On-demand healthcare and telehealth services are one of the fastest growing segments of the on-demand market, following well known on-demand services such as Uber and Lyft. The telehealth industry, as a whole, is projected to be one of the fastest growing components of the healthcare economy. In fact, Just this past October, healthcare giant, Kaiser Permanente, reported that telehealth visits outpaced in-person encounters for the first time in the company’s history.
Initial evaluation research demonstrates consumers are largely satisfied with the use of telehealth services; and that telemedicine can yield positive health outcomes while reducing utilization of higher cost options, such as the emergency room. Proponents of telehealth tout e-encounters as the critical extenders in service delivery that is both patient-centered and aligned with the larger industry shift toward value and population health.
Thus, in a healthcare landscape focused on leveraging efficiency and value, there is vast opportunity to expand the role of telehealth throughout the industry. Despite the immense opportunity, a myriad of barriers remain. These barriers range from vast inconsistencies in payment delivery formularies, licensure questions, concerns with parity, and large variances in state-based policies that continue to hinder the scaling of telehealth.
Obstacles aside, we are still seeing growth in this sector. The private market place (i.e., on-demand and direct-to-consumer products that can be purchased by consumers) is in the lead, followed by growth within value-based arenas, that are operating under bundled or capitated payment models (Kaiser Permanente’s growth was under a capitated model). From a provider perspective, the value-based landscape (driven by bundled and capitated payments) is of particular interest. This shifts the market from one based on volume, to one based in demonstrable value. The success in the value-base models lies, in part, in its ability to shift some of the risk from the payers to the providers to deliver on performance and outcomes while also allowing for provider flexibility in appropriately determining the service delivery interventions that best serve their populations.
A Maze of Options
In the community mental health space, we primarily work within Medicaid sphere of reimbursement, which follows a complex maze of both state and federal policies that limit options for telehealth reimbursement. As a community-based provider, we support safeguards to preserve quality and privacy, but also believe it is time to assess efficient means to extend patient-centered care options.
From initial research and exploratory planning, we believe appropriate use of telehealth applied to severe and persistent mentally ill and co-occurring populations could reduce admissions emergency rooms, psychiatric hospitals, and corrections facilities by providing timely, medically necessary interventions to clients in crisis.
For example, telehealth services could be wrapped into a mobile, community-based crisis response protocol administered by our Assertive Community Treatment (ACT) teams and delivered to adult consumers experiencing a psychiatric crisis in order to divert in-patient treatment.
A second example of a direct-to-consumer crisis intervention might be establishing a linkage between community mental health centers and emergency rooms for persons who have experienced an opioid-related overdose. In this scenario, the patient recovering from an overdose could engage in a pre-discharge teleconsult with a caseworker or peer support specialist, and schedule immediate/next day follow-up services.
By keeping people in their communities, with appropriate services and supports, community-based providers are able to more efficiently utilize public resources while increasing clinical outcomes. Additionally, well-planned implementation of telehealth interventions for high acuity populations has opportunity to advance access to underserved populations while more efficiently utilizing our behavioral health workforce, thus addressing some aspects of our state’s workforce shortage.
In conclusion, we endorse on-going, rigorous clinical research to ensure the maximum clinical efficacy of expanding telehealth; balancing utilization, costs, and patient privacy with opportunities to expand access, innovate, and more effectively extend quality care aligned with the triple aim.
-Lauren McGrath is the government affairs director at Centerstone Kentucky, formerly Seven Counties Services.
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