Dr. Nishi Rawat presents a personal story about substance use, stigma, and solutions at the 2022 NCQA Quality Talks

Dr. Nishi Rawat presents a personal story about substance use, stigma, and solutions at the 2022 NCQA Quality Talks

Nishi Rawat, M.D., chief clinical officer of Bamboo Health, spoke to a crowd of more than 1,000 registrants on Thursday at the 2022 Quality Talks presented by the National Committee for Quality Assurance (NCQA) in Washington, DC.  

Dr. Rawat’s remarks were part of a conference section centered around the broad topic of “Smarter Tech, Safer Care and Better Outcomes.” Her talk focused on substance use: the current state, what led to the problem, challenges, and solutions. 

She began with a personal story about her work as a critical care physician, when the mother of a teenage patient begged Dr. Rawat not to discharge him after he recovered from a drug overdose. “During his stay, I hear his parents calling treatment program after treatment program with no luck. Feeling their desperation, I make some calls and faxes myself, without success. I have to discharge Oscar,” Rawat said. Although that was more than a decade ago, she realized it was only the beginning of the opioid epidemic.

As Dr. Rawat went through residency and fellowships, drug overdose deaths doubled from around 1,000 per year to more than 20,000. While that seemed staggering at the time, provisional data from the Centers for Disease Control show more than 105,000 have died over the last year. “How did we get here? Because of three drivers: physical pain, mental pain, and economic pain,” Rawat said.  

Dr. Rawat argued that the challenge is stigma, which drives the lack of: 

  • Empathy. The belief that substance use disorder is a moral failure. 
  • Access to and recognition of evidence-based treatment. 
  • Parity. The Mental Health Parity and Addiction Equity Act passed 15 years ago, requiring insurers to cover behavioral health benefits at the same level as physical health. Unfortunately, a recent report from the federal government to Congress found many people are still being denied evidence-based therapy.  
  • Connectivity. In behavioral health, clinicians do not have the data they need at their fingertips, let alone usable data, to make informed care decisions. 

There are ways to overcome the challenges. “This problem seems insurmountable. But it’s not. Like many things, it’s going to take a village,” Rawat said. Solutions are largely in these four categories: 

  • Prevention 
  • Harm reduction 
  • Access to affordable, evidence-based treatment 
  • Recovery support resources 

Dr. Rawat argues that technology can help, in particular, for prevention and access to treatment. 

  • Prevention technologies support:
    • Screening assessments at scale, and 
    • Tracking of controlled substance prescribing
  • Technology facilitates access to treatment through: 
    • Telehealth 
    • Care coordination 
    • Integration of physical and behavioral health at the point of care 
    • Crisis care, in particular the implementation of 988 – akin to 911 – as the new easy-to-remember number for individuals facing a behavioral health emergency 

“The best technologies, however, are the ones that will amplify hands-on care,” Rawat added.  

In the conclusion to her remarks, Dr. Rawat challenged the audience to be part of the village working towards a solution. “It doesn’t matter how you contribute. Just that you do.” 

Thank you to NCQA for inviting Dr. Rawat as one of the 10 fantastic event speakers. We look forward to sharing the video recording of her presentation once it is available in a few months.