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1. © 2016 Matrix Institute on Addictions
Jeremy D. Martinez, M.D.
Chief Executive Officer, Matrix Institute on Addictions
Clinical Instructor, UCLA School of Medicine

2. © 2016 Matrix Institute on Addictions
Technology in Addiction Treatment
 Telemedicine
 Technology-Assisted
Treatment (TAT)

3. © 2016 Matrix Institute on Addictions
Technology-Assisted Treatment
Patient Acceptance
Antione et al. surveyed 174 patients in SUD treatment
(2016)
 83% of participants were interested in TAT
 91% had cell phones
 Only 50% had access to internet via their handheld device

4. © 2016 Matrix Institute on Addictions
Telemedicine Trends in Addiction
Treatment
 Molfenter et al. (2015) examined the use of Telemedicine
in 5 states (IA, MD, MA, OK, SC) and one county (San
Mateo, CA)
 In 2011, less than 1% of treatment centers were using
telemedicine
 During the 2013-2014 NIATx program through SAMHSA,
technical assistance was provided for implementation of
telemedicine for addiction treatment

5. © 2016 Matrix Institute on Addictions
Telemedicine Trends in Addiction
Treatment (Molfenter et al., 2015)
 Each treatment provider was given a list of evidence-based
telemedicine treatment options for implementation
 At baseline,
 IA had telephone-based care in 14 state-funded programs
 MD had Virtual World implementation in progress at 7 locations
 In MA, 4 providers were using A-CHESS mobile device recovery
support
 In OK, videoconferencing was being used at 14 facilities through
their state e-Psychiatry platform

6. © 2016 Matrix Institute on Addictions
Telemedicine Trends in Addiction
Treatment (Molfenter et al., 2015)
Telemedicine modality Products
Telephone-Based Care
Post-Treatment Supports Telephone-Based Continuing Care Program (Using McKay Model)
Web-Based
Computerized Screening/Brief Intervention www.drinkerscheckup.com (Drinkers Check-up) [10]
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Computerized Treatment TES
Computerized Treatment Support Recoveration
Videoconferencing
Dedicated videoconferencing equipment or video interface on
personal computer with secure line (e-Psychiatry)
Smartphone Mobile Devices A-CHESS
Virtual Worlds and Avatars Virtual worlds developed by Innovation or Second Life

7. © 2016 Matrix Institute on Addictions
Telemedicine Trends in Addiction
Treatment (Molfenter et al., 2015)
 When offered these possible technologies, there was
greatest interest in videoconferencing (n=4), followed by
mobile apps (n=3). (OK already has videoconferencing
implemented)
 In fact, each of the sites expressed interest in
videoconferencing, with the exception of Iowa, which
preferred the Web-based computerized system.
 Primary interest in videoconferencing was to provide
patients access to Suboxone (buprenorphine/naloxone)
providers, especially in rural areas

8. © 2016 Matrix Institute on Addictions
Perceived Benefits of Videoconferencing
(Molfenter et al., 2015)
Payer Anticipated Benefits
Maryland Telesuboxone to address opioid epidemic
Greater access to physician prescribers
Massachusetts Provision of recovery support
Oklahoma Greater engagement and extension of
recovery support
San Mateo County Greater access to physician prescribers
South Carolina Addressing identified disparities in access
to specialized SUD care

9. © 2016 Matrix Institute on Addictions
Perceived Barriers to Videoconferencing
(Molfenter et al., 2015)
Payer Perceived Barriers
Maryland Lack of willing and available MDs willing
to prescribe Suboxone
Limited reimbursement funding
Limited models to follow
Massachusetts Concerns with HIPAA & 42 CFR Part 2
regulations
Oklahoma Limited reimbursement model
San Mateo County Competing priorities
(implementation of ACA)
South Carolina Competing priorities
(significant changes in environment)

10. © 2016 Matrix Institute on Addictions
Reimbursement for Telehealth
 At the present time, 47 states have policies regarding
Medicaid reimbursement for videoconferencing (Trout et
al., 2017)
 Actual policies vary state-by-state
 Only 13 states have policies to reimburse telehealth at
the same rate as in-person treatment

