Health insurers hold a treasure trove of information within their claims databases. It’s information more comprehensive and extensive than any behavioral health provider could churn out. On Wednesday, Cigna and the American Society of Addiction Medicine (ASAM) announced a big data project that will examine the insurer’s claims in the context of clinical performance measures for treating addiction.
According to experts, the project is significant because it’s the first to leverage insurance claims to look for evidence to identify addiction-treatment best practices.
Measuring outcomes is one thing, but the only way to truly drive best practices is to identify specific clinical actions that lead to optimal outcomes so those actions can be broadly implemented across all providers, says Corey Waller, who chairs ASAM’s performance measures committee. ASAM released physician measures in 2014 with the intent of validating them for real-world implementation.
“As we utilize Cigna’s very large data set across a large population, it allows us to have a better understanding of whether we can apply this to the population as a whole,” Waller says. “And that’s the big issue.”
Cigna is providing two years of deidentified claims data related to substance use disorders that will be distilled by researchers at Brandeis University. The insurer covers 15 million U.S. beneficiaries and manages behavioral healthcare for 25 million individuals.
In addition to ASAM benchmarks, Waller says cost ultimately must be a variable in the analysis to align it with the big-picture goal of a more value-based model of care delivery in the United States. Additionally, ASAM must consider the downstream consequences—intended and unintended—of implementing the recommended measures, and cost barriers could be among them.
“The goal is to identify those things that get you a better outcome with a lower amount of spend, and that’s what we want to help ASAM members do,” he says. “And we hope they collaborate on this instead of fight against it.”
Pay for value
Undoubtedly providers will question whether they eventually will be driven toward the best practices through forthcoming reimbursement models.
“If the measures are found to comport with better outcomes, then the short answer is yes, you will not get paid if you don’t do good work,” Waller says.
Doug Nemecek, Cigna chief medical officer for behavioral health, says the huge variation in addiction treatment care delivery across the country combined with the lack of standard quality measures make it difficult to assess the ultimate value of the services. He says sharing such data would also be important in the value equation.
“From a reimbursement standpoint, once we have nationally accepted standards around how to measure outcomes and quality, we will be able to move forward with substance use treatment providers toward new reimbursement models on value of care, not just volume,” Nemecek says.
Other medical specialties have long-established clinical benchmarks that are used in everyday practice. Cardiovascular disciplines, for example, measure patient blood pressure, cholesterol levels and other data to determine whether care plans are working and where new interventions are needed. The measures are transparent, meaning all stakeholders are aware of what is being measured and how.
Nemecek says the ASAM project can allow Cigna and the industry to use the validated measures to transparently share data on quality of care and drive the evolution of treatment programs.
“Substance use treatment is years behind traditional medical treatment in terms of our ability to understand and measure outcomes of care to demonstrate quality,” he says. “And we need to start moving substance use treatment in that direction and make sure the care and the treatment programs are following along and providing evidence-based care, and we’re able to measure that.”
Waller believes 50% of providers today are already following best practices.
Cigna is also working on other efforts to address addiction, such as supporting the Shatterproof foundation with a $100,000 grant that was awarded late last year as well as encouraging greater use of prescription drug monitoring databases and new guidelines for opioid prescribers.
“Opioid addiction is a silent killer that is not so silent anymore,” said David Cordani, president and CEO of Cigna, speaking separately on Wednesday at a Washington Post addiction roundtable, where he highlighted the ASAM project and other efforts by the insurer to address addiction.