The Peterson Health Technology Institute released a report on virtual solutions for opioid use disorder that found companies prescribing medications for OUD virtually are an effective substitute for in-person care, though they don’t meaningfully expand access to care.
Along with companies that prescribe medications for opioid use disorder (MOUD) virtually, the PHTI also assessed digital wraparound services, which health plans and employers use to support people with OUD outside of the walls of a provider’s office.
The PHTI evaluated 16 companies, 13 of which participated in the review process. The companies that prescribed MOUD included Bicycle Health, Ophelia, Workit Health, Boulder Care, Eleanor Care and Pelago, among others. The digital wraparound solutions included CHESS Health, DynamiCare Health, Q2i and WEconnect Health.
The PHTI found that both the virtual MOUD prescribing services and the digital wraparound services to in-person MOUD prescribing slightly increased treatment retention for patients. The virtual prescribing companies—most of which also offer therapy, peer support and at-home drug testing—can effectively substitute for in-person care, PHTI found.
“The medication-focused solutions, because they're getting paid comparably with other care providers, and they can be substituted, they don't add any cost to the system,” Caroline Pearson, executive director of the PHTI, explained to Fierce Healthcare. “They work equally well or a little bit better. They are recommended for broader adoption. The digital wraparound solutions, even though they do provide some incremental benefit, if payers or public health agencies are paying extra for them, those clinical benefits may not be worth the price of the solution.”
The report comes as the Drug Enforcement Administration (DEA) is deciding how to regulate the online prescribing of controlled substances like buprenorphine. Since the start of the pandemic, the federal government relaxed virtual prescribing, but it has yet to finalize rules for the future of online prescribing.
Pearson said the positive findings of the report suggest the DEA should allow virtual prescribing of buprenorphine.
However, the virtual MOUD companies have more work to do in increasing nationwide access to MOUD and retaining patients on treatment regimens, Pearson said in an interview.
“Based on the available literature and company-reported data, there is currently no indication that virtual solutions are reaching a disproportionate share of new-to-treatment patients or materially expanding overall access to MOUD.”
The companies are treating a similar mix of people who had previously received treatment with in-person providers, the report's analysis found.
The weighted average of retention of patients in treatment is about 13 more days in treatment at the six-month follow-up mark. Virtual MOUD providers saw patients for about 150 days on average compared to 137 days for in-person providers.
“The good news is that MOUD care translates quite well to a virtual delivery,” Pearson said. “But we see only small improvements in treatment retention, which is the primary outcome of interest, because that's really what predicts people's ability to stay in recovery and protects against overdose.”
The virtual MOUD solutions saved roughly $400 per patient across commercial payers, Medicare and Medicaid.
Telehealth companies tout the ability of their solutions to reach more patients who lack specialists in their area or fear the stigma of seeing a provider in person. While telehealth may still increase access in some areas, the virtual MOUD companies’ access statistics reflect the national average of in-person providers, Pearson said. The companies aren’t increasing access for individuals that have never received treatment.
Currently, there is no silver bullet for increasing access or retention, but it's an issue the industry needs to work on, Pearson noted.
“We need new ways to go outside of the app and to pull people into treatment,” Pearson said. “It's not all about removing barriers to care. It's about convincing people that they should pursue treatment and helping them understand what options are available to them. There's just more work to do on that front.”