Over the last decade, the national opioid epidemic hit Pennsylvania particularly hard. As part of UPMC, an integrated delivery and finance system, UPMC Health Plan is dedicated to supporting positive health outcomes among our members by leveraging our access to data, research, clinical expertise, and its close relationships with academic institutions, medical providers, county and state governments, and community organizations to create and enhance holistic care strategies and programs tailored to serve individuals dealing with opioid use disorder (OUD) and other substance use disorders (SUDs).

These programs are more challenged and strained than ever during the COVID-19 pandemic, given that the pressures of the public health emergency have driven increases in substance use and abuse. The Centers for Disease Control (CDC) estimated that 2020 recorded more than 93,000 drug overdose deaths — the highest number of overdose deaths ever recorded in a one-year period and almost a 30 percent increase from 2019.

The heightened demand for behavioral health services underscores the importance of accessible, affordable support and care available when needed. UPMC Health Plan works closely with our network of health care providers to offer a range of innovative approaches and tools to support members struggling with SUD, including OUD. Our efforts engage providers and individuals in the following four areas:

  • Safe opioid prescribing and use, including alternatives to opioids for pain management. We arm providers with up-to-date, actionable information as well as general education about OUD prevention and treatment. We support our providers in their use of safe prescription practices for narcotics and aim to increase the utilization of effective alternative approaches to pain, such as cognitive behavioral therapy and physical therapy. These efforts also help providers identify individuals at risk for OUD, engage them, and refer them to treatment.
  • Expanding treatment options, including supporting the distribution of naloxone. There are many paths to recovery. An important first step for many people in their journey to recovery is knowing they have access to many types of treatment, including medications. UPMC Health Plan supports the expansion of access to treatment for patients, and we cover medications such as buprenorphine and naltrexone, crucial components in the treatment of OUD. We also partner with local and state governments to advance nationwide efforts to expand access to treatment. For example, the UPMC Center for High-Value Health Care has completed implementation of one grant and is facilitating the implementation of another aimed at expanding and enhancing access to medication for the treatment of OUD, in combination with counseling and behavioral therapies.
  • Improving the identification and referral to treatment of members at high risk for OUD or overdose. Identifying individuals who are experiencing OUD and helping them find treatment is our top priority. Our providers use assessments and screening tools to identify individuals at risk for OUD, which is supplemented by the UPMC Health Plan’s resources, including direct outreach to provide education and resources. Additionally, we support certified peer recovery specialists who engage individuals in emergency departments, either for an opioid-related event or for people who are at high risk of an overdose, and connect them with local, clinical resources. This ensures that patients receive the care they need with the goal of increasing the number of individuals in recovery.
  • Enhancing care coordination for OUD services and treatments. Mental health issues and OUD sometimes occur together, so it is crucial that treatment plans are holistic and treat both. UPMC Health Plan champions and facilitates this approach in several ways: streamlined member services coordination via a single phone number; “cross-over” referrals from physical health to behavioral health providers; and the certification of several UPMC facilities as Opioid Centers of Excellence, which are designated medical homes for individuals with OUD covered by Medical Assistance. In response to the shifting landscape created by COVID-19, UPMC created a Medical Toxicology Telemedicine Bridge Clinic to swiftly assess OUD patients via telemedicine and to provide medication to treat OUD while waiting to be seen by a provider, otherwise bridging individuals to local treatment providers.

These initiatives, as well as many other programs and services, have led to significant reductions in opioid prescribing and increases in the number of our members in treatment over several years. UPMC’s opioid medication utilization numbers are below national benchmarks. Every year, more patients are screened and referred for treatment of their OUD or other SUD.

There is no simple solution for the opioid epidemic. Our success depends upon sustained research, investment, collaboration, and innovative clinical care. UPMC Health Plan is committed to the creation and enhancement of strategies, initiatives, and programs based on science, research, and our members’ needs, preferences, and values. We believe this dedication will support the recovery of individuals with OUD and SUD.

The combination of our community partnerships, medical expertise, and physical and behavioral health resources will help us continue to empower individuals in need on their journey toward a happy, healthy life.

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