Academic psychiatry urged to collaborate with companies involved in behavioral telehealth

According to an article in Perspective, the strengths of academic psychiatric departments and the rapidly growing private telehealth sector are complementary published in Harvard Review of Psychiatry.

Justin A. Chen, MD, MPH, a psychiatrist at Weill Cornell Medicine in New York City, and colleagues reviewed the literature on outpatient mental health care delivery in the United States. They concluded that academic psychiatric departments and telehealth companies could mutually benefit from strategic collaboration.

Academic medical centers struggle to meet demand for outpatient psychiatric care

An overwhelming number of referrals to mental health services, coupled with chronic underpayment and mounting “bad debt,” has prompted some hospitals to reduce or eliminate their outpatient psychiatric services, the reviewers note. Many institutions also struggle to discharge outpatients who prefer or have grown accustomed to long-term care.

Meanwhile, the growing private telehealth sector is developing new technologies to improve access to care, demonstrate data-driven outcomes, and advocate for better insurer reimbursements.

The option of referring patients to telehealth companies would allow academic institutions to refocus on their missions of providing specialized and higher levels of care, education/training, and research, Dr. Chen’s group points out. Companies that demonstrate quality care across a wide range of diagnoses and disease levels could play a critical role as primary providers of mental health care for a large portion of the U.S. population, facilitating the development of long-term care relationships that many patients and clinicians value.

“Because some patients will inevitably resist discharge to a telehealth service and/or a new provider, academic ambulatory programs will need to develop structured ways to clearly communicate this model to patients from the beginning of treatment,” the authors said.

“In addition, long waiting lists, which are frustrating for both patients and referring clinicians, could be shortened by identifying patients who are unlikely to need academic resources and referring these individuals directly to telehealth companies.”

Characteristics of a well-functioning, well-integrated referral system

Academic centers are able to distinguish between higher- and lower-quality telehealth companies, the authors point out. To ensure that partnerships with telehealth companies benefit all parties, they advise academic centers to:

• Develop a list of diverse partner companies that can provide quality care to patients with a variety of characteristics, including serious mental illness; patients from underrepresented racial/ethnic, sexual, and gender minority backgrounds; patients with limited English proficiency; children and adolescents; and patients with public insurance.
• Ensure that partner companies have pre-screened patients and relevant medical documentation available and, in the event of clinical decompensation or psychiatric complexity, ensure that they are given priority access to the higher levels of care at academic centers.
• Create standardized referral pathways for stabilized patients.
• Develop meaningful clinical outcome measures that better capture the effects of mental health interventions, taking into account illness severity and chronicity.
• Provide paid continuing education and/or supervision to clinicians at telehealth companies.
• Communicate transparently with patients about industry relationships and emphasize the benefits of having companies assessed by a trusted institution. Refer patients directly to the appropriate agency.

“The administrative bureaucracy of academic centers can slow down negotiations and partnership formation,” Dr. Chen and his colleagues acknowledge.

“While this may slow progress, it can also provide an important layer of oversight for a sector that currently lacks adequate external regulation. Similarly, the agility and speed of the tech sector can provide a much-needed boost to an academia that is often slow to adapt.”