Leading the value-based care conversation

Opioids and Ice Cream: Closing Gaps Between Primary Care Providers and Specialists


Think about how a child acts when he really wants ice cream.

If he asks his mother and she says no, it's entirely possible that the child will do what millions of other kids have done for generations - seek out the father and make the same request. Only this time banking on a less-informed dad approving it, and not conferring with mom.

Patients seeking opioids are likely to follow a similar path of the child. That is, make an additional "ask" until the need is met.

For a kid wanting a snack, it might be a risk worth taking. For adults seeking prescriptions for opioids, it's not. Every day, more than 115 people in the United States die after overdosing.

One of the biggest challenges of the opioid epidemic is closing the gaps between primary care providers (PCPs) and specialists, who are like the mom and dad of the kid who wants ice cream. The PCP, with an understanding of a patient's medical history and prescriptions, may be more apprehensive about prescribing opioids. The specialist, who doesn't have a full grasp of a patient's medical history and not in close communication with the PCP, is likely to prescribe opiates more because of limited information about the patient.

Taken a step further, patients who get the prescriptions they're seeking are unlikely to notify their PCP. At the same time, patients often consult with friends and family to find specialists who prescribe opioids more frequently than other doctors.

The result of these communications problems? Patients are taking advantage of a system with limited institutional protections against opioid abuse.

The solution? Just like mom and dad need to stay in close communication about what their children eat and the frequency they are eating it, PCPs and specialists need to get on the same page when it comes to prescribing opioids.

As more and more physician practices transition to value-based care and incorporate population health management (PHM) solutions, there are opportunities to close some of the communications gaps related to opioids. While a simple phone call or text is a reasonable starting point, PHM solutions can do much more for delivering care coordination. By aggregating and analyzing data across the care continuum, health organizations can identify patients with conditions that put them most at risk for abuse (cancer, suicidal thoughts and major depression, COPD, muscuskeletal disorders) and intervene as necessary; flag specialists that are overprescribing; and note which pharmacies are dispensing the most opioid prescriptions.

Closing communications gaps and identifying problem areas won't stop the opioid epidemic overnight, but it's a good start. Over time, as obstacles are addressed and more providers adopt PHM solutions, there should be significant progress in the fight against opioid abuse.


Author: Velvet Thorne
Date of Publishing : 5/31/18 7:44 PM
About the Author : Velvet Thorne, LPN, CLNC is HealthEC’s manager of care coordination and lead for the Alliance for Integrated Care of New York (AICNY). A certified Six Sigma Green Belt, she has more than 30 years of healthcare experience and is the firm’s subject matter expert for care coordination.

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