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Telehealth Providers Make a Play for Online Psychiatry Services

Targeting a notable provider shortage, American Well is the latest to launch a telehealth platform that allows psychiatrists to meet with patients in their own homes.

By Eric Wicklund

- Telehealth providers are targeting the nation’s growing mental health crisis with online platforms that allow providers to speak with patients in their own homes, where they’re more comfortable and likely to be more at ease speaking to a professional.

The platform also enables healthcare providers to work from their own home, creating a flexible schedule that can accommodate more patients and save the office for those patients who need to be seen in person.

Among those joining the trend is Boston-based American Well, which has added psychiatry to the therapy services available on its Online Care Platform.

Zereana Jess-Huff, the company’s vice president of behavioral health, says the new service addresses a real need: Recent estimates indicate there is one licensed psychiatrist for every 30,000 people in the US, and with a projected 10 percent decrease in the clinician population over the next decade, that ratio will only get bigger.

“There’s a real need for this type of service,” she says, pointing out that psychiatrists offer more extensive care – including the ability to prescribe medications, where permitted – than typical online behavioral health platforms. “In some cases, therapy is only half the equation. You need a full, holistic platform” to meet those patients’ needs.

READ MORE: Telemedicine Gives ERs an Instant Link to Psychiatric Consults

According to a 2011 report by the American Psychological Association, an APA Center for Workforce Studies survey found that overall e-mail use with clients for service delivery more than tripled among practicing psychologists from 2000 to 2008, with approximately 10 percent of those sampled using it weekly or more in 2008. Video visits, meanwhile, increased from 2 percent to 10 percent.

That percentage has increased since that report, primarily due to an improvement in video visit technology. In general, video platforms run by American Well and other providers, such as Teladoc, Phillips, eVisit, InSight Telepsychiatry, Arcadian Telepsychiatry and health systems running their own services, are far better than most consumer-facing video services.

“We’re not Skyping with our patients,” Jess-Huff points out.

Jess-Huff, formerly CEO of Maryland-based Behavioral Health Options, says the online platform offers psychiatrists a more complete window into a patient’s world, giving the clinician a chance to see what the patient is going though at home. She recalls one case in which a psychiatrist spent six sessions with a patient in an office, during which the patient often talked about a cluttered home environment, before finding out that the patient was a hoarder.

“You can actually get into their environment” with an online platform, she says. “More than any other use case, this makes psychology an ideal (platform for) telehealth.”

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The platform may also be enticing for a psychiatrist looking to work out of his or home rather than an office, which typically takes up a quarter of a doctor’s operating costs.

American Well is rolling out the service on its commercial platform in six states this month, with another 13 states to be added in October. It’s available to adults age 18 and older, offering self-scheduling (typically on the same day), follow-up care (important when medication is prescribed), coverage through health plans and integration with other healthcare providers.

Jess-Huff says that last feature is important as the service moves forward and American Well works with large businesses, health plans and health systems. She sees psychiatric care as part of an integrated health platform, in which psychiatrists work with primary care physicians, specialists, pharmacists and other providers in the accountable care and patient-centered connected home environment.

As an aside, she notes that many underserved populations seek psychiatric care through community health clinics or – if they have one – a PCP.

That said, the service isn’t without its challenges. Some – if not many – psychiatrists may be hesitant to work with a patient via videoconferencing platform as opposed to in-person treatment, worried that they lose that “personal touch” or may miss something that the camera can’t catch. In the APA report, Ray Folen, PhD, chief of the psychology department at Tripler Army Medical Center in Honolulu, said clinicians have to be trained to work online.

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“You really can’t just take a provider who has been doing face-to-face work all their lives and put them in front of a camera and say, ‘go for it,’ because there are some very subtle, important things that need to be considered when you’re working with someone over an electronic connection,” he said.

“You really have to concentrate and attend to what you see on the TV monitor, and I find that our providers - particularly those who are just starting to provide therapy this way -  get pooped out very easily,” Folen added. “They have to do it enough to build up some resiliency.”

Still, Folen and organizations like the APA and American Telemedicine Association see telehealth as an important tool in reaching the estimated three-quarters of the 45 million Americans who need psychiatric care but aren’t getting it.

“By insisting that patients come to our offices, we’re excluding potentially millions of patients who need care,” Carolyn Turvey, PhD, a professor of psychiatry at the University of Iowa and former vice chair of the ATA’s Telemental Health special interest group, told the APA in its report. “Being more open to telepsychology is really going to help many needy people who just can’t meet the requirements of current face-to-face practice.”

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