Plan Type and Opioid Prescriptions for Children in Medicaid

Banks, Jordan; Hill, Courtney M.; Donald, L.

doi:10.1097/mlr.0000000000001504

Cited by 7 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, we found that Medicaid patients had higher patient-reported opioid consumption and opioid refill rates over time compared with patients with private insurance or Medicare. This finding is consistent with previous literature highlighting inequities among Medicaid patients related to opioid prescribing and opioid-related morbidity, although these findings may be a proxy for important unmeasured characteristics among Medicaid patients . For example, disability, chronic disease, and surgical morbidity and mortality have historically been higher among Medicaid patients .…”

Section: Discussionsupporting

confidence: 91%

“…This finding is consistent with previous literature highlighting inequities among Medicaid patients related to opioid prescribing and opioid-related morbidity, although these findings may be a proxy for important unmeasured characteristics among Medicaid patients. 23 , 24 , 25 For example, disability, chronic disease, and surgical morbidity and mortality have historically been higher among Medicaid patients. 30 , 38 , 39 , 40 , 41 Medicaid beneficiaries are also more likely to report lower satisfaction and worse pain compared with privately insured patients.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the success of the CQI model, the extent to which gains in health care quality achieved by this model extend across different health insurance payer types is unclear. This is concerning given known discrepancies in opioid prescribing and morbidity across payer types . Furthermore, in Michigan, 38% of individuals are covered by state or federal health insurance plans and 6% are uninsured .…”

Section: Introductionmentioning

confidence: 99%

“…This is concerning given known discrepancies in opioid prescribing and morbidity across payer types. 23 , 24 , 25 Furthermore, in Michigan, 38% of individuals are covered by state or federal health insurance plans and 6% are uninsured. 26 A uniform benefit to all patients regardless of payer type is imperative if CQI models are to be an effective strategy to address the ongoing opioid epidemic.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020

et al. 2023

View full text Add to dashboard Cite

ImportanceCollaborative quality improvement (CQI) models, often supported by private payers, create hospital networks to improve health care delivery. Recently, these systems have focused on opioid stewardship; however, it is unclear whether reduction in postoperative opioid prescribing occurs uniformly across health insurance payer types.ObjectiveTo evaluate the association between insurance payer type, postoperative opioid prescription size, and patient-reported outcomes in a large statewide CQI model.Design, Setting, and ParticipantsThis retrospective cohort study used data from 70 hospitals within the Michigan Surgical Quality Collaborative clinical registry for adult patients (age ≥18 years) undergoing general, colorectal, vascular, or gynecologic surgical procedures between January 1, 2018, and December 31, 2020.ExposureInsurance type, classified as private, Medicare, or Medicaid.Main Outcomes and MeasuresThe primary outcome was postoperative opioid prescription size in milligrams of oral morphine equivalents (OME). Secondary outcomes were patient-reported opioid consumption, refill rate, satisfaction, pain, quality of life, and regret about undergoing surgery.ResultsA total of 40 149 patients (22 921 [57.1%] female; mean [SD] age, 53 [17] years) underwent surgery during the study period. Within this cohort, 23 097 patients (57.5%) had private insurance, 10 667 (26.6%) had Medicare, and 6385 (15.9%) had Medicaid. Unadjusted opioid prescription size decreased for all 3 groups during the study period from 115 to 61 OME for private insurance patients, from 96 to 53 OME for Medicare patients, and from 132 to 65 OME for Medicaid patients. A total of 22 665 patients received a postoperative opioid prescription and had follow-up data for opioid consumption and refill. The rate of opioid consumption was highest among Medicaid patients throughout the study period (16.82 OME [95% CI, 12.57-21.07 OME] greater than among patients with private insurance) but increased the least over time. The odds of refill significantly decreased over time for patients with Medicaid compared with patients with private insurance (odds ratio, 0.93; 95% CI, 0.89-0.98). Adjusted refill rates for private insurance remained between 3.0% and 3.1% over the study period; adjusted refill rates among Medicare and Medicaid patients decreased from 4.7% to 3.1% and 6.5% to 3.4%, respectively, by the end of the study period.Conclusions and RelevanceIn this retrospective cohort study of surgical patients in Michigan from 2018 to 2020, postoperative opioid prescription size decreased across all payer types, and differences between groups narrowed over time. Although funded by private payers, the CQI model appeared to have benefitted patients with Medicare and Medicaid as well.

show abstract

Section: Discussionsupporting

confidence: 91%