Substance use disorder doesn’t discriminate. In Michigan, opioid misuse has plagued communities of all shapes and sizes. In 2020, due in part to the pandemic, the state saw the highest number of opioid overdose deaths to date after several years of declines. Blue Cross Blue Shield of Michigan has taken steps inside and outside the company in the health care space to limit opioids prescribed for pain management, work with physician groups to improve statewide prescribing practices and utilization, and to remove barriers to substance use disorder treatment. Tackling the opioid epidemic takes actions large and small, both inside systems and across communities.
Making a difference in communities
Selected members of the Michigan Opioid Partnership (MOP) – Blue Cross, the Blue Cross Blue Shield of Michigan Foundation, Michigan Health Endowment Fund, and Superior Health Foundation – along with community partners, the Michigan Health & Hospital Association, and the Upper Peninsula Health Plan, have partnered to contribute $490,000 in grant funding to four community organizations in the U.P. The projects address gaps in service for individuals and families facing substance use disorder (SUD) and support and develop the growth of recovery communities. Those projects include funding for Great Lakes Recovery Centers Inc., Superior Housing Solutions, Eastern Upper Peninsula Opioid Response Consortium and the Western U.P. Health Department. “Treating and addressing substance use disorder takes everyone – down to clergy in communities to health care centers to local businesses,” said Carrie Sevarns, project director with the Eastern Upper Peninsula Opioid Response Consortium. “This takes an all-hands-on-deck approach. You need health care providers and local and state and national leaders on board.” In the U.P., women in recovery are particularly vulnerable, as the fear of losing custody of their children often prevents them from seeking help. Childcare and transportation are barriers to treatment and can result in women relying on unhealthy relationships to meet those needs. Of the three residential SUD treatment centers in the U.P., only one is for women only and accepts mothers and their children. The Western U.P. Health Department’s FACE Project received funding to help it expand its programming. The FACE (Facing Addiction Through Community Engagement) Project is an effort to improve the health of people with SUD, and their families, in a five-county area in the Western U.P. The FACE Project offers women’s support groups (in the community and in two county jails) and it provides childcare and transportation to remove the most common barriers to treatment. “Women are fantastic at supporting one another,” said Gail Ploe, Healthy Connections Project Director for the Western U.P. Health Department. “Women who come to any of our groups learn a lot about addiction and trauma and themselves. They learn skills to cope with cravings and avoid relapse. More importantly, they have a chance to build friendships with other women who are in recovery, to create their own healthy, social support network.” The FACE Project also provides any person with SUD opportunities to learn about MAT (medication-assisted treatment) – which patients must access through a provider. MAT has a high success rate; but still carries stigma. Finding a provider that offers MAT is also a hurdle. The Michigan Opioid Partnership has supported Michigan hospitals, jails and community-based organizations combating the opioid crisis through prevention, treatment, harm reduction, and recovery services. BCBSM and the BCBSM Foundation were founding members of the partnership established in 2017. Current initiatives include helping Michigan emergency rooms initiate MAT in partnership with community-based treatment providers and enabling peer recovery coaches respond to overdoses in communities.
Removing barriers to MAT
Blue Cross continues to commit resources to prevent opioid abuse both systematically inside its institution and its provider partners. Part of that work includes removing barriers to treatment by expanding access to MAT. A waiver is required for physicians to treat patients with one form of MAT using Buprenorphine products (suboxone, probuphine and other brand name drugs). Physicians previously needed eight hours of training to receive this waiver. More recently, the U.S. Drug Enforcement Administration has allowed physicians without training to obtain a waiver which would allow them to treat up to 30 patients. If they want to expand treatment to a larger number of patients, they are required to complete the full eight-hour training. Other forms of MAT such as Naltrexone products (Revia and Vivitrol) do not require any waiver to treat patients. In 2018, the Blue Cross Blue Shield of Michigan Value Partnerships Program launched an initiative to expand access, incentivizing primary care physicians to become trained and deliver MAT to their patients. Blue Cross has also worked to increase access to MAT in emergency room settings and more recently in obstetric practices. As a result of Blue Cross’ MAT initiative in Michigan:
- 63 counties now have primary care providers delivering treatment. Previously, 25 of those counties had zero providers offering MAT.
- 78% increase of MAT providers statewide.
- 452 practices offer MAT services.
Partnering with providers
Here are some of the additional ways Blue Cross has partnered with doctors to help ensure pain management isn’t a pathway to addiction:
- Enforcing policy change: As of Feb. 1, 2018, we’ve been working with doctors to limit the quantity and day supply of addictive substances. This common-sense step helps members get the pain management medication doctors believe is needed, while taking positive steps to address a growing epidemic of addiction and overdose deaths.
- Forging partnerships: Blue Cross and the Michigan Opioid Prescribing Engagement Network work with our physician groups to improve statewide prescribing practices and utilization. Michigan OPEN works with doctors and hospitals to decrease new opioid prescriptions to surgical patients and raise awareness of the danger of opioids.
- Providing resources on appropriate treatment of pain: Blue Cross has worked with the state of Michigan and with our providers to develop clinical care guidelines for the prescription of opioid medication in primary care. We’ve also sponsored, in collaboration with provider partners, continuing medical education across the state to better equip providers to treat those with significant pain.
While there’s still much work to be done to address the opioid epidemic, Blue Cross has seen notable results from our efforts. Here are some significant statistics:
- From 2012 to 2021, the number of opioid prescriptions went down 68%.
- Electronic prescribing of controlled substances has increased over 65% since 2015.
Blue Cross Blue Shield of Michigan and Blue Care Network can help members find an in-network mental health professional by calling behavioral health access lines listed below: PPO: Behavioral Health Access Line | 1-800-762-2382
- A free and confidential resource that’s just a call away when you need immediate support. Behavioral health professionals answer, 24/7.
HMO: Behavioral Health Access Line | 1-800-482-5982
- Connect with a behavioral health clinician if you need help finding a mental health or substance use provider.
- Behavioral health clinicians are available for routine assistance from 8 a.m. to 5 p.m., Monday through Friday. For urgent concerns after hours, clinicians are also available 24 hours a day, seven days a week.
Learn more about mental health and options you have as a member to seek help at bcbsm.com/mentalhealth. More from MIBluesPerspectives:
- Families Against Narcotics: Combating Opioid Epidemic One Person, Family at a Time
- How Recovery Advocates in Livingston Help Women Take Back their Lives
- Researchers Studying New Ways to Manage Pain, Anxiety for Cardiac Surgery Patients
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