The University of Washington School of Medicine and Scene Health are continuing a federally funded project that uses video-based remote patient monitoring to treat people dealing with substance abuse issues at home rather than in a clinic.
Editor's note: This article has been amended to add the annual cost to health systems of medication non-adherence.
A multi-state pilot program overseen by the University of Washington School of Medicine will test whether an innovative remote patient monitoring program for methadone treatment can improve outcomes for patients living with substance abuse.
UW is partnering with Baltimore-based digital health company Scene Health, formerly emocha Mobile Health, on the program, which is funded by a $1.96 million small business innovation research award from the National Institute on Drug Abuse. The pilot will use Scene Health's video directly observed therapy (video DOT) platform, which enables patients to film themselves taking their medication and send that video to their care provider.
The pilot comes at a crucial time for a healthcare industry struggling to address an epidemic in substance abuse and looking for new ways to reach patients at home who can't or won't visit a clinic or doctor's office for regular treatment. Methadone has proven effective in treating opioid use disorder (OUD), but it's commonly taken by patients in a clinic or doctor's office.
It also addresses an issue plaguing healthcare organizations across the board: Medication adherence. Studies have shown that patients need to take their medications at least 80% of the time for that treatment to take effect, yet in the US adherence rates are typically at 50% or lower. RPM and digital health platforms that can boost that adherence rate could help health systems tackle $500 billion in preventable costs each year tied to treatment and hospitalizations.
That's where Scene Health comes into play. The company, spun out of Johns Hopkins, has proven the value of video DOT in treating patients living with hepatitis C, and is partnering with providers and some Medicare and Medicaid MCOs to address remote treatment for hypertension, asthma, diabetes, organ transplants, and sickle cell disease. In addition, the Centers for Disease Control and Prevention (CDC) announced this past March that video DOT meets the standard of care for programs treating patients with tuberculosis.
Some healthcare providers offer doses of methadone that patients can take home, so that they don't have to go to a clinic or office to keep up with their treatments, but federal regulations are very strict, greatly limiting those opportunities. During the pandemic the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed those rules to allow more home-based treatment, but the old rules are scheduled to go back into effect in May 2024.
Another issue is funding. Some healthcare providers steer clear of methadone treatment because of limited opportunities for reimbursement, and payers want proof that these services, including RPM, improve adherence and outcomes. Congress is considering reauthorizing The SUPPORT for Patients and Communities Act, a set of addiction treatment and recovery services that will expire on September 30 and which include funding for programs that provide remote treatment options.
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The UW partnership is the second phase of an ongoing project to prove the value of this platform for treating OUD. The first phase, a 60-day pilot launched during the pandemic, proved the feasibility of the platform and saw a boost in medication adherence, while a subsequent qualitative study proved that the technology was more convenient for both patient and providers and gave patients more opportunities for continuous treatment.
The goal now is to push the platform out on a much larger scale and prove its value as an OUD treatment not only to regulators but to payers.
"Findings from this phase will inform the evidence-based policy changes required to extend the use of video DOT technology for remote monitoring of methadone maintenance therapy, increasing access to care and advancing patient-centric outcomes for individuals with opioid use disorder," Judith Tsui, a professor of medicine at the UW School of Medicine and one of two clinical investigators for the pilot, says in a press release.
"Currently, SAMHSA’s regulations differentiate between a ‘supervised dose’ and a ‘take-home dose,'" says Scene Health CEO Sebastian Seiguer. "This project explores the possibility of creating a middle ground for patients and OTPs: a supervised take-home dose. With the recent declaration by the Centers for Disease Control that remote/video DOT sessions are equivalent to in-person DOT, the time has come to revolutionize methadone treatment."
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Methadone treatments have been proven effective in helping people living with opioid use disorder (OUD), but those treatments are traditionally done in-person.
Video directly observed therapy (video DOT), which enables patients to film themselves taking their medication at home and send those videos to their care providers, has been successful in treating patients with a variety of health concerns, including hepatitis C, tuberculosis, diabetes, and asthma, and could address some $500 billion in annual healthcare costs tied to medication non-adherence and hospitalizations.
The University of Washington School of Medicine and Scene Health are launching a multi-state pilot aimed at showing that video DOT for methadone treatment is scalable and can boost clinical outcomes, including medication adherence.