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Using Analytics to Attack Opioid Abuse

Recently, congressional staff requested a briefing from FICO on how our analytics are tackling the opioid epidemic – an issue that, despite pervasive gridlock in Congress, has become a priority for both Democrats and Republicans. Our experts welcomed the opportunity to share their experiences. We believe that the increased use of analytics can play a pivotal role in confronting this challenge.

Opioids are a class of drugs that include heroin as well as pain medications such as codeine, oxycodone and morphine. In 2014, according to the Centers for Disease Control, more than 28,000 people died from opioids – a number greater than the deaths from traffic accidents that same year. And the opioid problem is getting worse, with increasingly more deaths involving fentanyl and other synthetic opioids.

The House and Senate recently approved a bill addressing the opioid crisis by nearly unanimous votes. Though both parties wanted additional provisions, the compromise bill is a rare showing of bipartisan cooperation during a particularly divisive time on Capitol Hill. The Comprehensive Addiction and Recovery Act of 2016 expands educational resources and strengthens prevention, treatment and recovery efforts by providing medical professionals and law enforcement with more tools to assist people suffering from drug addictions. On July 22, President Obama signed the bill into law.

When congressional staff reached out to FICO, their goal was to learn more about how analytics are being used to combat the opioid crisis. FICO introduced behavioral analytics to combat healthcare fraud more than 15 years ago, leveraging learnings from our success in using analytics to significantly shrink fraud losses in the payment card space. As our experts explained to congressional staff, today our analytics identify and score anomalies associated with opioid fraud, waste and abuse among a full range of stakeholders: pharmacies, prescribers, members and even employees.

FICO also illustrated how we can leverage our link analysis tool to discover true identities of opioid abusers through social network relationships between people, entities and activities. This is especially helpful in scenarios where an individual is “emergency room” shopping for opioids by using false identities.

As our experts imparted, using the right analytics can be a huge part of the solution to this global epidemic. However, there are also disincentives in the system that need to be resolved. For example, payers for self-insured entities, representing 60% of the employer group healthcare market, get compensated for processing transactions, not for identifying fraud, waste and abuse.

Clearly, there is more work to be done. As policy leaders continue to identify the most effective methods for combating the growing opioid problem, we expect the use of analytics will receive even greater emphasis as part of an overall solution.

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