Telehealth has long been viewed as a potential solution for improving access to addiction treatment in rural and remote areas. But as Lisa McLaughlin, LLMSW, MSI, and her colleagues at Workit Health in Ann Arbor, Michigan, have discovered, telehealth can make a significant impact in urban areas as well.
Workit established a telemedicine-based practice in 2017 to address Michigan’s lack of options for medication-assisted treatment. The program has since expanded to multiple counties within the state, as well as Northern and Southern California.
In a presentation at the Rx Drug Abuse & Heroin Summit next month in Nashville, McLaughlin, co-founder and co-CEO of Workit, will share a case study on how the program has improved access to treatment, connected with patients in both rural and urban settings, and kept clients engaged in treatment. Ahead of the Rx Summit, McLaughlin recently spoke with BHE about the factors that drove Workit to pursue telehealth, changing perceptions about telehealth being viable not just for rural populations, and the advice she would offer to peers considering taking on a similar project in other regions of the country.
Editor’s note: This interview has been edited for length and clarity.
What were you seeing in your community and the state of Michigan overall in terms of a need for more addiction treatment options, and what factors led you to create a telemedicine practices vs. a more traditional brick-and-mortar facility?
In the state of Michigan specifically, what we have which is common in most states is an addiction treatment landscape that is pretty much flooded with Stage 4 treatment solutions. The cost in that case is staggering. That was pretty common in the state of Michigan. The gold standard, evidence-based treatment modalities, such as medication, for addiction treatment, were not well distributed across the state. We saw a gap in the market in that there was a need to deliver treatment to many individuals in rural areas who didn’t have any treatment, let alone science-based treatment. That provided a great environment to create a digital solution that could bring acceptable care to everyone’s doorstep at an affordable price. That was long overdue in the ecosystem here.
What were some of the biggest challenges you faced in getting this off the ground?
There are only three medications approved by the FDA to treat opioid addiction—methadone, naltrexone and buprenorphine. But there is a lot of misunderstanding in the treatment community around these medications, a lot stigma in thinking that the medications are replacing one drug with another. We had to do a lot of thought leadership early on about the science and the efficacy of these treatment modalities and put people at ease around their availability in communities. A secondary issue we faced was misunderstandings about telemedicine and the belief that telemedicine treatment is mostly supposed to be a last-mile option for people in rural and remote areas. We’ve found it’s almost the opposite to be true: About 60% of our patients are urban and only 20% are truly rural. So, it’s about spreading awareness that telemedicine is a tool that should be in everyone’s toolkit and not just for extreme circumstances.
That’s interesting. When we talk with others in the industry about telemedicine, the first thing you think of is serving rural populations. How do you change that longstanding perception within the industry?
Millennials are changing it a lot. They’re voting with their pockets; 60% of them prefer online care, so we know there’s a growing demand for telemedicine in all kinds of areas of health. That is going to influence the industry in the coming years. The other thing we can do to support understanding is that we can run our clinical trials against brick-and-mortar outcomes to show what the difference is and where convenience and privacy play an important role in getting better outcomes. People will be more willing to adopt telemedicine in more use cases. Historically, we’ve seen with post-stroke care a real understanding among clinicians that it has led to better outcomes to use telehealth, and it had a more rapid adoption curve. I think we’ll see the same with addiction care.
It appears you’ve had some encouraging results so far in terms of keeping patients engaged in treatment.
It’s been extremely encouraging. We did a concentrated study of patients in Michigan and in California who were predominantly safety net patients. We looked at their outcomes, engagement, retention and adherence in the program, as well as changes in their quality of life. What we found was that 84% of patients were still with the Workit program after four weeks, and much more exciting, 67% of patients were still with us after six months, which is great because longer treatment episodes are related to positive outcomes, and a lot of people drop out of traditional programs—as many as 50% within the first month. So, this is a huge bump and very encouraging.
The other exciting outcome we saw was when you measure adherence based on a harm reduction model, when you work with patients to gradually reduce their use of substances, patients get adherent quickly and stay adherent. What we found was that after at least one year, people tested adherent at 90% of the time on MAT and patients are honest with us about their drug test results. They’re not afraid that we’re going to kick them out of the program if they have THC in their system or are gradually reducing other substances. That leads to much better outcomes. Historically, you have a space where patients are afraid to tell their physicians and nurses what they’re taking, and that can lead to unsafe outcomes with, for instance, people being on methadone and buprenorphine at the same time or a benzodiazepine and a medication and not telling their doctor can be potentially dangerous.
If one of your peers in another state were looking to start a telemedicine practice similar to the Workit program, what is one piece of advice you would share?
Take a strong clinical-first approach. When you start with the MDs and the medication, you have a solid basis for delivering telemedicine that is medically relevant. Our program changed dramatically when we made it a full-service, comprehensive program. I would encourage others to create comprehensive programs as opposed to capabilities. When people typically think about telemedicine, they think about it as a capability as opposed to a type of programming. We’d like to see that shift in the market.