Opioid Over-utilization Prevention
The Opioid Over-utilization Prevention (OOP) program is designed to identify high utilizers and patients using multiple providers. The offering supports Medicare’s new display measure, Use of Opioids at High Dosage and from Multiple Providers in Persons Without Cancer (OHDMP).
Qualification: The OOP program is available as a stand-alone program or in combination with your existing Quality Improvement Program.
Targeted Medication Reviews (TMRs): For every patient enrolled in the OOP program, a targeted review is completed each time the patient fills a prescription for any medication. The reviews identify:
•Use of multiple prescribers and/or multiple pharmacies
Prescriber Interventions: TMRs that generate opportunities to improve care through care coordination (multiple prescribers) result in prescriber outreach. Interventions are tracked using Tabula Rasa HealthCare’s proprietary, claims-based outcomes process.
Opioid Management Program
The Opioid Management Program (OMP) is designed to support chronic opioid users. The goals are to prevent over-utilization, prevent medication-related problems, and identify potentially suboptimal pain management treatment.
Qualification: Program enrollment is based on a new qualifying condition, Chronic Opioid Use, which is defined as two or more opioid claims of greater than or equal to 30 days in a 150-day period. Both immediate-release and extended-release narcotic analgesics are included in the analysis. Every patient who meets this condition is automatically enrolled in the OMP. Those beneficiaries could also be jointly enrolled in the MTM program and Quality Improvement Program.
Targeted Medication Reviews: For every patient enrolled in the OMP, a targeted review is completed each time the patient fills a prescription for any medication or is due to fill a prescription for a chronic medication. The reviews identify:
•Use of multiple prescribers and/or multiple pharmacies
•Concomitant use of opioid potentiators, such as benzodiazepines
•Concomitant use of opioid activation inhibitors
Prescriber Interventions: TMRs that generate opportunities to improve outcomes through care coordination (multiple prescribers), improved medication safety, or improved pain management result in prescriber outreach. Interventions are tracked using Tabula Rasa HealthCare’s proprietary, claims-based outcomes process.
As an enhancement to the Opioid Management Program, we offer an Optimized Opioid Solution. The program enhancement includes in-depth pharmacodynamic, pharmacokinetic, and pharmacogenomic evaluations and consultations.
Qualification: Patients prescribed chronic opioid therapies are entered into TRHC’s MedWise® technology, which has a unique and proprietary risk stratification engine for opioid misuse and abuse. Patients are assigned the TRHC’s MedWise Risk Score™ for preventable adverse drug events related to opioids, on a scale of 0-50. Those patients with a risk score of 20 or higher are considered to be in the intervention group.
Targeted Medication Reviews: Pharmacists evaluate therapy for potential pharmacokinetic and pharmacodynamic multi-drug interactions that can cause the following adverse events.
•Ineffective pain management
•Excess sedation
•High anti-cholinergic burden or ‘dryness’
Prescriber Intervention: Recommendations for alternative medications are communicated to the primary prescribers. Continuing Medical Education (CME), Continuing Nursing Education (CNE), and Accreditation Council for Pharmacy Education (ACPE) accredited opioid education programs are offered to community pharmacists and physicians who prescribe to high-risk patients.
Patient Intervention: Actionable patient intervention is administered through in-depth pharmacodynamic, pharmacokinetic, and pharmacogenomic evaluations and consultations.
•Patient Medication Action Plan to Avoid Unintentional Misuse and Abuse
•Patient Opioid Regimen Personalization (Upon Request)
To learn more, please visit trhc.com.
