Fighting the substance abuse trend with Cigna integrated benefits

The trauma of life events can trigger dangerous choices. Unfortunately, the added anxieties of pandemic life have led many to up their intake of alcohol or other unhealthy substances. At least 13% of Americans reported a start or increase in substance use as a way of coping with stress or emotions related to COVID-19.1 U.S. consumption of alcohol also surged in 2020, with “heavy drinking” increasing by 19% overall among surveyed adults and 41% among women in particular.”2

At Cigna, the advantages of having health care benefits integrated under one roof go well beyond the convenience of a combined ID card, one online resource and a single point of contact. The true value is in having a connected, clear picture of an individual’s health from which to identify potential risk factors and intervene, when possible. This is key for those with already fragile health, for whom the choice to engage in substance abuse could be of grave consequence.

By the end of 2020, more than 40 states observed increased opioid-related mortality along with ongoing concerns for those with substance use disorders.3 Sadly, “over 81,000 drug overdose deaths occurred in the U.S. in the 12 months ending in May 2020 – the highest number of overdose deaths ever recorded in a 12-month period,” according to recent provisional data from the U.S. Centers for Disease Control and Prevention (CDC).3

Substance abuse can trigger or worsen certain disease states.
Abuse of alcohol and/or other substances can lead to many different health issues, including long-term heart-related diseases, high blood pressure, stroke, as well as certain cancers.5, 6 Alcohol abuse can also increase the risk of certain cancers – of the liver, colon, pancreas or breast, for example.7 Substance abuse can also increase the risk of heart attack in those with heart disease and/or type 2 diabetes.8,9

Hepatitis is an example of a disease that alcohol abuse may trigger. While there are several other causes – such as viral infections and autoimmune conditions – the inflammation of the liver known as alcoholic hepatitis is caused by regular high intake of alcohol. Excessive alcohol intake is about eight drinks or more per week for women and 15 or more per week for men.10 The liver may respond with cirrhosis, bleeding, or even failure.7

According to a recent NPR report, this type of liver disease is on the rise – in particular among younger women, in their late 20s and early 30s. This is likely because of the “added pressures of pandemic life and because women’s bodies process alcohol differently than men.”11 For patients suffering from this affliction, “coordination of care between hepatology and the cultures of psychology and psychiatry may not always connect.”10

Integrated benefits offer the advantage of extra oversight and support.
The link between body and mind is clear. According to the National Institute of Mental Health, chronic illnesses may make a person more likely to have or develop a mental health condition.12  With Cigna integrated benefits, we’re able to see the big picture for Cigna patients and refer them to behavioral health support when we see a potential need. We start with one clinical platform for all of our benefits – including pharmacy, medical and behavioral health – to meet customers wherever they are in their health journey. For example, with our integrated touchpoints approach, what may appear to be a simple inquiry, Cigna sees as an opportunity to engage in a meaningful way and measure health outcomes.

For pharmacy customers, we route inbound calls to a team of care advocates, when appropriate, to educate and assist with engagement opportunities specific to the customer’s needs. Some customers do not respond to traditional methods of engagement, such as outbound calls or mailings. So we connect with them during a pharmacy service center phone call. For example, we may see an opportunity to refer the customer to behavioral health coaching, prescription coaching, case management or specific health programs.

Integrated benefits mean that every checkpoint can also look to identify and help customers conquer behavioral health challenges, like stress, anxiety or depression. For customers with integrated benefits, we also offer inMyndSM. It’s a comprehensive tool that works by leveraging integrated claims data and multiple pharmacy touchpoints. It then identifies risk factors for behavioral health conditions, and helps customers and their providers to better recognize and find helpful resources.

With inMynd, we connect pharmacy customer engagements with data and clinical care teams, and then guide at-risk customers and their families to health education, resources and counseling support. This can increase customer engagement and help improve their health outcomes, while also reducing costs. Results show $2,800 savings in combined medical/pharmacy costs post intervention per engaged customer.13

We work closely with health care providers to spot potential drug abuse issues.
We continue to pursue a goal to reduce overdoses among our commercial customers in key markets by 25% by December 2021.14  Our Narcotic Therapy Management program is part of our broader commitment to help combat opioid misuse and overdose. We use it to closely monitor integrated data, flag potential misuse issues, and alert health care providers accordingly. We trigger our alerts based on real-time medical and pharmacy claims data, which provides the full view of a customer’s utilization behavior and potential high risks associated with taking more than one medication.

