Did you know that Array also offers therapists? While psychiatric prescribers are our primary niche, we also have a team of therapists who can support on-demand, scheduled and in-home applications of telebehavioral health. These clinicians include licensed clinical social workers and counselors who can work in collaboration with your onsite clinicians or with other Array telehealth clinicians.
The benefits of partnering with a diverse group of clinicians include:
Most Array therapists are either Licensed Professional Counselors or Licensed Clinical Social Workers.
LCPs primarily specialize in psychotherapy. The exact title for these professionals varies by state. In addition to secondary education (either a master’s or doctorate in counseling), LPCs must obtain supervised clinical experience and pass state-specific licensing exams. LPCs may specialize in certain areas like marriage issues or substance abuse. LPCs do not prescribe medications and typically do not offer formal diagnoses.
LCSWs vary significantly in credentials and licensing and can provide a range of services based on those credentials. Clinical social workers are licensed to practice psychotherapy, recommend treatment from other specialists, and typically work one-on-one with consumers.
Array has an extensive and diverse network of clinicians and works with its partner healthcare organizations to understand needs for clinicians with certain specialties, experience levels, philosophies of care, cultural factors and personality types.
Content last updated on June 30, 2020
In a world changing faster than we ever thought possible, the regulations surrounding telepsychiatry are evolving at lightning speed. The demand for telehealth service has exploded in recent weeks and it is imperative to know the rules and regulations as organizations rapidly adapt to this form of care. Below is a brief highlight of the most relevant policies impacting the telepsychiatry industry today. We will continue to update this post in the coming weeks as the situation evolves.
Disclaimer: The information on this page is a summary of the current laws, regulations, and guidance and not to be used as a comprehensive legal document. The information is continually changing so we encourage you to raise any questions to your legal counsel about how it may be applicable to your facility or organization.
Yes, there has been a flurry of activity and advocacy efforts surrounding making some of the telehealth changes within Medicare permanent. One of the main advocacy initiatives is for organizations to submit written letters to Congress. Here are some examples:
Additionally, the Senate Committee on Health, Education, Labor and Pensions (HELP) conducted a hearing on telehealth lessons learned during the pandemic. Joseph Kvedar, President of the ATA, was asked to testify along with other telehealth advocates. The speakers emphasized how the relaxed regulations around telehealth have had a significant impact of how services can be delivered, the number of patients that have accessed services via telehealth, overall patient satisfaction with telehealth, among other things.
Furthermore, telehealth advocate organizations, The American telemedicine Association, Alliance for Connected Care and the NCQA launched a task force to lobby for permanent policy changes. The goal of this group is to “develop recommendations for policymakers on how to maximize the benefits of telehealth services while maintain high standards for patient safety and program integrity”.
Individual states are also taking matters into their own hands and are introducing legislation or have passed regulatory changes that would keep some of the current loosened telehealth restrictions in place permanently:
IMLC Adoption: The ERISA Industry Committee (ERIC), a national advocacy organization that represents large employers that provide health, retirement, and other benefits to their nationwide workforces, has sent letters to the governors of the 21 states that are not currently members of the Interstate Medical Licensure Compact (IMLC). The letters urge the governors to introduce legislation to join the compact, which would allow qualified providers to receive a medical license from any participating state through an expedited licensure application process.
The states that received these letters include Alaska, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Indiana, Louisiana, Massachusetts, Missouri, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Texas, and Virginia. To view a sample letter, click here.
The Coronavirus Preparedness and Response Supplemental Appropriations Act 2020 is an $8.3 billion package that provides funding for the United States’ response to COVID-19. The Act was passed with close to unanimous support in both the House and the Senate and was signed into law by the President on March 6, 2020. Additionally, with the proclamation of a National Emergency, it allowed various federal agencies to exercise their authority to allow them to take relevant actions to protect its citizens. Many actions allowed for the expansion of telehealth to be used during this time as well as provide several waivers and exceptions to practice requirements and guidelines.
Yes, since the Secretary of the Department of Health and Human Services issued a public health emergency, that “practice of telemedicine” exemption within Ryan Haight can be met. Per the DEA, for as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:
Provided the practitioner satisfies the above requirements, the practitioner may issue the prescription using any of the methods of prescribing currently available and in the manner set forth in the DEA regulations. Thus, the practitioner may issue a prescription either electronically (for schedules II-V) or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy.
