Patient-brokering contributes to Opioid related deaths| Part 2 featured image for post titled Opioid Addicts Are Commodities in High Demand And Federalism Fuels Patient Brokering

Patient-Brokering: Opioid Addicts Are Commodities in High Demand

Patient-Brokering|Opioid addicts are commodities in high demand. Patient-brokering describes the $1 billion industry that puts a price tag on the lives of people seeking opioid addiction treatment.

What is Patient-Brokering?

Patient-brokering is when drug rehab centers or sober homes pay people and other third-parties (known as patient-brokers) for referring patients to their establishments. In patient-brokering schemes, people with opioid addictions — and their families —  think the establishments are medically proper.  This is not the case.

The substance abuse addiction treatment centers and sober homes that use patient-brokers are solely focused on profiting off insured opioid addicts. And the patient-brokers who recruit opioid addicts for the treatment facilities are solely focused on profiting from insured opioid addicts.

Patient-Brokering Facts

  1. Patient-brokering is a booming $1 billion industry.
  2. People with opioid addictions get bought and sold online and in person.
  3. Patient-brokering stems from the opioid epidemic.
  4. The actions of federal and state government officials have and continue to fuel the patient-brokering phenomenon.
  5. Patient-brokering is an unintended consequence of capitalism.

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About the Author

O.W.B Public Affairs Digest Home Image Meet Olivia P. Walker
Olivia P. Walker is a public affairs strategist, campaign consultant, and writer. Most recently, Olivia served as governance consultant for the International Society for Pharmaceutical Engineering. Before that, Olivia worked as government affairs and public policy analyst for WellCare Health Plans, a Fortune 500 health insurer. Olivia holds a master’s degree in public administration from the University of South Florida School of Public Affairs. In 2016, Olivia was duly initiated into Pi Alpha Alpha, the Global Honor Society for Public Affairs and Administration. She is a member of the American Society for Public Administration and a member of the ASPA Section on Public Law and Administration. Olivia also holds a Graduate Certificate in Globalization Studies. The certificate is a specialized graduate-level credential reflecting knowledge of the most up-to-date research on globalization.

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Managed Care and Rural Health: Medicaid and CHIP Managed Care Final Rule

In FY 2016, total Medicaid Expenditures — including the US Territories, administrative costs, and accounting adjustments — exceeded $574 billion. Meanwhile,  rural health outcomes are poor, and the health care utilization rate among rural residents is low compared with the nation’s urban residents.

Rural Health Care

Provider shortages, poor transportation infrastructure, socio-cultural dynamics, and inadequate broadband internet access are factors that diminish rural health care access. As a strategy to contain rising health care costs and improve rural health outcomes, states across the country are transitioning rural Medicaid beneficiaries from fee-for-service health care arrangements to Medicaid managed care.

Medicaid Managed Care

Managed care organizations (MCOs) have demonstrated an ability to provide Medicaid coverage that results in efficiency in the provision of government-sponsored health care and effectiveness in improving the health outcomes of rural residents through features such as telemedicine (if possible), allied health professionals, community health workers, and non-emergency medical transportation (NEMT).

NEMT is a mandatory Medicaid benefit but states can, and do, limit the availability of NEMT services via federal waivers. However, full-risk capitation arrangements incentivize MCOs to provide services such as NEMT.

Medicaid and CHIP Managed Care Final Rule 

The extent of recent reports detailing the ways in which rural hospitals are struggling to stay open further illustrates the benefit of managed care.  Specifically, MCOs must adhere to network adequacy requirements as established by the CMS’ 2016 Medicaid and CHIP Managed Care Final Rule. The network adequacy provisions require states to establish and enforce certain time and distance standards with contracted MCOs.

Facts on Rural Health 

  • The incidence of diabetes among rural residents is 17% higher than urban residents.[1]
  • Mental health comorbidities are more common in rural, long-term care populations.[2]
  • Limitations in activities of daily living are more prevalent among rural residents.[3]
  • The prevalence of hypertension is higher in rural populations than in urban populations.[4]
  • Rural Medicaid beneficiaries are more likely than their urban counterparts to be dually eligible for Medicaid and Medicare, and are overwhelmingly low income, elderly and disabled; dual eligibles are considered the most costly, at-risk, and vulnerable population.[5]

[1] Lorenz, G., Levey, M., and Case, R. (2013). Integrated Care Through Education: Improving Care for Those with Serious Mental Illness and/or Intellectual Disability and Diabetes in Rural Indiana. Journal of Rural Mental Health.

[2] Quinn, M. (2016). New Medicaid Rules Could Ease Rural Health Care’s Problems. Governing. Retrieved from http://www.governing.com/topics/health-human-services/gov-cms-medicaid-managed-care.

