Table 1.

Primary Care Clinic Characteristics and Examples of Opioid Improvement Efforts

StateClinic TypeLocationPayer MixExample Opioid ImprovementBuilding Block(s)
PAFQHC, nurse-ledUrban4% MedicareChronic pain group therapy4,5
58% Medicaid
14% commercial
23% uninsured
WVFQHC, AHECRural17% MedicareChronic pain group visits1,2,3
25% MedicaidPain registry
22% commercialChronic opioid prescribing policy and pathway
30% uninsured
SCFQHCRural32% MedicaidStandard care plans2,3,4
12% MedicarePatient agreements
15% OtherIn house physical therapy
40% uninsuredSuboxone
ORFQHC, residencyUrban20% MedicareChronic pain group visit2,3,4
50% MedicaidIn-house CAM therapy
0% commercialRevised policies
30% uninsuredRandom urine drug tests
Patient agreements
28-day refills
NHMMGRural45% MedicarePatient agreements2,5
2% MedicaidOpioid QI team
50% commercialRevised policies
3% uninsured
WAMMGRural, Suburban20% MedicareChronic pain re-design team2,4
9% MedicaidSuboxone
61.5% commercialPain registry
9.5% uninsuredPatient agreements
Random urine drug screens
Workflow for refills
MAMMGSuburban23% MedicarePatient agreements2,3,4
5% MedicaidRevised clinic policies
70% commercialSuboxone
2% uninsuredChronic pain group visits
Random urine drug screens
NMFQHCFrontier/ Rural28% MedicaidChronic pain group visits3,4
30% commercialBehavioral health integration on teams
19% MedicareMental health “first aid” training for staff
17% Sliding FeeSuboxone
6% self pay
COFQHCRural47% Sliding ScaleRevised policies2
17% MedicaidRoutine PDMP check with refills
15% MedicarePatient agreements
18% commercial dentalNo refills on Fridays
MEMMGSuburban35% MedicareRegistry with chronic pain manager2,3,4
4.4% Medicaid
45% commercialChronic pain group visits
5.4% uninsuredRevised policies
COMMGUrban, Suburban, Frontier/ Rural20% MedicarePatient agreements2,3,4
21% MedicaidPre-visit preparation in daily huddle
50% commercialRandom urine drug test
9% self-payTrack PEG scores and PHQ-9
OHFQHCUrban50% MedicaidRandom urine drug test2,3,4
20% uninsuredState PDMP check with refills
20% commercialClinic refill policies
10% Medicare
PAPVTSuburban90% commercialPatient agreements2
8% MedicareRevised policies
1% uninsured
1% Medicaid
MEFQHC, residencySuburban26% MedicareProvider support and learning group2,4
25% Medicaid
40% commercialSuboxone
9% uninsuredRevised policies
WAMMG, residencySuburban10% MedicareChronic pain registry with dedicated MA registry manager1,2,3,4
50% MedicaidRevised policies
30% commercialPatient agreement
10% uninsuredNurse intake for new patients on opioids
Random urine drug test
State PDMP check
PEG scores
Referral for high risk
WIMMGRural17.7% MedicarePatient agreement2
5.5% MedicareRevised refill policies
73.8% commercial
3% uninsured
MACHC (hospital network)Urban40% PublicPhysical therapy assistant2,4
40% uninsuredChronic pain group visits led by social worker
20% private
DCFQHCUrban63% MedicaidChronic pain group visits4
6% MedicareMassage therapy
20% DC Alliance
6% commercial
5% uninsured
NYAHC, residencyUrban10% MedicareRevised clinic policies2,4
50% MedicaidPatient agreements
30% commercialBehavioral Health Social Worker
8% uninsured
CAFQHCRural50% MedicaidChronic pain group visits2,3,4
17% MedicareRevised clinic policies
3% commercialPre-visit planning in daily huddle
28% uninsuredPatient agreements
  • Abbreviations: AHC, Academic Health Center; AHEC, Area Health Education Center; CHC, community health center; FQHC, Federally Qualified Health Center; MMG, Multi-specialty Medical Group or part of large system; PVT, Private Practice; RHC, Rural Health Centerl THC, Teaching Health Center.