A Quality Checklist for Virtual Behavioral Healthcare Solutions 

As the pandemic made very clear, current events can necessitate fast adjustments to health and benefits strategies. With in-person health care severely limited during the worst of the pandemic, telemedicine clearly got a boost. Especially notable is the rapid adoption of virtual behavioral healthcare. Over a third (34%) of all large employers responding to Mercer’s Survey on Health and Benefit Strategies for 2024 said their employees now have access to an exclusively virtual network of behavioral health care providers, or will in 2024. Virtual behavioral healthcare addresses access issues and navigation challenges often associated with in-person care. It is convenient and destigmatizing in that people receive care in the privacy of their homes without the need to get to and from a physical office space. For people living in rural communities with a limited number of local licensed behavioral health providers, virtual care increases opportunities to choose a provider of a preferred clinical specialty or demographic background.

Virtual options are critical to meet behavioral health care needs. However, with the rapid evolution of virtual behavioral health care, we have seen some gaps in clinical oversight and governance in some solutions. In selecting a virtual behavioral health care partner, employers should consider the following four areas:

Behavioral health experts are essential to ensuring that evidenced-based interventions and clinical best practices are used. While this may seem like a given, some digital solutions relied heavily on technology experts backed by venture capitalists and overlooked the importance of clinical leadership from behavioral health experts, leading to gaps in care quality. A best-in-class solution includes behavioral health experts such as psychiatrists, Licensed Clinical Social Workers (LCSW’s), Licensed Professional Counselors (LPC’s) and Licensed Marriage and Family Therapists (LMFT’s) as part of the core leadership team and on the board of directors, and these experts should be involved in all stages of development, testing, implementation and monitoring of the program. Employers can evaluate this component by asking vendors to provide organizational charts that include educational background and credentials.

Quality monitoring is critical to any behavioral health solution and virtual solutions require that we rethink the process for vetting and monitoring providers. Prior to the pandemic, most behavioral health services took place in an office. Providers and some facilities pivoted quickly to virtual offerings to meet needs. There was limited time to explore new ethical issues, provider qualification and best practices. While there are certification courses to increase proficiency with technology, state and/or federal oversight and guidelines are lacking. A best-in-class quality-monitoring program should feature rigorous vetting before a provider is admitted to a network and ongoing proactive monitoring of access and quality. This is achieved by requiring providers to submit documented proof of telehealth competency and clinical specialties (e.g. certifications to use specific clinical protocols and/or treating specific conditions) and ongoing monitoring of real-time metrics such as clinical outcomes, member-provider congruence measures, number of appointments available for clients, and member satisfaction.

Diverse provider networks that allow members to select behavioral health experts based on several dimensions of provider demographics, such as race,ethnicity, language, or LGBTQIA+ status, are fundamental. When members have choice in the background of their provider, they typically feel better understood and have better clinical outcomes. While there are no national diversity requirements for provider networks yet, employers can look for solutions whose provider network appears to match the demographics of their population base. A best-in-class solution tracks provider diversity, allows members to search the provider directory based on dimensions of diversity, and has a short-term and long-term plan to increase the diversity of their network.

Provider support in the form of training, peer support, and competitive pay is important to the long-term health of the profession in that it encourages more people to enter the field and progress in their careers. A best-in-class solution provides in-house opportunities for continuing education at no cost to the provider; includes peer support groups to build community and help providers stay current on clinical research; and has increased provider rates to stay current with or exceed inflation.

While brick-and-mortar behavioral health services will continue to play an important role in providing care, it’s clear that virtual services are here to stay. But – especially in these early days – oversight and governance is critical to ensure that members seeking virtual behavioral health care have a good experience and, most importantly, good outcomes.