How Telehealth Is Driving Engagement And Shaping The ACO Model Of The Future

By Emmanuel Giftson, Product Analyst, Vembu Technologies

By Derek Richards, PhD, director of clinical research and innovation, SilverCloud Health

The U.S. healthcare industry is rapidly transitioning beyond the traditional focus of treating individual patients’ physical conditions. Accountable Care Organizations (ACOs) and similar arrangements are leading the way, structured specifically to reward progress toward achieving the Triple Aim of improving the patient experience, improving the health of populations and reducing the cost of care. Fully addressing these dynamics will require providers to treat mental illness on par with physical conditions.

Mental Health As A Key Element Of The Triple Aim
The first element of the Triple Aim, improving the patient care experience (including quality and satisfaction), is attainable only when treating the patient holistically, both mentally and physically. According to the Centers for Disease Control and Prevention (CDC), nearly half of U.S. adults will develop a mental illness that both contributes to chronic disease and reduces adherence to treatment therapies. When mental illnesses, such as depression or anxiety, lead to reduced adherence to treatment for chronic illnesses, those conditions must be addressed simultaneously.

The second element of the Triple Aim, improving the health of populations, is inextricably linked to mental health. The conditions that most define high-risk populations, including cardiovascular disease, diabetes and obesity, are the same diseases cited by the CDC as having mental illness contributors.

The third Triple Aim element, reducing the cost of healthcare, can be dramatically impacted by addressing mental health. Research shows that readmissions increase for chronic conditions when patients also suffer from mental disorders. Conversely, the treatment of mental illnesses associated with chronic illness supports better outcomes.

How To Effectively, And Cost-Efficiently, Address Mental Health
The CMS Next Generation ACO Model – an initiative for ACOs already experienced in coordinating care for patient populations that will allow higher levels of financial risk and reward — expands coverage and reimbursement to providers of telehealth services. In the new model, Medicare telehealth services will be covered without regard to current requirements that a beneficiary be served at a health facility. Coverage will now extend to service in the home.

This move is especially significant in addressing two key challenges to effectively and efficiently treating mental health: a shortage of mental health providers and the stigma attached to mental illness. Primary care providers in rural or semi-rural areas simply don’t have the same ability to refer patients to mental health facilities as their counterparts in major population centers. This shortage is compounded across the country by the fact that the stigma of mental disease dissuades people from getting help.

Telehealth mental health platforms address both challenges. Nearly 80 percent of Americans have high-speed Internet access, which means that most people already have the means to access mental health treatment without having to leave their homes. Additionally, the inherent privacy of telehealth treatment minimizes the stigma associated with mental illness by eliminating the need for the patient to present physically.

Financial barriers are falling as well. In 2008, the Mental Health Parity and Addiction Equity Act established a general requirement that group health plans no longer impose lesser mental health benefits than medical/surgical benefits, and this was expanded in 2010 to include individual plans.

Furthermore, 72 percent of respondents to the HIMSS15 leadership survey said that patient engagement, satisfaction and quality of care will have the greatest impact on their organization over the next two years. Patient engagement is especially important as it relates to mental health, and telehealth platforms have tremendous potential for maximizing patient engagement and helping providers address mental health issues effectively and efficiently.

Evaluating Telehealth Mental Health Options
Not all telehealth mental health solutions are created alike, and it’s important for providers making referrals to choose an effective and engaging program. In general, the program should be evidence-based and outcomes-focused. It must offer high levels of availability and accessibility to promote utilization, and a high level of security to protect patient privacy. It should also offer a history of proven effectiveness.

It is critical for the telehealth mental health solution to be effective at patient engagement — i.e., designed on the SIPS model (Supportive, Interactive, Personal and Social), created by computer science experts to leverage technology for therapy.

For example, the best telehealth results come from platforms that include human support from multiple sources, starting with the patient’s primary care provider. The more support the patient receives, the greater the long-term engagement and ultimately, favorable outcomes.

Patient engagement can be further secured with interactive tools and techniques. In mental health, this includes such elements as tools to build coping skills, maintain journals and engage in lifestyle charting, all of which can intensify and sustain patient engagement.

The content delivered to the patient in a telehealth mental health platform must be personally relevant to be engaging. One patient may respond favorably to content that another patient with the same mental illness barely notices, due to differences in age, education, social conditions and other factors. Relevance for all patients requires flexibility in the telehealth platform.

Finally, the platform should include the ability to build social networks. This is especially valuable for long-term engagement with conditions such as generalized anxiety disorder, which can leave patients feeling isolated.

Moving Forward
The effective treatment of mental illness is not only essential to achieving the Triple Aim, it is an economic imperative. Being a successful ‘next generation’ ACO requires a more holistic and engaging approach to care. Simply put, we cannot afford not to address mental health better than we do today.

The World Health Organization (WHO) and the World Economic Forum (WEF) report that mental illness represents the biggest economic burden of any health issue in the world. These organizations estimate total costs of $2.5 trillion in 2010, projected to reach $6 trillion by 2030, with two-thirds of these costs in disability and loss of work.

ACO goals are aligned with the actions necessary to combat this trend. Telehealth mental health represents the ACO’s best solution for engaging patients and taking action now — and to more completely achieve the Triple Aim in the process.