Spotlight on Claims Data Uses in the Opioid Crisis

As healthcare information and other professionals confront the opioid crisis, claims data can illuminate trends and patterns at the national, regional, state and local levels. FAIR Health President Robin Gelburd explained how at the American Health Information Management Association (AHIMA) 90th Convention & Exhibit on September 25 in Miami.

In her presentation, entitled “Harnessing Claims Data to Bring Structure and Coherence to Opioid Trends and Treatment,” Ms. Gelburd revealed the ways in which multiple aspects of the opioid epidemic can be brought to light through claims data analysis. For example, differences in treatment protocols for opioid-related diagnoses can be identified on a state-by-state basis.

To illustrate this point, Ms. Gelburd showed that in New York State in 2017, methadone administration was the most common procedure code by utilization, accounting for 39 percent of total claims associated with opioid abuse and dependence. By contrast, in Texas and Pennsylvania, a code for “testing for presence of drug” was the most common, at 37 percent and 42 percent (respectively) of total procedure codes for opioid abuse and dependence by utilization in that same year. (For more on state-by-state differences in opioid-related procedures, see our recent white paper and online interactive heat map).

Trends in charges and allowed amounts can also be discerned using claims data. FAIR Health analyses reveal that professional charges and allowed amounts for services for patients diagnosed with opioid abuse or dependence rose dramatically—more than 2,500 percent—from 2013 to 2017.

Claims data can likewise shed light on demographic factors associated with opioid-related diagnoses. For instance, the FAIR Health analyses show that from 2013 to 2017, 19- to 35-year-old individuals accounted for the highest share of claims for opioid dependence and heroin overdose. Opioid diagnosis-related claims were more concentrated among middle-aged people in rural settings; in urban settings, they were spread more broadly among young and middle-aged people.

Health information management and other professionals can use geographically specific claims data to inform strategic decision making in their own hospitals and health systems, in areas such as treatment protocols, triage policies, expansion, network participation and clinical affiliation relationships.