America is in a Mental Health Crisis, What Payers Should do Now

America’s mental health is in crisis. A Health Resources and Services Administration (HRSA) survey revealed that over 117 million Americans live in areas designated as health professional shortage areas where only 27% of mental health needs are being met, according to U.S. News & World Report.  With numbers and costs rising, the healthcare community started to recognize the vicious cycle between mental health and chronic health conditions. PwC reported that untreated psychological issues accompanying chronic conditions increased cost to employers twelvefold. Today, the situation is compounded nationwide by the social and economic impacts of COVID-19 and its expected long-term psychological fallout. That leaves payers with a lot on the line, including higher costs to members and employers, as well as increased risk to patient outcomes.

Going back to 2017, Media Logic predicted in a blog post about optimizing telepsychiatry utilization that the provider shortage in mental healthcare would only worsen without greater patient access to virtual therapy. Though the climate for telemedicine was improving at the time, it took the COVID-19 health crisis to accelerate regulatory breakthroughs that truly opened the path for widescale utilization. In the few months since the onset of COVID-19, there has been a 12% jump in telehealth utilization, amounting to 16.5 million new users, according to PwC’s 2020 Health Research Institute (HRI) survey. Of the conditions treated virtually, mental health ranked third behind chronic health and complex chronic health issues. Delivery of telepsychiatry and telebehavioral counseling during the pandemic provided proof of its ability to help control healthcare costs while improving time efficiency for consumers, employers and providers.

The increased access to telehealth also brought reward in the form of a 39-point bump in member satisfaction for payers that expanded telehealth access, according to a JD Power survey. Still, there is clearly more work to do as the survey also reported that 54% of respondents were not sure if telehealth was available to them. I’d wager that an even higher percentage of members had no clue about the availability and reimbursement status of telemental services. 

As the healthcare ecosystem leans in more on telehealth, payers will need to stay on top of two main considerations to drive success: marketing and infrastructure.

Bolster marketing of telehealth options

A number of recent payer communications urged telemedicine trial, and that surely helped. However, many messages were generic, leaving the public largely unaware of the various available telehealth options, including telepsychiatric and telebehavioral treatments. “Plans need to get more aggressive around working with their health plan members around understanding their telehealth options,” said James Beem, managing director of global healthcare intelligence at JD Power in Health Payer Intelligence.

Just a few ways that payers can increase member utilization of telemental services through marketing include:

1. Focusing communications on geographic locations where there is a known deficit in mental healthcare, reference HRSA data and the Kaiser Family Foundation (KFF)
2. Leveraging member claims data to be sure communications are reaching the most vulnerable members
3. Making it easier for members to participate in screenings of their mental state
4. Collaborating with employers and CBOs to increase member engagement
5. Making human connections with members (especially during COVID-19)
6. Facilitating member ability to find the right telemental providers
7. Busting antipathetic and legacy perceptions of the high cost of telemental services

Shore up telemental/telehealth infrastructure

During COVID-19, many providers, including mental health professionals, were new to telehealth delivery. Payers and providers jumped into solutions, some with only short-term expectations. Now that members are reporting satisfaction with telehealth, and it looks like reimbursement is getting more equitable for providers, we can expect increasing utilization beyond COVID-19. To make sure the promise of telemental health doesn’t outstrip ability to deliver and cause another deficit, systems need to be re-evaluated for their ability to scale and meet compliance.

Payers looking to maintain member engagement while controlling costs in telehealth will need to evaluate and determine their long-term roadmaps. Considerations that need to be addressed include:

1. Should their networks include only providers that offer telemental services as an option?
2. Should payers build their own telemental/telehealth delivery system?
3. Should telemental/telehealth services be outsourced?
4. Are there organizational partnerships that can be forged?
5. Where and when can telemental services be employed to improve patient outcomes?

This is just the start of closing in on a dangerous and costly problem that is also enmeshed with COVID-19. The good news is that progress is already happening, and payers can take control to deliver now and for the future.