Geoffrey Boyce, CEO of Array Behavioral Care, the leading telepsychiatry service provider organization in the country, discusses the immediate and long-term mental health effects of the COVID-19 pandemic and the important role of telebehavioral health as a safe and effective way to meet the escalating need for care that will likely persist long after the initial crisis subsides.
MOUNT LAUREL, NJ – Telehealth has reached its tipping point. These are historic and unprecedented times as healthcare organizations, clinicians, consumers, payers, and regulators recognize the value of telehealth and are quickly pivoting to remote models of care as a safe, effective, and timely way to deliver services during this critical time of need.
In the wake of COVID-19, hospitals need to conserve available beds and resources; clinics and clinicians have countless reasons to virtualize and bring services into the home. Payers are increasingly supporting new methods of delivering healthcare services across communities at scale. And regulations are evolving to make all of this happen. This is the watershed moment for telehealth. Telehealth is finally in the national spotlight and is being heralded as the ideal solution to meet the escalating need for care during the COVID-19 crisis and beyond.
Telehealth for Mental Health
It is obvious that remote services via telehealth makes great sense for primary care right now. Many are also recognizing that telehealth makes intuitive sense for behavioral healthcare now and forever into the future.
An individual’s mental health, physical health, and overall well-being are inseparable, and with widespread closures, self-quarantines, and expectations of social distancing, telebehavioral health services have become virtually the only mechanism for maintaining access to care amid this unfolding COVID-19 crisis.
Telebehavioral health has become the new normal, and this mechanism for receiving services is here to stay. Telepsychiatry will survive as a standard for delivering care long after this crisis because it empowers healthcare organizations to use scarce resources wisely, payers to increase access and manage costs, clinicians to practice safely and effectively, and for individuals to have choice in where, when, and how they access vital behavioral health services.
Telepsychiatry Across the Care Continuum
Telepsychiatry can be used in various settings across the continuum of care to deliver behavioral health services to communities in need. This form of care delivery also ensures the safety of both patients and clinicians, especially during these challenging and uncertain times.
For Hospitals. Quick, safe throughput and the proper use of available ED beds and resources have never been more important. With coronavirus threatening to overwhelm capacity at hospitals across the country, telepsychiatry can bring a psychiatric professional into the hospital on demand to evaluate the patient via video to determine appropriate disposition. The net effect is that hospitals can better focus on conserving beds for COVID-19 patients. In addition to improving bed availability via timely and appropriate decision making, telepsychiatry can be used to initiate treatment from the hospital with a bridge back to a community resource. Telepsychiatry can also help hospitals and their staff conduct psychiatric consultation liaison services safely and remotely and can be used as a peer-to-peer consult resource to support strained and overextended in-person staff in the ED, on the med floors, and within psychiatric inpatient units.
For Community-based Clinics. Community-based clinics are facing significant pressure to maintain access to care for patients and decrease the impact of mental health patients on emergency services all while taking measures to contain the spread of COVID-19. In response to the evolving situation, many healthcare organizations are increasingly turning to telepsychiatry to help address the impact of the virus in their respective communities. In addition to clinic-based scheduled telepsychiatry services, doc-to-doc consult models for curbside consultations and various in-home care options are also increasingly available.
Perhaps the most significant change occurring right now is the shift of onsite mental health into a virtualized outpatient model where patients receive services within their own homes via their normal clinic. This allows patients to continue to get the behavioral health care they need from a remote clinician with whom they are already familiar, without having to come into the office. To accomplish this convenient and safe delivery, clinics are being forced to overcome significant challenges and transform a time-tested delivery mechanism nearly overnight. However, many are rapidly succeeding. Transforming to in-home virtual care enables these clinics to help contain the spread of COVID-19, sustain their own existence, and continue to serve some of the patients in greatest need with quality behavioral healthcare over video.
For Virtually-Based Clinics. Some forward-thinking practices had turned to telebehavioral health as the primary delivery mechanism of services well before COVID-19. These practices have no bricks and mortar locations and exclusively deliver services to individuals via telehealth. These practices bring life-changing behavioral care directly into people’s homes or any private place of their choosing, which is especially valuable during times like this. Whether it is individuals seeking care for themselves or employers or payer organizations seeking care for their employees or members, telebehavioral health allows individuals to receive psychiatry and therapy services when and where it works for them through online video.
