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
Long Beach, CA – Center for Family Guidance, PC, a comprehensive behavioral health organization (stylized as CFG), will be presenting at the OPEN MINDS Management Best Practices Institute, taking place from August 15-16 in Long Beach, CA. The OPEN MINDS Management Best Practices Institute brings together executives, thought leaders, industry experts and program innovators to focus on management best practices and clinical treatment tools.
On Wednesday, August 15, the clinical director of CFG will present during the session called Using Technology to Improve Consumer Engagement: A Look at Successful Models for Engagement. This session will feature “Getting Ahead of the Curve: Layering Home-Based Telehealth into an Existing Outpatient Mental Health Clinic” presented by Joel Freidman, PhD.
CFG recently implemented home-based telehealth into an existing outpatient mental health clinic in order to keep up with the national provider shortage, address consumer demand and stay competitive in an ever-changing healthcare landscape.
The program utilizes telehealth in two ways: providers are set up with access to a secure, web-based telehealth platform and are able to offer night and weekend appointments to new and existing consumers; consumers can be referred to CFG’s telehealth partner, Inpathy, if the individual is unable to make an in-person appointment or if CFG does not have resources available. This case study presentation will look at the design, implementation and ongoing lessons of this innovative program. Dr. Friedman will discuss challenges, advantages and important buy-in elements for the providers, consumers, administrators and intake coordinators involved.
The benefit of this program for is that it does not require travel and there are more appointment availabilities than in an in-person office setting. The benefit for providers is the convenience of seeing consumers from their own private home office. Providers can also utilize Inpathy, an online psychiatry resource, for referrals.
Other speakers in this session include Richard Louis, III, Senior Associate at OPEN MINDS, and Larry Smith, CEO of Grand Lake Mental Health Center, Inc.
CFG is a broad based healthcare provider that is dedicated to increasing access to care via innovative applications of technology like telepsychiatry and virtual environments.
Direct-to-Consumer Telehealth: The Disruptive Solution to the Behavioral Health Provider Shortage
By Scott Baker, MBA,
The link between behavioral health and medical outcomes is well understood. Providing behavioral health services can help keep some medical conditions in check and prevent hospitalizations and readmissions. However, more than half of US counties are currently without any psychiatrists, resulting in large care gaps and wait times of up to 3 to 6 months. As a result, many patients seek mental health services from primary care providers, who often lack both time and specialized psychiatric expertise to treat such conditions. A more dire situation arises when patients are discouraged from seeking treatment altogether, which can lead to further deterioration or crisis situations.
Amid this provider shortage and growing behavioral health crisis, telepsychiatry is emerging as an effective tool to meet providers’ referral needs. In addition, direct-to-consumer (D2C) telepsychiatry is becoming a more widely utilized treatment option—one that can fill gaps in care at a time when the need for services far outpaces provider supply and address issues before they escalate.
By enabling provider-patient interaction at any time from any location, D2C telehealth helps increase access to care and promotes a more comprehensive response to patient needs, whether physical or behavioral. Making care more convenient often leads to earlier interventions that help ensure patient needs are addressed before issues escalate and require higher-cost interventions.
D2C telepsychiatry: A natural fit for telehealth
The American Telemedicine Association defines telehealth as “the remote delivery of healthcare services and clinical information using telecommunications technology.” The more popular forms of telehealth rely on real-time videoconferencing to deliver services and address patients’ needs, emulating the kind of in-person exchange and connectivity experienced in a provider’s office setting. Continued growth of D2C telehealth underscores the attractiveness of the videoconferencing model, as patients—increasingly empowered in their own care choices—seek direct access to providers and alternative options to more conveniently manage their care.
When it comes to telehealth for behavioral health, telepsychiatry is now used for evaluation, consultation, and treatment throughout the care continuum, and it can be found in settings that range from acute inpatient settings and emergency departments (EDs) to community-based care environments and in-home referrals from primary care doctors and discharge planners.
D2C telepsychiatry takes the burden off primary care providers and expands referral options in areas lacking adequate psychiatric services. With additional providers available, patients are empowered with greater choice, rather than limited by what is within a drivable radius. Beyond primary care providers, community-based professionals such as referral coordinators, benefit managers, and discharge planners can leverage this option to help consumers access qualified behavioral health specialists in a timely manner.
