Numbers Don’t Lie: Opioid Addiction in Employer Health Plan Populations 

Caucasian surgeon reading book
May 10 2018

If you love good data but haven’t yet found your way to the Petersen-Kaiser Health System Tracker, allow me to introduce you. This excellent site pulls together and neatly displays key metrics and trends on the US health system (check out the dashboard) and posts relevant and reliable analyses. As far as I’ve seen, it’s not advocating anything, just providing the facts that could be used to support a position – for instance, the US healthcare system needs some work.

The article I want to draw your attention to is on the disturbing but critically important subject of opioids. It analyzes opioid use and spending on opioid addiction treatment in large employer plans (1,000 or more employees). First key fact: nearly 4 out of 10 people treated for opioid addiction in the country are covered in an employer plan. As we’ve been saying, opioid addiction is a problem employers cannot afford to ignore.

The analysis is based on a sample of health benefit claims from the Truven MarketScan Commercial Claims and Encounters Database, which was used to calculate the amounts paid by insurance and out-of-pocket on prescription drugs from 2004 to 2016. Nationally, the use of opioids is decreasing – but there are concerning variations by region. Among people with large employer coverage in the South, 16% had at least one opioid prescription in 2016, compared to 12% in the West and 11% in the Northeast. If you’re seeing this kind of regional variation among your population, it may warrant a conversation with your health plans to find out why.

Despite the cooling off in opioid prescription use, spending to treat opioid addiction and overdose – stemming from both prescription and illicit drug use –has increased sharply, rising to $2.6 billion in 2016 from $0.3 billion 12 years earlier. While the bulk of spending was for employees’ children (53%) or spouses (18%), still, just under a third (29%) was for employees themselves.

In 2016, 342 people per 100,000 large group enrollees received treatment for opioid overdose or addiction, including 67 people per 100,000 who received treatment in an inpatient setting. Average outpatient expenses totaled $4,695 per person being treated (of which $670 was paid out-of-pocket) in 2016, and average inpatient expenses totaled $16,104 (with $1,628 paid out-of-pocket).

For a discussion of what you can to do curb opioid abuse and improve treatment outcomes in your population, I refer to Mary Kay O’Neill’s post. For anyone who still needs convincing that this problem will not go away without concerted efforts by all stakeholders, the all-too-clear statistics provided in the Peterson-Kaiser Health System Tracker should do the trick.

More Mercer posts

About the author(s)
      Related products for purchase
      Related Solutions
      Related Insights
      Related Case Studies