ReVIDA CEO Reflects on Industry’s Shift to Telehealth and Future of Digitally Based Services

The sudden onset of the COVID-19 pandemic forced many behavioral healthcare organizations to embrace telehealth-based services on short notice. For ReVIDA Recovery Centers, the transition was as dramatic as it was swift. The Nashville, Tennessee-based operator of outpatient recovery centers had zero telehealth-based service offerings prior to the pandemic. Over 8 days in March 2020, that shifted dramatically.

At the Treatment Center Investment & Valuation Retreat, Lee Dilworth, ReVIDA president and CEO, spoke with Behavioral Healthcare Executive about the upsides and drawbacks of telehealth’s emergence in behavioral healthcare, lessons learned in the process of going from having no telehealth services to being almost fully telehealth-based in response to COVID-19, and the future of behavioral healthcare service delivery.

Editor’s note: This interview has been edited for length and clarity.

Behavioral Healthcare Executive: What do you see as being the positives and drawbacks of the emergence of telehealth over the past few years, both for providers and for patients?

Lee Dilworth: Well, for patients the biggest positive has been increased access to care, especially in underserved markets, plus the obvious convenience and privacy benefits for patients.

On the flip side, the digital divide in America is very real. We have treatment centers in the Appalachian region of the United States, and where millions of patients can't access care remotely due to either lack a broadband access or lack of hardware. Also, virtual exams simply are less comprehensive than a physical exam with a provider in-person. And for some patients, particularly those who struggle with substance use disorders, it further enhances social isolation that can contribute to the disorder.

On the provider side, it's great because they can see patients from anywhere and at any time of day or night or weekend if they want to. So those are obvious wins for the providers. Further, if you're not seeing patients and interacting with staff, you have reduced risk of viral infection. So some of our providers are very happy that they could still see patients without being exposed themselves.

Some of the negatives that our providers have mentioned include technology, complexity, and downtime. There are a lot of systems that have to operate at the same time. Think about the emergence of electronic health records (EHR)—the health record system, the online platform, the e-prescribing platforms, the state-controlled substance monitoring databases, and others. Some of them interface together and some of them don't. But a virtual encounter is reliant on all of those working at the same time.

Some of our providers have seen an uptick in patient no-shows, or patients who will stay for a portion of their treatment encounter but not all of it. They might see the physician, but then they might drop off while they're in the virtual waiting room waiting to see a counselor or a care coordinator. So that's frustrating because all aspects are treatment, not just one aspect.

And then there's plenty of legal uncertainty, especially when it comes to prescribing controlled substances. Now, not all provider or health providers prescribe, but certainly in medication-assisted treatment or medication for opioid use disorder, the area where we work, there's a lot of legal uncertainty because in many instances, you’re prescribing controlled substances amid state laws and federal laws.

BHE: Did you have telehealth-based services before the onset of the COVID-19?

LD: No, we were not in telehealth at all. When the pandemic hit in March 2020, we went from zero telehealth to almost all telehealth in 8 days. Now though, we use telehealth as an adjunct service. We have 8 treatment centers, so we use it as an adjunct to brick-and-mortar. It enables us to reach more patients across a wider geographic area and to deploy providers and staff across multiple locations. And it also, fortunately, in this employment environment, enables us to recruit from a broader potential pool of applicants.

BHE: What have been some of the most important telehealth-related lessons that you've learned since going down this path in the last couple years?

LD: First, telehealth is not a perfect substitute. It's maybe a good substitute for some specialties, but it's not a perfect substitute. The inherent benefits come with inherent limitations. Second, it's not ideal for all patients. Some patients want a personal interaction with personal accountability if you will. They need to or want to leave their home environments for these types of provider interactions. So it's not ideal for all patients, but regardless of 1 and 2, it's here to stay.

BHE: How do you see the delivery of behavioral health services evolving in the next few years, and what are going to be the biggest factors that drive any changes that are coming?

LD: Well, I think the overall demand for behavioral health care will remain elevated post-pandemic. Not to peak pandemic levels, but it will stay above the pre-pandemic levels.

But what will change is the modes of delivery for behavioral health care. We already see a number of mass retailers like Walgreens and Walmart (a lot of that has been in the news recently) coming into retail at the lower acuity levels, the retail delivery of healthcare. And that will spill over into the lower acuity levels of behavioral health as well. So we'll see more commoditization at those lower acuity levels.

But we will see more virtual delivery channels without question. We’ve already seen the national players emerging in this space. There are others as well that are very good examples. We'll see more and more virtual delivery channels, and they will continue to take hold. And then I think the third thing we'll see by necessity is regulatory changes to facilitate all this new reality. There are a number of bills that have been introduced on the federal and state levels, and there's a lot of tailwinds for those to pass.

Reference

Dilworth L. Telehealth: a senior leader’s perspective on the new treatment landscape. Presented at the Treatment Center Investment & Valuation Retreat. December 5-7; Scottsdale, Arizona.