Academic psychiatry urged to collaborate with behavioral telehealth companies

The strengths of academic psychiatry departments and the fast-growing private telehealth sector are complementary, according to a Perspective article published in Harvard Review of Psychiatry.

Justin A. Chen, MD, MPH, a psychiatrist at Weill Cornell Medicine in New York City, and colleagues reviewed literature on provision of outpatient mental health care in the United States. They concluded that academic psychiatry 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 mental health referrals, coupled with chronic under-reimbursement and increasing “bad debt,” has driven some hospitals to shrink or eliminate their outpatient psychiatric services the reviewers note. Many institutions also struggle to discharge outpatients who prefer or have become accustomed to long-term care.

Meanwhile, the growing private telehealth sector is developing novel technology to improve access to care, demonstrate data-driven outcomes, and advocate for improved payer reimbursement.

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

“As some patients will inevitably resist discharge to a telehealth service and/or a new provider, academic ambulatory programs will need to develop structural methods for clearly communicating this model to patients from the outset of treatment,” the authors say.

“Furthermore, long waitlists—frustrating to patients and referring clinicians alike—could be shortened by identifying patients who are unlikely to require academic resources and triaging these individuals directly to telehealth companies.”

Hallmarks of a well-functioning, properly integrated referral system

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

• Develop a formulary of diverse partner companies that can provide quality care for patients with a range of characteristics, including severe mental illness; underrepresented racial/ethnic, sexual, and gender minority backgrounds; limited English proficiency; children and adolescents; and public payer insurances.
• Provide partner companies with prescreened patients and relevant medical documentation, and ensure preferential access to academic centers’ higher levels of care in cases of clinical decompensation or psychiatric complexity.
• Create standardized pathways for referring out stabilized patients.
• Develop meaningful clinical outcome measures that better capture the effects of mental health interventions, factoring in illness severity and chronicity.
• Offer paid continuing education and/or supervision to clinicians at telehealth companies.
• Communicate transparently with patients about industry relationships, noting the benefits of having a trusted institution evaluate companies and refer directly to the appropriate resource.

“The administrative bureaucracy of academic centers may slow negotiations and the formation of partnerships,” Dr. Chen and his colleagues acknowledge.

“Although this may delay progress, it could also present an important layer of oversight for a sector currently lacking adequate external regulation. Likewise, the technology sector’s nimbleness and speed may provide a necessary nudge to an academic world that is often slow to adapt.”