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Highlights: Highmark Health Plans

Promoting recovery, restoring hope: the opioid crisis

As the opioid crisis has evolved, so has the response of Highmark Inc. and its subsidiaries and affiliates that provide health care coverage to their members (the Health Plans). From overcoming stigma, to preventing dependence, to accessing treatment, to promoting long-term recovery that allows individuals to return to their family lives and the workforce, the Health Plans are committed to helping their members and communities at all stages.

In schools and community spaces across western Pennsylvania, the Health Plans' financial investigations and provider review team is making a difference. Its Opioid Epidemic Education Program has empowered students, parents, and educators with the knowledge and resources to respond to opioid dependence in their communities. Participants learn about: opioids, including fentanyl and heroin, and deadly drug combinations; signs of abuse and addiction; strategies to help those who are experiencing opioid use disorder; and how the stigma of addiction can hinder recovery. For these efforts, the program was honored with the 2019 National Health Care Anti-Fraud Association's Excellence in Public Awareness Award.

That program is emblematic of an overall approach to the opioid crisis that spans the Highmark Health enterprise and beyond, emphasizing primary prevention, safe prescribing, and building the capacity of communities to respond through education, advocacy, and financial support.

In coordination with clinicians and other stakeholders, the Health Plans have implemented a progressively intensive strategy to address the opioid crisis. The first component focuses on prevention by offering effective, non-pharmaceutical pain management therapies at the site of care. The second component emphasizes safe opioid utilization through new evidence-based medication policies, as well as ongoing monitoring and educational efforts for both members and prescribers. The Health Plans use a data-driven approach to monitor members' prescribing patterns and identify potentially unsafe use of opioids and other controlled substances. The third component centers on identifying members with opioid use disorder and linking them with high-quality, accessible treatment programs.

Among other achievements, these efforts have ensured that more than 90% of Highmark health plan members who are prescribed opioids for the first time receive less than a week's supply of medication. Over the past three years, opioid-related overdoses among health plan members have declined by 70%, and the overdose rate among members is now 50% below the national average.

Throughout the past three years, Highmark Inc. and one of its charitable foundations have also provided $3 million to community organizations and programs fighting the opioid epidemic in Pennsylvania, West Virginia, and Delaware. These grants and sponsorships support frontline efforts, including filling an emergency need for naloxone, community-based drug prevention and addiction treatment plans, and rehabilitation and treatment facilities.

The crisis isn't over, and neither is the organization's work. Entering 2020, the Health Plans are expanding efforts to fight opioid stigma by offering new educational and advocacy tools and by harnessing technology to extend treatment into underserved communities.

Left to right: Delaware Insurance Commissioner Trinidad Navarro; Delaware Secretary of Health and Social Services Dr. Kara Odom Walker; Delaware Lt. Governor Bethany Hall-Long; Highmark Medical Director Avani Virani, MD; Highmark Vice President & Executive Medical Director Strategic Initiatives Caesar DeLeo, MD, MSHA; and Highmark Delaware President Nick Moriello

At an event related to Highmark grants to combat the opioid crisis in Delaware, left to right: Delaware Insurance Commissioner Trinidad Navarro; Delaware Secretary of Health and Social Services Dr. Kara Odom Walker; Delaware Lt. Governor Bethany Hall-Long; Highmark Medical Director Avani Virani, MD; Highmark Vice President & Executive Medical Director Strategic Initiatives Caesar DeLeo, MD, MSHA; and Highmark Delaware President Nick Moriello


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