Healthcare payer achieves significant cost savings with opioid education program

Both payers and providers can benefit from outreach campaign solutions to improve patient health


Nearly $24 billion USD is spent annually in the U.S. for treating substance abuse disorders, with 21% of those disorders based on opioid addictions i. For many patients, opioid substance abuse can occur following a healthcare procedure where pain medication is prescribed for short-term relief but turns into a lasting problem. Additional issues can include members not being aware when a prescribed medication is an opioid, or the dangers of mixing opioids with other medications or alcohol.

EXL Health’s client, a leading U.S. health insurance company working with thousands of healthcare providers including physicians; pharmacists; and nurses; and connected to patients through provider interactions at hospitals; clinics; and pharmacies; was acutely aware of the ongoing epidemic of opioid abuse and the devastating effects drug addiction can have on its members. The payer was looking for a way to positively influence the behavior of its members most likely to require education about opioids. The payer wanted to communicate targeted content to specific members at specific times, making them aware of the potential for opioid dependency—to help prevent dependency from occurring.

The solution

The healthcare payer, who has a longstanding partnership with EXL Health, wanted to develop a patient journey analytics campaign to send appropriate and timely information to at-risk members who have opioid prescriptions but may require more education about the medication. The goal of the campaign was to intervene with targeted members using effective messages to achieve a high-level of engagement and awareness. The plan partnered with EXL for their data science expertise to analyze, predict and target the payer’s most vulnerable members to be included in this campaign.

EXL Health worked with the payer’s clinical, marketing and content experts to create a pilot program focused on the payer’s Medicaid members throughout the U.S., focusing on the data science component to help the payer better understand member data to determine which patients to target and analyze the campaign’s performance. The program was designed to educate patients about how to use opioids safely while also providing information about alternative pain management solutions. This included developing a model able to predict members with a high likelihood of becoming opioid dependent within 12 months of taking their opioid prescriptions.

The payer developed the big data technology to test and run multiple campaigns at industrial scale and at any given time. Working with the healthcare payer, the team at EXL developed a comprehensive opioid risk profile based on demographics, claims and social determinants of health.

Following the principles of A/B testing in experiment design, the pilot program had some members in the test group who received the necessary communication over the defined channels, while other members in the control group did not. All members were tracked for six months, and the healthcare payer saw significant results both in cost savings and member behavior change:

  • Prevention of ~20% cost per member per year for members targeted by the pilot campaign
  • Member behavioral changes resulting in saving of 2% of the total expected medical cost

The campaign continues to operate with members being analyzed and potentially contacted as soon as they pick up their first opioid prescription.