Harvard Business Review: How Geisinger Health System Reduced Opioid Prescriptions

https://hbr.org/2018/11/how-geisinger-health-system-reduced-opioid-prescriptions

The devastating opioid epidemic in the U.S. is a crisis that was created, in part, by healthcare itself as prescriptions for pain-relieving medications rapidly increased in the 2000s. Now, healthcare is at the forefront in trying to fix the problem. At Geisinger, a healthcare system serving more than 1.5 million patients in Pennsylvania and New Jersey, where we work, we are taking a multifaceted approach and seeing a big impact.  By combining data-driven assessments, targeted engagement of high prescribers, EHR-based interventions, and pharmacist support in care management, Geisinger has dramatically reduced opioid prescribing.  In addition, programs promoting safe medication disposal in the surrounding communities reduced the number of left-over opioids in medicine cabinets, helping to stem opioid abuse in the surrounding communities.

Data-driven assessment

Using our robust data archive system which captures electronic health record, medical and prescription claims, and other information, we create dashboard displays for use by leadership, operational teams, and clinicians to reveal population-level trends and identify patients and clinicians for targeted interventions. For example, in 2012 we launched a controlled-substance monitoring dashboard to better understand use of controlled substances in our system, with a focus on improving pain management. This dashboard, updated in real-time, displays a myriad of types of information on a population and patient level including counts of patients prescribed opioids, those co-prescribed other controlled substances, patient use of naloxone, visits to emergency departments, medication use agreements, location heat maps, and other data to help us identify gaps in care and opportunities for improvement.

Engaging high prescribers

Using the dashboard, we quickly saw that clinicians were prescribing opioids at vastly different rates. In addition to developing programs on pain-management for our broad clinician population, we targeted a focused group of high prescribers. Generally, high prescribing clinicians were unaware of their rates. After alerting them about their pattern, we began regular feedback sessions where the prescriber, practice-site medical director, and a specially trained chronic-pain pharmacist reviewed individual patient cases and provided guidance on dose reduction strategies, risks associated with certain co-prescribed agents such as benzodiazepines, alternative treatment options, clinical support tools, and referral options. The combination of prescribing transparency, education, and one-on-one counseling has helped to dramatically reduce the number of high volume prescribers and cut the prescribing of new opioids by 44% over the past three years.

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