White paper

Virtual care for opioid use disorder: An evidence- and value-based approach  

Ophelia team
Ophelia team


The opioid crisis continues to drive increases in opioid-involved mortality and morbidity, and the majority of the estimated 7.6 million individuals with OUD are not receiving treatment. The costs to insurers of untreated and undertreated opioid use disorder (OUD) are immense, with total healthcare costs among patients with OUD up to 9-times greater than costs among patients without OUD. FDA-approved medications for OUD (MOUD, also referred to as medication-assisted treatment [MAT]) are the most effective form of OUD treatment, leading to significantly better clinical outcomes and reduced costs relative to other treatment models. However, barriers to access and retention have long constrained MAT from achieving its full potential. Fewer than 20% of patients with OUD receive MAT and the majority of those that do initiate treatment discontinue within a few weeks or months, even though longer treatment durations are associated with better health outcomes and reduced costs. High-quality telehealth platforms like Ophelia are able to expand the impacts of MAT on patient health and cost by increasing access and improving retention. Telehealth platforms can provide care to the millions of individuals who do not live near MAT providers, and with a level of convenience and quality that, in the case of Ophelia, results in retention rates more than double those of in-person MAT. To be most effective, MAT requires long-term, accessible care that incorporates medication management and ancillary services such as care coordination. Recognizing the efficacy and cost-savings associated with these ancillary services, the Centers for Medicare and Medicaid Services (CMS) recently created a reimbursement framework that allows bundled payment for MAT services, creating a standard that insurers can model for telehealth services. However, while most insurers cover the cost of MAT itself, coverage of these much needed ancillary services remains rare, which prohibits millions of individuals from receiving the full benefits of MAT and neglects a major opportunity for cost reduction. By encouraging long-term treatment with high-quality telehealth-based MAT providers and incentivizing effective and comprehensive care via bundled payments, insurers have a compelling opportunity to help combat the ongoing opioid crisis while also reducing the substantial costs associated with untreated and undertreated OUD.


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