Telehealth shows promise for treating substance use disorders in rural areas

Telehealth shows promise for treating substance use disorders in rural areas

The recognition of telehealth as an effective strategy for providing treatment for substance use disorders (SUD) has offered hope for improving access to this treatment in settings with limited transportation or when time constraints impede the regular use of consistent access to in-person substance use treatment.

But findings from a team of researchers from the Virginia Center for Health Innovation, UCLA, Rand and Medinsight, Milliman Inc., suggest that the promise of telemedicine may vary by insurance and geography.

New research suggests that people living in rural areas may benefit from telehealth as a modality for substance use disorder treatment to a greater extent than their urban counterparts. Meanwhile, despite receiving the vast majority of substance use disorder services, those covered by Medicaid managed care are less likely to use telemedicine compared to their counterparts who have Medicare benefits or are commercially insured.

We have found that rates of access to treatment for Medicaid managed care are largely lower or socioeconomically disadvantaged. In contrast, the use of telehealth appears to address previously reported gaps in substance use disorder treatment among rural individuals compared to those in urban settings. “

Dr. Lauryn Walker, chief strategy officer at the Virginia Center for Health Innovation and the study's lead author

The findings are described in a research letter published February 12 in the peer-reviewed reviewJama Network Open.

As telemedicine became more popular as a treatment modality in hopes of expanding access to care, Medicaid managed care beneficiaries received fewer SUD services overall, while commercial and Medicare benefit beneficiaries experienced increases in service utilization during the same period. Rural individuals receiving substance use disorder treatment experienced the greatest increase in substance use disorder among all populations studied.

Researchers used the Medinsight Emerging Experience database to collect Medicaid managed care, Medicare Advantage and commercial insurance claims for all 50 states for approximately 16 million adults ages 18 and older who were insured for 12 or more months between January 1, 2019 and June 30, 2023.

Key findings include:

• Die monatliche Behandlung der Telemedizin-Substanzkonsum wurde von 45 bis 10.974 Sendungen erheblich gestiegen, während die persönliche Behandlung zwischen 2019 und 2023 von 186.000 auf 292.300 Dienste viel weniger erhöhte
• Trotz der Hinzufügung von Telegesundheit als Modalität der Versorgung nahm durch durchschnittliche monatliche Behandlungsdienste für Substanzenstörungen pro 100.000 Erwachsene (Telemedizin und persönlich zusammen) 17% bei den von Medicaid bedeckten Personen zurück, während sie für Medicare-Vorteile und die Begünstigten der gewerblichen Versicherung um 4% bzw. 1% erhöht wurden.
• Mit von Medicaid bedeckten Personen, die 93% der gesamten SUD-Behandlung und persönlichen Dienste ausmachten, aber nur 75% der Telemedizinauslastung sind bei den von Medicaid versicherten Personen unter den versicherten Personen unterrepräsentiert. Gewerbliche und MA-Mitglieder dagegen nutzen unverhältnismäßig Telegesundheit und machen nur 5,8% bzw. 0,4% der persönlichen Sud-Dienste aus, aber 24,0% bzw. 1,0% der Telemedizin-Dienste.
• In den ländlichen Personen verzeichneten zwischen 2019 und 2023 eine Erhöhung der Gesamtbehandlung der Substanzkonsum um 90% pro 100.000 Erwachsene, während sie bei städtischen Personen um 49% stieg.
• Telegesundheit kann zur insgesamt erhöhten Nutzung für ländliche Personen beitragen, wobei 8% der Telemedien-Dienste für ländliche Personen angeboten werden, verglichen mit 6% der Behandlungsdienste für die Störungsdienste für Substanzstörungen und persönliche Substanzstörungen.

Federal policymakers continue to develop telemedicine and in-person requirements for Sudt. Research into how different populations use telehealth for their substance use treatment may inform future effective policies to improve all populations.

“Telehealth is a relatively new modality of care, and policies and procedures are evolving rapidly,” said Dr. Katherine Kahn, studying general medicine and health services at the David Geffen School of Medicine, who is a professor of medicine in the department of general internal medicine and health services at the UCLA School of Medicine, and creating guidelines. Worries. “

There are some limitations to the study. Organizations voluntarily control claims into the database, which may limit generalizability. However, the database reflects payer coverage consistent with U.S. demographics. Additionally, the results do not include uninsured individuals and providers that do not accept insurance.

Study co-authors include many CUI and Dr. John Mafi of UCLA, Jonathan Cantor and Cheryl Damberg of Rand, and Melody Craff of Medinsight, Milliman Inc. Kahn and Mafi are also affiliated with Rand.

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