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Integrating Telehealth and Traditional Care in Chronic Pain Management and Substance Use Disorder Treatment

An Action Agenda for Building the Future State of Hybrid Care

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As the United States grapples with the persistent challenges of chronic pain and substance use disorders (SUD), the rise in telehealth has opened new horizons for health care delivery. A new NAM Discussion Paper from the Action Collaborative on Combatting Substance Use and Opioid Crises delineates a comprehensive action agenda for the development of hybrid care models, combining the strengths of telehealth and traditional in-person care, to address the individual and intersecting needs of chronic pain and SUD management.   

At the core of this agenda are four cross-cutting areas of opportunity, each serving as a lens to guide stakeholder actions: (1) center the lived experiences of patients and caregivers; (2) enhance workforce support and infrastructure capacity; (3) focus on safety and quality of care; and (4) align regulations and payment policies with evidence-based care. 

By seizing these opportunities to catalyze health systems transformation, stakeholders across the health care ecosystem can create a more accessible, efficient, and equitable system of care, especially urgent in light of the ongoing opioid crisis and overdose epidemic. Authors of this agenda call for an integrated and proactive approach, encouraging multilevel action—from policy makers, regulators, clinicians, health professional societies and educators, researchers, health systems and treatments programs, individuals and caregivers with lived experience, payers and purchasers, technology development companies, and others—to drive toward a future of health care delivery that is person-centered, innovative, and responsive to the evolving needs of society.  

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Areas of Opportunity

Learn more about the specific actions you and your organization can take and join us in shaping the future of hybrid care! 

Click through the boxes below to see actions you can take across the four areas of opportunity outlined in Integrating Telehealth and Traditional Care in Chronic Pain Management and Substance Use Disorder Treatment: An Action Agenda for Building the Future State of Hybrid Care.

Center the Lived Experiences of Patients and Caregivers

This opportunity area underscores the importance of centering the voices and lived experiences of patients and caregivers in the development and optimization of hybrid care models. By addressing challenges such as stigma, the digital divide, and other systemic barriers, stakeholders can ensure that these models that are equitable, accessible, and truly person-centered, leading to improved patient outcomes and reduced health disparities.

  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Develop telehealth platforms to be more intuitive and user-friendly, incorporating inputs and perspectives of both patients and clinicians. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education.
    • Action: Develop telehealth platforms to be more intuitive and user-friendly, incorporating inputs and perspectives of both patients and clinicians. 
  • Challenge – Regulatory and administrative burdens on patients and caregivers: Regulatory and administrative burdens, including variability in telehealth coverage, affordability, licensure restrictions, and inconsistent practice guidelines, impede patients’ and caregivers’ access to telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Align state regulatory and payer policies with evidence-based care, removing unnecessary restrictions on telehealth-enabled chronic pain management and SUD treatment. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – Regulatory and administrative burdens on patients and caregivers: Regulatory and administrative burdens, including variability in telehealth coverage, affordability, licensure restrictions, and inconsistent practice guidelines, impede patients’ and caregivers’ access to telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Align state regulatory and payer policies with evidence-based care, removing unnecessary restrictions on telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Address the variability in coverage and affordability of telehealth services by ensuring health plans cover telehealth services and place fewer limitations on when and what types of services are covered and at what rates. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Collaborate with community organizations and libraries to provide accessible digital literacy training and support in local communities. 
    • Action: Provide assistive services to individuals in fostering digital literacy, accessing health information, and navigating telehealth platforms and portals. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Identify disparities in access to telehealth-delivered chronic pain management and SUD care to develop targeted solutions for under-resourced populations. 
    • Action: Provide assistive services to individuals in fostering digital literacy, accessing health information, and navigating telehealth platforms and portals. 
    • Action: Retain and/or expand supportive coverage and reimbursement of audio-only telehealth services to increase accessibility for those with limited broadband access. 
    • Action: Develop and promote public-private partnerships to facilitate investment in broadband infrastructure and technology access, particularly in under-resourced areas. 
  • Challenge – Regulatory and administrative burdens on patients and caregivers: Regulatory and administrative burdens, including variability in telehealth coverage, affordability, licensure restrictions, and inconsistent practice guidelines, impede patients’ and caregivers’ access to telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Align state regulatory and payer policies with evidence-based care, removing unnecessary restrictions on telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Expand and/or maintain regulatory flexibilities that increase access to care for patients with chronic pain and/or SUD, such as telehealth-based opioid treatment (TBOT), loosened restrictions on methadone treatment, and reduced drug testing requirements. 
    • Action: Promote streamlined cross-state licensure, such as through interstate compacts and licensure reciprocity agreements, to expand reach of existing specialty care clinicians. 
    • Action: Address the variability in coverage and affordability of telehealth services by ensuring health plans cover telehealth services and place fewer limitations on when and what types of services are covered and at what rates. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Retain and/or expand supportive coverage and reimbursement of audio-only telehealth services to increase accessibility for those with limited broadband access. 
  • Challenge – Regulatory and administrative burdens on patients and caregivers: Regulatory and administrative burdens, including variability in telehealth coverage, affordability, licensure restrictions, and inconsistent practice guidelines, impede patients’ and caregivers’ access to telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Align state regulatory and payer policies with evidence-based care, removing unnecessary restrictions on telehealth-enabled chronic pain management and SUD treatment. 
    • Action: Address the variability in coverage and affordability of telehealth services by ensuring health plans cover telehealth services and place fewer limitations on when and what types of services are covered and at what rates. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Identify disparities in access to telehealth-delivered chronic pain management and SUD care to develop targeted solutions for under-resourced populations. 
    • Action: Develop telehealth platforms to be more intuitive and user-friendly, incorporating inputs and perspectives of both patients and clinicians. 
  • Challenge – Lack of person-centered systems of care: Chronic pain management and SUD treatment systems often fail to deliver person-centered care, hindered by barriers related to access, stigma, and clinician shortages. 
    • Action: Collaborate with patients, caregivers, and clinicians to co-create innovative hybrid care models, ensuring that their valuable input is integrated into the development of person-centered workflows and policies pertaining to care delivery, as well as the implementation and integration of technology. 
  • Challenge – The digital divide: The digital divide, marked by unequal access to broadband, internet-enabled devices, and digital literacy, significantly hinders the adoption of telehealth for chronic pain management and SUD care, especially affecting rural residents, racial and ethnic minorities, and those with lower income and/or education. 
    • Action: Develop telehealth platforms to be more intuitive and user-friendly, incorporating inputs and perspectives of both patients and clinicians. 

Enhance Workforce Support and Infrastructure Capacity

This opportunity area recognizes the crucial need to better support the health care workforce and build the necessary infrastructure to successfully implement hybrid care models for chronic pain management and SUD treatment. This requires creating new roles and responsibilities for existing health professionals, investing in essential technology and infrastructure, and, importantly, leveraging clinicians’ direct care experience in the design and implementation of these models.

