OHA halts chronic pain proposal review amid issues
Oregon Health Authority Director Patrick Allen on Thursday asked a key policy committee to table review of proposed changes in Medicaid benefits for Oregon Health Plan members with chronic pain so the agency could seek independent review of the recommendation, after potential conflicts of interest surfaced on the part of a contracted medical expert involved in formulating the proposal.
In recent days, agency leaders said, they became aware the contracted expert is receiving compensation for her role in a long-term study on the effects of previous changes relating to back pain benefits for OHP members.
In response to this new information, Allen released the following statement:
Objectivity, integrity and transparency are the foundation of Oregon’s unique health evidence review process. This week I received information that a medical consultant to the Health Evidence Review Commission (HERC) is a paid researcher on a study evaluating the impact of back pain benefit changes previously authorized by the HERC. As a result, I have requested the HERC to remove a chronic pain management proposal from today’s agenda to allow OHA time to seek independent review to ensure no potential conflicts of interest compromised the way the chronic pain benefit proposal was developed for the HERC’s consideration. In addition, I’ve asked Dr. Dana Hargunani, OHA’s chief medical officer, to conduct a top-to-bottom review of the conflict of interest disclosure process for all staff, contractors and members associated with the HERC.
It is vital for the Oregon Health Plan to cover safe and effective therapies to help people reduce and manage chronic pain. Yet it is also vital that Oregonians have full confidence in the decisions the HERC makes to assess the effectiveness of health care procedures. The independent review will ensure the HERC can consider this proposal knowing that the outcome fully upholds the committee’s long-standing commitment to making decisions that are based on the best available scientific evidence and the highest ethical standards.
The Health Evidence Review Commission (and its Value-based Benefits Subcommittee) was scheduled Thursday to deliberate on a proposal that would have allowed coverage of pain management benefits for people on OHP suffering chronic pain from five conditions: chronic pain due to trauma, other chronic procedural pain, other chronic pain, chronic pain syndrome, and fibromyalgia. None of these conditions are currently covered by OHP.
The proposal would have expanded access to prescription opioids for four of these conditions. In addition, it would have added coverage for alternative therapies such as acupuncture, physical therapy and cognitive behavioral therapy. In addition, the proposal would cover supportive, individualized opioid tapers if the patient has fibromyalgia or their opioid prescribing is not aligned with the statewide opioid prescribing guidelines.
Dr. Catherine Livingston is a family medicine physician who serves as a contracted medical consultant to the HERC. In addition, she is a co-investigator on two studies evaluating the impact of HERC’s previous decision to expand pain management coverage for people suffering from back pain.
Dr. Livingston serves as a paid consultant for the Patient-Centered Outcomes Research Institute (PCORI), in collaboration with the Kaiser Center for Health Research and OCHIN, which is a three-year large-scale study that compares the impact of Oregon’s back pain benefits in its Medicaid program to benefits for back pain in California.
She is also a paid co-investigator for a study funded by the National Institute of Drug Abuse (NIDA), in which she has teamed with researchers from Oregon Health & Science University and Health Insight to examine the impact of Oregon’s back pain policy changes.
These studies were not under HERC consideration at Thursday’s scheduled vote on the chronic pain benefit recommendation.
About the HERC
The Health Evidence Review Commission reviews medical evidence in order to prioritize health spending in the Oregon Health Plan and to promote evidence-based medical practice statewide through comparative effectiveness reports, including coverage guidances and multisector interventions, health technology assessments and evidence-based practice guidelines.
The commission consists of 13 governor-appointed and senate-confirmed volunteer members including five physician representatives (one of whom must be a doctor of osteopathy and another a hospital representative), a dentist, a public health nurse, a behavioral health representative, a provider of complementary and alternative medicine, a retail pharmacist, an insurance industry representative and two consumer representatives.
