The COVID-19 pandemic has accelerated the adoption of telehealth across the healthcare industry, including behavioral health and substance use disorder (SUD) treatment. While many organizations quickly implemented telehealth programs in response to the crisis, Intermountain Healthcare, a not-for-profit health system based in Salt Lake City, had already been developing tele-behavioral health services for years. With the onset of COVID-19, the organization leveraged regulatory flexibilities to expand and enhance its medication-assisted treatment (MAT) programs for SUD.
Telehealth Adoption Among Behavioral Health Providers
According to a survey conducted by Tridiuum, a digital behavioral health solutions provider, over 80% of behavioral health organizations began using telehealth for the first time during the pandemic. While many providers scrambled to establish remote care options, Intermountain had a head start, with existing telehealth infrastructure in place for behavioral health services. This early adoption positioned the organization to adapt quickly to the unique challenges posed by COVID-19.
Overcoming Regulatory Barriers
A major challenge for tele-SUD programs has historically been the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which requires in-person evaluations before prescribing certain controlled substances. This law has limited the ability of MAT programs to fully leverage telehealth, particularly for new patients.
The pandemic, however, prompted temporary regulatory changes. The Substance Abuse and Mental Health Services Administration (SAMHSA) allowed opioid treatment programs (OTPs) to remotely prescribe buprenorphine to new patients, provided they can be adequately assessed via telehealth. This flexibility, combined with insurer support for home-based treatment, has enabled Intermountain to expand access to MAT services during the public health emergency.
Expanding Access to MAT
MAT is a cornerstone of SUD treatment, combining counseling with medications such as buprenorphine, methadone, and naltrexone to help manage cravings and withdrawal symptoms. Intermountain’s approach now allows patients to receive MAT from home or from participating clinical sites without an initial in-person visit. This expansion addresses two significant challenges: a limited number of waivered prescribers and geographically dispersed patient populations.
Kerry Palakanis, Executive Director of Connect Care Operations at Intermountain, notes that telehealth could account for at least 50% of SUD treatment going forward if regulatory flexibilities remain in place. By leveraging telehealth, providers can reach more patients across wider geographic areas, particularly in rural communities where access to care has historically been limited.
Building the Tele-SUD Program
Intermountain Healthcare operates 24 hospitals, approximately 160 clinics, and its own health insurance plan. Its behavioral health services include outpatient SUD treatment through the Dayspring program, three behavioral health access centers designed to address mental health crises, and a growing number of tele-behavioral health programs.
The organization’s tele-behavioral health offerings include Crisis Care, which provides remote support to 40 outreach facilities and hospital emergency departments. In response to COVID-19, Intermountain also established a behavioral health access line to assist patients experiencing pandemic-related mental health concerns.
The centerpiece of Intermountain’s telehealth expansion is its virtual behavioral health program, which includes tele-SUD services. Palakanis emphasizes that this program has been in development for over a year, and the pandemic accelerated its adoption and regulatory acceptance.
Telehealth Experience and Expertise
Palakanis brings extensive experience in tele-SUD programs, having worked in rural Maryland to provide remote MAT services where local providers lost their waivers. Her experience helped inform Intermountain’s approach to telehealth and MAT expansion, particularly in reaching patients who face geographic or logistical barriers to in-person care.
In previous pre-pandemic models, patients would travel to nearby health departments or behavioral health providers to receive telehealth consultations and medication therapy. Intermountain mirrored this model in rural areas such as western Montana and central Utah, using clinical sites as hubs for remote MAT delivery.
Adapting to COVID-19 Flexibilities
The COVID-19 public health emergency allowed Intermountain to deliver MAT services to new patients without an initial in-person evaluation. Patients can access telehealth sessions from home, an Intermountain facility, a community behavioral health provider, or through an emergency department appointment. Intermountain then provides a secure link for virtual visits via smartphone, computer, or tablet, making treatment more accessible and convenient.
These flexibilities have significantly expanded Intermountain’s reach, allowing providers to serve a larger number of patients efficiently. However, Palakanis notes that the long-term permanence of these waivers remains uncertain, and organizations must plan for potential regulatory changes once the public health emergency ends.
Planning for Long-Term Tele-SUD Care
Intermountain has a contingency plan to continue providing tele-SUD services even if temporary COVID-19 waivers expire. The organization can revert to its original model, working with clinical sites to tele-prescribe MAT medications. This approach continues to address the challenge of limited waivered prescribers while maintaining access to care for remote and underserved populations.
Palakanis advises other behavioral health providers to start by identifying the specific challenges they need to address, such as staffing, technology, and patient access. From there, organizations can build sustainable telehealth programs tailored to their needs and patient populations.
Considerations for Sustainable Telehealth
While COVID-19 waivers allow providers to use platforms like Google, FaceTime, and Skype temporarily, these solutions are not ideal for long-term care delivery. Providers should evaluate more secure and reliable telehealth platforms to ensure privacy, compliance, and scalability.
Planning for long-term telehealth infrastructure involves considering equipment, secure communication platforms, staffing, and workflow integration. By proactively developing these systems, behavioral health providers can maintain quality care while expanding access through telehealth.
Conclusion
Intermountain Healthcare’s tele-SUD program demonstrates how proactive planning and regulatory flexibility can transform behavioral health care delivery. By leveraging telehealth, the organization has expanded access to MAT, reached underserved communities, and adapted quickly to the challenges of the COVID-19 pandemic.
While regulatory uncertainties remain, Intermountain has developed a roadmap to sustain tele-SUD services long-term. Other behavioral health providers can learn from this model by identifying key challenges, leveraging technology, and preparing for scalable telehealth solutions that meet patient needs in both rural and urban settings.
Telehealth has proven to be an essential tool in behavioral health care, and organizations like Intermountain are leading the way in creating sustainable, accessible, and effective SUD treatment programs for the future.
