By: Barry Doan
Original article published on Benefits Pro
The value of an employer’s health benefit strategy is intrinsically linked to its ability to address an employee’s total health—both physical and mental. That’s why overall wellness trends are shifting to better acknowledge the strong connection between a robust behavioral health care benefit and better overall health, ultimately resulting in improved employee productivity.
While many wellness programs today incorporate tactics that promote positive behavioral lifestyle changes, they often fall short of systematically addressing behavioral health conditions that can hinder an employee’s willingness and ability to embrace those needed changes. Altering entrenched behavioral health lifestyle patterns can be difficult, even if it’s a change that would be beneficial for the member. For instance, diabetic employees are much less likely to engage in diet and exercise programs when they are struggling with active depression that robs them of energy, focus and motivation. These members often represent a substantial percentage of those with chronic health conditions who make up a disproportional share of total healthcare expenditures.
This reality is why many companies are setting their sights on comprehensive employee “well-being” as opposed to “wellness” alone. By prioritizing access to both physical and behavioral health care, employers set the stage for more systemic and long-lasting engagement in self-care—and ultimately improve employee well-being, productivity and the bottom line. It’s important to note, however, that while many companies have invested heavily in identifying high-risk, high-cost employees and programs to engage these employees, access to care is still a major obstacle to this change process.
As part of this shift, many employers are incorporating telemedicine options into health benefit packages as a viable solution for addressing access issues related to traditional in-office care. Telepsychiatry is emerging as a growing opportunity within this movement as an effective means of overcoming common barriers to behavioral health utilization such as stigma, busy lifestyles and poor coordination of services. These models help attract busy and reluctant employees who might otherwise procrastinate getting the help they need.
As a clinical model that leverages videoconferencing technology, telepsychiatry and telebehavioral health are used for evaluations, consultations and ongoing treatment. Employees access this care through live, interactive communication with a licensed psychiatry or behavioral health provider in a private setting. This improved access allows employees to not only address their behavioral health concerns before issues become more acute and costly, but also to reduce the behavioral health impairment that interferes with their ability and desire to engage in employer wellness programs.
The behavioral health challenge
The statistics speak for themselves. Behavioral health issues were the leading cause of disability in 2015, accounting for one-third of new claims.
Depression, for instance, ranks high as an employer health challenge, racking up an estimated $210.5 billion per year — nearly half of which is attributed to workplace absenteeism and productivity losses. In fact, one study points to employer costs as high as $3,386 per individual over a two-year period prior to an employee’s depression diagnosis.
Behavioral health issues often impact the effectiveness of wellness programs directed at physical conditions due to existing co-morbidities. One study found that 45 percent of breast cancer patients also had a psychiatric disorder.
While these statistics may be startling, the good news is that companies can achieve notable return on investment in wellness and complex condition management programs by investing in mental health treatment. In one study, researchers found that for every dollar spent treating depression, $1.55 was spent on the effects of depression in the workplace.
It’s not always easy to quantify the impact of behavioral health treatment, but human resource managers overwhelmingly agree that a healthy, well balanced employee is a better teammate and more productive worker. Often, the problem is getting employees to utilize the behavioral health benefits that are already available to them.
Consider a common example: A company launches an active lifestyle program that includes tracking daily physical activity as one means of supporting the employee’s goals of improving her health. A single mom in the workforce, who already struggles with mild depression and anxiety, finds it difficult to rise to the challenge of addressing her wellness goals. Feelings of guilt and inadequacy over this “failure” exacerbate her behavioral health conditions, ultimately decreasing her physical activity and lowering her overall health scores. Unfortunately, the wellness coach does not recognize the behavioral health condition that is impairing participation and fails to make an appropriate referral for additional professional support. The employee becomes demoralized, feels even worse and drops out of the program, and an opportunity is lost.
