Opioids and HEDIS®: Measures to Make a Difference (Video)

Written by Mike Vega, Search Consultant, West Coast
Contact him at 1.800.974.4828 x 119, or mike@carenational.com


CareNational is committed to providing the best service possible to our candidates and our clients. This includes continuing education through interactive conversations with contacts from both the client and candidate perspective. As the 2018 H.E.D.I.S.® (Healthcare Effectiveness Data and Information Set) season approaches, CareNational is dedicating a series of blogs to help health plans and HEDIS nurses, coders, and MAs.

In this article we will discuss how HEDIS is playing a role in addressing current social health issues in America. Opioid abuse is a serious public health issue. In fact, the US Department of Health and Human Services (HHS) identifies drug overdose deaths as the leading cause of injury death in the United States.

According to the National Institute for Drug Abuse, “Every day, more than 90 Americans die after overdosing on opioids. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.”

Now there is another worthy opponent in the fight against the opioid epidemic — health plans. This year NCQA (National Committee for Quality Assurance) added two new HEDIS measures created for health plans to track opioid use.  One measure tracks opioid use at high dose – this measures long-term, high dose use; a risk factor for overdose and death.

The second measure tracks opioid prescriptions from multiple providers or multiple pharmacies. Right now there’s no system for tracking prescriptions that are filled from one state to the other. However, health plans can use claims data to track opioid prescriptions across state lines and from more than one provider.

Additionally, the NCQA is updating an existing HEDIS measure to include medication-assisted treatment for people with dependence on alcohol and drugs.  “High dosage, multiple prescribers and pharmacies are all risk factors for dangerous overdose and death,” the NCQA said. “These measures add health plans to the group of stakeholders currently addressing the opioid epidemic.”

Some health plans are taking additional steps to limit the quantity of painkillers when appropriate, and explore additional controls for high-risk members. Specialized tracking programs will flag possible inappropriate use and the company will inform prescribers when an issue is identified.



As stated initially, CareNational is an expert in HEDIS staffing, and career search consultation in these specialized areas, but we do not perform the functions ourselves. So how did we do? Did you find this information useful? We love feedback!

Written by Mike Vega, Search Consultant, West Coast. For more great tips on hiring strategies and to discuss our current opportunities, reach out to one of CareNational’s top recruiters! Call him at 1.800.974.4828 x 119, or mike@carenational.com.

® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”

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