Substance Use Disorder: Bridging the Opioid Addiction Gap with Mobile-Based Care

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Now, nearly 2 million people in America have a prescription opioid use disorder...
— Vivek H. Murthy, M.D., U.S. Surgeon General, August 2016

Care for individuals suffering from substance use disorder (SUD) is expensive and complex. It needs to be coordinated across multiple stakeholders - caregivers, healthcare providers and diverse care settings. And the economic cost involved, standing at $740 billion, is staggering.

Despite heavy investment, however, the results have been bleak - only one in nine people in the United States get the care and treatment they need for addiction and substance abuse. And those who do receive it, continue to suffer due to a lack of coordinated care, preventative care and care in the most appropriate settings.

Bridging these and other key gaps in the current landscape of treatment for opioid use disorder (OUD) - a type of SUD - through advanced digital care is mobile health technology. This essentially represents person-centric, mobile-based care solutions that use real-time data capture and connects across stakeholders to offer highly measurable and equally accountable outcomes and realizes cost savings in a system burdened with costs.

But first, we offer a closer look at the problem.

Opioid Addiction: An Unsettling Reality

Addiction is a disease. We need to start treating it like one.
— Michael Botticelli, Former Director of National Drug Control Policy

Often, opioid addiction does not look the way one expects it to. It presents itself among working adults, the elderly, cancer survivors, and physicians alike. Healthcare professionals are especially susceptible to addiction given the stressful nature of their work, ready access to opiates in their workplaces, and an approach to potent substances that undermines their impact on them.

Such is the scale of the problem both in specialized populations, such as physicians, and also the general population, that it warrants its common nomenclature - the opioid epidemic. To put things in perspective, consider this:

  • Of the 20.5 million Americans suffering from SUD in 2015, 591,000 involved heroin. It is estimated that 23% of heroin users develop opioid addiction.
  • The US leads the world in the number of opiate prescriptions, overdoses on which led to over 42,000 deaths in 2016 alone, an increase of almost 150% since 2011.
  • Opioids are involved in over three out of five overdose deaths.

Current Challenges in the Treatment of OUD

The barriers to the treatment of OUD are many, ranging right from the perception of substance use disorder all the way to more practical aspects, such as the limited availability of addiction-related services, the presence of comorbidities and the high cost of treatment. It is the latter class of problems in OUD care that mHealth or digital healthcare addresses, some of the key issues among which are listed below.

Highly skewed physician-patient ratio:

Individuals who need addiction care far outnumber the number of physicians and treatment programs available in the US. To further exacerbate the problem, the rules that govern treatment facilities put a cap on the number of patients they can treat. A lack of sufficient clinical time to offer to patients is also commonly seen.

Insurance not a bulwark:

Although the ACA (Affordable Care Act) mandates that addiction services be covered by insurance, it is of note that not all insurance plans are governed by the ACA. To add to the problem, many treatment facilities do not accept ACA insurance, further limiting the number of healthcare professionals available to extend care to those in need.

Presence of comorbidities:

Often, comorbidities, such as mental health problems, present themselves in conjunction with substance use disorder. This further complicates healthcare needs and what is known as complex care is required to address such co-occurring conditions.

Staggering costs:

Complex care, by its very nature - that is, due to higher levels of complexity - increases the per capita costs of healthcare. Moreover, opioid addiction requires frequent, high-cost readmissions and specialized attention, and places a substantial economic burden on employers and payers alike.

How Connected Care Can Help

In an era where reimbursement models are changing from pay-for-service to pay-for-performance, healthcare providers are increasingly looking to technology to achieve demonstrable results and to drive down costs.

Here are some of the key barriers to OUD care that digital care solutions are equipped to help stakeholders overcome:

Care quality:

Digital healthcare makes it possible to collect real-time data from a number of sources - wearables and other devices, care team observations and patient reporting. Digital healthcare also offers automated and multi-point data collection possibilities. The collection of data around areas such as behavioral/mood changes, reactions to medications, and more are facilitated through these processes.

Cutting edge tools such as machine learning then process this data to predict outcomes. Further, this information is used to deliver improved, personalized care plans, including “smart alerts”, using mobile devices and wearables. Such an approach helps immensely in achieving measurable outcomes - a challenge in current OUD care.

Clinical time:

Remote care management and monitoring using devices and data considerably reduce the effects of the shortage of clinical time currently seen in the OUD care landscape. Pre-treatment education and assessments, daily check-ins, community and medical resources, voice/video calling and instant messaging (e-consulting) help close the patient-physician loop. Moreover, participants can easily reach out to their case management teams for assistance. Staff members are notified in real-time about the request for contact.

Costs:

Digital care solutions improve adherence through higher levels of patient engagement. This helps to prevent costly readmissions. Close monitoring and data collection renders expensive procedures redundant and makes it possible to avoid them altogether. Additionally, optimized care plans for individuals and health system integrations help realize further cost savings.

Mobile-based Care for OUD: More Than Meets the Eye

While mHealth may appear to be essentially just a mobile app at first blush, in reality, it makes use of a full-fledged digital healthcare platform. With portals for payers, patients, and providers that allow for collaboration, it connects the various stakeholders in an integrated health systems loop to provide optimized, high-engagement patient care and management along with smart analytics.

Other strategies that mHealth uses to achieve high levels of patient engagement include:

  • Enables active patient participation in his/her own care by providing a platform to communicate real-time outcome-related information - ranging from moods to medication reactions - to the care team.
  • Connects the patient to a seamlessly connected and informed care circle which includes family/informal caregivers as well as the professional care team. This becomes especially important in SUD care.
  • Fulfills the need for highly engaging and affordable care by leveraging modern technology, particularly the ubiquitous mobile phone. This is a need that is currently unmet by the largely web-based portals available today.
  • Makes possible the creation of fully customizable care plans through the creation of a “living” personal medical record using technology for data capture at the point of care.
  • Closes the feedback loop to deliver measurable outcomes through the tracking of real-time progress, which is then measured against the original care plan.

High engagement levels, in turn, lead to significantly improved adherence and reduced costs.

Deployable in days rather than months and easily scalable across complex care populations, programs and geographies, mHealth proves to be an effective care platform that is both patient-centric and accountable.

Watch our Substance Use Disorder Webinar, featuring Virginia Mathews from MAXIMUS, and learn how they used digital health technology in the California Diversion Program.