The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


Good Intentions Gone Awry: Solving for the Prescription Pain Medication Epidemic

By Truven Staff
Tami Mark imageHeroin in New England, More Abundant and Deadly” headlined an article in the July 18 edition of The New York Times that described the alarming comeback that heroin is making across the quaint towns and larger cities in New England.  Behind the growth in heroin use is a sad story of good intentions gone awry. A push to better treat patients’ pain and the introduction of oxycodone, a powerful and highly addictive pain medication, resulted in today’s massive prescription pain medication epidemic. The CDC recently reported that more people are dying from overdoses from pain medication than car accidents.

Efforts to clamp down on pain medication misuse have created the unfortunate consequence of, in effect, encouraging people with opioid addictions to substitute heroin for prescription pain medication. How can the healthcare system avoid this continuing cascade of unintended consequences? A key step is to ensure that individuals have access to a robust addiction treatment system. This effort can be enhanced with coordinated use of data and analytics.

Medicaid programs, for example, have established prescription drug monitoring to identify individuals who are abusing prescription drugs. However, such efforts need to be coupled with access to a robust substance abuse treatment system that includes access to the most effective medications for the treatment of opioid addiction – Suboxone® (buprenorphine/naloxone) and methadone, as well as coordinated substance abuse outpatient, inpatient, and rehabilitative services. A number of state Medicaid programs do not provide coverage of methadone treatment and many have time limits on the use of Suboxone. Analysis of de-identified Medicaid prescription and medical claims data, substance abuse treatment data, and prescription drug monitoring data can help states determine whether their systems are not only reducing misuse and diversion of prescription drugs, but are also providing access to high-quality addiction treatment that will keep their populations from substituting heroin use for pain medications that they can no longer obtain.

The total U.S. societal costs of prescription opioid abuse was recently estimated at $55.7 billion in 2009 - more than double the $24 billion that was spent on all of substance abuse treatment in 2009* as reported by Truven Health Analytics in Health Affairs. Thus, the numbers suggest greater coordination will have an economic, as well as a public health payoff.

Tami L. Mark, PhD
Vice President, Behavioral Health and Quality Research

Moving Patient Care Out of the Hospital, Into the Home

By Truven Staff
Tami Mark imageTo corrupt an old quote, there is nothing like a new payment system to focus the mind of a hospital administrator. The U.S. healthcare system is witnessing an explosion of delivery system experimentation, fueled by numerous payment initiatives such as CMS’s hospital readmissions reduction program (established through the Affordable Care Act).   New care models, such as the Presbyterian Healthcare Service’s “Hospital at Home” in Albuquerque, New Mexico and the Mercy Health “Care Transitions Program” in Cincinnati, Ohio are moving patient care out of the confines of hospital and clinic walls to the patient’s homes. There, patient education and care coordination may be more effective, thus preventing additional expensive hospital stays.

Preliminary data suggest that these programs work. Yet the history of the U.S. healthcare system tells us that these exciting initiatives can give way to perverse behaviors.  The implementation of inpatient prospective payment in 1983 stimulated the home health care industry. However, along with increased care in homes came concerns about sky-rocketing costs, overuse, inappropriate use, and fraud.

To find the ‘special sauce’ that will truly move our health care system from one focused on treating sickness to one focused on heath, we need to rigorously evaluate these exciting new initiatives, in particular, looking at their effect on the ultimate endpoint, population health.  The problem of paying for health rather than sickness has been a long standing conundrum. As George Bernard Shaw noted in 1906, “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.” If GBS were alive today he might be cautiously buoyed up by the current efforts to address this centuries old dilemma.

Tami Mark, Phd