LIVINGSTON OPIOID INITIATIVE
On August 24, 2026, at 6:00 PM, the Livingston County Board of Commissioners will vote on a resolution establishing a revolutionary health care program focused on preventing opioid use disorder before it starts, rather than treating addiction after the fact. The ultimate intent of this proactive initiative is to save lives and improve health outcomes for community members—benefiting all of Livingston County, not just county government—by ensuring local opioid prescribers have access to state-of-the-art prescribing protocols that greatly reduce the risk of addiction. Crucially, the program is funded by Opioid Settlement Funds—billions of dollars paid by opioid manufacturers, distributors, and pharmacies to settle lawsuits regarding their role in the epidemic—meaning no local tax dollars will be used. Community members can participate and share input by attending in person at 304 E. Grand River, Howell, MI 48843, or by joining the meeting online via the Livingston County Board of Commissioners Meeting Portal.
The 4-minute video below provides an overview of the program. For a fuller understanding of this unique program read the Frequently Asked Questions after viewing the video.
Livingston County Workforce Clinical Protection Initiative
Frequently Asked Questions
1. How does the program protect employee privacy and comply with HIPAA?
HIPAA permits health plans to use protected health information for health care operations, including quality improvement, population-based activities designed to improve health or reduce healthcare costs, case management, and care coordination. See 45 CFR §§164.501 and 164.506.
A health plan may also contract with an outside organization—known under HIPAA as a business associate—to perform functions such as claims analysis, data analysis, case management, and care coordination. The organization must operate under a Business Associate Agreement and comply with applicable HIPAA privacy and security safeguards. See 45 CFR §§164.502(e), 164.504(e), and HHS guidance on business associates.
For employer-sponsored health plans, 45 CFR §164.504(f) specifically governs when protected health information may be disclosed to an employer or plan sponsor and how it may be used. Protected health information may not be disclosed to or used by the plan sponsor for employment-related actions or decisions.
This does not mean Livingston County receives employees’ private medical information or can look through employees’ medical records.
Any patient-level claims information used for analysis and clinical outreach remains within the HIPAA-regulated health plan and business-associate environment. Direct employee identifiers may be removed or replaced with a code during the analytical process while relevant prescribing information is retained. When a concerning clinical pattern is identified, the authorized clinical team may communicate the information permitted and necessary for the treating practice to identify the appropriate patient, evaluate the concern, and make its own clinical decisions.
The important distinction is that individual employee medical information is not provided to Livingston County. The clinical interaction occurs within the healthcare environment, while the County receives aggregate reporting about program performance.
The health plan can use its claims information to protect its members without turning employees’ private medical information over to their employer.
2. Why are opioid-settlement dollars appropriate for this program?
Because prevention of inappropriate opioid prescribing is explicitly contemplated by the national opioid settlement agreements, and this program closely follows several of the specific remediation strategies identified in those agreements.
Michigan’s Attorney General has instructed local governments receiving settlement dollars to use those funds for opioid remediation consistent with the national settlement agreements and Exhibit E — List of Opioid Remediation Uses.
Exhibit E does not limit settlement spending to addiction treatment, naloxone, or recovery services. It specifically includes prevention.
Under Part Two — Prevention, Exhibit E expressly identifies:
“Prevent Over-Prescribing and Ensure Appropriate Prescribing and Dispensing of Opioids.”
Examples of approved strategies include:
- Medical-provider education and outreach regarding best opioid-prescribing practices
- Training healthcare providers regarding safe and responsible opioid prescribing
- Improving clinical decision-making surrounding opioid prescribing
- Using data and surveillance to identify patients at risk
- Monitoring prescribing practices and improving opioid stewardship
Exhibit E also recognizes monitoring, surveillance, data collection, and evaluation of opioid-abatement strategies as appropriate uses of settlement funds.
Those provisions closely describe what this initiative does.
