Telepsychiatry | News | Array Behavioral Care

A recent Forbes article noted that this movement has had the most impact on the behavioral health sector. Telepsychiatry models, provided through video conferencing platforms, are removing barriers associated with growing staff shortages, cost, location, and stigma. Access to care is no longer defined by the limitations of office hours, and patients appreciate the convenience of accessing care from the comfort of their own home.

Recent policy and legislative movements suggest growing acceptance of telemedicine as a mainstream form of care. The majority of US states have enacted or proposed some form of parity law regarding insurance coverage. In line with these trends, telepsychiatry is experiencing unprecedented growth, not only in terms of the number of users, but also the innovative ways that communities are incorporating these models into care delivery.

Addressing Growing Provider Shortages

Telepsychiatry is helping communities address growing psychiatric provider shortages. Currently, all US states have unmet psychiatric needs, and 60% of US counties lack a single psychiatrist. The outlook for psychiatric specialties, such as child and adolescent psychiatry, is even more critical.

In response, many community mental health centers and outpatient clinics have turned to telepsychiatry to supplement their provider capacity and increase access to specialists. These telepsychiatry providers often do everything an in-person provider would do—they serve a normal caseload of patients, participate in treatment team meetings, and oversee other clinicians—all through telehealth.

Molina Healthcare, a managed care organization based out of Long Beach, California, applied this model in a different way. Like many, Molina has understood the importance of bringing behavioral health expertise and care for residents at skilled nursing facilities (SNFs). Today, Molina has a program where 4 SNFs share a regularly scheduled block of time with a telepsychiatrist. With this model, residents receive care in a setting where they are comfortable and don’t have to travel to an appointment, and the psychiatrist benefits from greater clinical awareness of a resident’s behavior in the facility.

Additionally, direct-to-consumer telepsychiatry is expanding referral options in communities where psychiatric resources are lacking, providing a lifeline for under-resourced clinics and primary care providers. Lengthy wait times for appointments often cause patients to rely on their primary care providers for their psychiatric needs or opt to forego care altogether. The reality is that more than half of psychiatric drugs are prescribed by non-psychiatrists, although many primary care providers lack specific expertise on psychotropic drugs.

Expanding Access Across the Continuum

A growing body of evidence points to the effectiveness of telepsychiatry models and high patient satisfaction in a variety of settings. One literature review found the use of video conferencing models expedited access, decreased work absences, enhanced confidentiality and privacy, empowered patients in their care, and reduced the risk of hospitalization. For these reasons, telepsychiatry models are increasingly incorporated into care models across the health care continuum.

For instance, professional psychiatric shortages often slow down triage of emergency department (ED) patients presenting with a behavioral health crisis. It is not uncommon for hospitals to board these patients in the ED or tie up a hospital bed until a psychiatrist is available to make a psychiatric assessment, increasing costs for all stakeholders. Many EDs now leverage telepsychiatry models to relieve this pressure, ensure timely evaluation, and triage to the most appropriate level of care. Notably, a North Carolina statewide telepsychiatry initiative that implemented telepsychiatry in 18 hospital EDs found that 88% of consumers agreed or strongly agreed that they were satisfied with the service.

Telepsychiatry is also used in some inpatient units to augment in-person staff and ensure that a unit has 24/7 psychiatric coverage for patient evaluations.

Additionally, discharge planners—whether associated with a hospital or residential program—must often work within a restricted timeframe to connect individuals with appropriate services. Since psychiatry wait times in some communities can range between 3 and 6 months in many cases, telepsychiatry options open up a vital link to providers and help limit the potential that a patient’s condition will deteriorate back into a crisis situation.

Non-Traditional Community-Based Program and Settings

Outside of hospitals and other typical care settings, telepsychiatry models are starting to be used in school and university settings to improve access to care and meet students where they are. A study, published by Child and Adolescent Psychiatric Clinics, evaluated satisfaction rates of students who received services through a rural school-based telehealth center and found an average satisfaction rate of 93% among students and 97% among parents.

Telepsychiatry is transforming access to behavioral health care at a time when the need is critical. Communities are wise to consider effective telepsychiatry partnerships that can bolster behavioral health service options to improve access to care across the continuum, drive better outcomes, and lower costs.

Textbook economics teaches that, in a free market, supply rises to meet demand until price reaches an equilibrium. When it comes to mental health services, though, the supply of psychiatrists is declining despite widespread need, resulting in patients not getting treatment in a timely manner.

"Every single state suffers from a shortage," says David Cohn, CEO of Regroup Therapy, a telepsychiatry company he founded in 2011, "and 55 percent of U.S. counties have no mental health clinicians."

Regroup's mission

Regroup's mission is to fill that void by supplying credentialed and fully vetted clinicians—psychiatrists, social workers and advanced practice nurses—who can "see" patients via a secure video platform that's HIPAA-compliant. "Literally, the only difference is our clinicians are in two dimensions," Cohn says.

The for-profit company's customers are not the individuals themselves, but hospitals, primary care clinics, correctional institutions and community-based outpatient centers through which people access health care. In the Chicago market, clients include Sinai Health System, Oak Street Health and Metropolitan Family Services. They're billed monthly for services rendered and reimbursed by patients' insurers or government programs such as Medicaid and Medicare.

Cohn, 37, who grew up on the North Shore, says he always had an interest in both technology and mental health, but didn't see himself becoming a clinician. After majoring in economics at Colorado College, spending two years in Guatemala with the Peace Corps and managing sales and services in Latin America and Europe for CEB, formerly known as Corporate Executive Board, he earned his MBA at IE Business School in Madrid, where he hatched the idea for Regroup Therapy as a class project.

He started Regroup with $60,000 from friends, family and his own savings. The company has raised $8.4 million from investors including OSF Ventures, Hyde Park Angels, OCA Ventures and Frist Cressey Ventures.

Revenue jumped from less than $500,000 last year to a projected $10 million-plus in annual recurring revenue by year-end. Regroup now employs 23 full-time staffers in its headquarters in Ravenswood on the North Side and serves nearly 50 health entities with a network of more than 3,000 clinicians. Roughly half of treatment hours are provided by clinicians who work full time for Regroup; the remainder are part-time contractors. Clinicians are paid $45 to $300 per hour. Full-timers also receive benefits such as health care coverage, medical malpractice insurance and a 401(k) retirement plan.

At its 2017 awards program Nov. 9 in Chicago, the Illinois Telehealth Initiative recognized Regroup with an award for Advancing Telehealth by Innovation. Nancy Kaszak, the initiative's director, cites Regroup's easy-to-use video platform and system integration as strengths in the telehealth field. "Hospitals are big on their records and their systems," she says, "and if you can't integrate into that system, it becomes an issue."

Originally written by Lisa Arnett and featured in Crain's.