Association for Public Policy Analysis & Management

The President has called on the Federal government to “address factors fueling the opioid crisis, including over-prescription, illicit drug supplies, and insufficient access to evidence-based treatment, primary prevention, and recovery support services.” The Office of Evaluation Sciences (OES) at the General Services Administration (GSA) is applying its skills and expertise to combat the national opioid crisis by building a body of actionable evidence in partnership with the Defense Health Agency (DHA) and the Centers for Medicare and Medicaid Services (CMS). OES supports GSA’s Office of Government-wide Policy’s mission to “use policies, evidence, and analysis to help agencies drive efficiency, savings, and improved mission performance.”

OES is working within existing CMS and DHA programs to build evidence on cost-effective tools to reduce off-guideline prescribing of opioids. In these partnerships, OES brings expertise on promising evidence-based interventions and works with agency partners to implement rigorous, rapid field trials to quickly learn what works.

Defense Health Agency: Reducing Opioid/Benzodiazepine Co-Prescriptions - The Military Health System (MHS) Opioid Registry is a national database which aims to predict whether a patient is an at-risk opioid user and proactively monitor patient and physician prescribing behavior. In a randomized controlled trial in collaboration with MHS, OES will test interventions to reduce concurrent prescribing of opioids and benzodiazepines. The interventions focus on how to reduce co-prescribing of multiple drugs, possibly by multiple prescribers. The study will measure the impact of two different notifications on tapering or cessation of opioids, benzodiazepines, or both; and concurrent days of opioids and benzodiazepines.

Centers for Medicare & Medicaid (CMS): Reducing Over-Prescribing - CMS’s Center for Program Integrity (CPI) collaborated with OES to develop a series of letter interventions that informed high prescribers how their prescribing deviates from that of their peers. In the first round, CPI and OES sent letters to high prescribers of Schedule II controlled substances comparing their prescribing to that of their peers; this intervention did not detectably change prescribing habits. In the second round, CPI and OES sent a series of letters to high prescribers of quetiapine comparing their prescribing to that of their peers, stating that their prescribing was under review, and describing the consequences of medically unjustified prescribing. This intervention reduced the volume of prescribing and improved the guideline conformity of prescription fills: on-guideline patients obtained prescriptions for quetiapine from other prescribers, whereas off-guideline patients did not.

This presentation will highlight these two examples as ways Federal agencies are working together to build evidence in an area of critical need. The presentation will describe OES’ process for working with agencies to support evidence-building activities, including defining research questions, developing an evaluation design, implementing the study, and providing ongoing technical assistance. This presentation will highlight another important model of how Federal agencies can and do work together to develop evidence.