The Centers for Medicare & Medicaid Services (CMS) recently issued guidance to state Medicaid programs emphasizing the role of health IT in addressing the opioid crisis and highlighting funding sources for telemedicine and prescription drug monitoring programs (PDMPs).
According to a CMS press release, the new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction. The guidance, issued as a letter to state Medicaid leaders, directs state Medicaid leaders to consider how they may best use federal funding to enhance Medicaid technology to combat drug addiction and the opioid crisis.
“State-level innovation, including in the use of prescription drug monitoring programs and electronic health records, has been and will be a key piece of ending this crisis,” U.S. Department of Health and Human Services (HHS) Secretary Alex Azar said in a statement.
CMS’s opioid technology guidance advises states on which funding authorities may support health information technology efforts that could be used for the prevention and treatment of negative opioid outcomes. According to CMS, the guidance falls in line with the President’s Commission on Combating Drug Addiction and the Opioid Crisis final report released on November 1, 2017. Specifically, this report singles out telemedicine and prescription monitoring tools as useful in the effort to combat the opioid crisis.
States should consider accessing enhanced federal funding to integrate innovative substance abuse treatment in areas facing provider shortages, particularly in rural areas, such as virtual treatment centers or remote counseling, into Medicaid care coordination technologies, the letter states. The letter also describes how states can draw federal support for shared electronic care plans, which allows patients and providers to view and update a shared care plan describing goals for pain management regimens and counseling, and could complement Medication Assisted Therapy (MAT).
Support for Patient-facing technology in the form of apps and remote monitoring technology is also mentioned as possible state technology investments eligible for funding. Further, states may reduce provider burden by creating a single sign-on interoperability between electronic health records (EHRs) and PDMPs, allowing physicians to e-prescribe in the same platform where electronic health records are held.
The letter also suggests that states consider developing enhanced technologies, which might support the development of public health surveillance, to help strengthen the understanding of the crisis through better public health data and reporting.
State Medicaid program leaders should consider applying for federal financing to support recommendations from the President’s Commission final report, such as integrating PDMP system data into EHRs and supporting interstate data sharing and electronic prescribing of controlled substances. In addition, state leaders could use systems and funding to support advanced analytics in order to leverage data sources to create prediction models of patients at risk for opioid dependency and connect them with appropriate case management.
Health IT Now's Opioid Safety Alliance responded to the CMS guidance, specifically citing concerns about CMS’s emphasis on using PDMPs in combating the opioid crisis and encouraging states to consider applying for federal funding to enhance their PDMP. Health IT Now’s Opioid Safety Alliance is a working group of prescribers, dispensers, professional societies, and patients advocating for the use of technology to fight illegitimate opioid use.
The Opioid Safety Alliance has drawn attention to the shortfalls of PDMPs in the past, writing in an online op-ed in The Hill that "[PDMPs] operate as a patchwork of separate programs in each state, creating troubling blind spots that allow episodes of abuse and unintended misuse to fester ... in many states, data on a potential abuser may not be available in real time and do not include fill attempts, which encourages pharmacy shopping."
In fact, Alliance members have advocated for a facilitator model dubbed the Prescription Safety Alert System that would complement PDMPs by providing real-time clinical data at the point of dispensing using already existing transaction data.
In a statement, HITN Opioid Safety Alliance Executive Director Joel White said, “While CMS' comments about the need for integrating PDMP data with EHRs and minimizing provider burden to spur better usability are encouraging, the magnitude of the nationwide opioid crisis demands that we think bigger. Instead of tinkering around the edges and ultimately doubling down on a flawed system that leaves too much to chance, we need to empower clinicians with better, easy-to-use tools that complement the work of PDMPs to thwart opioid misuse in real-time - including transactions that occur across state lines.”
Further, White said, “The Prescription Safety Alert System, devised by OSA members and based on respected National Council of Prescription Drug Programs (NCPDP) standards, would do exactly that. OSA supports continued efforts to enhance state PDMPs but the stakes are simply too high to rely solely on a lagging, unwieldy system that has done little to change the status quo of 115 opioid-related deaths per day. The time to enact a Prescription Safety Alert System is now.”