Published Together: Exploring the access, equity, and obstacles of telehealth

Over the last several months, I have learned one very important lesson: systems CAN change. I have been working in the mental health field for a long time, over 25 years of which have been with Arbor Circle; an organization that provides mental health, substance-use treatment, and many other supportive services across West Michigan. When coronavirus hit, our nearly 300 employees— scattered across five counties—made the sudden change to work from home and provide behavioral health services remotely. This transition to telehealth has been the most significant shift I have ever seen, and one of the most broadly supported. Telehealth was suddenly the only safe way to access care, and our service providers, insurance payers, and funders adopted this method nearly overnight.

From the perspective of behavioral health, telehealth was an accessible option for care prior to COVID-19, but only for some. In our field, it was primarily a cash business catering to patients with financial means and often requiring some sort of membership or subscription. While it was an option for behavioral health nonprofits to provide services via telehealth, it wasn’t a sustainable option. Funders weren’t universally paying for it, and as an organization that serves a significant number of Medicaid and Medicare patients, it was difficult to invest in a tool that was not consistently covered.

With the onset of COVID-19, coverage for telehealth was activated almost immediately. Once Medicare and Medicaid made it available, it became universally accepted. Across our network of insurance payers and other funders, it was clear that telehealth services would not only be reimbursed, but would be considered a legitimate service method for the foreseeable future. In Michigan, our state oversight agencies fully embraced and promoted access to telehealth from the beginning and have continued to bolster support for the ongoing use and expansion of telehealth as a viable care option.

While the decision to move to telehealth was swift, the processes behind reimbursement have been slow to catch up. Telehealth infrastructure requires significant investment on the part of all players — provider and payer alike. Governor Whitmer’s recent package of bills outlining the continued use of telehealth will help sustain this important tool post-pandemic, and acknowledges the work of so many organizations across our state in preserving our ability to provide care. The decision to move to telehealth was a leap of faith — without knowing all the details, but in the best interest of the community.

Besides a new set of billing codes and an intimate knowledge of various video and audio conference software, what have we learned about telehealth? It is clear that telehealth requires a different kind of energy. People’s stamina for engaging in behavioral health tele-services is different, unlike coming to an in-person session where there is a standard order and structure. We are connecting more often and for a shorter period of time, changing the nature of how we work with the individuals, children, and families we serve.

We also know that while telehealth has reduced barriers to treatment for so many — such as transportation or childcare — it is not a panacea. Digital deserts and overall lack of resources means this treatment model does not work for everyone. It will require additional investment, especially in our rural communities. Both its successful implementation and its limitations define telehealth as a necessary tool in every provider’s toolbox.

As we look toward the coming months and the long-term impact of COVID-19 on our communities, it is important to recognize that our new “condition” is a different kind of stress. Stress does things to your body and mind, and the chronic stress we are all feeling has only begun to take a toll. Chronic stress is also a preexisting health condition accentuated by racial disparities, resulting in greater vulnerability and susceptibility to coronavirus.

We must acknowledge that all our tools are required to maintain care of and connection to vulnerable populations who are facing significant inequities along with the increased stress of COVID-19. I applaud our service provider network, insurance payers, and the funding community for ensuring all treatment tools are available to the communities we serve. We must continue on this telehealth journey to make mental health services more accessible to those facing continued barriers to care. Systems can change, and they should.

Kristin Gietzen is the President and CEO at Arbor Circle, a Grand Rapids based non-profit providing behavioral health, child welfare and other supportive services in West Michigan. As a licensed, master’s level social worker she has focused her practice on program development and social justice. Through innovative programs and initiatives, Kristin has leveraged funding and resources to develop opportunities for women in management positions, highlight the needs of people who have been marginalized, and bring the behavioral health voice to a number of community coalitions and groups.