Advertisement

Understanding the Business Case for Telemental Health in Rural Communities

  • David Lambert
  • John Gale
  • David Hartley
  • Zachariah Croll
  • Anush Hansen
Article

Abstract

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment.

Keywords

Mental Health Service Organizational Arrangement Telehealth Service Specialty Mental Health Service Telemental Health 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services funded the research on which this article is based.

Compliance with Ethical Standards

Conflict of Interest

The authors disclose no conflicts of interest.

References

  1. 1.
    Lambert D, Gale JA. Integrated Care in Rural Areas. In: Smalley KB, Warren JC, Rainer JP, eds. Rural Mental Health: Issues, Policies and Best Practices. New York: Springer Publishing Company; 2012:131–148.Google Scholar
  2. 2.
    New Freedom Commission on Mental Health. Subcommittee on Rural Issues: Background Paper. Rockville, MD: U.S. Department of Health and Human Services; June, 2004. DHHS Publication No. SMA-04-3890.Google Scholar
  3. 3.
    Smalley KB, Warren JC. The Current State of Rural Mental Health. In: Smalley KB, Warren JC, Rainer JP, eds. Rural Mental Health: Issues, Policies and Best Practices. New York: Springer Publishing Company; 2012:3–16.Google Scholar
  4. 4.
    Smith HA, Allison RA. Telemental Health: Delivering Mental Health Care at a Distance. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration 1998.Google Scholar
  5. 5.
    Lambert D, Gale J, Hansen AY, et al. Telemental Health in Today's Rural Health System. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; December, 2013. Research & Policy Brief PB-51.Google Scholar
  6. 6.
    UnitedHealth Center for Health Reform and Modernization. New Models of Technology—the Promise of Rural Telemedicine. In: UnitedHealth, ed. Modernizing Rural Health Care: Coverage, Quality, and Innovation (Working Paper 6). Minnetonka, MN: UnitedHealth Center for Health Reform and Modernization; 2011:42–52.Google Scholar
  7. 7.
    Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Affairs. 2008;27(3):759–769.CrossRefPubMedGoogle Scholar
  8. 8.
    Weinstein RS, Lopez A, Joseph B, et al. Telemedicine, telehealth, and mobilehealth applications that work: Opportunities and barriers. The American Journal of Medicine. 2014;127(3):183–187.CrossRefPubMedGoogle Scholar
  9. 9.
    American Telemedicine Association. Telemental and Behavioral Health: State Medicaid Best Practice. Washington, DC: ATA; August, 2013.Google Scholar
  10. 10.
    Goldstein E, Myers K. Telemental Health: A new collaboration for pediatricians and child psychiatrists. Pediatric Annals. 2014;43(2):79–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Hilty DM, Ferrer DC, Parish MB, et al. The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health. 2013;19(6):444–454.Google Scholar
  12. 12.
    Benavides-Vaello S, Strode A, Sheeran BC. Using technology in the delivery of mental health and substance abuse treatment in rural communities: A review. Journal of Behavioral Health Services and Research. 2013;40(1):111–120.CrossRefPubMedGoogle Scholar
  13. 13.
    Department of Defense. Telemental Health Guidebook. Washington, DC: National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; June 9, 2011. Version 1.Google Scholar
  14. 14.
    Velasquez SE, Duncan AB, Nelson E-L. Technological Innovations in Rural Mental Health Service Delivery. In: Smalley KB, Warren JC, Rainer JP, eds. Rural Mental Health: Issues, Policies, and Best Practices. New York: Springer Publishing Company; 2012:149–172.Google Scholar
  15. 15.
    Krupinski EA, Weinstein RS. Telemedicine in an academic center—the Arizona telemedicine program. Telemedicine and e-Health. 2013;19(5):349–356.Google Scholar
  16. 16.
    American Telemedicine Association. Evidence-Based Practice for Telemental Health. Washington, DC: ATA;2009.Google Scholar
  17. 17.
    Sood S, Mbarika V, Jugoo S, et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemedicine and e-Health. 2007;13(5):573–590.Google Scholar
  18. 18.
    Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment. Washington, DC: National Academies Press; 2012. Workshop Summary.Google Scholar
  19. 19.
    Annapolis Coalition on the Behavioral Health Workforce. An Action Plan for Behavioral Health Workforce Development. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2007.Google Scholar
  20. 20.
    Mohatt D, Bradley MM, Adams SJ, et al. Mental Health and Rural America: 1994–2005. Boulder, CO: 2006.Google Scholar
  21. 21.
    New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Rockville, MD: United States Department of Health and Human Services;2003. DHHS Pub. No. SMA-03-3832.Google Scholar
  22. 22.
    Gustafson DT, Preston K, Hudson J. Mental health: Overlooked and disregarded in rural America. Lyons, NE: Center for Rural Affairs;2009. No. 4: Series Examining Health Care Issues in Rural America.Google Scholar
  23. 23.
    Lambert D, Donahue A, Mitchell M, et al. Mental health outreach: Promising practices in rural areas. Rockville, Maryland: Published by U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Center for Mental Health Services; 2003. Google Scholar
  24. 24.
    MacDowell M, Glasser M, Fitts M, et al. A national view of rural health workforce issues in the USA. Rural and Remote Health. 2010;10(3):1531.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Thomas D, Macdowell M, Glasser M. Rural mental health workforce needs assessment—A national survey. Rural and Remote Health. 2012;12:2176.PubMedGoogle Scholar
  26. 26.
    Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry. 2008;53(11):769–778.PubMedGoogle Scholar
  27. 27.
    Hoge MA, Stuart GW, Morris J, et al. Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs. 2013;32(11):2005–2012.CrossRefPubMedGoogle Scholar
  28. 28.
    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). Report to Congress on the Nation's Substance Abuse and Mental Health Workforce Issues. Rockville, MD: SAMHSA; January 24, 2013.Google Scholar
  29. 29.
    Brooks E, Turvey C, Augusterfer EF. Provider barriers to telemental health: Obstacles overcome, obstacles remaining. Telemedicine and e-Health. 2013;19(6):433–437.Google Scholar
  30. 30.
    California Telehealth Resource Center. Telemedicine Reimbusement Guide. Sacramento, CA: The Center; January, 2014.Google Scholar
  31. 31.
    SAMHSA-HRSA Center for Integrated Health Solutions. A to Z: Developing Telebehavioral Health Capacity to Serve the Needs of Your Patients. Presented at the Telebehavioral Health Training and Technical Assistance Series; June 5, 2013; Webinar.Google Scholar
  32. 32.
    Center for Connected Health Policy. State Telehealth Laws and Reimbursement Policies. A Comprehensive Scan of the 50 States and District of Columbia. Sacramento, CA: Center for Connected Health Policy; February, 2015.Google Scholar
  33. 33.
    Center for Connected Health Policy. Telehealth Medicaid and state policy. 2014. Available online at: http://telehealthpolicy.us/telehealth-medicaid-state-policy. Accessed March 31, 2015.

Copyright information

© National Council for Behavioral Health 2015

Authors and Affiliations

  • David Lambert
    • 1
  • John Gale
    • 1
  • David Hartley
    • 1
  • Zachariah Croll
    • 1
  • Anush Hansen
    • 1
  1. 1.Muskie School of Public Service, Maine Rural Health Research CenterUniversity of Southern MainePortlandUSA

Personalised recommendations