  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Study and implement innovative, person-centered hybrid care models that minimize fragmentation and encourage coordinated care to optimize patient outcomes.  
    • Action: Develop user-friendly interfaces that integrate data across virtual and in-person care provision, promote collaboration, and break down silos between health care systems.  
  • Challenge – Shortage of Health Care Professionals in the Fields of Chronic Pain Management and SUD Treatment: The U.S. faces a critical shortage of health care professionals with the knowledge and skills to effectively manage chronic pain and SUD, particularly in underserved, rural areas. 
    • Action: Increase funding and support for specialty training programs in pain management and addiction medicine, including integrating these areas more thoroughly into existing curricula, and expanding residency and fellowship slots in these areas. 
    • Action: Increase funding and support for comprehensive training in pain management and addiction medicine for clinicians, including nurses, psychologists, social workers, pharmacists, and advanced practice clinicians, and emphasize integrating these areas more thoroughly into existing curricula.  
    • Action: Implement models integrating primary care and SUD treatment, such as the Collaborative Care Model, to help expand the existing workforce and enhance patient access.  
    • Action: Implement initiatives to combat the stigma associated with SUD and chronic pain. This could involve educational campaigns aimed at the public, as well as targeted interventions for health care professionals to reduce bias and improve understanding of these specialties.  
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Develop comprehensive, integrated workflows that allow for seamless coordination across different clinicians, patients, care settings, and technologies, with the goal of creating cohesive systems of care.  
    • Action: Ensure EHR interoperability across systems and platforms to improve information flow, and ensure coordinated care for patients, particularly those with chronic pain and/or SUD who receive care from multiple health care professionals across different care settings.  
    • Action: Establish clear data standards and protocols for interoperability to maintain consistent data exchange across different EHR systems.  
    • Action: Develop and implement interoperable EHR systems that can seamlessly share patient information across different health care professionals and settings to promote coordinated care and minimize duplicative or unnecessary procedures.  
    • Action: Study and implement innovative, person-centered hybrid care models that minimize fragmentation and encourage coordinated care to optimize patient outcomes. 
    • Action: Develop user-friendly interfaces that integrate data across virtual and in-person care provision, promote collaboration, and break down silos between health care systems. 
  • Challenge – Limitations of Telehealth and Technology in Chronic Pain Management and SUD Treatment: Despite its potential, telehealth-enabled chronic pain and SUD care is hindered by limitations including the inability to conduct essential in-person clinical procedures, variation in state policies and regulations, and concerns surrounding privacy and data security. 
    • Action: Invest in the development of new technologies that prioritize the specific needs of clinical end-users, including effective clinical evaluation, personalized treatment planning, and care coordination, while ensuring the security and privacy of patient information. 
    • Action: Establish and implement standardized protocols and guidelines for telehealth interventions in the treatment of SUD and chronic pain, considering the limitations of virtual care settings and ensuring privacy, safety, and quality of care.  
  • Challenge – Shortage of Health Care Professionals in the Fields of Chronic Pain Management and SUD Treatment: The U.S. faces a critical shortage of health care professionals with the knowledge and skills to effectively manage chronic pain and SUD, particularly in underserved, rural areas. 
    • Action: Increase funding and support for specialty training programs in pain management and addiction medicine, including integrating these areas more thoroughly into existing curricula, and expanding residency and fellowship slots in these areas. 
    • Action: Increase funding and support for comprehensive training in pain management and addiction medicine for clinicians, including nurses, psychologists, social workers, pharmacists, and advanced practice clinicians, and emphasize integrating these areas more thoroughly into existing curricula. 
    • Action: Implement initiatives to combat the stigma associated with SUD and chronic pain. This could involve educational campaigns aimed at the public, as well as targeted interventions for health care professionals to reduce bias and improve understanding of these specialties. 
  • Challenge – Inadequate Digital Education and Training to Prepare Health Care Professionals for the Hybrid Environment: For effective telehealth-enabled chronic pain management and SUD care, health care professionals must be adept in virtual communication, skilled in technology, and well-versed in telehealth-specific policies and regulations. 
    • Action: Develop and implement telehealth-specific training programs and curricula for clinicians and allied health care professionals focused on digital literacy and telehealth skills.  
    • Action: Create targeted training programs that focus on updating skills for the unique challenges of managing complex conditions like chronic pain and SUD via telehealth, providing in-depth education on remote assessment techniques, recognizing signs of substance use and withdrawal, interpreting pain signals remotely, and using remote monitoring tools effectively.  
    • Action: Develop continuing education programs specially tailored to address gaps in digital education and training for long-serving clinicians. 
    • Action: Invest in providing ongoing support and resources for the health professional workforce, including telehealth help desks and technology support teams, to ensure both health care professionals and their patients have access to the support they need to effectively use telehealth technologies.   
  • Challenge – Limitations of Telehealth and Technology in Chronic Pain Management and SUD Treatment: Despite its potential, telehealth-enabled chronic pain and SUD care is hindered by limitations including the inability to conduct essential in-person clinical procedures, variation in state policies and regulations, and concerns surrounding privacy and data security. 
    • Action: Establish and implement standardized protocols and guidelines for telehealth interventions in the treatment of SUD and chronic pain, considering the limitations of virtual care settings and ensuring privacy, safety, and quality of care. 
  • Challenge – Shortage of Health Care Professionals in the Fields of Chronic Pain Management and SUD Treatment: The U.S. faces a critical shortage of health care professionals with the knowledge and skills to effectively manage chronic pain and SUD, particularly in underserved, rural areas. 
    • Action: Invest in and expand the use of telehealth and hybrid models of care to extend the reach of the existing health workforce to underserved areas. 
    • Action: Increase funding and support for specialty training programs in pain management and addiction medicine, including integrating these areas more thoroughly into existing curricula, and expanding residency and fellowship slots in these areas. 
    • Action: Increase funding and support for comprehensive training in pain management and addiction medicine for clinicians, including nurses, psychologists, social workers, pharmacists, and advanced practice clinicians, and emphasize integrating these areas more thoroughly into existing curricula. 
    • Action: Implement models integrating primary care and SUD treatment, such as the Collaborative Care Model, to help expand the existing workforce and enhance patient access. 
    • Action: Implement initiatives to combat the stigma associated with SUD and chronic pain. This could involve educational campaigns aimed at the public, as well as targeted interventions for health care professionals to reduce bias and improve understanding of these specialties. 
  • Challenge – Inadequate Digital Education and Training to Prepare Health Care Professionals for the Hybrid Environment: For effective telehealth-enabled chronic pain management and SUD care, health care professionals must be adept in virtual communication, skilled in technology, and well-versed in telehealth-specific policies and regulations. 
    • Action: Develop continuing education programs specially tailored to address gaps in digital education and training for long-serving clinicians. 
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Develop comprehensive, integrated workflows that allow for seamless coordination across different clinicians, patients, care settings, and technologies, with the goal of creating cohesive systems of care. 
    • Action: Ensure EHR interoperability across systems and platforms to improve information flow, and ensure coordinated care for patients, particularly those with chronic pain and/or SUD who receive care from multiple health care professionals across different care settings. 
    • Action: Develop and implement interoperable EHR systems that can seamlessly share patient information across different health care professionals and settings to promote coordinated care and minimize duplicative or unnecessary procedures. 
  • Challenge – Barriers to Coordinated Care Across Modalities, Including Reimbursement and Adoption of Interoperable EHRs: While telehealth presents many opportunities for enhancing coordinated care, its potential impact could be hindered by barriers related to reimbursement and health information sharing. 
    • Action: Encourage the development and widespread adoption of interoperable EHRs by creating incentives and providing funding for health systems and treatment providers to transition to these systems.  
    • Action: Allocate funding and resources to promote and implement integrated and coordinated care models that bring together multidisciplinary care teams across physical health, SUD treatment, mental health, and social service providers.  
  • Challenge – Shortage of Health Care Professionals in the Fields of Chronic Pain Management and SUD Treatment: The U.S. faces a critical shortage of health care professionals with the knowledge and skills to effectively manage chronic pain and SUD, particularly in underserved, rural areas. 