Collaborative care between telepsychiatry providers and patients’ primary care and regular providers can also extend the value proposition of D2C telepsychiatry by improving coordination, increasing clinical exchanges and connecting a patient’s community of caretakers for more holistic care.
The advantages of D2C
D2C telepsychiatry delivers inherent advantages for both patients and providers, including:
Flexibility. Consumers can schedule appointments outside of traditional weekday time slots, including nights and weekends, and can often find available appointments within a few days of their request.
Convenience. Services can be accessed from any private location leading to better continuity of care. For example, consumers can continue treatment with the same psychiatric provider during life transitions, such as moving to a new city for college.
Privacy. Like in-person care, telepsychiatry protects the privacy of patients. In fact, confidentiality may be heightened since appointments are accessed from home, eliminating the potential that patients will see someone they know in a waiting room—a concern that keeps many from seeking out treatment.
High-quality care. Telepsychiatry meets the standard of traditional in-person care for diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction. Along with all major national healthcare associations, the American Psychiatric Association supports the use of this model.
Healthcare organizations interested in utilizing D2C telehealth and telepsychiatry should, of course, consider situational nuances prior to determining the best course of treatment. Conditions such as anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD align well with D2C telepsychiatry. However, it is not appropriate for patients who display suicidal, homicidal, delusional or paranoid symptoms.
In addition, providers should keep in mind that while most people have access to reliable internet connections and smart devices that can support telepsychiatry, not everyone has this luxury. Prior to making referrals, providers should assess a patient’s ability to follow through with the telepsychiatry option.
The potential of D2C telepsychiatry
D2C telehealth models, and specifically telepsychiatry, represent a disruptive care delivery movement that is laying the groundwork for a more connected community and collaborative care continuum. By improving access, these forward-thinking models of care promote early intervention, addressing issues before they escalate and require higher-cost interventions. Ultimately, it’s an optimal framework for improving outcomes and empowering consumers in their care.
Anna struggled to leave her home because of her severe anxiety and depression. Because her psychiatrist’s office was more than an hour away, the stress of commuting often made Anna’s symptoms worse. Anna needed a more practical treatment option and believed there had to be one out there. In her search, she discovered telepsychiatry.
Telepsychiatry is a growing and clinically effective way to provide mental health care via online video calls. One of telepsychiatry’s newest applications called direct-to-consumer (D2C) telepsychiatry is quickly becoming a popular solution for many struggling to find convenient and effective care. D2C telepsychiatry allows providers to deliver mental health care to individuals in their homes (or any other private space) using computers, tablets or phones.
For Anna, and the millions of people living with mental health conditions, this innovative option takes away the stress of commuting to and from an in-person office setting. Telepsychiatry sessions are also far easier to fit into busy schedules. With telepsychiatry, Anna could have her sessions at home after her children had gone to bed. Most importantly, Anna could now receive consistent treatment, empowering her to better cope with her conditions.
The Benefits of Telepsychiatry
Unfortunately, Anna is not alone. More than 55 percent of U.S. counties are currently without any psychiatrists at all. Even in areas that do have mental health professionals, there are simply not enough providers to go around. And because most psychiatrists are concentrated in cities, many people outside these areas, like Anna, endure long commutes to reach the nearest psychiatrist with available appointment times.
For those who share Anna’s experience, D2C telepsychiatry offers an alternative. Here are some of the many ways a person can benefit from telepsychiatry:
- Convenience. Anyone can schedule appointments—even outside of traditional workweek hours—and can easily attend sessions using any computer, tablet or smartphone with a webcam in any private space with a reliable internet connection.
- Increased access to care. Telepsychiatry expands choices for providers beyond those who are within driving distance. Any licensed provider in the individual’s state can offer services to them, allowing individuals to connect with the provider most appropriate for him/her.
- High-quality care. With more providers to pick from, a person can choose someone who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs train their licensed providers in best practices of delivering care appropriately and effectively through telehealth. Technical support is also available for pre-session test calls.
- Privacy. Telepsychiatry removes the fear of running into someone you know in the waiting room, while also protecting your information and following state and federal regulations. Many D2C telepsychiatry providers have annual audits to ensure their encryption systems meet HIPPA standards—this is how telepsychiatry providers differ from Skype or FaceTime.
Telepsychiatry makes it possible for people like Anna to receive care in a comfortable, familiar environment. This new form of treatment has the capacity to improve the lives of millions by increasing access to mental health care across the country.
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 Telepsychiatry. InSight’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.