A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations.
BACKGROUND
Oregon's Medicaid program is delivered through 16 Coordinated Care Organizations (CCOs) participating in a statewide performance improvement program to reduce high-dose opioid prescribing. CCOs were allowed flexibility to develop their own dose targets and any policies, trainings, guidelines, and/or materials to meet these targets. In this study, we characterize CCO strategies to reduce high-dose opioid prescribing across the 16 CCOs.


METHODS
We reviewed relevant CCO documents and conducted semi-structured interviews with CCO administrators to acquire opioid-related policies, practices, timelines and contextual factors. We applied a systematic coding procedure to develop a comprehensive description of each CCO's strategy. We used administrative data from the state to summarize contextual utilization data for each CCO.


RESULTS
Most CCOs selected a target daily morphine milligram equivalent (MME) dose of 90 mg. Sixteen issued quantity limits related to dose, eight restricted specific drug formulations (short-acting or long-acting), and 11 allowed for time-limited taper plan periods for patients over threshold. Many CCOs also employed provider trainings, feedback reports, and/or onsite technical assistance. Other innovations included incentive measures, electronic health record alerts, and toolkits with materials on local alternative therapy resources and strategies for patient communication. CCOs leveraging collaborations with regional partners appeared to mount a greater intensity of interventions than independently operating CCOs.


CONCLUSIONS
CCOs developed a diversity of interventions to confront high-risk opioid prescribing within their organization. As healthcare systems mount interventions to reduce risky opioid prescribing, it is critical to carefully describe these activities and examine their impact on process and health outcomes.
['Hartung|Daniel M|DM|', 'Alley|Lindsey|L|', 'Leichtling|Gillian|G|', 'Korthuis|P Todd|PT|', 'Hildebran|Christi|C|']
D000701:Analgesics, Opioid D003153:Community Health Services D006801:Humans D008484:Medicaid D009922:Oregon D016134:Organizational Policy D059408:Pain Management D010818:Practice Patterns, Physicians' D014481:United States
Opioid Coordinated care Tapering Opioid policy Opioid safety interventions Prescribing limits