Quality Standards for Virtual Therapy Needed More than Ever

Amidst the COVID-19 pandemic, the prevalence of mental health challenges rose significantly, worsened by fear and uncertainty as well as the consequences of physical distancing measures instituted to halt the spread of the virus. At the same time, limited access to in-person mental health services raised concerns that patients would not be able to get needed care.

In response, multiple stakeholders, including health plans, healthcare technology companies, as well as federal and state governments, found ways to increase access to mental health services by enabling virtual care delivery models and enabling traditional providers to deliver care remotely. The Centers for Medicare & Medicaid Services and states have eased telehealth regulations and permanently expanded coverage for telehealth services, including psychotherapy, but the focus was on access alone without discussion of quality standards. While the conversation has understandably revolved around improving access, we are reminded of the need to dedicate equal attention to ensuring that care is being delivered at high quality and with fidelity to clinical practice guidelines.

Ensure top-notch care delivery practices and measure, measure, measure

Establishing standards for virtual care delivery is a necessary prerequisite for ensuring high-quality care. Central to delivering quality care is having a clinical network of highly qualified clinicians with the requisite experience and training in appropriate behavioral health interventions. Care delivery needs to be based on evidence-based interventions. To make certain providers adhere to established guidelines and protocols, standardized clinical oversight processes are needed to measure performance. Effective care coordination is indispensable for directing patients to the proper level of care for their specific needs, for escalating or de-escalating issues that may arise, and integrating care with a patient’s circle of care providers.

Capturing data and measuring patient outcomes are necessary to demonstrate the success of these quality standards. While several organizations have sought to establish quality metrics in behavioral health, no single approach has been consistently applied by providers. Several key metrics can be measured using established and validated assessment tools. These include symptom severity, quality of life measures, and functional outcomes. Recognizing the impact that behavioral health can have on physical health, providers have an opportunity to show the impact on physical health measures and even the impact on total cost of care.

Technology platforms supporting virtual care can be utilized to support quality standards by enabling the protocolization of behavioral health delivery models and allowing oversight and assurance of fidelity to treatment. Technology that enables care delivery can also serve as mechanisms to capture important patient-reported outcomes to support quality measurement and continuous quality improvement initiatives.

Maintain high standards for digital tools

Digital technologies are an important part of the solution to improving access to resources during the pandemic. In recent years, there has been an explosion in the number of point solutions offering digital mental health tools, and it has become challenging to evaluate the quality and efficacy of such solutions. These digital applications similarly require high quality standards so that users and payers are assured the technologies are evidence-based. Unfortunately, reports have shown a lack of evidence and clinical rigor among many solutions, with only 14% of mental health apps considered to be evidence-based. It is critical that we focus greater attention on ensuring sound methodologies are applied in digital tools and that we establish quality of care standards for digital technologies just as we do for traditional care delivery models.

Elevate the discussion beyond “access”

While the national conversation on mental health and addiction treatment remains primarily focused on expanding access, we need equal focus on ensuring those services are delivered with high quality. And while we emphasize the expansion of services, we need to simultaneously broadcast the need for wider adoption of quality standards.

Virtual therapy has the potential to solve several urgent needs within our national healthcare system by addressing the rising incidence of mental health issues we are facing. Scaling to meet demand is essential, and deploying virtual care of the highest possible quality is the only way to ensure every patient gets the care they need for lasting improvements in their mental and physical health.

Improving mental healthcare and addiction treatment certainly starts with increasing access, but we have to remember that access alone is not enough.

Reena Pande, MD, is chief medical officer for AbleTo.