OUD patients on Medicaid face telehealth barriers

Medicaid patients with opioid use disorder (OUD) were less likely to receive treatment during the COVID-19 pandemic compared to privately insured OUD patients primarily due to lower telehealth use, indicating barriers to telehealth access, new research reveals.

The COVID-19 pandemic exacerbated the drug misuse problem in the United States, with drug overdose deaths rising from 91,799 in 2020 to 107,941 in 2022. Of the overdose deaths in 2022, 82,000 (76%) were deaths involving opioids.

As virtual care utilization rose during the pandemic, the technology was increasingly used to provide OUD treatment. A study published in 2022 shows that telehealth expansion was associated with an increase in the use of medications for OUD treatment and a reduction in the odds of medically treated overdoses.

Published in Health Services Research, the new study aimed to assess the impact of the rise of telehealth during the COVID-19 pandemic on Medicaid beneficiaries' access to OUD treatment.

For the study, Northwestern University researchers analyzed EHR data for Medicaid and privately insured adult patients diagnosed with OUD who had any encounter with the Northwestern Medicine system between Jan. 1, 2019, and Dec. 31, 2021. They included 486 individuals in the study, 235 of whom were Medicaid enrollees and 251 were privately insured.

The study shows that the onset of the COVID-19 pandemic in March 2020 was associated with decreased access to OUD treatment for Medicaid patients. Medicaid patients were, on average, 4.5 percentage points less likely than privately insured patients to receive any care in the month after the start of the pandemic.

Though the researchers did not observe a statistically significant reduction in the probability of receiving in-person care, Medicaid patients were, on average, 3.6 percentage points less likely than privately insured patients to receive any telehealth-based OUD care.

The researchers concluded that the decline in the probability of Medicaid patients receiving any OUD care after the pandemic began was driven by lower telehealth use. They theorized that the low utilization was linked to the digital divide, which is the gap between those with access to technology and the ability to use it and those without.

"Telehealth has been shown to address critical barriers to accessing opioid use disorder treatment such as child and family care obligations, travel times and costs, and stigma from the general public and healthcare professionals," said study co-author Melinda Xu, a first-year medical student at the Northwestern University Feinberg School of Medicine.

"However, telehealth has barriers of its own such as access to high-speed broadband, a working computer and high levels of technological literacy, factors that are more likely to challenge those with lower income than those with higher income," she continued. "Prior studies have focused on the use of telehealth for opioid use disorder treatment for either of these groups but not comparatively."

The study underscores that future telehealth policy should address telehealth access gaps for OUD treatment, especially because once Medicaid patients can access OUD treatment via telehealth, research shows they tend to remain in treatment.

A study published in 2023 examined Medicaid claims and enrollment data for 41,266 individuals in Kentucky and 50,648 in Ohio who had a buprenorphine prescription in 2020. Of these, 18,250 in Kentucky and 24,741 in Ohio initiated buprenorphine treatment.

The study shows that from the first quarter to the second quarter of 2020, telehealth treatment initiation increased from 2.4% to 16.3% in Kentucky and from 1.3% to 15.2% in Ohio. Initiating buprenorphine treatment through telehealth was associated with better odds of 90-day retention in treatment in both states compared with not starting treatment through telehealth.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.