Insurers Hire Social Workers To Tackle The Opioid Epidemic : Shots - Health News Some health plans in Massachusetts are putting tighter limits on painkiller prescriptions. Others are hiring their own social workers to help customers who struggle with opioid abuse quit for good.
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Insurers Hire Social Workers To Tackle The Opioid Epidemic

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Insurers Hire Social Workers To Tackle The Opioid Epidemic

Insurers Hire Social Workers To Tackle The Opioid Epidemic

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AUDIE CORNISH, HOST:

On the campaign trail and throughout the country, there's been a big discussion about how to combat opioid abuse. For those struggling with addiction, support is key to a successful recovery, and some are getting that support from an unlikely place - their health insurer. Deborah Becker of member station WBUR has the story.

DEBORAH BECKER, BYLINE: Twenty-four-year-old Amanda Jean Andrade has been drug- and alcohol-free since October, the longest amount of time she's been off substances in a decade. She gives a lot of credit for that to her case manager, Will, who works for her health insurance company.

AMANDA JEAN ANDRADE: Having Will is, like, the best thing in the world for me because if I have, like, the slightest issue with anything to do with, like, my insurance - that includes, like, prescriptions or even, like, when I had a court issue - I know that I can call him.

BECKER: Andrade's insurer is Celticare Health Plan, one of several health insurance companies taking new steps to deal with the growing opioid epidemic. Celticare has about 50,000 members in Massachusetts and mostly manages care for patients on Medicaid. Celticare president and CEO Jay Gonzales says making sure members stay in recovery is critical.

JAY GONZALES: This is the biggest potential solution to this problem, I think because at the end of the day, we've got to find the members who are in trouble or could be in trouble, and we need them to be invested in addressing their issues.

BECKER: Gonzales says for Celticare, the costs related to the opioid epidemic are huge. Nearly a quarter of its hospital admissions are related to substance use, and it spends more on suboxone, a medication to treat addiction, than on any other drug. Insurers typically do cover inpatient substance use treatment and detox, but those are usually short-term. So after a patient is discharged, relapses and readmissions are likely. So Gonzales believes that providing ongoing attention to patients like Andrade will eventually pay off.

GONZALES: And the end of the day, we think it's going to cost a lot less. They're going to be healthier. They're not going to be showing up in the emergency room, you know? We have people who show up in the emergency room 50, a hundred times a year. That's very expensive and not good for the member.

BECKER: Celticare is not the only insurer taking action. Neighborhood Health Plan in Boston has developed algorithms to identify who might be at risk. The insurer's chief medical officer, Dr. Paul Mendis, says they look for members with both a traditional medical diagnosis and a substance use issue. Then social workers try to develop trust.

PAUL MENDIS: You actually have to, in many cases, reach out using their other medical diagnosis as the reason for the outreach. If you just call somebody cold, saying, we found you, I don't think those calls would be very well-received (laughter).

BECKER: For patients like Amanda Jean Andrade, she says she quickly established trust with the case manager from her insurer who is now working on helping her find a job and more permanent housing. In recovery, she uses poetry to help her deal with the powerful emotions she has about her drug use. Although Andrade feels that many people in her life have let her down, she now believes that it's other people, many from her health insurer, who will help keep her on track.

ANDRADE: Like, I have, in one of my poems, don't let anyone diminished your self-confidence, your pride. If you feel at something, it means that you tried. I at least want to try for all the people that tried for me.

BECKER: Celticare appears to be taking the most aggressive steps in Massachusetts in response to the opioid problem. It's limiting first prescriptions for opioid painkillers, and its training members and their families how to use the overdose reversal drug Narcan. Massachusett's largest insurer, Blue Cross and Blue Shield, has focused on trying to prevent opioids from becoming a problem in the first place. For the past three years, it's limited first prescriptions for opioid pain killers, and it estimates that's kept about 21 million pills out of circulation in Massachusetts. For NPR News, I'm Deborah Becker in Boston.

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