    • Action: Invest in and expand the use of telehealth and hybrid models of care to extend the reach of the existing health workforce to underserved areas.  
    • Action: Increase funding and support for specialty training programs in pain management and addiction medicine, including integrating these areas more thoroughly into existing curricula, and expanding residency and fellowship slots in these areas. 
    • Action: Increase funding and support for comprehensive training in pain management and addiction medicine for clinicians, including nurses, psychologists, social workers, pharmacists, and advanced practice clinicians, and emphasize integrating these areas more thoroughly into existing curricula. 
    • Action: Increase financial incentives to attract and retain health care professionals in chronic pain management and SUD treatment, including improved reimbursement rates for services, loan forgiveness programs for professionals working in underserved areas, and subsidies for education in these specialties.  
    • Action: Implement models integrating primary care and SUD treatment, such as the Collaborative Care Model, to help expand the existing workforce and enhance patient access. 
    • Action: Implement initiatives to combat the stigma associated with SUD and chronic pain. This could involve educational campaigns aimed at the public, as well as targeted interventions for health care professionals to reduce bias and improve understanding of these specialties. 
  • Challenge – Inadequate Digital Education and Training to Prepare Health Care Professionals for the Hybrid Environment: For effective telehealth-enabled chronic pain management and SUD care, health care professionals must be adept in virtual communication, skilled in technology, and well-versed in telehealth-specific policies and regulations. 
    • Action: Invest in providing ongoing support and resources for the health professional workforce, including telehealth help desks and technology support teams, to ensure both health care professionals and their patients have access to the support they need to effectively use telehealth technologies.   
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Develop comprehensive, integrated workflows that allow for seamless coordination across different clinicians, patients, care settings, and technologies, with the goal of creating cohesive systems of care. 
    • Action: Ensure EHR interoperability across systems and platforms to improve information flow, and ensure coordinated care for patients, particularly those with chronic pain and/or SUD who receive care from multiple health care professionals across different care settings. 
    • Action: Establish clear data standards and protocols for interoperability to maintain consistent data exchange across different EHR systems. 
    • Action: Develop and implement interoperable EHR systems that can seamlessly share patient information across different health care professionals and settings to promote coordinated care and minimize duplicative or unnecessary procedures. 
    • Action: Develop reimbursement policies that provide an appropriate amount and type of billing codes for coordinated care by reimbursing clinicians for activities such as care coordination meetings, virtual rounds, and the use of interoperable EHRs.  
  • Challenge – Barriers to Coordinated Care Across Modalities, Including Reimbursement and Adoption of Interoperable EHRs: While telehealth presents many opportunities for enhancing coordinated care, its potential impact could be hindered by barriers related to reimbursement and health information sharing. 
    • Action: Encourage the development and widespread adoption of interoperable EHRs by creating incentives and providing funding for health systems and treatment providers to transition to these systems. 
    • Action: Address electronic barriers to observing patient consent protocols in information sharing across different types of treatment services, enabling better care coordination.  
    • Action: Develop and support innovative alternative payment models that incentivize coordinated care, such as value-based contracts or pay-for-performance arrangements. These models should reward clinicians the quality of care they provide, not just the volume of services delivered.  
    • Action: Allocate funding and resources to promote and implement integrated and coordinated care models that bring together multidisciplinary care teams across physical health, SUD treatment, mental health, and social service providers. 
  • Challenge – Limitations of Telehealth and Technology in Chronic Pain Management and SUD Treatment: Despite its potential, telehealth-enabled chronic pain and SUD care is hindered by limitations including the inability to conduct essential in-person clinical procedures, variation in state policies and regulations, and concerns surrounding privacy and data security. 
    • Action: Invest in the development of new technologies that prioritize the specific needs of clinical end-users, including effective clinical evaluation, personalized treatment planning, and care coordination, while ensuring the security and privacy of patient information. 
    • Action: Establish and implement standardized protocols and guidelines for telehealth interventions in the treatment of SUD and chronic pain, considering the limitations of virtual care settings and ensuring privacy, safety, and quality of care. 
  • Challenge – Shortage of Health Care Professionals in the Fields of Chronic Pain Management and SUD Treatment: The U.S. faces a critical shortage of health care professionals with the knowledge and skills to effectively manage chronic pain and SUD, particularly in underserved, rural areas. 
    • Action: Increase financial incentives to attract and retain health care professionals in chronic pain management and SUD treatment, including improved reimbursement rates for services, loan forgiveness programs for professionals working in underserved areas, and subsidies for education in these specialties. 
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Develop reimbursement policies that provide an appropriate amount and type of billing codes for coordinated care by reimbursing clinicians for activities such as care coordination meetings, virtual rounds, and the use of interoperable EHRs. 
  • Challenge – Barriers to Coordinated Care Across Modalities, Including Reimbursement and Adoption of Interoperable EHRs: While telehealth presents many opportunities for enhancing coordinated care, its potential impact could be hindered by barriers related to reimbursement and health information sharing. 
    • Action: Encourage the development and widespread adoption of interoperable EHRs by creating incentives and providing funding for health systems and treatment providers to transition to these systems. 
    • Action: Develop and support innovative alternative payment models that incentivize coordinated care, such as value-based contracts or pay-for-performance arrangements. These models should reward clinicians the quality of care they provide, not just the volume of services delivered.
    • Action: Allocate funding and resources to promote and implement integrated and coordinated care models that bring together multidisciplinary care teams across physical health, SUD treatment, mental health, and social service providers. 
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Study and implement innovative, person-centered hybrid care models that minimize fragmentation and encourage coordinated care to optimize patient outcomes. 
  • Challenge – Limitations of Telehealth and Technology in Chronic Pain Management and SUD Treatment: Despite its potential, telehealth-enabled chronic pain and SUD care is hindered by limitations including inability to conduct essential in-person clinical procedures, variation in state policies and regulations, and concerns surrounding privacy and data security. 
    • Action: Invest in the development of new technologies that prioritize the specific needs of clinical end-users, including effective clinical evaluation, personalized treatment planning, and care coordination, while ensuring the security and privacy of patient information. 
  • Challenge – Increasingly Complex and Fragmented Systems of Care: The U.S. health care system’s complexity and fragmentation pose significant challenges in managing chronic pain and SUD, contributing to treatment gaps, increased health care expenses, and poor patient outcomes. 
    • Action: Develop comprehensive, integrated workflows that allow for seamless coordination across different clinicians, patients, care settings, and technologies, with the goal of creating cohesive systems of care. 
    • Action: Ensure EHR interoperability across systems and platforms to improve information flow, and ensure coordinated care for patients, particularly those with chronic pain and/or SUD who receive care from multiple health care professionals across different care settings. 
    • Action: Establish clear data standards and protocols for interoperability to maintain consistent data exchange across different EHR systems. 
    • Action: Develop and implement interoperable EHR systems that can seamlessly share patient information across different health care professionals and settings to promote coordinated care and minimize duplicative or unnecessary procedures. 
    • Action: Develop user-friendly interfaces that integrate data across virtual and in-person care provision, promote collaboration, and break down silos between health care systems. 
  • Challenge – Barriers to Coordinated Care Across Modalities, Including Reimbursement and Adoption of Interoperable EHRs: While telehealth presents many opportunities for enhancing coordinated care, its potential impact could be hindered by barriers related to reimbursement and health information sharing. 
    • Action: Encourage the development and widespread adoption of interoperable EHRs by creating incentives and providing funding for health systems and treatment providers to transition to these systems. 
    • Action: Address electronic barriers to observing patient consent protocols in information sharing across different types of treatment services, enabling better care coordination. 
  • Challenge – Limitations of Telehealth and Technology in Chronic Pain Management and SUD Treatment: Despite its potential, telehealth-enabled chronic pain and SUD care is hindered by limitations including inability to conduct essential in-person clinical procedures, variation in state policies and regulations, and concerns surrounding privacy and data security. 
    • Action: Invest in the development of new technologies that prioritize the specific needs of clinical end-users, including effective clinical evaluation, personalized treatment planning, and care coo

