Spotlight analysis finds progress made on numerous fronts, recommends next steps for policymakers, insurers and physicians
by Kate Alfano, CMS Communications Coordinator
Featured in the March/April 2019 Colorado Medicine.
The American Medical Association, Colorado Medical Society and Manatt Health released a report in January that shows Colorado has implemented meaningful reforms in response to the opioid epidemic though further steps are needed to save even more lives.
The Colorado spotlight analysis found that progress is being made to increase access to evidence-based treatment for substance use disorders, several pilot projects have improved care for patients with pain, and increased access to the opioid overdose-reversing drug naloxone has resulted in thousands of lives saved.
“We conducted this analysis because it’s essential that policymakers know what is working, and where additional progress can be made,” said AMA President-elect Patrice A. Harris, MD, who also chairs the AMA Opioid Task Force. “Colorado has implemented many important policies that are impacting patients’ access to care. Using this momentum, we think Colorado can go even further to save lives of those affected by opioid use disorder.”
Colorado is the second in a series of individual state studies. The AMA released a study on Pennsylvania in December and also released additional analyses of North Carolina and Mississippi in early 2019.
Based on available data, review of policies, and discussions with key policymakers, the analysis found four key areas where Colorado is succeeding:
Adoption of policies and funding to increase access to medication assisted treatment, including initial steps to reduce administrative barriers, increased funding to address workforce issues, and plans to increase Medicaid coverage in residential settings.
Examining compliance with mental health and substance use disorder parity laws through the Colorado Division of Insurance’s review of insurers’ conduct and the establishment of an ombudsman’s office to assist patients in accessing behavioral health care.
Increasing Medicaid patients’ access to non-opioid alternatives for pain management, including coverage of non-opioid prescription medications and alternative therapies such as physical therapy, occupational therapy and additional behavioral health care treatment options.
Expanding access to naloxone with early legislation and implementation of a standing order for naloxone, Good Samaritan protections, and elimination of prior authorization for naloxone under Medicaid.
“This analysis comes at an important time for Colorado,” said CMS President Debra Parsons, MD, FACP. “Over the last six years, Colorado has developed policies, enacted laws and made important strides to have all stakeholders work together to reverse the opioid epidemic. While we continue these successful initiatives, we must closely evaluate how they are working so we can ensure we are putting our efforts in the right places.”
The analysis also highlighted the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has brought together several hundred stakeholders and continues to develop a data-driven, county- and state-level data dashboard that can be used to help direct resources to areas of greatest need.
The analysis also found areas where additional progress could be made:
Eliminating barriers to treatment, including further steps to increase enforcement of mental health and substance use disorder parity.
Expanding access to providers of medication assisted treatment, especially in the state’s rural areas.
Leveraging successful state pilots to increase access to multimodal pain care and comprehensive benefit and formulary designs.
Linking those whose lives have been saved by naloxone with follow-up treatment to begin and sustain recovery.
Evaluating state policies and programs to determine what is improving patient care and reduce opioid-related harms, including whether current policies may be resulting in unintended consequences.
“Many of the recommendations in this report related to commercial insurance – such as strengthening our market conduct examinations to better enforce mental health parity and more comprehensive front-end reviews of the number of addiction professionals in insurers’ networks – are fair and reasonable approaches that are within our authority to immediately tackle,” said Colorado Insurance Commissioner Michael Conway, head of the state’s Division of Insurance. “We look forward to working with Colorado’s health insurers and physicians to implement solutions that help ensure consumers receive the care that they need to help end our state’s opioid epidemic.”
Colorado was chosen for the demonstrated ability of government and private stakeholders to work together to implement a coordinated state strategy in the prevention and treatment of opioid use disorders. The AMA recognizes the key role of states in responding to the epidemic and seeks to disseminate best practices in prescribing and treatment that are implemented in a coordinated way, demonstrating that there is a path forward that reflects the complexity and challenges of tackling this epidemic.
The AMA has responded aggressively to the opioid epidemic, establishing an AMA Opioid Task Force, providing education and training to its members, and advocating for better policies and procedures with government leaders.
CMS has also responded aggressively, fully supporting and actively participating in the Colorado Consortium for Prescription Drug Abuse Prevention since its inception under former Colorado Gov. John Hickenlooper; convening the special CMS Committee on Prescription Drug Abuse comprising physicians and special advisors on this issue; providing education to physician members; and distributing best practices and education to members from other partners.
Read the full report at www.end-opioid-epidemic.org/coloradospotlight