News & Commentary

Chairman, President and CEO Joe Swedish Participates in President’s Commission on Combating Drug Addiction and the Opioid Crisis

October 20, 2017
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Today, the President’s Commission on Combating Drug Addiction and the Opioid Crisis held a meeting at the White House with health plan leaders, including Anthem Chairman, President and CEO, Joe Swedish.  Mr. Swedish discussed the proactive role Anthem is playing in addressing this devastating crisis, and how we are meeting the issue head-on through our holistic strategy centered on prevention, treatment and recovery, and deterrence.

Below are Mr. Swedish's remarks he shared during the meeting.

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President’s Commission on Combating Drug Addiction and the Opioid Crisis

October 20, 2017

Governor Christie and distinguished members of the Commission, I am Joseph Swedish, Chairman, President and CEO of Anthem, Inc., and it is an honor to appear before you today to discuss how we can collectively work together across the health care system, and beyond, to combat drug addiction and address the opioid crisis.

With over 1 in 8 Americans served by our affiliated companies with whom we work to manage health care, we have built programs upon a foundation of quality to improve outcomes for consumers.  With this underlying our approach to all major public health issues, I would like to share just a portion of the extensive actions Anthem is taking to address the opioid crisis. A crisis that crosses all demographics and impacts commercial, Medicare and Medicaid programs, and one that we are meeting head on through our holistic strategy centered around prevention, treatment and recovery, and deterrence.

Prevention

Just last month, we announced our success in reducing opioids dispensed to our members by 30 percent from historic peak levels in 2012 – more than two years earlier than planned.  But we are not stopping there and have increased our goal.

We have aligned our pharmacy benefit strategies with CDC guidelines, limiting initial short-acting opioid prescriptions to seven days, and put in place prior authorization for all long-acting opioids.

I want to emphasize the importance of taking evidence based care to the provider by way of training  and then paying providers to do the right things which we do through our value based payment arrangements.

Treatment and Recovery

Treatment and recovery work hand-in-hand, and our approach extends beyond “traditional” medications and care programs.   Many individuals facing addiction also have coexisting physical and mental health conditions.  So we are working to provide integrated care for all of our members.

Non-opioid pain management is a component of our holistic approach. We support coverage of pain relief drugs and non-drug treatments, according to best clinical practice guidelines and scientific evidence, including CDC guidelines. There are many non-opioid approaches that we cover - both non-opioid medications and non-drug treatments, alike.

We don’t require prior authorization for the use of Naloxone, a life-saving emergency drug, and we have eliminated prior authorization for certain drugs used in Medication Assisted Treatment.  We are working to double the number of members who receive Medication Assisted Treatment along with behavioral health support services and we are improving access to Medication Assisted Treatment in rural and underserved areas by providing technical assistance and training to providers so there is at least one Medication Assisted Treatment-trained physician in each primary care practice.

We’re supporting peer recovery services through partnerships with organizations like AWARE Recovery Services in Connecticut and New Hampshire, who provide comprehensive in-home substance use disorder treatment services.

We’ve also extended access to care and treatment through telehealth. LiveHealth Online, our telehealth program, permits individuals to access a physician any time of day, 365 days a year, and now includes opioid disorder treatment and Medication Assisted Treatment through our partnership with Bright Heart Health, who provides online addiction support services for substance use.

We’re accelerating best practices in local communities, such as funding and supporting an Extension for the Community Healthcare Outcomes project in West Virginia, which connects primary care providers with expert Medication Assisted Treatment information to treat individuals with substance use disorders.

And, we’re partnering with NICU facilities and their providers to establish care practices that follow established standards of care for newborns with Neonatal Abstinence Syndrome, which occurs in newborns exposed to addictive opiates in the womb, while encouraging non-pharmacological treatment, parental involvement, and protocols to decrease the severity of symptoms and improve outcomes.

Deterrence

As part of our efforts to address the fraud and abuse element of the opioid epidemic through deterrence, we operate a Pharmacy Home program across our commercial fully insured and Medicaid lines of business. This program assigns individuals, who meet certain criteria related to opioid utilization, to one pharmacy and/or one provider to receive their opioid prescriptions. This program allows physicians to monitor for dangerous combinations of medications and access to opioids and help ensure members are receiving counseling and mental health supports.  We have seen this program reduce hospital and emergency room admissions, increase the number of individuals in substance use treatment in some states, and reduce the cost of care.

We also have a range of strategies that leverage data mining and analytic capabilities to identify and address instances of opioid fraud and abuse, as well as diversion. Anthem’s Special Investigations Unit contains a team of professionals trained to combat fraud and abuse utilizing various methodologies.

Conclusion

While we are proud of the success, more can – and should – be done to address this crisis.  As we look to further expand our collective efforts, we recommend the Commission consider the following:

  • Work with stakeholders to address the shortage of qualified substance use disorder treatment providers and licensed health care professionals trained to support individuals with substance use disorders in the community, utilizing evidence-based models. 
  • Continue to develop more tools to educate patients with chronic and painful conditions on proper use of pain medications given the lack of accessible pain medicine specialists and trained primary care providers.
  • Invest more resources dedicated to research for establishing more evidence-based treatment guidelines and innovative payment models.
  • Improve data and health information sharing to facilitate better care – this includes changing 42 CFR part 2 to align with HIPAA which will allow addiction history to be shared with treating providers; permitting Medicaid and commercial health plans to access Prescription Drug Monitoring Programs (PDMP); and sharing Medicare fee-for-service part A and B data with stand-alone Medicare prescription drug plans.

Thank you for the opportunity to share our efforts to address the opioid crisis.  I look forward to our discussion today, and a continued working partnership going forward. 

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