How advisers can help clients address opioid treatment

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Concern over the abuse of painkillers has led addiction experts to declare the U.S. in the midst of an opioid and heroin epidemic. But, employee benefit professionals are not asking for enhanced addiction treatment coverage for their employees. Instead, benefit advisers are offering traditional alcohol and drug addiction treatment services to address the use of painkillers and heroin in the workplace.

Unless an employer specifically asks about opioid addiction services, advisers often do not broach the subject. The topics of extended stays at rehab and sober living facilities are rarely addressed.

“Brokers and employers in general are relying heavily on their carriers’ plans and the EAP that they wrote up. I don't think there are a lot of additional policies and programs going into this area, in part because it is a delicate subject. It is delicate for the employee and the employer for HIPAA concerns,” says Craft Hayes, an adviser for Bernard Health of Nashville, Tenn.

Brokers could take a more proactive stand in helping clients write their EAP policies, and offer greater assistance for self-insured clients. “If they have a well-rounded employee assistance program, it is something they should include,” he says.

Thus far, Hayes’ clients are not actively seeking enhanced opioid coverage. “I hate to stereotype it, but maybe our clients are little bit more white collar and gray collar, and we are not seeing a huge push for guidance on this,” he says. “Maybe the employers we have don't know and maybe it is going on in their population base and its hush-hush.”

He adds, “Maybe this is something they don't want to know.”

A misguided perspective?
Kristin Torres Mowat, senior vice president at Castlight, is seeing more curiosity about opioid treatment from her customers, but their perceptions are often based on news reports that may not paint an accurate picture of the epidemic.

“They're increasingly aware that this issue persists in their populations, but sometimes the popular press gives them a misguided perspective that this is only a problem among the disenfranchised and the unemployed,” says Mowat. “We've tried to bring an awareness that this is a problem that's happening among the … employed and otherwise actively-engaged people.”

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Opioid abusers cost their employers more than other addicts who are either abusing drugs or are in recovery. One estimate is that they generate twice as much in healthcare expenses and tend to have other behavioral health diagnoses as well as pain-related conditions, according to Mowat.

“It's important to look at the opioid abuse on its own. We believe that when treated earlier and if individuals are steered toward behavioral health programs early on — which most health plans and employers have invested in and make available to employees — perhaps some of the abuse can be prevented,” says Mowat.

Waiting is proving to be expensive. Opioid abuse costs U.S. employers $10 billion from absenteeism and presentism alone, according to the American Society of Addiction Medicine.

One silver bullet for opioid treatment and early intervention could be data analytics. If an employee, for example, has root canal or back surgery that requires pain medication, they could be flagged for potential abuse. While this opens up concerns for HIPAA compliance, this could lead to early intervention, says Mowat.

“To my knowledge there isn't that mechanism happening today that at the time when a prescription for painkillers is filled, providers are seeing a flag. However through data analytics, [we might be] able to understand and predict other behaviors or populations that are at risk,” says Mowat.

Predicting and monitoring behavior
Lockton is currently doing just that. “By reviewing medical and pharmacy claims we can help employers determine whether they are experiencing more in-patient care for substance abuse and behavioral service when compared to other companies,” says Dr. Ron Leopold, chief medical officer for employee benefits clinical services. “We can also help them understand whether this is happening in one particular geography; whether this is an employee, spouse or dependent issue, and whether this is happening to particular types of workers (i.e., salaried or hourly).”

Leopold believes that employers should not be in the business of designing opiate treatment programs. “The challenges faced by the American employer are the burgeoning numbers of working Americans with opiate addiction. What employers need to monitor are: overall costs of treatment; outpatient versus inpatient options; recidivism and efficacy of treatment. They should also be regularly reviewing cost of treatment where several options exist in a particular geographic area.”

Despite the news of the addiction epidemic in the media, some advisers are not seeing an increase in opioid addiction claims.

“Many of my clients are self-funded and because of MHPAEA [Mental Health Parity and Addiction Equity Act], the plans do not treat services with an opioid dependence diagnosis any different than other illnesses. In looking at my clients’ claim experience, we do not see any increase in claims due to services to treat substance abuse. We typically have one or two members incurring charges at either an inpatient or day treatment facility,” says Jean Casolaro, vice president, employee benefits, Gregory & Appel Insurance.

“I agree that there is an explosion of heroin addiction. Maybe we will begin to see different [treatment] trends in the future,” says Casolaro.

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