With a decline in providers and an increase in demand, the need for supplementary psychiatric services has never been clearer. Now, healthcare companies are scrambling to set up tele-psych networks, some opting for acquisition while others build from within.
The steady hum of voices and buzzers in the emergency department slowly escalates as staff gear up for a busy Friday night. The summer months bring with them a restless crowd of acutely ill patients. Dr. Schneider scans the board for his next patient. Jack, 32, has been off his psychiatric medications since moving, four months ago. He is here this evening because his thoughts of suicide have become both more frequent and more forceful, and he is afraid he will hurt himself. There is no doubt that Jack must see a psychiatrist emergently. The only problem is that the nearest one is 80 miles away.
Despite the distance, getting immediate psychiatric evaluation is a non-issue for Jack. A tech wheels over a remote-control operated robotic iPad stand and within three minutes, Jack is face-to-screen with a telepsychiatry consult physician. After a thorough evaluation, it is clear that an admission is warranted and arrangements are made to transport Jack to the nearest stand-alone psychiatric facility. An hour later, Jack is en route to the inpatient facility. Our telepsychiatrist moves on to his next patient – in an ER over 100 miles away.
This scenario occurs hundreds of times per day all over the Unites States. While telepsychiatry has existed for over two decades, recent advances in mobile technology and payment reform have made it a viable and common-sense solution for the access gap in mental health. According to Merritt Hawkins, a physician recruiting firm, forty eight percent of psychiatrists are over the age of sixty, a looming statistic indicating that psychiatry may actually see an imminent decline in the number of providers. This growing shortage means that patients already struggling to find psychiatric services will have increasingly sparse access. Patients with untreated mental illness suffer from higher rates of medication noncompliance, emergency room visits, and inpatient admissions, resulting in preventable cost to the healthcare system.
Samir Malik, co-founder and CEO of 1DocWay, which was purchased by Genoa, a QoL Healthcare Company and rebranded as Genoa Telepsychiatry, cites high-quality psychiatric care as a major factor in decreasing the cost of overall medical care for the most vulnerable patients. The ability for telepsychiatry to help mental health patients in geographically underserved areas has been greatly augmented by recent legislation making telemedicine an economically viable model for providers. As of 2011, Medicare defines telemedicine services reimbursable by Medicare as those that include “interactions between a healthcare professional and a patient via real-time audio-video technology.” While Medicare mandates that patients be in what is considered a defined “rural” region, private insurers and Medicaid plans in 24 states and the District of Columbia reimburse providers for care delivered to patients in any geographic setting. Changes to Medicare guidelines in 2015 have made some allotments to telepsychiatry from home, making the mandate of “clinic-based” telepsychiatry to guarantee reimbursement more flexible.
The impact of telepsychiatry is already unmistakable but is especially apparent in rural populations. A recent study in Health Affairs shows a 45.1% increase in telehealth visits among rural patients with mental illness between 2004-2014. In Iowa and South Dakota, ten out of every hundred beneficiaries with any psychiatric illness used telehealth services. According to Dr. Matt Stanley, a psychiatrist at Avera Health in Sioux Falls, the economic benefit of such widespread telepsychiatry use among rural patients is expected to be experienced as cost savings on prevented inpatient admissions.
When asked about any policy changes that can boost the impact of telepsychiatry, Dr. Stanley and his colleagues agree that reimbursement for provider services rendered through Direct to Consumer (DTC) apps is a necessary next step. The importance of fast access to a provider in high-quality psychiatric care makes DTC products especially valuable as patients can use apps such as TalkSpace to get on demand counseling. TalkSpace has several tiered services, the first of which gives you access to a dedicated licensed personal therapist over text message for $32 per week. For $59 per week, couples can get virtual relationship therapy and for $99 per week, consumers have access to talk therapy over the phone. Consistent and trusting patient-provider relationships are essential for the treatment of mental illness, making on demand DTC services like TalkSpace especially impactful as telepsychiatry evolves.
While DTC services still rely on consumers willing to pay out of pocket, enterprise solutions are being heavily sought out by health systems looking to expand access to psychiatric services. Companies like Genoa Telepsychiatry offer telepsychiatry services to emergency departments, community mental health centers, correctional facilities, primary care practices, and federally qualified health centers. The Genoa platform allows patient scheduling, ePrescribing, video conferencing, note taking and billing services to ensure providers are getting reimbursed. Most companies offer integration into an already-existing health system electronic health record.
The reliable reimbursements from telepsychiatry platforms have drawn investors and merger and acquisition activity to the space. In addition to Genoa acquiring 1DocWay in 2015, Pharos Capital, a private equity firm, acquired FasPsych, LLC in 2016. TalkSpace has raised a total of $28 million, most recently $15 million in a Series B led by Norwest Venture Partners. WeCounsel, focused on provider and enterprise solutions, has raised $4.1 million, including a $3.5 million Series A in May 2016. Canyon Healthcare Partners, a private equity firm invested $2 million in InnovaTel Telepsychiatry, an Erie, PA based telepsychiatry company that caters primarily to rural populations.
Investment in this space is already driving rapid technology and platform development. As mental illness, drug addiction, and suicide rates are brought to the forefront of the healthcare conversation and new legislation recognizes the importance of access to psychiatric care, we are at the cusp of a behavioral health revolution in which telepsychiatry services will play a central role in bringing care to typically underserved populations.