Use of in-network insurance benefits is critical for improving retention in telehealth-based buprenorphine treatment

Abstract

An empiric evidence base is lacking regarding the relationship between insurance status, payment source, and outcomes among patients with opioid use disorder (OUD) on telehealth platforms. Such information gaps may lead to unintended impacts of policy changes. Following the phase-out of the COVID Public Health Emergency states were allowed to re-determine Medicaid eligibility and disenroll individuals. Yet financial barriers remain a common and significant hurdle for patients with OUD and are associated with worse outcomes. We studied 3,842 patients entering care in 2022 at Ophelia Health, one of the nation’s largest OUD telehealth companies, to assess associations between insurance status and 6-month retention. In multivariable analyses, in-network patients who could use insurance benefits were more likely to be retained compared to cash-pay patients (aRR:1.50; 95%CI:1.40-1.62, p<0.001). Among a subsample of 882 patients for whom more detailed insurance data were available (due to phased-in EHR updates), in-network patients were also more likely to be retained at six months compared to insured yet out-of-network patients (aRR:1.86,95%CI:1.54-2.23, p<0.001). Findings show insurance status, and specifically the use of in-network benefits, are associated with superior retention and suggest Medicaid disenrollment and insurance plan hesitation to engage with telehealth providers may undermine the nation’s response to the opioid crisis.