Blue Review
A newsletter for contracting institutional and professional providers

November 2019

We’re Collaborating with Members and Providers to Help Reduce Opioid Abuse

At Blue Cross and Blue Shield of Illinois (BCBSIL), we pledge “to do everything in our power to stand with our members in sickness and health.” We take that commitment seriously. That’s why we’ve started a new program to help you when you’re caring for your patients, our members, who may be at risk for an opioid-related adverse event. We hope that by collaborating with you and your patients, our members, we can find ways to help reduce risk and promote patient safety.

As part of our new program, we’re now scanning pharmacy and medical claims that are submitted to BCBSIL to identify members with a combination of the following risk factors:

  • High morphine equivalent daily dosing (MED)1;
  • Dangerous drug combinations (i.e., opioids, benzodiazepines, muscle relaxers); and/or
  • Receiving controlled substance prescriptions from multiple providers.

When warranted, we may reach out to identified members and providers to inform them of potential risks. We also may provide support to help reduce that risk. Support may include helping to ensure that members have access to Narcan (naloxone) and are aware of how to use it. We also may suggest that providers and members consider non-opioid alternatives, such as physical therapy and cognitive behavioral therapy. This initiative is one of the enhancements BCBSIL made this summer to our Behavioral Health Program offerings.

“The number of opioid overdoses still occurring in this country requires a coordinated effort across the entire delivery system,” said Ben Kurian, M.D., executive medical director of our Risk Identification and Outreach Program. “We hope to use our data to partner with providers for the benefit of patients and their families.”

It is our hope that by identifying and sharing prescribing concerns, we can collaborate with members and providers to help promote positive changes. Thank you for everything you do to help ensure the safety and well-being of your patients/our members.

1 Dowell D, Haegerich TM, Chou R. Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1

This is only a brief description of some member plan benefits. Not all benefits are offered by all benefit plans. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. For more complete details, including benefits, limitations and exclusions, please refer patients to their certificate of coverage. If you have any questions, please call the number on the member’s ID card.