Employer Resource Center to Take on the Opioid Crisis

Employers focused on both good citizenship and a solid bottom line are making a difference

Overwhelmingly, those suffering from opioid overuse disorders are working-age adults or their dependents, leading to employer-sponsored health insurance as the accelerant that boosted the opioid crisis from a tiny spark to full-fledged wildfire.

Employers have unwittingly contributed to the opioid crisis by funding poor-quality healthcare linked to an old model called “fee-for-service.” In this system – which describes the vast majority of care Americans receive every day – medical providers have every incentive to do more tests, schedule more procedures and prescribe more drugs. Primary care is especially hard hit. Doctors don’t have enough time to truly talk to and understand the needs of their patients.

The fix is “value-based care” – especially value-based primary care. This system avoids paying for the volume of services provided regardless of whether your health has been improved.

Not only that, the incentives inherent in value-based primary care reward doctors for spending more time on individual appointments to get at the root cause of health issues. It’s the direct opposite of the traditional model, in which more patients mean more treatment and more treatment means more money.

The Solution for Employers

One of the most important pieces of leverage employers have in the fight against opioids is their role as employee benefits purchasers. If employers turn a discerning eye toward the insurance policies available to them and locate where the value lies among the providers in their community, they can make more informed benefits decisions that lead to more effective care solutions, higher rates of employee wellness, and even a better bottom line.

The drivers of the opioid crisis are well-understood, as are the steps employers can take to mitigate them.

See how your plan stacks up

Key Drivers & Proven Antidotes

Economic distress

With poor plan design, more than half the workforce is one minor medical issue away from financial ruin. Wise plan design eliminates cost-sharing for smarter health care decisions. Enovation Controls, a Tulsa-based manufacturer, made smart decisions free (eliminating copays and deductibles when using high-value surgical hospitals) and bad decisions expensive (going to low-quality providers who have higher complication rates, poor outcomes, and overtreatment).

Opioids used for non-cancer chronic pain (e.g., back pain

Progressive benefits programs weave non-opioid options into both clinical and non-clinical settings. A well-informed health plan document should include policies spelling out certain steps to be taken before and after administration of opioids – such as trying Physical Therapy for back pain – and also placing a time limit on how long an employee can be authorized to take the medication.

Big pharma’s sales and marketing blitz

Value-based primary care organizations ensure clinicians receive education on – and have in place – viable, quantifiable treatment options that maximize value and come from unbiased sources. They also provide the time to explain to patients how non-opioid treatment options are more effective.

Declining reimbursement that increases physician prescribing of opioids

In a value-based primary care model, patients have the proper amount of time with their doctor. An increase in patient interaction time shuts down some of the on-ramp to opioids, whether it’s inappropriate opioid prescribing or unnecessary and excessive surgeries that are typically followed by opioid prescriptions.

Insurers’ refusal to cover validated treatments

Even when a physician appeals to an insurance company to approve treatments that may help the patient, several months or even years can go by, especially in worker’s compensation cases. By then, the patient may be on escalating doses of opioids just to function as a result of increased tolerance. Good plan design eliminates this market failure.

Mental disorders treated with opioids

Behavioral health issues are particularly short-changed in the rushed, “drive-by” appointments that are all too common in volume-driven primary care. Evidence-based benefits plans ensure behavioral health is woven into primary care and isn’t an afterthought.

Patient satisfaction scores’ influence on hospital income

Evidence is mixed on whether patient satisfaction correlates with improved outcomes. Wise employers contract with health care organizations focused on other metrics—for example, the Net Promoter Score (NPS), a measure of customer likelihood to recommend a product or service and more likely aligned with holistic approaches focused on keeping people well.

Criminal abuse of the system

Appropriate use of drug testing and regular checks of state prescription drug monitoring reports can help identify a substance use disorder and start the process to wellness earlier.

Economic distress

It Can Be Done

One of the best ways employers can help solve the crisis is to improve their benefits—and by following Health Rosetta principles, providing better care for employees while reducing health benefits spending by 20-40 percent. Read more about how a range of employers in diverse industries have accomplished this feat:

City of Kirkland
Enovation Controls
Great Lakes Auto Group
Palmer Johnson Power Systems
Rosen Hotels

Continued action steps:

Complementary Download or Purchase The Opioid Crisis Wake-Up Call
Sign up for Health Rosetta employer course
Connect with a Health Rosetta benefits advisor

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