By Adam Herbst, senior vice president, chief legal, compliance, planning and government relations officer for Blythedale Children’s Hospital and adjunct assistant professor, and Ira Bedzow, Ph.D., associate professor of medicine, New York Medical College.
We continue to see how states are responding to the multiple challenges that the COVID-19 pandemic presents – trying to ensure there is hospital capacity for patients, protective equipment for healthcare workers, money in the hands of the unemployed, and food in the mouths of those who are hungry. All these endeavors have been responsive, by which we mean that even when states are preparing for problems, state leaders are enacting temporary solutions with the hope to return to the status quo ante.
Yet there is one major area of healthcare that the pandemic is forcing state and health leaders to confront, which can fundamentally change healthcare delivery in the future – telemedicine. While telemedicine has begun to replace office visits to primary care physicians and in certain specialties, it can be a major disruptor for behavioral health, where changes made now could last long after the pandemic. That will be a good thing. It would allow healthcare to meet the increasing needs for behavioral health, both because of the pandemic and in general. It would also serve as a paradigm case for how healthcare can and should adapt to meet the economic, social, and technological needs and opportunities of the future.
Because of the pandemic, states have loosened regulatory requirements, such as HIPAA and other privacy protection measures, so that patients can access clinicians through Skype and Facetime. This has created access to conventional clinical care, such as diagnosis and monitoring, as well as patient education and wellness promotion, among other services.
Telehealth has also benefited from the easing of restrictions, but states can and should do more. For example, while states have suspended border restrictions for telehealth due to the pandemic, the suspension is temporary, like all other responses so far. But it shouldn’t be. Public officials and health leaders need to find ways to maintain the increased and flexible access to telehealth even after the pandemic, especially in behavioral health.
Given the increasing demand for mental health services and the ease in which technology can provide a means to connect across vast distances, states should re-evaluate the need for individual licensure requirements. Having a standard licensure across states, or at least having the means for license recognition reciprocity between different states, would allow behavioral health providers to offer services in places where there is a lack of clinicians without having to move or spend time dealing with bureaucracy. Reciprocation agreements already exist in other fiduciary fields, such as law. There is no need to limit the benefit to patients simply for the sake of deferring to the status quo.
Not only would interstate telemedicine alleviate the widespread shortage of behavioral healthcare professionals, it would also provide economic opportunities for states to attract the telehealth industry. Telemedicine providers – and even retail clinic providers – have been quickly growing their telepsychiatry workforce to meet the demand.
Without having to be in the same city as their patients, these clinicians are no longer geographically limited. Just as Silicon Valley was created through the growth of an industry, other areas in the country could see benefits in all sectors of the economy through the growth of telehealth.
On the patient side, the benefits are many-fold. Rural health would no longer have a dearth of behavioral health providers, a problem from which it currently suffers. People also won’t have to worry about seeing their therapist in the grocery store. The latter point may be flippant, but it is still a concern for many.
Even though acceptance of behavioral health treatment has grown, stigma is still a problem for patients. A Price Waterhouse-Cooper survey of patients aged 18 to 44 found 72% of respondents would be willing to receive behavioral health care virtually, in place of an in-office visit.Through telehealth, states can give patients their privacy, even if they cannot directly fight social stigma.
With relaxed licensure obstacles, it will also be easier to require commercial health plans and state Medicaid programs to cover telehealth services. Network plans could become much larger, decreasing insurance costs for patients. Telehealth will not only increase access, it can make access cheaper.
Telehealth was already receiving significant attention before the pandemic to increase access to behavioral health care. The pandemic provided the urgent need to move from talking to acting. Now that we see its benefits, state and health leaders need to start constructing workable, long-term tele-behavioral health guidelines and solutions, which includes expanding telemedicine coverage for insurance companies
Eventually through innovations in biotechnology, America we will put this pandemic behind us. Yet, when the COVID-19 crisis fades into a thing of the past, let’s not return to the status quo ante. Let’s use these lessons to continue to innovate. Telehealth can give people the care they need – now and in the future.