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Michigan idea could help with chronic diseases, expand access to opioid treatment

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Championed for the past 14 years by University of Michigan physician and researcher A. Mark Fendrick, the proposed chronic disease bill borrows from Fendrick's concept of "value-based insurance design."

VBID, which was born in Michigan and is used in a growing number of commercial, Medicare and Medicaid plans, encourages people to use higher-value medical services by offering low or no copayments. It was hatched in the Affordable Care Act of 2010. Studies have shown VBID in benefit design plans can improve outcomes and reduce long-term costs.

"For 14 years I have been trying to change one sentence (in IRS regulation) and now we have a bipartisan bill with support from Congress, the White House and the Treasury Department on board, business, consumer and insurance groups," Fendrick said. "It has widespread support, and it encourages less regulation."

"(Congress) in 2004 created an IRS safe harbor for preventive care to be covered at a zero deductible, but not chronic care services for the highest-cost patients," Fendrick said. "We are on the 1-yard line, and the language in the bill gives plans and employers flexibility in what they want to do."

For example, a diabetic patient with a high-deductible plan must spend out of pocket for a regular eye or foot examination to determine if the disease is worsening. Fendrick said some diabetic patients can't afford to spend down a $1,500 or $2,000 deductible before seeking eye or foot examinations.

If approved, the bill also could give self-funded employers and health insurers the flexibility to add chronic disease treatments and prescription drugs to their benefit plans on a predeductible basis, said Becky McLaughlan, CEO of Marsh and McLennan in Troy.

"The description of chronic disease is so broad and the bill is so brief, but the concept is to allow people to allow access to treatments before deductions are met," McLaughlan said. "It is trying to reduce the number of complications with chronic disease that often results in more costly treatment."

Fendrick said the bill could also mean life-saving relief to opioid addicts seeking Naloxone overdose treatment or other opioid treatment medications.

Deaths and overdoses in Michigan from opioid misuse rank 18th-highest in the nation. In 2016, 2,356 people died of drug overdoses, more deaths than from car accidents. From 1999 to 2016, the total number of overdose deaths involving any type of opioid increased more than 17 times in Michigan from 99 to 1,699.

Two types of prescription drugs, painkillers and tranquilizers, are the leading cause of misuse. Opioids range from such illegal drugs as heroin to prescription pain medicine that include oxycodone, hydrocodone, morphine, methadone, and codeine.

Ilyse Schuman, senior vice president for health policy with the American Benefits Council, said the council's 425 employer members are supportive of expanding predeductible coverage of chronic disease benefits.

"People and family members with HSAs should be able to use those funds for first-dollar coverage," said Schuman. "We like them to be able to use it for treatment of opioid addiction and to use HSA funds to get that treatment. This could significantly increase access to Naloxone because (out-of-pocket costs) could be a significant impediment for treatment."

Janis Romanik, D.O., medical director of Sacred Heart Rehabilitation Center in Madison Heights, said the chronic disease act could vastly improve access to opioid medication and treatment for thousands of patients.

"Opioid addiction is a chronic disease that is a brain disorder and affects the way people think," Romanik said. "The have an internal struggle and know what they are supposed to do, but they can't. They need medication and psychosocial support and treatment."

The average dose for medication such as Vivitrol costs about $24 per day, or between $600 to $1,000 per month, she said. "Fifty to 70 percent of people avoid treatment because of costs," Romanik said. "Access to insurance on a predeductible basis is a great way to do it."

Larry Wagenknecht, a pharmacist and CEO of the Michigan Pharmacists Association, said the MPA board has not taken a position on the chronic disease bill but he personally believes it will encourage people with serious health problems to fill their prescriptions because they will be able to afford it.

"Designing plans to eliminate copays eliminates financial barriers to taking the critical medications that can improve health and decrease days off from work," Wagenknecht said. "We know when a person is adherent in taking medications for diabetes and heart disease, the benefits are positive."

One study in North Carolina showed that when the city of Asheville eliminated copayments under the VBID concept for certain chronic disease prescriptions and pharmacists were paid to provider medication management, the return on investment was high, Wagenknecht said.

"Patients felt better, their outlook on life was positive, and the city saved a ton of money," he said.

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