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We know the pandemic has forced “innovation” (read “telehealth”) in all of health care and especially in behavioral health. But as I have said, the reactive move to telehealth in itself is not innovation (see Innovation Does Not Stop With Telehealth). The 15- to 20-year lag between the development of a new and effective practice—and its common use at the community level—persists. As we look ahead and look beyond “video visits,” the question is how much and how will the consumer get services? What are the constraining factors? There is one big factor—the technology on both the consumer and organizational sides of the equation.
We got a glimpse into the strides and the gaps in technology in a national survey (see The New Role Of Virtual Care In Behavioral Health) of more than 1,000 behavioral health care executives and staff conducted by Qualifacts and the National Council For Behavioral Health. The survey confirmed the dramatic spike in telehealth use by most provider organizations that had no other option to keep their doors open. Pre-pandemic, only 2% of organizations were providing 80% or more of their care virtually but today 60% of organizations are providing 80% or more virtual care. Post-pandemic, only 8% of provider organization executives expect their organizations to deliver more than 80% of care virtually, while the majority (43%) say virtual will constitute 40% to 60% of their overall service delivery. It’s also interesting that organizations with fewer than 100 employees tended to adopt virtual care at a higher percentage than larger ones.
The consumer challenges
On the consumer side of the equation, consumer use of telehealth rose from 11% in 2019 to 46% during the pandemic and 76% of consumers are “interested” in telehealth moving forward (see Telehealth: A Quarter-Trillion-Dollar Post-COVID-19 Reality?). However, in this new survey, community behavioral health provider organizations reported concerns about consumers not having the right technology and not being able to understand and use the technology even if it is available. Poor connectivity, lack of Internet access, and difficulty understanding technology were rated as the top three consumer challenges, from their perspective.
The provider organization and staff challenges
Only 26% of clinical staff that were surveyed reported that they “preferred” to deliver service virtually. They expressed the need for consumer engagement solutions to enhance care between sessions. And 47% of clinical staff are concerned about maintaining connections with peers and supervisors in a virtual care environment. This is consistent with the overall U.S. workforce. Even pre-pandemic, remote workers said their greatest challenges were collaboration and communication, and loneliness (see The 2020 State Of Remote Work). And six months of lockdowns and isolation have exacerbated the situation.
Complicating the long-term use of virtual care are differences in executives’ and clinical professionals’ views of their technology capabilities and needs. There is agreement on the key requisites—a comprehensive telehealth platform, consumer engagement solutions to enhance care between sessions, telephonic interventions, consumer portals, and staff engagement sessions. But there is a divergence in how they perceive their electronic health record (EHR) system. Managers had a higher level of confidence (64%) in their EHR’s ability to support virtual care. But only 44% of staff felt the same way. Why the disconnect? One possible explanation is that while legacy EHRs are functional—allowing for service delivery, billing, and collections—workflows have not been reengineered for virtual care, resulting in inefficiencies for clinical staff.
As we look ahead, what are the takeaways for the many executives of specialty provider organizations looking to make virtual service delivery an integral part of their long-term recovery strategy? On the consumer side, provider organizations will have to figure out how to assure consumer access to technology and how to engage consumers in a more virtual service landscape.
For those consumers without the tools and bandwidth to participate in virtual care and remote monitoring, it is likely that provider organizations in value-based arrangements (with enough financial risk) will provide that technology. But even with “connection,” the bigger issue is finding the best practice engagement strategies that yield a return on investment. There is no doubt that engaged consumers have better health status and use fewer unnecessary health care resources (see Wellness Services & Consumer Engagement and Health Plans Invest In Consumer Engagement). The question is how much should health plans and their preferred provider organizations invest in engagement.
On the clinical service side, taking a look at virtual service workflows will be critical (see Successfully Integrate Telehealth Into Your Clinical Workflow and New Service Lines, New Measures). And, assuming organizations will have a greater proportion of staff members being totally remote, supervision practices will need to be enhanced along with models for clinical team collaborations. If we are going to make the shift to virtual service delivery a permanent one, rethinking how work gets done and how it is managed is critical.
For more on optimizing virtual care delivery at your organization, check out these resources in The OPEN MINDS Industry Library and our special-interest online communities:
And for even more, join us at The 2020 OPEN MINDS Management Best Practices Institute. In the session Virtual Health: How To Expand Access & Build A Seamless Consumer Experience on August 24 at 2:30 pm EDT, you’ll learn how provider organizations are leveraging technology to create a personalized experience that helps consumers find and access the care they need, at the time and place that’s right for them. Three executives—Diego Garza, vice president of strategy and innovation and director of telehealth, MindPath Care Centers; George Kolodner, founder and medical director, Kolmac Outpatient Recovery; and Shawn Brooks, executive director, special projects, Centerstone will discuss adapting workflow processes for scheduling; obtaining consumer consent; and emergency intervention and communications between provider organizations, consumers, and schedulers.
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