Through our Complex Psychiatric Case Management, we also offer an integrated solution for customers taking multiple psychotropic drugs. The program leverages Cigna integrated benefits, examining six months of retrospective pharmacy and medical claims data. This process works to identify individuals filling multiple therapeutic classes of psychotropic medications and/or multiple drugs within a specific class.

Integrated benefits mean we are able to access medical diagnosis information and identify those customers who may benefit from our proactive outreach to their prescribing physician(s). We do not notify physicians about customers who, for clinical reasons, should be on multiple narcotic medications.

Cigna also strives to help at-risk customers understand and have access to medication-assisted treatment (MAT), when appropriate, so they can enter active, ongoing treatment to prevent overdose. In MAT, monitored doses of methadone or buprenorphine are administered to prevent withdrawal symptoms for those who might otherwise make the unsafe choice to continue abusing opioids. At Cigna, we work with hospitals, through our Hospital Collaborative Care Program. Hospitals commit to take action on specific areas that can reduce opioid overdose. In looking at targeted customers with integrated Cigna pharmacy, medical and behavioral health benefits, the 2020 overdose rate was 18% lower than our observed 2018 baseline rate.15

Together, and with the information revealed and opportunities afforded through integrated benefits, we can help better support our customers’ health – in body and mind.

LEARN MORE

  1. Abramson, Ashley. Substance use during the pandemic. American Psychological Association. apa.org. 1 March 2021. < https://www.apa.org.monitor/2021/03/substance-use-pandemic>.
  2. Pollard, Michael S. Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US. JAMA Network. jamanetwork.com. 29 Sept. 2020. <https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975>.
  3. Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. The American Medical Association. ama-assn.org. 3 March 2021. <https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf>.
  4. Overdose Deaths Accelerating During COVID-19. Centers for Disease Control and Prevention. cdc.gov. 17 Dec. 2020. <https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html>.
  5. Quick Dose: When Drinking Becomes Binge Drinking. The Effects on Your Health and Well-Being. nm.org. April 2021. <https://www.nm.org/healthbeat/healthy-tips/emotional-health/nm-when-drinking-becomes-binge-drinking>.
  6. Piano, Marian R. Alcohol’s Effects on the Cardiovascular System. U.S. National Library of Medicine National Institute of Health. 2017. ncbi.nlm.nih.gov. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/>.
  7. Alcohol and Cancer Risk. National Cancer Institute. cancer.gov. <https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet#what-is-the-evidence-that-alcohol-drinking-can-cause-cancer>. Accessed April 19, 2021.
  8. Medical complications associated with substance use disorders in patients with type 2 diabetes and hypertension: electronic health record findings. National Library of Medicine. National Center for Biotechnology Information. PubMed.gov. Aug. 2019. <https://pubmed.ncbi.nlm.nih.gov/30851217/>.
  9. Increased Morbidity and Mortality in Hypertensive Patients With Substance Use Disorders: Electronic Health Record Findings. National Library of Medicine. National Center for Biotechnology Information. PubMed.gov. July 2020. <https://pubmed.ncbi.nlm.nih.gov/32800083/>.
  10. What is Excessive Alcohol Use? Centers for Disease Control and Prevention. cdc.gov. <https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html>. Accessed May 19, 2021.
  11. Noguchi, Yuki. Sharp, ‘Off The Charts’ Rise In Alcoholic Liver Disease Among Young Women. NPR. npr.org. 16 March 2021. <https://www.npr.org/sections/health-shots/2021/03/16/973684753/sharp-off-the-charts-rise-in-alcoholic-liver-disease-among-young-women>.
  12. Chronic Illness and Mental Health: Recognizing and Treating Depression. National Institute of Mental Health. nimh.nih.com. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml. Accessed March 30, 2021.
  13. Cigna National Book of Business. Predictive provider and customer engagement full year results. 2017. Results may vary.
  14. Initial focus will be on the following targeted U.S. communities where a sizable number of Cigna commercial customers reside and where there are higher incidences of overdose. These include: Connecticut, Maryland, New Jersey, Virginia, Chicago, New York City, Philadelphia, Washington, DC.
  15. Cigna Book of Business national study 2018-2020.

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