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Opioid crisis plagues privately insured

August 05, 2016

A new study that analyzed claims from a large database of employer-sponsored health insurance plans found a striking 3,000% increase in opioid dependence between 2007 and 2014. It’s yet more evidence of the opioid crisis and its prevalence in middle-class demographic groups.

The findings can also be seen as a significant big-picture indicator, considering that private health insurance plans historically have covered 70% or more of the adult population, according to the Census Bureau.

FAIR Health, an independent, not-for-profit organization that manages the bank of insurer data, discovered steep growth trends in opioid-related diagnoses and overdose incidents as well as increases in the utilization of related treatment services. Lab tests, provider visits and other services increased from 217,000 claim entries in 2007 to about 7 million in 2014.

“The findings suggest that it may be an appropriate time for insurers to look at benefit design and to what extent that takes into account the type of treatments and services that have proven to be effective or show promise, so they can allow for a reimbursement model that will help to propel those treatments forward,” says FAIR Health President Robin Gelburd, JD.

Gelburd also says insurers might want to examine their networks and make sure they offer a sufficient number of providers that can deliver treatment for opioid-related disorders.

For their part, insurers’ efforts so far seem to be focused on reining in prescribers of opioid medications by encouraging more training and adherence to new voluntary guidelines. U.S. physicians wrote 240 million prescriptions for painkillers in 2014 alone, according to the Centers for Disease Control and Prevention.

“What’s needed is a focus on education to train physicians about how to do intakes and be sensitive to the types of symptoms that suggest a possible opioid-dependence issue so they can be more attentive to it,” Gelburd says. “They also need to educate the patient about risks associated with certain types of drugs.”

Young adults

FAIR Health data analysis also revealed what many in the behavioral health specialty already know instinctively: Opioid dependence is especially prevalent among 19- to 35-year-olds. From 2007 to 2014, 69% of the claim items containing the diagnosis of opioid dependence, as defined by DSM-IV criteria, were attributed to the young adult age group, followed by just over 10% of claims in the 36- to 45-year-old age group.

It’s worth noting that an Affordable Care Act provision that went into effect in late 2010 allows young adults up to age 26 to remain on their parents’ health insurance plans and caused an increase in private coverage for the age group. According to federal health officials, 4.5 million young adults gained coverage from late 2010 through 2014.

Stakeholders likely will be interested in looking into the variables that could be contributing to the trends FAIR Health uncovered in the claims data, Gelburd says.

In terms of gender-related patterns, the data revealed that women were more likely than men to experience opioid-related overdose, with women accounting for 53% of the overdose incidents and men accounting for 47%.  The gap could be attributed to women’s lower average body weight. However, women are also more likely than men to have chronic pain and to receive higher doses of pain medications, according to the report.

Men in all age groups outpace women in receiving a diagnosis of opioid dependence.

National attention

Gelburd says the national attention surrounding the opioid crisis has prompted lawmakers to create new initiatives, such as first-responder training on naloxone use, good Samaritan laws, and grants for improved veteran and prenatal care. But the programs are still relatively new, so the impact might not be evident for several years.

“At least it’s clear recognition that the status quo is no longer acceptable, and the best thinking has to be brought to bear,” she says.

FAIR Health used ICD-9-CM codes and DSM-IV to sift the deidentified claims data from 20 billion claims representing 150 million people. In the future, FAIR Health aims to look more closely at methadone programs, naloxone use and geographic hotspots.

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