Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution.

Transcription

1 TM Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution.

2 Goals of Opioid Defense Manager TM Opioids are the most common drugs prescribed in workers compensation. This drug class is linked to the highest rate of prescription drug abuse. With mounting concern of the misuse and abuse of these drugs, the Center for Disease Control has proclaimed opioid abuse an epidemic. Chronic use of opioids can lead to higher medical costs, prolonged disability, overutilization and unintentional harm. Modern Medical is taking a proactive approach to solving the opioid abuse problem by introducing our revolutionary managed care program, Opioid Defense Manager TM (ODM TM ). ODM TM is a customized program designed to protect the employee, physician and the employer by reducing inappropriate drug use while maintaining the necessary balance to provide pain relief for the claimant. Claimant Centered Program Modern Medical s claimant centered approach focuses on prevention. It starts with recognizing claimants who are at risk for prolonged disability, opioid dependence and risk of harm from opioid therapy. Modern Medical s clinical team of nurses and pharmacists will then collaborate with prescribers to ensure appropriate opioid therapy. This includes the ongoing monitoring of pain, function, adverse drug effects and risk management strategies such as urine drug screens, state prescription drug monitoring and pain agreements. Claims examiners and nurse case managers will work with Modern Medical to access real-time alerting of potentially harmful drug use patterns to more effectively manage the claimant s drug coverage. Claimants need to be involved with their care by understanding the expectations of treatment while pharmacist nurse working toward Claimant treatment goals. This is accomplished through claimant education and the pain agreements. prescriber

3 Current Common Injury & Prescribing Cycle CONSERVATIVE CARE Hydrocodone/APAP Naproxen (14 days of therapy) $70 Injury Low Back Sprain pain continues Neuropathy Hydrocodone/APAP Celebrex Tizanidine Lyrica $430/month one year post-injury Treatment costs >$2,000/month Return to work unlikely chronic pain & depression Oxycontin Lyrica Oxycodone IR Cymbalta Celebrex Bupropion Tizanidine Nexium $1,290/month Opioid abuse is deadly and costing American corporations millions of dollars. Over the last 20 years, there has been a 10-fold increase in the medical use of prescription opioid drugs. With this escalating use and availability, the misuse, abuse and diversion of prescription opioid drugs has also grown. This is evidenced by the following statistics: Prescription drug abuse results in one death every 19 minutes in the U.S. 1 Claimants using opioids chronically have healthcare costs that are over four times higher than claimants not using opioids. 2 For 90 days or longer, odds of chronic work loss are times greater for claimants with opioid prescriptions compared to those without opioids. 3 Opioid abusers have health care costs that are more than 8 times higher than those of non-abusers. 4 Roughly one-third of all paid prescriptions are filled with an opioid drug the drug class with the highest rate of abuse. 5 Americans constitute only 4.6% of the world s population but consume 80% of the global opioid supply and 99% of the global hydrocodone supply Leider HL, Dhaliwal J, Davis EJ, Kulakodlu M, Buikema AR. Healthcare costs and nonadherence among chronic opioid users. Am J Manag Care. 2011;17(1): Volinn E, Fargo JD, Fine PG. Opioid therapy for nonspecific low back pain and the outcome of chronic work loss. Pain. 2009;142(3): White AG, Birnbaum HG, Mareva MN, Daher M, Vallow S, Schein J, Katz N. Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm. 2005;11(6): Data on file at Modern Medical, Inc., Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic Use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective. Pain Physician. 2010;13:

