Protecting your employees, physicians and you.
Opioid abuse is being talked about every day.
Modern Medical has a solution - now with real outcomes.
Opioids are the most common drugs prescribed in workers’ compensation. This drug class is linked to the highest rate of prescription drug abuse. With mounting concern of the misuse and abuse of these drugs, the Centers for Disease Control and Prevention has proclaimed opioid abuse an epidemic. Chronic use of opioids can lead to higher medical costs, prolonged disability, overutilization and unintentional harm.
Launched in November 2012, Opioid Defense Manager® (ODM®) is a proactive, customized managed care program. ODM® is designed to protect the employee, physician and the employer by reducing inappropriate drug use while maintaining the necessary balance to provide pain relief for the claimant.
The case study below is an example of one of the outcomes of Opioid Defense Manager®.
Modern Medical’s claimant-centered approach focuses on prevention. It starts with recognizing claimants who are at risk for prolonged disability, opioid dependence and risk of harm from opioid therapy. Modern Medical’s clinical team of nurses and pharmacists will then collaborate with prescribers to ensure appropriate opioid therapy. This includes the ongoing monitoring of pain, function, adverse drug effects and risk management strategies such as urine drug screens, state prescription drug monitoring and pain agreements. Claims examiners and nurse case managers will work with Modern Medical to access real-time alerting of potentially harmful drug use patterns to more effectively manage the claimant’s drug coverage. Claimants need to be involved with their care by understanding the expectations of treatment while working toward treatment goals. This is accomplished through claimant education and the pain agreements.
CASE STUDY: OPIOIDS WEANED
• Claimant injured in 2009 with a diagnosis of lumbago
• Initial RTW status: “NO”
• Patient returned to work within two months of ODM® enrollment
Result: Opioids weaned, back to work
1
How Opioid Defense Manager
®
Works
CLAIMANT IDENTIFICATION
30 days opioids in last 60 days
CLAIMANT EDUCATION
FOLLOW-UP
60 day follow-up
NURSE INTERVENTION
Opioid Progress Report (OPR) Pain Agreements
Medication History/Formulary
INJURY
The Core of ODM
®
The Modern Medical Nurse Intervention is the core of the ODM® program proactively monitoring claimants using opioids over time. We will review physician opioid progress reports every 60 days on an enrolled claimant, obtain pain agreements from the physician and monitor outcomes for claimants in coordination with the clinical pharmacists on staff. Other interventions may be recommended and the formulary may be modified based upon claimant progress and physician notes.
When utilizing your own nurse, Modern Medical will provide alerts with letters on TruNet™, Modern Medical’s web portal, every 60 days. Outcomes are reported through dashboard reporting on TruNet™ and actions can be sent to modify the formulary or request additional services.
The Technology Driving ODM
®
TruNet™
Modern Medical’s TruNet™ is a state of the art, web-based technology portal for tracking and managing all of your claims in real-time. With this tool, you will be able to review ODM® claimants, set and review alerts and take actions based on information and reports.
TruCase™
TruCase™ is the claims management system that Modern Medical’s clinical staff uses to track outcomes for pain, function, opioid use, adverse effects, urine drug screens and pain agreements.
TruRisk™
This prescriber intervention program works in tandem with the ODM® alerts to identify and address issues with opioid and other inappropriate drug use. Modern Medical will also track multiple aspects of claimant compliance. This program is complimentary and considered a claimant safety initiative program managed by our clinical pharmacists.
MEDICATION REVIEW SERVICES
An Independent Pharmaceutical Evaluation (IPE) provides a professional opinion from a clinical pharmacist on cost effective therapy that is appropriate for the covered claim as well as to identify and recommend solutions to mitigate claimant risk.
PEER REVIEW SERVICES
Modern Medical is working with a peer review organization that will provide a final report and will conduct peer-to-peer contact if the current treatment requires intervention. This service can be combined with a medication review.
PHYSICIAN REVIEW
This service allows the current prescriber to be reimbursed for an in-depth file review. While this service is available for all alerts, we recommend that claimants with a dose above 120 mg per day of morphine equivalents receive this intervention. This will require a random urine drug screen, a pain agreement on file, a treatment plan and a state prescription drug monitoring report to be pulled.
FORMULARY MANAGEMENT SERVICES
Allows you to make changes to the claimant’s formulary instantly. Options include: continue medications, block medications or restrict medications to a certain period of time. This action is available for opioids as well as other medications like: sedatives, hypnotics and muscle relaxants.
URINE DRUG SCREEN SERVICES
Modern Medical offers a comprehensive urine drug screen through Millennium Labs, that tests over 80 different drugs and metabolites including synthetic cannabinoids and bath salts. Reports are made available to you and the claimant’s physician.
