Quality improvement program
The Opioid Prescribing Improvement Program’s quality improvement initiative works with health care providers who prescribe opioids above specific thresholds outlined in the sentinel opioid prescribing measures to people enrolled in Minnesota's Medicaid and MinnesotaCare programs.The quality improvement work supports the program’s overall goal to:
- Prevent the progression from opioid use for acute pain to chronic opioid use
- Reduce variation in opioid prescribing behavior among peers
- Clarify best practices of opioid prescribing to ensure patient safety while providing appropriate pain management.
Participation in the quality improvement program will be based on the data provided in the DHS opioid prescribing reports. The one-page reports compare providers’ opioid prescribing to the average of their specialty group. DHS will release the first set of reports in summer 2019. Sign up to get your opioid prescribing reports electronically.
The quality improvement program will begin in summer 2020, following the release of the follow-up set of opioid prescribing reports.
Providers who must participate in the quality improvement program will need to submit a quality improvement plan to DHS for review. The Opioid Prescribing Work Group, members of the medical community and DHS are developing a list of key activities that must be included in the plan. Additional information will be available as the program progresses.The intent is to have providers develop a plan consistent with existing efforts at their clinic or health system. DHS will use external reviewers to review the quality improvement plans.
DHS will provide assistance and resources (e.g., templates) to providers who participate in the quality improvement program. DHS will monitor progress over time using administrative claims data.
Special cause exemption
Providers may request special cause exemption from the quality improvement program based on specific criteria. DHS, the Opioid Prescribing Work Group and partners in the medical community are currently developing the special cause exemption criteria and process.
Criteria under consideration for special cause exemption include the proportion of a provider’s patient panel with chronic pain or with very severe, acute pain of extended duration (e.g., burn victims, major orthopedic surgical procedures).
Disenrollment from program
State law (Minn. Stat. § 256B.0638) permits DHS to terminate providers who do not demonstrate improvement in opioid prescribing behavior over time. The disenrollment thresholds will differ from the quality improvement thresholds and will consider additional factors such as time and degree of improvement. DHS does not anticipate that disenrollment related to this program will begin until 2021, at the earliest. DHS will work with providers before disenrollment, and providers will be given due process before termination. DHS does not anticipate that disenrollment related to this program will begin until 2021 at the earliest. DHS will work with providers before disenrollment, and providers will be given due process before termination.