Study Shows In-Network Insurance Coverage Significantly Improves Opioid Use Disorder Treatment Retention

• The eight-month study spanned over 3,800 patients receiving telehealth-based opioid addiction care and found that those with in-network insurance benefits had successful six-month retention rates 50% greater than those required to pay cash
• The study calls attention to the detrimental effects Medicaid redeterminations pose to beneficiaries receiving opioid use disorder treatment and the need for commercial health insurers to increase functional coverage for life-saving treatment  

NEW YORK, March 5, 2024 /PRNewswire/ -- Ophelia, an opioid addiction care provider, today shared the results of its latest patient study, which observed retention rates for both in-network and cash-pay patients receiving telehealth-based opioid treatment (TBOT). Published in Health Affairs, the peer-reviewed study found that patients receiving opioid treatment via in-network insurance overwhelmingly (72.3%) stayed in treatment for at least 180 days in comparison to those who were either out-of-network or uninsured and paying for treatment with cash. Results highlight how insurance status impacts treatment retention rates and that not having in-network benefits can create a significant financial hurdle to receiving quality, life-saving 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 from Ophelia. 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.

The study results highlighted a disparity in treatment retention rates that was simply not a 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. 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 CMS. 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.

"When people are ready to seek OUD treatment, there should be no financial hurdles preventing them from receiving care," said Dr. Arthur Robin Williams, Chief Medical Officer, Ophelia. "This study is a call to our entire healthcare system to do more to eliminate barriers to OUD treatment and for health networks to be more expansive and offer a broad range of treatment providers, including telehealth providers. We need to help people stay on track with treatment plans by making care affordable."

Given the majority of insured patients were Medicaid beneficiaries, these findings increase concern about the Medicaid redetermination process, which could incorrectly disenroll patients and revoke their coverage. The Medicaid "unwinding" process has already disenrolled 16.4 million people as of February 2024. An even greater concern is 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 results of this study prove that the opioid crisis that's been impacting our nation for decades requires participation from health insurers, as a lack of coverage for OUD treatment is detrimental and possibly deadly for those who need help," said Zack Gray, CEO and co-founder at Ophelia. "We need more insurers to offer coverage for effective opioid addiction treatment, and we need them to do so now. It's the right thing to do, and it's smart business — while OUD is expensive for the healthcare system, it's even more expensive if it continues to go untreated."

For more information, visit: https://ophelia.com/.

About Ophelia
Ophelia is a digital provider of medication-assisted treatment (MAT) for opioid use disorder (OUD), committed to making evidence-based treatment universally accessible. Its mission is to remove barriers for the 80% of Americans with OUD who are unable to access care. At its core is the Ophelia Care Model, a team-based clinical model and software platform developed by leading experts in addiction medicine and psychiatry. Ophelia is licensed to provide care in 49 states and D.C. and is contracted with Medicaid, Medicare, and Commercial insurers covering 85 million American lives.

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SOURCE Ophelia