In a Society of Actuaries report, authored by Milliman, the total economic cost of the opioid crisis was estimated to exceed $631 billion from 2015 to 2018. Much of this cost was borne by employers, many of which offer health and disability benefits that individuals with opioid use disorder (OUD) rely on.
Within this estimate, lost productivity costs due to absenteeism and decreases in labor force participation resulting from nonmedical opioid use were found to total at least $79 billion from 2015 to 2018. Excess healthcare costs for commercially insured patients affected by OUD, a large portion of which are borne by employers, totaled $67 billion over the same period. When considering other types of opioid crisis-related costs that are more difficult to measure, the total cost may be substantially higher.
Did you know that the risk for suicide attempts and intentional self-harm is highest on Mondays and lowest on Saturdays? Or that there’s a threefold difference in risk between the lowest-risk and highest-risk states? As increasing rates of suicide have become a growing concern in the United States, Milliman’s consultants and researchers are working to leverage our expertise and data resources to help address this important issue. This blog post provides a preview of coming research from Milliman that will highlight some of the statistics regarding suicide attempts and intentional self-harm. Using large national research databases capturing administrative claims data for over 70 million Americans, we are able to shed light on the variation in risk of suicide attempts and intentional self-harm by age, sex, state, day of the week, and other features.1 Below are some of our early findings:
and sex. We observed the
highest rates of suicide attempts and intentional self-harm occurring between
ages 15 to 18 for both males and females. The risk for males was highest at age
17 (19.9 individuals per 10,000 population), while the risk for females was
significantly higher and peaked at age 16 (54.7 individuals per 10,000
of the week. We
observed higher rates of suicide attempts and intentional self-harm occurring
on Mondays as compared to other days of the week.
By state. We found that the rates of suicide attempts and intentional self-harm were lowest in California (4.2 individuals per 10,000 population) and the highest in Utah (13.2 individuals per 10,000 population).
While research indicates there is no single cause for the substantial increase in suicide rates since 2000, contributing factors may include:
Periods of stress or a lack of sense of security
Increased use of social media
Access to firearms
Better identification and reporting of attempts
Although the United States has faced continual increases in suicide attempt rates, other nations have made strides to alter this deadly curve. For example, Denmark’s rate fell from one of the highest in the world in the 1980s to one of the lowest in high-income nations by 2007 through a series of initiatives, including restricted access to more dangerous methods of suicide,2 increased capacity in outpatient treatments, and implementation of suicide prevention clinics, which offer counseling, therapy, and support to those at risk. Our research databases allow us to explore characteristics of suicide attempts and intentional self-harm that are not readily captured in many public data sources. Stay tuned for our full report, which will contain further details on the incidence and seasonality of suicide attempts and intentional self-harm, including details by age and sex, geography, insurance payer type, and changes over time, as well as further details regarding the specific categories of self-harm captured in our data, and the risks for repeated suicide attempts or intentional self-harm after an initial event. We hope that this information will be helpful to those working to address this important public health crisis.
1Milliman conducted an analysis of nonfatal suicide attempts in 2017 Milliman Consolidated Health Cost GuidelinesTM Sources Database and IBM Watson Health MarketScan Commercial Claims and Encounters Database, collectively representing over 70,000,000 lives. 2Dangerous methods of suicide may include (but are not limited to) firearms, certain prescription drugs, and harmful chemicals or household gases.
The state of Colorado has implemented integrated behavioral
healthcare in primary care medical settings under a Centers for Medicare and
Medicaid Services State Innovation Model Award. This program includes about 325
primary care practices across the state and four community mental health
centers where physical healthcare is being integrated into the mental health
A key challenge of this initiative is the financial
sustainability of the integrated care practices after the federal support ends.
In this paper, Milliman’s Steve Melek, Katie Matthews, and Ally Weaver present a payment model that they believe would support the sustainability of integrated care practices while also helping payers to control healthcare costs. They look first at commercial payer spending on primary care and outpatient behavioral services and then examine the costs of building and maintaining an integrated primary care practice from the providers’ perspective.
They build their integrated primary care practice using a
“teamlet” approach. Their design also addresses the primary care physician
shortage by adding a nurse practitioner and physician assistant to the
integrated primary care practice. It includes medical assistants and licensed
practical nurses to complete the medical team.
Opioid use disorder (OUD) may have added $10.8 billion to
the cost of treating commercially insured patients across the United States in
2016. Many patients with OUD have complex healthcare needs, contributing to
their significant healthcare costs.
