Here's How Insurance Companies Plan to Curb the Opioid Epidemic in Massachusetts

A handful of insurance companies have begun programs that connect their members with social workers.
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A handful of insurance companies have begun programs that connect their members with social workers.
(Photo: Darren McCollester/Getty Images)

(Photo: Darren McCollester/Getty Images)

The number of opioid abuse cases in Massachusetts is growing. According to data from the Massachusetts Department of Public Health, between January and July of 2015, an estimated 869 people died from opioid overdoses. That marks a 24 percent increase from the last seven months of 2014. To combat this upward trend, a handful of insurance companies like Neighborhood Health Plan and CeltiCare have created programs to connect their members with social workers. The initiative is a preventative measure to keep members with a history of opioid abuse, or those who might be vulnerable to addiction, from overdosing.

Back in November, when the outlook on the opioid crisis was just as bleak, Pacific Standard published Daniel J. McGraw's own account of being prescribed a hefty dosage of OxyContin after having a gall bladder operation. McGraw wasn't expecting the script, especially considering his doctors agreed that pain pills wouldn't be necessary for his recovery. McGraw, who'd once had a stint in a rehabilitation center for alcoholism, was anxious about taking OxyContin. "Americans are addicted to pain meds—legal and illegal," McGraw wrote, "because the United States' medical community had re-defined who needed these meds and who didn't."

Massachusetts has long wrestled with rampant opioid abuse, much more so than other states. Throughout the commonwealth, hundreds have fallen victim to fentanyl, OxyContin, Percocet, and similar drugs. In 2014, Massachusetts was home to the second highest number of fentanyl seizures in the country (after Ohio), according to the Centers for Disease Control and Prevention. Opioid overdoses are most concentrated in Boston and towns in the eastern part of the state. In 2014, the Massachusetts Department of Public Health counted a total of 940 overdose deaths in eastern counties, compared with 233 deaths in the rest of the state.

Between $53 and $72 billion is spent annually on opioids.

From government to non-profit, the state is working hard to decrease these numbers. The Boston Health Care for Homeless Program just opened up a supervised sanctuary for heroin users to safely experience their highs, with nearby assistance in the event of an overdose. In January, the Massachusetts Bar Association launched a hotline for people seeking legal assistance for friends and family struggling with opioid addiction in parts of southeastern Massachusetts. Around the same time, Massachusetts lawmakers passed a bill limiting opiate pain killer prescriptions to a seven-day supply, and requiring that overdose victims receive professional evaluation within 24 hours after hospitalization.

The programs that CeltiCare and Neighborhood Health Plan have rolled out are significantly more hands-on than these other initiatives. Linking up opioid abusers with experts who can actively help prevent them from overdosing is not only beneficial for drug users but also for insurance companies trying to avoid big hospital bills. For CeltiCare, reducing hospital fees is a serious priority, considering about a quarter of hospital intakes are substance abuse cases.

Beyond addiction, opioids are very expensive. In his piece, McGraw even mentions contemplating the opportunity to sell 30 OxyContin 30mg tablets, for which he originally paid $15, on the street for $1,000. And that's just one example. According to the Department of Health and Human Services, between $53 and $72 billion is spent annually on opioids.

Perhaps these new innovative programs will inspire larger insurance companies to follow suit. Blue Cross Blue Shield, one of Massachusetts' biggest insurers with two million members, told WBUR that 11 percent of their members received treatment for substance abuse in the last year.

One of the greatest obstacles these new programs face is figuring out which members need guidance for substance abuse. One possible solution, courtesy of Neighborhood Health Plan: algorithms that identify which members are at risk for opioid abuse, and can connect them with social workers and case managers.

It can't yet be determined what kind of impact these programs have had on their members. (Neither CeltiCare nor Neighborhood Health Plan responded to multiple requests for comment.) Regardless, it's a new approach that has serious potential to make waves in Massachusetts, and it might be setting a precedent for other opioid ridden communities throughout the country.


Since We Last Spoke examines the latest policy and research updates to past Pacific Standard news coverage.