Focus on Safety and Quality of Care

This opportunity area stresses the importance of maintaining safety and high-quality standards across all forms of care delivery, whether virtual or in-person. For telehealth-enabled chronic pain management and SUD care, this requires the development of best practices, evidence-based protocols, and consensus quality metrics to ensure optimal and appropriate care. 

  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Develop evidence-based guidelines and best practices for discerning the appropriateness of telehealth versus in-person care, considering factors such as patient needs, treatment goals, the complexity of the patient’s condition, and their comfort with technology. 
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness.  
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain or/or SUD. 
    • Action: Involve patients in decisions regarding the use and sharing of their health data, considering their preferences and concerns to build trust and ensure that privacy is respected.  
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration and data analytics for proactive detection and prevention. 
    • Action: Implement patient education programs to raise awareness of potential fraud schemes, including suspicious clinics or requests for personal information.  
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Develop and update clinical practice guidelines, with input from clinicians and people with lived experience, to prioritize the management of misuse and diversion therapeutically rather than enforcing “zero-tolerance” measures that may impede access to treatment.
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience.  
    • Action: Develop baseline process measures and gradually expand to include outcome measures as core treatment quality processes are strengthened.  
  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Develop evidence-based guidelines and best practices for discerning the appropriateness of telehealth versus in-person care, considering factors such as patient needs, treatment goals, the complexity of the patient’s condition, and their comfort with technology. 
    • Action: Develop defined clinical pathways for hybrid care delivery, including decision trees that guide clinicians on when to integrate telehealth modalities and when to prioritize in-person care, based on objective patient assessment and individual circumstances.  
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Develop, adopt, and use standardized, validated, and reliable outcome measures across studies to facilitate the comparison of results and enable a better understanding of the effectiveness of telehealth interventions.  
    • Action: Conduct long-term follow-up assessments to evaluate the sustainability and lasting effects of hybrid care models on chronic pain management and SUD care. Evaluate both patient outcomes and system-wide impacts.  
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain or/or SUD. 
    • Action: Educate and train health care professionals on privacy regulations, data security best practices, and the importance of patient confidentiality, ensuring that they understand and follow the necessary protocols when handling sensitive health information.  
    • Action: Involve patients in decisions regarding the use and sharing of their health data, considering their preferences and concerns to build trust and ensure that privacy is respected. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA.  
    • Action: Educate and train clinicians and health care professionals on appropriate claims submissions, billing practices, and fraud schemes to ensure compliance with regulations and reduce the risk of fraudulent activities.  
    • Action: Implement patient education programs to raise awareness of potential fraud schemes, including suspicious clinics or requests for personal information. 
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Develop and update clinical practice guidelines, with input from clinicians and people with lived experience, to prioritize the management of misuse and diversion therapeutically rather than enforcing “zero-tolerance” measures that may impede access to treatment. 
    • Action: Adapt diversion control strategies for the virtual environment, including the use of PDMPs, photo identification verification, drug screening with validity testing, pill counts, and monitored self-dosing, leveraging telehealth technologies such as remote patient monitoring and live video.  
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience. 
  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Develop evidence-based guidelines and best practices for discerning the appropriateness of telehealth versus in-person care, considering factors such as patient needs, treatment goals, the complexity of the patient’s condition, and their comfort with technology. 
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Develop, adopt, and use standardized, validated, and reliable outcome measures across studies to facilitate the comparison of results and enable a better understanding of the effectiveness of telehealth interventions. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain or/or SUD. 
    • Action: Educate and train health care professionals on privacy regulations, data security best practices, and the importance of patient confidentiality, ensuring that they understand and follow the necessary protocols when handling sensitive health information. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA.  
    • Action: Educate and train clinicians and health care professionals on appropriate claims submissions, billing practices, and fraud schemes to ensure compliance with regulations and reduce the risk of fraudulent activities. 
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Develop and update clinical practice guidelines, with input from clinicians and people with lived experience, to prioritize the management of misuse and diversion therapeutically rather than enforcing “zero-tolerance” measures that may impede access to treatment. 
    • Action: Adapt diversion control strategies for the virtual environment, including use of PDMPs, photo identification verification, drug screening with validity testing, pill counts, and monitored self-dosing, leveraging telehealth technologies such as remote patient monitoring and live video. 
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience. 
    • Action: Develop baseline process measures and gradually expand to include outcome measures as core treatment quality processes are strengthened. 
    • Action: Prioritize the adoption and effective use of EHRs to ensure precise and comprehensive data collection for quality measurement.  
  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Develop defined clinical pathways for hybrid care delivery, including decision trees that guide clinicians on when to integrate telehealth modalities and when to prioritize in-person care, based on objective patient assessment and individual circumstances. 
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain and/or SUD. 
    • Action: Establish and implement robust security standards and processes across all telehealth platforms and health systems, ensuring that patient data is protected from unauthorized access or breaches.  
    • Action: Develop and implement standards for interoperability and secure data transmission between various systems, devices, and software programs used in telehealth services.  
    • Action: Invest in the development of telehealth technologies, platforms, and software programs that prioritize privacy and confidentiality, implementing secure and use-friendly portals.  
    • Action: Establish thorough vetting and auditing processes to assess the practices of third-party vendors and contractors to ensure compliance with security measures and processes.  
    • Action: Involve patients in decisions regarding the use and sharing of their health data, considering their preferences and concerns to build trust and ensure that privacy is respected. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA 
    • Action: Continuously review and adapt policies and regulations to address emerging fraud schemes and strengthen enforcement and oversight of existing regulations and laws, particularly in the areas of chronic pain management and SUD treatment.  
    • Action: Leverage data analytics and monitoring tools, including PDMPs and EHRs, to identify unusual prescribing patterns, clinician outliers, and potential cases of inappropriate treatment, prompting further investigation and intervention.  
    • Action: Implement patient education programs to raise awareness of potential fraud schemes, including suspicious clinics or requests for personal information. 
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Adapt diversion control strategies for the virtual environment, including use of PDMPs, photo identification verification, drug screening with validity testing, pill counts, and monitored self-dosing, leveraging telehealth technologies such as remote patient monitoring and live video. 
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience. 
    • Action: Develop baseline process measures and gradually expand to include outcome measures as core treatment quality processes are strengthened. 
    • Action: Prioritize the adoption and effective use of EHRs to ensure precise and comprehensive data collection for quality measurement. 
    • Action: Support the development and implementation of standardized quality measures through regulations and financial incentives while considering the potential burden on clinicians and ensuring alignment with shared goals of improving the quality and outcomes of chronic pain management and SUD care.  
    • Action: Incorporate standardized quality measures into value-based payment models to drive quality improvement efforts, ensure coordinated care, and address health disparities in underserved populations.  
  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Develop evidence-based guidelines and best practices for discerning the appropriateness of telehealth versus in-person care, considering factors such as patient needs, treatment goals, the complexity of the patient’s condition, and their comfort with technology. 
    • Action: Invest in further research on the effectiveness of telehealth and hybrid models of care for managing chronic pain and SUD, including comparative studies against in-person care to validate these models’ efficacy and inform evidence-based guidelines.  
