How Effective Are Virtual OUD Solutions Compared to Usual Care?

Opioid use disorder (OUD) is a major public health crisis in the U.S. About 105,000 people died from a drug overdose in 2023, and 76% of those deaths involved opioids, according to the Centers for Disease Control and Prevention. The number of people who died from opioid overdose in 2023 is nearly 10 times higher than it was in 1999, though deaths tied to their use have been falling in recent years. 

Opioids also have a serious economic impact, with the U.S. spending $111 billion on direct healthcare costs for people with OUD each year, as well as $52 billion for related criminal justice costs. 

Numerous digital solutions have emerged to address this crisis, aiming to increase access to support without the need to see a clinician in person. That’s why the Peterson Health Technology Institute (PHTI), which is on a mission to evaluate the clinical and economic efficacy of digital health, chose to evaluate these companies in a recent report. 

It found that virtual OUD companies are just as effective as usual in-person treatment and can improve retention. While some solutions have comparable or slightly lower spending than standard treatment, others increase net spending.  The standard of care for opioid use disorder is defined as outpatient treatment with medications like buprenorphine, naltrexone and methadone, often combined with counseling and recovery support.

This report on virtual OUD companies follows similar reports on solutions that address depression and anxiety, hypertension, musculoskeletal conditions and diabetes.

Although OUD is a lower prevalence condition than some of the others that PHTI evaluated, it has a high disease burden and was therefore necessary to research the companies using technology to address this population, according to Caroline Pearson, executive director of PHTI. 

“In this case, you have a somewhat smaller patient population, but really significant effects on people’s health [and] high rates of deaths from overdose,” she said. “And then big economic consequences to the healthcare system, the criminal justice system, employers and others.”

The findings

PHTI evaluated two types of virtual OUD companies:

• Medication-focused solutions that offer medications for opioid use disorder (MOUD), such as buprenorphine, as well as therapy, peer support and digital content. These companies include Affect Therapeutics, Aware Recovery Care, Better Life Partners, Bicycle Health, Boulder Care, Eleanor Health, Groups Recover Together, Ophelia, Pelago, PursueCare, Wayspring and Workit Health.
• Digital wraparound solutions that enhance MOUD by offering services like peer support, care navigation and educational information. These companies include CHESS Health, DynamiCare Health, Q2i and WEconnect Health. 

The evaluation examined two key areas: clinical effectiveness (primarily the ability to retain patients in treatment) and economic impact (annual healthcare savings). To conduct the analysis, PHTI partnered with clinical advisors, experts in health technology and health economists. It also conducted interviews with patients who had used virtual OUD solutions, and companies included in the report were able to submit their own research for the assessment.

PHTI found that medication-focused solutions provide comparable or “slightly better” treatment retention that usual MOUD care. However, the researchers did not find any evidence that these improve access to care by increasing the number of patients who are entering treatment. 

It also found that medication-focused companies offer comparable or a slight decrease in net spending as they are used as alternatives to conventional MOUD care and are reimbursed using the same codes. For instance, with 25% participation in a plan covering one million members, healthcare spending would drop by $0.7 million in the commercial market, $0.2 million in Medicare and $0.8 million in Medicaid over one year.

When it comes to digital wraparound solutions, PHTI discovered that they provide slightly better treatment retention when they are added to usual MOUD care. 

However, they increase net spending because the “price of the solution exceeds the avoided healthcare costs from improved treatment retention,” according to the report. With 25% participation in a plan of one million members, healthcare spending would increase over one year by $1.2 million in the commercial market, $0.4 million in Medicare and $1.6 million in Medicaid. 

PHTI estimated that in the commercial market, digital wraparound solutions would need to increase treatment retention by 43 days at six months to offset an annual solution price of $1,230 per person.

Overall, virtual solutions improved retention in OUD care by an average of 13 days over a six month period.

“That is an improvement,” Pearson said. “In OUD, every day matters. Every day that somebody is out of treatment is a day that they are at risk for overdose. But we also can appreciate that in the context of the massive opioid epidemic in this country, and the desire of people with OUD to achieve a lifetime of recovery, 13 days is sort of a modest or a small improvement.” 

That said, these results still show the benefit that virtual solutions can bring.

“For a long time, I think a lot of the treatment community really thought that OUD care needed to be delivered largely in person, and we’ve seen, particularly since the pandemic, that virtual care is very effective and can really offer more convenience, more privacy and more access in places where there geographically aren’t a lot of providers,” Pearson said.

According to the Business Group on Health, an advocacy group for large employers, PHTI’s findings reinforce strategies that employers have already been implementing.

“By recognizing substance use disorder, which includes opioid use disorder, as a manageable condition and by directing employees toward effective treatments, employers can minimize safety risks, lower medical expenditures and promote a healthier workforce. Many employers already encourage virtual health offerings as part of a range of evidence-based treatments for substance use disorder,” said Ellen Kelsay, president and CEO of the Business Group on Health.

Several of the companies mentioned in the report also had positive responses to the findings. For example, Hans Morefield, CEO of CHESS Health, said it shows the need to “provide support to individuals between treatment visits, whether they’re going to a treatment provider or they’re getting treatment at home virtually.”

Bicycle Health’s CEO and founder, Ankit Gupta, noted that the results of PHTI’s analysis “show what we’ve long believed at Bicycle Health: teleMOUD care models can work for real people struggling with substance misuse.”

Boulder Care’s CEO, Stephanie Strong, echoed this, stating that the findings prove that medication-based virtual care works just as well or better than standard care. In addition, “to meaningfully move the needle in the massive opioid crisis, these programs should be scaled to reach many more people,” she said.

Recommendations

PHTI listed several recommendations for purchasers, innovators and policymakers based on the findings in the report, including generating more evidence on virtual OUD solutions and what tools work. 

More research should be done on if digital support services are more effective if they’re offered on the same platform as MOUD or if they’re provided separately as a wraparound service. PHTI also recommends looking into which wraparound services are the most impactful, such as care coordination, pharmacy navigation and peer support.

PHTI also called on payers to cover drug testing to better understand adherence to MOUD treatment plans.

In addition, PHTI urged the Drug Enforcement Administration to finalize a rule that would create a special registration process for the virtual prescribing of controlled substances, including buprenorphine. Due to the Covid-19 pandemic, temporary flexibilities have been in place that allow patients to access prescriptions for controlled substances without in-person evaluations. This is set to expire at the end of the year, but PHTI stressed the importance of making these flexibilities permanent.

“Even though these companies have been around for about a decade, it still feels like it’s a little bit of a first gen space from a health tech point of view, like they haven’t scaled and evolved as quickly as we have seen in some of the other disease areas that we’ve looked at,” Pearson said. “And one of the reasons for that is that prior to Covid, we had such considerable restrictions on buprenorphine prescribing virtually. … So I think it’s quite important that we finalize those flexibilities.”

Photo: Natali_Mis, Getty Images