The stigma surrounding the opioid addiction is similar to that of the AIDS epidemic in recent decades, says Dr. Martin Serota, chief medical officer for Prospect CharterCare Health Partners. The AIDS crisis became much more manageable with the cooperation of doctors, researchers and the pharmaceutical industry, he said.
“We need to do the same thing about the opioid crisis now,” Serota said during a panel discussion at Providence Business News’ Health Care Summit at the Crowne Plaza Providence-Warwick Oct. 5. The panel, the second of the day, recommended a stigma-free response to opioid addiction and, in the overall health care system, a just-enough strategy in terms of what is provided and insured to help control costs.
Stephen Kozak of Tufts Health Plan said opioid addiction doesn’t reflect on a person’s character or morality, particularly since people in all walks of life are exposed to the drugs when they’re prescribed following a variety of medical procedures.
“These substances change the way the brain works,” said Kozak, who is director of behavioral-health services.
When addiction must be addressed in the workplace, Kozak said, employers should approach it as they would any other health problem. Diabetics sometimes have problems with low blood sugar that affects whether they come in to work that day, or, sometimes, causes them to behave strangely, he said.
“The way we approach this issue should be really similar to the way we approach those issues,” Kozak said.
Ultimately, he said, opioid addiction and other behavioral-health issues are legitimate medical conditions, “many or most of which have biological, genetic and physiological causes and solutions.”
R.I. Health Insurance Commissioner Marie Ganim of the Office of the Health Insurance Commissioner spoke about her agency’s success with one of its directives: improving health care cost and quality following two strategies begun in 2010.
First, former Health Insurance Commissioner Christopher F. Koller capped the allowable price increases health insurers could pay hospitals, Ganim told the audience. Cory King, principal policy associate with OHIC, told PBN in September the cap has averaged 3.1 percent since 2010.
Ganim also noted OHIC’s mandated 1 percent annual increase in provider spending on primary care from 2010 until 2014, leveling off at 11 cents per dollar. Primary care involves proactive management of chronic conditions before they develop into more serious problems, a strategy for limiting health care costs.
Combined, the mandates appear to have resulted in slowed annual health care cost increases in the Ocean State, Ganim said. Rhode Island’s 1.6 percent yearly increase in personal health care cost is the second lowest in New England, slightly above New Hampshire’s 1.3 percent increase, as reported Sept. 15 by PBN.
“We cannot say necessarily there is a direct correlation, but we can say we think we’re going in the right direction,” Ganim said.
Ganim also showed a slide that tracked a downward trend on a benchmark Neighborhood Health Plan of Rhode Island silver plan for a 40-year-old nonsmoker, trending down from about $290 monthly in 2014 to under $250 for a monthly premium in 2018. Compared to similar plans in the nation, the cost is the lowest, she said.
“The Office of Health Commissioner has been a big partner for us in making sure we can offer affordable options for folks out there,” said Peter Marino, president and CEO of Neighborhood Health.
Marino said he believes focusing on quality drives cost savings. “That means you’re driving your resources to the places that are going to get you your highest return,” Marino said. Primary care is the closest thing in the health care system to a “magic bullet,” to that end, he said.
‘In efficient systems you can spend significantly less and get better outcomes.’
DR. MARTIN SEROTA, Prospect CharterCare Health Partners chief medical officer
Serota said data shows there’s no benefit in medical outcomes for a two-fold increase in spending on hospitalization, for instance. “In fact, there’s really good data to show that just the opposite is true, that in efficient systems you can spend significantly less and get better outcomes,” Serota said.
In California, data from the Integrated Health Care Association shows the only groups that have high quality and low cost, Serota said, were HMOs, where there was less choice for the insured. “Tightly managed groups,” he said.
The only plans that had low quality and high cost, “were PPOs (preferred provider organizations, allowing members to visit any in-network physician) with a lot more choice,” Serota added.
Serota said evidence shows that the access to care provided by the Affordable Care Act is crucial, “But once you have access to it, you want just the right amount of care,” he said. The standard, he added, should be that patients get everything they need but nothing they don’t need, which is important because excess care can be dangerous and costly.
In hospitals, Serota said, patients are at risk for dangerous bacterial infections, and older people are at higher risk for falls than in their own homes. “So, patients shouldn’t be in these facilities unless they really need to be,” he said.
On controlling prescription costs, Dr. Jason Spangler, executive director of medical policy and quality strategy for Amgen Inc., offered some hope for progress through drug research and value-based contracts between pharmaceutical makers and insurance providers.
“We’re using our expertise to increase the competition in certain areas,” he said, mainly in development of bio-similar drugs, generic-brand drugs designed to mimic the effects of biologics, drugs that treat arthritis, cancer and inflammatory diseases such as Crohn’s disease.
Serota said pharmaceutical value-based contracts can also help curb prescription costs. He pointed to Amgen’s value-based contract with Harvard Pilgrim in Boston, concerning their lipid-lowering agent, shown to lower the risk of heart attacks and strokes, as an example.
“We have a deal with Harvard-Pilgrim where if patients on our medicine actually have a heart attack or stroke, there’s basically a money-back guarantee,” Serota said.