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Expand the number of studies, using a range of study designs and methodologies, to evaluate the value and effectiveness of telehealth interventions, such as remote patient monitoring and digital therapeutics, for chronic pain management and SUD care.  
    • Action: Allocate funding and resources toward research efforts aimed at evaluating the efficacy and effectiveness of telehealth and hybrid models of care for chronic pain management and SUD treatment. 
    • Action: Develop, adopt, and use standardized, validated, and reliable outcome measures across studies to facilitate the comparison of results and enable a better understanding of the effectiveness of telehealth interventions. 
    • Action: Conduct long-term follow-up assessments to evaluate the sustainability and lasting effects of hybrid care models on chronic pain management and SUD care. Evaluate both patient outcomes and system-wide impacts. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain and/or SUD. 
    • Action: Establish and implement robust security standards and processes across all telehealth platforms and health systems, ensuring that patient data is protected from unauthorized access or breaches. 
    • Action: Develop and implement standards for interoperability and secure data transmission between various systems, devices, and software programs used in telehealth services. 
    • Action: Continuously review and update privacy regulations to address the evolving landscape of telehealth and patient data security. This includes considering the specific needs and vulnerabilities of patients with sensitive health conditions, such as chronic pain and SUD.  
    • Action: Invest in the development of telehealth technologies, platforms, and software programs that prioritize privacy and confidentiality, implementing secure and use-friendly portals. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA 
    • Action: Continuously review and adapt policies and regulations to address emerging fraud schemes and strengthen enforcement and oversight of existing regulations and laws, particularly in the areas of chronic pain management and SUD treatment.  
    • Action: Leverage data analytics and monitoring tools, including PDMPs and EHRs, to identify unusual prescribing patterns, clinician outliers, and potential cases of inappropriate treatment, prompting further investigation and intervention. 
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Develop and update clinical practice guidelines, with input from clinicians and people with lived experience, to prioritize the management of misuse and diversion therapeutically rather than enforcing “zero-tolerance” measures that may impede access to treatment. 
    • Action: Monitor and evaluate the impact of expanded treatment access, including remote prescribing of MOUD and take-home doses of methadone, on substance diversion and misuse. Similarly, monitor the impact of diversion measures on treatment access.  
    • Action: Adapt diversion control strategies for the virtual environment, including the use of PDMPs, photo identification verification, drug screening with validity testing, pill counts, and monitored self-dosing, leveraging telehealth technologies such as remote patient monitoring and live video. 
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience. 
    • Action: Support the development and implementation of standardized quality measures through regulations and financial incentives while considering the potential burden on clinicians and ensuring alignment with shared goals of improving the quality and outcomes of chronic pain management and SUD care. 
    • Action: Incorporate standardized quality measures into value-based payment models to drive quality improvement efforts, ensure coordinated care, and address health disparities in underserved populations. 
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications, and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain and/or SUD. 
    • Action: Invest in the development of telehealth technologies, platforms, and software programs that prioritize privacy and confidentiality, implementing secure and use-friendly portals. 
    • Action: Establish thorough vetting and auditing processes to assess the practices of third-party vendors and contractors to ensure compliance with security measures and processes. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA 
    • Action: Continuously review and adapt policies and regulations to address emerging fraud schemes and strengthen enforcement and oversight of existing regulations and laws, particularly in the areas of chronic pain management and SUD treatment.  
    • Action: Leverage data analytics and monitoring tools, including PDMPs and EHRs, to identify unusual prescribing patterns, clinician outliers, and potential cases of inappropriate treatment, prompting further investigation and intervention. 
  • Challenge – Lack of Consensus Quality Measures for Chronic Pain Treatment and SUD Treatment (both for In-Person and Telehealth): The absence of standardized, consensus quality measures for both in-person and telehealth care, hinders the effective evaluation and improvement of care quality. 
    • Action: Collaborate to develop and implement standardized, consensus-based quality measures for both chronic pain management and SUD care across care modalities and treatment settings, considering input from all stakeholders, including individuals with lived experience. 
    • Action: Prioritize research on the development and evaluation of quality measures, as well as the effectiveness of telehealth-enabled interventions and hybrid models aimed at improving chronic pain management and SUD care.  
  • Challenge – Lack of Guidelines and Best Practices for Determining which Aspects of Care are Most Appropriate for Telehealth versus In-Person Care: Establishing guidelines and best practices to determine the most effective use of telehealth versus in-person care for chronic pain and/or SUD treatment is hindered by a lack of comprehensive evidence on optimal modalities and approaches tailored to diverse patient needs. 
    • Action: Invest in further research on the effectiveness of telehealth and hybrid models of care for managing chronic pain and SUD, including comparative studies against in-person care to validate these models’ efficacy and inform evidence-based guidelines. 
    • Action: Conduct ongoing evaluations of telehealth’s efficacy, safety, and patient outcomes to ensure that patients receive the best possible care, whether in-person or via telehealth.  
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Expand the number of studies, using a range of study designs and methodologies, to evaluate the value and effectiveness of telehealth interventions, such as remote patient monitoring and digital therapeutics, for chronic pain management and SUD care. 
    • Action: Develop, adopt, and use standardized, validated, and reliable outcome measures across studies to facilitate the comparison of results and enable a better understanding of the effectiveness of telehealth interventions. 
    • Action: Conduct long-term follow-up assessments to evaluate the sustainability and lasting effects of hybrid care models on chronic pain management and SUD care. Evaluate both patient outcomes and system-wide impacts. 
    • Action: Ensure the research includes diverse patient populations to enhance the generalizability of findings and address potential disparities in access to and effectiveness of telehealth and hybrid care models.  
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications, and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness. 
  • Challenge – Detecting and Preventing Fraud, Waste, and Abuse in Chronic Pain Management and SUD Treatment: Combatting fraud, waste, and abuse is critical to control costs, protect patient data, and ensure effective care, necessitating collaboration, and data analytics for proactive detection and prevention. 
    • Action: Collaborate and establish partnerships to facilitate information sharing, identify emerging fraud schemes, develop effective strategies, and adapt policies and tools to counter FWA. 
  • Challenge – Competing Focus on Diversion of Controlled Substances versus Access to Treatment: Balancing the prevention of controlled substance diversion with improving access to treatment for chronic pain and SUD requires person-centered, innovative approaches to avoid limiting access to essential treatment. 
    • Action: Monitor and evaluate the impact of expanded treatment access, including remote prescribing of MOUD and take-home doses of methadone, on substance diversion and misuse. Similarly, monitor the impact of diversion measures on treatment access.
  • Challenge – Need for Comprehensive Evidence to Determine the Effectiveness of Telehealth and Hybrid Models of Care for Chronic Pain Management and SUD Treatment: To comprehensively assess the effectiveness of telehealth and hybrid care models in chronic pain management and SUD treatment, more extensive and in-depth research and data are needed. 
    • Action: Collect, analyze, and integrate data from traditional and non-traditional sources, including payers, clinicians, provider groups, telecommunications, and software companies, EHR vendors, community-based organizations, and patient-reported outcomes, to gain insights into real-world implementation and effectiveness. 
  • Challenge – Protecting Patients’ Privacy and Health Information Across Systems and Platforms: In a quickly evolving digital health landscape, it is crucial to prioritize patient privacy and data security, especially for individuals with sensitive health conditions like chronic pain and/or SUD. 
    • Action: Establish and implement robust security standards and processes across all telehealth platforms and health systems, ensuring that patient data is protected from unauthorized access or breaches. 
    • Action: Invest in the development of telehealth technologies, platforms, and software programs that prioritize privacy and confidentiality, implementing secure and use-friendly portals. 
    • Action: Involve patients in decisions regarding the use and sharing of their health data, considering their preferences and concerns to build trust and ensure that privacy is respected. 

