1. 1 Background and Framing: The Impact of the Opioid Crisis Christie L. Hager, JD, MPH Senior VP of Client Partnerships - New England June 16, 2016

2. 2 Beacon Health Options Overview Helping people live their lives to the fullest potential Largest MBHO, serving more than 50 million members 14.5 million EAP lives in the US & 6 million Global EAP members in over 200 different countries Serving 347 clients Boston Corporate Headquarters & more than 70 US & 3 UK locations More than 5,000 employees committed to high-quality BH care & service to others 3.4 million calls answered in 2015 18.4 million BH claims paid in 2015 with 74% auto-adjudicated Clinical first answer model for all Crewmember calls 30+ years of experience in Behavioral Health BH Provider Network of 100,000 clinicians Serving more than 8.5 million military personnel, federal civilians & their loved ones Serving 45 of the Fortune 500 companies Award-winning Achieve Solutions Crewmember Portal for EAP & BH- related Topics IT system in use since 1989, with 99% uptime in 2015 Beacon clients received the EASNA Corporate award for 9 out of the last 11 years

3. Massachusetts and New England Footprint 3 GeographyHighlightsClient Base Massachusetts Expansive Coverage: 1.8M covered lives Tenured Presence: 17+ years risk partner State Direct Relationship: MA city/state employees Innovator: “REACH” program for commercial BCBSMA population Broader New England Market NH: 75,000 lives covered ME: Built network for ME Co-Op CT: Manage 100% Medicaid Members for Behavioral Health Partnership RI: Responsible for 65% of all BH expenditures across Rhode Island

4. 4  Drug Misuse is taking a medication in a manner other than prescribed. The person is not likely not looking “get high” from use.  Drug abuse is intentionally taking a drug to produce euphoria. Using a drug without a prescription Exceeding a recommended dose  Drug diversion is best defined as the diversion of licit drugs for illicit purpose. It is diverting drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary. Source: US Food and Drug Administration. Combating misuse and abuse of prescription drugs: Q&A with Michael Klein, PhD www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM220434.pdfwww.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM220434.pdf July 2010 Definitions

5. What Are Opioids? 5 Opioid painkillers include:  Morphine (e.g., Kadian, Avinza)  Oxycodone (e.g., OxyContin, Percocet)  Hydrocodone (e.g., Vicodin)  Similar medicines, such as codeine.

6. Pain Management 6  People may think opioids are the best way to treat pain, but we know other, non-addictive medicines are just as effective.  Alternative approaches to pain management include:  Lifestyle adjustments  Behavioral therapy  Acupuncture  Massage

7. Why Employers Should Care 7  Reduced quality of work Cost to employers is around $26 billion per year, or about $200 per FTE Safety issues  Health issues  Workers’ comp costs Use of opioids after an injury:  Increases medical costs  Delays return to work  Doubles the risk of permanent disability

8. Opioid Crisis in America: Key Findings 8 PRESCRIPTIONS One out of every three (32%) opioid prescriptions is being abused. MEDICAL SPENDING Opioid abusers cost employers nearly 2 times as much in health care expenses on average than non-abusers. AGE Baby boomers are 4 times more likely to abuse opioids than Millennials. BEHAVIORAL HEALTH Patients with a behavioral health diagnosis of any kind are 3 times more likely to abuse opioids than those without one. PAIN Opioid abusers have 2 times as many pain-related conditions as non- abusers. The top 4 pain-related conditions for Opioid misuse are: neck, back, abdominal, and joint. Research on opioid abuse in the workplace provides employers with a more accurate picture of the extent and depth of this ongoing crisis: Source: American Society of Addiction Medicine; CDC; Castlight Health analysis of de-identified medical and prescription claims from 2011 to 2015 across demographic categories and 2015 annual medical health care spending

9. Opioid Crisis in America: Key Findings (cont.) 9 INCOME Individuals living in America’s lowest-income areas are 2 times as likely to abuse opioids as those living in the highest income areas. GEOGRAPHY Opioid abusers are more likely to live in the rural South than in other regions. ECONOMIC COST The cost of opioid misuse to the U.S. economy is $56 billion. HUMAN TOLL There are 16,000 overdose deaths from prescription opioids per year. Source: American Society of Addiction Medicine; CDC; Castlight Health analysis of de-identified medical and prescription claims from 2011 to 2015 across demographic categories and 2015 annual medical health care spending

10. Massachusetts Data 10

11. 11 Massachusetts Data (cont.)

