Using telehealth to connect mental and physical health and achieve the ACO triple aim

Only 14 percent of accountable care organizations have integrated behavioral health services with primary care in their organizations, while one-third have no formal relationship. Multiple reasons exist for this lack of integration. One study showed that a lack of available behavioral health providers, care coordination gaps, as well as insufficient financial incentives around behavioral healthcare quality were the primary reasons.

These challenges are significant, especially when primary care providers must also help patients manage multiple comorbid physical conditions. ACOs, however, should not allow these obstacles to prevent them from achieving the triple aim of improved care quality and patient experience, improved outcomes and reduced costs, all of which are possible with an integrated online behavioral telehealth program.

With a wide variety of program options available, it is crucial that ACOs focus on the "gold standard" of online behavioral telehealth programs, which are evidence-based, outcomes-focused and created by subject matter experts. From an IT perspective, the gold standard includes cloud-based, robust, engaging, secure and responsive platforms that are easily scalable as demand for the services accelerates across the ACO.

These programs allow ACOs to treat the whole patient, not just physical symptoms. By offering patients the behavioral healthcare they need, the entire ACO ends up reducing costs due to the many ways mental health impacts physical health.

Physical-mental health link
Physical health is inextricably tied to mental health, both in clinical outcomes and costs. Spending for patients with comorbid mental health or substance abuse problems is 2.5 to 3.5 times greater than for those without such problems – but most of that spending is on medical services instead of behavioral health.4 This spending includes readmissions, which for heart failure, acute myocardial infarction and pneumonia were 5 percent greater among patients who reported anxiety, depression and/or substance abuse.

Even just one mental health condition, such as depression, impacts spending. Medicare beneficiaries with depression cost the Centers for Medicare & Medicaid Services $20,046 over one year versus $11,956 for those without. The mounting evidence prompted the Centers for Disease Control and Prevention to conclude in a 2011 report on mental health: "increasing access to and use of mental health treatment services could substantially reduce the associated morbidity." The United States, however, requires 5,338 new mental health practitioners to meet the needs of Americans in underserved areas,8 a pipeline which isn't likely to be filled soon.

As a cloud-based service, an online behavioral telehealth program addresses these mental health challenges cost-effectively and increases the number of patients per provider six fold while overcoming well-known patient adherence obstacles, such as the feeling of stigma associated with seeking mental health services. Online therapies are accessed in private from patients' homes, eliminating co-pays or the need to take time off from work.

Online behavioral telehealth programs engage patients, improve outcomes
Centers for Medicare & Medicaid Services' "Next Generation ACO," model, which was announced in March 2015, expands coverage and reimbursement to providers for telehealth services, which offers ACOs another financial incentive for offering behavioral health services online apart from the associated overall improved care quality and cost reductions. To experience these benefits, however, online behavioral telehealth program selection is crucial as they vary in quality and usability.

The "gold standard" online behavioral telehealth program, at present, does not have a commonly accepted definition, however, I would contend it should include the following criteria:

• use of evidence-based and empirically supported content;
• focus on achieving clinical outcomes;
• developed on robust, engaging, secure and responsive technologies;
• informed and developed by behavioral health subject-matter experts;
• patient-centric and highly personalized; and
• research and evaluation supporting its effectiveness.

These criteria are not arbitrary, but based, in part, on the online behavioral telehealth programs that have been successfully integrated into European healthcare services, such as the Improving Access to Psychological Therapies in the United Kingdom. They are also widely used across other European countries and Australia. Each country has found that online behavioral telehealth programs address mental health care gaps, while offering users options beyond face-to-face therapy, which encourages treatment adherence and improves clinical outcomes, ultimately lowering cost of care.11

Cloud-based platform offers cost, scalability benefits
To ensure these programs achieve their intended clinical outcomes, ACOs must be able to capture ample data about patient usage, adherence and progress, in addition to the behavioral health professional's assessments. From an IT perspective, this is why a cloud-based platform is the preferred format to deploy such a program across an ACO.

The low-cost, rapid implementation as well as scalability of a cloud solution allows the ACO to easily expand the platform to new facilities and integrate with existing IT systems. Cloud-based platforms are also highly accessible to patients, since eight out of 10 Americans have access to high-speed Internet.

Reaching as many patients as possible is just one of the many reasons why integrating an online behavioral telehealth with primary care is essential for ACOs. Not only does the program help providers identify and cost-effectively address mental-health treatment gaps, which supports chronic physical condition management, but it also supports providers in delivering holistic, patient-centered, coordinated care and achieving the triple aim that all ACOs are pursuing.