By: Geoffrey Boyce
Originally published on Behavioral Healthcare Executive
In the world of telehealth, what a difference a few years can make. The industry has moved from burgeoning to mainstream and is seen as a viable model for behavioral healthcare. In fact, industry professional shortages are catapulting adoption and use of telepsychiatry to address unmet psychiatric needs in all states.
The field of telepsychiatry has much to celebrate in recent years, and the outlook ahead is brighter than ever. Here are five top predictions about where telepsychiatry is headed in 2018.
Growth of direct-to-consumer telepsychiatry
Consumerism is taking healthcare by storm as individuals demand greater access, convenience and empowerment in their care choices. It’s why the American Telemedicine Association recently named uptake of consumer-driven technology as one of the top five trends for the telemedicine market in 2018.
Thus, it’s understandable why the “anywhere, anytime” access of telepsychiatry continues to drive growth of direct-to-consumer models. As individuals embrace the ability to access care at home or other comfortable locations where a reliable Internet connection exists, continued evolution of this trend is expected.
Consumers will increasingly recognize the advantages of heightened availability that enables scheduling of sessions outside of traditional office hours. Many increasingly find that video-conferencing models tear down communication barriers and reduce stigma—a key factor that otherwise keeps many from seeking behavioral health treatment. Additionally, individuals can look outside of local referral networks to access services, expanding provider options and consumer choice.
Increased access through policy/legislation and coverage
Perhaps there is no greater confirmation of telemedicine’s positive impact on care delivery than recent policy and legislation developments. The clear majority of states have enacted or proposed some form of parity regarding insurance coverage of telemedicine.
This activity will likely continue as demand for greater access to behavioral health services soars and stakeholders recognize the benefits of telepsychiatry models.
Additionally, in efforts to address the growing opioid epidemic, President Donald Trump earlier this year declared a public health emergency, calling for expanded telehealth access for Americans in need of care. Telehealth is a valuable solution to help improve care and the overall outlook around this significant public health crisis. To ensure that the addiction and mental healthcare disciplines continue to advance and embrace telehealth, and in turn, increase access to much needed services surrounding this crisis, it will be important for states to closely monitor and enact legislation that considers all types of telehealth. For example, language written to curb the prescribing of schedule II drugs via telehealth might extend to the best-practice prescribing of medication for children with ADHD via telepsychiatry, causing unintended limitations.
Positioning for value-based care
The premise of value-based care is higher quality, better outcomes and lower costs. Industry stakeholders increasingly recognize that care delivery must address the whole health of individuals—both physical and behavioral—to achieve sustainable “value.” Individuals are best engaged in their care plans and overall wellness when behavioral health is addressed in tandem with physical illness.
As providers and employers embrace this reality, they are finding that telepsychiatry effectively addresses fragmentation that often exists across the behavioral health continuum. Timely access to behavioral health services—whether emergent or ongoing—improves continuity of care and mitigates the need for higher cost interventions. Especially in multifaceted cases with complex pharmacology, video consultations improve access to multi-disciplinary treatment teams and direct telepsychiatry interventions to improve monitoring and provide ongoing patient engagement.
Increased adoption of connected community models
In synch with positioning for value-based care, healthcare communities will continue to see growth of connected community models in 2018. This will be especially evident in progressive communities that recognize the need for a comprehensive, sustainable and multifaceted behavioral health strategy that increases access to care across the continuum.
For instance, communities will continue to realize notable gains in the coming year by integrating telepsychiatry across multiple settings including:
- Emergency departments (EDs): ED physicians often lack the psychiatric resources needed for timely evaluations of critical-need patients. Telepsychiatry helps by speeding up access and ensuring quick triage to the most appropriate level of care.
- Primary care: More than half of all psychiatric drugs today are prescribed by non-psychiatrists due to provider shortages. Telepsychiatrists can provide attractive referral options or a consultative partnership to primary care providers.
- Community-based care settings: Mental health clinics and other community-based organizations often struggle to retain and recruit local psychiatrists. Telepsychiatry brings long-term access to psychiatry providers who are the best fit for an organization’s needs.
- Inpatient units or residential program: Inpatient units or residential programs benefit from additional psychiatric support to make sure a unit has 24/7 coverage and consultative support.
- Medical/surgical floors of hospitals: Medical floors of hospitals often need psychiatric consultations or evaluations to ensure providers are fully treating the patient’s comprehensive health.
- Discharge planning: Telepsychiatry ensures timely continuation of services for discharge planners in need of referral options, where waiting lists in some clinics can reach upwards of 10 weeks.
New settings embracing telepsychiatry
The industry is also witnessing significant uptake and use of telepsychiatry in areas outside of the healthcare setting as community organizations recognize the advantages. A few examples of new settings include:
- Community agencies and correctional facilities: These organizations are increasingly engaging with telepsychiatrists to improve access to psychiatric evaluation and treatment.
- Crisis response teams: mobile mental health crisis teams are leveraged to assist individuals in need, offer assessment and decide the best course of action. By bringing telepsychiatrists with them virtually with a tablet or mobile device, the situation can be assessed and managed in real time.
- Assertive Community Treatment (ACT) teams: Designed as an intensive and highly-integrated approach, ACT teams support better transitions from hospital environments for individuals who are re-entering the community. Telepsychiatrists can attend home visits along with case managers virtually with a tablet or mobile device.
- Schools and universities: Young people need convenient, timely access to mental health services, often requiring specialty providers that are difficult to find. Telepsychiatry is a great solution for meeting students where they are with the right resources.
Looking ahead, the opportunities for leveraging telepsychiatry in new settings are endless as communities creatively address behavioral health needs. The telemedicine industry has come a long way in just a few years, and great momentum exists going in to 2018.
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