Joseph A. Banken, M.A., Ph.D., HSPP

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The Impact of Mental Health Telemedicine on
Patients Cost Savings

• Joseph A. Banken, M.A., Ph.D., HSPP
• Associate Professor
• Director of Research, Antenatal Neonatal
  Guidelines
• Education and Learning System
• (ANGELS)
• University of Arkansas for Medical Sciences
• Department of Obstetrics and Gynecology
• Little Rock, Arkansas

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Key Presentation Themes

• Growing demand for more cost-effective ways of
  delivering accessible behavioral healthcare
• Telemedicine can assist addressing the high costs
  associated with behavioral health illnesses in
  days missed from work
• Behavioral health telemedicine provides a
  possible solution to barriers for needed
  treatment
• Telemedicine Defined
• - Employment of telecommunications and
  information technologies for the clinical care of
  patients and patient counseling

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The Rural Hospital Program Interactive Video
Network
University of Arkansas for Medical Sciences
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Reaching the Hard to Reach Barriers for Access
to Healthcare

• Target area for the UAMS Telehealth Project
• East Arkansas Delta
• Seven counties, rural population
• More than 131,000 residents
• - 51 are minority African American
• - Some of poorest counties in Arkansas
• - Medically Underserved Areas (MUAs)
• - Health Professional Shortage Areas (HPSAs)

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Barriers for Access

• System Barriers
• Lack of providers, insurance, educational,
  transportation
• Travel Costs
• - Need to travel long distances for medical care
• Culture Barriers
• Feeling of distress, anxiety by idea of traveling
  to health professionals in large urban areas
• - Prefer familiar surrounding for healthcare
• - Family and social support in own community
• Individual Barriers
• Lack psychological, physical, financial resources
  to travel to healthcare settings
• Patient avoiding travel
• - Depression, anxiety, substance misuse

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The UAMS Rural Hospital Telehealth Project

• Developed in 1998, ended in 2003
• Delivered specialty telemedicine consultations at
  distant sites
• Served a poor, underserved, rural population in
  the East Arkansas Delta
• Project Objective
• Increase rural residents access to specialty
  medical services across the life-span using
  Telemedicine
• Funded by the Office for the Advancement of
  Telehealth, HRSA, DHHS
• Provides payment for medical consultations for
  patients without insurance

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Telemedicine Technology Polycom View Stations,
ELMO-400 Document Cameras, T1 Telephone Lines
(2003)
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Purpose of Study

• Evaluate patients cost savings with
  participation in behavioral health telemedicine
  consults in the UAMS Telehealth Project during
  1998-2003
• Differences in patients cost savings were
  assessed by demographic and socioeconomic
  variables

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Cost Variables
The variables examined for patients cost savings
with telemedicine

• Travel mileage for medical care, based on current
  2003 standard
• - 32 cents per mile
• Missed days at work
• Family expenses

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Demographic Socioeconomic Variables

• Gender
• Ethnicity
• Education
• Occupation
• Income
• Insurance
• Household Size
• Community Size

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Significance of Study

• Results can be used to determine strategies for
  improving cost savings with behavioral health
  telemedicine among subgroups of patients in
  Arkansas
• No other comparable study for behavioral health
  telemedicine

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Methods

• Post-use survey
• Behavioral health telemedicine patients
• Rural East Arkansas Delta population
• Telehealth Project during 1998-2003
• 186 consults
• Data collected
• - March 1998 to August 2003

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Procedures

• Primary care providers from distant, healthcare
  sites in the East Arkansas Delta requested
  behavioral health telemedicine consults through
  the project coordinator
• Primary care provider/site facilitator presented
  patient to the consultant in brief telemedicine
  interaction
• Consult sessions
• Patient interviews, MSEs, behavioral health
  treatment
• 45- minute session
• Follow-up care and instructions provided for the
  patient and site facilitator
• Patient privacy remained paramount
• Developed behavioral health protocols for urgent
  care
• Interactive compressed video technology
• Infrequent technical disruptions

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Instruments

• Patient Postsession Evaluation
• Patients cost savings
• - Travel
• - Missed days at work
• Patient Master Record
• - Demographic and socioeconomic data
• Data de-identified for study purposes
• - Family expenses

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Data Analysis

• Statistical Package for Social Sciences (SPSS)
• Chi Square Test of Independence
• Evaluated differences between proportion for two
  or more groups in the master data set
• - Assess differences in patients cost savings
  with behavioral health telemedicine by
  demographic and socioeconomic variables

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Results Characteristics ofResearch Population

• N 186 consults (N 73 patients)
• Response Rate 68-72, cost savings variables
• Female 58
• Adults 19-78 years of age 58
• African-American 43
• Less than High School Education 31
• Unemployed/Retired 46
• Income lt 25,000 57
• No Health Insurance 63
• 1-2 Persons in Family 55
• Resided in Smaller Rural 47
• Communities (population 50-1,506)
  

