Telebehavioral Healthcare: A Post-Pandemic View 

Jan 20 2022

Behavioral health concerns are on the rise. In the wake of a pandemic where social isolation is a safety measure, Americans are experiencing greater depression, anxiety, stress, burnout, and substance use. In fact, drug overdoses have reached the greatest number we have ever seen in American history.  People who want help with these types of problems often must overcome a number of barriers: stigma, cost, and simply knowing where to start and who to call.  Travelling to a provider’s office can also be a barrier -- but fortunately in many cases there’s now a way around it.

Behind the phenomenal growth of telebehavioral health

Telebehavioral healthcare -- virtual behavioral health coaching, therapy, and psychiatry -- has become far more common over the course of the pandemic and seems to be here to stay.  An analysis of data in MercerFOCUS, which warehouses the claims of over 1M health plan members, found that that the portion of total outpatient behavioral healthcare encounters conducted via telebehavioral health jumped from just 1% prior to Q1 2020 to more than 50% in Q2 2020 – where it has stayed for more than a year now (through Q3 2021). This stunning change is a result of a both a decrease in traditional office visits and an increase in telebehavioral health visits.

While the pandemic may have provided the impetus for growth, it doesn’t explain sustained growth of this magnitude. Telebehavioral healthcare addresses longstanding access issues and navigation challenges seen with in-person behavioral healthcare. It is also destigmatizing in nature, in that people receive care in the privacy of their homes without the need to get to and from a physical office space.  Recognizing these advantages, new players in the EAP and behavioral health market have begun over the last few years to offer tech-enabled user experiences designed to provide fast access to high-quality providers through virtual modalities, incorporating clinically validated assessments, evidence-based treatments, and outcomes monitoring.   More recently, traditional EAP vendors have begun to overlay their services with a variety of digital solutions, and to offer new ways to access care. In short, there is considerable momentum behind the shift to a virtual-first care delivery system as a means of counteracting challenges in service delivery.

In addition, telebehavioral healthcare helps address the full spectrum of mental health and substance use needs. Clinical care like therapy and psychiatry should be reserved for people with a condition that is severe enough to require a diagnosis. But what about people with subclinical issues? While their symptoms may not hit the diagnostic threshold, they could be at risk of developing mental health and substance use problems that early intervention has the potential to delay or prevent.  Self-guided behavioral health tools and subclinical coaching through text/chat, phone, and video have been introduced specifically for this larger population (in conjunction with therapy and psychiatry). Digital Cognitive Behavioral Therapy, for example, is used in solutions both for specific behavioral health issues and also for overall wellbeing. People can work on their behavioral health problems at their own pace and in the comfort of their own space with digital applications and programs.  In the context of public health, prevention is everything. These virtual players offer a solution for everyone on this spectrum.

The case for telebehavioral healthcare

Of course, the essential question is whether virtual care is making people better.  Happily, a growing body of literature indicates that telebehavioral health is in fact working. Some studies suggest that it is just as effective as in-person care and that retention rates are higher. While there is some disagreement as to whether therapy via text or phone is as effective as therapy via video (as people can be more easily distracted and the therapist cannot see facial expressions), text and phone remain a strong resource for those experiencing subclinical issues. More research is needed to compare treatment of different populations across modalities and platforms, and to determine best practices for conducting assessments, establishing an informed consent process (especially for child and adolescent care), fulfilling professional obligations, and tracking and reporting clinical outcomes. Addressing imbalances in care supply and demand cannot take priority over care quality. 

Building telebehavioral healthcare into your program

Here are some suggestions for employer plan sponsors looking to build a sustainable ecosystem that ensures timely access to quality behavioral healthcare:

  • Focus on early intervention. Build out the core program structures so you can provide your people with the tools they need to run at their best. This includes stress management tools—such as mindfulness training and resiliency support—that can help people while their issues are still manageable without clinical interventions.
  • Ensure your workforce can support early identification. Managers and supervisors are uniquely situated to identify signs and symptoms of common mental health conditions, and they need the tools to respond.
  • Review your vendors’ sustainability plans. As more point solutions are introduced into the behavior health space, look at ways your partners can retain providers and improve upon the quality of their panel. Ensure that networks can accommodate increasing demand and deliver care in a manner that is sensitive to the needs of specific and often marginalized groups.
  • Ask your people. Employees are willing to share their experience. While the inside of the onion may not look great – in fact, it may bring tears to your eyes! -- understanding perceptions around your programs is critical to success.

Despite some progress in expanding care access, we have not yet seen the worst of the behavioral health crisis. Now is the time to prioritize actions that will provide access points that meet people where they are and optimize all resources that currently support your population.

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