Executive Briefing | by Monica E. Oss | August 8, 2017
“The bigger the challenge, the bigger the opportunity” – this often quoted truism can be applied to many different situations in the health and human service market, but it came to my mind the other day when discussing the shortage of professionals specializing in behavioral health. The numbers paint a stark picture – Up To 90,000 Physicians Needed In United States By 2025 and 44% Of U.S. Population Lives In An Area With Psychiatry Shortage.
Health plans are particularly concerned about this issue. First, there is the economic cost of untreated behavioral health issues, which has been estimated at between $150 and $200 billion per year (see Economic Costs Associated with Untreated Mental Illness). Second, there is the public perception that there is a lack of access to these services or access to services that are too costly (see Mental Health Stigmas Shift; Care Access Seen As Poor).
Increasingly, we see that health plans are trying to address this issue – and address the behavioral health problems of their members – by turning to technology in general and to telehealth in particular. Last year, Kaiser Permanente reported that 52% of consumer transactions were conducted online, by virtual visits or through the health system’s apps (see Kaiser CEO: Telehealth Outpaced In-Person Visits Last Year).
This number is likely to go up. In June, the California Department of Managed Health Care (DMHC) cited Kaiser Foundation Health Plan, Inc. for failure to ensure that it provided timely follow-up behavioral health appointments (see California Department Of Managed Health Care Again Cites Kaiser Permanente Failure To Provide Timely Behavioral Health Appointments,). The citation comes as part of an original 2013 suit in which DMHC fined Kaiser $4 million for failing to correct violations of state laws governing access to mental health care (see California DMHC Fines Kaiser Foundation Health Plan $4 Million For Access Violations).
To meet the legal requirements, Kaiser is going to invest even more heavily in telehealth – including “advanced technology for videoconferencing and consultations” (see Kaiser Permanente Statement on Agreement With DMHC on Mental Health Care Services). By law in California, urgent care appointments must be offered within 48 hours; non-urgent appointments with specialists (such as psychiatrists) must be offered within 15 business days; and non-urgent appointments with a non-physician mental health care professional must be offered within 10 business days.
This movement is not an anomaly restricted to Kaiser. Optum is now paying for telemental health the same as in-person visits (see For Health Plans, Technology = Improved Consumer Access) and Cigna has expanded its suite of telehealth behavioral and physical health services for Cigna members (see Moving To The Flip Side – Telehealth, Urgent Care & Medical Homes). And here are just a few more of many recent examples – WellCare’s Staywell Health Plan Offers Behavioral Health Care Via Telehealth To Increase Access, Convenience And Engagement For Its Florida Medicaid Members, WellCare, Georgia Telehealth Partnership Open School-Based Health Centers, Cigna Expands Telehealth Behavioral Health Services, and Humana At Home Service Reduces Hospital Admissions by 45%.
A combination of consumer preference, access issues, and cost will continue to drive the increased use of technology to deliver behavioral health. This virtualization of service delivery will slowly but surely remove the relationship between geography and access to care. This is great for consumers. And it is an opportunity for the entrepreneurial provider of behavioral health services.
But it also means that the “off the shelf” rates for behavioral health therapy will stay flat or decline. There are skeptics among my colleagues when I say that fee-for-service rates could get lower. They argue that they are already losing money on the current fee-for-service rates. But, it is not just the rates – it is also the model of consumer service. What do I mean? Last week, I was in Florida and noticed a continuous stream of television advertising therapy through Talkspace. I checked out their website – the online therapy service offers many models, including $32 per week for unlimited chat, $59 for couples therapy, and $99 per week for “live talk.” Talkspace, and programs like it (including Breakthough and BetterHelp), will not be the model selected by every consumer – but it is an emerging model that will be attractive to many consumers.
For more on telehealth and strategy, check out these resources from the OPEN MINDS Industry Library:
For more on getting your own telehealth program up and running, join OPEN MINDS Senior Associate Matthew Chamberlain on November 7 at The 2017 OPEN MINDS Technology & Informatics Institute for his session, “Telehealth Best Practices: How To Build A Successful, Sustainable Program.”