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FHC President John Freedman: The Health Crisis that Didn’t Go Away (WV Gazette-Mail)

President, Freedman HealthCare, LLC

John, principal of Freedman HealthCare LLC, has 25 years of experience in performance measurement & improvement, health IT, care delivery, and health care reform. At FHC he has helped many states create all-payer claims databases, implement health insurance exchanges, and support health care transformation.

This Op-Ed was originally published in the Charleston Gazette-Mail.

Even in the midst of the COVID-19 pandemic and worldwide lockdowns, the opioid epidemic is raging unabated. According to the U.S. Centers for Disease Control and Prevention, since 1999, nearly 850,000 people in the United States have died from drug overdoses. About 500,000 of those deaths are related to opioids.

In 2020, in the middle of lockdowns and quarantines in states nationwide, the CDC reported 81,000 opioid overdose deaths in the 12 months ending in May — the highest ever recorded in a 12-month period.

And while we are seeing the light at the end of the tunnel with regard to COVID-19, thanks to the rapid development and rollout of multiple vaccines, there is no solution yet in sight for the opioid epidemic.

In fact, the CDC estimates that the economic burden of the opioid epidemic in the United States is an estimated $78.5 billion per year in health care costs, lost productivity, addiction treatment and criminal justice involvement.

The Department of Health and Human Services and the National Institutes of Health have declared the opioid epidemic a public health crisis and have outlined a response strategy that includes strengthening our understanding of the epidemic through better public health surveillance.

One of the tools that states should consider for collecting this critical data is All-Payer Claims Databases. These are state databases that collect and aggregate health care claims from public and private payer sources, including Medicare, Medicaid and private insurers. The data is culled from medical claims, pharmacy claims, dental claims, and eligibility and provider files, and can be used to identify pockets and prevalence of opioid abuse.

Some states have already begun taking advantage of this resource. In Colorado, for example, the Center for Improving Value in Health Care, which manages Colorado’s all-payer claims database, was able to show that nearly 80% of patients who received a prescription for Subsys, an opioid prescription specific for cancer patients, did not have a cancer diagnosis.

In Rhode Island, health researchers used Claims Database information to assess recent progress in the state toward the goal of expanding access to medication-assisted treatment for opioid use disorder.

Virginia, Utah and Minnesota have all used data from these systems to better understand and address trends in the epidemic, including which health conditions are most likely to result in a physician prescribing opioids. The Minnesota Department of Health produced a detailed report of its findings, noting, “Research using the MN APCD can be a valuable contribution, because of its unique ability to examine the interaction of medical diagnosis, health care service use, health care access and health care providers over time. Upcoming research, in which we extend work developed for state health care program populations to a broader Minnesota population to define and describe the transition of patients who become new chronic opioid users, will be one such contribution.”

Not every state has such a database. Currently, approximately half of the U.S. states have them, although several more are in the process of passing legislation or exploring options to establish one.

West Virginia, which leads the country in opioid prescription rates and opioid deaths, is one of the states that has not yet established such a database. After passing authorizing legislation in 2011 and investing $200,000 in its development, the state put the project on hold in 2017.

In October, the federal government is releasing $2.5 million in grant funding per state to help states launch or expand their databases. States can take advantage of this important infusion of dollars to expand their data resources and provide much-needed transparency into those who are most likely to be prescribed opioids, thus informing policy and practice to curb this epidemic.

Let’s not lose sight of the toll this epidemic is taking across West Virginia and across our nation. We must all pledge to marshal the resources and data needed to stop opioid abuse before it occurs.

This op-ed has been amended to properly reflect the number of opioid-related overdose deaths since 1999.


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