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Medical Economics for Complex Care

Healthcare resource utilization and costs initiatives and outcomes.

The Opioid Crisis

Health Plans Scramble to Control Costs

Revision: January 20, 2021

Original Publication: September 24, 2018

Written by Carol Yvette Thorney, MBA

According to the Centers for Disease Control and Prevention (CDC), over 160,000 Americans have died from COVID-19 as of August 2020. Those who have lost their lives directly from the virus are not the only ones who have suffered. Drug use and drug overdose deaths are suspected to be increasing for a number of factors influenced by the wreckage COVID-19 has caused. The Kipu Health reports states that the number of opioid overdoses in large cities has risen by 54% in 16 states. The link between opioid addiction and COVID-19 is a serious issue that individuals, families, and medical and treatment professionals are fighting to overcome.


The alarm was rightly sounded by the CDC (Center for Disease Control and Prevention) about the ever-growing opioid crisis. The CDC has even been proactive in developing a separate website to highlight policies and initiatives underway to combat this devastating health issue sweeping the country and impacting families at every socio and economic level. The ability to identify at-risk populations and enable payor and providers to work together to develop comprehensive approaches in collaboration with community-based organizations with street-level insights is still a challenge.


From 1999-2016, according to Blue Cross Blue Shield Association (BCBS), more than 350,000 people died from an overdose involving any opioid, including prescription and illicit opioids.Payors have been slow to proactively develop clinical programs targeted at identifying members at-risk and even slower to implement programs which are meaningful to members' lives. This became a hot issue in 2017 with the crafting of strategies to identify and develop clinical insights derived from claims data to determine social determination of health (SDOH).


Blue Cross Blue Shield Association (BCBSA) recently launched initiatives to use data-driven insights to improve the health of their members in all states and combat the opioid epidemic focusing on a multi-prong approach for preventing abuse and ensuring patients receive the right care in the right setting.


Key pillars to the approach:

  • Prevention
  • Treatment and Recovery
  • Research for Insights
  • Public Awareness Program to Combat Stigma of Addiction
  • Opioid Use Patterns: Dose and Duration

Progress has been made to reduce the dose and duration of opioid use among BCBS members who were prescribed at least one opioid in a calendar year. When medical professionals prescribe an opioid to a patient, the CDC recommends that the first prescription should have a duration of seven days or less and under 50 morphine milligram equivalents (MME) per dose. Any opioid prescription over these recommended guidelines is considered high dose and long duration.


The reality is that with all of the attention from healthcare, pharmaceutical, government and community-based actors, it is still the member/patient who needs to be inspired to come forward and ask for help. There is a fear that coming forward will have negative impacts to their employment especially if they have careers in healthcare; and access to children during custody negotiations, COVID-19 related isolation and so much more.


For more information email us at [email protected]


The views expressed in these posts are those of the authors and are current only through the date stated. These views are subject to change at any time based upon market or other conditions, and Thorney Advisors disclaims any responsibility to update such views. These views may not be relied upon as medical advice and may not be relied upon as an indication of medical policy on behalf of any Thorney Advisors consultants. The discussion herein is general in nature and is provided for informational purposes only. There is no guarantee as to its accuracy or completeness.

About the Author

Carol Yvette Thorney, MBA

Executive Advisor, Writer, Healthcare, Insurance, Financial Services, Technology and Digital Marketing Consultant

Carol is a strategic, resourceful healthcare executive with reputation for leading transformation and turnaround operations and IT initiatives driving performance focused on growth, optimizing customer experience while motivating teams. Transformation evangelist working tirelessly to build buy-in, alignment, and support from stakeholders. Strong focus on value generation for the company, customers, and patients. 


Carol has over 20 years’ experience as an innovative, profit-oriented executive with demonstrated success in directing global organizations in North, Central and South America, UK, Europe and Asia. Consistently achieve success, meeting aggressive top and bottom line and operational excellence goals while championing Agile and Lean enterprise strategy with deep understanding of strong technology skills and broad business expertise.

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