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CMS Opioid Roadmap Prioritizes Healthcare Interoperability

A new roadmap aims to leverage healthcare interoperability and clinical data to address the opioid epidemic.

A new CMS roadmap utilizes healthcare interoperability to reduce opioid overuse.

Source: Thinkstock

By Kate Monica

- A recently released CMS opioid roadmap provides strategies to reduce opioid overuse among Medicare beneficiaries through improved healthcare interoperability.

The federal agency’s three-pronged approach focuses on opioid use disorder (OUD) prevention, treatment, and data utilization to ensure prevention and treatment efforts target the patient populations who most need them.

“Current estimates show that over two million people suffer from opioid use disorder, with a prevalence in Medicare of 6 out of every 1,000 beneficiaries,” CMS announced. “In order to decrease that number, it is crucial that Medicare beneficiaries and providers are aware that there are options available for both prevention of developing new cases of OUD and the treatment of existing cases.”

In addition to utilizing health data to target prevention and treatment efforts, CMS will also identify trends of fraud and abuse among patients.

“Data provides insight into doctor, pharmacy, and patient use of prescription opioids and effectiveness of treatment,” the roadmap states.

CMS will leverage health data to understand opioid use patterns across populations, promote healthcare interoperability and health data exchange across the care continuum, and monitor trends to assess the effectiveness of prevention and treatment solutions.

Interoperability between prescription drug monitoring programs (PDMPs) can enable better-informed prescribing practices among doctors across state lines to reduce the likelihood of patients visiting multiple doctors to obtain prescriptions.

Some states have made great strides toward improving health data exchange and PDMP use. New York’s PDMP recently achieved interoperability with PDMPs in 25 other states and Washington DC.

In addition to improving data transparency and interoperability, CMS also plans to expand tools such as a Medicare “heat map.” The Medicare heat map shows prescribing rates across the country to allow CMS to easily identify which areas are most in need of OUD prevention efforts or safe prescribing strategies.

CMS will analyze prescription drug data across CMS programs and in special patient populations including those in rural areas, those with dual Medicare and Medicaid eligibility, and those certain health conditions. The federal agency also plans to continue to support state Medicaid programs to ensure they are able to track and report data.

“CMS is working to ensure that beneficiaries are not inadvertently put at risk of misuse by closely monitoring prescription opioid trends, strengthening controls at the time of opioid prescriptions, and encouraging healthcare providers to promote a range of safe and effective pain treatments, including alternatives to opioids,” the federal agency stated.

The federal agency is also looking at other programs outside of Medicare and Medicaid to see how other patient populations may benefit from certain tools to address the opioid crisis.

“Further, while we have initiatives specific to Medicare and Medicaid, we are also reviewing all of our programs to find solutions that are working at the local level with states, providers, and payers so that we can disseminate successful ideas as quickly as possible to help our partners know that they do not have to solve this alone,” wrote the federal agency.

While the opioid crisis remains a top priority of the Trump Administration, CMS has made progress in curbing the epidemic. As a result of safe prescribing policies, the number of Medicare beneficiaries receiving higher than recommended doses of opioids from multiple doctors declined by 40 percent in 2017, according to a CMS.

“CMS believes we can make progress in addressing the many aspects of the opioid epidemic in partnership with states and other stakeholder organizations,” stated the federal agency.

 “This roadmap is only a start, and as we begin to implement many of our plans and programs, it will continue to evolve,” continued the federal agency.

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