4 How Opioid Defense Manager TM Works The Core of ODM Modern Medical s Opioid Defense Manager TM program is completely customizable. The ODM TM Nurse Intervention is the core of the ODM TM program proactively monitoring claimants using opioids over time. When using Modern Medical s nurse, we will review physician opioid progress reports every 60 days on an enrolled claimant, obtain pain agreements from the physician every 6 months and monitor outcomes for claimants in coordination with the clinical pharmacists on staff. Other interventions may be recommended and the formulary may be modified based upon the claimant progress and physician notes. If you utilize your own nurse, Modern Medical will provide alerts with letters on TruNet every 60 days. Outcomes are reported through dashboard reporting on TruNet and actions can be sent from TruNet to modify the formulary or request additional services. Worker is injured ODM TM Enrollment Process last 2 months: Opioids for 30 days Claimant Education MMI Nurse or Your Nurse Physician Opioid Progress Reports Pain Agreements Tracking Pain & Function Managing Benefits Monitored every 60 days while eligible and on opioids The Technology Driving ODM TM TruNet Modern Medical s TruNet is a state of the art, web-based technology portal for tracking and managing all of your claims in real time with real results. With this tool, you will be able to review ODM claimants, set and review alerts and take actions based on information and reports. TruCase TruCase is the claims management system that Modern Medical s clinical staff uses to track outcomes for pain, function, opioid use, adverse effects, urine drug screens and pain agreements. TruRisk This prescriber intervention program works in tandem with the ODM alerts to identify and address issues with opioid and other inappropriate drug use. With ODM, Modern Medical is expanding this program to include additional interventions: multiple sedatives, early opioid refill attempts with accumulation, multiple prescribers and pharmacies and excessive use of hypnotics and muscle relaxants. Modern Medical will also track multiple aspects of injured worker compliance. This program is provided at no additional charge and is considered a claimant safety initiative program managed by our clinical pharmacists. Modern Medical s Clinical Services Team handles the complexities of the medication management system to cultivate positive claimant outcomes for the injured population.

5 Inappropriate Drug Use Alerts Pattern of Filling Prescriptions Drug Duration Drug Dosage Concurrent Drug Use Utilization *These alerts follow the Ohio Coordinated Services Program. 1. Early narcotic refill attempts 2. Using multiple physicians and pharmacies 3. Utilizing 2 or more pharmacies for prescriptions* 1. Narcotic utilization > 90 days 2. Narcotic utilization > 120 days 3. Excessive duration of use: hypnotics (beyond 90 days) 4. Excessive duration of use: muscle relaxants (beyond 90 days) 1. Daily narcotic use > 120 mg/day 1. Concurrent use of a narcotic + sedative 2. Multiple sedative drugs 3. More than 2 narcotics and a hypnotic filled monthly* 4. More than 2 prescribers for same drug class* 5. More than 2 narcotics filled monthly with concurrent use* 1. At risk for drug-related problems (> 7 drugs) 2. More than 2 narcotics filled monthly* 3. First fill Schedule II opioid Opioid Defense Manager TM Program Components Identify Risk Claimant Education Opioid Monitoring & Interventions Medication Reviews Peer Reviews Physician Reviews Urine Drug Screen Formulary Management Services Opioid Detoxification Services TruNet Alerts TruNet alerts are one of Modern Medical s clinical solutions for identifying inappropriate patterns of drug use. These alerts can trigger the following actions to be taken in the Opioid Defense Manager program. Medication Review Services An Independent Pharmaceutical Evaluation (IPE) provides a professional opinion from a clinical pharmacist on cost effective therapy that is appropriate for the covered claim as well as to identify and recommend solutions to mitigate claimant risk. Peer Review Services Modern Medical is working with a peer review organization that will provide a final report and will conduct peer-to-peer contact if the current treatment requires intervention. This service can be combined with a medication review. Physician Review This service allows the current prescriber to be reimbursed for an in-depth file review. While this service is available for all alerts, we recommend that claimants with a dose above 120mg per day of morphine equivalents receive this intervention. This will require a random urine drug screen, a pain agreement on file, a treatment plan and a state prescription drug monitoring report to be pulled. Formulary Management Services Allows you to make changes to the claimant s formulary instantly. Options include: continue medications, block medications or restrict medications to a certain period of time. This action is available for opioids as well as other medications like: sedative/hypnotics, benzodiazepines, and muscle relaxants. Urine Drug Screen Services Modern Medical is working with Millennium Labs to offer a comprehensive urine drug screen that tests over 80 different drugs and metabolites including synthetic cannabinoids and bath salts. Reports are made available to you and the claimant s physician. Opioid Detoxification Services Modern Medical offers an outpatient detoxification program as an optional treatment for the claimant when recommended by the peer review physician. This outpatient detoxification program is supervised by a physician specialized in addiction medicine.

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