The FDA released guidelines related to the use of REMS-required lab testing in order to prescribe certain controlled substances (including Clozapine). They state that providers should consider whether there are compelling reasons not to complete lab tests, or delay them and use best medical judgment in weight benefits and risks of continuing treatment in the absence of lab testing.
Furthermore, the FDA does not intend to take action against those providers for the duration of the PHE for failing to adhere to REMS requirements for lab tests.
Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday “non-public facing” communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.
UPDATED (04/02/2020): The enforcement waiver also extends to failure to enter into a BAA with vendors of non-public facing remote communication and other non-HIPAA compliance remote communication products.
“Public facing” remote communications that are not appropriate to use include Facebook Live, Twitch, TikTok and are not subject to the enforcement waiver
Enforcement waivers apply only to covered entity healthcare providers and not health plans or healthcare clearinghouses.
Furthermore, to what extent the enforcement waiver will apply to these vendors and products will analyze whether there was end-to-end encryption, support individual user accounts, logins, and passcodes to help limit access and verify participants and/or permit participants to assert some control over the interaction.
Individual states are providing guidance on licensure requirements on an ongoing basis. Currently, 49 states and DC have either waived their licensure requirements, as long as the clinician holds a medical license in another state, or have implemented a temporary emergency licensure process. Arkansas is the only state that has not waived licensure requirements in some form during the PHE. These actions are meant to remove barriers for clinicians to provide services in other states where they do not hold a license or to create an application process wherein applications are reviewed within a very short period of time.
However, waived licensure requirements and the temporary emergency license are only in effect until the public health emergency is terminated or otherwise stated. Ideally, if a clinician is granted an emergency license in a state that will be a permanent assignment for the clinician, they should still proceed with the full, permanent licensure during this time.
Only a handful of states are expediting the process to obtain a full, permanent license. Kansas, for example, is leveraging the Interstate Medical License Compact (IMLC) to expedite the licensure process for physicians who have received a license in another state through the compact within the past 365 days. Wisconsin is also communicating that they are reviewing full applications more frequently.
For more information, please refer to the FSMB’s resource, “States Waiving Licensure Requirements/Renewals in Response to COVID-19”. The resource is updated daily.
UPDATED (04/17/2020): In response to the declaration of a national emergency and emergency declarations by all states, many health care entities have taken unprecedented steps regarding licensure portability and the deployment of skilled health workforce resources. These health care entities rely on the NPDB to make informed hiring, licensing, and credentialing decisions. To support these entities during this national emergency, the NPDB is temporarily waiving query fees (both one-time query and continuous query).
The waiver is retroactive from March 1, 2020, through May 31, 2020. The NPDB will issue query credits to reimburse entities that conducted queries (one-time and continuous) between March 1 and the implementation of the fee waiver.
States may begin to extend any renewal periods for provider licensure renewals or adjust requirements to fulfill CME requirements as administrative offices are closing or the inability to attend live trainings (e.g. Illinois has extended renewals through September 30 if the licensee was to renew between March 1-July 31).
Guidance on this topic is still ongoing. Under the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), if there is a public health emergency declared, health centers that receive funding under Section 330 of the Public Health Service Act (PHSA), such as FQHC’s and CHC’s, may grant providers temporary privileges by the CEO of the impact health center and reviewed by the applicable clinical department head and/or CMO. The relevant areas that may allow for expedited review and verification that could occur that includes confirming: Identity, Professional Credentials, Claims History, and Fitness/References. Additionally, the AHA (American Hospital Association) sent a letter to HHS on Monday requesting the ability to have expedited or presumptive credentialing and privileging (along many other exceptions which some have been addressed - e.g. HIPAA, Telehealth Technology, etc.).
UPDATED: Additionally, if a state has requested for a Section 1135 waiver, they may include the ability to help facilitate any credentialing and privileging that is needed with payors to help expedite them to submit claims for services rendered by the providers. Currently 49 states have applied for and granted such waivers.
Medicare has temporarily expanded previous restrictions on telemedicine services. Firstly, the Coronavirus Preparedness and Response Supplemental Appropriations Act allowed the Secretary of Health and Human Services (HHS) to waive the geographic and originating site requirements within Medicare. With this change, Medicare beneficiaries can receive services in their own homes without having to be located in a rural or health professional shortage area. Furthemore, with the recent enactment of the CARES Act, the modality requirement is now open to phone based, audio-only services. Previously, only real-time, audio-visual technology could be used. The CARES Act also relaxed the requirement that the provider must have seen a patient within the past three years in order to be reimbursed. For more information, see the Center for Connected Health Policy’s Telehealth Coverage Policies in the Time of COVID-19.