OPIOID DETOXIFICATION SERVICES
Modern Medical offers an outpatient detoxification program as an optional treatment for the claimant when recommended by the peer review physician. This outpatient detoxification program is supervised by a physician
specialized in addiction medicine.
Identify Risk Claimant Education Opioid Monitoring & Interventions Medication Reviews Peer Reviews Physician Reviews Urine Drug Screen Formulary
Management Services Opioid Detoxification Services
TruNet™ Alerts
TruNet™ alerts are one of Modern Medical’s clinical solutions for identifying inappropriate patterns of drug use. These alerts can trigger the following actions to be taken in the Opioid Defense Manager® program.
ODM
®
Inappropriate Drug Use Alerts
Pattern of Filling
Prescriptions
1. Early narcotic refill attempts
2. Using multiple physicians and pharmacies 3. Utilizing 2 or more pharmacies for prescriptions*
Drug Duration
1. Narcotic utilization > 90 days 2. Narcotic utilization > 120 days3. Excessive duration of use: hypnotics (beyond 90 days) 4. Excessive duration of use: muscle relaxants (beyond 90 days)
Drug Dosage
1. Daily MED > 100 mg/day 2. Daily MED > 120 mg/dayConcurrent
Drug Use
1. Concurrent use of a narcotic and sedative 2. Multiple sedative drugs
3. More than 2 narcotics and a hypnotic filled monthly* 4. More than 2 prescribers for same drug class*
5. More than 2 narcotics filled monthly with concurrent use*
Utilization
1. At risk for drug-related problems (> 7 drugs) 2. More than 2 narcotics filled monthly* 3. First fill of a schedule II opioidOpioid Defense Manager® Program Components
*These alerts follow the Ohio Coordinated Services Program. MED = Morphine Equivalent Dose
Modern Medical’s Clinical Services Team handles the complexities of the medication
management system to cultivate positive claimant outcomes for the injured population.
ODM
®
Outcomes and Case Study Synopses
Modern Medical’s nurse intervention is the key to the success of Opioid Defense Manager
®
.
These case studies present real outcomes directly associated with our nurse intervention and
the Opioid Progress Reports.
CASE STUDY: STARTING TO WEAN
• Claimant injured in 2012 with resulting joint pain of the lower leg
• Nucynta® ER and oxycodone/APAP 5-325mg were being used chronically
Result:Opioids weaned in two months, formulary restricted
CASE STUDY: MULTIPLE PRESCRIBERS
• Claimant was injured over 12 months • Tramadol and oxycodone were prescribed by
different physicians
– Physician obtained information from our medication history on the OPR
Result: Oxycodone no longer being prescribed
3
5
MEDICATION DOSE INDICATION FOR USE
Carisoprodol 350mg
(generic for Soma®) 4/day Acute muscle spasm
OxyContin® 40
(brand)
8/day Chronic pain; chronic pain with opiod tolerance Zolpidem 10mg
(generic for Ambien®) 1/day Short-term treatment of insomnia characterized by difficulty falling asleep
CASE STUDY: DOCTOR SHOPPING (MEDICATION REVIEW)
4
• A 48 year old claimant injured in2005 due to amputation of four fingers
• Problem: Over a 4-month period, there were 4 different opioids prescribed by 6 different doctors, filled at 7 different pharmacies – Claimant received over 417 extra
opioid doses
Result: “Locked” to one physician, further coverage of opioids denied
• A 67 year old claimant injured in late 1990’s after falling on ice • Reported injuries were lumbosacral
sprain, disc herniation, major depression (single ep.)
• Problem: Opioid dose of 480 mg/day MED and chronic use of a sedative in an older claimant
Result:Carisoprodol and zolpidem stopped; OxyContin® weaned to 80mg/ day (over $1,500/month savings)
CASE STUDY: STARTING TO WEAN (MEDICATION REVIEW)
2
DATE DRUG QUANTITY/DAYS DOCTOR PHARMACY
6/9/12 Oxycodone 15mg 60/10 Doctor A Pharmacy 1
6/9/12 Oxycodone 5mg 60/10 Doctor A Pharmacy 1
6/25/12 Oxycodone 15mg 120/30 Doctor B Pharmacy 2
6/26/12 Tramadol 50mg 50/25 Doctor A Pharmacy 2
7/11/12 Oxycodone 5mg 120/30 Doctor B Pharmacy 1
7/20/12 OxyContin® 10mg 60/30 Doctor C Pharmacy 3
7/20/12 Oxycodone 20mg 120/30 Doctor D Pharmacy 4
70
%
of physicians are responding to Modern Medical nurse intervention46
%
decrease in opioid utilization38
%
decrease in the morphine equivalent dose (MED)19
%
decrease in opioid medication costs to the employerMED = Morphine Equivalent Dose
OPR = Opioid Progress Report
