No abstract

In the USA, the high cost and inefficiencies of the health care system have prompted widespread demand for a better value on investment. Reform efforts, focused on increasing effective, cost-efficient, and patient-centred practices, are inciting lasting changes to health care delivery. Integrated care, providing team-based care that addresses both physical and behavioural health needs is growing as an evidence-based way to provide improved care with lower overall costs. This in turn, is leading to an increasing demand for psychiatrists to work with primary care physicians in delivering integrated care. Telepsychiatry is an innovative platform that has a variety of benefits to patients, providers, and systems. Associated costs are changing as technology advances and policies shift. The purpose of this article is to describe the changing role of psychiatry within the environment of U.S. healthcare reform, and the benefits (demonstrated and potential) and costs (fixed, variable, and reimbursable) of telepsychiatry to providers, patients and systems.

The health care industry is evolving in response to increasing costs, poor health outcomes, and consumer dissatisfaction. Integrated care is a critical component of health care evolution, recognizing the particular burden of untreated behavioral health issues on both physical and behavioral health care outcomes and costs. Telehealth, the use of technology to provide care at a distance, is a flexible process adaptable to a variety of integrated care applications and models. Telehealth (telepsychiatry, telebehavioral health, telemental health) can help maximize limited resources and expand the reach of psychiatrists and other limited specialty providers. As evidenced in a strong and growing research base, telehealth can support integrated care, as well as forward its application in new and innovative ways across the integration continuum. This chapter provides examples of current telehealth supported care integration models along the Substance Abuse and Mental Health Services Administration (SAMHSA)’s articulated integration continuum.