UPDATED (05/01/2020): CMS released a second round of changes that further expand their telehealth policies during the public health emergency.
Modality Use and Payments: One of the biggest changes CMS made is to waive the requirement that services had to be provided using video-technology. Now, audio-only telephone services can be utilized for evaluation and management services and behavioral health counseling and education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. For a list of eligible codes and whether or not they qualify for audio-only, please refer to CMS’ list of covered telehealth services for PHE.
Additional Originating and Distant Site Changes: Hospitals can now qualify for the originating site facility fee for telehealth services furnished by hospital-based clinicians to Medicare beneficiaries registered as hospital outpatients even when the patient is at home. Furthermore, CMS is now paying for telehealth services provided by RHCs and FQHCs serving as the “distant site." Previously, these clinics were not paid if they were serving as the “distant site,” only if they were the “originating site.”
Types of Providers Eligible for Telehealth Reimbursement: Related to the types of clinical practitioners that can furnish Medicare telehealth services. Prior to the PHE, typically only physicians, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other providers including physical therapists, occupational therapists, and speech language pathologists would also qualify for reimbursable services.
Changes to the Rulemaking Process: when CMS previously added new services that would be reimbursable via telehealth, they would use its rulemaking process. CMS is changing its process during the PHE to speed up the ability to add telehealth services on a sub-regulatory basis by considering requests from practitioners now learning to use telehealth and its effects.
Individual state Medicaid programs are currently coming out with guidance on an ongoing basis. States are applying for Section 1135 waivers in order to make changes and offer flexibilities in providing resources to their state beneficiaires. Florida, for example, was the first state to submit and be approved for their Section 1135 waiver request to remove unnecessary barriers on clinicians such as prior authorization requirements. CMS has now approved an additional 48 state Medicaid waivers. These waivers are effective as of March 1, 2020 and will end once the public health emergency has been terminated.
UPDATED: Individual state Medicaid reimbursement policies continue to be updated. The Center for Connected Health Policy (CCHP) has provided a good resource on what changes each state has enacted.
CMS has provided a fact sheet of 3 ways that the patient may receive care and what codes the provider may submit which is summarized in the chart below. Additional CPT codes and guidance from CMS related to updated codes can be found here.
What is the Coronavirus Aid, Relief, and Economic Security (CARES) Act doing related to helping healthcare providers and organizations receive assistance to help sustain operations and/or increase access to patients through alternative services like telehealth?
As part of the CARES Act, healthcare providers and facilities who received Medicare fee-for-service (FFS) reimbursements in 2019 may begin to receive payments for relief (not loans) to assist with having to cease operations or who are struggling to keep their doors open from patients delaying care or cancelling services. Here is a link that provides more information including eligibility and how the payments are distributed.
UPDATED (05/01/2020): On April 10, as part of the CARES Act, the FCC announced began accepting applications to assist healthcare providers with funding to purchase and receive the connectivity and devices they need to care for patients remotely. In order to receive funding, providers may qualify as part of a consortium or as an Healthcare Provider (HCP) site (e.g. Community Health Center, Rural Health Clinic, Non-profit hospital).
Telepsychiatry has been proven to be an effective medium of care for essentially all populations and within all care settings. There is a growing body of evidence that supports telepsychiatry as an effective delivery method for mental health services. Research has found telepsychiatry to be equivalent to in-person care in terms of effectiveness, quality of care and patient satisfaction. Below is a curated list of some of the top telepsychiatry studies that have been conducted in recent years.
Rashid L. Bashshur, Gary W. Shannon, Noura Bashshur, Peter M. Yellowlees
Telemedicine and e-Health, Vol. 22 (2), 27 January 2016
This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental health disorders in terms of feasibility/acceptance, effects on medication compliance, health outcomes and cost. Researchers reviewed relevant studies that met strict eligibility requirements and rigorous methodological criteria. They determined that scientific literature on treatment of mental health reveals strong and consistent evidence of the feasibility of this model of care and acceptance by users, in addition to improvement in symptoms and quality of life among individuals across a broad range of demographic and diagnostic groups. There were also positive trends shown in terms of cost savings.
