Now is the time for telebehavioral health. The COVID-19 global healthcare crisis has meant a remarkable evolution for the already rapidly changing telehealth industry.

In recent weeks, every state, county and community across the United States has experienced a greater prevalence of mental health conditions. As the need for mental health rises, the push for virtualizing interactions is exploding, resulting in a major boom in telebehavioral health.

With unprecedented swiftness, the telebehavioral health industry is experiencing regulatory changes on multiple fronts, including reimbursement, HIPAA compliance standards, prescribing and licensure. Many care settings and clinicians are quickly virtualizing their operations and are working to navigate a whole host of new processes and a new regulatory environment.

Join eHI and Insight + Regroup for this important discussion on telepsychiatry best practices and regulatory guidance during COVID-19 and beyond. Topics to include:

- Best practices for blending clinic-based and in-home care models
- How EDs and crisis centers can face rising need for mental health services
- How phone consultations can supplement virtual care encounters
- Selecting a sustainable telehealth platform that is compliant beyond COVID-19
- Leveraging licensure options to begin delivering care
- Expedited credentialing processes to deploy services quickly
- Regulatory shifts and how they can shape the future of telehealth care delivery

Speakers:

Geoffery Boyce 
CEO, Insight + Regroup

Geoffrey Boyce is the CEO of InSight + Regroup, the leading telepsychiatry service provider in the United States with a mission to transform access to quality behavioral health care. Boyce is a leader in telemedicine advocacy, education and reform initiatives. He serves as a national voice promoting telemedicine and telepsychiatry and regularly interacts with state and local healthcare regulators and administrators. In 2017, he received the Industry Leader Award from the American Telemedicine Association. Boyce is an active participant in several ATA Special Interest Groups and Workgroups including: the Telemental Health SIG, the Interstate SIG, the controlled substances prescribing and telehealth workgroup and the proposed workgroup on the expatriate telemedicine providers. He also serves on the advisory board of directors for the Mid-Atlantic Telehealth Resource Center (MATRC). In 2018, he was appointed to the New Jersey Telehealth Review Commission. Boyce frequently speaks about the potential of telemedicine and the best practices for establishing new programs. He holds an MBA from Terry College of Business at the University of Georgia with a focus on entrepreneurship and business planning.

Dr. Irene Epshteyn, MD 
Adult Psychiatrist, Whiteside County Community Health Clinic; Associate Medical Director, InSight + Regroup

Dr. Epshteyn is a psychiatrist who earned her medical degree at SUNY Downstate College of Medicine in Brooklyn, NY, where she was a member of the Alpha Omega Honor Medical Society. She completed her adult psychiatry residency training at The Mount Sinai Hospital in New York City. She has experience working with a diverse population in both inpatient and outpatient settings through medication management, individual and group therapy, and crisis intervention. She is interested in trauma, integrative psychiatry, anxiety disorders, schema therapy, and third wave CBT. Dr. Epshteyn supports Regroup’s quality initiatives in various ways, including clinician interviews.

Naveen Kathuria
SVP of Growth & Advisory Services
Insight + Regroup

Naveen has worked in healthcare as an entrepreneur, attorney and consultant. Prior to joining InSight + Regroup, he worked for large law firms, co-founded a preventative care and wellness provider, and consulted hospitals and community health clinics. Naveen spends most of his time working with large partners and tribal communities and and is passionate about improving access to behavioral health in Indian Country and all types of health care settings across the country.

You can video slides for the video here. 

COVID-19 has forced people around the world to make drastic changes to their lives and routines. In the midst of these changes, digital health companies find themselves in a unique position to help people stay active, eat nutritious foods, sleep well, and manage stress during these challenging times. They are also partnering with public health and research partners in order to leverage behavior and biometric data to help detect and prevent the spread of COVID-19.

Fitbit’s Medical Director John Moore and Scripps Research Epidemiologist Jennifer Radin will provide insights as to how wearables can help keep people healthy in times of change, and help detect the spread of influenza-like illnesses, including COVID-19.

Join us to learn:

• How wearables can help keep people healthy in times of change
• How digital health companies can use their products and services to better support users during the COVID-19 pandemic
• How Scripps research harnesses data from Fitbit and other digital health platforms in order to improve detection of influenza-like illnesses

   

Speakers: 

Jonathan Moore
Medical Director, Fitbit

John Moore is a physician, engineer and the Medical Director at Fitbit. He is the former CEO of Twine Health, a Cambridge based company recently acquired by Fitbit. John studied biomedical engineering and then medicine at Boston University. He left the clinical career path, determined to develop solutions to improve healthcare delivery, and earned a PhD from MIT. His research included the intersection of health psychology, learning science, and human-computer interaction, which formed the health behavior change foundation of Twine Health that is now being leveraged at Fitbit. John was recently recognized by Employee Benefits News, as one of the 2019 Digital Innovators: Transforming HR. John finds his fit with various ocean-related activities, including surfing.

