What brokers need to know
By Michael Gorton and Michael Brombach
As employers strive to bridge growing care gaps in behavioral and mental health, the nation’s brokers are positioned to help health plan sponsors make informed benefits decisions by selecting the optimal behavioral telehealth provider. The terms telepsychiatry or telemental health are also used to describe a subset of telemedicine that uses telecommunications or videoconferencing technology to provide mental health services.
The emergence of providers offering these cost-effective care options comes in response to a changing workplace environment. Virtual behavioral health solutions provide a range of services, including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management. The intention is to provide additional access to care by reducing barriers, including needing transportation, child or care or time off work in order to meet with a doctor.
Why the immediate concern?
The increased prevalence of behavioral or mental health issues is documented by the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that more than one in four adults living with serious mental health problems also has a substance use disorder (SUD). Substance use problems occur more frequently with certain mental health problems, including depression, anxiety disorders, schizophrenia or personality disorder.
Furthermore, the severity of mental health conditions among children and teens has increased sharply. For as long as 10 years leading up to the pandemic, feelings of persistent sadness and hopelessness — as well as suicidal thoughts and behaviors — increased by about 40% among young people, according to the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System.
Given these and other stressors, it is now a priority for brokers to help clients ensure that their employees and families are receiving behavioral and mental health care when they need it.
Understanding the Difference Between Mental Health versus Behavioral Health
Brokers will encounter the terms “behavioral health” and “mental health” which are often used interchangeably. However, there are subtle differences and approaches to managing problems.
Behavioral Health as defined by the American Medical Association generally refers to SUD, life stressors and crises, and stress-related physical symptoms. The discipline examines how a person’s habits impact their overall physical and mental wellbeing and has more to do with the specific actions people take and how they respond in various scenarios.
Mental health as defined by The World Health Organization is “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.” The term encompasses a number of factors, such as the individual’s biology, psychological condition and habits and has more to do with thoughts and feelings.
Key Aspects of Telebehavioral Health – also known as Telepsychiatry
- Virtual-First Solution Integrates Behavioral Health with Primary Care
Virtual-first is the future of healthcare – treating people holistically and meeting them where they’re at. Brokers should look for a collaborative model that unifies primary care physicians, mental health professionals and specialists to effectively deliver the care every person deserves.
Today, forward-looking healthcare organizations are integrating primary care and behavioral care services into one seamless, innovative virtual care model. To optimize service, this approach should include therapy, counseling, psychiatry and medication management, all offered through secure and private online video and phone sessions. This combination presents brokers with options that offer clients opportunities to lower costs, improve outcomes and deliver better member experience scores.
A virtual care model that has thoughtfully designed and implemented a behavioral health solution to be a part of its core primary care services, enables members to access the right level of both behavioral health and primary care. This capability navigates members to their primary care doctor, a counselor or a psychiatrist based on their conditions, history, and acuity. By selecting this model of virtual care, brokers can better help their clients streamline access to the right level provider and appropriate care.
- Preventable Emergency Department (ED) Visits
Brokers recognize the cost and quality implications of overutilization of ED services. Unfortunately, frequent ED users with mental health and addiction challenges are in dire need of effective treatment and case management beyond the constraints of the local EDs. Further, pediatric emergency physicians may struggle to provide effective care and consider the ED ill-suited to ensure continuity of care when treating alcohol or SUD-related issues among adolescents.
When telepsychiatry is available 24/7 (365) to patients who need access to affordable, convenient, quality care on-demand, the right virtual care model helps bring more timely psychiatric care to the frequent ED users with mental health, alcohol and addiction challenges. An estimated one in eight ED visits involves a mental health and/or substance use condition, according to the Agency for Healthcare Research and Quality (AHRQ). Many EDs do not have psychiatrists on-site to support people with serious mental health issues in person. Brokers that provide clients with the ability to access psychiatric care through a virtual behavioral health solution reduce dependency upon EDs and lower ED utilization costs.
While telepsychiatry may involve direct 1:1 interaction between a psychiatrist and patient, including video or audio-only care, it also encompasses psychiatrists supporting other clinicians, including primary care providers, with mental health care consultation and expertise.
- Address Clinician Shortage
Today, telepsychiatry via phone and online communications improves access to care and enables workers of all ages to more readily receive behavioral or mental health care services with a clinician. Studies confirm that the U.S. has a shortage of mental health providers and estimates are that the country will be short between 14,280 and 31,109 psychiatrists in the next few years. This is highly problematic for employees who eventually recognize that they need help but may not be able arrange an appointment with a doctor. Virtual behavioral health – telepsychiatry — effectively closes this gap in care.
- HIPAA Compliance
Health care providers have 90 days to comply with HIPAA telehealth rules after the COVID Public Health Emergency (PHE) ends at midnight on May 11, 2023. The U.S. Department of Health and Human Service’s Office of Civil Rights (OCR) announced that it will continue to exercise its enforcement discretion – and not impose penalties – on covered providers for noncompliance with unsecure video chats or FaceTime during the 90-day transition period, which will expire on August 9, 2023.