Even when the employee recognizes the underlying behavioral health condition that is compromising her health and happiness, she may have challenges taking the desired action to address it. While an existing behavioral health benefit would cover the employee’s treatment, she still must do the following research:
- Identify what is wrong and what type of provider she needs to find
- Determine what her benefits cover
- Find which providers can she see that are covered
- Schedule her appointment
- Manage the logistics of attending the appointment which may include taking time off and arranging child care and transportation
Taking hold of the telepsychiatry opportunity
Offering telepsychiatry and other behavioral health care services as part of employee benefits is a trend on the rise, and for good reason
When employees can access psychiatrists and therapists from the comfort of their home or another private space, the behavioral health stigmas are reduced, and individuals are more apt to follow through with care plans. Privacy and confidentiality are also stronger with telepsychiatry because online sessions eliminate the potential of individuals seeing someone they know in a waiting room. Many patients also report greater comfort addressing difficult issues while in familiar surroundings.
Additionally, telepsychiatry expands scheduling options and provider choice, opening the door to greater access. Work and family schedules, for instance, can limit the ability of employees to access traditional services provided in an office setting. Through telepsychiatry, employees can schedule appointments in evenings or on weekends in addition to traditional weekday time slots, which reduces absenteeism or tardiness from work.
The reality is that patient satisfaction trends are higher with online psychotherapy as opposed to traditional face-to-face treatment. While telepsychiatry and telebehavioral health are not for every person, this approach to care addresses many of the common barriers to receiving prompt, professional behavioral health treatment that sets the stage for greater overall health and wellbeing.
Employers seeking to achieve the greatest return on health plan investment are wise to consider telepsychiatry and telebehavioral health as means for promoting use of behavioral health benefits. This effective model of care provides the needed framework for improving access to appropriate healthcare resources and empowering employees to take more control of their health.
By: James Varrell, M.D.
Originally published on Arizona Telemedicine Program
As a child and adolescent psychiatrist practicing in person for a number of years, and eventually making the shift to telepsychiatry, I have observed the subtle differences and nuances between the two mediums of care.
In my experience, telepsychiatry can be particularly powerful when working with children and teens. I had one experience with a 15-year-old adolescent who was admitted to the hospital for the fourth time with continued severe abdominal pain that could not be attributed to a medical cause. The hospital staff was puzzled, as the diagnostic tests did not show any signs of ailments and there were no physical afflictions present in the child. Interestingly enough, the teen had already been evaluated by another psychiatrist at the hospital, who was unable to get the teen to “open up.”
However, a caring on-site staff member had noted the teen admired technology. She recommended that the telemedicine cart that was normally used in the ED be brought up to the teen’s room to connect him to a telepsychiatrist who specializes in child and adolescent psychiatry. It was clear he felt much more at ease talking with me on a screen than he had been talking with his in-person providers. During our session, I was able to leverage his interest in technology, as well as my child and adolescent psychiatry experience, in order to ease his reservations about sharing his story. I found that in the past the teen had seen his brother shot in the stomach, causing psychological trauma that resulted in his abdominal pain.
Just as my experiences have shown, the effect of technology on children in a clinical setting has been researched and shown to have positive impacts in a number of ways. In one study, adolescents reported that telemedicine promoted a transfer of power and control by allowing them to feel more comfortable with terminating a consultation or walking out of it, that the process is more structured, and that the adolescents feel better informed when speaking with a telepsychiatry provider, which can result in a better understanding, sense of shared responsibility and better decision making.
Although telepsychiatry is almost identical to in-person psychiatry, there are small adaptations providers can make to facilitate responses, especially in the case of special populations, including children and adolescents. Provider flexibility is often the key to success. Slowing down your speech, communicating with gestures and remembering to not infantilize your speech when evaluating children can all contribute to establishing a more effective patient-provider relationship. I educate other telepsychiatrists about games they can play and questions they can ask to encourage children to interact with them more freely. It can also sometimes be beneficial to involve a child’s parents or an on-site facilitator in the session to observe interactions. These tactics have helped me gain trust and encourage meaningful responses from children I have treated through telepsychiatry.
In the case of the boy with stomach pain, instead of providing continued costly and time-consuming medical intervention, we were able to get him the appropriate psychiatric treatment after our conversation.
