Direct-to-Consumer Telehealth: The Disruptive Solution to the Behavioral Health Provider Shortage

By Scott Baker, MBA, Business Innovations Manager | August 09, 2017 – Original article on Oliver Wyman Health

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.

Implementing telepsychiatry

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.

By James Varrell, M.D. | Jul. 172017 – Original article on Physicians Practice

The United States is facing a severe shortage of psychiatrists, in which 55 percent of counties nationwide currently have no psychiatrists available, according to a new report. This shortage is impacting the country’s health care system, particularly for primary-care doctors, who increasingly have to assume these roles to treat mental or behavioral health conditions.

Taking on mental health care often requires more time and resources to adequately assess and treat such conditions, which can further limit the valuable time doctors have with other patients at the point of care.

Moreover, the delivery of specialized mental healthcare can be out of the realm of expertise or comfort for many primary-care doctors. When it is, it makes sense to refer care to psychiatry providers. Yet, due to the current shortage of psychiatrists, patients may need to wait weeks—sometimes even months—to be seen by a local psychiatry provider in their community.

This is where direct-to-consumer telepsychiatry, also known as in-home telepsychiatry, can help fill the gap for primary-care doctors. Telepsychiatry is a type of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment.

Why direct-to-consumer telepsychiatry?

Telepsychiatry offers several benefits, and meets the standard of traditional in-person care. Telepsychiatry can meet patients where they are, whether at home or in a private office, eliminating time spent traveling to appointments or in waiting rooms. It also allows more flexibility with scheduling, as direct-to-consumer telepsychiatry providers usually work from home themselves and can offer appointments during non-traditional hours, including evenings and weekends.

By eliminating long wait times associated with community-based psychiatry options, direct-to-consumer telepsychiatry enables greater accessibility to psychiatry providers and supports continuity of care. It expands the reach outside the local community, so patients have access to high quality care and a variety of specialized providers. As long as a telepsychiatry provider is licensed in the state where a patient is physically located, they can deliver care. This also opens the door for patients to continue seeing their same psychiatry provider throughout many life transitions; including job changes, college, and vacations.

Just like with in-person treatment, patients meet with the same telepsychiatry provider over time, allowing the patient and his or her consented primary-care doctor to develop a rapport with the remote psychiatrist. By ensuring the mental health of a patient is appropriately addressed, primary-care doctors can better attend to the patient’s physical health.

Key considerations when referring patients

Referring patients to direct-to-consumer telepsychiatry is similar to referring to any outpatient setting. Like other referrals, the process begins with an intake of patient’s medical history and applicable screenings to determine if the patient requires specialty care.

Telepsychiatry is versatile and has been proven effective with all age groups. For patients who worry about mental or behavioral health stigmas, telepsychiatry may help them follow-up with referrals to psychiatry providers who they can see through telehealth as opposed to those they would have to see in-person.

Referral coordinators can help determine if a patient is appropriate for in-home, direct-to-consumer treatment by asking a few simple questions and considering the following:

1 – Can this condition be treated through direct-to-consumer telepsychiatry?
Anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD are all conditions that can be successfully treated using telepsychiatry. Much like outpatient care, direct-to-consumer telepsychiatry is not appropriate for patients who currently may be suicidal, homicidal, delusional or paranoid.

2 – Does the patient have the technology needed to access telepsychiatry?
When considering patients for telepsychiatry, referral coordinators should make sure the patient has access to a computer, tablet or smartphone with video calling abilities. Most people already have one or more of these devices and can access telepsychiatry sessions from home. As long as the patient has an email address and is moderately comfortable using technology—telepsychiatry can be an option.

3 – Does the patient have a safe space for accessing direct-to-consumer appointments?
The patient should have consistent access to a safe and private space in their home, office or another location, such as a community center to have their telehealth sessions.

For many remote referral groups, patients have the option to choose from a list of applicable psychiatry providers based on specialty and area of expertise, and schedule an online appointment at their convenience.

Expanding your referral community

Because telepsychiatry is a newer type of referral option, a practice may want to test direct-to-consumer care on a small group of early adopters to create an easy system for referring before offering this option practice-wide. When evaluating remote referral group options, primary-care doctors should consider:

  • Whether the group is a technology company or if real people are behind the service and involved in supporting the process.
  • If there are opportunities to meet the potential providers referred beforehand, either in person or via video.
  • Whether the group accepts only certain insurance or if all patients are eligible.
  • If the telepsychiatry provider will share information periodically with the primary-care doctor, so all parts of the care team can stay involved and informed (with the patient’s consent).

