Recommendations could help inform long-term policy decisions regarding the use of telehealth for behavioral health services
Federal and state policy changes prompted by the COVID-19 pandemic have enabled behavioral health providers in Michigan and across the country to rapidly expand their telehealth use to continue treating clients for mental health and substance abuse disorders from a safe social distance.
Up until March 2020, providers were relatively slow to adopt telehealth services, often because of regulatory barriers. As the coronavirus began to spread across the U.S., the Centers of Medicare and Medicare Services (CMS) loosened regulations and reimbursement requirements, and Michigan and 29 other states passed emergency orders to permit expansion of telehealth services. Most of these policy changes, however, are set to expire once the COVID-19 pandemic is declared over.
To help assess the impact of these policy shifts, a new University of Michigan report examined behavioral health providers’ perspectives and experiences using telehealth, including their views on care quality, access to care, and client satisfaction.
“With the rollout of COVID-19 vaccines underway, policymakers will decide whether to make many of the recent telehealth reimbursement and authorization policy changes more permanent,” says senior author Angela Beck, Ph.D., M.P.H., clinical assistant professor at U-M School of Public Health and director of the U-M Behavioral Health Workforce Research Center which conducted the study. “It’s important for policymakers to consider behavioral health providers’ perspectives on how telehealth has impacted their day-to-day work and how they view its role in a post-pandemic world.”
Between late July and mid-August of 2020, the researchers conducted phone interviews with 31 behavioral health providers across the state of Michigan, including a psychiatrist, psychologists, clinical social workers, mental health counselors, registered nurses, substance use disorder counselors, applied behavior analysts, and peer support providers.
The providers reported they felt better equipped to meet their clients’ diverse needs after receiving the flexibility to offer telebehavioral health services when appropriate. The majority of providers (30 out of 31) reported that clients were satisfied with telebehavioral health services, and over half said that virtual care was of the same or better quality than in-person care.
Most providers (28 out of 31) noted that telehealth helped mitigate frequently cited barriers to accessing behavioral health care, including lack of transportation, inability to miss work, and childcare issues. Moreover, 22 providers said that telebehavioral health helped decrease no-show and cancelation rates for appointments.
Audio-only telebehavioral health services, in particular, helped providers expand access to care for clients who were geographically isolated, lacked transportation, and had limited access to the internet or internet-connected devices. Nearly half of the providers reported that audio-only telebehavioral health services were as effective as audio-visual services and were sometimes preferable for clients with anxiety, serious mental illness, or trauma, who were uncomfortable with video.
However, virtual care does not work well for everyone or for all services. More than a third of providers (11 out of 31) reported that certain behavioral health services, such as group therapy and physical health assessments, were not well suited for telebehavioral health.
“Telehealth works better for some clients than others and is more effective for certain services,” says Beck. “Ultimately, more choices for providers and clients means better access to care, and providers feel that they should be allowed the flexibility to identify the most effective modality to serve their clients’ specific needs.”
When considering the use of virtual care amid the pandemic and beyond, all providers said they preferred to continue offering telebehavioral health moving forward, most often as a hybrid model with both in-person and virtual options offered to clients for certain services as appropriate.
Based on their interviews, Beck and colleagues outline several policy considerations to sustain and further improve access to care via telebehavioral health:
- Allow audio-only telebehavioral health options when other forms of care are not feasible.
- Remove procedural barriers for providers offering telebehavioral health services, for example allowing verbal consent for treatment rather than written only.
- Broaden the definition of services covered and reimbursed through telebehavioral health to enable clinicians to be flexible in deciding the best course of treatment for each client.
The team’s work was funded by the U-M Institute for Healthcare Policy and Innovation as part of its Policy Sprint initiative. Beck’s co-authors were Cory Page, M.P.H., M.P.P., and Jessica Buche, M.P.H., M.A., of the U-M Behavioral Health Workforce Research Center.