Opioid Safety Toolkit for Health Plans

Health Highlights

Editor’s Note: The United States is in the midst of the worst drug crisis in history. In 2017, nearly 50,000 Americans died of an opioid overdose. For the California Health Care Foundation (CHCF), Manatt Health has created a toolkit for health plans implementing opioid safety initiatives. The toolkit, summarized below, showcases best practices and success stories, as well as provides practical tools, across five areas: leadership and change management, provider network, medical management, pharmacy benefit, and member services.

Based on the work of Smart Care California—a public-private partnership supported by CHCF—the toolkit was informed by a literature review and conversations with health plan leaders. It translates the leaders’ experiences into actionable steps and tools—including model work plans, project management checklists, infographics, slide decks and more—that can be customized to meet the needs of individual organizations. Click here to access the full toolkit free.


Leadership and Change Management: Mobilizing to Prevent New Starts, Manage Pain, Treat Addiction and Stop Overdose Deaths

As payers and financial stewards, health plans can influence the behavior of patients and providers around the use of opioids. Therefore, health plans have a leading role in stemming the tide of the epidemic.

Health plans that are successful often employ a broad change campaign with an engaged leadership team. Key elements of change campaigns include executive sponsorship, clear goals and accountability, effective planning and coordination, and data analysis to evaluate progress. To succeed, it is important for plans to:

  • Create a sense of urgency, rallying their organizations to address the opioid crisis impacting their members.
  • Form an internal coalition, engaging broad executive and departmental leadership in an opioid safety initiative.
  • Build their case, communicating about their opioid safety initiatives and garnering support for change.
  • Remove obstacles, proactively identifying and addressing barriers that may impede their opioid safety initiatives’ progress and success.
  • Create quick wins, setting up opioid initiatives for success by setting attainable goals, tracking progress and celebrating achievements.

Provider Network: Preparing to Support Safer Pain Management and Access to Evidence-Based Addiction Treatment

To support safer pain management and ensure access to evidence-based addiction treatment, health plans must first understand their networks’ capacity to serve at-risk members—and if necessary, fill gaps to ensure medication-assisted treatment (MAT) is available throughout the network and at various access points (e.g., emergency departments).

In some cases, health plans may need to encourage additional providers to become waiver-trained. Waiver-trained providers may also benefit from mentorship and other support programs. In addition, health plans should continuously educate the provider networks—both waiver-trained and other providers and care team members—to recognize at-risk plan members and connect them to MAT and safer pain management. It is important for health plans to:

  • Understand their provider networks, making certain the networks are adequate to meet the needs of members with opioid use disorder.
  • Improve access, ensuring at-risk members have access to waiver-trained providers and evidence-based pain management and addiction treatment.
  • Offer support, providing networks with adequate support to treat at-risk patients using MAT and safer pain management techniques.

Medical Management: Supporting Safer Pain Management Options

Health plans have a critical role to play in influencing and managing their members’ care. Health plans can work to ensure that their members receive appropriate treatment, including safer pain management; effective care coordination; and clear communication between the health plan, member and member’s care team. Health plans should:

  • Augment benefits, supporting safer pain treatment options.
  • Coordinate services, strengthening care coordination and improving communication among members, providers and the health plan.

Pharmacy Benefit: Reducing New Starts and Streamlining Access to Buprenorphine and Naloxone

Many health plans have made great strides in combating the opioid epidemic by reviewing and revising their formulary policies to ensure they are aligned with industry best practices. Health plans should continue to refine their formularies when new data emerge about how these policies improve health or cause harm.

Health plans also should ensure their prescribers and members have access to buprenorphine and naloxone and that the pharmacies in their networks are actively stocking and dispensing these lifesaving drugs. Health plans should revise their formularies to support safer pain management. They also should work with prescribers and communities to ensure access to buprenorphine and naloxone. It is important for health plans to:

  • Reduce new opioid starts, implementing appropriate formulary policies and effective communication with their provider networks.
  • Streamline access to MAT, designing benefits and improving pharmacy and prescriber support to promote simplified access to buprenorphine and naloxone.

Member Services: Offering Learning Resources for Members, as Well as Their Families and Caregivers

Members, as well as their families and caregivers, may reach out to health plans to learn more about options for treatment. Encounters with their providers or care managers, the health plan’s website, or the health plan’s member service lines are all important touch points through which members can learn important information about options for safer pain management and evidence-based treatment. Health plans should:

  • Identify at-risk members (for example, members who are experiencing pain or who are concerned about mental health issues, substance use disorder (SUD) or overdose).
  • Develop and make available resources for members.
  • Train member services to recognize and respond appropriately when members are at risk. 


pursuant to New York DR 2-101(f)

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