Magazine article Behavioral Healthcare Executive

Blue Cross Health Plans Collaborate on Opioid Protocols

Magazine article Behavioral Healthcare Executive

Blue Cross Health Plans Collaborate on Opioid Protocols

Article excerpt

There are 36 health insurers that comprise the national Blue Cross Blue Shield Assn., and every one of them has encountered the costs of today's opioid crisis. To respond, the Blue plans have created a new executive committee to identify best practices in prevention and risk reduction.

According to Kim Holland, vice president of state affairs for the association, the committee includes clinicians, chief medical officers, fraud experts, governmental affairs leaders and pharmacy leaders from the Blue plans. The insurers are implementing programs in their respective territories to manage members with addictions.

"What this committee is going to do is bring together those people who have knowledge about those programs to talk about them and explore ways that they collectively can establish best practices for our systems, which can be executed by every plan," says Holland.

For example, Blue Cross Blue Shield of Massachusetts (BCBSMA) tracks prescriptions filled by its members and identifies when a single member is obtaining multiple opioid prescriptions. As part of the process, the BCBSMA medical director initiates phone calls to the members' prescribing physicians to alert them to the red flags and to reinforce prescriber education.

"Our objective is to prevent addiction from prescription opioids," Holland says. "We know this is a complicated issue, and there are many moving parts to it."

She says the Blue plans can provide resources to consumers and healthcare providers to help them take preventive action, but "Blue plans have no illusion that they can stop opioid addiction." Likewise, the committee is not going to examine or establish any standards for treatment of addiction specifically.

Case management

Sarahlee Browning, LICSW, the behavioral health operations leader for BCBSMA, says some of the local detox facilities in Massachusetts can refer their patients, who are members of the health plan, to BCBSMA's case management services. …

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