My colleagues who work a lot with telehealth talk about this being “the year of telehealth.” Why? There have been lots of legislative changes in the past couple of years, which have made the use of telehealth services easier (see VA Finalizes Telehealth Rule Allowing Health Care Professionals To Practice Across State Lines, 29 States Adopt Multistate Compact For Nurses Permitting Cross-State Telehealth Services, Bipartisan Budget Act Included The CHRONIC Care Act, Expanding Medicare Telemedicine, Home Care, & Value-Based Care, 2018 Medicare Fee Schedule Expands The Telehealth & Remote Monitoring Code Sets).
But, while reimbursement is catching up, there is a consumer utilization gap. Only 18% of consumers have used telehealth for a number of reasons (see Telehealth Gains Popularity, Telehealth Budgets Don’t). The main reason is that individuals are confused about insurance coverage and how to access. Other reasons for the lack of adoption include not knowing the clinical professional, concern about health records, and comfort with the medium.
The four executives featured in our telehealth session at The 2018 OPEN MINDS Strategy & Innovation Institute session, “Can Telehealth Be Sustainable For Specialty Provider Organizations? A Town Hall Discussion On Reimbursement, Regulation & The Next Generation Of Telepsychiatry,” Samir Malik, EVP and General Manager – Genoa Telepsychiatry, Genoa Healthcare; Deb Adler, Senior Associate, OPEN MINDS & Former SVP Network Strategy, UnitedHealth Group/Optum; Mehdi Qalbani, M.D., Psychiatrist, Integrated Behavioral Health; and Kristi Daugherty, LCSW, LISW, MBA, Chief Executive Officer, Emergence Health Network, offered some interesting perspectives on the current use of telehealth in the health and human service system. The most striking observation to me was that very soon, we won’t be talking about the practice of telehealth—the use of telehealth will be assumed in any clinical practice, like using a telephone. But, that is not the case right now.
Instead, our panelists viewed telehealth as a way that organizations can increase their effectiveness and improve the experience of their consumers. But, they noted that doesn’t happen by accident. Rather, there are three important points to consider. First, take time to educate consumers and set clear expectations; second, environment is important and you need to take time to design a space where consumers are comfortable; and finally, help your clinical professionals to develop their “webside” manner.
Educate consumers and set expectations—The panel concurred that before conducting telehealth visits, it is important to educate consumers on what telehealth is and what they can expect. Mr. Malik explained, this means walking consumers through what telehealth is, letting them know how the session will run, making them comfortable before the actual visit, etc. For example, if a consumer is not going to be receiving telehealth services in the community rather than an office-based setting, it is important to discuss privacy and appropriate places to do the visit. All agreed that consumers are actually less resistant to the idea of telehealth than clinical professionals and that most individuals have very little issue using this model. Dr. Qalbani even noted that their SMI population likes that the service is instantaneous and that sometimes it is easier to say difficult things than during an in-person visit.
Design a comfortable environment—If you are operating as an originating site, providing the physical location where the consumer receives telehealth, it’s important to set up the room to be as comfortable and pleasing as possible. This means painting the walls a soothing color, purchasing comfortable chairs, and decorating appropriately. By taking the time to create a comfortable room, you can also make sure it is set-up for the maximum benefit of the clinical professional. For example, placing a clock on the wall behind the consumers makes documentation easier and less obvious. And since telehealth by definition requires technology and a television, Ms. Daugherty said that, most importantly, “Do not buy a cheap TV. A high-res, high-def, and large TV makes a huge difference. If you are budgeting for an in-office program, you have to invest in the nice TV.”
Train clinical professionals to develop a “webside” manner—Equally important to setting up a telehealth program, is making sure your clinical professionals are trained and able to deliver quality care over video, and that the consumer setting is comfortable. Dr. Qalbani explained; “You need to set up your screen appropriately and have the right amount of landscape. I put the patient’s video right below my camera and ask them to do the same so we are making eye contact throughout the session. You also have to maintain the animation on the screen. Not quite a caricature of yourself but more than normal. If you are engaged with the patient and the story, that becomes second nature.”
For provider organizations, a telehealth program can make a big difference in addressing the shortage of psychiatrists and the issues it causes for consumers—wait times and access to care. But these programs are only going to work if consumers engage in this model and feel comfortable using the model.
For more on the topic of telehealth see:
- Telehealth Gains Popularity, Telehealth Budgets Don’t
- Telehealth Billing – Easier Than You Think?
- Getting Ready For The Era Of Telehealth
- Telemental Health Is Booming
- Telehealth Is Remaking More Than Therapy
- For Telehealth, The ROI Is Where You Plan For It
- Moving To The Flip Side – Telehealth, Urgent Care & Medical Homes
- The On-Demand, Direct-To-Consumer Online Therapy Market – A Glimpse
- Employer Health Plans Pushing Telehealth Adoption One Step Closer To ‘Ubiquity’
- The On-The-Ground Reality Of Making Telehealth Work
For even more, join us at The 2018 OPEN MINDS Management Best Practices Institute in Long Beach, California on August 15 for the session, “Cutting Edge Telepsychiatry: Sustainable Program Models In Practice,” led by OPEN MINDS Senior Associate Joseph P. Naughton-Travers, EdM; and featuring Christina Mainelli, Executive Vice President of Strategy and Product Development, Beacon Health Options, Carol Carmichael, Assistant Vice President, Network Strategy, Beacon Health Options, and John MacKenzie, RN Coordinator Psychiatric Telemedicine, Dignity Health.