Behavioral health has become nearly synonymous with mental health in many conversations. With its focus on addressing specific actions or behaviors that cause distress and ill health, behavioral health has the potential to empower patients to make concrete, lasting changes that lead to an increased sense of control, well-being, and ability to manage their physical and mental health issues.
Because behavioral health often focuses on teaching strategies that patients can then apply to their daily lives, it is well-suited to the rise of telemedicine, in which practitioners and patients confer via phone or video conference.
Here, we examine the rise of behavioral telehealth in recent years and the opportunities and challenges it faces in reaching its potential.
Why Has Behavioral Health Embraced Technology?
Approximately 18.5 percent of US adults struggle with mental illness symptoms each year, according to the National Alliance on Mental Illness. Nearly the same number, 18.1 percent, will deal with a condition that responds to treatment via behavioral health at some point in their lifetimes, says NAMI.
Psychiatry was one of the first specialties to adopt technological solutions to reach more patients. Today, "assessments performed via videoconferencing are reliable, and telepsychiatric interventions lead to clinical outcomes that are comparable to in-person treatment," write David Cohn and Hossam Mahmoud of Regroup Therapy.
The use of technological tools to expand the reach of psychiatrists and other mental and behavioral health services providers has helped to address the chronic shortage of staff and resources in these areas, as well. Today, about 48 percent of psychiatry and mental health counseling practices say they use behavioral telehealth tools, according to a March 2018 study by Shannon Mace, Adriano Boccanelli and Megan Dormond at the University of Michigan Behavioral Health Workforce Research Center.
Patients with a wide range of chronic medical conditions often experience co-occurring behavioral health issues, exacerbating symptoms of the chronic condition, as well as depression, anxiety and stress.
In a February 2018 article in Psychiatric Services, researchers Loren Dent, Aimee Peters, Patrick L. Kerr, Heidi Mochari-Greenberger and Reena L. Pande studied a standardized program to provide cognitive behavioral therapy (CBT) to such patients. "A retrospective before-after evaluation of the program demonstrated national reach, high patient satisfaction, and significant reductions in symptoms of depression, anxiety, and stress," the researchers wrote.
Opportunities for Behavioral Telehealth
As behavioral telehealth proves its effectiveness, more stakeholders are jumping on board. Perhaps one of the most exciting, from a provider's perspective, is employer-funded insurance programs. In 2018, 56 percent of employers said they planned to offer insurance that covered behavioral telehealth services, Bruce Japsen writes at Forbes.
One extraordinary opportunity for behavioral telehealth is the chance for providers to see inside a patient's life. "You can actually get into their environment," says Zereana Jess-Huff.
For instance, behavioral health patients can carry their devices around their home, showing their providers how they live and where they spend their time. The provider can use what they observe to give specific advice on environmental, lifestyle or behavioral changes that are directly relevant to the patient's personal situation.
Behavioral telehealth also provides alternatives for the treatment of chronic pain, a condition that affects more than 100 million Americans, and which is frequently accompanied by depression, anxiety, and other mental health symptoms, says Lily Mercer at Health Recovery Solutions. Behavioral treatment can help chronic pain patients manage not only the mental health symptoms, but also address behaviors that may aggravate the pain itself, notes Erica Hoffman at Mental Health First Aid.
Being able to connect with patients at home also means fewer missed appointments. When patients don't have to deal with timing, transportation, or the difficulties that co-occurring conditions can cause in getting out of the house, they're more likely to meet with their providers, improving both their treatment and the provider's bottom line.
Telehealth also offers a way to provide many people with support they could not otherwise access. In Polk County, Florida, county officials have created a program that offers free behavioral telehealth services to approximately 84,000 low-income, uninsured county residents, Heather Landi reports at Healthcare Informatics. The program is paid for by a half-cent sales tax increase, approved by county residents.
Regulatory interest in a standardized set of rules and regulations has increased, as well. In July 2017, the Centers for Medicare and Medicaid Services (CMS) announced a plan to design "a potential payment or service delivery model to improve healthcare quality and access, while lowering the cost of care for Medicare, Medicaid, or CHIP beneficiaries with behavioral health conditions," says Eric Wicklund at mHealthIntelligence. The resulting program could easily include behavioral telehealth.
Challenges for Behavioral Telehealth
While behavioral telehealth shows promise, it still faces challenges. For instance, lack of access to either in-person or telehealth-based care still remains a significant hurdle in rural areas, says Jeff Lagasse at Healthcare IT News.
And these rural areas may be where behavioral health can have the greatest impact. Mental health and mental disorders rank highly among the priorities for providers in these areas, according to a brief from the Substance Abuse and Mental Health Services Administration (SAMHSA).
No matter where a patient is located, though, willingness to participate remains an ongoing challenge in behavioral health, whose outcomes often depend on how the patient implements the tools they learn into their daily lives. The use of technology to provide behavioral health support remotely has not changed the fact that patients must still participate in their own recovery, as Charles Townley and Rachel Yalowich note in an article for the National Academy of State Health Policy.
When patients do participate, however, states have seen significant cost reductions as a result of implementing behavioral telehealth programs. They have also seen reductions in the number of prescriptions for psychotropic medications, particularly for children under 5, noted Townley and Yalowich.
While increasing numbers of patients have the tech tools they need to access telehealth services, not all providers have the same access. Network connectivity, uncertainty about reimbursement, and piecemeal implementation have caused many providers to balk at adopting the technology. "Telehealth is easy for patients, but it's hard for doctors and health plans," says Wally Adamson, family physician and staff vice president at LiveHealth Online.
Finally, regulatory responses at the state level have been slow when it comes to behavioral telehealth. Most states focusing solely on psychiatrists' use of the technology, says Amy Lerman, a member of Epstein Becker Green's Health Care and Life Sciences Practice. To date, only New Jersey has released regulations that appear to cover not only physicians but also other practitioners of behavioral health, such as psychologists and therapists.
"We have a pretty under-resourced mental health workforce," says Mike Anderes, president of Inception Health. Access to behavioral telehealth "goes a long way toward fixing a big supply-and-demand mismatch."
Telemedicine providers like Doctor on Demand, Talkspace,Teladoc, and Zipnosis depend on PokitDok's suite of mix and match application programming interfaces (APIs) to help them bring new applications and services to market faster. PokitDok is especially well-suited to behavioral telemedicine applications and services, enabling real-time connections to over 700 payers to confirm medical and pharmacy benefits eligibility, automate claims processing, and more.
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