Telehealth is poised to make a meaningful difference in many segments of the healthcare delivery system. It shows special promise to benefit patients, families and providers for treatment of substance use disorder (SUD), including opioid addiction.
The devastating impact of the opioid crisis in the United States is well-documented:
According to a new report from America’s Health Insurance Plans (AHIP), “Strategies to Expand the Capacity for Substance Use Disorder Treatment,” opportunities exist for health plans and others to improve care by encouraging team-based care, coordinating care, facilitating assistance for clinicians offering treatment and leveraging technology including telehealth. AHIP notes, “telehealth is increasingly becoming an option to augment capacity, support remote interaction between individuals and clinicians, improve convenience and efficiency, and potentially reduce stigma.”
Addressing Provider Shortages
A primary barrier to treatment is the national shortage of qualified clinicians: 49 states have a SUD provider shortage. This includes providers certified to administer medication-assisted therapy (MAT). There are only about 60,000 such professionals across the country.
These shortages are expected to grow worse. By 2025, the Health Resources and Services Administration (HRSA) projects “significant deficits in the supply of counselors, mental health and substance abuse social workers” and the entire continuum of behavioral care professionals.
But, SUD treatment programs offering telemedicine options can improve capacity by allowing providers to schedule more appointments and reach more patients without geographic limits. It can also enhance the continuity of provider-to-provider and provider-to-patient interactions.
According to a physician discussant cited in the Using Telehealth to Support Opioid Use Disorder Issue Brief prepared by the Assistant Secretary of Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (HHS):
“If you read about the [opioid] epidemic, every national and state organization talks about improving access. I think telehealth is a simple way to do it… Also, you can use it to train and do consultations with physicians that may not feel as comfortable with MAT. That’s huge for expanding access.”
Promoting Convenience and Efficiency
Residents of rural areas often find it difficult to access care without nearby facilities and/or the right providers. Valuable time and money may be required to travel to appointments, take time off work and arrange child care.
According to the AHIP report, we can “expand convenient and efficient access” through technology. Specifically, “health insurance providers can continue to expand use of telehealth to enable patients to meet remotely with a waivered clinician, counselor, or clinical social worker. Patients can be e-prescribed a MAT medication, and his or her care can be managed remotely by the waivered clinician, breaking down geographic barriers and providing easier access to care for the patient, while also potentially enhancing provider efficiency.”
Allowing patients to receive care from home and providers to practice from any location, benefits all.
Overcoming Treatment Stigma
For some, seeking treatment for SUD or other mental health issues carries a stigma that may prevent them from seeking needed care. Telehealth provides the option of virtual visits with a SUD specialist in the privacy and comfort of home or another private location. By offering treatment options in a virtual care environment, opportunities exist to reach patients who otherwise would avoid seeking care due to the stigma.
Reimbursement for telehealth services under Medicare-Fee-For-Service and Medicare Advantage (MA) Plans has improved with the relaxation of some restrictions related to geography and type of service, and the creation of new payment codes for telehealth and remote patient monitoring. This follows a report on Medicare Telehealth by the Centers for Medicare and Medicaid (CMS) that identified barriers to use and opportunities for improvement.
For example, regulations effective July 1, 2019 will allow Medicare payment for Opioid Treatment Programs (OTP) and other SUD services provided to Medicare beneficiaries at home and residing in non-rural areas.
Still, reimbursement issues continue to create challenges: a key finding from the 2018 ASPE report states “financing and sustainability influence which services organizations chose to implement. One of the key challenges of using telehealth…is financing for ongoing delivery and sustainability.”
Encouraging Medicaid Coverage
CMS sees enormous opportunities for state Medicaid programs to address the opioid crisis using telehealth. Guidance documents encourage state program directors and providers to use telehealth to “leverage Medicaid funding for opioid abuse treatment.” They suggest telehealth could be used for:
How effective telehealth is in treating people with substance use issues will be evaluated moving forward. The SUPPORT for Patients and Communities Act (PL 115-271) requires a report on the issue from HHS within five years.
Clearly, public awareness about the opioid crises and growing over-does rates is significantly greater than it was than just a few years ago. Other good news is that public policymakers are more frequently focusing on telehealth as a way to address the epidemic.
As part of this process, CHQI’s Telemedicine Accreditation Program, along with its under development Remote Patient Monitoring Accreditation Program, can help standardize and promote best practices as telehealth opportunities continue to be authorized and funded.