America’s Benefit Specialist: Telemedicine’s Role in Behavioral Health Care

Treatment of Substance Abuse and Opioid Use Disorders Doesn’t Come Without Challenges

By: Michael Gomes, CEO, ClearHealth Quality Institute

Mental health issues – including Substance Use Disorder and Opioid Use Disorder (SUD/OUD) – impact all age groups, education and income levels, geographic areas and coverage types. Chances are likely that you know a family member, neighbor or colleague affected – or are affected yourself.

Yet access to behavioral health care, including treatment for substance use disorders and opioid use disorders (SUD/OUD), remains a serious, cross-cutting problem. The issue presents significant challenges for overall system costs, payors, and population health, as well as productivity and quality of life for individuals of all ages.

One tactic that is making a meaningful impact in tackling the issue? Telemedicine. In fact, more than one-third of all telemedicine encounters today are for behavioral health care. That number will only grow.

However, with a number of stakeholders continuing to be skeptical about the value of telemedicine and its ability to produce clinical and financial outcomes that are equal to, or better than, in-person patient/provider encounters – it’s important for advisors to better understand how telehealth is eliminating barriers to care and how especially useful it is in treating SUD/OUD.

We’ll also discuss why it’s important to have a national, standardized means of assuring quality, safe, and competent care available to the quickly-growing number of telemedicine patients.  

A few facts:

  • 1 of every 5 Americans will experience a mental health issue at some time during the year, and so will 1 in 6 young people (aged 6 -17), according to the National Alliance on Mental Illness (NAMI)
  • Opioid overdoses are the #1 cause of injury-related deaths in the U.S.; and, 115 people die every day from opioid use, according to the CDC
  • 60% of the 43.8 million Americans experiencing mental illness did not receive mental health services in the previous year, according to NAMI
  • In California, only 1 in 10 adults with a SUD receives any kind of treatment, according to the California Health Care Foundation

The Importance

The state of mental health in America, including access to and utilization of behavioral health care, presents a public health crisis. In addition to the grim personal consequences for individuals and their loved ones, behavioral health issues present a major financial impact in the form of health care costs:

  • Close to 70 percent of behavioral health patients have a medical co-morbidity including heart disease, stroke, hypertension, diabetes, or asthma, according to the Robert Wood Johnson Foundation
  • Costs are 75% higher for people diagnosed with both behavioral health/common chronic conditions than for those without a co-occurring mental health diagnosis, according to the Substance Abuse and Mental Health Services Administration (SAMHSA)
  • Untreated mental illness costs the country up to $300 billion every year due to productivity losses, according to NAMI

The Role of Telehealth

The use of telemedicine can dramatically expand convenient and efficient access to behavioral health treatment, especially for patients in rural or underserved areas.

Curtis Lowrey, MD, Chairman of the Center for Telehealth & e-Health Law (CTeL), stated that telemedicine has “exceptional potential to provide high-quality, accessible healthcare amidst an ongoing opioid epidemic.” Specifically, in America’s Health Insurance Plans’ (AHIP) March 2019 report, the group reports that telehealth:

  • Helps reduce stigma
  • Supports patient/provider interaction
  • Improves convenience and efficiency
  • Provides digital health solutions to help patients, providers, and families virtually manage many aspects of treatment
  • Encourages a team-based approach to care coordination
  • Improves data sharing to help prevent patients from receiving multiple prescriptions for highly addictive drugs from multiple doctors

Understanding the full potential of telehealth has led to new federal laws and regulations that expand its use for SUD/OUD, including eliminating originating-site limits under Medicare. Still, significant challenges remain, including the ability to prescribe controlled drugs for medication-assisted treatment (MAT) via telehealth without an in-person visit.

Consumer Interest

Nearly 74% of private and public employers offered a telemedicine benefit in 2018, up from 27% in 2015, according to the Kaiser Family Foundation’s 2019 Employer Health Benefits Survey. Telehealth’s mitigation of health plan costs and convenience for employees are appealing.

