Telemental health services are becoming an increasingly viable part of the behavioral healthcare continuum, but industry analysts caution that video conferences will not entirely replace in-person therapy sessions anytime soon.
Walgreens and MDLive joined a growing list of providers to offer telemental health service offerings, announcing an expansion of their partnership earlier this month. A network of more than 1,000 licensed therapists across the country is now available to Walgreens customers through MDLive’s counseling services. The program allows patients to schedule secure video sessions by appointment through the Walgreens website or the Breakthrough mobile app.
Telemental health—the provision of remote mental health services through technology such as video conference calling and mobile apps—fills a need, but experts say the solution has both positives and negatives for care givers, payers and patients.
“In the practicing community, we’re in an age where people are comfortable using technology, but there’s still a stigma in dialing in through technology and taking care of it in such a way that is different from a traditional in-person encounter,” says Amy F. Lerman, senior counsel for Epstein Becker Green (EBG) and co-author of the firm’s 50-State Survey of Telemental/Telebehavioral Health, published this year. “People are still getting used to accepting that as a mode of care. But the convenience factor is winning people over, especially those who are increasingly comfortable with the use of technology in multiple aspects of their lives.”
Moving forward, here are five factors that will define the future of telemental health services.
Perhaps the biggest driving factor in the emergence of telehealth—and what will likely continue its expansion—is its ability to bring treatment options to rural and underserved populations. According to the EBG study, a report to Congress found that 55% of U.S. counties have no practicing psychiatrists, psychologists or social workers. As a result, 57% of adults with mental illness receive no treatment, a statistic that climbs as high as 70% in some states, per a Mental Health America study.
“There’s a real dearth of mental healthcare providers around the country. In certain parts of the country, the scarcity is alarming. It’s of crisis proportion,” says René Quashie, senior counsel for Epstein Becker Green and the study’s other co-author. “Looking at other ways to bring care via technology is a very viable solution that should be examined.”
In order to treat a patient remotely in most states, care providers must be licensed to practice in the state in which the patient resides. Reapplying, taking tests and paying necessary fees in each state can become costly and time consuming.
Efforts are underway to break down this barrier. The Interstate Medical Licensure Compact offers a pathway way for qualified physicians to practice in multiple states by providing an expedited process to obtain licensing in participating states. Compact legislation has been enacted in 16 states with legislation introduced in an additional 10.
3. Quality of care
A study cited by EBG notes that the use of telehealth in rural and underserved areas reduced psychiatric admissions by 24% and patients’ days of hospitalization by an average of 26%.
Still, some caregivers remain skeptical. While mental health providers rarely have to put hands on patients, communicating by video conference can still paint an incomplete picture.
“For the therapist, you limited in that you’re not seeing the body language of the person,” says Diana L. Williams, director of the Behavioral Health Technical Assistance Center at Altarum Institute. “Even though the patient is telling you one thing, as a therapist, you can see something else happening [in person]. The person could be saying, ‘Yes, I’m fine. Everything’s good.’ But under the table, their legs are shaking really hard, which would be a sign that maybe they are feeling a bit anxious.”
4. Insurance coverage
Parity as it relates to insurance coverage is an ongoing issue for telemental health services in two ways. The federal government has addressed one—the equal treatment of mental health and substance abuse vs. physical medical conditions—with the parity laws. The second issue relates to coverage of in-person services vs. receiving the same treatments via telehealth. To this point, this issue has been addressed at the state level, with 60% of states having telehealth parity statutes, Quashie says.
Not wanting to deal with red tape and complicated insurance claims, Williams says, many care providers still accept cash only.
Getting payers onboard is “a slow-moving train,” Lerman adds. She says states are looking at their Medicaid programs to structure coverage and reimbursement models.
“In the private sector, you have a patchwork,” she says. “Some payers are being very innovative in how they are covering and reimbursing for these services, while others have some catching up to do.”
5. Patient acceptance
Telehealth has opened the door to mental health services for some individuals in need of care who have been otherwise afraid to engage, Williams says.
“What I’m hearing from field is that people may access telehealth because they feel safer doing that than walking into mental health facility because they feel like it is more private in their home with their computer,” Williams says. “Some people are more comfortable on the computer than they are one-on-one with a person.”
For others, though, there is value in having a physical location specifically for the purpose of opening up and discussing personal issues.
“When a client walks into a therapist’s office, it becomes a safe place for you to be open and honest and dump stuff, and when you leave, that stuff stays there,” Williams says. “It’s an unspoken kind of safe place, but it has a healing piece to it. People find that helpful.”
To that end, Williams says that no matter how much telemental health expands in the coming years, it’s more likely to remain a viable alternative to in-person treatment than an outright replacement.
“I don’t know if [telehealth] will ever be the norm, but I think it should be an option for people,” Williams says. “People find it helpful, but it’s not for everybody. That’s why we need to have options. Whatever works, we want people to get well.”
Tom Valentino is Senior Editor for Behavioral Healthcare.