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Improving Mental Healthcare - Where are we now?

Eight years ago, colleagues and I published a study in JAMA Psychiatry where we found that psychiatrists were significantly less likely to accept insurance than other specialties. We found that about half of psychiatrists in the U.S. accepted insurance compared with almost 90% for other specialties. It was the first to quantify an issue that many people suspected.

Eight years ago, colleagues and I published a study in JAMA Psychiatry where we found that psychiatrists were significantly less likely to accept insurance than other specialties. We found that about half of psychiatrists in the U.S. accepted insurance compared with almost 90% for other specialties. It was the first to quantify an issue that many people suspected.

As a practicing primary care doctor, these results didn’t surprise me. I regularly found it challenging to find mental healthcare clinicians who accepted insurance for my patients. Much of their care fell on my shoulders even though I was not highly trained in this area nor did I have adequate resources.

Eight years later, we have seen substantial progress in mental healthcare — particularly digital mental healthcare. I have been encouraged by this progress and am excited for the future so that we can truly meet the needs of patients and families afflicted by mental illness.

Years of Progress Progress for mental healthcare services has been tremendous in the past decade. When we first published our study in 2013, tele-psychiatry, digital therapeutics, and remote monitoring were not even on our radar. We now have leading companies providing virtual care and digital therapeutics that are being covered by employers, health insurance, and pharmacy benefits.

Last year, a survey from Willis Towers Watson found that over half of U.S. employers offered a third party digital or virtual solution for mental healthcare and two-thirds of employers covered tele-psychiatry and tele-therapy through their medical benefits. Several studies have also shown that virtual mental healthcare is as effective and, in some cases, preferred by patients and providers. For example, a study from the VA found that virtual care for mood disorders like depression and anxiety and PTSD was as effective as in-person care.

Digital therapeutics for mental healthcare are also an exciting advancement in the past several years. The majority of FDA-approved digital therapeutics are for mental health conditions such as substance use disorder, anxiety, and ADHD. Although there is a long road ahead to fully realize the potential of digital therapeutics, we’re seeing traction by payers and PBMs to cover digital therapeutics and early signs that clinicians are starting to prescribe them.

Lastly, the industry has recognized the challenge of navigating mental healthcare services and we have seen the development of a number of solutions to help patients with this issue. For example, when I was the CMO at Bind, we established a dedicated team to help members navigate mental healthcare. It’s encouraging to see companies like Spring Health and Included Health focus on the complex process of care navigation and fill gaps that have not been filled by legacy players.

The Future of Mental Healthcare From my experience as a health plan CMO, physician, and consultant and through conversations with industry experts, investors, and key decision-makers for employee benefits and health systems, there’s a general sentiment that the mental health space is crowded. There are so many solutions and benefit mangers, doctors, and patients are overwhelmed by these many options. One key question as we look to the future is whether there still is opportunity to innovate and improve in this space? I believe there is opportunity and outline four areas where innovation and execution will drive change.

Precision Diagnosis Diagnosis of mental health conditions remains a challenge. As a primary care doctor, I use scoring tools like the PHQ-9 and GAD to screen and diagnose for common mental health conditions and refer to the DSM-V for diagnostic criteria but these tools are simplistic and rudimentary. We know that there is a spectrum of severity of mental health conditions, significant overlap in conditions, and subtypes that we are just starting to define. We have yet to unlock the value of genomic data, biomarkers, and more precise patient reporting. It’s exciting to see research coming out of academia and the NIH but this research needs to be operationalized and brought into the industry.

Personalized Treatment Even with more options like telehealth and digital therapeutics, mental illness treatment often feel like trial-and-error. For example, many doctors prescribe SSRIs for depression but should they choose a digital therapeutic instead or combine pharmacotherapy with talk therapy? These questions are hard to answer and many doctors, including me, fall into patterns of practice that are not very personalized. Often it takes weeks to months to optimize treatment and in some instances, treatment is never optimized. Couple that with a shortage of mental health providers and lack of time and tools and personalized treatments seems like a futuristic fantasy.

24/7 Care We know that factors in the home are both instigators and facilitators for management and treatment. We’ve made progress in this space. For example, telepsychiatry allows practitioners to understand more about a patient is his or her environment and their life experiences. Companies like Ginger IO incorporate remote monitoring and artificial intelligence to monitor and support people in their home environment. I believe we are just at the tip of the iceberg in our ability to leverage 24/7 connections to both diagnose and treat mental illness better. We have an opportunity to offer more wholistic care, incorporate information and data from real-life environments, and to personalize treatment in real time.

Better Solutions for our Most Challenging Conditions Despite many new companies and solutions for mental healthcare, we continue to have challenges managing the highest cost, highest need patients. These include patients who have serious mental illnesses like schizophrenia, autism spectrum disorder, and bipolar disorder but also those with high severity of common conditions like mood and eating disorders. In my experience as a health plan CMO, many of our highest cost members and longest hospitalizations were for mental health conditions. Given the high cost of care, payers, employers and at-risk providers are incentivized to find solutions to address cost and health outcomes for these groups.

The Road Forward If you asked me eight years ago if we’d see so much innovation in mental healthcare, I would have been skeptical. But the past few years has surprised me. We have recognized the need for better care in this space and built a plethora of solutions to solve problems. As we think about the road forward two key factors will drive innovation. First, cutting-edge technology such as artificial intelligence, edge computing, and closed loop automation will be necessary. This is particularly important for mental healthcare where we know that clinician shortages are dire and likely to worsen over time. Secondly, innovative solutions will have to demonstrate that they can drive better health outcomes and better access at lower costs. This is particularly important given the continuing rise of healthcare costs.

Although it’s hard to predict what innovation will happen in the the next decade, I’m optimistic that if we continue at the pace and scale of this past decade and keep outcomes and value as key goals, then we will be much closer to a world where the right mental healthcare is delivered to the right patient at the right time.

This article was originally published on Medium


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