Understanding the Business Case for Telemental Health in Rural Communities


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.

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    This definition of telemental health is consistent with services currently reimbursable through Medicare as well as some Medicaid and commercial payers which require a “one-on-one” encounter between the patient and provider. Collateral contact with family members or others without the patient present are typically not reimbursable. While some mental health stakeholders advocate for a broader use of technology (e.g., e-mail and telephone) to deliver behavioral health services, few third-party payers currently reimburse providers for delivering services using these broader technologies.

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    A response rate of 40% was also obtained in a similar exploratory study of rural mental health outreach programs conducted by one of the authors for the Substance Abuse and Mental Health Services Administration a decade earlier.23 Rural mental health outreach programs and rural telemental health programs are similar in that they are both relatively popular, usually started with grant funding, and face significant sustainability challenges when grant funding ends. There is not a definitive list or roster of either type of program, creating the need for exploratory study.

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    Although state Medicaid policies may use similar language, states vary in how telehealth is defined and reimbursed.


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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.

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Correspondence to David Lambert PhD.

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Lambert, D., Gale, J., Hartley, D. et al. Understanding the Business Case for Telemental Health in Rural Communities. J Behav Health Serv Res 43, 366–379 (2016). https://doi.org/10.1007/s11414-015-9490-7

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  • Mental Health Service
  • Organizational Arrangement
  • Telehealth Service
  • Specialty Mental Health Service
  • Telemental Health