I love the new year. I’m always impressed by its power to somehow force us to look back on what we’ve accomplished, where we’ve failed and what lessons we’ve learned along the way. More importantly, I love how it grants us the opportunity to look forward. As my team has strategized for the future, I wanted to share some of our predictions for where the telepsychiatry industry is going in 2015 and beyond.
First the facts:
Telepsychiatry, or psychiatric care provided through real-time videoconferencing, is a widely used medium for bringing psychiatric care into locations with limited access to mental health professionals. It allows for a psychiatrist or other mental health professional to see, evaluate, diagnose and treat patients without having to be in the same physical space.
I have been working in this field since 2008. I oversee a staff of psychiatrists and psychiatric nurse practitioners who utilize their time efficiently and serve patients all over the country from their home office. Some of these providers, including our medical director, have conducted around 10,000 psychiatric evaluations via video throughout their careers. In recent years, I have seen an incredible upswing in the use of telepsychiatry in nearly all settings and applications. There are now hundreds of clinical research studies that show the effectiveness of telepsychiatry with nearly all settings and populations. Telepsychiatry is successfully extending care into rural and underserved areas and allowing individuals to access behavioral health services like never before. My team estimates that over a million psychiatric encounters will occur via telepsychiatry in 2015 and that the industry will continue to develop and make telepsychiatry easier and more ubiquitous than ever.
Here is our list of what we are excited about in 2015.
1. The Growth of Direct-to-Consumer Models of Care
Healthcare is in an exciting era, it’s going through what I like to call an “uber-ization.” People are beginning to demand convenience, choice and transparency in their healthcare. They want to be able to shop providers, book appointments on the go, track and view their own health data. As such, there has been an expansion of direct-to-consumer models of care in behavioral health and beyond. We anticipate this model will continue to grow in popularity and that individuals will continue to demand more convenient, accessible forms of care. In response to this movement, our company is in the process of launching our own online behavioral health marketplace for direct-to-consumer care called Inpathy that enables consumers to videoconference with a provider from home. We predict major growth in this area in 2015.
2. Policy Improvements that Make Licensing Less Challenging for Telehealth Providers
One of the biggest headaches with telepsychiatry to date is that a provider must be licensed in both the state where he or she is located and the state where the consumer is physically located. To get additional licensure in in new states takes many months and is a major hindrance to truly delivering care “anywhere.” Luckily, the Federation of State Medical Boards (FSMB) has drafted a compact that will make the licensing process much shorter and easier for telemedicine providers. We look forward to the adoption of the compact by many states and a more streamlined licensing process in 2015.
3. Insurance Companies Embracing Telehealth as a Tool for Improving the Overall Health of Their Populations
In 2014, many insurance companies explored how to incorporate telehealth into their services in order to give additional choice and control of their care to their members. While some of this exploration followed regulation, many insurance companies took their own initiative to create telehealth benefits because they have begun to see the advantages of empowering their customers with the tools they need to live healthier lives. These payers are increasingly recognizing the need for comprehensive, whole person care that incorporates both physical and mental health. In 2015, we anticipate even more forward-thinking insurance companies to take the plunge and develop meaningful telebehavioral health programs for their members by even offering to pay for visits occurring at home.
4. Hospitals Will Expand Telepsychiatry and other Telehealth Programs
More and more hospitals have implemented telepsychiatry programs and seen positive returns on their investment. With the ability to get a psychiatric assessment within an hour or so, telepsychiatry has allowed EDs to quickly place individuals in the appropriate level of care and improve their overall throughput. The American College of Emergency Physicians (ACEP) has recognized telepsychiatry as a focus area for 2015, so we anticipate many new hospitals considering programs for their EDs. For hospitals that already utilize telepsychiatry within the ED, we anticipate many of them expanding their programs into new realms such as consultations on medical floors and rounding services and inpatient unit services. We anticipate individual hospitals and large health systems continuing to develop and expand telepsychiatry programs in their emergency departments and beyond in 2015.
5. Expansion of Reimbursement for Telepsychiatry
While CMS has recently increased reimbursement for some telepsychiatry services, and many state Medicaid programs have mandated reimbursement for telehealth, there is still considerable room for improvement. There are still a number of states that have not yet mandated insurance coverage for facility-based telepsychiatry programs that reimburse at the same rates as in-person encounters. We anticipate improvements in this via legislation. Additionally, I’ll predict that several new states will also mandate insurance reimbursement for in-home telepsychiatry in 2015.
6. New Opportunities for Remote Clinical Collaboration
With the development of virtual private practices and expansion of online tools we anticipate the growth of collaborative care models that utilize one or more remote providers in order to address the comprehensive needs of an individual. You can’t treat an individual on an island. It takes teamwork and communication on the part of the individual and multiple types of providers to achieve overall wellness. We anticipate that technological and conceptual advances will make remote clinical collaboration increasingly easier as 2015 progresses.
7. Proliferation of Clinical Practice Guidelines and Best Practices
As more and more players enter the field of telepsychiatry it is increasingly important that professional organizations take a stand to create guidelines for appropriate care. My team looks forward to organizations like the American Psychiatric Association (APA) and American Academy of Child and Adolescent Psychiatrists (AACAP) releasing more guidelines for clinically appropriate telepsychiatry. Standards from nationally recognized organizations like these will help telemedicine to become more universally accepted in 2015.
Along the same lines, we anticipate that the American Telemedicine Association’s recently launched direct-to-consumer certification process will help to ensure that providers and organizations offering telehealth directly to consumers are doing so with the patient’s needs and wellness in mind. I applaud ATA for these efforts.
8. New Settings Embracing Telepsychiatry
More and more people are seeing the value of telepsychiatry beyond just clinics. The technology as it is now means that telepsychiatry can truly be accessed from anywhere. One unique model of care InSight helped to develop in 2014 was a Pennsylvania-based remote crisis team that began to “take telepsychiatry with them” as they responded to psychiatric crisis situations within the community. Using a 4G card and a laptop, the crisis team accesses an on-demand psychiatrist for when they need assessment, consultation and the option for a bridge prescriptions.
In addition to growth of similar models like this, we expect to see other settings that have not yet fully leveraged the power of telepsychiatry also jumping on board in 2015. This list includes universities, skilled nursing facilities, family service departments, in-home healthcare companies and more.
9. Tools to Help Maintain Wellness and Addresses Behavioral Health Concerns Before Stage Four
There are all sorts of tools out there to help consumers stay more informed and aware of their health status and to help providers stay connected and available to their clients. We anticipate that these will continue to be incorporated into clinical practice, particularly within behavioral health, and that providers and organizations will begin to incorporate this health data into an individual’s health record and regular care plan. Seeing how this this intersection of telemedicine, telehealth and e-health evolves into a coordinated and comprehensive approach to wellness will be tremendously exciting in 2015 and beyond.
10. Expansion of Training Opportunities on Telebehavioral Health
Telepsychiatry is a hot topic and an appealing lifestyle for many providers who want to work from home and have the flexibility in their location and practice that telepsychiatry provides. We have already seen an upswing in requests for clinical training content and presentations about telepsychiatry and we anticipate a number of training programs working to further incorporate clinical best practices for telepsychiatry into their day-to-day as 2015 progresses. If my prediction that telepsychiatry will become a mainstream way of delivering care is to come true, then we all must spend energy on developing new generation of remote providers and consumers who embrace technology as a tool to increase access to care.
Will all of this happen? Maybe not, but if we see any incremental progress in these areas, our entire system will see significant improvements in access to much-needed psychiatric care.
What do you see happening in 2015?