A new study on the rise of remote care during the pandemic affirms the benefits of the treatment approach
By Jason Langendorf
The expansion of telehealth services for people with opioid use disorder (OUD) during the pandemic was associated with better outcomes, including reduced risk of overdoses, according to new research.
Published last week in JAMA Psychiatry, the study found that emergency authorities to expand telehealth use and facilitate access to medication-assisted treatment (MAT) for people with OUD were associated with improved MAT retention and lower rates of medically treated overdoses.
The longitudinal cohort study, led by researchers at the National Center for Injury Prevention and Control, National Institute on Drug Abuse (NIDA) and Centers for Medicare & Medicaid Services (CMS), examined data collected from 175,778 Medicare beneficiaries from September 2018 to February 2021.
“Strategies to increase access to care and [MAT] receipt and retention are urgently needed, and the results of this study add to the growing research documenting the benefits of expanding the use of telehealth services for people with OUD,” said lead author Christopher M. Jones, PharmD, DrPH, acting director of the National Center for Injury Prevention and Control, a division of the Centers for Disease Control and Prevention (CDC). “The findings from this collaborative study also highlight the importance of working across agencies to identify successful approaches to address the escalating overdose crisis.”
An Opening for Telehealth
In January 2020, the U.S. Department of Health and Human Services declared the COVID-19 pandemic to be a public health emergency (PHE), permitting federal agencies to make key regulatory changes—including many around the deployment of telehealth addiction care services. In March 2020, CMS further expanded access to Medicare telehealth under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
By June 2020, CMS was officially engaging health insurers to throw their support behind telehealth services: “As part of the effort to expand telehealth options, we encourage issuers to reduce barriers such as prior authorization and other limits to telehealth services for covered mental health and substance use disorder services. Continued delivery of mental health and substance use disorder services via telehealth, including partial hospitalization services to enrollees in their homes, is critical during this PHE.”
Pre-pandemic utilization of telehealth through employer health plans accounted for less than 1% of outpatient visits, according to research from the Kaiser Family Foundation. Meanwhile at its pandemic peak, between March and August 2020, that number reached 13%.
The result was an explosion in the availability of these remote care services and a rush to use them. Pre-pandemic utilization of telehealth through employer health plans accounted for less than 1% of outpatient visits, according to research from the Kaiser Family Foundation. Meanwhile at its pandemic peak, between March and August 2020, that number reached 13%. Another report, from the nonprofit Fair Health, found that telehealth usage had expanded by more than 7000% across the U.S. in 2020, compared to the year before.
Data analysis from the JAMA study seems to confirm the benefits of telehealth, or at least a strong positive association within a major cohort: Researchers found that a group of Medicare beneficiaries initiating an episode of OUD-related care during the pandemic, when measured against a comparable group initiating care before the pandemic, were more likely to receive OUD-related telehealth services (19.6% compared to 0.6) and more likely to receive MAT (12.6% compared to 10.8).
As many state policymakers enact more permanent changes to telehealth laws, and as influential groups lobby for the permanent relaxation of restrictions at the federal level, a gradual shift in attitudes may be nudging the healthcare and insurance industries in the direction of broadened access and fewer barriers to addiction care services.
No shortage of red tape (as well as a host of other entrenched issues) may still slow progress: According to the Kaiser Family Foundation, “While many continue to envision an expanded role for telehealth in the delivery of care following the pandemic, there remains considerable uncertainty in what services will be available, where and how providers will be able to practice, how benefits will be structured, and how providers will be paid.”
One finding from the JAMA study discovered that some groups were less likely to receive OUD-related telehealth services, including non-Hispanic Black people and those living in the South.
For example, Walmart reportedly has issued a new policy restricting its pharmacies from accepting telehealth prescriptions for controlled substances (including MAT) without an in-person visit in the prior 24 months. The national retail chain, recently found liable for negligence in its past opioid-prescribing practices, is reportedly just one of several pulling back on writing telehealth scripts.
Additionally, one finding from the JAMA study discovered that some groups were less likely to receive OUD-related telehealth services, including non-Hispanic Black people and those living in the South.
“These outcomes,” the researchers write, “underscore the need for future efforts to focus on eliminating the digital divide and reducing underlying inequities in access to care and services.”
Top photo: Greg Rakozy