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CareSource: Progress seen in reducing opioid prescriptions

We spoke with Jonas Thom, CareSource’s vice president of behavioral health, about some of the latest work the Dayton company is doing to fight the addiction crisis. Here’s the conversation, condensed and edited.

Q: CareSource recently announced that it had made some strides to reduce opioid use in the state. Can you talk about that program and how it worked?

Jonas Thom: So one of our key strategies in assisting our members and the community is cutting the amount of opioid prescriptions. We are a payer, so if we are going to pay for them we have a responsibility around insuring appropriate opioid prescriptions and sales. Over the last few years, we have reduced opioid prescriptions in Ohio by 40 percent, and we’re tracking to reduce by half by the end of the year.

There are three big areas we’ve worked in. First there’s the care management approach, where people who are getting a lot of opioids are put into care-coordination programs. We have also done a lot of provider education and outreach – where we’ll give letters to physicians on how they are doing on opioid prescription relative to their peers. That drives a lot of change – if you see you’re prescribing a lot more than your neighboring physicians, that’s a wake-up call for you.

Third is our pharmacy policy – what we cover, and when we cover it. We’ve worked with the state to align that around when opioids should be used, and adjusting with the evidence as it emerged. The Kasich administration and the legislature have had a lot of interest in managing the opiod epidemic, and have been very successful.

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Q: Where do you think we are in the epidemic?

Thom: We’ve had a lot of success, but there is a lot more than needs to be done. It’s important that substance abuse treatment and awareness have become part of our health care and culture, but took a long time to get here and it will a lot more than a couple of years to get where we want to be.

Q: What does that look like?

Thom: On the treatment side, we want substance abuse treatment to be a strong enough part of our health care system that people who need it can get it when they need it. We want opioids to be used but not misused. And we want a community that is supportive of people in recovery, that helps them take part in the wonderful things in life.

Q: Some patients have expressed concern that they legitimately need opioids for their medical situations which are now becoming harder and more inconvenient to get – thoughts on that, and how they can be helped?

Thom: I think there are three groups of people we’re talking about. There are those who have never had or used opioids, and so we will do what we can, through alternative pain treatments that aren’t addictive, to keep them from ever getting started. Then there are folks with chronic pain who are actually well-managed on opioids that they need, and we have no interest in taking away what they need. The third group is people who use opioids on and off, and who could benefit from coming off. Those are the ones we want to target and work with their physicians as they transition off opioids. We’re not talking about eliminating, we’re trying to get opioids to the right people at the right time, and the right level.

Q: We reported last week that the latest numbers on ODs showed they are up again in a spike, but OD deaths are down. Thoughts?

Thom: Well, deaths being down is no small feat. It speaks to the availability of Narcan and other drugs that can reverse overdoses, and to the combined efforts of the community, the police, first responders, health care providers, families, peer groups. It’s been amazing. I’d like to say, too, that CareSource was the first insurance plan in the country to pay for Narcan and figure out a way to pay for it over the counter, to help make it widely available. We’re really proud of that.

On the increase in overdoses, I know “blips” is a terrible way to put it, but I think we are going to see changes in statistics as this goes on – but I also think that over time, everything will come down. But it’s not going to be something where we learn from it month to month, quarter to quarter – you have to look at it over the long term. I’m thankful for this community’s response and I’m hopeful.

Q: We’re running a story in today’s paper about how businesses are looking at ways to employ people in recovery.

Thom: Recovery support is so essential, and it’s something we take seriously here. We have our JobConnect program, and we’ve worked with the courts to help divert people to treatment. The business community here is receptive to making sure folks have the opportunities they need to go back to work and continue their lives, which is a critical part of recovery.

I think employers are figuring out that this is just part of our community and culture from now on, and I think they’re waking up to the fact they already employ people who are in recovery, and are asking, “How do I continue to support them?” This epidemic has touched so very many of us already that it’s opened a broad dialogue of what these disorders are and what these people look like, and there is a lot more awareness and kindness being shown as a result.

Q: Final thoughts?

Thom: One final thought: at CareSource, we’re an insurance plan, so it’s central to who we are and our mission, to help people have productive and fulfilling lives. And we know we have to attend to substance abuse and mental health not as side issues but really as the main things we do. I’m proud of CareSource and I’m proud of Dayton and the way this community has come together to address this problem — frankly, a lot better than many other communities I’ve seen. This is a great place, and the collaborative spirit in Dayton is second to none.

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