Having already spent tens of millions of dollars toward the cause, the California Public Employees’ Retirement System is continuing its efforts to combat the statewide opioid epidemic, following the launch of a 2017 objective to reduce prescriptions of opioids.
In addition to internal actions within the pension system aimed at reducing prescription levels for drugs like Oxycodone and OxyContin, CalPERS has joined forces with Medi-Cal and Covered California for Smart Care California, a collaborative effort to promote safe health care.
The three partners account for the purchasing and management of health care services for over 40 percent of the state, Smart Care reports.
CalPERS health plan partners include Anthem Blue Cross, Health Net and Kaiser Permanente.
“We have worked closely with each of our health plans to form plans to reduce opioid use,” said Dr. Richard Sun, CalPERS chief medical consultant. But he explained CalPERS does not have a direct influence in opioid prescriptions.
Kaiser Permanente officials were present at a CalPERS meeting which took place last week to discuss their approach to reducing opioid usage. The meeting focused on The Challenges of Managing Opioids with the pension system’s board of administration.
Kaiser offered alternatives to pain management for lower back pain, which include behavioral therapy, mindfulness training, tai chi and acupuncture.
CalPERS officials first identified issues related to opioid use in 2004, when Oxycodone began to show up as one of the pension system’s top five high cost drugs, reported Kathy Donneson, the chief of the Health Plan Administration Division for CalPERS at last week’s meeting.
The pension system worked to curb the use of prescription opiates from 2012 to 2016. In 2015, CalPERS spent over $14 million on OxyContin. As of 2017, that number was down to $10 million, “but it’s still a high cost of our spend,” Donneson said.
In 2017, the pension system continued its efforts to utilize opioid management programs, putting limits on opioid prescription quantity and duration. And this year, outreach programs were launched.
Experts have identified an ongoing, nationwide opioid epidemic. An estimated 115 people die from an opioid overdose in the U.S. every day, reports the National Institute on Drug Abuse.
“The impact in the United States is tremendous,” said Dr. Sameer Awsare, an internal medicine doctor with Kaiser Permanente. “As this meeting goes on, every 19 minutes someone will die from an opioid overdose.”
Compared to the rest of the nation, California has a relatively low rate of opioid use. But some pockets of the state have been ravaged, said Dr. Kelly Pfeifer, a family doctor and a director with the California Health Care Foundation who is helping to launch and lead the foundation’s opioid initiative.
Health plans under CalPERS cover an estimated 1.4 million people, including state employees and retirees and their families and local contract employees and retirees and their families at both the state and local level.
The agency covers both Medicare and commercial health plans.
A CalPERS data sheet shows the total amount of opioid prescriptions given out under commercial health plans over the past few years has decreased. In 2017, 515,063 opioid prescriptions were given out under these plans, compared to 712,456 prescriptions in 2013. But opioid prescriptions given out under Medicare plans covered by CalPERS have slightly increased, from 317,076 in 2013 to 323,339 in 2017.
Sun explained there aren’t as many opportunities to decrease opioid use under Medicare plans likely due to restrictions in these plans.
The agency hasn’t been able to identify an exact cause for the differences in prescription levels between the two plans, but CalPERS officials have theorized possible explanations.
“Health care providers for Medicare members and health care providers for commercial members could have different prescribing patterns,” Sun said. “... Among other analyses, we would want to look at the types of opioids prescribed, the opioid dosages and quantities across (prescriptions), the diagnoses for which the opioids were prescribed, data prior to 2013.”
Contracted health plans for commercial members may also have more effective opioid utilization management plans compared to plans for Medicare members, Sun said. And there may have been changes in the “disease mix.” For example, there might have been a decrease in diseases associated with pain, like cancer, among commercial members but not among Medicare members.
CalPERS, and the Smart Care California partnership, has identified the use of opioid prescriptions for pain management as an area of concern. Health officials have specifically pinpointed the inappropriate use of opioids for lower back pain as an issue to tackle.
A majority of Americans will experience lower back pain in their lives, reports Smart Care, and overprescribing opioids for the condition may be worsening the epidemic, reports Smart Care.
A study released by the Center for Disease Control in March 2017 reports a person’s risk of developing a dependency on opioid drugs spikes after just four to five days.
“Many of us have had minor surgery or had a tooth extraction and got 30 days of Percocet,” Pfeifer said at CalPERS’ November meeting. “If you actually took those pills for 30 days, your chance of continuing these opioids one year later is 30 percent. If you didn’t take those pills, they’d be in your medicine cabinet exposing teenagers to the risk of addiction.”
With the latest research showing a high risk of developing an opioid addiction, Kaiser launched an effort to reduce the prescription of opioids and education for both providers and patients.
Sun said Kaiser has the most active opioid reduction plan he knows of.
Kaiser physicians were given data on the number of their patients taking opioids as well as alternative treatments available and patients were able to take an in-person class. Twenty percent of patients who received education requested to stop opioid usage or requested to cancel plans to begin usage.
As a result of these efforts, Kaiser saw a 40 percent decrease in the number of opioids prescribed from 2011 to 2017.
“If you look at all the counties where KP (Kaiser) is, the numbers are low,” Awsare said.
Moving forward, CalPERS has plans to continue to work collaboratively with the California Department of Public Health through the Smart Care partnership. The agency will work to identify hot spots of usage in Northern California and eastern parts of the state.
“We also have now (have) strategic measures on dose and duration,” Donneson said. “We are going to be working on a low back pain and how to measure alternative therapies.”