A Comparative Cost Analysis of an Integrated Military Telemental Health-Care Service

Abstract

The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated. While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs.

Review of key telepsychiatry outcomes

“…The majority of these studies (n = 13) found that telepsychiatry was associated with less direct and indirect costs than FTF services. A handful of studies utilized expenses associated with patient travel time as a cost outcome measure and found telepsychiatry reduced costs associated with travel compared to FTF [53,99,102,[104][105][106][107] . The literature reviewed suggests that telepsychiatry may have greater up-front costs associated with service delivery when compared to FTF; however, there appears to be "tipping points" at which telepsychiatry begins to eclipse the cost-effectiveness of FTF interventions.…”

Telemedicine for Improved Delivery of Psychosocial Treatments for Post Traumatic Stress Disorder

“…Researchers reported the successful expression and interpretation of emotions via VC (Bischoff et al, 2004;Cluver et al, 2005;Griffiths, Blignault, & Yellowlees, 2006;Hill et al, 2001;Manchanda & McLauren, 1998;Oliver & Demiris, 2010;Simpson, 2001;Simpson et al, 2002). Moreover, programs offering telehealth services may realize decreased costs for patients in terms of time and travel expenses (Davalos, French, Burdick, & Simmons, 2009;Grady, 2002). Eighteen of the 47 empirical studies (38%) explicitly addressed how this mode of treatment can contribute to reductions in travel burdens and costs, reduced intervention costs, and/or increased access to care for rural, underserved, or geographically isolated populations.…”

Telemental health: videoconferencing in mental health services

“…These include services for the deaf, the support of a remote clinic by the US military (Grady 2002) and prison services (Zaylor 2001). In secure settings, the use of video can reduce the need for expensive staff escorts for patients to access clinicians outside or timeconsuming security procedures for specialists entering a prison or a secure hospital.…”