4 Predictions for Teletherapy in 2021

Like many fields in telehealth, teletherapy has experienced significant growth during the coronavirus pandemic, a teletherapy CEO says.

Teletherapy is likely to experience growth and other significant changes in 2021, the CEO of a teletherapy provider says.

Last March, when the coronavirus pandemic took hold in the United States, telehealth visits increased 50%, according to Frost and Sullivan. With in-person medical visits associated with the risk of coronavirus infection, virtual visits have emerged as a safe and effective way for patients to meet with their healthcare providers in many circumstances.

Trip Hofer, MBA, CEO of New York City-based teletherapy provider AbleTo has four predictions for teletherapy in 2021.

1. Upward growth trajectory

In 2021, there will likely be a continuation of the increased patient adoption of teletherapy that was seen in 2020 because of the COVID-19 pandemic, Hofer says.

"The coronavirus pandemic has been a horrific event; but for telehealth, the pandemic has advanced the industry by five years to a decade. People who were not used to telehealth have been exposed to it. We probably will see a dip in teletherapy in 2021 as people go back to office settings, but a lot of people have become comfortable with these services. As a result, the trend in 2021 is likely to be continued growth," he says.

2. Startups, mergers, and acquisitions

Teletherapy is drawing a significant amount of investment dollars, which will drive market changes this year, Hofer says.

"In 2021, you are going to see more teletherapy startups come into the market. You also are going to see more M&A activity this year because money is flowing in and larger organizations such as health plans are seeing opportunities to bring teletherapy in-house," he says.

3. Targeting outcomes

This year, there is going to be increased focus on teletherapy outcomes—both clinical and financial, Hofer says. "There is recognition that teletherapy is increasing patient access, but health plans are getting more focused on what they are getting for that access."

AbleTo works mainly with health plans, and they ask for a spectrum of data, he says. "One data point is patient satisfaction—health plans want to know whether patients are satisfied with the services they are receiving. They want to see utilization data—how much was a service utilized and how often. They also want to see data for clinical outcomes."

In teletherapy, examples of clinical outcome measurement tools include the DASS 21 and the PHQ-9.

Health plans also are interested in return on investment and financial outcomes, Hofer says.

For example, he says a large share of AbleTo's service offerings is for individuals who have a mental health need and a physical comorbidity. For a patient who is depressed and has had a heart attack, AbleTo can treat the depression, which can lower total cost of care by reducing emergency room visits and hospitalizations, Hofer says.

4. Regulatory environment

Licensure requirements are more restrictive in behavioral health than in physical health, Hofer says. "For example, nurses have compact state licensure; where if they get licensed in one state, they can get licensed in dozens of other states. We don't have that in mental health—if you are licensed in one state you can only practice in one state. Multistate licensure is onerous. On average, our therapists have two state licenses."

During the pandemic, the Centers for Medicare & Medicaid Services have relaxed the licensing requirements for behavioral health, so professionals can practice across state lines. "My hope is that CMS is going to continue to allow us to do that because it is going to provide more access for patients," he says.

If CMS ends the cross-state licensure waiver for behavioral health professionals in 2021, it is unlikely that the federal agency will make the change abruptly, Hofer says.

"I predict that CMS will continue to allow behavioral health professionals to practice across state lines for at least a period of time after the pandemic. What is most concerning is continuity of care for the patient. For example, if a therapist is licensed in Massachusetts and is treating a patient in New Hampshire then CMS ends the licensure waiver, all of a sudden the patient can lose continuity of care. I think CMS is very concerned about that."

To maintain continuity of care, CMS is likely to allow therapists to continue treating patients across state lines as long as services are needed, he says.

Related: FAIR Health Tracking Robust Monthly Telehealth Utilization