Moderator: Michelle C. Landers, JD, Vice President & General Counsel, Kentucky Employers’ Mutual Insurance, and Member, National Rx Drug Abuse & Heroin Summit Advisory Board

CE Certified By: AMA,AAFP,ACPE,ADA,ANCC,APA,NAADAC,NASW,NBCC

Effectively addressing the overdose epidemic will require a coordinated effort by all stakeholders, including practitioners and third-party payers. It is imperative that third-party payers and practitioners work together to ensure access to addiction treatment in a manner that reduces patient discrimination, allows for quality care and decreases opportunities for waste, fraud and abuse. In this session, two presentations will demonstrate these dynamics at work in Tennessee — which has one of the nation’s highest rates of Rx painkiller use, with a record number of people dying from opioid overdoses in 2014.

Representatives of the state’s largest health insurance carrier, BlueCross BlueShield of Tennessee (BCBST), will explain how the company is demonstrating results through a clinical and social approach to combat the misuse and unintentional overuse of Rx painkillers. To assist lawmakers, regulators, providers, and, most importantly, its members in providing measured solutions to the Rx drug abuse epidemic, BCBST began a focused investigation into Rx drug utilization in the state in 2014. BCBST initiated a multi-prong approach to address this critical issue, and pain management was one of the disciplinary concentration areas. In 2015, BCBST began evaluating its Medicaid population by contracting an organization that specializes in alternatives ways to address pain management. Presenters will outline the Pain Management and Care Improvement Program that has been implemented for BCBST Medicaid members. They will discuss outcome measurements and lessons learned from the pilot program, as well as results of various prescriber education and outreach initiatives.

A Tennessee physician, with over a decade of experience, will examine coverage and payment issues that impede access to valuable treatment for individuals with opioid use disorder. He will explain the urgent need for laws and regulations to be up-to-date and flexible to allow the use of new, innovative products, including practitioner-administered medications approved by the U.S. Food and Drug Administration to treat opioid use disorder, as well as to allow new policies and programs to take effect and make a meaningful impact. The speaker will propose practical solutions, including current legislative and regulatory initiatives and reimbursement models that ensure proper care for individuals with opioid use disorder.

UPON COMPLETION OF THIS COURSE, PARTICIPANTS WILL BE ABLE TO:
- Describe health plan strategies to implement safe prescribing efforts.
- Identify the components of the health plan’s Pain Management and Care Improvement Program pilot and various prescriber education initiatives.
- Explain outcomes collected and lessons learned from the Pain Management pilot and provider outreach initiatives.
- Describe current reimbursement methods and how they are affecting access to addiction treatment.
- Explain how some legislative and regulatory efforts have either aimed to, or unintentionally resulted in, a decrease in access to quality, evidence-based addiction treatment.
- Outline legislative and regulatory initiatives that could improve care and coverage of treatment for individuals with opioid use disorder.