Align Regulations and Payment Policies with Evidence-Based Care

This opportunity area calls for the alignment of regulations and payment policies with the most current evidence-based practices in chronic pain management and SUD care. This encompasses addressing issues such as restrictive practice parameters, reimbursement policies, and telehealth service coverage to foster a more supportive and less burdensome regulatory environment.

  • Challenge – Uncertainty About Continuation of Pandemic-Era Regulatory Flexibilities: The future of hybrid care and its ability to ensure equitable access to evidence-based care depends on the continuation of pandemic-era regulatory flexibilities, including reimbursement policies and the waiver of in-person examination requirements for prescribing controlled substances like MOUD. 
    • Action: Implement innovative reimbursement models that incentivize and reimburse clinicians based on the quality and outcomes of care delivered via telehealth, rather than the quantity of services provided.  
  • Challenge – Large and Complex Regulatory Differences in State Rules and Regulations: Navigating the complex web of varied state regulations governing chronic pain management, SUD treatment, and telehealth poses a significant barrier to advancing hybrid care, requiring a coordinated effort at federal and state levels to harmonize guidelines and regulations for high-quality care. 
    • Action: Collaborate to harmonize state laws and regulations that govern the treatment of SUD and chronic pain, with a focus on aligning regulations with evidence-based practice.  
    • Action: Collaborate to develop consistent regulations and guidelines for interstate telehealth practice, including clarifying licensure requirements for telehealth practitioners and determining which state laws apply during cross-border telehealth encounters.  
  • Challenge – Inconsistent Billing, Coverage, and Reimbursement Policies Across States and Payers: Inconsistent billing, coverage, and reimbursement policies across states and payers complicate the provision and expansion of hybrid care for chronic pain and SUD, creating administrative hurdles and financial uncertainties for clinicians and limiting patient access to care. 
    • Action: Deploy “Any Willing Provider” laws, in which all licensed clinicians providing evidence-based care would be eligible for reimbursement, regardless of their medical specialty.  
  • Challenge – Balancing Quality and Cost Concerns: Balancing quality and cost concerns in advancing hybrid care for chronic pain and SUD involves ensuring effective telehealth services without escalating overall care costs, while addressing uncertainties in effectiveness, cost-effectiveness, and payment parity for such services. 
    • Action: Develop targeted reimbursement policies that incentivize clinicians to use evidence-based telehealth modalities and ensure that telehealth services are reimbursed at adequate rates.  
  • Challenge – Navigating the Complex Interplay Between Innovation and Pragmatism in the Telehealth Industry: Balancing innovation and pragmatism in the rapidly growing telehealth industry requires aligning technological advances with regulatory compliance, patient privacy, and system integration to improve patient outcomes. 
    • Action: Support research and development of innovative telehealth technologies and interventions, particularly for chronic pain management and SUD treatment, by allocating resources for pilot programs, offering incentives for innovation, and promoting evidence-based practices to ensure clinical effectiveness and improved patient outcomes.  
  • Challenge – Variation and Discrepancies in Telehealth Definitions and Terminology Among Legislators, Regulators, Federal Agencies, and Payers: The lack of standardized telehealth definitions and terminology across legislation, regulations, payment policies, best practices, guidelines, and research creates confusion, emphasizing the need for consensus and clarity in defining these terms. 
    • Action: Establish standard, consensus-based definitions and terms for telehealth, and implement their usage across federal agencies, states, payers, and health care organizations to promote clarity and consistency.  
  • Challenge – Large and Complex Regulatory Differences in State Rules and Regulations: Navigating the complex web of varied state regulations governing chronic pain management, SUD treatment, and telehealth poses a significant barrier to advancing hybrid care, requiring a coordinated effort at federal and state levels to harmonize guidelines and regulations for high-quality care. 
    • Action: Collaborate to harmonize state laws and regulations that govern the treatment of SUD and chronic pain, with a focus on aligning regulations with evidence-based practice.  
    • Action: Collaborate to develop consistent regulations and guidelines for interstate telehealth practice, including clarifying licensure requirements for telehealth practitioners and determining which state laws applying during cross-border telehealth encounters. 
  • Challenge – Inconsistent Billing, Coverage, and Reimbursement Policies Across States and Payers: Inconsistent billing, coverage, and reimbursement policies across states and payers complicate the provision and expansion of hybrid care for chronic pain and SUD, creating administrative hurdles and financial uncertainties for clinicians and limiting patient access to care. 
    • Action: Deploy “Any Willing Provider” laws, in which all licensed clinicians providing evidence-based care would be eligible for reimbursement, regardless of their medical specialty. 
    • Action: Provide comprehensive education, training, and resources for health care professionals to navigate the complex telehealth billing landscape, understand evolving telehealth regulations, and make informed decisions about offering telehealth services.  
  • Challenge – Variation and Discrepancies in Telehealth Definitions and Terminology Among Legislators, Regulators, Federal Agencies, and Payers: The lack of standardized telehealth definitions and terminology across legislation, regulations, payment policies, best practices, guidelines, and research contributes to confusion and miscommunication, emphasizing the need for consensus and clarity in defining these terms. 
    • Action: Establish standard, consensus-based definitions and terms for telehealth, and implement their usage across federal agencies, states, payers, and health care organizations to promote clarity and consistency. 
  • Challenge – Navigating the Complex Interplay Between Innovation and Pragmatism in the Telehealth Industry: Balancing innovation and pragmatism in the rapidly growing telehealth industry requires aligning technological advances with regulatory compliance, patient privacy, and system integration to improve patient outcomes. 
    • Action: Prioritize the development and use of secure data exchange protocols to protect patient privacy and promote seamless communication among clinicians and telehealth systems.  
