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Diana J. Haniak, BAPractice Integration Advisor
Quality Insights Quality Innovation Network
June 17, 2019
Quality Insights’ Special Innovation Project (SIP): Opioid Misuse and Diversion
Special Innovation Projects• SIP 1- Reducing Opioid Misuse and Diversion
– This project is a statewide effort in all five of Quality Insights’ Quality Innovation Network states
• Focusing on physicians/practices recruited for all current initiatives
• Original project ran from September 2016-2018– Extension granted September 2018-September 2019– More intensive technical assistance for 5% of high
prescribers in each state
Opioid Prescribing Patterns:National vs. New Jersey
Beneficiaries with MME>=50 CY2013
Beneficiaries with MME>=50 CY2017
Provider Education• Promote CDC Guidelines
– Opioids are not first line of therapy – Lowest Dose First– Avoid benzo/opioid concurrent prescribing– NJ PMP
• Promote Annual Wellness Visit – Tool for OUD screening
• New Jersey Opioid Law• Medicare Part D opioid policies• Expand MAT (DATA 2000 Waiver)• Reduce stigma associated with Naloxone
– Pharmacy Policy
National Naloxone Use• A CMS analysis of Medicare Part D claims showed that
amongst 4 million high-risk Medicare FFS beneficiaries on opioids, less than 1% filled an Rx for naloxone*
• Expanded access programs make assessing the accuracy of this statistic difficult; however, there is room for improvement
• Does your facility keep naloxone in emergency boxes?• If a patient is prescribed high doses of opioids (>50 MME –
morphine mg equivalents/day), is an Rx for naloxone and patient education also provided?
• Pharmacies – do you offer naloxone to high risk patients?• Providers – do you co-prescribe naloxone with high-dose
opioid prescriptions?*CY 2017 analysis of FFS beneficiaries with Part D considered to be “HRM” beneficiaries – 3 or more chronic meds plus chronic opioid
Co-prescribing of naloxone with high-dose opioid prescriptions
Opioid SIP: Extension • Reduce opioid prescribing by:
– Focusing on a minimum of five percent (5%) of primary care providers in each state
– Identifying a group of primary care providers who are low prescribers of opioids
– Providing outreach and technical assistance to high prescribers of opioids will include review of Opioid Prescription Utilization Reports, current practices for prescribing opioids, root cause analysis and, whenever feasible, small tests of change using the Plan Do Study Act (PDSA) cycle for self-reported data from clinician’s electronic health record.
Opioid SIP: Data Measures to Consider• Opioid use statistics
– Number of beneficiaries who filled an opioid prescription/number of beneficiaries continuously enrolled
• Opioid prescriptions from multiple providers – Number of beneficiaries who filled an opioid prescription from
multiple providers/number of beneficiaries continuously enrolled with at least one prescription for an opioid
• Opioid prescriptions filled concurrently (overlapping)– Number of beneficiaries with concurrent opioid prescriptions/
number of beneficiaries continuously enrolled with at least one prescription for an opioid (7 day lag)
Sample Report • Reports for providers• Data reports utilizing
Medicare Part D claims– Identify “high
prescribers”
Opioid SIP: Available Resources• QPP alignment document• Practice Change Package
(PCP)• Patient education flyer
– “Not Just a Pill”– Powtoon: Slippery Slope of Opioid Use– https://www.youtube.com/watch?v=XRFvTfGEfe8
Developing Resources and Participation• Collaboration with local School of Pharmacy to develop a
prescribing pocket card– Card will have legislative requirements for acute prescriptions
on one side – On the reverse will be legislative requirements for chronic
prescriptions– Each state will have their individual care
• Continue to collaborate and coordinate our efforts with other initiatives – Are you a provider or systems that is interested in participating?
Does anyone have an idea of a provider that may be interested in participating?
Success in the Practice Setting • Implementation of electronic prescriptions for
controlled substances (EPCS) within electronic health records– Self-policing – Promote transparency to drive change
• Alignment with commercial insurance programs– Work with Opioid Task Force (already in place) – Target prescribers identified by both
• Community organization – Partnered with community coalition in order to bring a
sense of “home town” resources
Next Steps: CMS Broad Goals• Reduce opioid overdose death
– 7% nationally• Reduce opioid prescribing
– 12.5% acute and specialty hospital settings– 10% outpatient facilities
• Decrease opioid adverse drug events (ADEs), including death– 7%
• Implement pain and opioid best practices– Target 20% US population
• Increase access to behavioral health– 15.7% increase in access
Thank YouDiana J. Haniak, BAPractice Integration AdvisorQuality Insights Quality Innovation Network [email protected]
Connect with Quality Insights Quality Innovation Network on social media.
This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI-SIP12016-061319