Minnesota​ deploys​ telehealth​ to​ expand​ mental​ health​ access​ to​ rural​ areas

Editor's note: This article was edited to appear in the print edition of Modern Healthcare. Experience the multimedia version of this special report.

Minnesota's Arrowhead Region, situated in the northeastern part of the state, encompasses 20,000 square miles of mostly rural communities. The region covers 23% of the state but contains only 6% of its population. Providing regular healthcare services across the vast area is difficult at best; offering adequate mental health services is even more challenging.

Like in many parts of the U.S., Minnesota has a shortage of mental health professionals. The state ranks No. 44 in terms of meeting mental health needs, with just 29% of the need met, well below the national average of 44%, according to the .

Recently, the Arrowhead Health Alliance—a collaboration of five county public health and human services departments—assessed how to expand access to behavioral health services across such a wide area with too few providers. With good broadband coverage throughout the region, the answer became obvious.

"The only feasible way for us to extend the scarce resource of mental healthcare is through tele-mental health and engaging the primary-care side to partner in that," said Dave Lee, director of public health and human services for Carlton County, a partner within the alliance.

The goal of the program, which kicked off in January 2016, has been to link community mental health resources to expand services to schools, jails and Native American Tribal Health and Human Services providers to cover the entire region.

"A lot of what we've been doing is focusing on what we call the nontraditional integration of mental health in locations where people are in need of behavioral health services but haven't been able to receive them—whether it was because of geographic distance, or lack of a provider in that community, or just difficulty in getting (a provider) into that jail as needed," said Ric Schaefer, director of the Arrowhead Health Alliance.

The alliance partnered with the Minnesota Department of Human Services to use a video system that the agency already had in place to provide telehealth within its hospitals and clinics. The collaboration marks the first time the state agency has linked with a community partner to expand telehealth for behavioral health services. For providers such as Stacy Englund, the use of telehealth has greatly increased her ability to provide mental health counseling to a service area where her clients typically drove nearly two hours for an appointment. Since much of her work is with schoolchildren, getting to an appointment became a logistical challenge.

"A lot of parents would not bring their children to therapy if this were not an option," said Englund, an outpatient therapist with the Range Mental Health Center in Hibbing. "Students are getting care that they normally would not receive."

With nearly 1 in 5 U.S. residents living in a rural area, many proponents see telehealth as an effective solution to meet the demand for services within those underserved communities.

"From a sustainability and short-term opportunity perspective, it certainly seems that telehealth offers some effective solutions," said Katherine Steinberg, vice president in healthcare consulting firm Avalere Health's Center for Payment and Delivery Innovation, adding that it also allows for providers to conduct therapy during nontraditional hours.

Englund said being able to hold therapy sessions through her laptop has allowed her to almost double her caseload in an average week.

Nonetheless, telehealth continues to face major barriers, not the least of which is reimbursement. Steinberg believes more businesses will adopt the technology as they learn more about its value and ability to actually drive down costs.

"I'm hopeful that because telehealth also offers a lower cost mechanism for providing mental health services that we might see greater expansion of reimbursement," Steinberg said.