Behavioral Telehealth: How it Lowers Barriers, Cuts Costs and Improves Outcomes

The use of electronic information and telecommunications to facilitate clinical healthcare and coordination of care -- also known as telehealth -- has been part of the healthcare landscape for the past 50-60 years. Over that time, it has become a standard component of physical health care as it offers a number of patient benefits: improved service access, cost efficiency, and improved service quality.


Indeed, the global telemedicine market is projected to triple to $27.3 billion by 2016, and is moving to include nit just physical health, but behavioral telehealth as well. Compared to its use in physical health care, applying telehealth to behavioral health has been much slower to be embraced or even adopted. But that's beginning to change.


Using video technology for behavioral health engagement has been in place for almost 20 years at the Department of Veterans Affairs and other government organizations (particularly those that serve patients in rural areas). More psychologists and other mental health professionals have begun offering telehealth for behavioral intervention in their practices in recent years.


Cost, transportation, and time constraints often prevent people from seeking behavioral health services. Perhaps the biggest barrier is the stigma and embarrassment many people still feel about being brought face-to-face with a therapist. Telehealth - be it by phone, email, or video conferencing - can help overcome these obstacles. The question then becomes: what is the efficacy of remote behavioral health engagement? Can it achieve the same or acceptably similar outcomes as face-to-face engagement?


A 2008 meta-analysis of 92 studies found that the differences between Internet-based therapy and face-to-face were not statistically significant (Journal of Technology in Human Services, Vol. 26, No. 2). A 2009 meta-analysis of 148 peer-reviewed publications studying video conferencing in patient interventions indicated high patient satisfaction, moderate to high clinician satisfaction, and positive clinical outcomes (Clinical Psychology: Science and Practice, Vol. 16, No. 3).


Plus, a 2010 study in the Journal of Clinical Psychiatry (Vol. 71, No. 7) found that video conferencing can be successful in treating post-traumatic stress disorder. Which is to say, the clinical case for behavioral telehealth is quite solid.

Integrated Behavioral Telehealth

Where Telehealth is particularly promising is in the area of integrated behavioral healthcare -- where physical and behavioral telehealth intersect. Patients with chronic medical conditions such as diabetes, heart disease, and chronic obstructive pulmonary disease and co-occurring behavioral health conditions like anxiety, depression, bipolar, and substance abuse disorders are responsible for disproportionately high medical costs.


Moreover, these patients are the most difficult to treat effectively. In 2010, preventable chronic diseases (diabetes, hypertension, cardiovascular disease, and chronic obstructive pulmonary disease) cost the U.S. close to $347 billion -- 30% of overall healthcare spending and an estimated $50 billion per year in productivity costs. Nearly half of all adults report at least one of six chronic illnesses where there's a high rate of behavioral health co-occurrence.


Results from a 2007 World Health Survey on depression and chronic disease found that, worldwide, in adults 18 years of age and older, the presence of one or more chronic health conditions (i.e., diabetes, heart disease, arthritis) was associated with between a 9% and 23% rate of co-occurring depression.


Analysis of data from 60 countries showed that after adjustment for socioeconomic status and health conditions, depression had the largest and most negative effect on overall health scores of all chronic conditions. Furthermore, across countries and demographics, respondents with depression co-occurring with one or more chronic diseases had the worst health status.

Behavioral Telehealth Lowers Barriers to Utilization

As is the case with all health and wellness services and programs, the first hurdle is in improving utilization. Telehealth programs improve employee utilization by making remote access to care easy and affordable. It is also more convenient, discrete, and can offer users a broader choice in the type of therapy they want or prefer.

  • Convenience. Speaking directly with a therapist from a computer or mobile device is clearly more convenient than having to show up at a therapist's office -- particularly if you work or live in a heavily trafficked metropolitan area. It may even be feasible to conduct the session during work hours if it's possible to find a private area in or outside the workplace for an uninterrupted session.
  • Responsiveness. You can engage a therapist at the point of need -- if you're experiencing acute anxiety or simply have an urgent need for counseling, a telehealth platform can quickly route you to a therapist and initiate a session.
  • Comfort. Many patients feel more relaxed when they're conducting the session at home or in familiar surroundings.  As most therapists will tell you, the counseling process is greatly facilitated when the patient is at ease.
  • Distance. While many people prefer traditional, in-person counseling, others may find it hard to open up and discuss their pain or problems when face-to-face with another person, even if that person is a trained therapist. Engaging a therapist through their computer or phone provides another option, and the sense of distance may enable them to feel less vulnerable and more comfortable engaging in the counseling process.
  • Choice. There might be those who are looking for alternative therapies, such as mindfulness therapy or Buddhist Psychology. A behavioral telehealth platform can offer an array of therapies that such users can readily explore.

Marrying telehealth to behavioral health has obvious benefits to employers as well: reduced absenteeism and presenteeism, improved employee readiness, resiliency, and  productivity.

What to Look for in a Behavioral Telehealth Platform

Generally, organizations evaluating behavioral telehealth platforms should determine the degree to which it's customizable, secure, and HIPAA-compliant. It should offer:

  • Remote face-to-face interaction through high quality, real-time streaming video
  • Easy-to-use appointment setting with virtual waiting rooms
  • Access to specialists and providers that would otherwise be out of reach
  • Support when you need it through triage video consults and immediate access to shared health records
  • Collaborative approach benefiting both patient and provider
  • Seamlessly coordinated care management with high-powered, customizable scheduling, EHR, and billing tool options

On-demand access to quality behavioral health care through online, multipoint video teleconferencing will change how employees and employers experience healthcare by expanding access, increasing utilization, reducing the cost of care for everyone involved, and ultimately, putting more people on the path to sustainable behavioral and physical health.

About the Author

Dr. Dani Kimlinger HR/OD Leader with MINES and Associates, a business psychology firm. Dr. Kimlinger's broad expertise includes organizational assessment, strategic planning, conflict resolution, and human resources consulting.