FAIR Health Presents at National Labor & Management Conference

On February 15, FAIR Health President Robin Gelburd spoke at the 42nd Annual National Labor & Management Conference in Hollywood, Florida. The conference is a prominent forum for the critical issues of the moment affecting both labor and management. Addressing an audience of more than 200 members of the labor community, Ms. Gelburd co-presented on the opioid epidemic with Andy Johnson of the Teamster Center Services Fund.

Drawing on data from FAIR Health’s repository of private healthcare claims, Ms. Gelburd built on research from FAIR Health’s series of opioid-related white papers, which have opened a window into the national epidemic. She presented changes in volume of claim lines for opioid-related diagnoses, noting, for example, that claim lines for pregnancy drug dependence increased 18,700 percent from 2013 to 2017 and those for heroin overdose 340 percent. The highest increasing services with an opioid-related diagnosis were diagnostic/screening processes or results, which grew 120 percent from 2015 to 2017.

Age and Gender

Ms. Gelburd presented age and gender findings. For example, in urban areas, individuals aged 23-30 accounted for 18 percent of the distribution of opioid abuse and dependence claim lines, but in rural areas, they accounted for only 9 percent. In every age group, more claim lines for opioid dependence were submitted for males than females.

Costs

Discussing the costs of the opioid epidemic, Ms. Gelburd reported that aggregate charges and imputed allowed amounts for patients diagnosed with opioid abuse and dependence both had increased over 2,500 percent from 2013 to 2017. Charges increased from $303 million in 2013 to $8 billion in 2017, and imputed allowed amounts from $159 million to $5.3 billion.

Geographic Factors

Ms. Gelburd presented a heat map showing the states with the highest number of opioid abuse and dependence claim lines as a percentage of all medical claim lines in a state in 2017. The five states with the highest percentages were Rhode Island, Kentucky, West Virginia, Florida and California. She also compared the top five procedure codes by utilization and cost in four regions (Northeast, Midwest, South and West) and four states (Florida, Texas, California and New York).

Comparing the age distribution of opioid-related diagnoses in Florida to the nation in 2017, Ms. Gelburd spotlighted differences between diagnoses. Opioid abuse and dependence accounted for a much higher percentage of claim lines in Florida than the nation for the age groups 19-22 and 23-30. But opioid overdose accounted for a higher percentage of claim lines in Florida than the nation for the age groups 31-40 and 61-70. The difference may in part be due to the relatively older age of Florida’s population.

Ms. Gelburd also showed how geographic distribution of opioid-related claim lines may not reflect population distribution. New York City accounted for 43 percent of New York State’s population in 2017 but only 20 percent of the state’s opioid-related claim lines in the period 2007-2017.