12. Beacon published a white paper in 2015 addressing the crisis of opioid addiction. 12 Opioid Addiction: A chronic illness should be treated through a chronic illness model  Medication-Assisted Therapy (MAT) is an essential evidence-based therapy –Reduces all-cause mortality –Effective as part of a holistic addiction treatment program  There are six essential elements of the chronic care model –Community-based treatment and resources –Health care organization –Self-management support –Delivery-system design –Decision support –Clinical information systems

13. Medication-Assisted Treatment (MAT) is highly effective at reducing the risk of relapse 13  Opioid agonist therapy (OAT) is associated with lower monthly expenditures and lower relapse risk. Clark R, Baxter J, Aweh G, O’Connell E, Fisher W, Barton, B. 2015. Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. Journal of Substance Abuse Treatment. 57: 75-80 2015 Massachusetts study (Medicaid specific)

14. Medications used in treatment of opioid dependency 14

15. MAT is only one part of an effective treatment program – other types of care help ensure engagement and adherence. 15  Medication-Assisted Treatment (MAT) is an evidence-based treatment for opioid addiction; however, it is not a stand-alone treatment choice.  MAT is very effective as part of a holistic, evidence-based treatment program that includes behavioral, cognitive, and other recovery- oriented interventions, treatment agreements, urine toxicology screens and utilization of Prescription Drug Monitoring Programs (PDMPs).

16. Clinical strategy to improve education and treatment models 16 Detox MAT initiation Early engagement Maintenance Education and prevention Treatment Help members, providers, and partners understand condition and reduce stigma Identify people at risk and intervene early Promote evidence-based clinical practice Prioritize accessible, community-based treatment Improve access and adherence to medication-assisted treatment Address inconsistent care pathways by smoothing care transitions Improve community tenure and care longevity by increasing member participation

17. Easily accessible information for patients and other impacted individuals Beacon Health Options Opioid webpage 11 OPIOID TREATMENT WEBPAGE Create an online compendium of resources for those impacted by opioid addiction Recently launched website with information for members, families, and loved ones Contains information regarding priority topics, such as: ‒ The national opioid epidemic ‒ Educational materials ‒ Treatment options and resources Health plans and corporations can link directly to the Beacon page from their websites. Objective Overview Implications

18. Resources 18  Beacon Health Options White Paper - Confronting the Crisis of Opioid Addiction  Accompanying blog on the opioid crisis: www.beaconlens.comwww.beaconlens.com  Additional support: Article: “Behavioral Therapies for Heroin Addiction” - https://www.achievesolutions.net/achievesolutions/en/bho/Content.do?contentId=407 https://www.achievesolutions.net/achievesolutions/en/bho/Content.do?contentId=407 Article: “Opioids” - https://www.achievesolutions.net/achievesolutions/en/bho/Content.do?contentId=7034 https://www.achievesolutions.net/achievesolutions/en/bho/Content.do?contentId=7034 Article: “Evidence for the Efficacy of Pain Medications,” National Safety Council Recording of last fall’s client summit, “Pain Pills Are Hurting Your Business: What You Can Do” http://healthandperformancesolutions.net/summit%20info/Pain_Meds/pain_meds.html http://healthandperformancesolutions.net/summit%20info/Pain_Meds/pain_meds.html

19. 19 Thank you For questions and additional information Christie L. Hager, JD, MPH Senior Vice President, New England Region, National Client Partnerships Christie.Hager@beaconhealthoptions.com 617-476-1629