Excess costs for individuals with OUD and comorbid chronic
medical conditions represent a significant value opportunity for potential
reductions through targeted treatment strategies. Previous Milliman studies
have found that most of the excess healthcare costs for patients with
behavioral and chronic comorbidities result from increased medical treatment
rather than directly from higher utilization of behavioral services. A new analysis
by Milliman actuaries found a similar result for patients with OUD: over half
of the excess costs for these comorbid patients were spent on physical
Although the OUD and long-term opioid user population make
up only 1.5% of the total population, they account for over 80% of the total
opioid spent among the commercially insured population in the U.S. The
remaining 98.5% of the population accounts for only 20% of the prescription
Due to the complexity of health status for patients with OUD and elevated opioid use, there is no simple treatment solution that works for all patients. In this paper, Milliman’s Katie Matthews and Ally Weaver discuss in more detail items to be considered when it comes to OUD, including costs, utilization, and comorbidities.
Congress is close to voting on a bill that, if passed, seeks to address the opioid crisis in the United States. The bipartisan bill includes legislation aimed at combating the public health epidemic, from strengthening efforts to stop illegal drug trafficking to expanding access to treatment and prevention programs. According to research from the Kaiser Family Foundation, 66% of all overdose deaths in the United States are related to opioids.
Consultants and actuaries at Milliman have recently published two articles exploring opioid use disorder data in the United States. The first focused on the scale of the opioid epidemic within the insurance industry. The second examined opioid prescription drug patterns in diagnosed and non-diagnosed opioid use disorder populations. The following infographic illustrates key findings from Milliman’s latest research.
Over 25 million American adults report suffering from chronic pain on a daily basis, and a range of adverse health outcomes accompanies their pain. Beginning in the early 2000s, opioid analgesics were increasingly seen as a solution to the problem of under-treatment that had been a concern in the 1990s. From 1991 to 2011, the number of opioid prescriptions filled at U.S. retail pharmacies nearly tripled, increasing from 76 million to 219 million per year, though those numbers have started to decrease since the peak in 2011.
Despite the recent decrease in prescriptions of opioids, the human toll of the opioid crisis has continued to intensify. Illegally acquired heroin and synthetic opioids such as fentanyl have become the leading cause of overdose deaths. Opioid overdose deaths are now the single largest factor slowing the growth in U.S. life expectancy, and if current trends continue, opioid overdose deaths could outnumber suicides by 2019.
Based on a sample of over 42 million people with commercial insurance, nearly 1.3 million Medicare beneficiaries, and a Kaiser Family Foundation analysis of Medicaid beneficiaries in 49 states, we estimate that over 1.5 million insured Americans were diagnosed with an opioid use disorder in 2015 (the most recent year available). Figures 3 and 4 summarize these findings by payer. These results (and others presented throughout this report) have been age- and area-adjusted to be representative of the U.S. insured population as of 2015 using U.S. Census Bureau data.12
Figure 3: Diagnosed opioid use disorder by payer, 2015 (or most recent year)
We found that about 41.4% of those with diagnosed opioid use disorder were commercially insured, 15.9% were Medicare beneficiaries, and 42.7% were Medicaid beneficiaries. Overall, the diagnosed prevalence rate of opioid use disorder was 3.28 per 1,000 for the commercially insured, 5.39 per 1,000 for those with Medicare, and 8.90 per 1,000 for those with Medicaid. Across all insurance payers, we found that the prevalence of opioid use disorder was 4.91 per 1,000.
Figure 4: National estimates of opioid use disorder diagnosis by payer, 2015 (or most recent year)
Diagnosed prevalence per 1,000
Total diagnosed nationally No. (%)
The authors also highlight the rate of opioid use disorder by age and sex.
Rates of opioid use disorder varied widely by age and sex, with men generally experiencing higher rates of opioid use disorder through age 65, and women experiencing higher rates from 66 and older. Rates were quite low through childhood, followed by a marked increase in the late teen years, peaking in the mid-20s at a rate of 5.47 per 1,000 for women (at age 24) and 10.00 per 1,000 for men (at age 25). Rates showed a sharp drop-off in the late 20s, followed by a rise to another peak in the mid-30s of about 3.76 per 1,000 for women (at age 35) and 6.37 per 1,000 for men (at age 36). From the late 30s through age 64, the gap between men and women closed and both experienced prevalence rates hovering between 3.50 to 4.00 per 1,000 through retirement age. Opioid use disorder rates for Medicare beneficiaries were generally higher for women than for men, and tapered off with advancing age. Comparable data for Medicaid were not available.
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