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	James L. Holly, M.D.

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Letters - October 7, 2017 Response to Dr. Lembke’s Helpful Analysis CVS Health and Opioids

October 7, 2017

Dr. Lembke,

Your analysis was very helpful. I totally agree that physicians are unwittingly one of the major causes of the opioid abuse crisis and that if physicians and physician organizations were better at policing themselves, pharmacists would not need to. Thank you for your insight. It is helpful. I do agree that our intents and our commitments to finding a solution are the same

As a result of this discussion about CVS Health, the CDC Primary Guideline’s for Opioid Use and your lectures, I met with our IT staff yesterday and we are deploying a support tool which automatically calculates the Morphine Milligrams Equivalent and prominently display it in several places in our EMR.

All records which exceed 50 MME will be reviewed; all which exceed 90 MME will be referred to a SETMA specialist with special interest in this concern, and those unresponsive will be referred to a Pain Management Specialist.

Thank you, also, for your kind comments about SETMA’s progress (see www.jameslhollymd.com). This section does not relate to opioids specifically but the processes which we have use for the past twenty-two years do relate.

You may find some of it interesting. Of the 55,000 pages of material which we have produced and posted on our website, the following five help explain us.

Process Analysis and Problem Solving - First Delivered at Massachusetts Medical Society

Process Analysis and How Many Tasks Can You Get A Provider to Perform at Each Encounter?

Four Seminal Events From May, 1999 - These Reflect What We Believed and Therefore What we Would Become.

May, 1999 -- Four Seminal Events in SETMA’s History

A Description of SETMA’s Model of Care

SETMA’s Model of Care Patient-Centered Medical Home: The Future of Healthcare Innovation and Change

This Document was Completed For A Real Patient Who Is Not Identified - it is a good example of patient activation, engagement and shared decision making.

Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making - Letter to Patient seen 12.8.2013

A Summation of the First Nine Years of Our Being A PC-MH - What We Know and What We Think

PC-MH: SETMA’s First Nine Years - Continuity, Creativity, Consistency

Sincerely,

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
UT Health San Antonio
Joe R. and Teresa Lozano Long School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

From: Anna Lembke
Date: October 7, 2017
To: "James L. Holly" <jholly@jameslhollymd.com>
CVS Health and Opioids.

Yes of course fine to share with others.

Thank-you for the below. When I have time, I will read the various links.

I think we are basically in agreement, except that I do think that dispensing a smaller quantity of opioids at a time is a potentially useful way to limit the overall numbers of opioids in the community.

I do not think this is necessarily changing the quantity prescribed by the physician, but rather titrating access to that quantity, that limits borrowing from tomorrow to pay for today, a problem that many patients have.

If doctors were better at policing themselves, pharmacist wouldn't have to step in at all.

Sounds like you are making important systemic interventions at STEMA, which puts you way ahead of the curve compared to the rest of the country.

Regards,

Anna

Related Articles

	CVS Health Controlling Dispensing of Opioids Through Caremark - Part I CVS Health Controlling Dispensing of Opioids Through Caremark - Part II CVS Plans to Change Prescriptions without Physician Approval - An Open Letter to CVS’ CEO The Opioid Epidemic: Part I The Problem The Opioid Epidemic: Part II Better Record Keeping The Opioid Epidemic: Part III - Electronic Prescribing of Control Substances The Opioid Epidemic: Part IV - Medication Reconciliation and the Electronic Medication History The Opioid Epidemic: Part V - The Real Surprise in Medication Reconciliation The Opioid Epidemic: Part VII - Public Health and Opioids The Opioid Epidemic: Part VI - Texas Medical Board and the Prescribing of Habituating Medications The Opioid Epidemic: Part VIII - What is the Solution
Related Tutorials

	Tutorial for Individual Provider Assessing Patients Screener and Opioid Assessment for Patients with Pain (SOAPP)
Related Letters

	CDC Checklist for Prescribing Opioids for Chronic Pain, Primary Care Providers Treating Adults 18+ CDC Guideline for Prescribing Opioids for Chronic Pain CVS Health and Opioids - Dr. Lembke’s Question About Pharmacists and Opioids and Dr. Holly’s Response CVS Health Dr. Lembke and Limiting Dispensing of Opioids to a Seven-Day Supply CVS Health Response to Troy Brennan Letter and Health Affairs Blog CVS Health Summary of September and October, 2017 Ten-Part Conversation About Opioids Abuse Letter to 105 Pharmacies in our 5-county Area about CVS and Opioids Summary of Analysis and Recommendations About CVS Health’s Use of Their Pharmacy Benefits Management to Limit Opioid Dispensing Transmission Cover Letter for Final Summary of Analysis of CVS Health CareMark Opioid Plan Transmittal Letter to Final Copy of Analysis of CVS Health’s Opioid Abuse Plan and Why it Should be Rejected

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