Access the article here.
Gajari, A; Conn D; Madan R
Smart Homecare Technology and Telehealth, Vol. 3, April 2015
This narrative review was performed to consider the evidence that telepsychiatry is feasible and effective across a variety of patient populations and clinical settings. They found that telepsychiatry is feasible to implement, effective across multiple age groups and clinical settings and is generally well accepted by patients and clinicians. They specifically review guidelines/frameworks, assessment of psychiatric illness, treatment using telepsychiatry, providing psychotherapy via videoconferencing, telepsychiatry for acute care and emergency consultations, feasibility/barriers/cost-effectiveness, telepsychiatry for special populations, and emerging approaches and technologies.
Access the article here.
Sam Hubley, Sarah B Lynch, Christopher Schneck, Marshall Thomas, Jay Shore
World Journal of Psychiatry, Vol. 6 (2), June 2016
This literature of telepsychiatry articles looked for data on satisfaction, reliability, treatment outcomes, implementation outcomes, cost effectiveness and legal issues relating to telepsychiatry. They found that patients and providers are generally satisfied with telepsychiatry services. Evidence suggested that telepsychiatry performed as well as, if not better than, in-person services and was not found to be more expensive than in-person treatment. They did not find any legal issues. This large evidence base supports telepsychiatry as a delivery method for mental health services.
Access the article here.
Linda Godleski, MD; Adam Darkins, MD, MPH; John Peters, MS
Psychiatric Services Vol. 63 (4), April 2012
This study assessed clinical outcomes of 98,609 individuals enrolled in the VA’s telemental health program between 2006 and 2010. They compared the number of inpatient psychiatric admissions and days of psychiatric hospitalizing among patients who participated in remote clinical video-conferencing during an average period of six months before and after their enrollment in telehealth services. They found that during this time, psychiatric admissions of telemental health patients decreased by an average of 24.2% and days of hospitalizing decreased by an average of 26.6%.
Access the article here.
Meera Narasimhan, MD; Benjamin G. Druss, MD, MPH; Jason M. Hockenberry, PhD; Julia Royer, MSPH; Paul Weiss, MS; Gretl Glick, MPH; Steven C. Marcus, PhD; John Magill, MSW
Psychiatric Services, Vol. 66 (11): 1167-1172, 1 July 2015
This study estimated the impact of a statewide, centralized telepsychiatry service utilized in emergency departments between March 2009 and June 2013. Individuals treated via telepsychiatry were compared to a control group of individuals with mental health diagnoses being treated at other hospitals. They found that when compared to the control group, telepsychiatry recipients were more likely to receive a 30-day and 90-day outpatient follow-up. Telepsychiatry recipients were less likely to be admitted to the hospital during their initial ED and 30-day inpatient costs were $2336 lower for the telepsychiatry vs. control group, but total health costs were not significantly different.
Access the article here.
Aaron Reliford, Blessing Adebanjo
Telemedicine and e-Health, Vol. 25 (9), 6 September 2019
Through implementation of telepsychiatry for child psychiatry patients seen in the pediatric emergency room, this study evaluated whether telepsychiatry can reduce length of stay and factors contributing to physician burnout through reduction of on-call travel burden. They reviewed data regarding child psychiatry fellow use of telepsychiatry through a real-time questionnaire filled out by the on-call clinician from July through December 2017. Telepsychiatry significantly reduced the total monthly length of stay for non-hospitalized patients during the study period compared to all prior months (285 hours down to 193 hours) and reduced travel for in-person evaluations by 75% saving 2.2 hours per call day. They conclude that telepsychiatry is effective in reducing length of stay and improving on-call burden.
Access the article here.
Rockhill, CM; Tse YJ; Fesinmeyer, MD; Garcia, J; Myers, K
Journal of Child and Adolescent Psychopharmacology, Vol. 28 (8): 662-667, October 2016
The purpose of this study was to examine prescribing strategies that telepsychiatrists use to provide pharmacologic treatment in the Children’s Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS). CATTS was a randomized controlled trial that demonstrated the use of telehealth for the treatment of ADHD with combined pharmacotherapy and behavior training compared with management in primary care augmented with a telepsychiatry consultation. Telepsychiatrists showed high fidelity (91%) in their chosen algorithms in medication management, meaning that they received the same outcomes across patients (high accuracy). At the end of the trial, the CATTS intervention showed 46% attainment of the treat-to-target goal compared to 13.6% for the augmented primary care condition. This study shows that telepsychiatry is an effective delivery method for providing pharmacotherapy for ADHD.
