20-513 Start with Primary Care to Manage High-Risk-Opioid Use
Date: 08/18/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Fresno, Kings, and Madera counties.
Learn how to improve your Health Care Effectiveness Data and Information Set (HEDIS®) rates.
Review these quality measures on opioid use and other resources available to you.
Quality measure | Percentage of members ages 18 and older who… |
Use of opioids1 at high dosage (HDO) | Received prescribed opioids at a high dosage (average milligram morphine equivalent [MME] > 120 mg). Denominator: Two or more prescriptions on different dates of service with ≥ 5 total days covered by opioids during the measurement year (calendar year).2 |
Use of opioids from multiple providers (UOP) and pharmacies | Received prescribed opioids for ≥ 15 total days during the measurement year (calendar year)2 from ≥ 4 providers and pharmacies.
|
Concurrent use of opioids and benzodiazepines | Had a concurrent use of prescription opioids and benzodiazepines. Beneficiaries with a cancer diagnosis or in hospice are excluded.
|
Initiation and engagement of alcohol and other drug treatment (IET)
| Had a new episode of alcohol or other drug (AOD) abuse or dependence who received the following (each measurement year, the quality measure collects data on new episodes of AOD abuse and dependence between January 1–November 14 of the calendar year):
|
Resources
Access the provider updates below in the Provider Library.
For questions or more information, email the Quality Improvement Department at cqi_dsm@healthnet.com.
Provider update | Distribution date | Update number |
Best Practices Prescribing and Managing Opioid Medications | May, 20, 2019 | 19-243 |
Patient Education Tips for Opioid Therapy | July 26, 2019 | 19-431 |
To Help You End Opioid Abuse: Preferred Drug List Changes Focus on Opioid Pain Medications | September 11, 2019 | 19-706 |
Improve Treatment of OUD in Pregnancy with These Resources | October 21, 2019 | 19-816 |
Refer Members to myStrength: An Additional Resource to Help with OUD and Substance Use | February 4, 2020 | 20-123 |
Online articles and sites
Title | URL |
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) | www.psychiatry.org/psychiatrists/practice/dsm/educational-resources |
Assessing Benefits and Harms of Opioid Therapy | www.cdc.gov/drugoverdose/pdf/Assessing_Benefits_Harms_of_ |
Benzodiazepines and Opioids | www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids |
Calculating Total Daily Dose of Opioids for Safer Dosage | www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf |
Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain | |
Opioid Oral Morphine Milligram Equivalent (MME) Conversion Factors | https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/index |
Additional information
- DEA X-Waiver - Go to the Providers Clinical Support System website. Attend free on-line webinars and get your certification.
- Buprenorphine Waiver – Get a waiver to prescribe buprenorphine. To learn more, visit the Substance Abuse and Mental Health Services Administration website.
For questions or more information, email the Quality Improvement Department at cqi_dsm@healthnet.com.
1Excluded:
- Members diagnosed with cancer or sickle cell disease.
- The opioid medication list excludes injectables; opioid cough and cold products; and single-agent and combination buprenorphine products used to treat opioid use disorder for medication assisted treatment (buprenorphine sublingual tablets, buprenorphine subcutaneous implant and all buprenorphine/naloxone combination products), and Ionsys® (fentanyl transdermal patch; for inpatient use only and is available only through a restricted program under a Risk Evaluation and Mitigation Strategy [REMS]).
2The measurement year is the year data is collected for HEDIS. Example: HEDIS 2020 reporting year reflects services or data collected in the 2019 calendar year and reported in July 2020.