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Telehealth use in behavioral health cases shows promise in cost control, with utilization on the rise

The lack of telemedicine's accessibility can negatively affect patient engagement and follow-through in care, according to new research.

Jeff Lagasse, Associate Editor

Telemedicine technology has been improving steadily over the past several years, and as the tech gets better, so does its reputation. 

Increasingly, payers and providers are realizing that telemedicine has the potential to control costs, but the sector has now crossed a threshold. Complex clinical cases and behavioral health are now being treated viably using a virtual approach.

Much of telemedicine's appeal lies in accessibility. The lack of access to care through telemedicine negatively affects patient engagement and follow-through, according to new research from telehealth provider Teladoc. Treating mental health in particular becomes easier, less costly and less stigmatized when behavioral health treatment can take place in a virtual setting.

"Increasingly, people who are suffering from behavioral health disorders are recognizing that virtual care can often be a highly effective solution," said Dr. Lew Levy, Teladoc's chief medical officer. "About 42 million Americans have anxiety disorders, and more than 16 million suffer from major depression. But most haven't received treatment in the prior year."

That's problematic, because in the U.S., 70 percent of people with a behavioral health issue also have a medical comorbidity, the research showed. For those dealing with multiple conditions, such as hypertension and depression, a single point of virtual access to answers to their healthcare needs means improved outcomes through better care coordination. And in a value-based world, better health for patients usually translates into better financial standing for providers.

Whether a patient's primary malady is behavioral or physical, there's a cost to the delivery system. Something as simple as adjusting blood pressure medication can often be done in a more cost effective way through a virtual setting.

"There's a quality aspect as well," Levy said. "Someone doesn't have to be in a waiting room where people may be suffering from flu or other illnesses. If they have some complexity to their blood pressure situation they can be referred to some expertise. … For an individual living in rural Maine, the best provider might be a physician with a Maine license practicing in Portland, but it's an hour car ride for the patient. But now that expertise can be delivered in a convenient way, and with top-notch medical knowledge."

The potential for telemedicine to address clinical cost becomes clearer when examining a breakdown of what contributes cost to the system. Episodic care, said Levy, drives about 23 percent of the costs. Telehealth programs rooted in general medicine are beginning to tackle those.

When it comes to more complex care, 27 percent of the population drives 40 percent of the costs, including expert medical opinion and behavioral health. 

"These are areas in which an individual might have a fairly serious medical condition that has not been very well controlled on a very costly medication, or individuals who might be facing yet another complicated virtual procedure," Levy said.

Then, at the top of the pyramid, is clinical care, which affects 3 percent of the population but drives 37 percent of the costs, said Levy. Telehealth is addressing this through artificial intelligence, applying it to areas such as challenging oncology cases.

"Putting the medical situation first, I believe, has been some of the key to how we see the delivery of clinical quality, and it's happening in all of the markets in which we've delivered our services," he said. "The quality of our expert medical opinion service, for instance, is done through leveraging the expertise of board-certified specialists in countless aspects of medicine."

Costs large and small can be addressed. Say someone wants to use telemedicine to get to the bottom of a pesky skin rash. The patient would typically provide high-resolution photographs for review by a top dermatologist, but if the condition was more complex and chronic -- perhaps the patient was having these skin lesions for an extended period of time -- an expert would be brought on board to conduct an in-depth interview. If there was pathology involved, the telemedicine group would collect the pathology and review all of the care the patient has received, making substantive treatment changes up to 75 percent of the time to get patients into the correct course of care.

"And we can save money by avoiding therapies and interventions that would not be efficacious in the ongoing care of the individual," said Levy.

Early results in the behavioral health space have been equally as encouraging. According to its research, Teladoc's behavioral health service have seen meaningful symptom reduction, with a 32 percent decrease in depression symptoms, a 31 percent reduction in anxiety symptoms and a 20 percent reduction in stress symptoms.

Levy sees telemedicine as being at an inflection point, with growing utilization and acceptance that he only anticipates will grow.

"I do believe quite strongly we are in many ways at the beginning of the story in terms of the ubiquity of virtual care being adopted in the future," he said.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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