Jennifer Radin
Epidemiologist, Scripps Research

Jennifer Radin is an epidemiologist at Scripps Research, where she conducts research to improve disease prediction and prevention by incorporating digital devices, sensors and platforms. Before joining Scripps, she worked with the Operational Infectious Disease Department at the Naval Health Research Center and the Influenza Division at the Centers for Disease Control and Prevention. Jennifer received her doctoral degree in Epidemiology from the University of California, San Diego and San Diego State University. She also holds a master's of public health, specializing in Epidemiology of Microbial Diseases, from Yale University and a bachelor's degree in Biology from the College of William and Mary.

View Slides Here

Background: Through Congressional action, the Secretary of Health and Human Services (HHS) was granted the authority to waive underlying statutory restrictions on Medicare reimbursement of telehealth services during the COVID-19 public health emergency period. The Centers for Medicare and Medicaid Services (CMS) has implemented this flexibility through the issuance of waivers, as well as an interim final rule. 

As health care facilities and provider practices look to protect their providers and patients from COVID-19, telehealth provides a safe and effective option for providers to continue to treat patients from a distance. eHI has put together this FAQ document to help those who are implementing telehealth during this period.*  

Adverse health effects of the opioid epidemic continue to climb. Opioid-related overdose deaths reached an all-time high of 42,249 in 2016,¹ prompting President Trump to declare an opioid public health emergency in 2017. From July 2016 to September 2017, emergency department visits associated with opioid-related overdoses spiked about 30%.² Those with opioid use disorders (OUDs) face dramatically increased risk of early death, typically from overdose. Provision of evidence-based medication-assisted treatment (MAT), which can involve methadone, buprenorphine, or naltrexone, to those with OUDs has been shown to reduce the risk of death by as much as 50%.³ Yet access to MAT remains severely inadequate—notably in rural America, particularly hard hit by the epidemic. Policymakers generally agree that more widespread access to MAT is desperately needed; the question remains: how?

Prominent among strategies proposed to ramp-up MAT access is providing it via telemedicine. Telemedicine, or the remote delivery of health care using telecommunications technology, has the potential to increase access to MAT medicines and concurrent therapy in underserved, remote rural areas by providing direct-to-patient or specialty consultation services from afar. Although telemedicine to treat patients with OUDs has been piloted favorably, scaling up its provision is not as simple as connecting a patient to a provider. Rather, stakeholders must surmount considerable regulatory, logistical, and quality hurdles before telemedicine can help to mitigate the opioid epidemic.

Read more of this perspective from the Mayo Clinic below.

Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed.

PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video-based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy.

Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians’ perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.

Read more by clicking the link below.

Our COVID-19 Federal Policy Work Group series to help craft a report with a set of recommendations to fully leverage health IT and digital health to fight COVID-19 and future public health challenges. This meeting will focused on artificial intelligence and machine learning. 

Our guest speaker was Eileen Koski, Program Director, Health Data and Insights, Center for Computational Health, IBM Research who will discuss how IBM has deployed AI in the fight against COVID-19. 

The recent report of critically ill emergency physicians infected by the novel coronavirus disease 2019 (COVID-19) is a sobering reminder of the vulnerability of the nation’s health care workforce. While all members of the health care workforce are vital as the health care system faces perhaps its greatest challenge in memory, physicians and nurses are the caregivers who typically have the most direct contact with patients, whether through advising, triaging, or treating those who require hospitalization. Hospitals and other care delivery organizations, including state and local health departments, should carefully consider how best to protect and preserve their workforce, with careful consideration involving older physicians and nurses.

Read more of this viewpoint by clicking this link below.

Rural veterans are older and have more complex medical issues than their urban counterparts. Veterans aged 65 and above represent 57% of all rural veterans who are enrolled in the Veterans Health Administration (VHA; Department of Veterans Affairs, 2019a). These older adults often have multiple chronic conditions and aging-related issues that require care from multiple disciplines, including primary care, specialty care, mental health care, and coordinated health and social services; and yet, accessing these services at a health-care facility may require extensive travel. This article describes telehealth approaches by the VHA, including the Geriatric Research Education and Clinical Centers (GRECC) Connect clinical demonstration project, to increase access to geriatric care for aging veterans and family caregivers residing in rural areas.

Read more below.

Intent of Toolkit: Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.

Get access to CMS's telehealth tool kit below.

About once in a generation, a global pandemic emerges and wreaks havoc on a vulnerable world population. This is why most of us have limited personal experience with such events. The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans that is causing a major epidemic in the last 2 decades. Recent outbreaks such as severe acute respiratory syndrome in 2003 and Middle East respiratory syndrome in 2012 were successfully confined to small regions of the planet. As such, they were of peripheral concern to allergists practicing in the United States because we and our patients were not exposed to them. Now that COVID-19 is affecting us and our patients directly, concerns about this novel emerging infection have gone, well. viral. It was only a matter of time until a global pandemic affected us, and our time has run out.

Read more of this editorial below.