  • Challenge – Variation and Discrepancies in Telehealth Definitions and Terminology Among Legislators, Regulators, Federal Agencies, and Payers: The lack of standardized telehealth definitions and terminology across legislation, regulations, payment policies, best practices, guidelines, and research creates confusion, emphasizing the need for consensus and clarity in defining these terms. 
    • Action: Establish standard, consensus-based definitions and terms for telehealth, and implement their usage across federal agencies, states, payers, and health care organizations to promote clarity and consistency. 
    • Action: Identify types of services and technologies covered under “telehealth” within legal requirements and reimbursement policies.  
  • Challenge – Uncertainty About Continuation of Pandemic-Era Regulatory Flexibilities: The future of hybrid care and its ability to ensure equitable access to evidence-based care depends on the continuation of pandemic-era regulatory flexibilities, including reimbursement policies and the waiver of in-person examination requirements for prescribing controlled substances like MOUD. 
    • Action: Implement permanent regulatory changes to remove medically unnecessary restrictions, including the in-person examination requirement for the remote prescribing of MOUD, instead deferring to clinical judgment and individual patient needs as the basis for determining the appropriateness for remote prescribing.  
    • Action: Sustain pandemic-era regulatory changes governing payment parity and adequate reimbursement.  
    • Action: Implement innovative reimbursement models that incentivize and reimburse clinicians based on the quality and outcomes of care delivered via telehealth, rather than the quantity of services provided. 
  • Challenge – Large and Complex Regulatory Differences in State Rules and Regulations: Navigating the complex web of varied state regulations governing chronic pain management, SUD treatment, and telehealth poses a significant barrier to advancing hybrid care, requiring a coordinated effort at federal and state levels to harmonize guidelines and regulations for high-quality care. 
    • Action: Collaborate to harmonize state laws and regulations that govern the treatment of SUD and chronic pain, with a focus on aligning regulations with evidence-based practice.  
    • Action: Collaborate to develop consistent regulations and guidelines for interstate telehealth practice, including clarifying licensure requirements for telehealth practitioners and determining which state laws apply during cross-border telehealth encounters. 
  • Challenge – Variation in Credentialing and Interstate Licensing Requirements: State-specific credentialing and licensing requirements create barriers in delivering hybrid care for chronic pain and SUD, hindering health care professionals’ ability to practice across states and limiting patient access, especially in rural and underserved areas. 
    • Action: Promote and incentivize states to participate in interstate compacts and/or licensure reciprocity agreements.   
    • Action: Reduce application and licensure fees associated with interstate compacts to incentivize more professionals to treat patients in multiple states.  
    • Action: Develop additional interstate compacts for professions beyond medicine, nursing, and physical therapy.  
    • Action: Establish more standardized credentialing and licensing requirements across states to streamline processes and reduce duplication of effort and costs for clinicians seeking to practice in multiple states.  
    •  Action: Establish state telehealth registration for physicians to practice telehealth in additional states.  
  • Challenge – Inconsistent Billing, Coverage, and Reimbursement Policies Across States and Payers: Inconsistent billing, coverage, and reimbursement policies across states and payers complicate the provision and expansion of hybrid care for chronic pain and SUD, creating administrative hurdles and financial uncertainties for clinicians and limiting patient access to care. 
    • Action: Develop and implement clear and consistent reimbursement policies to ensure clinicians receive adequate reimbursement for services and patients have equal and equitable access to care, regardless of insurance status, state of residence, or modality of care.  
    • Action: Deploy “Any Willing Provider” laws, in which all licensed clinicians providing evidence-based care would be eligible for reimbursement, regardless of their medical specialty. 
    • Action: Expand coverage for audio-only visits and provide adequate reimbursement rates to ensure clinicians are available for those who lack access to sufficient broadband or live video technology.  
    • Action: Provide comprehensive education, training, and resources for health care professionals to navigate the complex telehealth billing landscape, understand evolving telehealth regulations, and make informed decisions about offering telehealth services. 
    • Action: Provide financial support to SUD and pain management clinicians for telehealth services, including technology, training, and education, to help them recoup the costs associated with offering essential telehealth services.  
  • Challenge – Balancing Quality and Cost Concerns: Balancing quality and cost concerns in advancing hybrid care for chronic pain and SUD involves ensuring effective telehealth services without escalating overall care costs, while addressing uncertainties in effectiveness, cost-effectiveness, and payment parity for such services. 
    • Action: Develop targeted reimbursement policies that incentivize clinicians to use evidence-based telehealth modalities and ensure that telehealth services are reimbursed at adequate rates. 
  • Challenge – Navigating the Complex Interplay Between Innovation and Pragmatism in the Telehealth Industry: Balancing innovation and pragmatism in the rapidly growing telehealth industry requires aligning technological advances with regulatory compliance, patient privacy, and system integration to improve patient outcomes. 
    • Action: Support research and development of innovative telehealth technologies and interventions, particularly for chronic pain management and SUD treatment, by allocating resources for pilot programs, offering incentives for innovation, and promoting evidence-based practices to ensure clinical effectiveness and improved patient outcomes. 
    • Action: Foster collaboration and partnerships among regulatory bodies, technology development companies, health systems and treatment programs, payers, clinicians, and patients to facilitate information exchange, share best practices, and develop coordinated strategies to address challenges in the telehealth sector.  
    • Action: Create flexible yet robust regulatory frameworks that can keep pace with rapidly evolving telehealth technologies, ensuring safety and efficacy while minimizing approval delays.  
