Behavioral Health - Key Activity 15

KEY ACTIVITY #15:

Optimize Telehealth

 

Overview

Telehealth may be implemented in various ways, ranging from clinicians working off-site (e.g., at home) delivering care to patients in their home to clinicians in the office delivering care to patients by phone (e.g., audio-only telehealth). Telehealth is a preferred modality for many patients seeking behavioral health services, making it an important area of growth for most practices. This activity offers suggestions for enhancing the quality of telehealth services.

Why this matters

For most practices, BH services are at least partly delivered via telehealth; in 2023, BH was the type of health service most likely to be delivered via phone or video. In California, 60% of these telehealth visits are via video platform while 40% of all behavioral health visits are audio-only (e.g., phone).[1] Studies have repeatedly shown no differences in health outcomes between BH services delivered via phone, video or in-person.[2]

Telehealth BH visits are now permanently covered in California as a reimbursable service.

Implementation tips

  • Develop workflows that prioritize patient preferences for the modality of service for BH care. Ideally, patients are able to choose whether they receive services in person, on the phone, or via video. Research indicates patients prefer telehealth modalities for BH about 50% of the time.[3] Delivering services based on patient preferences lowers missed appointments, increases adherence to recommendations, and improves activation.[4]
  • Expand telehealth offerings in practices in rural areas, as distance to receive care is a barrier in rural counties; telehealth for BH services allows people to obtain care they would otherwise likely not receive.
  • Expand audio-only services to patients in geographic areas or homes with little or no internet access to receive necessary BH services.
  • Train BH staff and providers on delivering care via video and phone (e.g., audio-only). Care via video is similar to in-person visits, while delivering high-quality care via the telephone demands a different set of skills.
  • Ensure telehealth services support and enhance equity. Without intentional focus and effort, telehealth services can replicate inequities in traditional care. Make sure patient preferences are adhered to equally and anti-bias strategies are integrated into phone and video care; training for staff in other equity practices is crucial. A starting point for resources to support this are available below.
  • Offer digital navigation services for patients who prefer video visits but need assistance in accessing this. Demonstrate the telehealth option while a patient is in the clinic or dedicate a staff member to call patients ahead of appointments and walk them through the video set-up to help them overcome technical barriers. For patients needing further support, consider leveraging community health workers to offer a home visit to assist with establishing telehealth.

Endnotes

  1. Canady VA. California FQHCs see increased audio‐only BH telehealth visits. Mental Health Weekly. 2023 Apr 21;33(16):5–6.  
  2. Bulkes NZ, Davis K, Kay B, Riemann BC. Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. Journal of Psychiatric Research. 2021 Nov;145:347–52.  
  3. Waite MR, Diab S, Adefisoye J. Virtual Behavioral Health Treatment Satisfaction and Outcomes Across Time. J Patient Cent Res Rev. 2022;9(3):158-165. Published 2022 Jul 18. doi:10.17294/2330-0698.1918 
  4. Smith SG, Pandit A, Rush SR, Wolf MS, Simon CJ. The Role of Patient Activation in Preferences for Shared Decision Making: Results From a National Survey of U.S. Adults. J Health Commun. 2016;21(1):67-75. doi: 10.1080/10810730.2015.1033115. Epub 2015 Aug 27. PMID: 26313690; PMCID: PMC4706032.