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How telepsychiatry and telehealth improve mental health outcomes in primary care practices

By Ed Cladera, MD, AristaMD Medical Director
Given the clear role of primary care in improving mental health outcomes, telepsychiatry and telehealth improve access to care, providing a clear avenue toward better mental health outcomes and ultimately creating a brighter future for a large proportion of the population in need of treatment for mental illnesses.

Over the past few years, we have seen some encouraging improvements in the realm of mental health care in the United States. Notably, recent government acts have markedly improved access to mental health services for many Americans. Despite this, however, significant issues remain that signify our patient population still isn’t accessing the mental health care they require.

Among these issues is the continued shortage of mental health care providers needed to treat the 1 in 5 adults suffering from mental illness in the United States. The troubling results of this gap between demand and specialty care availability are easily seen in some critical statistics. For example, roughly half of the nearly 8 million children diagnosed with depression, anxiety, or attention deficit hyperactivity disorder (ADHD) in the U.S. receive no treatment. And despite recent improvements in terms of access, nearly 6 in 10 Americans with any mental illness receive no treatment or medication, according to the National Institute of Mental Health.

In providing “right time, right place, right provider” mental health treatment for many Americans, no single area of focus will be enough to address the entire problem. Indeed, as the National Council for Behavioral Health reports, improvements are needed in 5 key areas: workforce development, service efficiency, reducing burdensome regulations and restrictions, implementation of innovative models, and adoption of novel reimbursement methods for psychiatric services. Accountable Care Organization (ACO) models have placed particular importance on the role of primary care, and these organizations are uniquely positioned to promote innovation and efficiency in care models through telehealth technologies such as eConsults. Telehealth and telepsychiatry technologies can support primary care practices in addressing the factors that impact access to mental health care.

The role of primary care in accessing mental health services

ACO models pay particular attention to primary care providers (PCPs) in improving health outcomes; when it comes to mental health services, PCPs are an excellent way to address access issues. Many PCPs lack adequate resources to address mental health issues. While they can use the referral system, resulting office visits with therapists are 5 times more likely to be out of network—and, thus, far more expensive.

Because of this challenge—along with other access factors, such as specialist shortages and increasing patient wait times—patients with mental health issues are increasingly winding up in emergency departments in search of mental health services. In fact, in hospital emergency departments, a lack of access to psychiatric services and mental health resources stands out among all medical diagnoses, resulting in long waits not just for these patients, but for all others seeking emergency medical care. These patients ending up in emergency departments rather than receiving treatment from PCPs can lead to reduced access to care for those with acute medical issues and result in poorer overall outcomes. Additionally, hospitals struggle to recruit enough psychiatrists. And reimbursement rates are lower for patients seen with mental illnesses, causing hospitals to eliminate beds for such cases.

All of these factors indicate that improving the mental health resources that PCPs provide to patients is an effective way to improve access to mental health care. Telehealth technologies, particularly eConsults that allow PCPs to consult psychiatrists without using the traditional referral system, can improve access to mental health care for patients to increase efficiency, reduce the burden on emergency departments, and improve health outcomes for patients. Making telepsychiatry and other telehealth solutions readily available will not only reduce mounting patient wait times but improve outcomes

Policies have made mental health care more accessible through an emphasis on its importance and support for telehealth resources

Early steps toward improving outcomes of mental health services have achieved improvements primarily by requiring increased insurance coverage for mental health. Over the past decade, several policies have played a role in extending this coverage, including the Mental Health Parity and Addiction Equality Act (2008) and the Affordable Care Act (2010). The latter of these, the ACA, required that smaller health plans (such as those for individuals and small groups) cover mental health services at levels comparable with physical medical care. Further parity rules were extended to Medicaid managed care plans in 2016. In compliance with these laws, insurers are required to write policies in which copays and deductibles for mental health care are comparable to those for physical care.

These policies do not address the access issues caused by the referral system, and in particular by the high likelihood of mental health professionals to be out-of-network for many patients. However, telehealth services such as eConsults are being increasingly covered and reimbursed for physicians, increasing their rates of adoption and use at various PCP clinics. With eConsults and other telehealth technologies, PCPs are able to consult with qualified psychiatrists without requiring patients to make separate, expensive appointments. This increases access to necessary care for those patients for whom visiting an out-of-network therapist would be an undue burden. Furthermore, telepsychiatry and other telehealth solutions are introducing new and innovative ways for this patient population to access the mental health care they need—from virtually anywhere.

AristaMD’s eConsult platform connects PCPs with adult and pediatric psychiatry, addiction medicine, and behavioral health specialists to provide care planning support and treatment recommendations.

A common need for psychiatry referral is medication regimen introduction and adjustment. Many of these types of cases can be managed within the primary care setting with the support of specialty insight. Ninety-one percent of AristaMD’s mental and behavioral health eConsults have been shown to include medication regimen guidance, including the initiation of new treatments, diagnostic recommendations, and medication dosage adjustment. The ability to receive these necessary mental health care treatments within the primary care setting positively impacts outcomes and financial bottom lines for payors and health systems alike by maximizing health care resources. This frees queues for mental health providers to see higher acuity patients in need of face-to-face appointments and provides lower acuity patients necessary care within the comfort of their primary care office.

The role of telehealth technologies in improving mental health outcomes

The status of mental health treatment within the United States has improved over the years, but there is still much farther to go in improving outcomes for those suffering from mental illnesses. While access has been improved—particularly through insurance coverage—more innovative models and solutions must be explored and implemented if mental health parity is to become a reality. Given the clear role of primary care in improving mental health outcomes, and the benefits of telehealth technologies such as eConsults, in improving efficiency and access to resources among PCPs, telehealth technologies provide a clear avenue toward significantly improving mental health outcomes, ultimately creating a brighter future for those in need of treatment for mental illnesses.

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