For Individuals. Given the constant news coverage and nearly singular focus on COVID-19 along with the stress of an unexpectedly imposed regime at home and new financial worries, it’s not surprising that people are feeling stressed and anxious. Many people with mental health concerns now expect their clinic to virtualize or are turning online to an already fully virtualized practice. Virtual visits allow individuals to safely continue or start their care without risk of exposure. Telebehavioral health makes it easier for individuals to get the help they need, when and where it works for them, with licensed therapy and psychiatry providers.
For Employers. With remote work as the new standard, employees are experiencing unintended mental health effects such as isolation, anxiety, depression, and new types of burnout. In response, employers are scrambling to find resources to help their employees cope and to connect them with care options to help them navigate these uncertain times. Employers recognize that providing their employees with convenient access to appropriate psychiatric and mental health care can help boost productivity, reduce absenteeism, improve employee emotional wellbeing and promote a more positive work culture.
For Payers. Similarly, insurers are embracing telebehavioral health to meet the growing mental health needs of their members who are experiencing additional stress and anxiety caused by social isolation and the spread of COVID-19. Payer organizations are making dramatic and sweeping changes to ease restrictions and revise reimbursement policies that previously limited the use of virtual care. In an effort to improve member access to quality behavioral health care, these payer organizations are relying on telehealth to bring these services into the home. With convenient, secure online appointments, payers have expanded their network, and members are able to access psychiatrists and other behavioral health clinicians who most closely fit their needs.
Regulatory Updates to Expand the Use of Telepsychiatry
In response to the growing need for healthcare organizations to provide safe, uninterrupted care to existing patients and meet new behavioral health needs brought on by the stress and anxiety surrounding the coronavirus pandemic, regulators and payers are making significant moves to expand the use of telehealth and telepsychiatry. In fact, many of the regulations that have historically challenged the adoption of telebehavioral health have changed in recent weeks in response to the public health crisis.
Federal and state declarations of emergency have given healthcare providers and organizations much more leeway and many more resources to meet community mental health needs while combating the spread of the virus. Several well-intended but impractical limitations on telehealth have been temporarily waived such as requirements around specific technology, geographic location, provider type, DEA registration, and even prescribing practices.
States are creating temporary exclusions to licensure for certain healthcare professionals in response to COVID-19, both for onsite and telehealth practice. Other states are crafting pathways toward reciprocal and expedited healthcare licensure that may survive our immediate crisis and represent broader access to care without reconstructing unnecessary limitations to where a healthcare provider may serve patients.
Medicare, Medicaid programs, and private payers are similarly loosening restrictions and expanding reimbursement options to encourage the use of virtual care and telehealth. The provider community and our healthcare organizations are responding and are embracing these innovative solutions to meet immediate need for care, lessen the impact on the system, and provide appropriate support as the consequences of the pandemic unfold across our country and across our individual lives.
For years, the behavioral health community has suffered from an access problem. The shortage of qualified professionals has been grossly misaligned against the rising demand for behavioral health services within healthcare. Almost overnight, the world recognized that a critically important part of the solution was to virtualize behavioral health. Adoption challenges that previously would have taken the industry years to overcome have nearly disappeared, and telebehavioral health is occurring across the continuum in unprecedented ways. While our access problems are far from over, I implore us never to let those self-imposed and imagined barriers to care back into our definition of normal. Telehealth will prove its value in the months ahead, and we can go nowhere but forward from here.
About the Author
Geoffrey Boyce is the CEO of Array, the leading telepsychiatry service provider in the United States with a mission to transform access to quality behavioral health care. Boyce is a leader in telemedicine advocacy, education and reform initiatives. He serves as a national voice promoting telemedicine and telepsychiatry and regularly interacts with state and local healthcare regulators and administrators. In 2017, he received the Industry Leader Award from the American Telemedicine Association. Boyce is an active participant in several ATA Special Interest Groups and Workgroups including: the Telemental Health SIG, the Interstate SIG, the controlled substances prescribing and telehealth workgroup and the proposed workgroup on the expatriate telemedicine providers. He also serves on the advisory board of directors for the Mid-Atlantic Telehealth Resource Center (MATRC). In 2018, he was appointed to the New Jersey Telehealth Review Commission. Boyce frequently speaks about the potential of telemedicine and the best practices for establishing new programs. He holds an MBA from Terry College of Business at the University of Georgia with a focus on entrepreneurship.
Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.