Public/private safe prescribing initiative results in significant reductions of Apple Health (Medicaid) opioid prescriptions

October 17, 2018

Better prescribing better treatment logoA public/private safe prescribing initiative launched in late 2017, called Better Prescribing, Better Treatment, has resulted in significant reductions in Apple Health (Medicaid) opioid prescriptions in less than a year, initiative partners announced today.

The partners, the Washington State Medical Association (WSMA), the Washington State Hospital Association (WSHA) and the Washington State Health Care Authority (HCA), are reporting that the initiative has reduced opioid prescriptions exceeding new state Apple Health (Medicaid) program prescribing guidelines by nearly 70 percent. It has also reduced total Apple Health opioid prescriptions for acute (non-chronic) pain by nearly 30 percent.

Better Prescribing, Better Treatment is a component of the state opioid response plan. The initiative was conceived and designed by a joint opioid task force comprised of physicians from WSMA and WSHA, who then partnered with the Washington State Health Care Authority to help implement the initiative. The goal of the initiative is to reduce the number of opioids in Washington’s communities by encouraging prescribers treating Apple Health patients to follow the latest evidence-based best practices and by providing data to help inform their prescribing.

More than 20 health systems and groups are currently participating in the Better Prescribing, Better Treatment initiative, representing more than 11,000 Apple Health prescribers in the state.

“I’m pleased to see positive results in our Apple Health program,” said Gov. Jay Inslee, whose executive order set this change in motion in 2016. “We are leading the nation in taking action to reduce inappropriate opioid prescribing and now we’re seeing 50 percent declines in prescription opioid-related overdose deaths. We have reason to hope that we can prevent even more death, and that our programs are working as designed. But we must focus on the next phase of the work to provide opioid treatment for people who need it and that’s what we’re doing here in Washington with our hub and spoke treatment networks.”

“This initiative is allowing us to drive change without adding more administrative requirements that create barriers to patient care,” said Dr. Nathan Schlicher, Tacoma emergency medicine physician and one of the lead architects of the initiative. “Physicians want to do the right thing for their patients, and through this initiative they are taking the lead on reducing the amount of these dangerous addictive medications in our communities while keeping appropriate pain treatments accessible for patients who need them. This initiative allows them to do both with a gentle nudge towards better care.”

Better Prescribing, Better Treatment takes a three-pronged approach to safe prescribing:

  • Apple Health prescribing policy. The initiative encourages compliance with a new opioid prescribing policy for Washington’s Apple Health program that establishes pill limits for all opioid prescriptions written for the treatment of acute pain—commonly understood as pain expected to last less than three months. This limits doses to 18 (an approximate three-day supply) for patients age 20 or younger, and 42 (an approximate a seven-day supply) for patients age 21 or older.
  • Prescriber discretion. The initiative emphasizes a broad exemption in the policy that allows the prescribing clinician to override those limits if they feel it’s in the best interest of their patient by simply documenting in the medical record and indicating the reason on the prescription. Importantly, this approach avoids the additional paperwork and administrative burden that accompany similar policies adopted in other states and that can take time away from patient care.
  • Physician-led feedback program. Washington Opioid Reports provides data compiled from the state’s prescription monitoring program to physicians and other prescribing providers allowing them to see how their opioid prescribing practices compare to others in their health care system and specialty. This comparison to peers has been successful at encouraging physicians to adjust their prescribing habits, reducing the number of prescriptions exceeding the policy’s pill limits per quarter by 64.7 percent (3,462 to 1,223). And it has reduced the total acute pain prescriptions per quarter by almost 2,500 prescriptions.

“The feedback program, combined with the exemption and pill limits, is driving safer prescribing in the Apple Health program while not burdening providers with additional paperwork, a win-win solution for the health care system,” said Health Care Authority Chief Medical Officer Dr. Judy Zerzan.

“Better Prescribing, Better Treatment enables physicians to reduce the number of opioids in our community without compromising patient care, and so far the results have been very promising,” WSHA President and CEO Cassie Sauer said. “We believe this strategy will be key to addressing the opioid epidemic, which has impacted all parts of our state. Working together, we will save lives.”

As a result of the program’s success, the Washington State Department of Health is currently in negotiations with the initiative partners to merge all data from the state’s Prescription Monitoring Program with the physician feedback program, meaning at some point in the future, Better Prescribing, Better Treatment will expand beyond Medicaid to improve care for all patients in Washington state, regardless of their insurance carrier.

In addition to this initiative, new state rules covering all prescribers of opioids are being implemented this fall. More details on those rules are on DOH’s webpage.


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