PERSONNEL MATTERS: Huge increase seen in opioid dependence-related claims

CHICAGO (Aug. 8, 2016) — The number of claims made to private health insurers that include a diagnosis of opioid dependence rose by more than 3,200 percent in the past decade, according to a report released Aug. 2.

The nonprofit group FAIR Health used data gleaned from ICD-9 diagnostic codes used for insurance claim forms. Researchers found adults between ages 19 and 35 were by far the most diagnosed age group, accounting for 69 percent of claim lines for opioid dependence during the study period. The same age group composed the majority, or 78 percent, of heroin overdoses.

Heroin use among women grew by 100 percent over the time period while its use among men grew by 50 percent. While the rate of death from opioid overdose is higher among men, women were more likely to experience an opioid overdose, according to the analysis. Claim lines where the diagnosis was related to drug dependence in pregnant women rose 511 percent from 2007 to 2014.

“The current opioid crisis in the United States affects most demographic groups, including, notably, the privately insured,” the study concluded. “To resolve the crisis, participation from all healthcare stakeholders will be necessary — federal, state and local governments; insurers; employers; physicians, hospitals and other providers; researchers; community leaders; and consumers.”

The report's findings show how the current opioid abuse epidemic has disproportionately affected white middle-class America. While 71 percent of whites have private insurance, only 47 percent of blacks and 39 percent of Hispanics carry the same coverage, according to a 2013 analysis by the Kaiser Family Foundation.

According to its website, FAIR Health is a national independent, not-for-profit corporation “whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products and consumer resources.” The company said it uses its database of billions of billed medical and dental services to power a free website “that enables consumers to estimate and plan their medical and dental expenditures,” offering “clear, unbiased educational articles and videos about the healthcare insurance reimbursement system.”

A 2014 study in JAMA Psychiatry — a monthly, peer-reviewed medical journal published by the American Medical Association — found that nearly 90 percent of those who said they began using opioids over the past decade were white, mostly driven by the widespread use of prescription painkillers.

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This report appeared in Modern Healthcare magazine, a Chicago-based sister publication of Tire Business.