Access the article here.
Wanhong Zheng, MD; Michael Nickasch, BS; Laura Lander, MSW; Sijin Wen, PhD; Michan Xiao, PhD; Patrick Marshalek, MD; Ebony Dix, MD; Carl Sullivan; MD
Journal of Addiction Medicine, Vol. 11 (2), 2017
The purpose of this study was to review clinic records to assess the difference between face-to-face (in-person) and telepsychiatry buprenorphine medication-assisted treatment (MAT) programs for the treatment of opioid use disorder based on additional substance use, average time to achieve 30 to 60 days of abstinence and treatment retention rates at 90 and 365 days. They did not find any significant statistical difference in any of the three outcomes.
Access the article here.
Maryann Waugh, Jacqueline Calderone, Shandra Brown Levey, Corey Lyon, Marshall Thomas, Frank DeGruy, Jay H. Shore
Telemedicine and e-Health, Vol. 25 (8), 1 August 2019
This study sought to determine whether utilizing primary care in the telepsychiatry setting can increase access, quality and efficiencies in care. Telepsychiatry was implemented into an existing integrated care model in a high-volume, urban primary care clinic in Colorado. Over 35% of the requests for psychiatry services were medication changes and this was also the most frequent referral outcome of psychiatric consultations. They determined that telehealth will become an increasingly necessary component in building integrated care teams and lessons learned includes the importance of team attitudes.
Access the article here.
Stacie Anne Deslich, MA, MS; Timothy Thistlethwaite, MD; Alberto Coustasse, DrPH, MD, MBA, MPH
The Permanente Journal, Vol. 17 (3): 80-86, 2013
The purpose of this literature review was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. They found that telepsychiatry provided improved access to mental health services through the continuum of mental health care. Additionally, telepsychiatry saved correctional facilities between $12,000 to over $1 million. Increasing access to mental health care in corrections with telepsychiatry can improve living conditions and safety inside correctional facilities.
Access the article here.
Originally Published in Telemedicine Magazine
By: Olivia Boyce and Christopher Adams
Hospitals throughout the nation are plagued with psychiatric patients boarding in their emergency departments (EDs). The wait times for psychiatric patients to see a psychiatrist for that evaluation can take hours or even days. A report of 300 ED directors found that 41% of EDs have a wait time of over two days to see a psychiatrist.[1]
One solution that is helping to reduce psychiatric boarding in EDs across the country is on-demand telepsychiatry.
“The goal of on-demand telepsychiatry evaluations is for the remote psychiatrist to decide on the most appropriate and least restrictive level of care,” says Dr. Jim Varrell, Medical Director of InSight Telepsychiatry, the largest private telepsychiatry company in the US.
“By having a psychiatrist available to do the assessment, on-demand telepsychiatry programs help hospital systems avoid inappropriate admissions, shorten length of stays and improve overall ED patient flow,” explains Dr. Varrell.
According to Dr. Varrell, with on-demand telepsychiatry, psychiatric assessments are able to occur within about an hour of a request on average. Since psychiatric patients typically spend over 3 times longer in the ED than medical patients,[2] telepsychiatry’s timeliness means that psychiatric patients are able to move on to the next level of care much more quickly.
This improvement results in shortened wait times for all patients within the ED, and ultimately an increase in revenue for the hospital system.
A study done on the impacts of psychiatric boarding found that boarders prevent an average of 2.2 bed turnovers which results in a lost opportunity cost for the hospital of $2264 per psychiatric patient.[3] By implementing telepsychiatry and improving the rate of bed throughput, a hospital is ultimately able to increase revenue.
Another way telepsychiatry programs are adding value to hospital systems is by reducing costly inappropriate commitments.
South Seminole Hospital in Longwood, FL is an Orlando Health Facility that implemented a telepsychiatry program in November 2014. Through videoconferencing, South Seminole’s ED staff accesses a telepsychiatrist when they have difficult cases or when they need to determine whether an individual who came in under Florida’s civil commitment law, merits psychiatric hospitalization. According to the hospital’s data, during the first six months of the program, one third of the involuntary commitments assessed by telepsychiatrists were rescinded. [4]
“Telepsychiatry allows us to make sure that the psychiatric patients in our ED move on to the most appropriate treatment, whether that is hospitalization or community-based care quickly,” says Charles Webb Manager of the ED at South Seminole Hospital. “When patients don’t have to wait as long for care, they are able to get on a path to better health sooner.”
