Health insurers invest in social workers to fight opioid abuse

Carriers are hoping to cut back on costs generated by the opioid epidemic, which has plagued both workers’ comp insurers and clients

Insurance News


Workers’ compensation costs have skyrocketed in recent years, creating a mass of affordability problems for employers, and producing a profit for just once in the past 15 years. One thing that’s fueling that rise in particular is the increase in opioids to treat work-related injuries: the number of prescriptions for these drugs has increased 41% from 2003 to 2011 and directly affected claims costs.

The trend is so widespread, that many in the workers’ compensation industry view opioid use as the single biggest problem facing the industry. Because opioids carry significant side effects and can become addictive, they lead to an increase in comp claims and costs.

Insurance companies in Massachusetts are hoping to fight this, however, by bringing on trained social workers to aid clients.

At CeltiCare in Boston, social workers are assigned to some patients to monitor use and help train recipients of opioids on how to reverse overdoses.

“This is the biggest potential solution to this problem, I think because at the end of the day we have to find the members who are or could be in trouble, and we need them to be invested in addressing their issues,” said Jay Gonzalez, CEO of Celticare, which has about 50,000 members in Massachusetts.

CeltiCare also hopes to lower its own costs related to opioid use. According to the insurer, nearly a quarter of hospital admissions are related to substance use and CeltiCare spent more than 10% of its budget last year on Suboxone, a medication to treat addiction to narcotics.
That’s more than it spent on any other drug, it said.

“At the end of the day, we think it’s going to cost a lot see,” Gonzalez told NPR.
Other insurers in the state are taking similar measures to combat opioid abuse. Blue Cross Blue Shield of Massachusetts, the largest health carrier in the state, has been limiting the supply of opioids it allows patients for the past three years.

Dr. Tony Dodek, associate chief medical officer for the insurer, said roughly 11,000 of the more than 2 million insureds were treated for a substance use problem in the past year. By limiting initial prescriptions, he hopes to deal directly with the problem.

“We decreased the number of doses in circulation when you compare the three-year period after implementation to the prior period by over 21 million doses,” he said.

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