The Importance of Telehealth
This Necessary and Essential Benefit for Behavioral Health Treatment Should Continue Post-Pandemic
Date: July 2020
Author: Dr. Deni Carise, Chief Scientific Officer, Recovery Centers of America
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Much of the country has re-opened and re-emerged from COVID-19 stay-home orders, bringing joy to many, albeit with proper precautions. Yet to be seen however, is how people and the virus will respond to this newfound freedom, but one thing is sure, healthcare delivery options now available as the result of COVID-19 are beneficial to many and should certainly continue.
The Rise of Telehealth
On March 13, 2020, President Trump declared a national emergency in response to the COVID-19 pandemic, activating the Stafford Disaster Relief and Emergency Assistance Act. This allowed for expansion of telehealth benefits under the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act. Prior to this announcement, it was predominantly rural areas that made use of this path for treatment and the beneficiary would generally not be allowed to receive telehealth services in their home.
Now, a range of healthcare providers such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers can offer telehealth services. Patients may now receive telehealth services in any healthcare facility, including substance use disorder treatment centers, such as Recovery Centers of America, physician’s offices, hospitals, nursing homes as well as from their homes. Many have benefitted from this.
While many states put laws in place requiring commercial health plans to cover telehealth services, the requirements are not universal and vary in the levels of services covered. In response to the pandemic, some (but not all) state Governors issued emergency orders to increase access to telehealth services and to increase the pool of available health care providers.
Impact on Substance Use Disorders
The result: many people who otherwise would not or could not attend treatment for substance use disorder (SUD) in-person were able to explore the option via telehealth, offering greater safety but also anonymity and less perceived stigma. However, enactment of the Stafford Act always has an end date, and as the country returns to some sense of normalcy, it is imperative that we acknowledge that the telehealth services made available through the Stafford Act are both necessary and essential to continue.
Many clinicians believe that in-person treatment is the preferred format for maximum success. There is nothing like human contact, connection, and support, as well as the importance of what we call the therapeutic alliance between clinician and patient. But connection and rapport can still be achieved via telehealth, and, in fact behavioral health research has shown that telehealth care can be considered an effective alternative to in-person therapy. In a poll of 57 SUD treatment program directors, the Collaborative for Advancement of Recovery Excellence (CARE) advisory group found that 51% said that the quality of telehealth treatment was the same as in-person services and 11% rated it as better.
We are at an opportunity crossroads where we can benefit from the knowledge, expertise, and infrastructure that is now in place to allow people to continue utilizing telehealth options as a means for seeking SUD treatment, supplementing current treatment, and continuing to get support in recovery.
Telehealth and Barriers to Treatment
Until now, barriers to treatment for SUD have included accessibility/availability, privacy, and fear. Let’s consider each in relation to telehealth.
Accessibility is not just pertinent for the many Americans who live in rural areas and do not have access to SUD treatment due to geography, it also impacts other groups. Individual struggling with drugs and alcohol who are the primary breadwinners for their families and who will encounter financial difficulties if they have to travel multiple times a week for outpatient care can benefit from telehealth. Additionally, Individuals with health concerns – especially compromised immune systems during this time of COVID-19 – may also benefit from receiving treatment via telehealth. For these groups and others, telehealth could very well provide life-saving treatment access and opportunity for sustained recovery and support.
For those already in recovery, telehealth can provide an added layer of accessibility and services when combined with in-person treatment. Individuals can attend more treatment sessions each week by supplementing attendance in-person with virtual attendance on other days. In addition, if someone can’t go to group but can still attend a telehealth appointment, that option should be available and may help them to continue in treatment until they are ready or able to do so in-person.
Family accessibility should not be underestimated either. Recovery Centers of America has a “Seeds to Recovery” program that helps families learn the root causes of addiction and how to support themselves and their loved one on the road to recovery. These groups went from reaching an average of 45 families attending in-person every 3 months to over 300 families attending via telehealth in a two-month time period during COVID-19. Staffing and logistical issues had kept the in-person groups limited to about 15-20 families pre-pandemic. Moving to a virtual format multiplied the program’s scope and community impact.
Accessibility to necessary specialty services should also be considered. There is a shortage of psychiatry and other important professionals to provide all needed services to SUD patients. Additionally, many smaller treatment programs for SUD can’t afford to pay a full-time psychiatrist, or other important professionals to provide all the services their patients need. These services are perfectly poised for telehealth delivery and allow more individuals with SUD to receive them. In addition, the cost to consumer, including travel costs, is lower with telehealth while allowing more members of our communities the ability to access quality addiction treatment and recovery services.
Privacy and fear are also concerns that stop some people from accessing behavioral health treatment. It would be impossible to estimate the number of people who have a substance use disorder or who are unsure whether they have a problem but are afraid to show up at a treatment center. The ability to receive an assessment or treatment via telehealth – something a little less intimidating, would be immensely helpful. Telehealth also provides an alternative for individuals such as professionals who are especially concerned about stigma.
Telehealth options can offer discretion and convenience in a judgment-free zone for obtaining Medications for Addiction Treatment or “MAT.” In March, the Drug Enforcement Agency (DEA) activated the public health emergency exception to the Ryan Haight Act to allow providers to prescribe controlled substances via telehealth without first conducting an in-person examination. The DEA further expanded this prescribing exception for authorized practitioners treating opioid use disorder (OUD) patients, allowing them to prescribe buprenorphine to new and existing OUD patients for maintenance or detoxification treatment on the basis of a telehealth examination, without the need for an in-person exam. This is a huge step that should not be recanted after quarantine, especially considering that 40 percent of U.S. counties still have no clinicians authorized to prescribe buprenorphine, one of the proven medications effective for opioid use disorders.
Studies on the use of telehealth services prior to COVID-19 showed that 74 percent of U.S. consumers would use telehealth services, 76 percent of patients prioritize access to care over the need for human interactions with their health care providers, and 70 percent of patients are comfortable communicating with their health care providers via text, e-mail or video, in lieu of seeing them in person. The acceptance of telehealth cannot be ignored. For the sake of the 20 million-plus Americans who currently need but do not receive treatment for substance use disorders, I am hopeful that the ability to provide life-saving care in this way continues alongside in-person treatment.