The best care, especially for children, adapts to the preferences and needs of each individual. Telemedicine is a fantastic tool for increasing specialty care options and making sure that every person can access the right provider and the right type of care for them.
By Jeanine Miles, LPC
Original article posted on NAMI
Unprecedented need exists for child and adolescent mental health services in today’s communities, however, parents have limited options at their disposal. Shortages of child psychologists and psychiatrists are leaving our most vulnerable populations without care. Currently, all U.S. states are facing high or severe shortages, with many communities lacking even one qualified child and adolescent psychiatrist.
We need an effective solution, and it might be telebehavioral health. This convenient, accessible model of care has been gaining traction: Studies consistently reveal high satisfaction rates for children, adolescents and parents, often reaching above 90%. In fact, a 2013 study determined that telebehavioral health might be better than in-person care for children and adolescents because this age group often expresses an unwillingness or reluctance to participate in traditional therapy sessions.
Telebehavioral health might be a natural solution for improving access to care, but that’s just one benefit. As a counselor who offers telesessions, I’ve seen many more. Consider the following:
Clinical office settings often intimidate children and adolescents. I find that younger populations are more willing to open up when they are in their own environment surrounded by familiar possessions or in reach of pets who may offer comfort. With telebehavioral health, I also get clues and information from a home environment I never see in an office setting.
For example, one child was well-behaved during our traditional office appointments. Yet her mother described a very different child with erratic behaviors while at home. Through our telebehavioral health sessions, I could see family interactions that confirmed the mother’s assessment. I was then able to teach the young girl and her family healthy coping techniques right there “at home.”
Familiar Modes Of Communication
Younger generations have grown up with technology. In fact, a 2015 study shows 67% of teens own a smartphone and spend more than four hours daily engaged with it. Videoconferencing, therefore, is a natural fit for today’s youth. Many teens prefer telesessions compared to traditional office sessions because it’s familiar and helps build trust. Simply put: Today’s youth are more comfortable communicating through a screen.
One of the greatest barriers to engaging younger populations in mental health treatment is stigma. Many adolescents fear their peers will find out they go to therapy and ask questions. Professional shortages and scheduling challenges often causes students to miss school to attend therapy sessions. When a student leaves school early or checks in late, their peers may ask questions or make them feel uncomfortable.
With telebehavioral health, scheduling becomes much easier, as sessions can take place outside of traditional office hours. Patients do not have to miss school, nor do they run the risk of running into someone they know in a waiting room.
When choosing a telebehavioral health care organization or provider for your child, it’s important to do research before pursuing treatment. Things to consider are whether or not they are HIPAA-compliant, if they offer technical or care navigation support, whether they have providers licensed in your state, and if you can pay with your insurance plan. A good place to start is a reference guide, such as the one created by Open Minds that lists reputable telebehavioral health organizations.
Telebehavioral health care is changing the way communities and families approach mental health services. At a time when the need for mental health care is soaring, this option holds great promise for addressing gaps in care and providing parents with a critical resource for addressing their child’s health and well-being.
Jeanine Miles, LPC, Cognitive Behavioral Therapist with Inpathy and the Director of Business Development and Training at the Center for Family Guidance. Jeanine is a New Jersey Licensed Professional Counselor and has over 20 years of administrative and management experience in healthcare and behavioral healthcare. She is responsible for the development and implementation of new programs including overseeing all start-up projects, social skills training and school based programs. Jeanine has provided therapy and other telebehavioral health services through Inpathy since the program was launched and has long been an advocate for telebehavioral health.
By Dr. James Varrell
The concept of “connected community” holds great potential for elevating and improving behavioral health outcomes for all patients. Connected communities proactively address a patient’s whole health—both physical and mental—and benefit from a comprehensive, multi-faceted behavioral health strategy.
Health care leaders recognize the potential of these models to positively impact clinical outcomes and reduce the need for higher-cost interventions by improving access to care at various points along the continuum. Yet, today’s communities often struggle to achieve this framework amid a severe shortage of psychiatric providers.