Brokers may be aware that during the public health emergency, providers did not have to be licensed in the state in which the patient was located and were allowed to treat patients in other states. In addition, non-HIPAA-compliant platforms were allowed if they were not public facing, such as video chats or FaceTime. However, it is important that brokers connect clients with virtual care vendors that have transitioned to this change whereby these flexibilities are coming to an end, with other telehealth provisions set to expire at the end of 2023 and 2024.
- Role of Pharmacogenomics
Culturally intentional care and inclusion of optional pharmacogenomics, also called pharmacogenetics for medication management, are a recent advancement for only a few virtual behavioral health providers. Brokers should ask a potential virtual care provider if they include this emerging area of medicine that focuses on understanding how genes might affect individual responses to treatment or affect medication choice or dose.
Pharmacogenomic testing (PGx) informs prescribing decisions and helps to recognize and address the role of genetics in medication management. It has been proposed that addressing genetic variations in patients by individualizing prescribing can maximize treatment benefit and reduce undesirable outcomes.
- More Affordable Healthcare
Brokers should be on the lookout for virtual behavioral health/telepsychiatry options that help to combat increasing health insurance plan costs. Generally, these appointments cost less than comparable in-office visits. According to a study, net cost savings is estimated at $19 to $21 per telemedicine visit, depending on where the Employee would have otherwise sought care. It’s important to remember that these are generalizations and brokers should consider the unique healthcare needs of their clients. For example, employers with families that have children/teenagers may find it critical be able to access telepsychiatry that results in a reduction in the number of ED and urgent care visits, as explained above.
Furthermore, new reports show: more than 100 million people in the United States don’t have a primary care provider (PCP), and about a quarter of those are children; and 26% of adults under the age of 30 do not have a PCP. This data nullifies the opportunity for integrating behavioral health with primary care, a challenge that is resolved by adopting the right virtual behavioral solution.
- New Data Emerges on ER Visits by Children, Teens and Young Adults
Mental health-related visits to the emergency room by children, teenagers and young adults soared from 2011 to 2020 and rising from 4.8 million to 7.5 million, according to a new report published in the Journal of the American Medical Association. The sharpest increase was for suicide-related visits, which rose fivefold. The findings indicated an “urgent” need for expanded crisis services, according to the team of researchers and physicians who published the report.
The number of visits rose for many conditions, including mood and behavioral disorders, substance use and psychosis. But the increase in suicide-related issues was most pronounced, increasing to 4.2 percent of all pediatric emergency room visits in 2020 from 0.9 percent in 2011.
This clearly matters since a growing number of children and adolescents are grappling with mental distress, but medical systems have not kept up. Insufficient treatment options and availability of preventive care is leading many families to seek help in emergency rooms, which are ill-equipped to deal with mental health-related issues.
Telebehavioral health options are part of a dedicated commitment to address these care gaps.
Brokers Guide Employers to Optimal Virtual Behavioral Health – also called Telepsychiatry
The COVID-19 pandemic triggered a rapid expansion of virtual behavioral health and telepsychiatry. A 2022 study of 126 million patients across all 50 states found that 39% of mental health visits were virtual and it is expected that utilization of behavioral telehealth will continue as the COVID-19 pandemic subsides. Advantages of this approach include greater access, flexibility, convenience of routine care, and potential for increased privacy.
Clearly, the convergence of technology, growing patient demand, greater regulatory flexibility and greater availability of payment for behavioral health care continue to support telehealth as a driver of greater access to behavioral health services. Regulatory developments also continue to boost the use and expansion of telehealth as a critical component of rendering behavioral healthcare, including extended flexibilities in providing such care, removal of geographic restrictions, loosening of certain healthcare supervision requirements.
Brokers are now tasked with helping clients select a virtual solutions provider that respects mental health services as an essential part of the human experience. Employees need easy access to virtual primary care and mental health support in a way that respects individual privacy, is collaborative and fully integrated.
Authors:
Michael Gorton is a quintessential entrepreneur and company builder. As CEO of Recuro Health he leads a team which includes several leaders from Teladoc, where he served as the founding CEO and pioneered an industry-changing health care model that created a new efficiency paradigm in healthcare. Gorton co-authored and published “The Digital Medical Home,” a compendium of stories, personal anecdotes and true accounts of how telemedicine was born and how it grew into the industry we know today. Ernst & Young LLP (EY US) recently named Gorton as one of the 2022 Entrepreneurs of The Year® based upon his entrepreneurial spirit, purpose, growth and impact, among other core contributions and attributes.
Michael Brombach is a contributing author to The Digital Medical Home and has published multiple thought leadership articles on topics including, how to solve healthcare’s complexity, future applications of virtual care models, the growth potential of consumerism in health care, and provider transformation. As Chief Operating Officer of Recuro Health, he leads strategy and development of Recuro’s digital health platform and products, overseeing integration, go-to-market strategy, and future product innovation.
michael.brombach@recurohealth.com
Contact:
Website: www.recurohealth.com