Children in America were increasingly struggling with mental health before COVID-19, but the pandemic compounded an already growing crisis. Today in the U.S., nearly one in five children experience a mental health disorder. What’s just as alarming is that for every five children with a mental health disorder, only one will receive treatment.
In October 2021, leading pediatric healthcare associations declared a national emergency in child and adolescent mental health. This declaration was a stark warning for policymakers and the public to advocate for increased access to mental health resources. We need to take this warning seriously and take steps to make sure every child gets the care they need. But it’s a momentous task and one that a single person or organization cannot accomplish alone. To be successful, we need to put every option on the table and work together to remove roadblocks to care. Telehealth will be a big part of expanding access, but there’s still a lot to do before it can deliver on its full potential.
Telehealth: A great equalizer
The declaration of a national emergency from the American Academy of Pediatrics (AAP) and others advocated to “assure continued availability of telehealth to provide mental health care to all populations.” Expanding access to telehealth will be a key component to addressing the pediatric mental health crisis for two main reasons: it breaks down geographic barriers and it helps distribute mental health professionals across a larger area to maximize the dwindling supply of providers.
The U.S. Department of Health and Human Services estimates that the country will have 10,000 fewer therapists than it needs by 2025, and that estimate was developed before the pandemic hit. In recent years, while the demand for qualified therapists has increased significantly, the number of therapists available to treat patients has not.
Teletherapy will play a crucial role in closing the gap and providing equitable care between patients and therapists, making sure we maximize the people and resources available to help children in need. Meeting with patients virtually creates efficiencies for therapists and their patients who no longer need to travel and can attend appointments from anywhere. Perhaps more importantly, teletherapy’s ability to erase geographic boundaries can help ensure patients are able to see the right therapists—both in terms of a culture and personality fit as well as a therapist’s expertise and qualifications. This can have a significant impact reaching people in rural or urban areas where finding a therapist can be difficult, especially therapists with an expertise in pediatrics.
While making it easier to reach more people, we know that teletherapy can be just as effective as in-person therapy too. Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy.
However, just because teletherapy can break barriers and create efficiencies—while delivering care that’s on par with traditional settings—doesn’t mean it’s always easy. There’s a lot we can do on the back end to streamline processes and make sure kids can get care quickly.
The policies for streamlining care
It’s a good thing teletherapy had been proving its effectiveness for years before the pandemic. It enabled mental health providers to quickly shift to delivering care online when social distancing entered everyone’s vocabulary in early 2020.
To accommodate this shift, payers relaxed many policies that would have otherwise made it difficult to utilize telehealth in favor of receiving care in a traditional setting. For example, the Coronavirus Aid, Relief, and Economic Security (CARES) Act included a payment parity requirement for Medicare; and many private insurers followed suit implementing similar regulations in their commercial plans. In addition, both state governments and the federal government made policy changes such as granting waivers to insurers and regulators for telemedicine and mandating that private health plans cover telemedicine if they cover the same services in person through parity laws.
It's critical to ensure these policies do not expire and that we put in place permanent structures that do not disincentivize delivering behavioral healthcare virtually. There have been some positive steps toward making sure this happens, including a Roadmap for Behavioral Health Integration that the Department of Health and Human Services (DHHS) published in mid-September and the Investing in Kids’ Mental Health Now Act introduced in the Senate in August.
While policymakers do their part to implement changes, payers and providers can step up too. For example, it’s not easy and can saddle providers with a large administrative investment on a state-by-state basis; but more telehealth companies could expand their payer contracts to include Medicaid. Considering that more than one-third of children in the U.S. get their health coverage through Medicaid, this is absolutely essential to ensure healthcare equity.
For commercial payers, there’s room to improve the process parents and families have to go through in order to seek care, find providers contracted under their plans, and ensure that essential care will be paid for once it’s delivered. Too many parents struggle to get the information and the help they need when we should be making it as easy as possible. This undue stress and burden to parents seeking care only adds to the strain families are facing, which can compound the mental health challenges in children at a time when all our effort should be focused on improving it.
Reimagining technology’s role
If there’s one thing that’s clear when thinking about the steps payers, providers, policymakers, parents, and others can play in improving access to care, it’s that this issue is very complex. But this is where leaders in technology can step up to simplify the manual effort required to navigate the complexity.
Technology’s role in meeting the behavioral health needs of children doesn’t stop at facilitating video chats. There’s much more technology can do to streamline the entire process, from finding to delivering and paying for care. For example, therapists must complete credentialing, state licensure, and a whole host of other requirements prior to practicing in different states; and teletherapy providers that are capable of delivering care across state lines need to keep track of all this to ensure compliance. When it comes to children whose care might be covered by programs and budgets in school systems, government payers like Medicaid and CHIP, private insurance, or various other mechanisms, there’s a lot of minutiae around prior authorizations, collections, and connecting with and following up with payers.
All of this can be automated, taking stress away from families and giving providers more time and resources to spend actually delivering care versus navigating the administrative requirements around it. For example, medical APIs can streamline relationships between payers, providers, and patients. They make it possible to easily connect with different health plans, confirm eligibility, or process claims. And by letting technology take care of preauthorization and enforcing negotiated contracts and policies, it enables speedier access to care while avoiding resource-draining issues and denials that can cause the roadblocks to care we need to avoid. By partnering with solutions that can offload the provider burden of billing, your providers can focus on what they are best at, which is delivering care.
The bottom line is that there is no silver bullet to easing access to care. It’s going to take a lot of effort to overcome this generational challenge, and everyone needs to work together to do their part. That’s the only way we’ll reach the ultimate goal of ensuring that every kid gets the care they need.
Serrah Linares is the vice president of partner sales at Change Healthcare. Serrah has nearly 20 years of experience in digital transformation and leads the company’s partner strategy, account management, and business development teams. She is passionate about equality with a focus on helping girls and women grow in STEM-based careers.
Rachel Mack Robinson
Rachel Mack Robinson is the founder and president of DotCom Therapy (DCT), the most comprehensive pediatric teletherapy provider for healthcare and educational organizations across the nation. As a speech language pathologist by training, Rachel launched DCT in 2015 to close the gaps in care for children so they can access the therapy services they deserve.