A group of telehealth leaders from 18 states worked the past two years on proving the value of telehealth with data to convince payors and legislators that continuing reimbursement post-COVID 19 is the right thing to do. Over the course of two years, 40 people, including five physicians, four nurses, four other clinicians, and 27 telehealth leaders in provider organizations, contributed to the effort.
The group chose to focus initially on video visits for those in need of mental health care. We succeeded in step one: we surveyed 16 mental health provider organizations to find out what data they were collecting, and how success was being measured in 2020. The organizations ranged from large university medical centers to private practices in nine states. Not surprisingly, the data and metrics varied widely, even across large university-based systems.
For example, in response to the question “What, if anything, is being measured regarding clinical outcomes?”
- Four organizations reported no clinical outcomes measurements
- Four organizations used a wide variety of validated and commonly used clinical outcome metrics:
- PHQ-9 (used by 3 of 4 )
- Patient Health Questionnaire (columbia.edu)
- GAD7 (used by 2 of 4)
GAD-7 (General Anxiety Disorder-7) - MDCalc - BASIS-24 (use)
BASIS-24® — eBASIS - ACES ACE.pdf (odmhsas.org) Adverse Childhood Experiences Study
- EDE-Q PDFfiller - ede q online(1).pdf (uslegalforms.com)
Eating Disorder Examination Questionnaire - OCI-R Obsessive Compulsive Inventory - Revised (OCI-R) (psychology-tools.com)
- SF-12 The SF-12v2 PRO Health Survey (qualitymetric.com) Short Form Health Survey
- BAI beck-anxiety-inventory.pdf (jolietcenter.com)
- EDE-Q ede-q_quesionnaire.pdf (corc.uk.net)
Eating Disorder Examination Questionnaire - EDY-Q Microsoft Word - Hilbert, van Dyck_EDY-Q_English Version_2016 (harvard.edu) Eating Disorders in Youth Questionnaire
- McMaster Family Assessment Device
- STAI-C-S State-Trait Anxiety Inventory for Children (STAI-CH) - Assessments, Tests | Mind Garden - Mind Garden State Trait Anxiety Inventory – Child Version – State only
- DERS Difficulties in Emotion Regulation Scale (DERS) (novopsych.com.au)
- PCL-5 PTSD Checklist for DSM-5 (PCL-5) - Fillable Form (va.gov)
Post-traumatic Checklist
In another question on cost savings, the survey question was “What, if anything, is being measured regarding cost savings?”
- 13 organizations reported no cost savings measurements
- Two of the three organizations reported savings measurements shared the following metrics (video visits vs in person visits)
- Handouts, parking vouchers, meal vouchers
- In person clinicians paid salary, video visit clinicians paid per hour,
Future: space cost savings (video visit clinicians providing care from home)
In our next effort we wanted to add payor leaders or legislators to join the conversation to determine which, if any of the metrics being used and data being collected, might convince them to support continued reimbursement post-COVID 19. The 40 participants were all associated with provider organizations with insufficient connections with payors/legislators to successfully bring them into the conversation.
The group took a break and then decided on a new approach. We came up with what we THINK would be most important to payors/legislators, based on our understanding of what drives their success. Here’s the list:
Compare the following data for specific groups of mental health patients (e.g., based on location, disorder, gender, age, first time vs return patients, newly diagnosed vs existing patient, prior telemedicine use, other relevant demographics, and characteristics), with or without access to care by video:
- number of ED visits
- number of hospitalizations
- suicide rates
- survey results that measure mental health status using validated tools (e.g., PHQ9)
- timing to access -(i.e., length of time to get patients in front of provider for first visit)
- provider and patient satisfaction and retention (i.e., remain in care)
Interestingly, I have since learned that, in fact, there are many data sources on these topics with many peer-reviewed articles based on well-controlled studies. That leads me to a different question: Why were none of the 40 participants, including me, aware of these data sources and how to access them? It perhaps has its roots in the type of data available. Much of the data available comes from academic institutions reporting on research studies and publishing in peer-reviewed journals. These can be readily found through a PubMed or Google Scholar search using appropriate search terms (e.g., telemental health, outcomes, cost) but if one is unfamiliar with conducting this type of search these articles will not be available to review. Other sources of information include websites of the professional societies of which the providers are members (e.g., American Psychiatric Association) and government websites (e.g., Substance Abuse and Mental Health Services Administration, but one has to know about these before they can be searched. Finally is the fact that although many healthcare systems and funders collect data, they use these data for internal purposes only and simply do not publish or share them.
We are currently in search of a few provider organizations interested in/willing to collect some of these data. We have not had success. If you are interested in joining this collaborative effort, please contact me at:
janground@gmail.com
https://www.linkedin.com/in/jan-ground-3089742/
A new thought is to focus on a current hot topic in the US, such as COVID 19, to identify data to prove (or not!) the value of care by video. Perhaps we could find an organization willing to provide some funding to more likely successfully identify organizations willing to collect the data. It should not have to be this hard!
