Misalignment of Stakeholder Incentives in the Opioid Crisis.

Alireza Boloori,Frederi Viens,Bengt B Arnetz,Taps Maiti,Judith E Arnetz

doi:10.3390/ijerph17207535

Alireza Boloori, Frederi Viens + Show 3 more

Open Access

https://doi.org/10.3390/ijerph17207535

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Abstract

The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

Highlights

From 1999 to 2018, the total number of drug-related deaths in the U.S increased from 16,849 to67,367
Providers and Systems (HCAHPS) survey, which partially rewards healthcare systems and providers when patients score high on pain management experience of care, making providers more inclined towards opioid analgesics [4]; Lack of a comprehensive multi-modal pain management strategy [5]; Barriers in adopting treatments for opioid /substance use disorders [6]; Efforts that have influenced downplaying the negative impacts of opioids, such as marketing by pharmaceutical companies and professional associations promoting opioids [7] or pain being declared as the fifth vital sign [8]; Int
We pursue the following objectives in this review: (1) we evaluate evidence in the extant literature surrounding factors that can potentially cause misalignment among stakeholders by compromising either cost, quality, or access to care in this epidemic and (2) identify efforts and strategies that may contribute to alleviating such misalignments

Summary

Introduction

From 1999 to 2018, the total number of drug-related deaths in the U.S increased from 16,849 to67,367. Opioid analgesics have contributed the most, from 8048 to 46,802, a 481.54%. This dramatic change has contributed to a substantial drop in the average life expectancy in the U.S for consecutive years, among men [2,3]. A myriad of factors have been attributed to the opioid crisis. Providers and Systems (HCAHPS) survey, which partially rewards healthcare systems and providers when patients score high on pain management experience of care, making providers more inclined towards opioid analgesics [4]; Lack of a comprehensive multi-modal pain management strategy [5]; Barriers in adopting treatments for opioid /substance use disorders [6]; Efforts that have influenced downplaying the negative impacts of opioids, such as marketing by pharmaceutical companies and professional associations promoting opioids [7] or pain being declared as the fifth vital sign [8]; Int. J. Public Health 2020, 17, 7535; doi:10.3390/ijerph17207535 www.mdpi.com/journal/ijerph

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