Access to timely care means that hospitals are more likely to be able to meet standards for patient care set by regulating bodies like The Joint Commission who advocate that patient boarding times not exceed 4 hours.
“When hospitals are able to reduce psychiatric boarding from say 14 hours to under 4, there are other financial benefits,” explains Dr. Varrell. “The average sitter for a psychiatric patient costs $15 per hour. By cutting 10 hours from the time a psychiatric patient waits for care, that’s $150 per patient saved on just sitter costs.”
At a more operational level, the implementation of a telepsychiatry program is reported to better empower onsite staff to handle psychiatric patients. For example, after a telepsychiatry program had been in place for several months at Chester County Hospital in Pennsylvania, the hospital saw an increase in their clearing and placing psychiatric patients without telepsychiatrybecause staff reported greater confidence in their abilities to assess difficult cases knowing that they had a specialist available for consult or assessment when needed.[5]
Dr. Varrell explains that this case study is an example of why collaboration between remote and onsite staff lends itself to the most effective telepsychiatry programs. “Telepsychiatrists are most effective when they establish a rapport and team-approach with the onsite staff. The remote psychiatrists benefits from onsite staff sharing difficult-to-collect information like odor or agitation in the waiting room while the onsite staff benefits from having the expertise of a team of psychiatrists who they know and trust on-call.”
Because telepsychiatrists are able to work from remote or home offices and don’t have to be in-person at the emergency department, it is much easier to staff difficult hours like weekends, nights and holidays.
Ultimately, establishing an ED telepsychiatry program can set up a health system to more effectively manage the psychiatric needs of an entire community or population. In addition to using telepsychiatrists within EDs, many systems are also expanding programs into other settings within the hospital and beyond.
“It’s important to design a telepsychiatry system with growth in mind from the beginning,” explains Dr. Varrell.
For example, hospitals are using telepsychiatry on their Med/Surg floors and on their inpatient units for weekend and overnight rounding.
Within communities, telepsychiatrists commonly serve community mental health centers, outpatient clinics, correctional facilities, primary care offices and other settings where it is difficult to staff and retain onsite physicians.
More creatively, newer direct-to-consumer models of telepsychiatry are gaining popularity as a convenient way to access services and follow-up care outside of a traditional setting and potentially from home or another private space. Some health systems and insurance companies are beginning to refer psychiatric patients leaving the hospital to in-home telehealth options that make them more likely to attend their follow up appointments and less likely to end back up in the hospital.
“Telepsychiatry can be challenging to implement because it’s a change and it requires the buy-in of many parties,” says Webb. “But ultimately, the return on investment is clear.”
Sources
[1] Schumacher Group. (2010) Emergency department challenges and trends. 2010 survey of hospital emergency department administrators.
[2,3] Nicks and Manthey. “The Impact of Psychiatric Patient Boarding in Emergency Departments.” Emergency Medical International. 2012.
[4] Orlando Health Telepsychiatry Data 2014-2015.
[5] Cuyler, Robert. Chester County Hospital Emergency Psychiatry Case Study, 2012.
The value of an employer’s health benefit strategy is intrinsically linked to its ability to address an employee’s total health—both physical and mental. That’s why overall wellness trends are shifting to better acknowledge the strong connection between a robust behavioral health care benefit and better overall health, ultimately resulting in improved employee productivity.
While many wellness programs today incorporate tactics that promote positive behavioral lifestyle changes, they often fall short of systematically addressing behavioral health conditions that can hinder an employee’s willingness and ability to embrace those needed changes. Altering entrenched behavioral health lifestyle patterns can be difficult, even if it’s a change that would be beneficial for the member. For instance, diabetic employees are much less likely to engage in diet and exercise programs when they are struggling with active depression that robs them of energy, focus and motivation. These members often represent a substantial percentage of those with chronic health conditions who make up a disproportional share of total healthcare expenditures.
This reality is why many companies are setting their sights on comprehensive employee “well-being” as opposed to “wellness” alone. By prioritizing access to both physical and behavioral health care, employers set the stage for more systemic and long-lasting engagement in self-care—and ultimately improve employee well-being, productivity and the bottom line. It’s important to note, however, that while many companies have invested heavily in identifying high-risk, high-cost employees and programs to engage these employees, access to care is still a major obstacle to this change process.
