Coronavirus Is Driving a Telehealth Evolution



By Melissa Laitner, PhD, MPH, SWHR Director of Science Policy

The coronavirus pandemic has caused an unprecedented and swift change in access to health care. Mental health professionals have been some of the first health care providers to switch full time to telehealth during this crisis.

This transition to telehealth particularly affects women, who receive mental health care at significantly higher rates than men. Over 20% of women experienced mental health concerns within the past 12 months. Depression and anxiety also present more frequently in women, and some disorders — including postpartum depression and premenstrual dysphoric disorder — are tied to sex-specific hormone changes.

In addition, women appear to be bearing more of the social and economic burden caused by the pandemic, which will likely affect their mental health. One Kaiser Family Foundation poll conducted March 25-30 showed that 49% of women said their lives had been disrupted “a lot” by coronavirus compared to 40% of men. Another KFF poll found more women were worrying about the negative consequences of the coronavirus and taking greater precautions than men.

SWHR spoke to Jennifer Mundt, PhD, a sleep psychologist and assistant professor of neurology at the Northwestern University Feinberg School of Medicine, about what the transition to telehealth for mental health care has looked like for patients and providers.

Mundt typically sees four to eight patients per day in a behavioral sleep medicine clinic located in downtown Chicago. When COVID-19 became more widespread in her area, she said the transition to telecare was abrupt. “All of our patients had to be converted to telehealth and there was no way to teach them how to use the platform overnight,” she said.

“Initially, the hardest thing was trying to get a good understanding of what the current ethical and legal situation was for providers and patients. Some of that was a little unclear even before coronavirus,” Mundt explained.

The federal government and private insurers have taken steps to help make telehealth more accessible during the pandemic. The Centers for Medicare and Medicaid Services (CMS) quickly broadened access to telehealth for beneficiaries and expanded regulations to ensure providers can receive reimbursement for patients who only have access to an audio connection.

Private insurers typically follow the directives that CMS puts into place. Anthem, for example, is recommending telehealth to help prevent virus spread and, for 90 days, will waive any cost sharing for telehealth visits — including mental health care — for fully insured employer plans, individual plans, and Medicare and Medicaid plans, where permissible.

“In the past, I had to be very careful with patients to make sure they checked that telehealth was covered.” Mundt said. “It can be damaging to the patient-provider relationship if they are forced to jump through hoops with insurers to determine financial burden. Now we can focus on patient treatment without having as much concern about insurance coverage.”

She added that patients seem to be adjusting to the situation. “In the first couple of weeks, I saw about 50% fewer patients per day,” Mundt said. “But this week looks almost like a normal week — all of my [patient] slots are filled.”

Mundt is also looking forward to what telehealth could mean for patients after the pandemic. “Even in the first week I was thinking it would be great to continue to devote a certain percentage of time to telehealth,” she said. “We do get patients coming from far enough away that it would benefit the patients and free up needed space in our clinic.” At the Feinberg School of Medicine in Chicago, patients come from up to two or three hours away — and sometimes even from different states — to receive care.

For women facing specific caregiving challenges or cost concerns, allowing the flexibility of telehealth can save time and money. Mundt sees many women in busy jobs and balancing care for families after work. For those women, it can be difficult to take time off, so telehealth may provide a better solution.

The coronavirus has forced the health care system to embrace telehealth — at least temporarily — but there remains a great deal to consider to ensure virtual visits remain an option in the post-coronavirus world.

“We need national, federal-level clarity on how to make telehealth work,” Mundt said. “It’s been very confusing and piecemeal, state-by-state. We need broader agreement. … We need a better consensus.”

CMS and policymakers should consider the following when contemplating the future of telehealth:

  • Telehealth is transforming the delivery of health care. Reversing course in the aftermath of the global pandemic would be a setback for patients and health care providers. While the administration was already expanding telehealth options prior to the pandemic, CMS must consider how to preserve its current changes in a way that is workable for the long term.
  • Disabled, home-bound, and rural patients stand to benefit greatly from telehealth, but all patients may find advantage in enhanced flexibility. Federal law in place prior to the pandemic forbid Medicare from paying for most telehealth visits except in the most rural communities. Fewer than 1% of Medicare beneficiaries were receiving telehealth services under these restrictions. Congress and CMS should push for maintaining expanded coverage for services without geographical restrictions and improving reimbursement for telehealth care. The CONNECT Act, introduced last fall by Sen. Brian Schatz (D-HI) and a bipartisan work group, is an ideal first step in targeting these issues.
  • Investing in innovative telehealth delivery models can increase access and provide more convenient, affordable, and higher levels of care. The U.S. can take inspiration from other countries that have implemented unique telehealth models, as well as private U.S. companies that have worked to scale up in the midst of this pandemic. Certain hospital systems have also been using telehealth to conduct screening and triage visits, which may also be a source of inspiration for mental health and medical providers.
  • Telehealth should also be considered as a model for expanding the reach of government-funded research trials. Leveraging telemedicine platforms in clinical research studies can foster personalized engagement and interaction between investigators and patients throughout the clinical trial journey. Decentralized and siteless trials seem more appealing than ever in the midst of a pandemic and may have the added benefit of increasing participation and improving diversity within research.

Guaranteeing women have access to mental health care services has been and will remain crucial. Many patients “are relieved [that telehealth] is being offered right now,” Mundt said. “They’re happy we’re doing what’s best.”

Policymakers and insurers must ensure health care providers can do what’s best for the health of women at all times — both during the current health crisis and into the future.

