N.C. Payers Council Report

In 2017, North Carolina launched a comprehensive Opioid Action Plan. As part of the plan, the NC Department of Health and Human Services (NCDHHS) https://www.ncdhhs.gov initiated a Payers Council to enable both private payers to share best practices, align policies, and issue consensus recommendations to positively impact the Opioid epidemic.

According to the report, payers and health plans can play a critical role in mitigating the consequences of the opioid epidemic. Payers have the ability to promote safer prescribing patterns, facilitate non-opioid approaches to pain management through benefit design, address substance use disorder treatment through coverage policies, educate beneficiaries on opioid risks, and develop and track programmatic and policy changes.

The NCDHHS convened the Payers Council that included representatives from Medicare, Medicaid, Military and Veterans Administration, private insurers, pharmacy benefit manager, and workers’ compensation organizations.

In September 2018, the Council released the “North Carolina Payers Council Report” with recommendations to help positively impact the Opioid epidemic. One important area under discussion includes the importance for leveraging data to inform best practices.

Data analysis and surveillance can be used to support a range of activities to include:

  • Analyzing the amount of opioid medication needed for various types of surgeries and make recommendations based on the data
  • Using data sets to include state surveillance data and claims data to identify emerging risk factors in patients
  • Using data to identify patients in need of naloxone co-prescription or updating patient risk scores
  • Doing routine tracking of a set of key evidence-based prescriber indicators to drive quality improvement


There are data sets that can be used for surveillance purposes. These include the National Survey on Drug Use and Health (NSDUH) https://nsduhweb.rti.org/respweb/homepage.cfm, Medicare Part D data, and NC Vital Statistics https://vitalrecords.n.c-gov.

Data available on treatments include the National Survey of Substance Abuse Treatment Services (N-SSATS) https://www.datafiles.samhsa.gov, and the National Mental Health Services Survey (M-MHSS). In addition there is surveillance data on the county level that is available on the NC Opioid Action Plan Data Dashboard. https://injuryfreenc.shinyapps.io/OpioidActionPlan.

https://files.nc.gov/ncdhhs/documents/files/NC-Payers-Council-Report-WEB-FINAL-9.5.18.pdf has the “NC Payers Council Report” (September 2018).

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