MedicaidAdministrativeLow impact
20-513 Start with Primary Care to Manage High-Risk-Opioid Use
Health Net·CA · Family Medicine, Internal Medicine, Pain Management +2 more·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net California released new quality measures and resources for managing high-risk opioid use, focusing on HEDIS reporting requirements for opioid dosages, multiple provider usage, and concurrent benzodiazepine use. This is primarily informational guidance to help providers improve quality scores rather than a billing requirement change.
Action Required
Review quality measures for opioid prescribing patterns to improve HEDIS scores. Providers should familiarize themselves with high-risk opioid criteria (MME >120mg, multiple providers/pharmacies, concurrent benzodiazepine use) and utilize provided resources for better patient management. Contact Quality Improvement Department at cqi_dsm@healthnet.com for questions.