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Telebehavioral health is a win-win for payers and patients

Our nation’s behavioral healthcare system is stressed. Approximately one in five of all U.S. adults were living with mental illness in 20191. More recently, current data suggests that the COVID-19 pandemic has resulted in an increased prevalence of anxiety and depression among the general population2. When coupled with increased barriers to accessing care as result of provider shortages, quarantine, job loss, and other consequences of the pandemic, the need to address behavioral health challenges is more important than ever.

Payers are finding ways to fill the gap between current community needs and industry constraints. One innovative modality of care delivery is telebehavioral health, also known as telemental health, which uses information technology to connect patients virtually to behavioral health services. For the purposes of this blog, telebehavioral health services refer to video visits, e.g. live audio-video connections in which patients receive health care at an originating site, such as a clinical or home setting, from providers located at a different site. The existing research on telebehavioral health is still growing, but evidence suggests that it is a convenient, affordable and effective medium for providing behavioral healthcare that can increase patient engagement. This mode of care can address the growing demands for behavioral health services while aligning with the transition to value-based care.

Some of the most common barriers individuals face when attempting to access behavioral health services can be overcome with the use of telebehavioral health. For millions of Americans living in rural and other underserved areas with shortages of providers, virtual care can allow individuals to obtain treatment that would otherwise not be available. Additional barriers to accessing behavioral healthcare include transportation issues, being homebound or disabled, not being able to take time off from work, and stigma. Stigma, or the negative views or stereotypes that people sometimes assign to individuals with mental health issues, creates an insecurity and discomfort with seeking care. Stigma can lead to discrimination, whether subtle (such as social avoidance) or overt (which may include negative remarks about an individual’s mental health condition).

Over time this impacts how individuals perceive themselves and others, which in turn fosters a reluctance to seek proper care. In addition, engagement in services and treatment is often a struggle for individuals with mental health for a number of reasons including limited access, social risks and previous negative experiences. A Report to Congress cites an example showing a 90% rate of completion among adolescents in virtual substance use disorder (SUD) treatment, which suggests that treatment engagement may be enhanced with delivered virtually3. Taking a person-centered approach is key in helping to drive engagement with consumers and that technique is easily leveraged with telehealth services.

Several studies have shown that telebehavioral health is also just as effective as in-person care for certain behavioral health conditions, including adults with depression, anxiety, post traumatic stress disorder, and substance use disorders; and adolescents with substance use disorders4 5 6 7. One study showed that among nearly 100,000 patients receiving telebehavioral health services from the U.S. Department of Veterans Affairs, between 2006 and 2010 psychiatric hospitalization admissions decreased by an average of nearly 25%, and the patients’ number of days in the hospital decreased by an average of 26.6%8. Although existing studies regarding cost for telebehavioral health services are limited, telebehavioral health costs less as long as patients have devices they can use, and future long-term studies could demonstrate a significant savings to payers through a reduction in use of higher levels of care and length of stay6.

With all the existing evidence supporting the numerous benefits of telebehavioral health, why isn’t it more widely adopted? One issue may be related to infrastructure. Reliable technology and broadband needed to engage in telebehavioral health services is not universally affordable, but payers can consider bridging these access gaps in order to help patients receive needed services. Another factor may be training. Behavioral health practitioners may not feel comfortable seeing patients virtually due to worries about technical issues, how to respond to a patient in danger, and maintaining good rapport without face-to-face interaction. In the Deloitte 2020 Survey of US Health Care Consumers, consumers ranked empathy and reliability as the top two factors when seeking out a healthcare experience. At the same time, in the Deloitte 2020 Survey of US Physicians, 85% of physicians said training around improving skills such as conveying empathy in virtual visits is essential, but absent, in their practice. One of the authors of this blog experienced the same concern before implementing telebehavioral health in her work for the U.S. Department of Veterans Affairs, but this quickly abated after she completed an online course and learned that her patients were very grateful for the newfound convenience.

The behavioral healthcare industry is likely to see long-lasting effects of the COVID-19 pandemic, but with unprecedented challenges come great opportunities. Telebehavioral health has been shown to improve access to services, generate equivalent outcomes to in-person care, increase patient engagement, and reduce cost. It continues to transform behavioral healthcare delivery by redefining traditional “best practices” in an ever-changing healthcare landscape. With the patient at the center of the business model, payers and other healthcare stakeholders can help accelerate the adoption of services offered through telebehavioral health in order to empower patients to take charge of their health and improve the mental well-being of our nation.

  1. National Institutes of Mental Health: Mental Health Information, January 2021
  2. 2019 National Health Interview Survey and the 2020 and 2021 Household Pulse Survey, from CDC’s National Center for Health Statistics and the Census Bureau
  3. Report to Congress: Reducing Barriers to Furnishing Substance Use Disorder (SUD) Service Using Telehealth and Remote Patient Monitoring for Pediatric Populations Under Medicaid, May 2020
  4. Milbank Memorial Fund Issue Brief: Telebehavioral Health: An Effective Alternative to In-Person Care, October 2020
  5. The Effectiveness of Telemental Health: A 2013 Review
  6. Evidence Brief: Video Telehealth for Primary Care and Mental Health Services, February 2019
  7. Report to Congress: Reducing Barriers to Furnishing Substance Use Disorder (SUD) Service Using Telehealth and Remote Patient Monitoring for Pediatric Populations Under Medicaid, May 2020
  8. Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services, 2006 – 2010. April 2012.