The program uses existing health-plan claims information to identify concerning clinical patterns associated with prolonged opioid exposure, clinically reviews those findings, conducts peer-to-peer outreach with treating prescribers, provides evidence-based prescribing information, and measures clinical and financial outcomes over time.
Michigan’s 2026 Settlement Guidance
The Michigan Attorney General has emphasized that opioid-settlement dollars must be used for opioid remediation and that local governments should direct these resources toward qualifying future remediation activities.
This program is prospective. The County is not using settlement dollars to reimburse itself for ordinary healthcare expenses. It is investing those dollars in an opioid-prevention intervention designed to reduce future opioid-related harm.
The approach also aligns with the Johns Hopkins principles for opioid-settlement spending, which emphasize:
- Spend the money to save lives
- Use evidence to guide spending
- Invest in prevention
- Consider equity and community impact
- Use a fair and transparent process and measure results
The County will have baseline data, quarterly analysis, clinical outcomes, prescribing outcomes, and healthcare-utilization data with which to evaluate its investment.
Why does prevention matter?
Much of our response to the opioid crisis necessarily addresses harm that has already occurred—treatment, recovery, naloxone, emergency services, and other essential programs.
We absolutely need those programs.
But the settlement agreements themselves recognize that remediation should also include preventing the problem from occurring in the first place.
Think of a flooded basement:
We need the pumps, fans, mold remediation, and restoration. But if we never fix the leak, the basement keeps flooding.
Appropriate prescribing, early identification of clinical risk, physician education, and measurable prevention are ways of addressing the leak.
Using opioid-settlement dollars to prevent avoidable opioid dependency before it occurs is consistent with the prevention and responsible-prescribing strategies contemplated by the settlements.
3. Is Livingston County going to see which employees are taking opioids?
No. The County does not receive a list of employees taking opioids or information identifying individual employees as being at risk.
The program operates within the health-plan and clinical environment. Individual clinical information is used only as permitted under applicable privacy requirements.
Reporting to Livingston County is aggregate.
4. Is the County going to be tracking employees’ prescriptions?
No. This is not an employee-surveillance program.
The County’s health plan already generates claims information whenever covered members receive healthcare or fill prescriptions. The program analyzes that existing information for clinically meaningful patterns associated with potentially dangerous opioid prescribing.
The purpose is clinical protection—not employee monitoring.
5. What does Michigan’s MAPS prescription-monitoring system require, and what are its limitations?
MAPS—the Michigan Automated Prescription System—is Michigan’s Prescription Drug Monitoring Program (PDPM). It is an important patient-safety tool that gives prescribers access to a patient’s controlled-substance prescription history.
Under Michigan law, before prescribing or dispensing a Schedule 2–5 controlled substance in a quantity exceeding a 3-day supply, the licensed prescriber must obtain and review a MAPS report concerning that patient. See MCL 333.7303a.
The law requires the prescriber to obtain and review the report. It does not require a separate narrative note documenting what the prescriber concluded from that review.
Michigan guidance permits MAPS information to be documented or retained in the medical record, but that is different from a statutory requirement for a written clinical assessment of the MAPS findings.
The process can also be delegated. A registered MAPS delegate—such as a nurse or other authorized office staff member—may retrieve the report on behalf of the prescriber. The prescribing clinician remains responsible for reviewing the information when required.
What does MAPS show?
MAPS provides controlled-substance prescribing and dispensing information. It can help clinicians recognize important warning signs such as:
- Multiple controlled-substance prescriptions
- Multiple prescribers or pharmacies
- Overlapping controlled substances
- Early or frequent prescription activity
- Increasing opioid exposure
- Patterns suggesting misuse, diversion, or “doctor shopping”
MAPS has been valuable. Michigan reported that opioid prescriptions dispensed declined 15% from 2017 to 2018, while total opioid morphine milligram equivalents dispensed declined 21.2% during a period of rapidly increasing MAPS participation and other opioid-prescribing reforms.
Those reductions cannot be attributed to MAPS alone, but they demonstrate the substantial change that occurred in Michigan prescribing during this period.
