Telepsychiatry Works. Here’s the Right Way to Scale It.

An unprecedented 90 percent of Americans believe the United States is in the midst of a mental health crisis. Telepsychiatry holds the most promise for solving the nationwide problem. 

But the toll on patients and the costs for our entire healthcare system are too high if we sacrifice quality of care in the process.

Here’s some context. During the height of the pandemic, with stay-at-home orders instituted across the United States, telehealth visits were a lifeline for physicians across all specialties, reaching 13 percent of all outpatient visits at its peak. In many cases, remote care was the most consistent option for physicians and patients looking to stay connected with each other. 

As vaccines became widely available, people returned to everyday life and in-person care increased. But something interesting happened in psychiatry. Most patients wanted to keep their care virtual. 

Psychiatry saw the most significant uptake of telehealth in the Covid-19 era, according to a McKinsey report. Mental health is the only specialty where patients still book more virtual than in-person appointments, a figure that rose to 87 percent in May of 2022, up from 74 percent in May of 2020 according to a recent Zocdoc survey. 

Telemedicine increased access to psychiatric care at a previously unimaginable scale in a country with a severe shortage of psychiatrists. It has made serving patients living in rural and remote areas possible, increased patient accessibility generally, and made receiving care from home a possibility for millions. 

Here’s how we can build out our telehealth infrastructure the right way.

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Conquer 2 Telehealth Hurdles

Telehealth and telepsychiatry face two hurdles: The time it takes to “onboard” and work with a patient, plus the sheer number of people who need help. Pre-pandemic, one-fifth of Americans, or 51.5 million people, had a mental health illness.

For new patients, psychiatrists make a proper examination, including a full medical history, thorough discussion of symptoms, possible diagnoses and treatment options. This process, a collaborative one between patient and doctor, can take three to four months on average to see clinically significant improvement. 

In the pandemic-accelerated hurry to acquire new patients as efficiently as possible, too many providers can skip necessary steps. The result is misdiagnosed patients whose paths to proper care are unnecessarily prolonged. To make matters worse, many clinicians are incentivized to prescribe medication as early as possible, too often before a complete diagnosis can be made. 

Telehealth business models derived from subscription software are where these perverse incentives originate. Fixated on rapid growth, businesses incentivize prescribing too quickly and often, then hold brief and infrequent follow-up appointments led by unqualified or overworked staff. Speed and scale at the expense of quality may provide success in the crowded and hasty tech world but don’t produce good outcomes in healthcare. 

It is good to build new healthcare businesses using the power of technology. But the danger comes when we allow ourselves to build new tech-enabled businesses where healthcare is treated as just another unmanaged marketplace product. Telemedicine for behavioral health won’t work if a company sees its clinicians as a pool of undifferentiated labor to be connected to a pool of customers, or if entities that provide it see patient data as a path to revenue rather than a useful source of insights to improve patient outcomes. 

Telehealth will work if organizations employ clinical experts and allow quality of care, not price or competition, to guide business practices. Creating a platform that increases access to healthcare, rather than building apps or platforms that create hyper specialized or exclusive patient experiences, will also result in success. 

The two remedies are best delivered together — placing doctors and clinical experts prominently on the About Us page and deploying or adopting tech that drops barriers to quality care.

Ultimately, all care providers have to make a crucial distinction. They either have customers, or they have patients — and all the ethical responsibilities that the word patient implies.

Compile Better Data for Better Outcomes 

Spending on mental health mobile applications will top $500 million by the end of this year, according to Deloitte Global predictions. While this number reflects an increase in patient interest in telehealth, it’s important to note that any tech-enabled solution seeking to solve the problems of our mental healthcare system must also solve the unique problems of all its stakeholders — patients, providers and insurers. Ignore the needs of one group, and any proposed solution will face barriers to system-wide adoption.

For example, telemedicine can never deliver accessible care at scale if quality treatment is only available to private-paying clients. That means we must take the time to understand the unique obstacles that insurers face to increasing access. 

One such obstacle, perhaps the most important one, is that behavioral health lacks the kind of comprehensive, system-wide outcomes data that insurance companies need to measure the effectiveness of care.

Building a system to generate this data will give insurers better insight into the patient populations they serve. It could allow them to make better-informed decisions about how to target care, taking into account what the long-term costs are and which modalities are most effective for specific conditions and even specific patient populations. 

From a patient perspective, better data means faster diagnoses, better-informed decisions about their own care pathways, better medication management, access to support between appointments, and more transparency into how mental health conditions are diagnosed, treated, and understood. 

Better outcomes for patients and insurers need not be at odds. Reducing the cost and length of care will produce better outcomes for both.

Improve Access to Telehealth

Solving the unique problems of providers is also essential to building out telepsychiatry responsibly. First on the list of telehealth’s advantages is merely reducing the administrative burden of building a practice. By some accounts, many psychiatrists spend more than 20 percent of their time on administrative tasks such as handling patient scheduling, doing lab work and maintaining electronic medical records. 

Telemedicine can go one step further by giving psychiatrists quicker access to larger patient populations, which can be paired to their particular specialty or clinical interests. Working in a hospital setting, as many psychiatrists do, does not afford them much control over what type of patients they see. Working from a private practice, as nearly half the profession does, deprives psychiatrists of the collegial environment that can support their education and career development. It is also much harder to structure a private practice to accept insurance.

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Innovate Telemedicine to Help Patients 

Psychiatrists overcome the significant barriers to their profession because of an intrinsic motivation to help patients. If telemedicine increases patient access while also clearing a path for physicians to fulfill their motivation, it is bound to scale faster and more successfully. 

And moonshot opportunities in telepsychiatry — telehealth in general — will appear clinical or practical on the surface. But when built with providers involved and access in mind, they will transform how quality care is delivered on a grand scale. Real, transformative action will take the form of things like incorporating hearing or vision accessibility into video chat technology and converting online booking platforms or patient portals into individualized, API-integrated platforms that offer access to clinical experts at a moment’s notice. 

Telemedicine presents the most exciting opportunity for the psychiatric profession in over a generation, and just at the moment when patients need access to quality care most. If both technologists and the medical profession can work to build a solution that lasts, we will not only weather the current crisis in mental health, but we can build a system to avert such a crisis in the future.