By Cooper Zelnick, Chief Strategy Officer, Groups Recover Together
In the face of the emerging Covid-19 public health crisis, legislators, regulatory bodies and private companies enacted new policy and formed the types of working coalitions that had not been seen since World War II. Businesses and healthcare providers transitioned nearly overnight to relying on teleconferencing applications and the federal government supercharged a vaccine development program that delivered multiple effective vaccines faster than ever before.
Combatting a deadly pathogen that spreads easily created tremendous urgency and demanded significant resources, but despite our successes – including the vaccines – we have seen worsening outcomes across other disease states over the past eighteen months. Opioid use disorder, a chronic condition directly impacted by loneliness and isolation, not to mention economic uncertainty, has long plagued the United States, and outcomes have worsened markedly since the pandemic began. Amidst rising overdose deaths and growing despair for those struggling with addiction, we have many lessons to learn from our fight against Covid-19 as we continue to combat addiction.
The opioid epidemic is decades old, but a combination of new technology and new policy could reverse some of the devastation wrought by Covid-19 and improve outcomes moving forward. Here are three sensible changes that could get us on the right track:
Expand access to treatment with telehealth
The Department of Health and Human Services adopted a new policy at the onset of the pandemic that allows DEA-registered practitioners to prescribe buprenorphine and other controlled substances used to treat addiction without an in-person consultation between patient and provider. This was a positive step for increasing access to treatment for OUD and allowed countless patients to obtain needed prescriptions for medication-assisted therapy over telehealth. However, the policy was enacted as a temporary measure, only in effect “for the duration of the public health emergency.”
In the days of restrictive lockdowns and social distancing measures, telehealth was essential for treating all patients. But normalizing telehealth services beyond the pandemic will expand access to care for patients in rural areas or “healthcare deserts” that are medically underserved. Modifying existing legislation marks an obvious first step toward that normalization. The Ryan Haight Act of 2008 generally requires prescribers to conduct in-person evaluations before prescribing these life-saving medications, but adjusting the rule to allow providers to e-prescribe buprenorphine more broadly would expedite the start of therapy for patients.
Similarly, The Telehealth Response for E-Prescribing Addiction Therapy Services (TREATS) Act is a bipartisan bill that supports expanding the reach of telehealth in addiction treatment. Passing this new legislation would introduce more flexibility to prescribe medication-assisted therapy virtually and would allow providers to bill Medicare for audio-only telehealth services – a key to reaching rural patients who have limited access to the internet.
At Groups Recover Together, we have found telehealth isn’t just a “nice to have” anymore – patients are demanding it. In a survey, 89% of patients said they felt as or more supported in a telehealth care model. Moreover, Groups saw no degradation in outcomes for patients receiving care exclusively via telehealth – observing no reduction in retention rates and no increase in the percentage of patients testing positive for illicit opioids.
It’s clear that patients want choice in how they consume their care. Congress must act to align telehealth policy with the preferences of patients.
Commit to value-based care
Health systems and independent providers alike are gradually incorporating value-based care initiatives to replace legacy “fee-for-service” models. That’s because reimbursement tied to health outcomes has been shown to reduce costs and drive higher quality care for patients. Unfortunately, addiction treatment providers have not adopted value-based reimbursement models as broadly as general healthcare practitioners. This fact means that most patients continue to receive legacy care, paid for via legacy reimbursement models that are devoid of responsibility for outcomes or quality.
We need more behavioral therapy providers to assume financial risk for their patients’ outcomes. Additionally, payer networks should proactively work with providers on value-based care contracts. Too many providers currently manipulate fee-for-service billing by ordering costly tests and labwork that have little impact on patients’ recoveries. In some states, Medicaid reimburses more for a single urine drug screening than it does for individual or group therapy. Those backwards economics create adverse incentives, worsening a crisis that has brought about a historic spike in deaths over the past year.
If providers and payers all have a role to play in this shift, so too will federal support for value-based care. Medicare and Medicaid cover most insured patients who seek addiction therapy and can shape how addiction treatment is delivered by incentivizing value-based care contracts with providers. Patients on Medicaid in particular face steep challenges in accessing the same quality of care that patients with private insurance enjoy. Closing that disparity would impact a significant number of patients and save the government on spending – as Medicaid paid about a quarter of all spending for substance abuse treatment as recently as 2019.
Cooperation in the face of a challenge
The length and devastation of the opioid epidemic have established it as one of the greatest challenges the U.S. healthcare system has ever faced, but the elements of a plan for more effective treatment already exist. The pandemic forced the issue with telehealth, which proved valuable and effective in a time of need, and it showed the power of timely legislation and public-private coalitions that helped to deliver multiple effective vaccines at lightning speeds. By applying the urgency and coordination of the Covid-19 pandemic response to the opioid epidemic, we can achieve similar results and end a decades-long public health crisis.
Cooper Zelnick is the chief strategy officer for Groups Recover Together, a national health care company for individuals with opioid use disorder.