What doesn’t MAPS tell the clinician?
MAPS is fundamentally a controlled-substance prescription-history database. It does not provide a complete picture of the patient’s care over time across all doctors, hospitals, pharmacies, and other healthcare settings.
For example, it does not independently determine whether a patient who appropriately began opioids after surgery or an injury is developing early physiologic dependency, withdrawal symptoms, or related downstream healthcare utilization.
Those early manifestations may be nonspecific—such as nausea, anxiety, insomnia, or other symptoms—and may generate additional physician visits, medications, urgent-care encounters, or other healthcare utilization before more recognizable behavioral signs of opioid misuse or addiction appear. The program materials describe the ability to recognize these earlier physiologic patterns before later behavioral indicators become apparent.
A patient could therefore have one prescriber, one pharmacy, no early refills, no doctor shopping, and no obvious MAPS red flags, yet still progress toward prolonged opioid use or physiologic dependency.
MAPS is an important prescribing safeguard. But it is a prescription-monitoring database—not a comprehensive clinical surveillance system for detecting the earliest physiologic and healthcare-utilization consequences of prolonged opioid exposure.
6. Doesn’t Michigan’s 7-day opioid prescription limit already solve this problem?
No. Michigan’s 7-day law is an important safeguard, but it does not mean opioid therapy automatically ends after seven days.
Michigan law limits a prescriber treating acute pain to no more than a 7-day supply of an opioid within a 7-day period. The limitation does not apply to chronic pain.
If a patient continues to report pain, additional evaluation and treatment may occur. That can mean another physician encounter, urgent-care visit, or other healthcare utilization—and potentially continued opioid exposure.
This is one of the fundamental challenges of opioid prescribing:
When should an opioid that was appropriately started for acute pain actually be stopped?
A 7-day prescribing limit controls the quantity prescribed during a particular period. It does not guarantee that opioid therapy ends after seven days.
7. Will this program prevent an employee from receiving an opioid when one is medically appropriate?
No.
The program does not change the County’s health benefits, formulary, deductibles, copays, physician network, or access to medications.
It does not deny prescriptions or restrict access to any form of pain treatment. Treatment decisions remain entirely between the patient and the treating physician.
When a potentially dangerous pattern is identified, the treating prescriber is provided with objective clinical information and evidence-based prescribing guidance.
The treating physician remains responsible for the patient’s care and makes the ultimate clinical decision.
Opioids remain important and appropriate medications for many patients. The objective is appropriate prescribing and early identification of avoidable clinical risk—not eliminating opioids.
8. Does this interfere with the physician-patient relationship?
The intention is the opposite—to strengthen it.
Healthcare is increasingly fragmented. A physician treating one episode of care may not have the complete picture of prescriptions, procedures, diagnoses, medications, or care occurring elsewhere.
The technology was developed by reverse-engineering clinical patterns associated with opioid dependency. Its AI-enabled analysis looks for patterns in claims and prescription information that may indicate emerging physiologic dependency up to approximately five months before more recognizable behavioral signs of addiction appear.
When a concerning pattern is identified, the information is clinically reviewed, and the treating prescriber can be provided with objective information to help guide care.
The program gives the treating clinician additional clinical context that may otherwise be unavailable.
It is essentially a clinical safety check—a “check engine light” for the health plan.
The physician evaluates that information in the context of the individual patient and determines the appropriate course of care.
9. How much will the program cost?
The current projected first-year cost for Livingston County is approximately $75,000, based upon the expected number of members meeting the program’s clinical criteria.
The fee is based on identified at-risk members rather than charging every covered member.
10. How do you know the program will save money?
The primary objective is preventing harm. However, inappropriate or prolonged opioid use can also generate substantial downstream healthcare costs through additional physician visits, emergency care, hospitalizations, medications, disability, and other healthcare utilization.
We are not asking Livingston County to rely on theory alone. Previous implementations have demonstrated substantial reductions in both clinical risk and healthcare spending.