    • Action: Encourage the adoption of standardized data formats and protocols to improve interoperability among telehealth devices, EHR systems, and other health care platforms.  
    • Action: Prioritize the development and use of secure data exchange protocols to protect patient privacy and promote seamless communication among clinicians and telehealth systems. 
    • Action: Establish and disseminate robust cybersecurity guidelines and best practices for technology development companies, health systems, and payers, safeguarding patient data and ensuring secure communication channels.  
    • Action: Establish programs, grants, and financial incentives to encourage the development of innovative telehealth technologies, particularly in areas such as chronic pain management and SUD treatment.  
  • Challenge – Variation and Discrepancies in Telehealth Definitions and Terminology Among Legislators, Regulators, Federal Agencies, and Payers: The lack of standardized telehealth definitions and terminology across legislation, regulations, payment policies, best practices, guidelines, and research creates confusion, emphasizing the need for consensus and clarity in defining these terms. 
    • Action: Establish standard, consensus-based definitions and terms for telehealth, and implement their usage across federal agencies, states, payers, and health care organizations to promote clarity and consistency. 
  • Challenge – Uncertainty About Continuation of Pandemic-Era Regulatory Flexibilities: The future of hybrid care and its ability to ensure equitable access to evidence-based care depends on the continuation of pandemic-era regulatory flexibilities, including reimbursement policies and the waiver of in-person examination requirements for prescribing controlled substances like MOUD. 
    • Action: Sustain pandemic-era regulatory changes governing payment parity and adequate reimbursement.  
    • Action: Implement innovative reimbursement models that incentivize and reimburse clinicians based on the quality and outcomes of care delivered via telehealth, rather than the quantity of services provided. 
  • Challenge – Inconsistent Billing, Coverage, and Reimbursement Policies Across States and Payers: Inconsistent billing, coverage, and reimbursement policies across states and payers complicate the provision and expansion of hybrid care for chronic pain and SUD, creating administrative hurdles and financial uncertainties for clinicians and limiting patient access to care. 
    • Action: Develop and implement clear and consistent reimbursement policies to ensure clinicians receive adequate reimbursement for services and patients have equal and equitable access to care, regardless of insurance status, state of residence, or modality of care.  
    • Action: Deploy “Any Willing Provider” laws, in which all licensed clinicians providing evidence-based care would be eligible for reimbursement, regardless of their medical specialty. 
    • Action: Expand coverage for audio-only visits and provide adequate reimbursement rates to ensure clinicians are available for those who lack access to sufficient broadband or live video technology.  
    • Action: Provide comprehensive education, training, and resources for health care professionals to navigate the complex telehealth billing landscape, understand evolving telehealth regulations, and make informed decisions about offering telehealth services. 
    • Action: Provide financial support to SUD and pain management clinicians for telehealth services, including technology, training, and education, to help them recoup the costs associated with offering essential telehealth services. 
  • Challenge – Balancing Quality and Cost Concerns: Balancing quality and cost concerns in advancing hybrid care for chronic pain and SUD involves ensuring effective telehealth services without escalating overall care costs while addressing uncertainties in effectiveness, cost-effectiveness, and payment parity for such services. 
    • Action: Develop targeted reimbursement policies that incentivize clinicians to use evidence-based telehealth modalities and ensure that telehealth services are reimbursed at adequate rates. 
    • Action: Establish reimbursement models that optimally integrate coverage, care, and the use of measurement-based approaches and digital capabilities to support the implementation and sustainability of hybrid care for patients with chronic pain and/or SUD.  
  • Challenge – Balancing Quality and Cost Concerns: Balancing quality and cost concerns in advancing hybrid care for chronic pain and SUD involves ensuring effective telehealth services without escalating overall care costs while addressing uncertainties in effectiveness, cost-effectiveness, and payment parity for such services. 
    • Action: Encourage research into the use of remote monitoring and medication management tools to improve patient outcomes and decrease costs by reducing the need for more expensive and resource-intensive care.  
    • Action: Conduct more robust research to establish the effectiveness and cost-effectiveness of telehealth for chronic pain and/or SUD, including cost savings associated with telehealth and the effectiveness of different modalities.  
    • Action: Examine the potential impact of payment incentives, such as value-based and bundled payments, on promoting the appropriate use of hybrid care for patients with chronic pain and/or SUD.  
    • Action: Compare overall costs, public health imperative to treat at-risk individuals, and financial sustainability of telehealth and hybrid care with in-person care.  
  • Challenge – Navigating the Complex Interplay Between Innovation and Pragmatism in the Telehealth Industry: Balancing innovation and pragmatism in the rapidly growing telehealth industry requires aligning technological advances with regulatory compliance, patient privacy, and system integration to improve patient outcomes. 
    • Action: Support research and development of innovative telehealth technologies and interventions, particularly for chronic pain management and SUD treatment, by allocating resources for pilot programs, offering incentives for innovation, and promoting evidence-based practices to ensure clinical effectiveness and improved patient outcomes. 
  • Challenge – Navigating the Complex Interplay Between Innovation and Pragmatism in the Telehealth Industry: Balancing innovation and pragmatism in the rapidly growing telehealth industry requires aligning technological advances with regulatory compliance, patient privacy, and system integration to improve patient outcomes. 
    • Action: Support research and development of innovative telehealth technologies and interventions, particularly for chronic pain management and SUD treatment, by allocating resources for pilot programs, offering incentives for innovation, and promoting evidence-based practices to ensure clinical effectiveness and improved patient outcomes. 

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