Maryland-Based Insurer Announces Moves to Address Opioids Crisis

"The impact of opioids in the region we serve has been well documented," CareFirst President and Chief Executive Officer Chet Burrell said. "As the region's largest health insurer and one with a unique community mission, we want to take a comprehensive approach to address the opioid crisis for the greater community."

CareFirst BlueCross BlueShield, which provides health insurance to 3.2 million individuals and groups in Maryland, the District of Columbia, and Northern Virginia, announced new actions on Dec. 13 to combat the region's opioid crisis in the communities it serves and programs to address substance use disorders and provide addiction and behavioral health services to CareFirst members. Its efforts include $1.5 million in funding for non-profit community organizations for programs aimed at addressing substance use disorders, new prescribing limits, and treatment programs to limit opioid abuse and improve care for members battling addiction.

The company is an independent licensee of the Blue Cross and Blue Shield Association and is a not-for-profit health care company.

"The impact of opioids in the region we serve has been well documented," CareFirst President and Chief Executive Officer Chet Burrell said. "As the region's largest health insurer and one with a unique community mission, we want to take a comprehensive approach to address the opioid crisis for the greater community, as well as to create and promote policies and programs for our members that address addiction and its disastrous health impacts on the individuals and families we cover."

Baltimore Mayor Catherine E. Pugh joined him for the announcement. "Far too many individuals are familiar with the toll on our community caused by the use and abuse of opioids. It takes a toll on individuals, families, and the entire community," she said. "The Baltimore City Health Department has developed a comprehensive, three-pillar strategy to combat opioid addiction: prevent deaths from overdose and save lives, increase access to on-demand treatment and long-term recovery support, and provide education to reduce stigma and prevent addiction. But this is one of those situations which you can never do enough to address, and where you always welcome additional partners and resources. I'm glad to be here today with representatives of CareFirst BlueCross BlueShield. We know CareFirst as the area's largest health insurer, but the company is also one of the biggest corporate philanthropists in the region, and this effort is a great example of their commitment to greater Baltimore."

CareFirst said it is taking several steps, including:

  • In January 2018, CareFirst will issue a request for proposals to community non-profit organizations serving the company's Maryland, Washington, D.C., and Northern Virginia service area in order to award $1.5 million for programs and initiatives to directly address opioid use, addiction, and related issues.
  • CareFirst has in place and continues to develop a network of high-performing addiction recovery centers.
  • Because many individuals with addiction have co-occurring medical and behavioral health disorders, CareFirst has developed a Behavioral Health and Substance Use Disorder program through which primary care providers, nurses, and behavioral health providers can refer CareFirst members. In the program, members are assessed and connected to specially trained clinicians who work one on one with patients to identify mental health providers, assist with access, and coordinate their overall care.
  • Based on CDC Guidelines for the Management of Chronic Pain, CareFirst implemented in October 2017 new requirements related to opioid prescription quantity and duration limits.
  • CareFirst monitors controlled substance pharmacy data to identify members with multiple prescribers/pharmacies, excessive use, and high claims costs, which indicate behavior patterns that signal possible misuse. Pharmacists notify providers of the member's utilization history and work with them to outline and address concerns.

"All of these efforts are intended to work together, both to address what has become a public health crisis and, beyond that, to treat addiction for what it is – a chronic disease," said Dr. Daniel Winn, CareFirst Senior Medical Officer and vice president. "Unfortunately, only one in ten people in the United States with addiction to alcohol and drugs are diagnosed and receive treatment – compared to 70 percent with hypertension or diabetes. Community-based efforts, new guidelines, and programs to staunch the dangerous flow of opioids, and programs that comprehensively treat addiction and its attendant medical issues, are all necessary to address this pressing problem."

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