Telehealth emerges as critical weapon for public health officials combating the opioid epidemic
This past October, the U.S. passed a package of bills focused on confronting the nation’s opioid epidemic. Collectively known as the SUPPORT for Patients and Communities Act, the legislation contains a number of legal and regulatory tweaks designed to make addiction treatment more accessible. Among them is a new focus on telehealth, which will make it easier for Medicare and Medicaid beneficiaries to avail themselves of telehealth services.
Specifically, the new legislation will remove geographic restrictions that previously limited access to telehealth for patients in many locations and – eventually – it will bring some much-needed clarity to the process of prescribing controlled substances via telehealth.
The move is part of a trend toward broader patient adoption of telehealth services and wider acceptance among healthcare payers – notably Medicare and Medicaid – to incorporate telehealth into the patient care mix.
This evolution presents a tremendous opportunity for public health officials to start leveraging new strategies to intervene earlier and treat some of the most elusive at-risk populations, such as teens and adolescents and those living in rural areas without access to more conventional in-person health services. But it does not mean it’s going to be easy. With many of the specific details of how the telehealth components of the SUPPORT for Patients and Communities Act will be implemented still being sorted, and many healthcare providers still unaware of reimbursement options for telehealth services a great deal of marketplace education still needs to take place.
Based on our work with CMS at the federal level, state Medicaid agencies, private health plans and providers throughout the country, we have been able to identify some critical best practices that will ensure that public health officials are able to extract the most value from these newly expanded virtual care provisions.
Following are some of the core building blocks:
- Overall Awareness Levels Still Very Low: One of the key components of the new opioid legislation is the removal of many of the geographic barriers to telehealth adoption. Previously, different rules applied on a state-by-state basis depending on factors such as the originating site where a patient is located, what type of treatment is being provided, and even the very definition of telehealth. While those geographic barriers are now removed, there is still going to be a lingering concern about complexity among providers who have experimented with telehealth only to struggle to be reimbursed. What’s more, a recent survey found that 67 percent of physicians and health IT leaders were still not aware that they could be reimbursed for telehealth services regardless of the patient’s location. Provider education will be critical to advancing the use of telehealth services to combat the opioid epidemic.
- Quality Measures Will Be Essential: One of the driving forces behind the opioid epidemic is the fact that only 10% of those in need of treatment for opioid dependence actually seek help, and we can infer that barriers to care ranging from geographic to socioeconomic to personal shame all play a factor. Telehealth, with its focus on easy, on-demand access, anonymity, and remote monitoring capabilities, is tailor made to address those hurdles, but the ability to drive new adoption of the technology will be contingent on proving progress. Quality measures that identify cost, quality and utilization opportunities, spot patterns in utilization and gaps in care, and track prescribing and dispensing practices of providers and their impact on outcomes will be core to any successful telehealth initiative.
- Beware Data Silos: The telehealth vendor marketplace is growing rapidly, with new innovations such video capabilities, integration between various hospital medication-assisted treatment programs, and other capabilities expanding by the day. Population health professionals need to stay mindful of the scalability and interoperability of these technologies as they are deployed. Data that is stored in multiple silos with little to no consistency in quality, standardization or integration will be of little use once telehealth initiatives expand beyond a single institution level.
- Watch for Clarity on Prescriptions: One important piece of the new legislation that is still unresolved is the treatment of prescription of controlled substances via telemedicine. Previously, this process was governed by the Ryan Haight Online Pharmacy Act of 2009, which laid out a special registration process by which telehealth providers could prescribe controlled substances via telemedicine when legitimately necessary. The new law specifies that the Attorney General must issue final regulations that specify the limited circumstances in which a special registration may be issued, and the procedure for obtaining a registration. The SUPPORT Act gives the Attorney General until October 25, 2019 to develop those final rules. Until that step is complete, there will be a lack of clarity as to how controlled substances can be prescribed in a telehealth environment. Population health officials will want to watch closely for new developments here.
With the new legislation, the stage is set for telehealth to become an increasingly important tool in the population health arsenal. However, as we’ve seen previously the adoption of any new technology comes with the need for widespread marketplace education, hard evidence of impact on outcomes, and vigilant monitoring of any new developments in the technological and regulatory landscape.