Telemental health is increasingly being used to expand behavioral health care access to clients in need, especially those living in rural areas with limited clinical resources. However, there are some challenges to overcome before telemental health will be able reach its full potential as a delivery system for behavioral health services. Surprisingly, some of the challenges for on-site face to face sessions in rural communities may also limit the success of telemental health services in these communities. Per the authors of the article Understanding the Business Case for Telemental Health in Rural Communities, the challenges that impede success in rural areas for both face to face and telemental health sessions include:
- Poor insurance reimbursement
- Difficulties recruiting and retaining qualified behavioral health providers
- High rates of un-insurance
- Appointment no show rates
Additionally, rural telemental health delivery has a unique set of challenges due to the technology requirements for the delivery of care that include:
- Poor connectivity due lack of sufficient Wi-Fi speeds
- Insufficient access to required technology devices
- Possible licensing limitations for the provider
Despite these challenges, the Affordable Care Act supports the use of technology to provide behavioral health services. This is part of a shift from a fee for service reimbursement model to a focus on the population and value based care (VBC) reimbursement. VBC demands efficient and quality health care services that support prevention and wellness, while decreasing costs. In my own private practice, my telemental health clients have reported benefits such as ease of use, positive therapeutic relationship, improvement of symptoms, and 90% report that they experience no difference with the quality of their treatment when using video-teleconferencing vs face to face sessions.
Regardless of the next approved healthcare approach passed by the Federal Government, I believe the aims identified and initiated by ACA for VBC will remain in place. However, there needs to be additional financial and government support to successfully transition from traditional face to face sessions to the use of technology for behavioral health delivery. Some of the key areas required for success include:
- Standardized reimbursement supported by clear measurement tools for documentation of evidence based treatment and services
- Broader privileges/licensure for clinicians to work across state lines
- Nationwide infrastructure for high speed Wi-Fi/access that includes rural communities
- Education/training for the provider and client on how to use technology tools
In my opinion, once the above four areas have been addressed, the challenges that have been previously identified as currently impeding the success of telemental health will significantly decrease. Telemental health in rural communities will then not only be a viable delivery system, but it will also support efficient and quality care for those in need!
Lambert, D., Gale, J., Hartley, D., & Croll, Z. H. (2016). Understanding the Business Case for Telemental Health in Rural Communities. The Journal of Behavioral Health Services & Research, 366-379.
Submitted by: Martha Ireland, PHD, RN