Payer Interview Guide

Attachment G. Payer Interview Guide

Form Approve

OMB No: xxxx-xxxx

Exp. Date: xx-xx-xxxx

Public Reporting burden of this collection of information is estimated at 60 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn:  PRA (xxxx-xxxx).

Hello, I’m (NAME) from Abt Global. Thank you for taking the time to speak with me.

As a reminder, in 2022 the Centers for Disease Control and Prevention (CDC) released the Clinical Practice Guideline for Prescribing Opioids for Pain, which provided up to date evidence regarding pain management approaches and emphasizes the need for prescribers to be focused on patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. For shorthand, we call it the 2022 CDC Clinical Practice Guideline throughout this interview.

General Dynamics Information Technology (GDIT) and Abt Global are conducting a research study for the CDC to better understand the adoption and implementation of the 2022 CDC Clinical Practice Guideline on evidence-based care for pain management.

This interview aims to better understand your experiences working as a public or private payers (i.e., Medicaid, Medicare, private health plans providing employer, marketplace, managed care or Medicare Advantage plans) with applying the recommendations from the 2022 CDC Clinical Practice Guideline and the effect on patient outcomes. This study is funded by the CDC.

Before we begin, I want to read a few points about this interview:

• Participating in this interview is voluntary.

• You will receive a $100 virtual gift card for participating in this interview.

• Your answers will not be connected to any information that could individually identify you, such as your name in any internal CDC reports or publicly-facing publications. With your permission, the name of your organization will be included in the acknowledgements in any report or publication; however, we will not attribute our findings to you or your organization explicitly. You can decline to answer any question, without affecting your continued participation in the interview or your relationship with the CDC. There is a small risk of loss of privacy. We have many procedures in place to reduce this risk.

• This interview will last approximately 60 minutes.

We also would like to record the interview, so we do not miss anything. The recording will not be shared with anyone outside Abt Global, GDIT or CDC. We will use this recording to make de-identified transcripts of the recordings, which will be shared with GDIT and CDC. This recording will be deleted once our notes from the interview have been completed. 

Do any of you have any questions before we get started?

Do I have your consent to participate in this interview? Yes _____ No _____

May we record this interview? Yes _____ No _____

RESPONDENT’S ROLE

1. Please describe your title and role at your [organization, company, or agency.]

2. What role does your organization, company, or agency serve in setting coverage policies, formulary management strategies, or other policies related to pain management, opioid prescribing and management, or medications for opioid use disorder?

PROBE: if they only discuss opioid coverage, probe for what policies affect other pain treatments, including coverage of or access to non-opioid therapies such as physical therapy, exercise therapy, or acupuncture, and coverage for expanded visits for chronic pain, etc.

3. Please describe your organization’s formulary management strategies related to pain management, opioids, or medications for opioid use disorder?

PROBE: Do these strategies differ for different programs or lines of business under your organization’s purview (e.g., private payer with MA, Marketplace, Medicaid, and/or employer plans)?

4. Does your organization and/or your insurance plans monitor utilization of nonpharmacologic therapies for pain, in conjunction with pharmacologic therapies or on their own? Please describe.

AWARENESS

SAY: I’m going to ask a few questions about your level of awareness of the 2022 CDC Clinical Practice Guideline and your thoughts on how aware clinicians, health systems, clinical practices, or peer organizations are of the contents of the Guideline.

5. In 2022, the CDC released its 2022 Clinical Practice Guideline for Prescribing Opioids for Pain. How did you learn of the 2022 CDC Clinical Practice Guideline?

6. What is your general sense of the 2022 CDC Clinical Practice Guideline and its recommendations?

7. It’s been about two years since the 2022 CDC Clinical Practice Guideline was released. What’s your sense of the level of awareness amongst relevant individuals at your organization/agency? What about amongst clinicians or health systems?

IMPLEMENTATION SUPPORT [Spend the most time during the interview in this section]

SAY: I’m now going to ask a few questions about YOU and your ORGANIZATION’S role in the adoption or implementation of recommendations from the 2022 CDC Clinical Practice Guideline.

8. How well do you think the 2022 CDC Clinical Practice Guideline aligned with your organization’s existing coverage of pain management strategies (pharmacological and nonpharmacological) and its formulary management strategies for pain treatment, opioids, and/or OUD treatment and referrals?

9. In what ways did your organization update any coverage policies (e.g., change or remove old policies) or create new ones related to pain management and opioids, or formulary management approaches since 2022? Was this a result of the release of the 2022 CDC Clinical Practice Guideline?

• PROBE: Can probe for:

  • …covering nonpharmacologic or nonopioid modalities?

  • …altering formulary management approaches for opioids? (incl. prior authorizations, caps, drug selections, etc.)

  • …creating or administering practices or policies governing opioid prescribing?

  • Other payment incentives, billing codes or billing guidance, mandated or encouraged trainings, or other coverage or incentive policies in line with the recommendations in the guideline.

• If no changes have been made or are planned, why do you think that is?

  • PROBE: current policies/practices were already in line with the 2022 CDC Clinical Practice Guideline

  • Outside agency’s scope

10. Other than to communicate policy or practice changes, have you conducted any communication to clinicians or health systems to encourage more effective utilization of benefits to better align with recommendations in the 2022 CDC Clinical Practice Guideline?

11. What is your sense of how recommendations in the 2022 CDC Clinical Practice Guideline have influenced:

…payers covering nonpharmacologic or nonopioid modalities?

…payers altering formulary management approaches for opioids?

…payers creating or administering practices or policies governing opioid prescribing?

• PROBES: How do you think it is informing payers? How do you think it is being used by health systems? Are these observations in line with what you have seen in your own organization?

12. [Optional question if time] What is your sense of other payers’ awareness of the 2022 CDC Clinical Practice Guideline? Do you know of any specific awareness or outreach campaigns going on, or that already happened, related to the 2022 CDC Clinical Practice Guideline from other organizations?

BARRIERS & FACILITATORS

SAY: Now I’m going to ask a few questions about any challenges or successes you’ve perceived or experienced related to the uptake of the 2022 CDC Clinical Practice Guideline recommendations within your organization/agency.

13. What went well or is going well related to the uptake of the 2022 CDC Clinical Practice Guideline?

14. What if any challenges did your organization face as a result of the 2022 CDC Clinical Practice Guideline release or adoption of any included recommendations?

• PROBES: Conflicted with existing coverage policies, needed to change formulary management practices, feedback/pushback from clinical practices or health systems

• What about amongst clinicians or health systems that your agency/organizations works with?

• Any unintended consequences? If yes, please share some details or examples.

15. From your perspective within your organization, how has the 2022 CDC Clinical Practice Guideline improved or worsened pain management practices across the health care system since its release two years ago?

• PROBES: What specific improvements? What specific shortfalls? Shortfalls that may need attention?
  
  
  

16. Have you seen any changes (positive or negative; intended or unintended) in clinical practice after the release of the 2022 CDC Clinical Practice Guideline that you weren't expecting?

RECOMMENDATIONS OR LESSONS LEARNED

17. Before we conclude today’s interview, is there anything else that you would like to share?

18. You may remember that earlier I indicated that with your permission, the name of your organization can be included in the acknowledgements in any report or publication; however, we will not attribute our findings to you or your organization explicitly. Would you be willing to have us include the name of your organization in the acknowledgements in reports or publications?

If yes: What is the full, formal name of your organization.

19. Are there any questions for us before we wrap up? [Address questions]