It’s no secret that the United States is experiencing an epidemic of addiction, owing in no small measure to opioid-based drugs, which are widely used and among the most addictive there are.
Opioid-based pain medications have, for years, been prescribed for pain and readily available – both legally and illegally. Optima Health has recently implemented a new program aimed at reducing addiction and finding ways to offer pain management without prescribing habit forming opioid-based drugs.
The Patient Utilization Management and Safety program is designed to make sure Optima members are getting proper care, and to make sure they use services safely and efficiently.
“It’s designed to coordinate care for members by reducing the number of pharmacies or providers they are using,” said Teresa Carpenter, PharmD, Optima Health clinical pharmacist. “This helps reduce duplicate therapies and the likelihood of drug interactions and/or overdoses.”
The goal of the PUMS program is safe and effective use of services through coordination of care for Optima members and to promote positive health outcomes, said Moriah Everhart, Optima Health manager, Integrated Care Management, Clinical Care Services.
“The integrated care team collaborates with members and providers to prevent overdoses and drug interactions, and to promote healthy prescribing practices,” she added.
Per Centers for Disease Control and Prevention guidelines, nonpharmacologic therapy and non-opioid therapy are preferred for chronic pain, and Optima Health abides by these guidelines, Carpenter said.
“Opioids are not first-line or routine therapy for chronic pain,” she said.
Non-opioid pain relievers are available to Optima members without prior authorization, Carpenter said. They include non-opioid pain relievers such as Lidocaine patches, Capsaicin topical gel, Gabapentin and more.
In their Annual Report for 2017, Optima reported an 11.3 percent reduction in total opioid users across their service areas and 26.5 percent fewer opioid claims paid by the system.
The ARTS program
Optima also established a program called Addiction Recovery Treatment Services, or ARTS, which helps Optima members who may already have addiction issues.
“As a provider of managed care for Virginia Medicaid, Optima Health helps its members who are suffering from addiction and who are ready to seek treatment by ensuring they have access to credentialed treatment services within 24 hours of first contact, through the ARTS program,” Everhart said.
Before ARTS was implemented in April 2017 by the Virginia Department of Medical Assistance Services, Everhart said it was difficult for Medicaid recipients to access the life-saving treatment they needed to recover from substance use disorders.
They faced very long waiting periods to access treatment, limited options for quality treatment providers, and a lack of covered services.
“These barriers, coupled with the debilitating effects of the disease of addiction for both the member and their family, dramatically decreased the chances for recovery,” she said.
Optima members who are interested in either of the programs should speak with member services.
