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use disorder treatments DATA Data provides insight into doctor, pharmacy, and patient use of prescription opioids and effectiveness of treatment CMS CAN BUILD ON THESE EFFORTS TO FURTHER: 1. Identify and stop inappropriate prescribing of opioids 2. Enhance diagnosis of OUD to get people the support they need earlier 3. Promote effective, non-opioid pain treatments 1. Ensure access to treatment across CMS programs and geography 2. Give patients options for a broader range of treatments 3. Support innovation through new models and best practices 1. Understand opioid use patterns across populations 2. Promote sharing of actionable data across continuum of care 3. Monitor trends to assess impact of prevention and treatment efforts IMPLEMENTING THE SUPPORT ACT The SUPPORT for Patients and Communities Act was enacted on October 24, 2018. CMS is implementing a number of new initiatives under that law that aim to increase options for treating beneficiaries with opioid use disorder, ensure prescriber accountability and improved safety for patients across CMS programs, and illuminate Medicaid prescribing data. A CLOSER LOOK: DETAILED ACTIVITIES ON THE 2019 ROADMAP TREATMENT Identify and develop solutions for treatment barriers for pain and opioid use disorders across Medicare, Medicaid, and private health plans, including: • Access to non-opioid pain treatments, • Access to medication-assisted treatments (MAT), and • Access to providers in rural and other low-access communities. PREVENTION Continue reducing inappropriate opioid prescribing by: • Implementing a new authority to limit Medicare beneficiaries to certain pharmacies and doctors (or “lock-in”). • Strengthening real-time prescription controls with the use of prescription drug databases and point of sale pharmacy edits. Incorporate incentives for appropriate prescribing into future Medicare Quality Star Ratings and the Quality Payment Program. Align monitoring of systemic inappropriate prescribing to the CDC Guideline for primary care practitioners and partner with law enforcement to stop egregious prescribers. Outline options and share best practices for state Medicaid agencies and other payers on non-opioid treatments and other tactics to help address pain and the opioid crisis. MEDICAID 1115 SUBSTANCE USE DISORDER WAIVERS LEARN MORE MEDICAID INNOVATION ACCELERATOR PROGRAM (IAP) LEARN MORE MEDICARE AND MEDICAID INNOVATION MODELS LEARN MORE MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS (QIOs) LEARN MORE Foster innovation and expand opportunities to support on-the ground initiatives through: DATA & ANALYTIC TOOLS CMS will focus our data efforts and provide tools for states, plans and providers to: • Monitor success of prevention measures related to • Analyze prescription opioid use patterns across reducing overuse and misuse of prescription opioids. • Improve transparency tools and interoperability, and expand data tools like the “heat map” of prescribing rates in Medicare and Medicaid that help determine where to target safe prescribing efforts (see maps below). CMS programs and in special populations such as individuals in rural areas, with dual Medicare/Medicaid eligibility, and with certain health conditions. • Support state Medicaid program capacity to track and report data. 2016 MEDICARE PRESCRIBING RATES 4 2016 MEDICAID PRESCRIBING RATES 5 HIGHLIGHTING INNOVATION MEDICAID DEMONSTRATION PROJECT CMS approved an 1115 Medicaid demonstration project for Virginia and worked with the state to strengthen the delivery system for treatment of substance use disorders, including opioid use disorder. Virginia’s Medicaid demonstration project has significantly improved access to treatment by increasing reimbursement, which led to increased provider capacity and a 49% increase in number of members accessing opioid use disorder treatment. It also resulted in a 39% decrease in opioid-related emergency department visits in the first 5 months.6 HUB AND SPOKE MAT CMS approved and provided technical assistance to Vermont on its Hub and Spoke MAT program to add