Current Telehealth Expansion in the Behavioral Health Sector

Technology permeates almost every facet of our lives, personally and professionally, making communication easier and faster. With seemingly limitless avenues for connection, technology increases the number of touchpoints between people. Now in the middle of an unprecedented heath crisis, many clinicians and service providers have had to move rapidly to adopt new technologies in order to respond and manage continuity of care for the most vulnerable populations.

Telehealth and other technology assisted care solutions have been growing as an adjunct service option in the behavioral health (BH) sector, becoming more desirable as consumers culturally shift their communication preferences to text and video chat. Strict telehealth regulations have made it hard for agencies to adopt this innovative approach within their care settings. The increased availability of reliable broadband Internet, combined with consumer comfort with applications like FaceTime, WhatsApp and other social entertainment apps, has accelerated the willingness of individuals to accept non clinic-based treatment modalities. In the 2019 Behavioral Health and Emerging Technologies Whitepaper, a survey conducted by CBC, with over 400 consumers receiving mental health and substance use disorder treatment services in the Bronx, showed that over 70% of consumers had access to a smart phone with Internet and 70% of these accessed the Internet multiple times a day. Participants were asked which technology features they would use before, after, or between appointments to communicate with program staff. Text messaging, phone call reminders, and calendar appointments were the most common features requested by consumers as a way to communicate with staff.

Recent events have opened the door for telehealth to be widely used across the entire sector as a means of adapting to social distancing requirements. Individuals dealing with behavioral health conditions and/or impacted by social determinants of health factors are now at higher risk for stress and anxiety, potentially worsening health conditions and facing economic hardship. The opportunity to speak with therapists and doctors, even if through these technology-assisted care solutions, offers solace and encouragement in these challenging times as well as needed information and treatment interventions. Regulatory requirements around the use of telehealth have been substantially relaxed due to COVID-19 to allow for continuity of care via phone and video telehealth options. We recognize the potential benefits of leveraging technology to connect with and treat consumers, both in this current COVID-19 environment as well as post-pandemic.

Through this health crisis, telehealth’s growth was accelerated. The Office of Mental Health (OMH) and Office of Alcoholism and Substance Abuse Services (OASAS) have had to quickly develop and distribute guidelines and waiver processes to allow providers to add telehealth to their service delivery options. Additionally, telehealth vendors have substantially scaled up production and increased service functionality, as a response to the growing demands.

REIFY (formally known as Innovative Management Solutions NY (IMSNY), celebrates its new branding while being a joint venture of two large Behavioral Health IPAs, Coordinated Behavioral Care and Coordinated Behavioral Health Services, together make up a network of nearly 100 behavioral health (BH) provider agencies. REIFY conducted an evaluation and compared eighteen telehealth vendors. The evaluation included; demos, provider insights, and review of available material. The vendors were scored based on four criteria items: Price, Accessibility, System Functionality and Security. The vendors were then categorized based on the complexity of their system. For example, a pure play video chat app like FaceTime is a relatively easy “plug and play” option. On the other end of the spectrum were vendors that provided substantial add-on features, including health monitoring and on-demand therapeutic interventions. After a concise evaluation process, two vendors were selected as preferred partners in which we negotiated pricing for the larger network of providers.

Through this process, we established 3 key takeaways:

1. Telehealth capacity building: While most telehealth companies had a roadmap and business scale-up plan, the pandemic required a drastic ramp-up and caused many to expand past their growth capacity. That included the need to quickly hire sales representatives with limited knowledge of the product, unable to meet the growing demand of customer support inquires, limited features and not having complete privacy and encryption systems in place. We collected feedback from the IPA network providers and identified use case scenarios to evaluate usage and security risks. We continue to follow updates related to feature enhancements. It is apparent that telehealth companies are rapidly improving by the minute. In fact, the cadence of system updates and enhancements are now almost daily for some solutions.

2. Strength in numbers: For many small- to medium-sized BH organizations, spending significant time viewing product demonstrations, trying to get a sales representative on the phone, analyzing product options, and negotiating price can be overwhelming. The CBC and CBHS Network, via REIFY, was able to:

   • Conduct virtual round table discussions to gather agency (end-user feedback);

   • Survey the network to hear about direct experience with potential vendors;

   • Leverage network size to secure lower prices; and

   • Leverage volume to negotiate rates and support for the network providers.

     
     

3. Planning for post-COVID-19: Organizations that embrace this new form of communication and treatment delivery option will need to build new workflows, adjust scheduling expectations, and enhance privacy protections. They will find new ways to maximize revenue opportunities and connect quickly to consumers. Meanwhile organizations who fail to invest and adapt may struggle to meet the new needs for a changed environment. Even if an organization wishes to revert back to in-person interventions, building the capacity to safely and effectively incorporate telehealth, even on an as-needed basis, is a relatively inexpensive move that will keep consumers engaged and organizations viable and thriving.

Over time, the BH sector will need to consider the right mix of telehealth-delivered services versus in-person interventions. We will need to assess the impact of telehealth in the outcomes and effectiveness of the intervention versus care-as-usual. It will be very hard to go back to pre-COVID-19 status quo. The BH sector will need to evolve and change to meet the needs and demands of our consumers through more episodic and technology assisted care solutions. As all this unfolds, what is constant is that people need meaningful connections, and telehealth can assist in making that possible.

REIFY (formally known as Innovative Management Solutions NY (IMSNY)) is a collaborative partnership that focuses on leveraging shared skills and expertise in the Behavioral Health sector. We are focused on the integration of transformative technologies and innovative strategies within practice care settings in scalable and cost-effective ways. IMSNY coordinates information technology (IT), data analytics, telehealth initiatives, value-based payment strategies and management services for IPAs and other entities.

Coordinated Behavioral Care (CBC) is a member-led, mission-driven, organization dedicated to realizing the opportunities under Medicaid redesign to improve the quality of care for Medicaid beneficiaries with serious mental illness, chronic health conditions and/or substance use disorders.

Elise Kohl-Grant, MBA, is Chief Information Officer at REIFY and Jorge R. Petit, MD, is President & CEO of Coordinated Behavioral Care (CBC).