As part of this shift, many employers are incorporating telemedicine options into health benefit packages as a viable solution for addressing access issues related to traditional in-office care. Telepsychiatry is emerging as a growing opportunity within this movement as an effective means of overcoming common barriers to behavioral health utilization such as stigma, busy lifestyles and poor coordination of services. These models help attract busy and reluctant employees who might otherwise procrastinate getting the help they need.
As a clinical model that leverages videoconferencing technology, telepsychiatry and telebehavioral health are used for evaluations, consultations and ongoing treatment. Employees access this care through live, interactive communication with a licensed psychiatry or behavioral health provider in a private setting. This improved access allows employees to not only address their behavioral health concerns before issues become more acute and costly, but also to reduce the behavioral health impairment that interferes with their ability and desire to engage in employer wellness programs.
The statistics speak for themselves. Behavioral health issues were the leading cause of disability in 2015, accounting for one-third of new claims.
Depression, for instance, ranks high as an employer health challenge, racking up an estimated $210.5 billion per year — nearly half of which is attributed to workplace absenteeism and productivity losses. In fact, one study points to employer costs as high as $3,386 per individual over a two-year period prior to an employee’s depression diagnosis.
Behavioral health issues often impact the effectiveness of wellness programs directed at physical conditions due to existing co-morbidities. One study found that 45 percent of breast cancer patients also had a psychiatric disorder.
While these statistics may be startling, the good news is that companies can achieve notable return on investment in wellness and complex condition management programs by investing in mental health treatment. In one study, researchers found that for every dollar spent treating depression, $1.55 was spent on the effects of depression in the workplace.
It’s not always easy to quantify the impact of behavioral health treatment, but human resource managers overwhelmingly agree that a healthy, well balanced employee is a better teammate and more productive worker. Often, the problem is getting employees to utilize the behavioral health benefits that are already available to them.
Consider a common example: A company launches an active lifestyle program that includes tracking daily physical activity as one means of supporting the employee’s goals of improving her health. A single mom in the workforce, who already struggles with mild depression and anxiety, finds it difficult to rise to the challenge of addressing her wellness goals. Feelings of guilt and inadequacy over this “failure” exacerbate her behavioral health conditions, ultimately decreasing her physical activity and lowering her overall health scores. Unfortunately, the wellness coach does not recognize the behavioral health condition that is impairing participation and fails to make an appropriate referral for additional professional support. The employee becomes demoralized, feels even worse and drops out of the program, and an opportunity is lost.
Even when the employee recognizes the underlying behavioral health condition that is compromising her health and happiness, she may have challenges taking the desired action to address it. While an existing behavioral health benefit would cover the employee’s treatment, she still must do the following research:
Offering telepsychiatry and other behavioral health care services as part of employee benefits is a trend on the rise, and for good reason
When employees can access psychiatrists and therapists from the comfort of their home or another private space, the behavioral health stigmas are reduced, and individuals are more apt to follow through with care plans. Privacy and confidentiality are also stronger with telepsychiatry because online sessions eliminate the potential of individuals seeing someone they know in a waiting room. Many patients also report greater comfort addressing difficult issues while in familiar surroundings.
Additionally, telepsychiatry expands scheduling options and provider choice, opening the door to greater access. Work and family schedules, for instance, can limit the ability of employees to access traditional services provided in an office setting. Through telepsychiatry, employees can schedule appointments in evenings or on weekends in addition to traditional weekday time slots, which reduces absenteeism or tardiness from work.
The reality is that patient satisfaction trends are higher with online psychotherapy as opposed to traditional face-to-face treatment. While telepsychiatry and telebehavioral health are not for every person, this approach to care addresses many of the common barriers to receiving prompt, professional behavioral health treatment that sets the stage for greater overall health and wellbeing.
Employers seeking to achieve the greatest return on health plan investment are wise to consider telepsychiatry and telebehavioral health as means for promoting use of behavioral health benefits. This effective model of care provides the needed framework for improving access to appropriate healthcare resources and empowering employees to take more control of their health.
