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Mental Health Care Dominates Growing Missouri Telemedicine Field

More people in Missouri are consulting doctors via telephone or video services — and mental health care is most in demand.

Patient visits using telephones or video conferencing systems have increased tenfold since 2010 among Missouri Medicaid users, according to the Missouri Telehealth Network at the University of Missouri. 

The vast majority of those visits were for behavioral or mental health services, said Rachel Mutrux, senior program director at the network. 

“It really increases access,” Mutrux said. “If someone's in crisis … you can't just plan to be in crisis a week from next Tuesday. Now with telemedicine, they can get in touch with their health care provider during those acute times.”

The network researched insurance claims from telehealth patients on Missouri’s Medicaid insurance program. In 2016, mental and behavioral health accounted for 65% of such services.

Although the network only included Medicaid patients, that data is a good indication of how popular telehealth has become, especially for behavioral health services, Mutrux said.

Health care providers in Missouri have offered telehealth services since at least the early '90s. But increased broadband access, the flight of providers from rural areas and less restrictive laws have made them more accessible than ever, she said.

Credit Susannah Lohr | St. Louis Public Radio

Psychiatry is a perfect fit for the service, because it focuses on patients verbally reporting their symptoms, she said.

“Because that specialty lends itself perfectly to telemedicine, that’s where we’ve seen most of the growth,” Mutrux said.

It’s important to treat a patient’s mental well-being before addressing other health issues, said Melissa Van Dyne, executive director of the Missouri Rural Health Association.

“If you look at a person holistically, if they’re hopeless and helpless, you can provide them with all the services in the world, but they’re not going to truly take advantage of all those services if they’re hopeless or helpless,” she said.

Telemedicine’s growth is vital as more providers move to urban areas, she said.

“Telehealth is definitely one thing to help address the gaps and rural health care,” Van Dyne said.

Counties in the middle of the state have few psychiatrists to see patients, said Cathy Grigg, deputy chief clinical officer of outpatient psychiatry services at Compass Health Network, which operates nonprofit clinics in Missouri.

Grigg estimates that 75% of the Compass clinics, many in rural counties, don’t have an on-site psychiatrist.

“A lot of our counties, obviously, in the middle of the state are very rural,” she said. “Our providers don’t want to live there; they want to live in St. Louis, Kansas City, Columbia.”

Instead of a counselor or coming to patients a few times a month, they’re now available all the time, she said.

Although psychiatric services still make up a majority of telemedicine services in Missouri, the percentage is going down each year. In 2012, behavioral health visits comprised 76% of all visits. In 2016, they comprised 65%.

That’s a good thing, Mutrux said. It indicates that providers of in-demand specialties, such as primary care and even dentistry, are expanding their services to include telemedicine.

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Sarah Fentem reports on sickness and health as part of St. Louis Public Radio’s news team. She previously spent five years reporting for different NPR stations in Indiana, immersing herself deep, deep into an insurance policy beat from which she may never fully recover. A longitme NPR listener, she grew up hearing WQUB in Quincy, Illinois, which is now owned by STLPR. She lives in the Kingshighway Hills neighborhood, and in her spare time likes to watch old sitcoms, meticulously clean and organize her home and go on outdoor adventures with her fiancé Elliot. She has a cat, Lil Rock, and a dog, Ginger.
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