By Melissa Laitner, PhD, MPH, SWHR Director of Science Policy

The coronavirus pandemic has caused an unprecedented and swift change in access to health care. Mental health professionals have been some of the first health care providers to switch full time to telehealth during this crisis.

This transition to telehealth particularly affects women, who receive mental health care at significantly higher rates than men. Over 20% of women experienced mental health concerns within the past 12 months. Depression and anxiety also present more frequently in women, and some disorders — including postpartum depression and premenstrual dysphoric disorder — are tied to sex-specific hormone changes.

In addition, women appear to be bearing more of the social and economic burden caused by the pandemic, which will likely affect their mental health. One Kaiser Family Foundation poll conducted March 25-30 showed that 49% of women said their lives had been disrupted “a lot” by coronavirus compared to 40% of men. Another KFF poll found more women were worrying about the negative consequences of the coronavirus and taking greater precautions than men.

SWHR spoke to Jennifer Mundt, PhD, a sleep psychologist and assistant professor of neurology at the Northwestern University Feinberg School of Medicine, about what the transition to telehealth for mental health care has looked like for patients and providers.

Mundt typically sees four to eight patients per day in a behavioral sleep medicine clinic located in downtown Chicago. When COVID-19 became more widespread in her area, she said the transition to telecare was abrupt. “All of our patients had to be converted to telehealth and there was no way to teach them how to use the platform overnight,” she said.

“Initially, the hardest thing was trying to get a good understanding of what the current ethical and legal situation was for providers and patients. Some of that was a little unclear even before coronavirus,” Mundt explained.

The federal government and private insurers have taken steps to help make telehealth more accessible during the pandemic. The Centers for Medicare and Medicaid Services (CMS) quickly broadened access to telehealth for beneficiaries and expanded regulations to ensure providers can receive reimbursement for patients who only have access to an audio connection.

Private insurers typically follow the directives that CMS puts into place. Anthem, for example, is recommending telehealth to help prevent virus spread and, for 90 days, will waive any cost sharing for telehealth visits — including mental health care — for fully insured employer plans, individual plans, and Medicare and Medicaid plans, where permissible.

“In the past, I had to be very careful with patients to make sure they checked that telehealth was covered.” Mundt said. “It can be damaging to the patient-provider relationship if they are forced to jump through hoops with insurers to determine financial burden. Now we can focus on patient treatment without having as much concern about insurance coverage.”

She added that patients seem to be adjusting to the situation. “In the first couple of weeks, I saw about 50% fewer patients per day,” Mundt said. “But this week looks almost like a normal week — all of my [patient] slots are filled.”

Mundt is also looking forward to what telehealth could mean for patients after the pandemic. “Even in the first week I was thinking it would be great to continue to devote a certain percentage of time to telehealth,” she said. “We do get patients coming from far enough away that it would benefit the patients and free up needed space in our clinic.” At the Feinberg School of Medicine in Chicago, patients come from up to two or three hours away — and sometimes even from different states — to receive care.

For women facing specific caregiving challenges or cost concerns, allowing the flexibility of telehealth can save time and money. Mundt sees many women in busy jobs and balancing care for families after work. For those women, it can be difficult to take time off, so telehealth may provide a better solution.

The coronavirus has forced the health care system to embrace telehealth — at least temporarily — but there remains a great deal to consider to ensure virtual visits remain an option in the post-coronavirus world.

“We need national, federal-level clarity on how to make telehealth work,” Mundt said. “It’s been very confusing and piecemeal, state-by-state. We need broader agreement. … We need a better consensus.”

CMS and policymakers should consider the following when contemplating the future of telehealth:

  • Telehealth is transforming the delivery of health care. Reversing course in the aftermath of the global pandemic would be a setback for patients and health care providers. While the administration was already expanding telehealth options prior to the pandemic, CMS must consider how to preserve its current changes in a way that is workable for the long term.
  • Disabled, home-bound, and rural patients stand to benefit greatly from telehealth, but all patients may find advantage in enhanced flexibility. Federal law in place prior to the pandemic forbid Medicare from paying for most telehealth visits except in the most rural communities. Fewer than 1% of Medicare beneficiaries were receiving telehealth services under these restrictions. Congress and CMS should push for maintaining expanded coverage for services without geographical restrictions and improving reimbursement for telehealth care. The CONNECT Act, introduced last fall by Sen. Brian Schatz (D-HI) and a bipartisan work group, is an ideal first step in targeting these issues.
  • Investing in innovative telehealth delivery models can increase access and provide more convenient, affordable, and higher levels of care. The U.S. can take inspiration from other countries that have implemented unique telehealth models, as well as private U.S. companies that have worked to scale up in the midst of this pandemic. Certain hospital systems have also been using telehealth to conduct screening and triage visits, which may also be a source of inspiration for mental health and medical providers.
  • Telehealth should also be considered as a model for expanding the reach of government-funded research trials. Leveraging telemedicine platforms in clinical research studies can foster personalized engagement and interaction between investigators and patients throughout the clinical trial journey. Decentralized and siteless trials seem more appealing than ever in the midst of a pandemic and may have the added benefit of increasing participation and improving diversity within research.

Guaranteeing women have access to mental health care services has been and will remain crucial. Many patients “are relieved [that telehealth] is being offered right now,” Mundt said. “They’re happy we’re doing what’s best.”

Policymakers and insurers must ensure health care providers can do what’s best for the health of women at all times — both during the current health crisis and into the future.