(76) Bridging the Divide: A Telemedicine Bridge Clinic Improves Access to OUD Care

Background & Introduction: Despite overwhelming evidence demonstrating improvement in mortality and other health outcomes only ~17% of people with opioid use disorder (OUD) are treated with medications for opioid use disorder (MOUD). Barriers include stigma, costs, transportation, knowing where to go for treatment, and delays in initiation. These challenges are experienced inequitably contributing to medication access and overdose death rate disparities.
Bridge clinics provide rapid, low-barrier engagement and initiation of MOUD. Public Health Emergency policies allowed these services to be offered remotely. The UPMC Telemedicine Bridge Clinic (Bridge Clinic) was launched in April 2020, to provide accessible, short-term OUD treatment services including buprenorphine prescribing to patients in Pennsylvania. Prior analysis demonstrated increased medication utilization, outpatient OUD treatment engagement, reduced unplanned care utilization and cost savings among Bridge Clinic patients, but was limited by small sample size from a single payer without a comparison group which hindered generalizability.
Medicaid is the largest payer of SUD treatment covering ~38% of individuals with OUD, nationally, and 60% of Bridge Clinic encounters. We sought to evaluate a cohort of PA Medicaid patients treated by the Bridge Clinic to assess engagement with MOUD, ED utilization, and costs of care relative to a matched comparison group of Medicaid enrollees.

Methods: With IRB approval, we used Pennsylvania Medicaid claims data matched with Bridge Clinic data to identify enrollees who received care from the Bridge Clinic. We then compared their MOUD use, ED use, and Medicaid expenditures 6 months before and after the index visit relative to a matched comparison group using difference in differences models.
The comparison group included enrollees who did not receive Bridge Clinic services but had a new encounter with OUD treatment providers during the study period. Bridge clinic enrollees were then matched to up to 4 comparison group enrollees based on age group, gender, race and ethnicity, eligibility type, and urbanicity based on Rural Urban Commuting Area codes.
We used linear panel difference in differences models to estimate changes in the outcomes attributable to receiving care at the Bridge Clinic. We tested whether trends in each outcome were parallel between the Bridge Clinic and comparison groups in the pre-period using a Wald test to measure differences in slopes. From these models we present the mean levels of the outcomes pre and post index month for both groups, and the average treatment effect on the treated (ATET).

Results: Before matching, 15.4% of the Bridge Clinic population was Non-Hispanic Black compared to 8.74% of the comparison group. After matching, 552 Bridge Clinic patients were compared with a cohort of 2,208 patients who met inclusion criteria. Bridge Clinic patients were significantly more likely to have co-occurring Hepatitis C or alcohol use disorder diagnoses (19.6% vs. 12.0%; 11.8% vs. 9.0%, respectively) and an ED visit in the prior 6 months (42.9% vs. 37.9%).
Prior to index visit, the Bridge group had a declining buprenorphine fill rate while the fill rate in the comparison group was rising and higher. The Bridge Clinic patients had significantly lower Proportion of Days Covered (PDC) with buprenorphine prior to the index relative to the comparison group. We found that both groups experienced large increases in the proportion of enrollees with any MOUD fills after engagement in treatment with Bridge Clinic patients demonstrating a much larger percentage of MOUD fills in the first month (92% vs. 74%). In our difference in differences models we estimated that the proportion of enrollees with a MOUD fill treated by the Bridge Clinic was similar to that of the comparison group after the index month (ATET = 0.0291 (95% CI: -.009 - .0673); however, trends in MOUD use were not parallel between the 2 groups in the pre-period (F = 8.45, Prob > F = 0.0037). We estimate that MOUD PDC increased by .0485 (95% CI: 0.017 – 0.08) for the Bridge Clinic group relative to comparison group; a 6.9% relative increase. Finally, we found that the proportion of Bridge Clinic enrollees with an ED visit declined relative to the comparison group by 18.2% (ATET = -.0202 (95% CI: -.0371 - -.0032).
Medicaid expenditure among Bridge Clinic enrollees was $1,608 per member per month (PMPM) in the pre-period, increasing to $1,782 PMPM in the post-period, compared to $1,431 to $1,871 PMPM among the comparison group. While monthly costs rose in both groups as patients accessed care, new spend was ~2.5x higher in the comparison group. Costs rose disproportionately for the comparison group around the index month, predominantly driven by changes in inpatient spending.
The total cost of care was significantly lower for the Bridge Clinic cohort, primarily related to lower inpatient care costs, in the month preceding and month of the index visit.

Conclusion & Discussion: This analysis supports the effectiveness of a telemedicine Bridge Clinic model in improving access and outcomes for patients with opioid use disorder, particularly those facing structural and geographic barriers. The model facilitates timely engagement, initiation, and retention on buprenorphine, reducing care discontinuity and associated risks of relapse. Bridge Clinic patients, though more clinically complex, showed higher buprenorphine fill rates within one month and greater improvements in medication adherence compared to a matched cohort. Additionally, Bridge Clinic use was associated with a reduction in ED visits and potentially lower care costs post-engagement primarily due to avoided unplanned hospital-based care. However, differences in patient treatment pathways and challenges in cohort matching limit causal inference. Future research should evaluate the impact of adding telemedicine Bridge Clinics to broader care systems and further refine matching methodologies to enhance comparative analyses. Overall, the Bridge Clinic model demonstrates promise in expanding equitable, effective OUD care for high-risk Medicaid populations.

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