The statistics are staggering: More than 70,000 people died in the U.S. in 2017 from drug overdoses, and emergency department (ED) visits for opioid overdoses rose 30 percent in all parts of the U.S. from July 2016 to September 2017.1
The lesser-known story is what happens to those who survive an overdose… the individuals who are at highest risk for a subsequent fatal overdose.
The emotional aftereffects of an overdose—guilt, anger and anxiety—are often compounded by the lack of resources and assistance survivors may find upon returning to the responsibilities of daily life.
Aetna’s Guardian Angel program works to close this gap, using claims data to identify members who have recently been admitted to the ED following a non-fatal opioid-related overdose. Once a member is identified, a clinician who specializes in addiction recovery calls the member to connect him or her with evidence-based treatment and provide education on community support and resources.
Finding a Path to Recovery
“The care delivered in an ED is really focused on ensuring that you remain alive,” said Jeff Balek, LCPC, CADC, clinical team lead for the program, noting that most post-revival ED stays only last about four to six hours. “Patients who survive an overdose then often receive messages from providers asking why they’re harming themselves in this way and urging them to stop. However, they aren’t typically given actionable information about obtaining treatment. Having a near-death experience is incredibly traumatic, and survivors and their families need help.”
That’s where the Guardian Angels come in. Launched in 2018 as a pilot, the program grew out of a call-to-action after Aetna claims data revealed hundreds of ED visits each month related to opioid-related overdoses. Today, this unique program has connected with and helped more than 600 members and their families to find a pathway out of opioid addiction and toward lasting recovery.
“Our data revealed that there were significant gaps in care for many members who had survived an overdose. We noticed patients would be treated in the ED and discharged with minimal ongoing support,” said Daniel Knecht, M.D., vice president of health strategy and innovation for Aetna, a CVS Health company. “We felt this was a critical opportunity to step in with support to help our members heal at a vulnerable time during which they may be most receptive to accepting help.”
Although first responders and ED personnel often use Narcan (naloxone) to reverse an overdose, the antidote is just the first step of a long journey to recovery, Knecht noted. Through the Guardian Angel program, Aetna works with its provider partners to ensure members have access to coordinated, longitudinal care as well.
The program is part of a three-pronged strategy Aetna launched in 2016 to provide better prevention, intervention and support for members struggling with opioid use disorder (OUD). The Angels’ clinical expertise in substance use dependency and the personal connections they make with members differentiate the program.
A Safe Space to Connect
“A key piece of our success is the active outreach Angels do. Often, they make up to eight calls just to be able to connect with the member,” said Jennifer Johnson, senior director of program management, adding that the program has a high engagement rate of around 50 percent. “This program is designed to allow us to build trust and let members know we’re supporting them.”
Guardian Angel Ramona Zarate, LCPC, CADC, shared that she uses her clinical judgment to assess how ready a member is to begin the process of recovery. “Talking about substance use is difficult,” she said. “It’s important to give the person a safe space to discuss their experiences, their fears and their hopes for the future.”
Zarate added that if a member is willing and motivated to get treatment, the Guardian Angels then focus on finding in-network providers who offer medication-assisted treatment (MAT), educating on appropriate alternatives to opioids for pain management and even scheduling provider appointments.
The success of the Guardian Angel program hinges on meeting members where they are in their battle with addiction and readiness for recovery, according to Balek.
“I am interested in establishing a relationship with this person and humanizing his or her experience,” he said. “If someone is in distress, I’m going to be right there to empathize with what’s causing stress. Eventually, we’ll get to the ‘why’ behind the opioid use. And that’s where the real healing can begin.”
The outreaches have helped hundreds of members to be treated with MAT, reconnect with family members, get jobs, live independently and reclaim their lives.
Despite the successes, Balek notes that tremendous progress remains in tackling the stigma people with OUD often face. “When I reach out to someone, my focus is on finding a way to connect with the person behind the label,” he said. “As a society, we need to remember that these are good people who just need a helping hand… and this program will go a long way toward chipping away at this mountain of a problem our country is facing.”
Editor’s note: Aetna’s parent company CVS Health also has made an enterprise-wide commitment to help address prescription OUD by designing programs to increase access to safe medication disposal, encourage appropriate utilization, educate patients and communities, expand access to life-saving overdose reversal agents, and support local recovery programs. For more information, click here.