After a few early adopters, a practice can gauge their comfort level with this type of referral option, generate buy-in from staff and patients and roll out the direct-to-consumer referral option practice-wide.

The impact of telepsychiatry

With direct-to-consumer telepsychiatry as a referral option, primary-care doctors don’t have to settle for the limited choices within their community or provide mental or behavioral health services themselves. Using telepsychiatry, doctors can ensure the mental health of their patients is addressed in an effective and timely fashion, which can ultimately have a direct impact on their health, wellbeing and overall quality of life.

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 currently accepts patient referrals for psychiatry and therapy is called Inpathy.

 

By James Varrell, M.D.

Due to trends in mental health advocacy and growing clinical evidence, people are increasingly recognizing the benefits of psychiatry and behavioral health care. For example, a 2012 study published in Contingencies measured the cost of a single employee’s depression over a two-year period prior to that employee receiving depression treatment and found the cost to the business to be as high as $3,386 per affected employee.

Unfortunately, even with a cultural shift towards addressing mental illness in Lynchburg, employers and families are struggling to get convenient and timely access to care due to a significant shortage of psychiatrists. According to the National Alliance on Mental Illness, there are over a million Virginians who experience mental illness and about 300,000 of those illnesses are classified as serious. Even with 930 psychiatrists licensed in Virginia, there simply aren’t enough providers to go around. As a psychiatrist, the demands for services can be overwhelming.

Moreover, because most psychiatrists are concentrated in Virginia’s urban pockets (Northern Virginia, the Richmond metropolitan area and Hampton Roads) many individuals outside of these areas endure long commutes to reach the nearest psychiatrist who has available appointment times. Oftentimes, getting care for oneself or a family member can be off-putting and stressful.

How Telepsychiatry Can Help
Telepsychiatry is a growing and clinically effective way to provide psychiatry, mental and behavioral health care to individuals through online video calls. Telepsychiatry can be used to provide psychiatric evaluations, consultations and treatment to individuals in various settings including outpatient offices, correctional facilities, hospitals, emergency departments, crisis centers or even in homes.

Facility-based telepsychiatry has a decent foothold in the healthcare industry. Today one of telepsychiatry’s newer applications, direct-to-consumer (D2C) telepsychiatry, is quickly becoming popular. D2C telepsychiatry allows providers to give psychiatry, mental and behavioral health care to people directly in their homes or any other private space. This takes away the stress of commuting to and from in-person offices. It also means that the time individuals and their families spend getting care is shortened to only the duration of the session, making it easier to fit into a busy schedule.

An Individual’s Experience with D2C Telepsychiatry
For example, one of my patients, whom I will call Anna, suffers from severe anxiety and depression. As a result of her disorder, Anna struggled to leave her home, and her husband, Rick, often had to take time off of work to accompany her to appointments with her psychiatrist whose office was 50 minutes away.

The stress of her appointments made Anna’s symptoms worse, negatively impacted Rick’s work and put additional strain on their family life.

It was in their search for a better care solution that Anna started to receive psychiatric medication management from me and therapy from one of my colleagues all through telepsychiatry. Anna started to access her sessions from home in the evenings after her children had gone to bed. Using telepsychiatry allowed her to receive treatment independently and the reduced stress of receiving care has empowered her and helped her to better cope with her disorder.

The Benefits of D2C Telepsychiatry

Anna’s experience is one that is shared by many Virginians who struggle to find a convenient psychiatry or behavioral health solution for themselves or their loved ones. Here are some of the many ways people can benefit from D2C telepsychiatry:
• Convenience. People can schedule appointments outside of traditional weekday hours and can easily attend sessions using any computer, tablet or smartphone in any private space with a reliable internet connection.

• Increased access to care. Telepsychiatry expands choices for providers and specialists beyond those who are within driving distance. Any provider nationwide who is licensed in the individual’s state can offer services to them. Practicing online means providers can spend more time treating people instead of traveling between offices.

• High-quality care. With more providers to pick from, people can choose the one who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs will have their providers trained to deliver telehealth appropriately and effectively.

• Privacy. Telepsychiatry is safe and secure. Some individuals prefer seeking care from the privacy of home without the fear of running into a nosy neighbor in the waiting room.

Not only does this type of treatment make it possible for people like Anna to receive care in a comfortable environment, but it also removes stress from their work and personal relationships. Telepsychiatry improves lives and is an excellent tool for increasing access to psychiatry and behavioral health care in Virginia communities.

Read the original article on the Lynchburg Business Magazine website.