More than 16 million Americans to date have obtained healthcare coverage under the Affordable Care Act, either through commercial health plans or Medicaid. Due to this expanded coverage, as well as the Mental Health Parity and Addiction Equity Act of 2008, there is an unprecedented, growing demand for mental health and substance abuse treatments.

Healthcare organizations, already faced with a shortage of providers to treat patients’ physical health, are even more challenged concerning available mental health practitioners, especially for Medicaid recipients and Americans in rural areas. Given the size of the challenge compounded with a shortage of resources, telehealth is now viewed as a key component for delivering effective mental healthcare.

This is proven by the recent announcement from The Centers for Medicare and Medicaid Services (CMS) in relation to the launch of a new ACO model, dubbed The Next Generation ACO. CMS officials pointed out in the announcement that telehealth is a significant focus of the new ACO model, as participating organizations will be asked to provide access to telehealth and home visits, both of which will be reimbursed.

Online telehealth platforms for treating mental health have been proven effective for many years, which is good news for mental health providers and accountable care organizations who are unfamiliar with such services. These telemental health platforms are tremendously cost-effective tools for enhancing traditional in-person interventions and improving patient engagement.

Effective programs
While in-use across Europe for over a decade, online mental health interventions are only starting to be adopted in the United States. The challenge facing healthcare organizations and payers is finding platforms that are more than just aesthetically attractive and technologically innovative. These features are important, but the available interventions must be clinically driven with years of evidence-based content that have been proven in practice.

In short, the five essential elements organizations should require from their telemental health platform, are:
1. Evidence-based and empirically supported content
2. Developed with subject matter experts (SMEs)
3. Patient-centric and highly personalized
4. Focus on achieving desired clinical outcomes
5. Research and continuous evaluation of its effectiveness

We explore these elements in greater detail below.

Evidence, research and expertise is the foundation
The content for these telemental programs should build upon scientific evidence-based theories of behavioral change, clinical expertise and expert opinion. In addition, now that most healthcare organizations design treatment plans and configure care teams around the concept of “patient-centeredness,” these evidence-based and expert-developed telemental health programs must always consider the patient’s perspective first, while also supporting the needs of that patient’s mental health provider.

Likewise, the content-delivery technology should also be based on patient-centered, research-proven methods that have resulted in improved clinical outcomes. In this regard, evidence-based telemental health programs that have been developed in collaboration with clinical SMEs are likely to be most effective. When SMEs have expertise in the specific, highly prevalent conditions facing organizations, such as anxiety disorders, which affect 18 percent of the U.S. population, their insight is especially beneficial. Incorporating SME expertise can significantly improve the outcomes of an online program by identifying and preventing obstacles that the patient may encounter after initiating treatment.

After these evidence-based telemental health programs are offered by organizations, however, officials must continually evaluate them to ensure maximum efficacy. Organizations should also expect clinical leaders involved with telehealth solutions to continually improve the content and presentation of the platform.

Technology and personalization crucial for engagement
While evidence-based content developed and reviewed by subject matter experts is recommended, content alone is unlikely to secure continued patient engagement or desired outcomes. The patient-facing technology should be easy-to-use, secure, interactive and include a social component that allows the patient to maintain their anonymity while reaping the benefits of interacting online with a community and receiving their support.

In addition, although the symptoms of a mental health condition, such as anxiety, may be common, the patients receiving treatment will respond more favorably to personalized content that is relevant to their lives. For example, younger patients will not relate to narratives of anxiety-triggering scenarios for older adults, and vice versa. This customization should be configurable based on socio-demographic characteristics, as well.
From the provider’s perspective, personalizing content for the telemental health program should be as simple as clicking certain modules when structuring the patient’s program. Although core content is expected regardless of the patient, a highly personalized, relevant experience is essential to not only ensuring acceptance, but also long-term engagement.

Benefits to providers and payers
Effective, evidence-based telemental health therapy can certainly deliver innumerable benefits to patients, but they can also be implemented and disseminated much more cost-effectively than traditional in-person mental health interventions.

When patients address their mental health issues, their chronic physical health conditions can improve, reducing financial risk for payers and providers. Concurrently, when physical health conditions are better managed, the risk for developing or exacerbating a mental health condition is reduced. Evidence-based therapies delivered through online technology are also more accessible to patients than an in-person visit with a provider, and mitigates apprehension about seeking help with a mental health issue. Removing these obstacles can encourage long-term patient engagement in the therapy program.

Online technology can also offer providers increased oversight into patients’ progress through the programs and adherence to their providers’ recommendations. Outcome monitoring can provide therapists with notifications so they can be responsive to patients’ progress and adjust interventions based on data captured from the telemental health program. This type of insight is usually more delayed with traditional in-personal behavioral therapy alone, which contributes to increased costs and reduced quality.

Technology a bridge to better mental healthcare
While not widely deployed yet, telemental health programs are likely to expand in the coming years due to increased health plan coverage and provider shortages. These telemental health programs, however, could vary greatly in features and methodology and require a careful exploration and review process by the provider or payer organization before being offered to patients.

During this exploration, providers and payers should target their search to proven-effective telemental health programs, ensuring they are evidence-based and developed in collaboration with subject matter experts. The technology platform delivering the interactive programs must also be based on research into proven methods of online behavioral health therapy, and include a social component and highly personalized content.

In the end, patients will be able to confront their mental health issue with greater confidence and convenience at lower costs, while providers and payers can more cost-effectively intervene and improve mental and physical health outcomes.

Derek Richards is director of Clinical Research and Innovation, and Noemi Vigano is clinical programs manager, both for SilverCloud Health.