All PlansAdministrativeMedium impact
20-512 Start with Primary Care to Manage High-Risk Opioid Use
Health Net·CA · Family Medicine, Internal Medicine, Pain Management +1 more·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net California has issued new guidelines for managing high-risk opioid use through primary care, establishing HEDIS quality measures for tracking opioid prescribing patterns. The policy defines specific metrics for monitoring high-dosage opioid use, multiple provider prescriptions, concurrent opioid/benzodiazepine use, and alcohol/drug treatment engagement.
Action Required
Immediately: Clinical staff should review the list of opioids and benzodiazepines specified in the policy to ensure proper documentation for HEDIS reporting. Providers must be aware of the quality measures for opioid prescribing patterns, including tracking patients receiving >120 mg MME dosages and concurrent opioid/benzodiazepine prescriptions. Contact Quality Improvement Department at cqi_dsm@healthnet.com for questions about implementation.