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Deloitte's Life Sciences & Health Care Blog

When building a virtual health portfolio, behavioral health might be the perfect place to start

Although still in its infancy, virtual health has already begun to transform patient care by improving access to care, extending the reach of clinical management, and making it easier to gather, store and share information.1As health plans, health systems, and physician groups develop their enterprise-wide virtual health strategies, behavioral health care is  increasingly being seen as an appealing starting point for its impact on total medical expenses. While behavioral health typically requires frequent outreach and interactions with patients, it does not require significant medical equipment.

Behavioral health issues are pervasive in the U.S., and it remains an underserved practice area. About 20 percent of adults have a behavioral health condition, and more than half of them (56 percent) do not receive treatment due to barriers that hinder their access to care. In addition, 80 percent of youths who have been diagnosed with depression receive either insufficient or no professional care.2 The responsibility for addressing these unmet needs increasingly falls to acute care hospitals where patients land due to concomitant somatic health issues (i.e. other medical problems).3

 Virtual health could address access issues

A virtual health strategy aimed at behavioral health patients could help health systems increase access to care while enhancing quality and improving the patient experience.4 More specifically, virtual visits can make behavioral health accessible to patients who live in remote areas, who are housebound, or who otherwise struggle to attend in-person treatment sessions. This technology typically results in fewer missed appointments. One leading telemedicine vendor touts a 3.5 percent no-show rate among virtual behavioral health patients. This is significantly lower than the industry average of between 30 percent and 40 percent.5 Moreover, increased access to behavioral health care—via virtual technology—could yield broader benefits for society, such as workplace absenteeism and incarceration. Those two issues, which are tightly linked to behavioral health conditions, translate to $193 billion in lost earnings.

While many health care organizations have started to explore behavioral virtual health, the complex regulatory environment has contributed to slowed adoption. A favorable shift in legislation, combined with changes to reimbursement rules, are helping to remove some of these barriers. Some of these barriers are beginning to shrink. Case in point: In 2018, state lawmakers passed 65 virtual and mobile health-related bills—up from 62 bills in 2017. Also in 2018, 49 virtual health-related regulations were finalized across 38 states.6 With this rapid pace of change, health care organizations should carefully monitor the evolving regulatory environment to identify emerging opportunities.

While implementing a comprehensive virtual health model might seem daunting, organizations can begin by launching four concrete and attainable initiatives:

  1. Leverage technology to screen patients: Health care providers might be able get more out of their electronic health record (EHR) software by adding a behavioral health screen for periodic exams. This would allow patients to complete their screening online. The screening can help identify potential behavioral health issues early, which can lead to timelier and more appropriate referrals.
  2. Focus analytics on early identification: Existing data can be used to segment the behavioral patient population. A focused analysis can help health systems determine which population segments are most in need of behavioral health intervention, and which patients are most amenable to virtual health solutions.
  3. Strategically deploy clinical resources: An analysis on the patient population segmentation can be useful when deploying behavioral health clinicians (e.g., care managers, social workers). Along with creating a more targeted approach to care, the data can help highlight potential barriers to efficient clinician utilization (e.g., missed appointments).
  4. Pilot a virtual health practice: Piloting virtual health services for a select segment of behavioral health patients can help demonstrate clinical and financial effectiveness as well as patient and provider satisfaction. The pilot can then be scaled into other specialties.

A number of leading health care providers are already implementing these steps. They will likely also need to develop a focused business case to demonstrate the financial benefits of virtual health. Consider the following:

  • In California, the annual hospital cost savings created by virtual health is estimated at $104,564 per facility—a powerful demonstration of the financial opportunity of virtual behavioral health.7
  • A multiyear study of VA patients found that the use of behavioral virtual health led to a 24.2 percent drop in hospital admissions, and a 26.6 percent reduction in the average length of hospital stay.8
  • Another study showed that using behavioral virtual health to triage ER patients led to a 5 percent increase (from 8 percent to 13 percent) in the number of medical holds released.9

We recommend that health systems and other providers tailor their clinical and business cases to their specific organization, culture, market, and patient population, and conduct pilots in a focused behavioral health area. For example, as part of a digital wellness offering pilot, a health system might offer digital psychology consultations to help improve the management of certain patients. This low-risk, high-impact approach can help providers better understand how virtual health can help improve the behavioral care.

As the use of behavioral virtual health accelerates, health systems, hospitals, and physician groups should develop a cohesive strategy to promote sustained clinical and financial success. Such a strategy should include these simple steps:

  • Use focused analytics to better understand the clinical opportunity based on the organization’s behavioral health burden.
  • Build a business case and a short-term work plan of next steps. This can help accelerate the implementation of virtual health tools.
  • Integrate behavioral virtual capabilities into an overall virtual health plan and long-term clinical strategy.

Many organizations have already started this journey. Navigating the world of technological change and the increasingly complex behavioral health patient population is challenging, and the need for a coherent approach to behavioral virtual health approach is becoming critical.

1 Annals of Internal Medicine, Policy Recommendations to Guide the Use of Virtual health in Primary Care Settings: An American College of Physicians Position Paper, November 2015
2 http://www.mentalhealthamerica.net/issues/state-mental-health-america
3 https://www.anxietycentre.com/FAQ/why-is-mental-illness-on-the-rise.shtml
4 https://intouchhealth.com/3-ways-telehealth-can-transform-your-health-system /
5 https://www.healthitoutcomes.com/doc/the-role-of-telemedicine-in-mental-health-0001
6 https://www.telehealthresourcecenter.org/2018-in-review-state-federal-telehealth-policy/
7 https://www.urac.org/blog/telehealth-offers-cost-savings-opportunities-hospitals-and-patients
8 American Psychiatric Association, Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services, April 2012
9 https://www.himss.org/connected-health-case-study-dignity-health-increasing-timely-access-high-quality-care-leveraging

Author bio

Bill Fera, MD, is a principal in Deloitte’s Consulting’s Health Care Provider practice in the strategy and operations service line. With 18 years of health care consulting experience, Bill has led multiple projects including EMR implementations, payer/provider integration strategies, and care management platform implementations. He also served as vice president of clinical technologies at University of Pittsburgh Medical Center. Bill is an industry thought leader in the areas of clinical informatics, quality, and analytics. He has been a frequent presenter at HIMSS, and is quoted frequently in industry journals and publications. Bill holds a BA in Biochemistry of the University of Pennsylvania, an MD from Drexel University, and is a graduate of the Wharton School of Business.

Felix Matthews is a physician strategist at Deloitte Consulting LLP. He advises his clients on strategies to succeed in an increasingly competitive market. His clients include academic health centers, national health systems, health plans, and life sciences companies. Felix is experienced in corporate strategy, pre-deal strategic fit assessments, clinical affiliation strategy, care model innovation, value-based payments, operating model, physician engagement, and digital strategy, among others. He also advises his clients on strategy implementation and enabling capabilities. With over 18 years combined experience in medical practice and health care consulting, Felix brings to his clients a unique blend of clinical understanding and business insight.