The pandemic caused a significant increase in overdose and Substance Use Disorder (SUD) related deaths, exposing long-standing deficiencies in the identification and treatment of SUD. So, with the end of the public health emergency (PHE) on May 11, 2023, and the cessation of PHE-related exceptions that increased access to mental health resources, there is reason for concern. And recent statistics bolster this worry.
Ninety percent of US adults believe the country faces a mental health crisis, and the numbers back that up. The CDC reported 100,306 drug overdose deaths in the US in the 12 months ending in April 2021, the highest number ever recorded in 12 months and a staggering 28.5% increase from the previous year.
Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. Twenty-one percent of Medicaid enrollees have mild, moderate, or severe SUD, compared to 16% of commercially insured individuals. And the PHE provided additional State-level incentives to open Medicaid enrollment, which has led to record-high participation. However, this expanded access has ended and states have restarted the process of disenrollment, with analysts estimating that millions will lose coverage. It’s important to note that Medicaid is the leading payer for SUD treatment in the country.
During this record-high enrollment and as the largest payer of behavioral health services in the United States, Medicaid has played a crucial role in improving the delivery, quality, and effectiveness of behavioral health services through policy implementation. And the availability of detailed and comprehensive claims data for Medicaid has helped answer critical questions and shape policy decisions.
State and national policymakers must build on the momentum of Medicaid’s role in improving SUD treatment in recent years. Furthermore, providers need to leverage technology and, more importantly, data, to mitigate the effects of the end of the PHE, a large-scale Medicaid disenrollment, and the challenges surrounding access, cost, care, and many other social determinants of health (SDoH).
Shifting the momentum: pressure and policy
During the emergency and under congressional legislation, states received additional funding for continuous Medicaid coverage to enrollees, putting eligibility renewals and redeterminations on hold. And an analysis from the Kaiser Family Foundation found Medicaid/CHIP enrollment increased 29% from February 2020 to November 2022.
After the expiration of the COVID-19 PHE, analysts predict a potential loss of health insurance coverage for as many as 15 million Medicaid and Children’s Health Insurance Program enrollees, ages 12 -64. And as of the latest data, 7.3% of Medicaid enrollees in this age range have at least one clinically-identified SUD in Medicaid claims data.
It’s not all doom and gloom, however: in recognition of this momentum shift, efforts are underway at the state and federal levels to enhance awareness, coordination, and access to treatment for SUD. The Consolidated Appropriations Act Congress enacted in December 2022 includes several provisions, including expanding providers who can prescribe buprenorphine to treat Opioid Use Disorder (OUD).
While policymakers can learn many lessons from the Medicaid expansion, they lack robust outcomes data regarding the impact of PHE-related Medicaid expansion on lowering mental health acuity and severity. This gap is partly driven by the lag in data and reporting and partly by the lack of technology adoption across SUD and mental health providers. And the deficit puts increasing pressure on State Medicaid programs to justify program spending or lower costs.
Closing the gap: technology and transformation
The end of the PHE and impending disenrollment leaves providers to manage the demand and unmet needs of uninsured individuals. Roughly two-thirds of individuals dis-enrolled from Medicaid go through a period of uninsurance. This shortfall means that the Exchange and commercial insurers aren’t effective at filling the gap. Providers face a wave of desperation as patients who recently lost coverage struggle to initiate or continue treatment.
Technology is critical in managing and justifying patient reimbursement regardless of coverage status. But the impending onslaught of uninsured, high acuity, and rising risk patients require new solutions and technology to make up the difference where government programs and policies fall short. Some actionable areas and examples include:
Access
Telehealth – Rural and underserved areas face the most significant barriers to care and access. And although Medicaid has expanded coverage for telehealth services during the pandemic, providers will need to prioritize telehealth and telemedicine to bridge any gaps in coverage.
Telemedicine – Providers can remotely prescribe medication-assisted treatment (MAT) medications, which have proven highly effective treatments for opioid addiction. Telehealth can also reduce the cost of care by allowing providers to see more patients in less time.
Cost
Digital therapeutics – Mobile apps and online programs can provide low-cost alternatives to traditional SUD treatment. For example, patients can use apps to offer medication reminders, track mood and symptoms, and connect individuals with peer support groups. Further, providers and patients can utilize these digital solutions to educate, counsel, and support individuals with SUD at a fraction of the cost of traditional treatment options.
Artificial intelligence – Providers can leverage AI to optimize treatment plans and reduce the cost of care. For example, clinicians can use AI algorithms to predict which patients are most likely to relapse and target interventions to these individuals, reducing the need for costly hospital readmissions.
Care
Data analytics – Behavioral health can utilize a “data-informed” approach to identify individuals at high risk of relapse and target interventions. By using data to identify individuals most in need of care, providers can help ensure that clinicians direct resources to those who need them the most and the care delivered is ultimately more impactful. Providers can also intervene earlier, lowering acuity and the total cost of care.
Electronic health and medical records – EHRs/EMRs can improve provider communication and help ensure patients receive coordinated care while reducing administrative costs. These solutions can also help providers monitor patients’ progress and share treatment plans with other care team members, providing a centralized record of a patient’s treatment history to reduce duplicative testing and empowering providers with access to the most up–to–date information. Moreover, these solutions deliver critical insight into outcomes and tie treatment to the patient journey.
A pivotal moment
The coming months and years carry broad and significant implications for SUD treatment and behavioral health providers, with several regulatory shifts that expanded health coverage or access to services scheduled to sunset. Legislatively, policymakers must continue to build on the momentum created by the recent record expansion of Medicaid and shape fresh policies that enhance awareness, coordination, and treatment access. And lastly, behavioral health providers must also pick up the slack in the line left by the end of the PHE and impending Medicaid rollback with equally novel solutions and technologies to address long-standing deficiencies in the treatment and identification of SUD.
About Talib Jaber
Talib Jaber, RPh is the VP of Customer Success at Sunwave Health, Inc., an integrated software platform that handles all aspects of a behavioral health provider, including electronic medical records, revenue cycle management, and customer relationship management. Talib is a visionary entrepreneur, healthcare professional, and accomplished pharmacist with over 25 years of experience. He is known for his innovative and compassionate approach to patient care through roles with Walgreens, Merck Medco/Express Scripts, and Liberty Medical. Most recently, he was a managing partner and CEO of Wellcare Health Group, a SUD treatment entity.