The next challenge in caring for those who experience opioid overdoses is long-term reintegration into the workforce and society, panelists said during Providence Business News’ Oct. 30 Health Care Summit at the Crowne Plaza Providence-Warwick.
The panel also focused on ways to curb wasteful spending in health care, including making end-of-life choices that are cost-effective.
The morning’s first panel included Michael Souza, CEO, Landmark Medical Center; Stephen Farrell, CEO, UnitedHealthcare; Dr. Peter Hollmann, chief medical officer, Brown Medicine; Dr. Gus Manocchia, executive vice president/chief medical officer, Blue Cross & Blue Shield of Rhode Island; Linda Hurley, CEO, CODAC Behavioral Healthcare; and Angela Patterson, chief nurse practitioner officer, CVS MinuteClinic.
Hurley, when asked what more the state can do to fight the public-health threat of the opioid epidemic, noted that advances in the immediate treatment of overdoses have begun to stem the rate of opioid-overdose deaths. In October, Rhode Island’s R.I. Department of Health reported the Ocean State recorded a slight downturn in the number of opioid-overdose deaths in 2017 and the start of 2018, as the U.S. Department of Health and Human Services reports national numbers plateauing.
Hurley praised Congress’ February 2018 addition of $6 billion in funding nationally for opioid-addiction prevention and treatment, including $300 million for medication-assisted treatment, through the CARA 2.0 Act co-sponsored by Sen. Sheldon Whitehouse, D-R.I., as well as the statewide efforts of Gov. Gina M. Raimondo’s Task Force on Overdose Prevention and Intervention in stopping the crisis from becoming worse.
Hurley noted she was recently interviewed about the decision to write Roseanne Barr’s character out of the ABC show “The Conners,” using the device of an opioid overdose, announced in September.
“From my perspective, it probably made good sense, because it is daily conversation” for Americans, Hurley said.
While that’s promising, Hurley said, a prominent, unmet challenge to providing care to opioid users is the stigma surrounding opioid addiction.
“What has happened is, it has shadowed over into treatment as well,” Hurley said.
Often, Hurley said, CODAC treatment facilitators accompany people with an opioid disorder to the physician’s office to settle qualms offices have about the patient’s behavior. The qualms are often unwarranted, Hurley said in a phone interview following the summit.
“This becomes an increasingly expensive patient profile,” Hurley said.
Hurley also noted the lack of parity in reimbursement of opioid-addiction services provided by treatment centers such as CODAC, reimbursed at the lowest of four tiers, and at hospitals, at the top of the reimbursement rate scale. The services provided and the training of the professionals who provide them are the same, Hurley said. That dichotomy remains a challenge to delivering necessary care to people fighting opioid addiction.
Hurley said an element of care that hasn’t gotten much attention is long-term recovery, and the rehabilitation of the person as a part of society. She said that opioid addicts spend their lives routinely compromising their values in the course of their disease.
“That is a soul-eroding experience. That is a confidence-eroding experience,” Hurley said.
Because of the psychological damage opioid-addiction patients suffer, combined with the stigma they face even after they’ve begun recovery, more work has to be done to support people in recovery, including removing the stigma of opioid-addiction treatment from the workplace.
If an employee tells their supervisor they can’t come into work because they need to see a medical specialist, that day off is usually provided without much question. “But if I say I have to see a specialist for a substance-abuse disorder, it’s not going to happen,” Hurley said. She said she is working on a committee under Raimondo’s direction to help solve that problem.
Behavior issues drive health care, said Stephen Farrell, CEO of UnitedHealthcare, who noted about 40 percent of health care costs are the result of behavioral choices. About 20 percent of health care costs is spent on end-of-life care, he said, usually where people are placed in high-care settings in hospitals unnecessarily.
A better alternative, he said, is hospice at home services, which are cost-effective and provide a high level of care in a person’s home during the end of their life.
‘A huge amount of money [is] spent every year on low-value or no-value care.’
DR. GUS MANOCCHIA, Blue Cross executive vice president and chief medical officer
Most health care waste, in fact, said Dr. Peter Hollmann, chief medical officer at Brown Medicine, is found in end-of-life care.
The majority of health care costs add up for care at the end of a person’s life, mostly in nursing homes,” said Hollmann, though it’s a little each year over a long period of time.
“But it does add up,” Hollmann said.
Manocchia agreed a significant element of health care spending, about 30 percent, is the result of behavior, particularly the public’s insistence on low-value or no-value care, such as annual EKG tests, vitamin D screening and prescribed antibiotics for sinus infections, which he noted is often unwarranted.
Rather, he said, the health care system, doctors and patients included, should focus on high-value care such as colorectal screening, immunization and making sure people have a primary care physician.
Manocchia said that at just 10 percent spent on low-value care, Blue Cross would have spent, or wasted, $170 million last year. Considering the amount other health care insurance companies must also be wasting on low-value care, he said, “That is a huge amount of money spent every year on low-value or no-value care. We have to fix it.”
Manocchia said Blue Cross’ long-standing partnership with Virgin Pulse, provider of workplace-wellness programming, has helped them realize health gains in-house and among companies they work with, through wellness programs that are driving down employers’ health care costs.
In 2017, he said, large-group companies saw an average 58 percent enrollment in and engagement with a Virgin Pulse wellness program.
“When you look at those people over time, there is a 19 percent lower cost for people who are enrolled and engaged in a wellness program,” Manocchia said.
He said that from 2004 to 2012, Blue Cross’ health care costs rose 55 percent, or about 8 percent per year. But then, from 2013 to 2016, he said, costs decreased, year over year, by about 20 percent.
“What’s the difference? The difference is that we put a strategy in place to produce wellness,” he said. The company has a gym, two employee health stations where you can get your heart rate and blood pressure checked, and 52 percent of their employees track their steps, he said.
Manocchia said a good rule of thumb is to work at least 10,000 steps into your daily routine. But, if you work at an office job where you’re in meetings or otherwise stuck sitting around for long periods of time, you’re getting less than 3,000 steps worked into your day.
“You need to get up and move around,” Manocchia said.
Souza said waste contributing to health care costs includes too many unnecessary tests. He said that, due to his asthma, his physical exams routinely include a chest X-ray and EKG test.
“I’m not sure why,” he said.
Another element of waste, he said, are the resources spent on medical lawsuits.
“I get sued about once a day,” he said.
Overuse of the emergency department is also driving costs, Souza said.
But an often-unspoken drag on resources and contributor to medical costs, Souza said, is the energy spent on recruiting professionals, encouraging them to make a jump from one institution to another.
“Hospitals struggle with it because we’re all stealing [professionals] from each other,” Souza said.
Patterson noted the cost savings realized from the recently approved merger between CVS Health Corp. and Aetna Inc. will allow CVS to offer customers more preventive care and to educate people about their own preventive care. She said the merger will allow the company to improve its customers’ health care experiences, including better integration of pharmacy information that will allow quicker, more-focused care in the company’s clinics. Better care will allow for swifter intervention in people’s health that can avert more costly care in the future, she said.
“Even a small portion of that population can translate into savings for both payers and consumers,” Patterson said.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
