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AMA Reviews Colorado, Pennsylvania Opioid Reform

Where the states are exceeding, and what they can do to improve

The AMA has released two reports on opioid reform, focused on the states of Colorado and Pennsylvania, and how they are tackling opioid reform.

Colorado

In partnership with the Colorado Medical Society (CMS) and Manatt Health (Los Angeles, CA), AMA’s report1 on Colorado focused on the state’s improved access to evidence-based treatment for substance use disorders, several pilot projects aimed at improving care for patients with pain, and increased access to naloxone.

“This analysis comes at an important time for Colorado,” said Debra Parsons, MD, president of CMS, in a news release.1 “Over the last six years, Colorado has developed policies, enacted laws and made important strides to have all stakeholders work together. While we continue these successful initiatives, we must closely evaluate how they are working so we can ensure we are putting our efforts in the right places.”

 

Key areas in which Colorado is succeeding, according to the AMA report:

  • adoption of policies and funding to increase access to Medication-Assisted Treatment (MAT), including initial steps taken to reduce administrative barriers, increased funding to address workforce issues, and plans to increase Medicaid coverage in residential settings
  • examining compliance with mental health and substance use disorder parity laws through the Colorado Division of Insurance’s review of insurers’ conduct and the establishment of an ombudsman’s office to assist patients in accessing behavioral healthcare
  • increasing Medicaid patients’ access to non-opioid alternatives for pain management, including coverage of non-opioid prescriptions and alternative therapies such as physical therapy, occupational therapy, and behavioral healthcare treatment options
  • expanding access to naloxone via early legislation and implementation of a standing order for naloxone, Good Samaritan protections, and elimination of prior authorization for naloxone under Medicaid
  • highlighting the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has developed a county- and state-level data dashboard that can be used to help direct resources to areas of greatest need.

The report also found that the state could use additional progress by focusing on:

  • eliminating remaining barriers to treatment, including by taking further steps to increase enforcement of mental health and substance use disorder parity
  • expanding access to providers of MAT, especially in Colorado’s rural areas
  • leveraging successful state pilots to increase access to multimodal pain care and comprehensive benefit and formulary designs
  • linking those whose lives have been saved by naloxone with follow-up treatment to begin and sustain recovery
  • evaluating state policies and programs to determine what is improving patient care and reduce opioid-related harms, including whether current policies may be resulting in unintended consequences.

Pennsylvania

The AMA’S report on Pennsylvania, released in December 2018,2 also outlined several ways in which the state is succeeding in opioid reform, including:

  • comprehensive support for MAT, including removing administrative barriers and establishing 45 Centers of Excellence across the state to expand access to MAT, including mental and behavioral healthcare services
  • enforcement of mental health and substance use disorder parity laws through market conduct examinations of health insurance companies
  • comprehensive naloxone access policies, including a statewide standing order and stakeholder support for increased naloxone access
  • medically based oversight for Medicaid patients with careful review of care plans for patients with an opioid use disorder as well as for patients with chronic pain, including coverage of non-opioid prescription medications as well as alternative therapies.

“It’s essential that policymakers know what is working, and where additional progress can be made,” said Patrice A. Harris, MD, MA, AMA president-elect and chair of the AMA Opioid Task Force, in a press release.2 “There is [a] long way to go to fully end the epidemic in Pennsylvania and across the nation, but it’s clear that Pennsylvania’s policymakers are employing multiple strategies that are showing promise.”

According to the report, Pennsylvania could also build on its accomplishments by:

  • continuing to build out state infrastructure and ensure health insurers and Medicaid identify and remove barriers to adequate networks and workforce shortages. (Infrastructure improvements might include further development of hub-and-spoke arrangements, including leveraging federal funding to turn grant programs into sustained practices)
  • identifying and learning from best practices to provide comprehensive, multimodal pain care, and work closely with stakeholders to review and reform benefit design and formulary requirements to ensure patients have access to non-opioid alternatives
  • building on the state’s improved naloxone access successes through statewide education efforts with physicians and other key stakeholders
  • building on efforts underway at the Pennsylvania Department of Health to evaluate the policies, programs, and other efforts in the state to determine what is truly working to improve patient care and reduce opioid-related harms, including understanding relationships between current policies and clinical outcomes to further successful efforts while amending those that may be having unintended consequences.

These two state reports are part of a series of in-depth analyses produced by Manatt Health and AMA, which are set to include two more, yet to be announced states. According to a Manatt Health release,3 these spotlights are intended to “identify best practices and next steps to address the [opioid] crisis.”

Last updated on: February 21, 2019
Continue Reading:
States Take Action to Manage Opioid Addiction
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