HOW WE GOT HERE
Bradley Karlin , Ph . D ., ABPP , MBA , vice president and executive medical director of behavioral health at Highmark Health says West Virginia ’ s proud tradition of hard work in various industries — many associated with injuries — contributed to the rise of SUD-related needs in the state . Also contributing were the changing economic conditions .
Highmark ’ s Focus on Substance Use Disorders
While substance use disorders ( SUD ) remain a concern nationally and in the state , Highmark Blue Cross Blue Shield West Virginia , one of the state ’ s top employers , has been working purposefully to make a meaningful difference since 2015 . Highmark has already implemented innovative programs to benefit its health insurance members and positively affect all the state ’ s employers .
“ Focusing on improving SUD outcomes supports Highmark Health ’ s multipronged opioid strategy to combat addiction ,” says James Fawcett , president of Highmark West Virginia .
Highmark ’ s multipronged approach includes programs for its insurance members , a public service announcement aimed at teenagers and foundation partnerships with West Virginia community organizations on the front lines .
Outside the health risks to its insurance members , Fawcett says that substance use disorders are a concern because of the double consequence they have for employers , who often provide health insurance coverage . First , employers incur the direct costs of SUD recovery and treatment for their affected employees or covered dependents . Second , they experience indirect costs , like lost productivity and work time .
One of Highmark ’ s first programs implemented in West Virginia worked to identify and make a difference for its covered members . By using data analytics , the company helped promote the appropriate prescribing of opioids , deploy SUD case managers to work with members to provide them access to care providers , reduce harm and pursue sustained remission .
The efforts are paying off . In West Virginia , the company saw its members on opioids decrease by 48 %, members with multi-prescribers decrease by 40 % and the number of overdoses decrease by nearly 40 %.
“ A variety of factors contributed to high rates of substance use in West Virginia . Chief among these are occupational and economic factors ,” Karlin says . “ This includes high rates of manual labor jobs as well as changing industries that led to increased unemployment and negative social and psychological consequences .”
In the 1990s , the U . S . pharmaceutical industry promoted opioids as safe , effective and non-addictive for pain management . This turned out to be untrue . As demand for opioids steadily increased , exploitative “ pill mills ” cropped up in West Virginia and other states , filling communities with opioids and temptations for substance abuse . Pill mills are illegal pain management clinics that prescribe opioids without proper medical evaluation and often just for cash .
“ For years , West Virginia had among the highest rates of opioid prescribing and the highest rate of drug overdose deaths in the nation ,” Karlin says .
WHERE WE ARE NOW
But as the escalation of opiate prescribing was curbed , some people turned to cheap drugs like heroin and fentanyl .
“ Fentanyl , which is 100 times more potent than morphine , has been particularly widespread and challenging to control in communities within West Virginia and throughout the nation ,” Karlin says . “ While pharmaceutical fentanyl is used for managing acute or chronic pain , counterfeit forms of fentanyl are very cheaply produced in labs outside of the U . S . and smuggled into the country through Mexico .”
Approximately 9 % of Highmark members have a treated SUD diagnosis and 22 % of respondents over 18 years of age in the government ’ s annual National Survey on Drug Use and Health reported at least one event of illicit drug use in the past 12 months . “ The total health care costs among those with SUD are about five times higher than the costs of those without SUD ,” says Karlin .
According to Fawcett , these higher cost drivers are not due to the SUD treatments , but rather the associated medical conditions . These medical conditions include high blood pressure , heart disease , diabetes , lung disease , HIV , hepatitis , various complex infections , trauma , depression and anxiety , among others .
“ We have reasons to be positive for our outlook ,” Fawcett says . “ The pandemic has forever changed access to care , particularly for behavioral health and SUD care , using virtual care tools that enable people to connect with the right level of care when , where
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