The reality is 96 percent of U.S. counties have unmet needs for mental and behavioral health services at a time when demand is soaring.1 Current shortages leave those needing care with less-than-optimal choices. People often turn to primary care doctors, or alternatively, opt for no treatment at all—leading to further deterioration or crisis situations that result in costly interventions.
The good news is that direct-to-consumer (D2C) telepsychiatry can help fill these gaps and improve the outlook on connected community models. While D2C is a relatively new concept, other settings across the care continuum have leveraged telepsychiatry for the past two decades, including hospitals, inpatient units, community-based case centers and correctional facilities.
Leveraged through easy-to-use videoconferencing technology, D2C offerings are opening new doors to psychiatric providers for evaluation, consultation and treatment.
D2C Telepsychiatry: Expanding Access And Referral Options
Growth of D2C telepsychiatry in recent years has expanded as patients become more empowered and seek out convenient ways of managing their care. Patients increasingly prefer “anywhere, anytime” options like the D2C model because it enables access to care from the comfort of home—or other private locations—on their own schedule.
This type of care allows providers to be more proactive and address issues before conditions reach what Mental Health America (MHA) refers to as a “stage four” level of severity. In effect, better patient engagement can trigger greater follow-through with care plans and minimize the potential for symptoms and issues to escalate.
Telepsychiatry often gives providers greater insights into their patients’ environments. For instance, a colleague of mine is a therapist in New Jersey, and she’s been treating one of her patients for years in person. When my colleague started using D2C Telepsychiatry, she was able to see her patient online through real-time video calls rather than in person, and noticed right away that her patient was hoarding her belongings. My colleague was able to learn about her patient’s living condition and other factors that influenced her treatment plans. Further, her patient reported feeling more comfortable and at-ease during their appointments.
D2C telepsychiatry also provides more referral options, enabling earlier interventions and greater access to services. While frequently sought out as a mental health alternative, many primary care providers are uncomfortable prescribing psychotropic medications or lack psychiatry expertise.
By providing a reliable behavioral health referral option, D2C telepsychiatry takes the pressure off of primary care providers. Moreover, collaboration and information exchange between the referring physician and D2C provider can allow for more comprehensive care.
Outside of primary care, D2C expands referral options for discharge planning from acute and inpatient settings. The current mental health provider shortage can slow down referral processes, leading to disjointed transitions where patients must “settle” on whatever is available in the nearby area instead of what is best.
Closing The Loop To A Connected Community
Even as health care leaders increasingly embrace telepsychiatry models, most are currently used in siloes across community settings. However, there’s opportunity to leverage existing resources and establish community-wide telepsychiatry networks to connect all appropriate care settings.
This connected community model improves both information sharing between providers and continuity of care for patients. Patients can use telepsychiatry to see the same provider or same network of providers across different care settings or from home with D2C care. In tandem, primary care doctors, community organizations and telepsychiatry providers can better collaborate on patient care.
Telepsychiatry networks not only improve care outcomes, but also create economies of scale. For instance, health care settings can benefit from sharing a telepsychiatry provider network. This option places less pressure on community resources to recruit and retain local behavioral health providers.
Communities can take steps to utilize a telepsychiatry network across care continuums by:
- Bringing together payers, primary care, hospital systems, outpatient behavioral health, corrections, schools, skilled nursing and other community organizations
- Assessing their current behavioral health resources to identify gaps and opportunities
- Setting multiple locations up with technology to access telepsychiatry
- Establishing a telebehavioral health network of licensed providers who are aware of community services and resources
- Utilizing shared scheduling tools for booking psychiatric resources and appointments
Telepsychiatry helps address the gaps in behavioral health care across the continuum by proactively treating patients’ whole health through the concept of the connected community. By increasing patient access to care and referral options, this evolving model supports timely, proactive intervention, minimizing the potential need for more costly care and enabling better outcomes.
About The Author
James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight + Regroup. InSight+ Regroup’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.
Original article posted on Health IT Outcomes