Insurance coverage improves opioid use disorder treatment retention

Photo: Malorny/Getty Images

At a rate of 72.3%, patients receiving opioid treatment through in-network insurance overwhelmingly stayed in treatment for at least 180 days, in comparison with those who were either out-of-network or uninsured and paying for treatment with cash, a new study finds.

The study, conducted by opioid addiction care provider Ophelia and published through Health Affairs Scholar, observed retention rates for both in-network and cash-pay patients receiving telehealth-based opioid treatment (TBOT). The results highlight how insurance status impacts treatment-retention rates and that not having in-network benefits can create a significant financial hurdle to receiving care.

Conducted from January to September 2022, the study analyzed 3,842 patients – 1,613 in-network patients and 2,229 cash-pay patients – with opioid use disorder (OUD) receiving evidence-based medications for OUD treatment via telehealth. 

The study aimed to understand the relationship between insurance status, payment source and outcomes among patients with OUD on telehealth platforms and any unintended impacts of post-pandemic Medicaid policy changes.

WHAT'S THE IMPACT?

The results highlighted a disparity in treatment retention rates that was more than just a simple difference between insured and uninsured patients. 

Patients who had to pay cash, even if insured (because their plan was out of network), had significantly worse retention, undermining the progress they could otherwise be making in their health and OUD treatment plan, numbers showed. 

In-network patients were predominantly Medicaid beneficiaries. Patients who were insured, but out-of-network, or uninsured paid a flat $195 monthly fee.

Compared to cash-pay patients, those who could use in-network benefits had almost twice the retention rate for six months of treatment, a quality benchmark established by the Centers for Medicare and Medicaid Services. Uninsured cash-pay patients had a 48.1% retention rate, which was higher than the 37% six-month retention rate of insured out-of-network cash-pay patients.

Given that the majority of insured patients were Medicaid beneficiaries, authors argued the findings increase concern about the Medicaid redetermination process, which could incorrectly disenroll patients and revoke their coverage. The Medicaid "unwinding" process has already disenrolled more than 16 million people as of January.

Of greater concern, they said, are the hesitation from health insurers to engage with telehealth providers and their lack of coverage for telehealth-based opioid treatment, especially in underserved areas.

THE LARGER TREND

Although more needs to be done, Medicaid fee-for-service has improved throughout the years when it comes to patients with SUD being able to access treatment, according to a 2023 study published in JAMA Network. 

Researchers said these findings are "highly salient," given that just 10 states use Medicaid FFS and that state Medicaid FFS programs set the minimum standard for SUD treatment coverage in Medicaid MCO plans.

OUD treatment in particular has garnered increased attention in recent years as the opioid epidemic continues to affect the healthcare landscape. In September 2022, HHS awarded more than $1.6 billion in investments for communities throughout the country to address the addiction and overdose crisis.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.