[3]Rural Health Information Hub. (2016). Medicare and Rural Health. Retrieved from https://www.ruralhealthinfo.org/topics/medicare.

[4] Ibid.

[5] CMS. (2015). People Enrolled In Medicare and Medicaid: Medicare-Medicaid Coordination Office Fact Sheet. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination//Medicare-and-Medicaid-Coordination/Medicare-Medicaid -coordination-Office/Downloads/MMCO Factsheet.pdf.

Social Determinants of Health Post Welcome to the Conversation Policy Experts

80 – 90% of Diseases are Caused by Non Biological Factors – Psst… Welcome to the Conversation Health Policy “Experts”

updated July 2018

Quantifying the Impact of the Social Determinants of Health  

At the US News Healthcare of Tomorrow Conference on Nov. 2, Dr. Pedro J. Greer told conference attendees “between 80 and 90 percent of diseases are caused by non-biological factors.”  He explained “the number one cause of transplants for patients under the age of 50 is fatty liver, and the number one cause of fatty liver is obesity.”

This is by no means news.

Zip Code Matters

There are lower rates of obesity and diet related diseases in census tracts with access to healthy and affordable foods, safe recreational spaces, reliable and affordable transportation, and affordable childcare — the list goes on. Moreover, the built environment, location familiarity, and perceptions of safety are highly correlated with dietary habits and population health (outcomes).

Again, these facts are by no means news. In fact, they are well documented across disciplines.

Between 80 and 90 percent of diseases are caused by non-biological factors. These factors are referred to as SOCIAL DETERMINANTS OF HEALTH. Click To Tweet

SOCIAL DETERMINANTS OF HEALTH

The Office of Disease Prevention and Health Promotion (ODPHP) refers to Social Determinants of Health (SDOH) as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

HEALTH POLICY vs. PUBLIC HEALTH 

Prior to consulting for ISPE, I:

  •  Worked as a public policy and government affairs analyst for a Fortune 500 health insurer;
  • Worked in local government as a community policy analyst for an Affordable Care Act (ACA) funded, multi-sector healthy food access (SDOH) initiative;
  • Worked as a public health and outreach professional for five years prior to attending graduate school. Cumulatively, I have provided community based services and supports to > 7,000 Hillsborough County (FL) residents in home and community based settings; and
  • Studied Food Systems Policy and Planning in graduate school. I have since given presentations on the topic in academic settings.

The disconnect between health policy and public health is concerning, yet not surprising. Politics direct health policy. Evidence-based interventions direct public health (initiatives).

I’m glad certain policy and health care circles have finally caught on to the fact that there is a link between the built environment and health outcomes. Notwithstanding, I find it unacceptable it has taken this long.

Better Late Than Never

Fortunately, the popularity of full-risk capitation and value-based payment models have prompted recent SDOH discussions among Medicaid and other health policy stakeholders.

Unfortunately, these discussions entail health policy experts enumerating the ways in which they struggle to define SDOH indicators, collect and analyze standardized SDOH data, understand geographical components of SDOH, and incorporate SDOH indicators in capitation rate development and value-based payment arrangements.

Best Practices

1. SDOH indicators and data collection standards already exist.  

As a best practice, a prerequisite to taking on a new endeavor should be the completion of a thorough benchmarking and best practices study.

2. The use of GIS software remains severely underutilized  in Medicaid and other health policy circles.

As a best practice, when hardships identifying geospatial components of a problem arise, utilize geospatial technology. Having used GIS to map various SDOH data points,  I struggle to understand why this is — seemingly — such a challenge.

Notably, GIS is useful for health insurers required to meet network adequacy standards enumerated in CMS’ Medicaid managed care final rule. GIS is also an effective business development tool.

3. Innovation, a term health policy experts often use, requires new ideas and methods.  

To that end,  the following organizations (and their affiliates) should have a seat at the table during future SDOH discussions:

  • The American Planning Association;
  • The International City/County Management Association; and
  • The National Association of Counties.    

Each association has experience with SDOH initiatives and can offer valuable insights.

Through sweeping authority to direct zoning and other land use policies, local government actions profoundly inform the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Finally, social workers and case managers — not program directors, the people on the ground — need a seat at the table if the goal is to meaningfully address SDOH.

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What Gets Measured Gets Managed: Medicaid Encounter Data Quality Submission Standards|White Paper

updated 02 October 2018

What Gets Measured Gets Managed: Medicaid Encounter Data Quality Submission Standards| White Paper

What Gets Measured Gets Managed: Medicaid Encounter Data Quality|White Paper
What Gets Measured Gets Managed: Medicaid Encounter Data Quality|White Paper

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