Claims data analysis of provider-to-provider tele-mentoring program impact on opioid prescribing in Missouri.

OBJECTIVE: The objective of this study was to assess opioid prescribing patterns of primary care providers (PCPs) participating in a virtual tele-mentoring program for patients with chronic pain as compared to nonparticipants. DESIGN: We utilized Missouri Medicaid claims from 2013 to 2021 to compare opioid prescription dosages and daily supply of opioids prescribed by PCPs. Participants and nonparticipants were matched using propensity score matching. SETTING: Missouri Medicaid data were received through partnership with the Center for Health Policy's MO HealthNet Data Project, the state's leading provider of Medicaid data. PARTICIPANTS: Missouri-based prescribers. INTERVENTION: Show-Me Project Extension for Community Healthcare Outcomes (ECHO), an evidence-based provider-to-provider telehealth intervention that connects PCPs with a team of specialists. MAIN OUTCOME MEASURES: We compared the rate of prescription opioid >50 morphine milligram equivalents (MMEs), mean MMEs/day, and mean number of daily supply to understand the impact of the ECHO model on providers' opioid prescribing. RESULTS: Patients treated by ECHO providers have 33 percent lower odds of being prescribed opioid dose >50 MME/day (p < 0.001) compared to non-ECHO providers. There is also a 14 percent reduction in the average opioid dose prescribed to patients of ECHO providers (p < 0.001). We observed a 3 percent (p < 0.001) reduction in average daily supply of opioids among patients of ECHO providers compared to the comparison group. CONCLUSIONS: Pain Management ECHO supports PCPs with needed education and skills to provide specialty care in the management of pain conditions and safe prescribing of opioid medications.

Improving Access to Care for Vulnerable Missourians: The Hotspot Project.

Context: Many rural areas across the country are considered "health and technology desserts." They lack access to healthcare facilities and broadband connectivity for telehealth services. With the emergence of the COVID-19 pandemic and social distancing requirements, rural residents have become even more vulnerable. Purpose: To evaluate the utility of distribution of internet hotspots to rural and underserved Missourians for telehealth access. Methods: Mobile wi-fi devices (hotspots) were distributed to Federally Qualified Healthcare Centers and Community Mental Health Centers to be used by clinics and patients for telemedicine visits through the Missouri Telehealth Network project. We analyzed six sets of surveys from clinic administrators, collected between January and June 2021, to assess usage, technical utility of hotspots, and satisfaction with the project. Findings: A total of 163 (71.5%) survey responses were received. Seventy-seven percent (7,981) of the 10,345 ordered hotspots were distributed. Hotspots were used for video visits, with an average of 5,915.66 monthly visits (range: 3,449 - 8,420). Seven facilities reported technical issues. Open-ended survey responses reported overall satisfaction with the project. The project allowed convenient access to telehealth services for both routine and specialty care, while decreasing patient and staff exposure to COVID-19. Hot-spot service enabled patient access to educational opportunities and providers noticed a decrease in no-shows. Conclusion: The importance of internet connectivity in enabling access and means to care for rural, underserved communities cannot be overemphasized. The hotspot distribution project helped the most vulnerable Missourians access needed care during the public health emergency.