Payer Readiness for Technology Implementation (P-RTI) Tool Application and Assessment

Patient-centered telemedicine applications can provide access to hard-to-reach populations and extend a clinician’s ability to monitor and influence patient behavior beyond the exam room. Despite the promise of telemedicine, its potential benefits have not been fully achieved. Adoption has been slow and is disproportionally lower in the substance use disorders (SUDs) field, which affects 24 million Americans a year. Additionally, many injuries and chronic diseases including cancer, diabetes, and cardiovascular problems are caused or exacerbated by SUD. Improving telemedicine adoption provides an opportunity to reduce the gap between suggested evidenced-based digital health use and actual practice.

This study consisted of two analyses: a) the assessment of interest and use for patient-centered technologies in the SUDs treatment field and b) a multilevel technology adoption analysis of how payer and provider variables affected the use of telephonic- and video-based SUD therapy. Telephonic-based therapy, where therapists hold treatment sessions over the phone, can result in greater substance use abstinence than in-person therapy. Video-to-video therapy, where patients and clients interact through a web camera, historically increases access to SUD services, performs as well as face-to-face visits, and is preferred by patients due to convenience and confidentiality.

The specific aims of this project were originally as follows:

• Develop strategies to increase use of telemedicine technologies capable of improving addiction treatment quality and access. 
• Determine the level of interest in different patient-centered health IT for addiction treatment and recovery. 
• Determine ways to improve diffusion of evidence-based telemedicine applications from research into real-world practice. 

The original purpose of the study was to test an instrument called the Payer Readiness for Technology Implementation (P-RTI) tool on use of telephonic- and video-based therapy. However, the scope of the study expanded and the instrument, as well as the payer- and provider-level moderating factors, were included as part of the analyses.

Researchers conducted a cross-sectional survey analysis of telemedicine technology interest, use, and barriers in 342 SUD treatment organizations for 11 patient-centered technologies including texting; patient portals; computerized screenings; telephone-based therapy; and 3-D virtual worlds for treatment, where patients and therapists communicate through avatars. Investigators assessed technology adoption at the payer level using the P-RTI tool and payer processes of influence.

Among the 11 technologies assessed, there was high or very high interest among treatment organizations, ranging from a low of 36 percent for virtual worlds to a high of 70 percent for computerized screenings. The overall average interest in all the technologies assessed was 37 percent. The P-RTI tool analysis could not prospectively determine payer behaviors in supporting technology. However, providers’ assessments of payer support of telephonic- and video-based technologies were associated with provider readiness to adopt a targeted technology. Findings indicate that use of telemedicine in SUD treatment settings may begin with computerized assessments and texting appointment reminders, followed by the use of telephone, video, and mobile health applications. Currently, however, there continues to be a significant gap between research findings and application.