11. © 2016 Matrix Institute on Addictions
Effective Dates of Reimbursement
Policies

12. © 2016 Matrix Institute on Addictions
Types of Services Reimbursed

13. © 2016 Matrix Institute on Addictions
GAO Report on Telehealth
 GAO published the Telehealth and Remote Patient
Monitoring Use in Medicare and Selected Federal
Programs in April 2017
 Significant interest was present on the part of patients
and physicians
 Several demonstration projects have been successful
 Merit-based Incentive Payment System, stating in 2017,
may encourage further use of telehealth

14. © 2016 Matrix Institute on Addictions
Technology-Assisted Treatment
Cost Effectiveness
 Murphy et al. examined cost-effectiveness of TAT (2016)
 Therapeutic Education System (TES) is an internet-
delivered version of community reinforcement approach
(CRA) and contingency management (CM)
 TES was implemented at a cost of $278 above TAU for 12
weeks

15. © 2016 Matrix Institute on Addictions
Technology-Assisted Treatment
TES Fixed Costs
Variable Annual Average Across Sites Cost of site resources
Computers $650
Annual TES license $9,800
Space for TES $5,913
Furniture $245
Maintenance $2,172
Training $840
Total annual fixed costs $19,620

16. © 2016 Matrix Institute on Addictions
Technology-Assisted Treatment
Willingness to Pay
 Payers and Providers were likely to consider
implementation of CES when willing to pay at least
$20,000 per abstinent-year
 Ideal cost-effectiveness ratio at about $9,000 for 12-week
episode
 Most expenses related to start-up costs, not ongoing
licensing

17. © 2016 Matrix Institute on Addictions
Technology-Assisted Treatment
Willingness to Pay

18. © 2016 Matrix Institute on Addictions
Received
Treatment
Perceived a
Need, but did
not Receive
Treatment
Did not Receive
Treatment, and
did not perceive
a need for
treatment
Past Year Treatment - Alcohol Use Disorders
90.6%
6.3% 3.1%
Source: SAMHSA,
Center for Behavioral Health
Statistics and Quality,
National Survey on Drug Use
and Health, 2013.

19. © 2016 Matrix Institute on Addictions
Received
Treatment
Perceived a
Need, but did
not Receive
Treatment
Did not Receive
Treatment, and
Did not
Perceive a
Need
Past-Year Treatment - Illicit Drug Use
80.9%
13.4%
5.7%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013.

20. © 2016 Matrix Institute on Addictions
Matrix Hub and Spoke Model

21. © 2016 Matrix Institute on Addictions
Conclusions
Technology in Addiction Treatment
 Patients are interested in Telehealth and TAT
 States and Health Plans are willing to pay for Telehealth
and TAT
 States and Counties are most interested in telehealth,
primarily to provide access to Suboxone
 Reimbursement barriers are being resolved (best
reimbursement policies in Medicare and Medicaid)
 Cost effective at about $9000 per 12-week treatment
episode

22. © 2016 Matrix Institute on Addictions
References
Antoine, D., Heffernan, S., Chaudhry, A., King, V., & Strain, E. C. (2016).
Age and gender considerations for technology-assisted delivery of
therapy for substance use disorder treatment: A patient survey of
access to electronic devices. Addict Disord Their Treat, 15(4), 149-156.
Molfenter, T., Boyle, M., Holloway, D., & Zwick, J. (2015). Trends in
telemedicine use in addiction treatment. Addict Sci Clin Pract, 10, 14.
Murphy, S. M., Campbell, A. N., Ghitza, U. E., Kyle, T. L., Bailey, G. L.,
Nunes, E. V., & Polsky, D. (2016). Cost-effectiveness of an internet-
delivered treatment for substance abuse: Data from a multisite
randomized controlled trial. Drug Alcohol Depend, 161, 119-126.
Trout, K. E., Rampa, S., Wilson, F. A., & Stimpson, J. P. (2017). Legal
Mapping Analysis of State Telehealth Reimbursement Policies. Telemed
J E Health. doi:10.1089/tmj.2017.0016