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Results Patients Cost Savings for Behavioral
Health Behavioral Health Care

• WITHOUT Telemedicine
• 90 of patients would travel greater than 70
  miles for care
• 59 would miss one day of work
• 56 would spend 75-150 for family expenses
• 2003 Expense Costs

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Patients Cost Savings with Behavioral Health
Telemedicine

• With telemedicine
• 96 of patients traveled lt30 miles
• 3 traveled 31-50 miles
• 87 saved a travel distance of at least 40 miles
  (40-60 miles)

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Patients Cost Savings with Mental Health
Telemedicine

• With telemedicine
• 87 of patients saved 32 in fuel costs by saving
  a travel distance of 100 miles for a round trip
  (2003 fuel expense data)
• 56 saved 75-150 in family expenses

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Patients Cost Savings with Behavioral Health
Telemedicine

• Assuming an average annual income of 25,000
• - Behavioral health telemedicine patients, this
  translates to a daily income of 100
• Assuming the cost of missing one day of work is
  100
• - 59 saved 100 in wages by avoiding one day of
  missed work with telemedicine

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Patients Cost Savings with Behavioral Health
Telemedicine Demographic and Socioeconomic
Variables

• With Telemedicine
• 95 of Medicaid patients saved 32 in fuel costs
• 78 of Medicaid patients saved 75-150 in family
  expenses

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Medicaid Patients Cost Saving for Travel and
Family Expenses with Telemedicine
Percent
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Travel Distance Saved With Telemedicine by
Education

• Patients with a college education were more
  likely to save a distance of at least 40 miles
  (40-60 miles) with telemedicine
• Compared to patients with a high school degree or
  less (p 0.043)

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Travel Distance Saved 40 60 Miles with
Telemedicine by Education
Percent of Patients
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Family Expenses Without Telemedicine by Income
Patients in households with annual incomes over
25,000

• More likely to have family expenses over 150
  without telemedicine
• - Patients in households with annual incomes of
  25,000 or less (p 0.001)

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Family Expenses Over 150 Without Telemedicine
by Household Annual Income
Percent of Patients
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Family Expenses Without Telemedicine by Education

• Patients with a College Education
• Significantly more likely to have family expenses
  over 150 without telemedicine
• - Patients with a high school degree
• (p 0.002)

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Family Expenses Over 150 Without Telemedicine by
Education
Percent of Patients
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Missed Days at Work Without Telemedicine by
Income

• Although not significant (p 0.080)
• Patients in households with annual incomes of
  25,000 or less (63)
• More likely to miss one day of work without
  telemedicine
• - than patients in households with annual
  incomes over 25,000 (39)

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Conclusions
The study findings suggest that behavioral health
telemedicine patients in rural Arkansas

• Saved on travel for medical care
• Missed fewer days of work
• Saved on family expenses
• Saved an average of 282 in travel fuel costs,
  family expenses, and wages by avoiding travel and
  missed work days (2003 Fuel data)

Significant differences in patients cost savings
with telemedicine were found by health insurance
status, education, and income
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Limitations

• Post-use survey of self-selected mental health
  telemedicine patients
• - Convenience sample
• Non-respondents for demographic and socioeconomic
  variables were higher than desired
• Self-reported data extrapolated (2003) for
  patients cost savings with behavioral health
  telemedicine
• Study design limited the ability to determine the
  cost-effectiveness of program methods

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Implications for Clinical Practice

• Study findings demonstrated that behavioral
  health telemedicine is serving a useful purpose
  for a poor, underserved rural population in the
  East Arkansas Delta
• Improve cost savings with behavioral health
  telemedicine among subgroups of patients by
  program methods that address patients needs
  regarding travel for medical care, missed days at
  work, and family expenses
• The findings provide evidence for third-party
  payers regarding patients cost savings with
  behavioral health telemedicine

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Implications for Future Research

• Decrease the sample of non-respondents for
  demographic and socioeconomic variables
• Instructions for patients, train site
  facilitators
• - Completion of all instrument items for
  demographic, socioeconomic variables

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Implications for Future Research

• Future studies
• - Compare mental health telemedicine programs
  and face-to-face mental healthcare on patients
  cost savings
• Assess patients cost savings with behavioral
  health telemedicine in small, remote rural
  communities in other states and among different
  ethnic groups
• - Assess hospitalizations
• - Treatment adherence
• - Emergency Department Visits
• - Consider involvement of high-risk patient
  groups

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Acknowledgements

• Ann Bynum, EdD
• Cathy Irwin, RN, PhD
• Narissa Perry