One 10,000-member health plan reported $2.28 million in reduced health-plan spending over 12 months, together with a 75% reduction in members identified with high-risk opioid prescribing and a 56% reduction in average health-plan cost among those members.
A Florida school district implementation reported approximately $1.45 million in reduced health-plan spending, along with a 60.4% reduction in members incurring unnecessary costs associated with opioid overprescribing. The case study also reported reductions in emergency visits, physician visits, and hospitalizations.
Livingston County’s preliminary analysis identified 52 members with clinical indicators associated with prolonged opioid exposure and estimated approximately $770,000 in associated financial impact and targeted potential savings of approximately $578,000.
Those Livingston County figures are projections—not guaranteed savings.
For that reason, we have used a substantially more conservative expectation when discussing the potential financial return:
Approximately $3 in potential healthcare savings for every $1 invested.
Most importantly, Livingston County will be able to measure its own results rather than relying indefinitely on projections or outcomes achieved elsewhere.
11. How will Livingston County know whether the program is working?
The results will be measured and reported quarterly.
This is not a program where the County invests settlement dollars and simply assumes that it is working. The program uses ongoing claims surveillance to establish a baseline and then measures what happens following clinical intervention.
Each quarter, the program will evaluate and report aggregate results, including:
- Prescriber acceptance of clinical recommendations
- Changes in the number of members identified with high-risk opioid-prescribing patterns
- Changes in associated healthcare utilization
- Changes in overall health-plan costs
- Financial savings and return on investment
Because claims analysis is ongoing, the program can determine whether identified clinical risks are actually declining and whether those improvements are translating into lower healthcare utilization and costs.
Individual employee medical information is not reported to the County. Commissioners and County administrators receive aggregate clinical and financial results that allow them to evaluate the program objectively.
The process is straightforward:
Establish the baseline → Identify risk → Intervene clinically → Measure outcomes → Report quarterly → Continue to monitor
If the program does not produce the expected clinical and financial results, the data will show that as well.
Ultimately, Livingston County will be able to judge the initiative based on what actually happens in its own employee population and its own health plan—not simply on projections or results achieved elsewhere.
Evidence Supporting the Financial and Clinical Estimates
This program has been in the commercial market for over 4 years. It is installed in over 1700 health plans in 40 states and impacting over 1 million employees and their dependents.
Prior 10,000-Member Health Plan
After 12 months, the case study reported:
- 75% reduction in members identified with high-risk opioid prescribing
- 56% reduction in average health-plan cost per identified high-risk member
- 99% prescriber reception/adoption of best-practice prescribing recommendations
- $2.28 million in reduced health-plan spending
Florida School District
The case study reported:
- 60.4% reduction in members incurring unnecessary costs associated with opioid overprescribing
- 37% reduction in emergency visits
- 41% reduction in physician visits
- 39% reduction in hospitalizations
- 98% provider conformance
- Approximately $1.45 million in reduced health-plan spending
Livingston County Preliminary Analysis
The preliminary analysis identified 52 members with extended opioid exposure and specified clinical indicators.
It estimated:
$770,000 in associated financial impact
$578,000 in targeted potential savings
These are projections, not guaranteed outcomes.
The analysis also projects approximately 4–6 future cases of opioid use disorder could potentially be prevented annually, depending upon duration of exposure and individual risk profiles.
Bottom Line
This initiative does not change employees’ health benefits, restrict access to any form of pain treatment, or give Livingston County access to individual employees’ medical information.
It uses information the health plan already generates to identify clinical risk that might otherwise go unseen, brings relevant information back into the healthcare system, and leaves the ultimate treatment decision with the treating physician.
It also gives Livingston County something particularly important when investing opioid-settlement dollars:
measurable accountability.
Every quarter, the County can evaluate whether high-risk prescribing is declining, whether physicians are responding to clinical recommendations, whether healthcare utilization is changing, and whether the health plan is saving money.
Identify risk earlier. Support physicians. Prevent harm. Measure the results.
4-minute video about this program