Welcome to the 21st WCP Virtual Congress Program Scheduling

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Background
Office-Based Opioid Treatment (OBOT) is a delivery model which seeks to make medications for opioid use disorder (MOUD), particularly buprenorphine, widely available in general medical clinics and offices. Despite evidence supporting its effectiveness and cost-effectiveness, uptake of the OBOT model has been relatively slow. One important barrier to faster diffusion of OBOT may be the financial challenges facing clinics that could adopt it.
Methods
We review key features and variants of the OBOT model, then discuss different approaches that have been used to fund it, and the findings from previous economic analyses of OBOT’s impact on organizational finances. We conclude by discussing the implications of these analyses for the financial sustainability of the OBOT delivery model.
Results
Like other novel services, OBOT poses challenges for providers due to its reliance on services which are ‘non-billable’ in a fee-for-service environment. A variety of approaches exist for covering the non-billable costs, but which approaches are feasible depends on local payer policies. The scale of the challenges varies with clinic size, organizational affiliations and the policies of the state where the clinic operates. Small clinics in a purely fee-for-service environment may be particularly challenged in pursuing OBOT, given the need to fund a dedicated staff and extra administrative work. The current pandemic may pose both opportunities and challenges for the sustainability of OBOT, with expanded access to telemedicine, but also uncertainty about the durability of the expansion.
Conclusion
The reimbursement environment for OBOT delivery varies widely around the US, and is evolving as Medicare (and possibly other payers) introduce alternative payment approaches. Clinics considering adoption of OBOT are well advised to thoroughly investigate these issues as they make their decision. In addition, payers will need to rethink how they pay for OBOT to make it sustainable.

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Objectives: This report applies a recovery perspective to inform mental health policy and research by focusing on the unexpected, uneven distribution of the economic burden of the mental health consequences of the coronavirus pandemic among different segments of the population by age. The goal of the analyses is to advise the allocation of public mental health interventions and financial resources to reduce the disproportionate mental health burden of the coronavirus pandemic on the younger age groups.
Methods: The study builds upon the mental health relevant literature emerged quickly during the coronavirus pandemic given the availability of a large data infrastructure created by a/low cost online survey methodology, and b/brief, scientifically validated mental health screening tools. The Center for Disease Control’s nationally representative PULSE survey and the screening data of Mental Health America are the key sources of the epidemiological analysis. Economic approach applied by Cutler and Summers (2020) is used for presentation of the economic magnitude of mental health impairment during the pandemic and return on mental health services and research investments provide economic rationale for the study’s recommendations.
Results: Throughout the COVID-19 pandemic the various surveys consistently reported increasing numbers of people experiencing anxiety, depression, psychosis, loneliness, and other mental health concerns. Some authors considered the 41% prevalence rate of mental distress an indicator of a mental health pandemic within the coronavirus pandemic. (Lake 2020). It was not expected that while the burden of the coronavirus pandemic caused physical illness and death disproportionately impacted the 65+ population, the negative mental health consequences of the pandemic primarily concentrated in the younger age groups: almost 2/3 of the population seeking for help for mental health conditions was in the 12-22 age group and considerable mental health distress in the 6-11 age group was reported by parents and teachers.
Conclusions: The author formulates four recommendations to reduce the disproportionate mental health burden of the coronavirus pandemic on the younger population with mental distress: 1/investing in training more mental health providers to scale up cost-effective psychosocial services in educational settings, 2/efficiently and equitably investing in long-term studies of the school-age and the young adult population of the pandemic whose psychological development have been disrupted by school closures (Di Nicola 2020), 3/investing in psychiatric epidemiology training and surveillance and 4/ investing in social safety net programs focusing on health related social needs (food and income security, housing, education) for the younger age groups. Society as a whole can observe high yields on human capital and human infrastructure related investments in these areas.
References:
Cutler DM, Summers LH: ”The COVID-19 Pandemic and the $16 Trillion Virus” JAMA 324 (15) 1495-1496 (2020).
Lake J: A Mental Health Pandemic: The Second Wave of Covid-19. Psychiatric Times, June 15, 2020
Di Nicola V, Daly N, Growing Up in a Pandemic: Biomedical and Psychological Impacts of the COVID-19 Crisis on Children and Families. World Social Psychiatry, 2020 2(2): 148-151.