Telehealth is increasing in usage and popularity, and this is becoming true for behavioral healthcare providers, who have typically been reticent in adopting virtual care technologies. A recent survey from digital behavioral health company Tridiuum found that 81% of behavioral health providers began using telehealth for the first time in the last six months due to the COVID-19 pandemic.
Even more importantly, 70% of respondents reported they plan to continue offering telehealth services post-pandemic, and that they intend to leverage video visits for at least 50% of their patients moving forward.
The findings are significant because behavioral health providers have historically cited concerns that virtual therapy could not be as effective as in-person visits – despite literature suggesting those fears are unwarranted. As a result, such providers lagged even further behind primary care and other physical health providers in adoption of telehealth prior to the pandemic.
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The survey confirmed that behavioral healthcare delivered via video-conferencing is comparable or even better on multiple quality indicators.
Paul Castaldo, chief development officer at Triduum, said 36% of respondents saw improved clinical effectiveness after implementing remote care technology, and 8% thought clinical effectiveness was equal to or better than what they were offering face-to-face.
"These are not controlled studies, but given the reluctance they had in giving this care, it's encouraging," said Castaldo.
In another encouraging sign, proprietors said their patients' adherence to clinical recommendations improved 25%, and adherence to psychiatric medications improved 16%.
"Getting better outcomes is important, because obviously that's why patients come to mental healthcare," said Castaldo. "In addition to that, helping people get better (and) improving outcomes reduces the likelihood of problems becoming more severe, requiring more expensive or higher levels of care."
Anecdotally, many providers reported that their patients appreciated the convenience and appeared to be more comfortable in a virtual format. On top of that, retention improved by 35%, meaning patients were more likely to keep their appointments.
"Their patients were no-showing a lot less," said Castaldo. "So patients are following treatment a lot more. You're treating them as patients more consistently. That has a big impact on costs. If patient care is interrupted, care is ineffective and can go on longer, increasing costs. And for providers, they lose when patients don't show up. They don't get paid. So this drives a great deal of efficiency."
Other results showed further encouraging trends: 83% of respondents, for example, said video conferencing had no impact, or a positive impact, on the level of information patients shared about their personal lives, conditions and symptoms. Thirty-nine percent felt that patients disclosed even more information during video visits – possibly because they felt more comfortable within their homes, rather than in a traditional office setting.
The impact on workflow has also been positive. Eighty-five percent of respondents said video conferencing had no impact, or a positive impact, on their clinical workflows, referring to the time and effort required to deliver care. Forty-six percent said their clinical workflows were positively impacted by the shift to virtual care.
These findings support the case for integrating behavioral health into primary care, which Castaldo said reduces costs for patients with comorbidities, and improves the identification of patient needs – particularly crucial given that consumers seek out primary care more often than mental healthcare.
"Many primary care practices are carrying some degree of risk associated with the patients they're caring for, and if they can integrate models like this … they can reduce the overall cost of providing that care," said Castaldo. "But perhaps more important, with patients with medical conditions in addition to a behavioral health condition, there's been evidence for quite some time that, if we can manage behavioral healthcare needs better, those other medical costs can be drastically reduced. That's where much of the savings for these patients are."
That isn't to say there aren't challenges. There can be questions about privacy, depending on where a person lives and with whom they live. And then there are social determinants of health, which can adversely affect some people's ability to use virtual care, especially if one of their social determinants is poverty or lack of an Internet connection.
Providers are plowing ahead though, with 70% expecting they'll continue to do it, and anticipating that close to half of their business in the future could be telehealth.
"It's more acceptable to them, they like it more, and they're adhering more consistently," said Castaldo. "They're already saying, 'It's a new world. This is what I'm going to be doing.' That surprised me, given how careful mental health professionals are about preserving these relationships."
Much of the progress made on mental telehealth services has been due to the relaxation of federal rules regarding telehealth reimbursement and licensure, and those waivers are intended to expire at the end of the ongoing public health crisis. That could complicate adoption, but long-term, Castaldo sees virtual care becoming the norm.
"Largely those regulations pertain to things like Medicare, but very often private plans model their benefit structures on those kinds of regulations," he said. "There's a conversation occurring congressionally about what the future will look like. I don't think they'll bring those regulations back for quite a while, but there will be questions moving forward."