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Putting Gainwell’s Opioid Research to Action for Medicaid Populations

doctors problem solving in front of a computer

Medicaid members often experience more and different barriers to care than individuals with commercial health insurance. Unfortunately, a lack of data has made it difficult to understand the challenges facing Medicaid populations. Federal government databases, for example, are of limited use since their information is often several years old.

To attack this problem head-on, Gainwell Technologies has partnered with academic researchers through the Digital Health Cooperative Research Centre, as well as other initiatives. Thanks to its advanced research platform and access to de-identified Medicaid claims, the company has a one-of-a-kind data asset. According to Dr. Gary Call, Gainwell’s chief medical officer, “We want to collaborate with universities and participate in projects that will support new approaches to care. That’s the goal of all our research.”

Data Holds the Key to Proactive Treatment of Chronic Opioid Use

To support a recent study focused on prescribing practices and opioid use disorder, Gainwell provided Stanford University with a unique research database containing millions of de-identified Medicaid claims from six states. Of these, Stanford selected 180,000 relevant claims to use in their study. 

The goal of this study was to develop analytic models that use claims data to predict whether opioid-naïve patients in the Medicaid population would progress from acute to chronic opioid use. Researchers discovered that 29.9% of these individuals developed chronic opioid use. In addition, the risk of progression from acute to chronic usage increased as the tablet quantity and the days’ supply increased.

Gainwell sees an opportunity to incorporate these findings into models and predictive risk scores for patients. “The goal is to look into the future and identify who may be at higher risk for chronic opioid use disorders and then use that information to tailor interventions for those individuals,” Call explained.

By integrating predictive risk scores into care management platforms, case managers and program directors can develop outreach and education for patients, providers and prescribers. If people at high risk of chronic opioid risk have been authorized for surgery, for example, case managers can educate them about the proper use of opioids for post-surgical pain management and what to do if they have concerns. Case managers may also want to reach out to prescribers and ask them to modify their prescribing practices based on patient risks.

“Many clinicians still prescribe opioids by habit when perhaps they aren’t needed, or they prescribe too many pills. One of the key findings in Stanford’s research was the strength of the initial prescription and its duration,” Call said.

Given the severity of the opioid crisis in the United States, more research is needed. Opportunities exist for analyzing other Medicaid populations, such as individuals with a history of substance use disorders. This could identify the factors that influence who has access to treatment and whether they stay on treatment programs. Call also noted, “If you can get enough data, it could guide Medicaid policy around prescribing of opioids and increasing access to effective treatments for substance use disorders, based on who’s at greatest risk.”

Outreach Opportunities Based on Patient Risk Go Beyond Opioid Use

Although opioids are a major focus area for Gainwell’s research initiatives, the company is also taking a closer look at social determinants of health and hospital readmissions, among others, to develop data-driven solutions.

Gainwell recently worked with the University of Canberra in Australia, for example, on a geospatial mapping project which analyzed whether diabetic patients had access to nutritious food sources. The researchers mapped where high-risk patients lived, considering social determinant barriers like food deserts, and then overlaid the two data sets.

In the area of hospital readmissions, Gainwell has initiated projects with Southern Methodist University to identify risk factors for people with specific conditions like diabetes, congestive heart failure or COPD.

“If we have a patient with a higher risk of hospital readmission, we want to reach out to them and ensure they get appropriate discharge instructions and perhaps a more rigorous care transition program. Although we can’t do that for all patients due to the expense, it makes sense for individuals who are high-risk,” Call said.


Today, opioid usage, social determinants of health and hospital readmissions are high priorities for Gainwell’s research agenda. Looking ahead, however, the company has many more ideas for using its data to support innovative approaches to healthcare.

“We try to focus on areas that are directly translatable from research to action. In many cases, academic research sits on a shelf after it’s done. It may be published in a journal, but it can take years before it’s used in healthcare. Our goal is to shorten the time between research and when insights are put into practice to positively impact patients’ lives,” Call said.