Moved to action: Employee benefits broker takes on opioid crisis

Cristy Gupton never thought much about the nation’s opioid crisis until it hit her hometown in rural North Carolina.

Her awakening disturbed her deeply. Settling in a year ago for what she thought would be a routine annual presentation from her county sheriff, she instead learned about a surge in opioid-related home invasions.

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“There has to be something I can do,” Gupton recalls thinking as the sheriff stunned her local Rotary Club with statistics about drug deaths and arrests and recounted tales of tragedy.

Drug overdoses are claiming lives at unprecedented rates across America, but in the nation’s rural hamlets and towns, such as those in North Carolina, the toll is especially high. The death rate from opioid overdoses in Gupton’s state is higher than the national rate, according to the National Institute on Drug Abuse. In 2016, there were 1,505 opioid-related overdose deaths in the state, a rate of 15.4 deaths per 100,000 compared to the national rate of 13.3.

For Gupton, the crisis struck home in Burke County where three teenagers met a fateful end. The three broke into a house to raid prescription drugs from the medicine cabinets. As they sped away after the break-in, the driver lost control of the car and the three teens died in the crash.

The senseless deaths spurred Gupton to champion a community effort to tackle the issue head-on. As founder and CEO of employee benefits brokerage firm Custom Benefits Solutions in Morganton, North Carolina, Gupton knew that employers could play a vital role in “knocking a dent” in the problem by developing health plans that included opioid education and disease management vendors that could counsel employees struggling with the drugs.

Working with the local health department, Gupton organized a forum that not only drew 200 HR professionals, substance abuse counselors and local leaders but inspired North Carolina’s Attorney General Josh Stein to give the keynote address. The attorney general had written a law restricting opioid prescriptions that had just gone into effect.

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“It was a very timely appearance,” Gupton says, adding that the attorney general gave the “kind of gravity to the subject that it needed.”

The event turned Gupton into an instant local employee benefits star. Attendees circulated her name on social media and soon thereafter health underwriter and other groups were clamoring for her to speak at their conferences and national conventions.

“When Cristy saw the need, she rose to the challenge,” says Eric Silverman, founder of Voluntary Disruption, who nominated Gupton for Employee Benefit Adviser’s Top Women in Benefit Advising Award.

As Gupton’s popularity rose, she worked with clients — all local public sector employers — to develop health plans that would help mitigate the risk of opioid abuse within their workforces. Gupton reminded them that as city, town and county government employers, they more than others needed to lead by example.

Addiction a chronic disease

Six of the 25 clients were sold on her proposals. They partnered with select pharmacy benefit managers and added opioid education and disease management systems to identify individuals who might be struggling with opioid issues. The disease management vendors would watch for red flags in employee buying behavior, such as inappropriately refilling opioid prescriptions, filling them in other states or paying in cash. Employees whose prescriptions had too long a time frame were also a red flag to vendors of possible drug abuse issues.

Having identified potential over-users of pain killers, vendors would then be able to reach out to them with the help and information they might need. They might, for example, remind them of the risks of drug abuse and the availability of opioid alternatives.

“Addiction needs to be seen as any other chronic disease, just like diabetes,” Gupton says.

Gupton also worked with employers to implement a surgical advocacy program that she says reduced the need for opioid prescriptions. The program educates employees about what they need to know concerning upcoming surgeries and recommends options to treat pain in a non-opioid manner. It also helps employees weigh options to surgery, such as acupuncture or physical therapy.

Employees might consider alternatives first before “going straight for the knife,” Gupton says.

‘The magic sauce’

As part of the new protocol, employees are prompted to call the disease management vendor, which evaluates whether the procedure they seek is recommended based on the diagnosis code. In many instances, after getting a required second opinion, employees learn that surgery is not necessary.

If surgery is necessary, the program helps employees identify surgery centers that have “practically zero” infection and re-admission rates and quality ratings that Gupton describes as “off-the-charts.”

“Choosing the right provider and having the right quality around a surgical procedure is part of the magic sauce that makes you not really need to use an opioid to treat post-surgical pain,” Gupton says.

For the six employers who implemented the recommended protocols, it “worked out swimmingly,” according to Gupton.

As a result of the measures, they have seen the number of filled opioid prescriptions drop 30% from last year’s levels. They also have helped employees avoid many procedures that otherwise would have taken place without the second opinion that the new protocols now require.

Gupton is heartened by her clients’ early adoption of the measures as government entities tend to be slow to accept new ideas. She hasn’t given up though on her remaining 19 clients.

“I’ll keep working on the other two-thirds. They’ll come along onboard soon enough,” she says.

Indeed, all employers — whether government or not — need to pay attention to the issue as it can significantly increase already high healthcare costs even more. Employees on opioids rack up $100,000 a year more in medical claims than employees managing pain in a natural way, according to what technology vendor Opioid Clinical Management told Gupton.

Gupton enjoys working with government clients, saying that she’s found a niche that works. Still, she would like to expand her client base to the private sector and the non-profit world. She credits her small team of six for her company’s high productivity.

“We’re lean and mean and we can accomplish more than we realize being small,” she says of her company, which produces almost $1 million a year in revenue.

Association health plans hold promise

While she would like to grow her company, Gupton’s biggest priority moving forward is continuing to champion ways in which employers can help eradicate opioid abuse. “I want to take this message to a broader stage,” she says.

Gupton is especially optimistic about association health plans, seeing in them a solution to the opioid epidemic. With recent rules expanding the use of association health plans, communities can now band together more broadly to design their own health plan and benefit from their collective bargaining power.

“I think association health plans hold a lot of promise to not just provide better healthcare for communities, but I think they can tackle this opioid issue,” she says.

Gupton is already working with community leaders to talk up the idea and expects to generate enough interest to soon hold meetings with the local chamber of commerce, hospital and municipalities.

“I think we will have a huge opportunity to help communities solve some of their most pressing healthcare issues, and the opioid issue is right at the top of the list of concerns that can be solved with a community-wide effort,” she says.

Gupton encourages other brokers to take similar actions in their communities even if they feel they don’t have enough knowledge to approach the subject.

“Advisers should put this issue on the table even if they don’t know everything they need to know and just say to their client ‘we can work on this and figure it out together,’” she says.

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