With high-profile suicides in 2018 along with the opiate epidemic, mental health is high on the list of national medical concerns. Demand for behavioral health services, combined with increasing access to those services via telehealth, could dramatically improve treatment options for rural residents.
Last year’s report on Medicare telehealth from the Centers for Medicare and Medicaid (CMS) shows promise that behavioral health services – which address mental well-being – could become more widely available via tele-health services. CMS policy changes could lead to an increase in community broadband to support home telehealth. The report offers insights to broadband owners about subscribers’ potential telehealth needs.
“Emerging research such as that from CMS indicates telepsychiatry can reduce disparities in access to psychiatric care,” says Marlene M. Maheu, Ph.D., an executive director of the Telebehavioral Health Institute who has worked in telehealth for over 25 years.
“For example, psychiatric care delivered remotely by broadband increases the chances that individuals living in rural communities will be able to access professionals,” she said.
CMS found in 2016 that 84% of all telehealth users (74,547 Medicaid beneficiaries) had a mental health diagnosis. “In the years that CMS conducted studies, a majority of Medicare telehealth users were diagnosed with one of eight common mental health and substance use conditions,” says Dr. Maheu.
Community Broadband and the Tele-Health Challenge
In the two years since the study, the various disciplines of telehealth have increased their respective percentages of encounters. Private insurers are expanding their telehealth coverage, and telehealth vendors such as American Well have popularized telehealth for general practice medicine. Nevertheless, telepsychiatry is likely to be the lion’s share of telehealth encounters.
“Community broadband could facilitate deployment of mental health services in urban and rural areas because of its relatively low cost, convenience, and ease with which they can implement some integrated behavioral health approaches,” says David Peterzell, Ph.D, professor of clinical psychology at John F. Kennedy University in California. “Broadband-based telehealth also can provide services to underserved populations who otherwise can’t or won’t come to a facility, either because they lack insurance, transportation limitations, or the stigma of coming to a mental health practitioner.”
More prevalent today are treatments for behavioral health challenges that involve multiple psychiatric disciplines with each patient. This can be difficult to manage when a patient or various practitioners are many miles apart. Broadband becomes the practical way to coordinate and deliver those treatments.
“When designing and engineering broadband infrastructure, network owners must take care to meet ethical and legal requirements involving, for example, how you manage protected and confidential health information that is typically handled by mental health practitioners,” states Peterzell. That is, systems need to be compliant with the Health Insurance Portability and Accountability Act (HIPPA).
Digital Therapeutics and Community Broadband
Digital therapeutics is a subset of digital health that uses online health technology to treat a medical or psychological conditions. The treatment commonly tracks personal data on behavior such as exercise or nutrition and uses it to help patients make healthy choices.
Several chronic illnesses such as type 2 diabetes, obesity, hypertension, and heart disease can be the result of people’s bad habits – smoking, drinking, overeating – which in turn are driven a lot by stress, anxiety and other aspects of behavioral health. It is more effective and cost-efficient for patients and healthcare providers to prevent illnesses than treat illnesses. So, the Center for Disease Control has developed programs to address prevention, such as its Diabetes National Prevention Program.
Telehealth vendor Fruit Street delivers digital therapeutics for addressing bad habits that have severe medical consequences – type 2 diabetes. Fruit Street CEO Laurence Girard says, “Digital therapeutics may be programs that deal with sleep, stress, and resiliency, while others may focus on opiate addiction or general mental health.
Fruit Street’s Digital Diabetes Prevention Program combines group telehealth sessions, wearable monitoring devices, and dietary tracking within the vendor’s mobile application. Besides lowering the risk of developing type 2 diabetes, the program can also lower the risk of having a heart attack or stroke, improve health overall, and help subscribers feel more energetic.
“We have a 6 million people who are pre-diabetic, meaning they are at risk for developing diabetes,” says Girard. “You have somewhere between 20 and 30 million people with diabetes. It may not technically be considered an epidemic, but it is a major problem.”
Their program is designed so users don’t need a real-time Internet connection, but patients maximize their investment by having live video and interactions with health coaches and other users. Girard worries about communities that don’t have good broadband.
“In an ideal world, insurance companies and broadband network owners would structure deals in which participants in our program would get a discount for their Internet accounts. Insurers would reduce preventable illnesses, and owners would increase subscriber loyalty.”
Providing behavioral health services is not necessarily easy or inexpensive. But the benefits for individuals and the communities where they live are obvious. Creating better access through tele-behavioral health might provide communities with more peace of mind on multiple levels.