Chief Medical Officers at Hims / Hers; Amwell, Doctor on Demand, CEO of Neuroflow @ event on May 19th
Benefits and effectiveness What actually works from a clinical point of view? Moderators: Dr. Archana Dubey (Global Medical Director, HP), Bambi Francisco Roizen (Founder and CEO, Vator) Speaker: Dr. Peter Antall (Chief Medical Officer, I am fine); Dr. Ian Tong (Chief Medical Officer, Doctor on Demand); Dr. Patrick Carroll (Chief Medical Officer, he & her), Chris Molaro (CEO, NeuroFlow)
The group talks about how behavioral health becomes a dominant service. For Doctor on Demand it is 30-40%. For Amwell it is 40% of the volume. Watch the video and listen as they talk about the importance of behavioral health.
Here are the takeaways [highly edited for clarity]
What is your differentiator and what are the results?
HIMS / HERS ‘Carroll: We have expanded the coverage of hair loss and sexual dysfunction treatments. Eight months ago (fall 2020) we looked at behavioral health. Our demographic are millennials. 30% of this population struggle with anxiety. Treating anxiety and depression. We have a price that is below the average insurance deductible. For mental and behavioral health and the management of other chronic illnesses, our members come and we offer synchronous connections for behavior. You will have medication delivered to your home.
Doctor on Demand’s Tong: We are very focused on delivering care at a reasonable cost. And we focus on how value-based care can be integrated. We were able to achieve this because telemedicine was great for providing access. Quality is easier to control. Plus, 43% of our clinicians are black and Native-colored. We have built a practice that is inclusive. Over 70% are women. 20% LGBTQ. 5% of doctors in the country are black, but at Doctor on Demands 20% of our doctors are black. Our diversity allows us to connect patients with someone who is culturally the same.
Amwells Peter: We value the quality of care. Our differentiator is that, as a software service company, we are more than a delivery company. It wasn’t that obvious before COVID. But with the explosion of telehealth, it had a dramatic impact. 80% of all of our activities were carried out outside of our network. We saw this at the Cleveland Clinic, Intermountaint, etc. For us, everything revolves around synchronous interaction, which is particularly important in medical interventions. We have deployed W2 and a mix of full-time, part-time and a range of structures and guidelines to act as a coherent group for all of the medical providers we work with. For the results, we work with health plans to get damage-based reports. That is the source of trust that exists. These are not direct result measures, but process measures. So we focus on how many visits it took to complete an episode of nursing. We also use PHQ8 or PHQ-9, GAD, PHQ-2 scores. However, we mainly use these for sales and marketing measures.
Ian from Doctor on Demand: We also use PHQ-2 for screening in primary and emergency care. When you trigger this, it triggers behavioral health practices. Then you may need to get a PHQ-9 and a GAD-7. Since we have the integrated primary / behavioral practice in a business, we research chronic diseases or disease-specific outcomes related to blood pressure, cholesterol and diabetes and start to wonder what happens when someone comes in for behavioral health and is treated for another conditions . Do we see a correlation or cause with improved PHQ-9 and GAD-7 with physical condition? We started coaching and it’s a subclinical offer. We want basic care for the whole person.
Chris at Neuroflow: We work with these organizations. Neuroflow helps measure results between appointments. Get navigation and measure results between appointments. When I see Ian (this will only take a limited amount of time); It would be great to keep in touch with him between appointments. We designed this connection so that it just happens to have this supplier feedback loop to do all of these reviews / evaluations between appointments. We believe that the way we gain and bridge physical and mental health strengthens the people involved. Improving care; When Peter is with a patient, he can risk stratify the patient and stay in touch with the patient during the out-of-sync times. Proper feedback loop. We have integrated into EHRs.
Our clinical advisors and doctors advise us on exactly what would create more work and what would link this patient to the right care in the organization. We are doing this with 400,000 patients who are under contract with patients today. We differ from messenger tools because these tools are typically used for administrative purposes. Epic has MyChart; Athena Help has its own portals (check invoices, set appointments); We are able to provide these screening tools. We’re helping to redefine the way they are delivered. If I’m a patient on Amwell and I get a 10 (moderately depressed), what happens? This screening goes to the provider and there is branching logic that suggests what to do next: coaching or motivational interviews or other exercises or activities. Automating the provision of self-service tools and providing feedback so that employees at higher risk can be tested more collectively.
Are we moving from pharmaceutical science to behavioral science?
Peter: It is too easy to say that we are switching from one model to another. We see an acceleration in the use of digital tools – more self-help, mindfulness. I see an acceleration of tools that are not pharmacological.
Ian: Let’s all acknowledge, we’ve had the toughest year of our lives, we all have the biggest excuse ever. They are not in competition with each other. We need the whole spectrum. We are finally fighting multiple battles. We have a lot to do. For us it goes without saying that we can do some things with them for the seriously ill. Are we overmedicating them? Are we reaching for it too easily? Clinically minded people like me shouldn’t ignore the effects of social determinants of health and coaching.
Chris: It depends on the measurement based care. Who needs to be on therapeutics and / or who needs to be on therapeutics plus coaching. All of this new data can help determine the direction of treatment.
Patrick: Talk therapy can only go so far and medication has played a very valuable role. We have decided to offer holistic support. Talk therapy will fail for some patients. We had group sessions and individual psychotherapy and then access to a prescribing doctor. In fact, behavioral health problems focused only on anxiety and depression – it’s not one size fits all. For many patients it is a combination of medication and psychotherapy. For our population group, this seems to be the most effective.
Peter: I’ve been in healthcare long enough to see trends come and go. There was certainly a time when SSRIs were new. Everyone went to Prozac to make minor mistakes in their lives. Realize that when something is trending, there is value there, and let’s not forget the tried and tested methods of CBT, talk therapy. Often the treatment associated with long-term remissions is CBT.
The future of mental and behavioral health is brought to you by Vator and UCSF Health Hub. Many thanks to our sponsors: Advsr, Scrubbed, Stratpoint. Next to BetterHelp, go to BetterHelp.com/Vator for a 10% discount on BetterHelp. This podcast is also provided by Octave, your mental health and emotional wellbeing partner. Learn more at FindOctave.com. Also thanks to NeuroFlow The company works with hundreds of health organizations to provide world-class technology and services for the effective integration of behavioral health. Learn more at neuroflow.com)