How Telehealth Can Enhance Academic Psychiatry Services

The strengths of academic psychiatry departments and the rapidly expanding private telehealth sector are seen as complementary, according to a Perspective article in the Harvard Review of Psychiatry, part of the Lippincott portfolio by Wolters Kluwer. Dr. Justin A. Chen, a psychiatrist at Weill Cornell Medicine in New York City, along with his colleagues, reviewed literature on outpatient mental health care provision in the United States. They concluded that both academic psychiatry departments and telehealth companies could gain significantly from strategic collaboration (1^✔ ✔Trusted Source
Finding Our Lanes: A Roadmap for Collaboration Between Academic Medical Centers and Behavioral Telehealth Companies

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Challenges in Academic Medical Centers

Academic medical centers face significant challenges in meeting the demand for outpatient psychiatric care. The reviewers highlight that a high volume of mental health referrals, combined with chronic under-reimbursement and rising “bad debt,” has led some hospitals to reduce or discontinue their outpatient psychiatric services. Additionally, many institutions find it difficult to discharge patients who prefer or are accustomed to long-term care.

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Innovations in the Private Telehealth Sector

On the other hand, the burgeoning private telehealth sector is pioneering new technologies to enhance access to care, demonstrate data-driven outcomes, and advocate for better reimbursement from payers. This sector's advancements could provide academic psychiatry departments with the tools and support needed to address their current challenges and improve patient care.

The option to refer patients to telehealth companies would allow academic institutions to refocus on their missions—providing specialized and higher levels of care, education/training, and research—Dr. Chen's group emphasizes. Companies that demonstrate quality care for a wide range of diagnoses and illness severities could assume a critical role as primary mental health providers for a large segment of the U.S. population, facilitating development of long-term care relationships that many patients and clinicians value.

"As some patients will inevitably resist discharge to a telehealth service and/or a new provider, academic ambulatory programs will need to develop structural methods for clearly communicating this model to patients from the outset of treatment," the authors say. "Furthermore, long waitlists—frustrating to patients and referring clinicians alike—could be shortened by identifying patients who are unlikely to require academic resources and triaging these individuals directly to telehealth companies."

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Hallmarks of a Well-Functioning, Properly Integrated Referral System

Academic centers are positioned to discern between higher and lower quality telehealth companies, the authors point out. To ensure partnerships with telehealth companies benefit all parties, they advise academic centers to:

• Develop a formulary of diverse partner companies that can provide quality care for patients with a range of characteristics, including severe mental illness; underrepresented racial/ethnic, sexual, and gender minority backgrounds; limited English proficiency; children and adolescents; and public payer insurances.
• Provide partner companies with prescreened patients and relevant medical documentation, and ensure preferential access to academic centers’ higher levels of care in cases of clinical decompensation or psychiatric complexity.
• Create standardized pathways for referring out stabilized patients.
• Develop meaningful clinical outcome measures that better capture the effects of mental health interventions, factoring in illness severity and chronicity.
• Offer paid continuing education and/or supervision to clinicians at telehealth companies.
• Communicate transparently with patients about industry relationships, noting the benefits of having a trusted institution evaluate companies and refer directly to the appropriate resource.

"The administrative bureaucracy of academic centers may slow negotiations and the formation of partnerships," Dr. Chen and his colleagues acknowledge. "Although this may delay progress, it could also present an important layer of oversight for a sector currently lacking adequate external regulation. Likewise, the technology sector's nimbleness and speed may provide a necessary nudge to an academic world that is often slow to adapt.

Reference:

1. Finding Our Lanes: A Roadmap for Collaboration Between Academic Medical Centers and Behavioral Telehealth Companies - (https://pubmed.ncbi.nlm.nih.gov/38990902/)

Source-Eurekalert