Recently, three virtual medication-assisted treatment (MAT) startups have released research findings that demonstrate telehealth has been key to retaining patients and improving care outcomes.
The companies — Bicycle Health, Quit Genius and Ophelia Health — are burgeoning behavioral health tech companies that have secured major venture capital funding and have grown significantly during the federal government’s COVID-era policies. Specifically, the federal government has allowed providers to prescribe controlled substances without an initial in-person visit, a vital freedom for these digital-first companies.
Since 2021, these three companies have raised $261 million, according to Crunchbase.
Cumulatively, the three recent studies build the validity of the behavioral health tech segment’s assertion that care can be impactful when provided via telehealth. A separate study of federally backed health care providers finds that behavioral health services delivered via telehealth to rural patients had the same impact on anxiety or depression symptoms as in-person services.
Behavioral health and telehealth almost go hand in hand following the onset of the pandemic. It was the health care segment to use it the most during the acute phases of the pandemic and has held onto it at elevated rates the longest.
The Ophelia Health and Bicycle Health studies examined MAT in treating OUD. The Quit Genius study looked at MAT in treating alcohol use disorder.
Telehealth and retention
Bicycle Health and Ophelia Health reported retention rates higher than what each identified as an industry average. Quit Genius reported that “most” of its study participants completed the intervention.
Bicycle Health reported a 59% 90-day retention rate for a mixed population of uninsured and cash-pay patients. Insured patients alone had a retention rate of 80%. For comparison, the study pointed to a 90-day industry retention average of 44%.
Ophelia Health reported a 69% 180-day retention rate for a population where the majority of participants had Medicaid while some had commercial health plans. It benchmarked retention for Medicaid at 27% and commercial insurance at 31%.
“We have created a virtual care platform to have all of the evidence-based services needed for high-quality care that a patient would find in traditional brick and mortar settings — but we bring the care to them,” Dr. Arthur Robin Williams, Ophelia Health’s chief medical officer, said in a statement. “It is incredibly convenient. And our patients love our clinicians because they feel generally cared for.”
Stronger retention in addiction treatment, especially for MAT in treating opioid-use disorder (OUD), is tied to lower mortality rates. Retention is also a common metric in value-based care arrangements.
Impact on symptoms
Quit Genius patients started with patient averages of consuming alcohol 25.9 of the previous 30 days and 6.7 drinks a day. After 12 weeks, the group reduced usage to an average of consuming alcohol 17.7 days in the past 30 days and an average of 2.66 drinks per day.
The study also found that 68% of participants reduced their consumption by at least one or more WHO risk drinking levels.
“Though we are gradually seeing improvement as awareness of the efficacy of medications for alcohol and other substance use disorder increases, the greatest advancement that our pilot study offers is the capacity to expand access to underutilized and well studied, efficacious treatments for alcohol use disorders,” Suzette Glasner, vice president of clinical affairs at Quit Genius, said in a statement.
The Bicycle Health and Ophelia Health studies did not assess impacts on symptoms.
Telehealth in rural settings reduces depression and anxiety symptoms the most for those with the highest levels of symptoms, according to the study of federally backed health care providers. Depression symptoms, as measured by a PHQ-9, decreased by an average of 2.8 points for telehealth treatment and 2.9 for in-person treatment. Anxiety symptoms decreased by an average of 2 points and 2.4 points for telehealth and in-person treatment, respectively, as measured by the GAD-7 assessment.
Perceptions of telehealth
The growth of telehealth generally and the retention rates at these companies imply strong, positive perceptions of telehealth and MAT. However, immense challenges remain.
“Research on predictors of response to telehealth-based treatment of substance use disorders is still in relatively early stages; we know that those who have negative perceptions of the value of a telehealth approach to care may have a more difficult time establishing trust and rapport with a treatment provider, which in turn can impact their response to treatment,” Glasner said.
She added that patients with the most “acutely severe cases” don’t respond as well to telehealth treatment. These often require intensive in-person care including psychiatric care and/or medical stabilization.
The other primary hurdle for virtual MAT companies is a potential shift in federal regulations. The prescribing flexibilities that have so benefited these companies end with the public health emergency which is slated to expire on January 11 and is expected to be renewed at least one more time.
And there is no guarantee that Congress will enshrine these types of regulations in law. It has so far not moved major mental health legislation. This could relegate telehealth to a second-class modality, according to some advocates.
“Telehealth isn’t just a B-grade version of in-person care,” Williams said. “Clinical outcomes can actually be superior to traditional in-person care. We have retention rates at 6 months that are double those of usual care populations and we have very high rates of medication adherence. These findings speak to the convenience and accessibility of telehealth-based care.”
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