A Window into Texas's Response to the Opioid Crisis

San Antonio Increases over 140,000 Percent in Private Insurance Claim Lines with Opioid-Related Diagnoses from 2007 to 2016

News provided by

FAIR Health

Jun 12, 2017, 11:11 ET

NEW YORK, June 12, 2017 /PRNewswire-USNewswire/ -- Texas's opioid crisis is evident from the increase in private insurance claim lines with opioid-related diagnoses in many parts of the state from 2007 to 2016, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. San Antonio had the largest increase of the areas studied, at 141,022 percent, with Dallas second at 40,562 percent. Accompanying the increases were a variety of healthcare procedures and services designed to deal with the epidemic. In Texas, the five most common procedures associated with opioid-related diagnoses in 2016 were laboratory tests. Notably, the patterns of care and treatments sought in Texas differed from those of other states profiled in the third FAIR Health white paper on the nation's opioid epidemic, Peeling Back the Curtain on Regional Variation in the Opioid Crisis: Spotlight on Five Key Urban Centers and Their Respective States. Drawing on its database of more than 23 billion privately billed healthcare claims, FAIR Health focused on the five states—California, Illinois, New York, Pennsylvania and Texas—where the nation's five most populous cities (Los Angeles, Chicago, New York, Philadelphia and Houston) are located. The results showed substantial regional variation in trending associated with the opioid crisis and the treatments, tests and procedures associated with those receiving opioid-related care.

The Opioid Crisis in Texas, A Study of Private Claims Data

The term "opioid-related diagnoses" referred to four diagnoses: opioid abuse, opioid dependence, heroin overdose and opioid overdose (i.e., overdose of opioids excluding heroin). Opioid dependence is more severe than opioid abuse. By compiling and analyzing the claim lines for healthcare treatment for individuals with these diagnoses, FAIR Health revealed in this white paper the scale and variety of approaches employed to deal with this crisis. Claims provide a strong measure for healthcare statistics because they reflect healthcare usage and their information reflects the assessments of providers, whose training and experience qualify them as judges of health conditions.

Among the findings in Texas, some of which deviate from findings in other states:

In 2016, the number one procedure code in the distribution associated with opioid-related diagnoses was G0479, "Drug test(s), any number of drug classes, not optical." On an aggregate basis, it was also the state's second most costly procedure; another drug test, G0483, "Drug test, definitive, 22+ classes," represented the highest expenditure.
Other common procedures included tests for creatinine and pH, as well as urinalysis, possibly indicating greater use of urinalyses than some other states.
San Antonio and its immediate surrounding areas constituted 5 percent of the population in 2016, but 66 percent of the distribution of claim lines with opioid-related diagnoses in the period 2007-2016.

In San Antonio in the period 2007-2016, claim lines with an opioid overdose diagnosis outnumbered those with a heroin diagnosis by 90 percent to 10 percent.

Dallas, at 5 percent of the population in 2016, constituted 23 percent of the distribution of claim lines with opioid-related diagnoses in the period 2007-2016.

For the full white paper, click here. See also the infographic below.

About FAIR Health
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation's largest collection of healthcare claims data, which includes a repository of over 23 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics, episodes of care analytics and market indices—to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has earned HITRUST CSF and Service Organization Controls (SOC 2) certifications by meeting the rigorous data security standards of those organizations. As a testament to FAIR Health's data security and validation protocols, its data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish and as an English/Spanish mobile app, which enable consumers to estimate and plan their healthcare expenditures and offer a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Elisabeth Rosenthal's new book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.

Contact:
Dean Sicoli
Executive Director of Communications and Public Relations
FAIR Health
646-664-1645
[email protected]

SOURCE FAIR Health