Imagine that a doctor can predict very early in the pain management process if a patient is at risk for opioid abuse.
That day may not be far off. In fact, it may be here.
Aaron McKethan Ph.D, president of RxAnte, told the National Pain Report that pilot programs will be launched later this year by his company working with some major insurers using what is called “predictive analysis” that can identify highest risk patients in the first 90 days of treatment.
So how does it work?
The premise is that not all pain patients are alike.
McKethan said that most analysis of pain medication use is driven by Medicare and Medicaid and health insurers who are mostly looking for patients who are already being harmed by drug use and tend to emphasize whether there is fraud, waste and abuse.
Not enough attention has been given to what he calls, “patient safety”.
McKethan said he has a cousin who is a chronic pain sufferer (failed back surgery) who “needs high powered medication in order to live his life”.
In the RxAnte model, which already has over two dozen predictors, his cousin would be at low risk. That’s because, among other reasons, he gets his medication from the same physician and the same pharmacy, he picks it up regularly and there’s no evidence of abuse.
The model that has been developed includes data on the patients themselves (gender, geography, age), the attributes of the medication on the patient (using claim information can see if dosing is change, other medications that are being taken) and the attributes of the medication themselves (how strong are they, are patients stopping and starting).
McKethan is certain that the predictive analysis works. They’ve been working a year and a half using claims data of large insurance companies to develop the model.
What the pilot projects are designed to find is whether it matters.
Will it change how doctors and others use the information in how they treat their patients?
McKethan thinks it will.
Each patient will have a score – (his cousin’s score would indicate a low risk) and the doctor will see that.
What RxAnte wants to ask the doctors is “If we could tell you accurately whether the patient is at higher or lower risk for unsafe use of these medicines, would that change how you treat him or her?”
So it’s not pain specialists who will be part of the pilot – it’ll be family doctors. Primary care physicians write 80% of the initial opioid prescriptions and also refill 80% of those prescriptions.
Another target audience is what he calls the “care management programs” which are mostly run by health plans and the questions are the same. “Would knowing a patient at risk earlier result in you engaging that person earlier, and presumably getting him or her help, earlier?”
While pharmacists won’t be part of the first pilot, McKethan said he has already had some initial conversations with large pharmacy chains about his model and there appears to be some interest.
So what will this year’s pilot programs show?
Realistically, it will show whether having predictive analysis can “move the needle” in terms of reducing the estimated $70 billion in extra costs, 100,000 emergency room visits and 120 deaths per day that are tied to prescription drug abuse in the United States that RxAnte cites.
It will have another impact.
McKethan’s cousin and millions of chronic pain patients like him who are at low risk won’t be lumped in with those from those who either are at risk for abuse or might be selling or other nefarious pursuits ascribed to pain medication.
As he told McKethan, “Hallelujah, treat me like a normal person. I deserve that!”
For the record: RxAnte is a Millennium Health company. Millennium is a powerful bioinformatics and analytics company. Doctors send urine samples to Millennium, whose system can detect 130 drugs and return results to doctors within 24 hours.
McKethan also said that the insurance companies and health plans that will participate in the pilot have not yet been publicly disclosed. We will follow up with him and RxAnte in the future as more details are released.
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