California’s opioid crisis is evident from a statewide increase in private insurance claim lines with an opioid dependence diagnosis of over 24,000 percent from 2007 to 2016, with an even greater increase of almost 32,000 percent in claim lines with opioid-related diagnoses in southern California, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Accompanying these increases were a variety of healthcare procedures and services designed to deal with the epidemic.
In California, the most common procedures in 2016 were outpatient services and drug tests. Notably, the patterns of care and treatments sought in California 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 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 reveals 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 California, some of which deviate from findings in other states:
- In 2016, the number one procedure code by distribution and by expenditure (on an aggregate basis) associated with opioid-related diagnoses was HCPCS code H0015, “alcohol and/or drug services; intensive outpatient.” It made up 32 percent of the distribution of top five codes and 34 percent of the top five expenditures.
- In 2016, codes for drug tests and partial hospitalization lasting less than 24 hours made up the rest of the distribution of top five codes and the top five expenditures.
- Claim lines associated with the four opioid-related diagnoses all grew in California from 2007 to 2016, but at different rates:
- Opioid dependence—24,515 percent
- Heroin overdose—1,950 percent
- Opioid abuse—1,582 percent
- Opioid overdose—462 percent
- Claim lines with opioid-related diagnoses increased from 2007 to 2016 in all six California regions (Bay Area, Central Coast, Inland Empire, northern California, San Joaquin Valley and southern California). But the greatest increase was in southern California (including Los Angeles), where the increase was 31,897 percent—more than five times as great as the next largest increase. The increase in the other five regions was:
- Inland Empire—5,773 percent
- San Joaquin Valley—4,098 percent
- Bay Area—1,309 percent
- Northern California—887 percent
- Central Coast—353 percent
- Claim lines with opioid dependence outnumbered opioid abuse lines by 97 percent to 3 percent in the period 2007-2016.
- Claim lines with opioid overdose outnumbered heroin overdose lines by 55 percent to 45 percent in the period 2007-2016.
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.