Advancing Health Equity in Opioid Use Disorder: Key Steps and Strategies

As I write about the importance of health equity during National Minority Health Month, I am reminded of my mother’s journey navigating the healthcare system. While working in a factory, my mother was diagnosed with lung cancer. When she became too sick to work, she could no longer keep her employer health benefits. Yet, she could not spend her assets quickly enough to qualify for Medicaid and receive the care she deserved. She passed in 2009 while uninsured and unable to afford necessary treatment. I often think back to how her end-of-life care would’ve been different if health equity, meaning the absence of unfair and avoidable barriers to healthcare access, was a pillar of our society. It is my mom’s story and so many others like her that drive me to advocate for policies that dismantle barriers to care.

My dedication is mirrored in Braeburn’s purpose to transform the management of OUD to help people begin and sustain their recovery. Each day, we keep the people with OUD, and their families, in mind, aiming to create a world where every person with OUD gets the best possible care and opportunity to reach their full potential. Health equity is inextricably tied to our purpose. We understand that addressing health equity is a complex challenge that demands collective action and a holistic approach from diverse stakeholders beyond Braeburn alone. From policymakers and healthcare providers to community organizations and individual advocates, it will require a concerted effort from all sectors of society to enact meaningful change and ensure equitable access to healthcare for all.

As the Director of Government Affairs at Braeburn, I have spent many hours considering steps that could advance health equity. I was delighted to see that Congress passed a provision this year that suspended, and did not terminate, health benefits while in carceral settings. The provision allows Medicaid to be reinstated upon release. This is a step in the right direction, and I know there is more positive change we can make together. I am excited to share some of my ideas with you.

Graphic showing the difference between equity and equality

Expand Medicaid: States should expand their Medicaid eligibility under the Affordable Care Act. There are numerous studies showing that states which expand their Medicaid eligibility experience improvements in access to treatment for patients in rural and underserved communities. To encourage conversations on this topic, creating a Healthcare Council of insurers, manufacturers, distributors, pharmacies and hospitals would be helpful. Members of the Council may agree on more aspects of the issue than they disagree. The Council could develop a report for Congress and the National Governor’s Association with solutions to improve health equity through Medicaid.

Offer Culturally-appropriate Care and Structural Support: Culturally-appropriate care is paramount in helping those living with OUD, recognizing the diverse needs and perspectives within communities. By tailoring treatment approaches to align with cultural values, traditions, and beliefs, individuals are more likely to engage and remain committed to their recovery journey. However, offering culturally-appropriate care alone may not suffice if individuals face practical barriers to accessing treatment. Structural support, such as housing assistance, transportation assistance, and childcare, plays a crucial role in breaking down these barriers. Government agencies and nonprofit organizations should work together to ensure support for all individuals seeking care.

Consider the Impact of Prior Authorizations for MOUD: Prior authorizations may present obstacles to patients seeking access to treatment. Providers need full access to all options in treating patients with OUD. Delays in access due to burdensome prior authorizations and non-clinically based step therapies may jeopardize medical adherence, timeliness of services, and ultimately endanger patient lives. Eliminating these administrative barriers is critical to minimizing treatment disruptions and medication nonadherence, particularly in communities disproportionately affected, such as Native American, Black and Hispanic communities. To move the needle on this issue, State Departments of Health and Human Services can examine the impact of prior authorization on utilization and the time to treatment.

During National Minority Health Month, it’s crucial to reflect on the ongoing challenges of and potential solutions for achieving health equity. While this goal may seem daunting given the current limitations within our systems and structures, it’s imperative for advocates to remain committed to this important cause. I encourage fellow advocates to actively engage with their communities, listen to their leaders, identify barriers to care, and collect data to inform meaningful solutions. By fostering collaboration and sharing knowledge, we can collectively work towards improving health equity for all members of society.