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May 17 — The rapid growth of telehealth services for mental and behavioral care means employers should consider the rewards and risks associated with this delivery of health care, particularly when it comes to privacy and state laws.
Mental and physical health problems are often related, and many studies show that stress is the top workforce risk, leading to lots of chronic health conditions in the workplace, Rene Y. Quashie, senior counsel in the health-care and life sciences practice of Epstein Becker Green in Washington, told Bloomberg BNA May 17.
Furthermore, while mental health issues increase employer health-care costs and absenteeism, and decrease employee productivity, only a small segment of employers have identified mental health as a top priority in their benefits program, Quashie said.
This could be due to cultural stigma that still surrounds mental health issues, in addition to workplace productivity disruptions that can occur when employees need treatment, Quashie said.
According to a study released May 11 by Epstein Becker Green, only 40 percent of Americans with mental illness report receiving treatment, and there is only one mental health-care provider for every 790 individuals.
For many people, the solution to these disparities is telemental and telebehavioral health, meaning mental health care and behavioral health care delivered via interactive audio or video, computer programs or mobile applications.
Mental health care lends itself particularly well to remote delivery, because the provider usually doesn't need to “lay hands on the patient” to provide care, Quashie said.
The EBG study, “50-State Survey of Telemental/Telebehavioral Health (2016),” found that new technologies are also driving the boom in telemental health, with a significant increase in mobile applications related to mental health (now almost 6 percent of all mobile health apps) and another 11 percent devoted to stress management.
A growing number of companies also provide “text therapy” services, which allow users, for a flat-rate fee, to chat by text with any number of licensed mental health providers, the study found.
According to the 2016 health plan design survey from the National Business Group on Health, 74 percent of large employers are making telehealth options available to employees to the extent that they can, up from 48 percent in 2015, Steve Wojcik, vice president of public policy at NBGH, told Bloomberg BNA May 17.
Telebehavioral counseling and other services are providing more and more people with the help they need by bringing the treatment to the privacy of an individual's home, eliminating the need to take time off from work and the fear of stigma, Wojcik said.
“By and large, it’s a win for the employee, in terms of cost and access, and it’s a win for the employer in terms of assuring there is access to appropriate services that are needed by their employees and anyone else in their plan,” he said.
Access to telemental health and telebehavioral health services looks different across the country, determined by various state laws, Quashie said.
The EBG study found that many states haven't addressed telemental health specifically, but that states that have “are pretty progressive about it,” especially in regard to treatment that doesn't include prescribing medication, he said.
Overall, the main challenges for telehealth are the same as those associated with other types of health care, such as maintaining the confidentiality and privacy of health records and health data in accordance with the Health Insurance Portability and Accountability Act, Quashie said. States that allow telemental health also have requirements concerning informed consent, meaning the patient is aware of the risks and benefits associated with care provided virtually.
Despite these challenges, payers should start providing telehealth coverage for mental health in the same way they provide telehealth coverage for physical health, Quashie said. “I think there’s starting to be a recognition of that,” he said.
Though telehealth may not be the preferred delivery mode of care for every employee, these services are a particularly good fit for companies with a lot of mobile employees, such as airlines, he said.
“Leveraging technology for this kind of care is a great fit for this kind of employee set,” he said.
Wojcik also touched on this kind of care for certain industries, especially companies that provide on-site clinics for employees. According to Wojcik, employers with workers scattered around the country or globe can still take advantage of a central clinic provided by the organization because telebehavioral health technology enables counselors to extend their reach to those in remote locations.
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The EBG study is available at http://www.epsteinbeckergreen.net/Telemental/EPSTEIN-BECKER-GREEN-50-STATE-TELEMENTAL-HEALTH-SURVEY.pdf. The NBGH survey results are available at https://www.businessgrouphealth.org/benchmarking/large-employer-surveys.cfm.
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