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Exploring innovative alternatives to pain management

Health care organizations across the country are grappling with the staggering cost of opioid addiction. In 2012, the cost of inpatient hospitalizations related to opioid abuse reached $15 billion. Three out of four Americans who are addicted to heroin were introduced to opioids through prescription drugs taken for pain. Many patients who leave the emergency department with opioid prescriptions risk becoming dependent.

Some hospitals are taking innovative approaches to pain management. At St. Joseph’s Regional Medical Center’s emergency department, one of the busiest in the US with about 170,000 patients per year, physicians are trying alternative pain therapies before resorting to opioids. Alternative methods include nonnarcotic infusions and injections, ultrasound guided nerve blocks, laughing gas, and energy healing. In certain emergencies, opioids are the preferred treatment.

At Geisinger Health System in Pennsylvania, a team of researchers analyzed the EHRs of more than 2,000 patients admitted to the hospital for overdoses over a 10 year period to identify factors affecting patient outcomes, including death. Results showed that history of previous addiction, mental illness, and comorbidities were associated with adverse overdose outcomes. Patients who were married and had private health insurance tended to have more positive outcomes. These kinds of studies suggest there are opportunities for identifying patients at-risk for overdosing.

In Canada, where nearly 13 percent of patients are on opioids for chronic pain, Toronto General Hospital is also developing and testing innovative strategies, particularly focused on transitioning patients who have had surgery off of opioids. The alternatives to opioids the hospital is trying include combinations of physiotherapy, meditation, acupuncture, and counseling. The transitional pain service has seen approximately 400 patients since its inception two years ago, and other hospitals have expressed interest in pursuing similar programs.

Many health plans also recognize they can help address this crisis. Blue Cross Blue Shield of Massachusetts created a Pain Medication Safety Program that requires prior authorizations for short and long-acting opioid prescriptions and imposes checks and balances between physicians and pharmacists to identify and curb multiple prescriptions. Cigna is partnering with the American Society of Addiction Medicine to analyze two years of de-identified claims to develop standardized metrics, baseline measures, and opioid use goals. Other health plan strategies include using algorithms to track where and how often members fill opioid prescriptions and using social workers to support high-risk members.

Analysis: Individuals with chronic pain are also at increased risk for long-term exposure to and dependency on pain medications. Similar to addiction treatment and recovery, the solutions to this complex problem may require innovative strategies from many different health care stakeholders. In “Collaboration at every level: Solving the country’s opioid crisis,” Deloitte’s US Public Sector Leader Mark Price called for coordination across the ecosystem – from state and federal government agencies to health plans, health care providers, and life sciences companies. For states, Medicaid programs can play a role in improving service delivery; and federal health agencies can collaborate on surveillance and guidelines. Hospitals are on the front lines of patient care and developing programs like those described above to address this crisis.

Jan Hoffman, “An E.R. kicks the habit of opioids for pain,” New York Times
June 10, 2016; Beth Haynes, “ASAM collaboration with Brandeis and Cigna tests addiction treatment performance measures,” ASAM Magazine, May 3, 2016; Geisinger Health System, “Geisinger researchers profile overdose patients and predictors of death,” Geisinger Health News, June 2, 2016

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Author bio

Doug leads Deloitte Consulting LLP’s Life Sciences and Health Care practice. With 24 years of experience, he works closely with multiple top health care organizations on major clinical and enterprise transformation efforts and on large-scale technology implementation projects. Doug has extensive experience in comprehensive quality and patient safety transformations, turnaround and performance improvement in academic medical centers as well as organization/workflow redesign and technology enablement. He has served as the lead on a number of enterprise transformation initiatives with some of Deloitte’s most largest and most complex clients.