In today’s busy, on-demand world, more employers are offering online or telemedicine services to employees to give them the ability to speak with a psychiatrist or nurse practitioner remotely. Telemedicine is not only convenient for employees who don’t have to take time off work for an appointment, but also helps employers reduce the cost of hospitalizations. While two-thirds of employers currently offer employees access to telemedicine services, that number is expected to increase to 90 percent by 2018.
One popular form of telemedicine is telepsychiatry, a clinical model that uses videoconferencing to provide psychiatry and mental health services, such as evaluations, consultations and ongoing treatment. It allows employees to receive mental health care through live, interactive communication with a licensed provider in a private setting, whether that’s at work, at home or in a healthcare facility. Telepsychiatry is particularly useful given the severe shortage of psychiatrists, which limits access to critical care and results in long wait times.
Mental illness is the leading cause of disability, accounting for one-third of new disability claims in 2015. Depression is among the top workplace challenges for employee assistance programs, along with family crisis and stress. While most employers provide coverage for mental health care, benefits and services aimed at preventing or reducing depression are often underutilized by employees for a variety of reasons. For example, they may have difficulty finding an in-network psychiatry provider in their area, trouble making an appointment that fits around their work schedule or employees may feel stigmatized or embarrassed by their condition.
Untreated mental health issues are costly to employers. The total economic burden of major depression, for example, is estimated to be $210.5 billion per year — nearly half of which is attributed to the workplace, including missed work days and reduced output. Further cost implications can also be attributed to treating medical conditions that often coexist with depression. Employees who suffer depression frequently have other medical conditions that occur at the same time, including diabetes, asthma, COPD, heart disease, chronic pain and insomnia. Treating these coexisting problems can significantly drive up costs. For example, researchers found that for every dollar spent treating depression, $1.55 was spend on depression workplace costs, while $2.13 was spent on treating coexisting disorders.
Investing in the mental wellbeing of employees creates measurable returns. Research by the American Psychiatric Foundation found that after only three weeks of mental health treatment, the number of work-impaired employees with behavioral health conditions was reduced by half, and after a little more than four months of treatment, two-thirds were no longer work-impaired.
Telepsychiatry can help employers improve productivity and profitability. Here are five reason why:
Providing convenient access to psychiatric and mental health care via telepsychiatry can help reduce absenteeism, tardiness and anger issues by allowing employees access to easy and convenient treatments thus enabling more consistent work attendance. Online appointments allow busy professionals to easily access specialty behavioral health services in a private and comfortable setting. Employees can also schedule appointments outside of traditional weekday time slots, such as weekends or in the evening, which reduces travel time and time away from work. By providing enhanced access to care, employees are more likely to engage in services more proactively and routinely.
When behavioral health issues are left untreated, they tend to get progressively worse. With telepsychiatry, employees have prompt access to routine care that reduces the chance of the condition becoming urgent or emergent. In light of the dramatic shortage of mental health providers, resources are scarce, driving up wait times to be seen in person. Telepsychiatry meets employees where they are, offering them faster access to care. Accessing telepsychiatry through online platforms not only allows for real-time diagnosis and treatment, but also provides more opportunities for communication between the employee and their mental health provider between sessions.
Employees who suffer from behavioral health issues cost employers $44 billion per year in lost productivity, mostly in the form of presenteeism — when employees are physically but not mentally present or working at full capacity. Offering mental health care not only reduces employee stress but improves morale. One study found employees who completed just one session with a mental health provider experienced significant improvement in work performance. Employers reported increased productivity and substantial improvement in overall mental health.
Telepsychiatry protects employee privacy and confidentiality just as in-person care does. Moreover, many find that not being in the same room as the provider actually enhances feelings of safety for many. Accessing appointments online also eliminates the possibility of running into co-workers in waiting rooms and/or psychiatry providers’ offices, which can be uncomfortable and contribute to anxiety.
Telepsychiatry is has been clinically proven to deliver high quality care that meets the standard of traditional in-person care for diagnostic accuracy, treatment, effectiveness, quality of care and patient satisfaction. Telepsychiatry offers enhanced access to care, which improves an employee’s ability to use services proactively and routinely, and providers can diagnose and prescribe medicine in the same way an in-person psychiatrist can.
Through telepsychiatry, employees and employers can experience better outcomes across the board.
Barry Doan has more than 30 years of behavioral health industry experience and now works for Inpathy, a division of the leading national telepsychiatry service provider organization that delivers telepsychiatry directly to employees and other individuals online.
Original story published on BenefitsPro.com on 4/24/17.
