As a psychiatrist, I am not surprised by this data. Since the onset of the pandemic, my schedule has been full. I’ve been seeing 14 patients a day, most of whom are struggling with anxiety and depression. At Brightside, the telemedicine service I cofounded, we’ve seen approximately a 50% surge in new members seeking mental health support. The pandemic has led to a demand for mental health services that exceeds what existing systems can handle, triggering an acceleration in telemedicine adoption, as well as some long overdue policy changes.
Five months in, we are beginning to see radical changes in the mental health and telemedicine landscape. So, it’s time to ask critical questions about the future: How will technology rise to the occasion to facilitate treatment for those in need? How will larger health systems adopt telemedicine and the tools that have been promoted by startup companies for years? What policy changes have been implemented to address mental health access issues? And are these changes here to stay?
Mental Health Stigmas are Eroding
One of the few silver linings of the COVID-19 pandemic is that the social stigmas associated with mental health have begun to erode. Historically, fewer than half of people who need care end up getting it, and the cultural perception of mental health issues is one of the many reasons why.
Patients suffering from depression and anxiety often express feelings of loneliness or isolation—that no one understands what they’re going through. In a COVID-19 world, this point of view has shifted, and having anxious thoughts under these circumstances is viewed by many as commonplace. People who never vocalized struggles before are now openly expressing their anxiety. This has equipped those who have always been suffering with a forum to discuss their feelings and connect with others more easily than they did in the past—despite geographic separation.
At the organizational level, employers, academic institutions, and consulting groups have embraced topics related to mental health more than I’ve seen in my 25-year career. It’s been a dramatic shift. More people struggling is bad, but facilitating space to talk about those struggles without fear of judgement is good.
Leading by Example
I was recently asked if I could remember a moment in my career when it felt like this many Americans were suffering from mental health issues in response to a specific incident or event. Both the terrorist attacks on 9/11 and the economic recession of 2008 came to mind.. What is different about this mental health crisis is that the technological advancements of the last decade have had an enormous impact on the way healthcare can be delivered.
The last 10 years have been a formative period in the healthcare industry due to the slow but growing adoption of telemedicine. Even in a pre COVID-19 world, most healthcare stakeholders agreed that safe and effective care could be delivered remotely. But as telemedicine has emerged, it’s primarily been implemented for single encounters, such as in primary and urgent care when physicians are able to make a swift decision on what needs to be done, rather than to manage chronic conditions.
The pandemic has brought into focus the fact that some of the largest health systems either waited too long to implement telemedicine or did so in a way that failed to optimize the quality of care for patients. When telemedicine was suddenly the only option to manage anything deemed “non-essential,” there was a rush to implement solutions that actually work. Telemedicine, which had been viewed as a lower priority solution, second-best to in-person care, was suddenly the only game in town. This has provided a chance for telemedicine to step out of the shadows and shine.
The result? Health systems are quickly catching on to what’s been obvious to those of us in the field for years: telemedicine is the most efficient way to treat conditions that do not require a physical exam. And even for conditions that may require a physical examination up front, many of them can be managed via telemedicine thereafter.
But it’s a bit more complicated than just putting a doctor and patient behind a video camera. At Brightside, we’ve spent years perfecting our approach to deliver sophisticated tools that lead to the best outcomes. It requires more than just steady video quality—effective remote care for chronic conditions requires synchronous (real-time) conversations, as well as remote monitoring, asynchronous evaluation, and ongoing messaging, all powered by complex rules and logic that help doctors stay one step ahead of a patient’s needs. It isn’t easy or simple, and the right solution is different for each condition. Many startups have been working on specialized solutions for some time now, but have become leaders in telemedicine overnight—I hear from healthcare consultants every week who are scrambling to help the largest health systems figure out telemedicine solutions that don’t feel like a B-grade experience.
One key benefit of telemedicine to treat and manage chronic conditions is that it changes the nature of the relationship between the patient and doctor. Whereas traditional care has almost always been defined as, “come back and check in with me in 8 weeks,” newer telemedicine approaches allow for responsive, and even proactive, intervention by a doctor when a patient really needs it. This helps doctors quickly address issues and optimize treatment, plus it makes patients feel really cared for. Health systems are beginning to realize that this also supports better outcomes. Getting patients on the right treatment and quickly addressing any issues that come up drives better treatment adherence and avoids adverse events. Plus, the efficiencies of telemedicine often mean that this better care can be delivered for similar or lower costs than the traditional model.
Would it have been nice to see this emerge sooner? Of course. But the adoption of telemedicine as a best-in-class solution is welcome, even if overdue. It is unfortunate that it takes a global pandemic to bring about these changes. But I believe both the positive perception of telemedicine and adoption of tools to remotely monitor chronic conditions are here to stay. Yet another silver lining of the pandemic.
Relaxed Policies Fueled Growth—Let’s Hope it Lasts
It’s hard to think of an industry with more complicated and entrenched regulation than healthcare. Innovative health-related solutions are often held back from growing at the rate they otherwise could due to strict policies that, in some cases, predate half the American population.
Once shelter-in-place orders were broadly issued in March, the federal government relaxed some policies so that telehealth services could reach broader audiences, including millions of Medicare patients. This came in many forms, including temporarily facilitating cross-state licensure so that doctors could cross state lines virtually to treat patients in need. This allowed for the redistribution of physician resources in a time of crisis, which is of paramount importance.
And then there’s the topic of insurance and reimbursement. Telemedicine has historically been viewed as a second best compromise, rather than reimbursed at parity with in-person services. Doctors are often paid less for virtual patient visits compared to in-person ones, and reimbursement for tele-services has lagged. With the pandemic, we have seen this change. Telemedicine is a service patients clearly want. Blue Cross Blue Shield of Massachusetts, for example, recently announced that the number of telehealth claims rose from 200 per day in February 2020 to 38,000 per day in May 2020, with the majority of those in mental health services
So what does post-pandemic policy look like? It’s not yet clear. As the Editorial Board at Bloomberg News recently pointed out, some of these shifts could be reversed by the federal government as the pandemic subsides. That would be a mistake—a sentiment shared by telehealth experts who recently implored a Senate health panel not to undo such significant medical progress once the country gets a handle on the virus. The relaxation of policies during the pandemic has sent a clear message: telemedicine is a best-in-class solution that’s as good as it gets and will only get better. It’s hard to legitimize undoing that.
Dr. Mimi Winsberg is cofounder and chief medical officer of Brightside, a mental health telemedicine service.