PHTI: Key limitations of virtual OUD tools & industry implications
A new report shows that virtual OUD solutions match traditional treatment effectiveness and slightly improve retention, but don't meaningfully reduce costs or expand access.
Opioid use disorder, or OUD, is a trenchant public health issue in the United States, resulting in approximately 806,000 deaths between 1999 and 2023. Healthcare providers have employed various strategies to help stem the tide, including virtual OUD solutions. But now, a new report shows that despite the growing implementation of these solutions, they do not meaningfully boost new participation in treatment or reduce costs.
Released by the Peterson Health Technology Institute (PHTI), the report found that virtual OUD solutions are as effective as traditional medication-based treatment and slightly improve retention in treatment programs.
The latest report adds new considerations to healthcare providers' and payers' embrace of virtual OUD solutions.
UNDERSTANDING THE REPORT
The PHTI report assessed the clinical effectiveness and economic impact of 16 virtual OUD solutions across two categories: medication-focused solutions that provide virtual prescribing with optional support services; and digital wraparound solutions that aim to enhance medication-based OUD programs with services like contingency management and peer support.
Caroline Pearson, executive director at the Peterson Center on Healthcare and the Peterson Health Technology Institute, explained that the report is based on a systematic literature review of 43 studies, including 11 randomized controlled trials.
The report shows that virtual OUD solutions deliver outcomes comparable to usual medication-based treatment. There was also evidence showing small improvements in treatment retention. Pearson shared that patients engaging with virtual OUD solutions stayed in treatment an average of 13 more days over six months compared to traditional care.
Purchasers shouldn't expect these solutions to dramatically reduce spending or expand their patient base beyond those already seeking treatment.
Caroline PearsonExecutive director, Peterson Center on Healthcare and the Peterson Health Technology Institute
However, the solutions did not enhance access by increasing participation among the previously untreated.
"This is important because only one in four adults with OUD currently receive evidence-based medication treatment," said Pearson.
Additionally, the review found no evidence that virtual OUD solutions lower spending compared with usual care. In fact, digital wraparound solutions provided as an adjunct to medication-based OUD treatment could slightly increase annual healthcare spending because the cost of the solution often exceeds the avoided healthcare costs from improved treatment retention.
IMPLICATIONS FOR HEALTHCARE PAYERS AND PROVIDERS
The report's findings have several implications for healthcare payers and providers looking to incorporate virtual OUD solutions.
First, Pearson noted that the findings should encourage healthcare stakeholders to temper their expectations of these solutions.
"Purchasers shouldn't expect these solutions to dramatically reduce spending or expand their patient base beyond those already seeking treatment," she said.
Next, healthcare payers and providers must better understand the patient barriers to using these solutions. Pearson cited various social determinants of health as significant hurdles to virtual OUD care, including reliable technology access, baseline digital literacy, unstable housing and active addiction or acute medical needs. These populations will likely face barriers to "both treatment entry and sustained engagement with digital platforms," she said. Understanding these barriers can help providers and payers employ strategies to curb them and expand access to virtual OUD solutions.
Further, Pearson underscored that while virtual solutions remove certain logistical barriers, such as geographic access and scheduling convenience, they don't address the fundamental barrier to OUD treatment: stigma. There is a pervasive lack of awareness about the effectiveness of OUD treatment and a reluctance to engage with addiction treatment, which technology cannot solve.
To combat this issue, healthcare providers and payers must work to eliminate the stigma surrounding OUD treatment, virtual or otherwise.
RECOMMENDATIONS FOR VIRTUAL OUD SOLUTION DEVELOPERS
The report includes a number of recommendations for developers of virtual OUD solutions.
Pearson highlighted the critical need for better evidence about the components of virtual care that can drive retention.
"Currently, many solutions offer multiple interventions simultaneously -- peer support, therapy, contingency management, digital CBT -- but we don't know which combinations work best for which patients," she noted.
Other key questions about virtual OUD solutions that need to be answered include which support services are most effective for patients from different demographic backgrounds and whether digital support services are more effective when integrated into the same platform as OUD medication prescribing ones.
Additionally, the report stated that virtual OUD solution developers should educate providers on available solutions and create mutual referral relationships. This coordination could smooth care transitions between virtual and in-person care and create care continuity for patients transitioning between health insurance plans.
But, most importantly, developers must focus on patient acquisition and engagement strategies that bring previously untreated individuals into care.
"This might involve partnerships with employers for targeted outreach, integration with emergency departments to reach people during crisis moments, or community-based engagement programs that address stigma and awareness," Pearson said.
As with other digital health tools, virtual OUD solutions have immense promise to ease some of the access and treatment challenges facing OUD patients; however, providers and payers must be aware of the limits of virtual solutions and work to mitigate them.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
