD when a family member also had an opioid prescription. Given the high risk of opioid-related morbidity and mortality, more attention should be given to safeguard opioid diversion and to facilitate appropriate disposal of unused opioids.
•Having a family member with an opioid Rx increased odds of opioid addiction.•Effect was greater in spouses and employees than in adolescents.•Effect was greater in adults with pre-existing non-OUD substance use disorder.
Context: Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the ...existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods: Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings: Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse care management and registries were largely retained. Greater proportions of baseline Medicaid practice revenue (incidence rate ratio IRR = 1.44, p < 0.001) and increasing proportions of revenue from Medicaid (IRR = 1.02, p < 0.05) were associated with greater CMP exnovation by physician organizations on net. Practices with greater expansion of HIT functionality exnovated fewer CMPs (IRR = 0.91, p < 0.001) compared to practices with less expansion of HIT functionality. Conclusions: Exnovation of CMPs is an important reason why the population-level adoption of CMPs by physician organizations has remained low. Expanded HIT functions and changes to Medicaid reimbursement and incentives may aid the retention of CMPs by physician organizations.
PDF
