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Overuse of opiates has reached a crisis point in the United States, so Keenan & Associates’ PRIME Managed Care Services created a Saving the Opiate Patient pharmacy intervention program that helps injured workers avoid opiate addiction and resume work sooner, while enabling employers to control prescription drug costs.
A Torrance, California-based unit of AssuredPartners Inc., Keenan won the Managed Care Provider Team of the Year in the 2018 U.S. Insurance Awards.
Before STOP began in 2013, pharmacy spending for PRIME Managed Care’s clients was about $8 million; spending is expected to be about $2.8 million by the end of fiscal 2017-18, said Ron Nassif, vice president of PRIME Managed Care and STOP founder.
Narcotic use dropped by 21% between fiscal 2015-16 and 2016-17, he said.
“Each patient is individualized, and that’s key,” Mr. Nassif said. “Each person has different psychosocial dynamics occurring in their life at the same time as the injury and recovery. Each patient has their own comorbidities … A treatment plan must be established based on that particular patient.”
Once the local physician creates a care plan, PRIME performs a nurse review to ensure the most effective treatment plan, using research by a STOP team of pharmacists, physicians and pain management specialists.
A utilization review identifies any overuse of narcotics or whether the patient is getting narcotics from different physicians.
“We would have some patients chewing up 360 opiate tablets a month combined with a sleeping pill, muscle relaxer and anti-depressant,” Mr. Nassif said. “Some of these folks were so impaired they couldn’t return to work, compounding the problem.”
Appropriate prescription drug use may be part of pain treatment, but alternatives such as counseling or acupuncture might also be recommended, he said.
Ultimately, STOP aims to help the patient resume a productive life.
“The goal is for them to be able to function at their pre-injury level,” Mr. Nassif said.
• Liberty Mutual Insurance Co. (two entries)
• Sedgwick Claims Management Services Inc. (two entries)
2018 Business Insurance US Insurance Awards home
Business Insurance recognized achievements by outstanding executives and teams of professionals working in the field of risk management and commercial insurance at its inaugural U.S. Insurance Awards presentation in New York on March 8.