When it comes to consumers, seniors express a strong interest in using telehealth, often for mental health issues. Among those aged 50-80, more than 1 in 3 would like to use telehealth to see a mental health specialist, according to a recent University of Maryland poll on Healthy Aging and Telehealth.

This indicates enormous potential for telemedicine utilization amongst Medicare Advantage (MA) enrollees, especially given recent regulatory changes promoting telehealth. Beginning with the 2020 plan year, MA plans will be able to offer telehealth as part of their basic benefits; such changes are expected to save enrollees almost $560 million over 10 years, according to the Government Accountability Office (GAO).

On the Medicare Fee-For-Service side, the greatest use of telehealth services by beneficiaries is for behavioral care, according to a Centers for Medicare and Medicaid Services (CMS) 2018 report.

Millennials have the strongest interest in using telehealth amongst all demographics – 74% are willing to try it, with nearly 40% saying they would regularly use telehealth for behavioral health management, according to a 2019 consumer survey from American Well, a global telehealth platform and provider. That’s notable, given 6 of the top 10 health conditions affecting Millennials are behavioral issues, according to 2019 data from the Blue Cross Blue Shield Association (BCBSA).

The Need for Quality Standards and Outcomes Measurement

Telemedicine is already transforming the delivery system in meaningful ways as recognized by the growing willingness of public and private purchasers to pay for services. Accordingly, there has been a proliferation of telemedicine vendors to meet this demand. While this is good news, the enormous potential impact telemedicine can have on individual patients and families, and ultimately, on population health, requires that quality and patient safety be at the forefront.

Yet we face a critical challenge in promoting and evaluating quality in a landscape that is diversified, dynamic and complex. To ensure the long-term value of and payment for telemedicine, the fidelity and consistency of telemedicine programs must be evaluated for entities of all sizes. How can we do this, given that our state and federal government laws and regulations have not yet caught up to the pace of telemedicine technology and growth?

Part of the answer comes in evaluating a telehealth program’s attributes such as quality, safety, efficiency, standardization, risk management, and compliance – preferably through an independent, third-party accreditation organization.

In a growing, competitive field such as telemedicine, independent accreditation allows entities to demonstrate that their processes and procedures promote better clinical and financial outcomes, including patient safety. Having the right seal of approval aids consultants and serves as a differentiator, helping capture increased market share.

One More Barrier to Care: Mental Health Parity Compliance

There’s an additional barrier to behavioral health care that accreditation can help address: a lack of compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA). MPHAEA requires the scope of health insurance coverage for mental health and substance use disorder (MH/SUD) services to be the same as for medical/surgical benefits.

While admittedly complex, lack of parity compliance deprives patients of needed care and exposes entities to risk, including significant regulatory fines and lawsuits. Parity compliance is an essential building block to ensuring appropriate coverage is available and needed services are delivered.

ClearHealth Quality Institute’s MH/SUD Parity Accreditation Program and ParityManager™ tool are two resources designed to assist health plans, third-party administrators and others build, implement, and manage a parity compliance program that meets key federal and state regulatory requirements.

Final Thoughts

As telehealth helps tackle barriers to improved care and access – especially for behavioral health – there’s reason for hope.

Federal and state policymakers increasingly look to telehealth to address the opioid epidemic and other behavioral health issues, which means they’ve been trying to eliminate some limits on reimbursement.

Still, explosive industry growth as well as the number of patients, providers, plans and payers involved have created significant challenges, especially in terms of evaluating quality and patient safety.

We believe the way forward is through partnership among key stakeholders to ensure that effectiveness and patient safety are central to every telehealth program. This partnership should call for and utilize national standards that measure quality and outcomes, and for performance that is evaluated through an independent, third-party organization.

Of course, doing so is complicated and ever-changing, but quality healthcare is about collaboration, especially when it comes to solving our biggest problems. When it comes to your clients, they deserve no less.

Click here to read this story in America’s Benefit Specialist e-magazine.

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