Case Study: MO HealthNet reduces opioid overuse with Conduent SmartPA

MO HealthNet - Managing Pain without Opioids

MO HealthNet, Missouri's Medicaid program, faced the significant challenge of reducing opioid prescription misuse and overuse among its participants while still ensuring patients in need retained access to necessary pain therapy. The agency partnered with vendor Conduent to implement strategies to combat this critical issue and decrease overutilization.

Conduent implemented its SmartPA automated prior authorization solution, which used a rules engine to conduct safety checks like cumulative morphine dose editing and prevent doctor shopping. This multi-faceted approach automated clinical reviews, reduced administrative burdens, and facilitated access to alternative pain treatments. The results were substantial, including a 12% reduction in participants receiving opioids and a 25% drop in the quantity prescribed in 2019 alone. Compared to its peak, MO HealthNet saw a 40% decrease in participants receiving opioids and a 65% reduction in overall prescription potency, contributing to a reported 10% drop in opioid overdose deaths in Missouri.

MO HealthNet

Josh Moore

Director of Pharmac