Prescription Practices/Third Party Payer
Representatives of Kaiser Permanente will explain how the integrated health care organization has successfully lowered opioid doses to safer morphine milligram equivalent (MME) levels in accordance with the recommendations from the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services. They also will discuss how their programs have led to an improvement in their physician’s ability to monitor the use of prescribed opioids and other control substances and appropriately address drug-seeking behavior when suspected.
Within Kaiser Permanente, clinical pharmacists with pain management expertise play a pivotal role in decreasing opioid overutilization in collaboration with physicians. In 2016, the organization established a chart review consult service, which allows physicians to have a direct, organized, auditable process for consulting with the pain pharmacists on several areas, including appropriate opioid dosing, opioid dose-tapering, use of nonopioid analgesics, patient monitoring, and overall pain management. The chart review functionality is built into the electronic medical record. Initial assessment of the service showed high physician satisfaction. Additionally, Kaiser Permanente has developed processes and procedures to comply with its local state Medicaid lock-in programs (Virginia PUMS and Maryland CMC). Patients are identified for review based on state-specific established criteria. Pharmacy pain specialists review medical records and prescription drug monitoring program data for each patient. Patients are then presented at the monthly Chronic Pain Board meetings, which are comprised of subject matter multi-disciplinary clinical experts in pain management, primary care, and behavioral health. This process could be implemented by other organizations that have state-mandated benefit restricted-access controlled substance programs.
This session is accredited for the following accreditation types: CME, CNE, CPE, APA, AAFP, AAHCPAD*, NAADAC*, ASWB*
*State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.