Like many providers, Boston-based Steward Health Care System is taking on an increasing amount of financial risk for health outcomes. It now has hundreds of thousands of patients under risk-based contracts.
But the 11-hospital group identified a weak link in those efforts—behavioral health, a field that is often considered separate and distinct from physical health, but nevertheless can have a dramatic impact on issues ranging from treatment compliance to readmissions.
“For too long, under value-based contracts, behavioral health was in a silo,” said Dr. Sanjay Shetty, president of the Steward Health Care Network, the chain's physician organization. “If we look at the data, behavioral health is a big deal. Behavioral-health conditions do exacerbate spending on total medical costs.”
An estimated 1 in 5 individuals has a mental-health disorder. For hospitals moving toward risk-based insurance contracts, solving the mental-health puzzle will be vital for lowering their medical costs and improving outcomes.
And providers like Steward are turning toward new technology tools to help solve deep challenges in the behavioral-health space, including psychiatrist shortages, a lack of inpatient psychiatric beds and the enduring disconnect between physical and mental-health services.
Digital-health entrepreneurs also are shifting their focus to mental health, and investors are following suit. Last month, for instance, UPMC Enterprises led a $17 million Series A round to fund Lantern, a San Francisco-based startup that offers online coaching and cognitive behavioral-therapy tools for emotional health. The funding is one of the largest rounds yet for a digital mental-health company.
Technology can help address capacity issues and create connections, not only between doctors and patients, but between patients and social services, or doctors and law enforcement, which mentally-ill patients too often encounter in last-ditch efforts to get care.
“We need better integration with mental-health services,” said Dr. Rhonda Medows, executive vice president of population health at Providence Health & Services in Renton, Wash. “We absolutely know we need to do a better job as a system.”
Providence's venture arm recently made an investment in Lyra Health, a behavioral-health startup based in Burlingame, Calif., that helps primary -care physicians screen patients and connect them to services. The system also is piloting the technology.
“What we are trying to do is help patients get cost-effective mental healthcare in an evidence-based and timely manner,” said Dr. Dena Bravata, Lyra's co-founder and chief medical officer.
Lyra is focusing first and foremost on primary-care doctors, who are often on the frontlines of diagnosing a mental-health disorder. They prescribe as much as 80% of antidepressants, for instance, Bravata said.
The company also helps guide patients through the mental-health system, and follows up to make sure they're getting appropriate treatment.
Patients who have a relationship with a provider are more likely to disclose a mental-health problem, allowing Providence to reach people before they end up in an emergency department, Medows said.
Other technology firms believe telemedicine may offer a solution for the psychiatrist shortage.
Telehealth provider Doctor on Demand last month added psychiatric video visits as an option for its clients nationwide. Psychiatrists are in high demand, but the Doctor on Demand model is appealing, because it allows physicians to work from home, set their own hours and reduce overhead costs, said Dr. Donovan Wong, the company's clinical director of emotional and mental health.
“We get calls all the time: 'I just can't find somebody who's taking new patients and has availability,' ” Wong said. “I think telemedicine is one of the biggest things revolutionizing healthcare and especially mental healthcare. We don't need to lay our hands on patients … so it's a really good fit for telemedicine.”
Steward Health Care last year began piloting technology from New York-based Quartet Health, a company that helps connect primary-care physicians to mental-health professionals who can do consults and take referrals.
Its technology platform also scans claims data to identify patients—like those making frequent trips to the ED—who may benefit from a psychiatric evaluation.
“The reality is that we do have a shortage of psychiatrists in this country, particularly on the child side,” said Arun Gupta, who founded Quartet Health. “It's incumbent upon us to find a working model to use this scarce resource in the most efficacious way.”
By using the service, the turnaround time for Steward's primary-care physicians to consult with a psychiatrist went from a matter of weeks to a matter of days, Steward's Shetty said. Many doctors are repeat users of the service, and in January, the health system expanded the partnership across its network.
“We've really tried to push this conversation pretty aggressively,” Shetty said. "This is part of a multiprong strategy; we're really committed to value-based care. This is bridging the gap."