The recent headlines surrounding the nation’s opioid crisis begs the question, “How is this epidemic happening, when many of these drugs are prescribed?” The National Institute on Drug Abuse reports that anywhere from 21% to 29% of prescription opioids are misused. They also hold that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
While the implications are troubling not only for those who are developing addictions and even losing their lives to overdose, with the CDC reporting 68% of the 70,000+ drug overdose deaths in 2017 involving opioids, the negative blowback filters into the business world as well. Kyle Cheek, Clinical Associate Professor of Information and Decision Sciences (IDS) and the Director of the Center for Research in Information Management (CRIM), has worked within the analytics space in the healthcare industry for over 20 years and has developed a deep understanding of how the recent opioid crisis has hurt employers.
On the surface, it can be difficult to understand how the opioid epidemic relates back to business. However, Professor Cheek believes there are a couple of connections to be made, and he makes the first connection plain: “One of the things that I began working on long ago was how could I, with data from all these claims we [the insurance companies] were paying, how could we identify instances of benefit abuse, or healthcare fraud? So, the tie back to business, on one side, is that fraud detection is a very big part of risk mitigation.” Minimizing risk and detecting fraud, especially in insurance businesses where claims are paid, is a critical part of business management. However, Professor Cheek sites another, less obvious tie: “The more convoluted, but more important tie back to business is that for businesses above a certain size, there’s legal provision and some incentive to pay for their own employee’s healthcare. Businesses of all sizes lose a huge amount of money through these healthcare inefficiencies and through benefit abuse, and sometimes outright fraud instances, that we found as we worked through the data for them.”
Through years of analyzing data and noticing trends, Professor Cheek holds that a lot of benefit abuse can happen from the patient-side, doctor-side and even from the pharmacy side. This prescription abuse is expensive for hospitals as well as employers who insure employees with opioid addictions. “The cost implications of this are really twofold: one is tied to patients’ drug-seeking behavior; an emergency room visit is very expensive. Then, for those with long term opioid abuse, they tend to have catastrophic health effects – organ failure, liver failure – that are expensive to their employer. Businesses respond to these costs in different ways. One of the big accounts I looked at when I worked for an insurance company, was a school district and the most egregious oversupply we found in the data belonged to a person who turned out to be a school bus driver.” Although Professor Cheek noted that some employers did not want to be informed about employees with possible opioid addictions, this scenario was not one of them. “That’s the kind of situation where you’d want to know. One of the things that has become apparent – even for the ones who don’t want to affirmatively seek to know which of their employees are exhibiting this problem, they are interested in being able to trace their employees’ behavior back to the doctors and pharmacies that are facilitating this benefit abuse. That gives the employers some leverage to go back to insurance companies and say you need to tell these doctors in your network to cut it out.”
The problems that the opioid crisis have caused come from different angles, however, Professor Cheek states that, through data analysis, trends from certain doctors who tend to over-prescribe opioids are revealed and do have professional consequences. Professor Cheek notes, “The leverage insurance companies have is that they could say particular doctors are writing prescriptions that are not clinically supported. They can inform the doctor that their practice behavior is inappropriate and could lead to removal from the network.” Removal from an insurance network is highly detrimental for doctors, so this is one critical example where healthcare analytics has been able to, at the very least, identify trends of where these drugs are sourced and curb some of the over prescription of opioids in light of the current crisis. “The businesses we’ve worked with since I’ve been here – we do this collaborative research thru CRIM the work we’ve done has been with pharmacy benefit management companies that administer pharmacy benefits and pay pharmacy claims; we’ve helped them more proactively identify these types of patterns when they appear in the data.”
While discussing next steps regarding this problem, Professor Cheek informed UIC Business that publishing research about this issue has its challenges. “A couple of weeks ago I was at the National Healthcare Anti-Fraud Association. They gave us a booth at their annual conference to talk about our work, and there were a few slides to depict the work that we do. However, in terms of [research] publication – I’d love to, but the challenge is that the work we do with third party partners, we can’t share that data because it contains patient data and other proprietary information like pricing.” There are laws in place, such as the Health Insurance Portability and Accountability Act (HIPAA) that sets protections for certain individually identifiable health information. “We have actually been working on a synthetic data set we can use to support further research without some of the limitations of real, regulated data.” Recently, Professor Cheek has worked with the Electronic Visualization Lab in the Computer Science department to develop a visualization layer that can better illustrate patients' drug seeking behavior as well as their connections to doctors and pharmacies that attract patients with demonstrable opioid oversupply. The research and analysis that Professor Cheek and his colleagues have done thus far has provided businesses with beneficial insights to help quell the opioid epidemic.