This is the world kids live in and telehealth allows us to meet them where they are
The tragedies, big and small, of COVID-19 are innumerable. That said, if you look closely at how life is changing as society continues to adapt, there are some things that may have gotten better after the pandemic than they were before we ever heard of the novel coronavirus, or have spoken.
There is an argument that behavioral health can be classified under the category of things that have improved.
Let me explain: The behavioral health services practice I oversee, MEBS Counseling in Covington, Kentucky, consists of a multidisciplinary team of professionally licensed mental health and behavioral health specialists. Prior to COVID-19, MEBS provided counseling and other behavioral health services primarily to children and families in northern Kentucky. Many of our customers came from family situations with high levels of conflict. an experienced trauma; many were expelled through the Kentucky public school system; Few had access to other sources of behavioral health care. Most of MEBS’s revenue comes from Kentucky Medicaid.
Given the populations we serve, we did a lot of community work prior to the pandemic, meeting with customers where they are, especially in schools. We also offered in-office services, but for a rural population spread across eight counties and hundreds of kilometers, we spent a lot of time on the road.
When the pandemic broke out, like everyone else, we were forced into a situation at home overnight. We were cut off from our customers and from each other. We knew the isolation we were feeling was increasing for our customers, so we tried to find a workaround as soon as possible. We knew that our integrated EHR and billing provider, Azalea Health Innovations, Inc, also offered telemedicine, so we agreed with them to include telemedicine in our portfolio. The process was very quick: we had our first talks with Azalea on a Wednesday morning and on Friday we were in training. The following Monday, we provided behavioral health services through telemedicine.
One of the biggest factors that made our transition to telehealth so easy and quick was the relaxation of HIPAA guidelines by CMS, which allowed providers like MEBS to offer and reimburse telehealth appointments. It is interesting and regrettable that our health system has seen such a disaster to push through this expansion of behavioral health service delivery, but this forced experiment has proven the effectiveness of remote counseling.
The results we’ve seen using telemedicine to maintain continuity with our customers have been somewhat unexpected, especially with children. We work with children from three years up to 18 years. For many of these young people we expected difficulties in getting them to contact us via a telehealth platform. What surprised us is that so many of them not only managed to transition to remote sessions with us, but that they actually thrived in ways that we didn’t see when we met with them in person to have. When they are in their own comfortable environment and can show us a favorite cuddly toy or something else that matters to them, and when we include some of these treasured items in our work with these children, they have really opened up to our therapy.
For the teenagers we work with, the chat functionality in telemedicine has been very helpful. For many, texting can be a simpler way of speaking than speaking the words. Having this alternative form of communication available was an important aspect of building relationships with young people who are particularly reserved. For some providers, of course, this took some getting used to. But it is important to remember that this is the world children live in. This interface is their element. Our telehealth platform enables us to meet them where they are.
We have also seen some very positive developments in the adults we work with. Many have difficulty leaving their homes due to anxiety or other problems. Just making an appointment and being on time can be a huge obstacle. Telemedicine has made it possible for them to feel comfortable in their own four walls and assured them that they will be able to have regular access to their care providers. This continuity is critical to building the trust that is essential to caring for them.
The benefits of providing behavioral health services through telemedicine extend to the families of our younger customers as well. Time management for parents who juggle their own jobs with caring for their children (including counseling time) is easier without the travel time to and from appointments. This is twofold for families also looking to support online learning while schools work remotely or in a hybrid model.
Of course, we can’t say this year of behavioral health via telemedicine has been a clear success. Some of our clients who we thought would do reasonably well with the pandemic isolation have not responded as well to the telemedicine modality as we expected. It is important for them to return to face-to-face meetings as soon as possible. However, if in the future we consider telehealth as an additional means of supplying our customers and not as a replacement for personal delivery in wholesale, the forced introduction of telehealth has had a positive effect on the health of our customers and the health of our practice as well.
There is another challenge we didn’t anticipate: The convenience of receiving services through telemedicine has given some families we serve a false sense of informality about scheduled appointments. Some mistakenly assume that advice on telemedicine with video and chat capabilities will be available upon request. For others, the convenience of getting services without leaving home may mean that skipping a scheduled session isn’t a big deal. In any case, it is important that all recipients of telemedicine services treat scheduled sessions like in-office appointments so that a regular cadence is maintained and the services are not underutilized due to last-minute cancellations. Overall, however, we are very pleased with the freedom CMS has given providers to remotely deliver behavioral health.
I know we all had to adapt to living with COVID. Everyone deserves credit for finding a way to get through. I have to say that I am very impressed by our team and proud that they were so flexible, learned new techniques and pushed them further. This also applies to our customers. We both endured a lot of teamwork and that’s a huge area of positivity that I saw in it.
In retrospect, while the transition to offering telemedicine was not a trivial one – there were lots of moving parts and important training we had to go through – it was an easier extension for MEBS than I could imagine (or maybe) be in the future) for other providers. We were lucky on two fronts: First, apart from the pandemic, we had identified telehealth as an operational target for 2020. We had already done our homework so we didn’t have to find an in-house champion whose job it would be to evangelize telehealth and sell it to the members of our practice. Second, we knew our EHR and billing provider had a telemedicine module on their platform, so adding Azalea’s telemedicine to the platform we were already using was a breeze. Overall, the lead we accidentally gave ourselves simplified the technical integration and made the increase in staff manageable.
Looking ahead, we anticipate that CMS will continue to leverage the flexibility of offering telemedicine for behavioral and other clinical services. What is likely to change, however, is the relaxation of CMS in using non-HIPAA compliant platforms for telemedicine delivery and management. For care organizations that have relied on a conferencing solution like Zoom or some other service and are currently identifying a HIPAA compliant telemedicine product, I have some unsolicited advice: Find a provider who can provide integrated services that will turn your telemedicine on a native function of your healthcare IT platform and not an integrated solution that cannot share data with the other technology tools. That way, both your frontline vendors and back office staff will be happier, so everyone on the team can focus on what matters most – a better patient experience.
(Vator will host the Future of Mental and Behavioral virtual event on May 19. We will have high-level VCs and C-level executives from leading mental and behavioral companies like BetterHelp from Teladoc, Amwell, Doctor on Demand, and Kaiser Permanente, Bessemer Venture Partners, GSR Ventures and more)
(Image source: Parade.com)