How WellCare Is Addressing the Opioid Epidemic

The numbers are staggering, and they’re not slowing down.

The opioid epidemic is the deadliest drug crisis in American history, and according to the Centers for Disease Control and Prevention (CDC), opioids could kill nearly half a million Americans over the next decade.

As a provider of government-sponsored managed care, including Medicaid and Medicare, the opioid epidemic is a critical issue impacting WellCare and its members. Today, Medicaid covers approximately 30 percent of Americans with an opioid addiction, and the Medicare population has one of the highest and fastest-growing rates of diagnosed opioid use disorder.

In response, WellCare has established an Opioid Task Force and is implementing a number of programs and policies to address this epidemic. For example:

  • From 2015 to 2017, WellCare intervened with members receiving opioid prescriptions higher than 120 mg morphine equivalent doses per day through member education on alternative treatments, prescriber outreach and connections to our behavioral health case management team. As a result, opioid utilization dropped by 43 percent.
  • In Kentucky, WellCare leveraged a pharmacy management pilot program to curb opioid misuse and abuse and identified approximately 1,300 members at risk based on risk criteria such as prescription dispensing, prescription refills, pharmacy use and emergency department utilization. At-risk members were connected to one pharmacy, one healthcare provider and a care manager specialized in substance abuse treatment. As a result of the program, opioid dispensing dropped by 55 percent.
  • In Illinois, WellCare’s Harmony Health Plan is rewarding providers when at-risk members are referred to substance abuse treatment, appointments are scheduled and members complete visits. Members are also rewarded with gift cards for attending appointments. Early 2017 results showed a 10 percent increase in initiation appointments and a 7 percent increase in follow up appointments.

Additionally, WellCare is rolling out a telehealth program for use in emergency rooms to help increase access to Medication Assistance Treatment (MAT) and is developing an incentive program for physicians to become Substance Abuse and Mental Health Services Administration (SAMHSA) certified given the increased demand for addiction specialists.

Laura Hungiville_Ways and Means_2-6-18These are just some steps we’re taking to help curb the opioid epidemic. Tackling the problem also requires broader policy changes at a national level. [Watch recommendations from WellCare’s chief pharmacy officer Laura Hungiville in her testimony before the U.S. House Ways & Means Committee.]

In the coming months, we will continue to roll out new, innovative solutions and will work with our members, providers and government partners to address this dangerous crisis.

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