Morgan Stanley, Optum, Talkspace Execs: Behavioral health tech must standardize outcomes

The growing segment of behavioral health technology is still defining its boundaries.

The lack of clarity requires cross-industry collaboration and a full focus on patient needs. The behavioral health technology industry needs to quickly unite around industry norms and standards, according to stakeholders

“I think the innovation is great,” said Dr. Yusra Benhalim, senior national medical director at Optum, during a panel discussion at HLTH. “I think we got swept, which is exciting. But we lack a collective agreement to hold ourselves accountable to make sure this happens in a safe way.”

Establishing industry standards and norms in behavioral health technologies is likely to be difficult. It certainly has been for traditional behavioral health because there aren’t many well-known industry standards when it comes to care delivery, processes, and measures of care processes and outcomes.

This is particularly painful in the transition to value-based care, which implies a standardized set of care and process outcomes.

Yet the tech sector’s norm-bending approach has permeated behavioral health more than ever before. COVID has led to this in at least two ways. First, the pandemic revealed the potential of telehealth and other technical tools in behavioral health. Second, it brought a wave of capital into the space. But in the last year the funding has decreased somewhat.

However, the two industries have different and often opposing ethics. This can be problematic given the relative immaturity of behavioral health. Behavioral health suffers from gaps in scientific knowledge, suboptimal systems and data, and systemic isolation from the rest of health, a 2021 Deloitte report says.

Still, behavioral health technologies hold promise for addressing several big problems, the panelists said.

More healthcare stakeholders are pointing to non-clinical staff as a way to address staffing shortages. These roles include Peer Support Specialists and Coaches. The payer-provider conglomerates Aetna and Cigna each include coaches and colleagues in their behavioral health strategies.

“In the context of the change in behavioral health over the last two years, it’s become kind of the Wild West,” Benhalim said. “We have to be intentional about defining the words we use. A coach can mean many different things.

“I think as an industry we want to learn together, but we want to make sure we do it in a very safe way.”

Varun Choudhary, chief medical officer of New York-based virtual mental health provider Talkspace Inc. (Nasdaq: TALK), said coaches can be used to help patients navigate the organization’s systems and services.

Talkspace itself only provides services from licensed clinicians, such as psychiatrists and therapists, he said.

However, patients can send text, audio or video messages to their providers and receive asynchronous services. This system increases patient access to care and increases the reach of therapists. Choudhary maintains live sessions and asynchronous messaging are effective treatment modes, citing company studies.

Panel moderator Nikhil Krishnan said asynchronous telemedicine lends credence to the idea of ​​automated mental chatbot services by removing a human from the provider side of the interaction. Choudhary disagreed.

“There is no substitute for licensed therapists … That human connection, that therapeutic alliance that you get from a licensed clinician — I’m not sure you can get that from a chatbot,” Choudhary said.

Dr. David Stark, chief medical officer of investment bank Morgan Stanley (NYSE: MS ), said he sees behavioral health technologies such as chatbots and artificial intelligence services having the biggest impact on administrative and customer service processes .

“In the near future, it’s about replacing the clipboard,” Stark said.

This may include patient intake and triage, symptom screening, tracking treatment response with standardized assessments, better patient-provider matching, and remote patient monitoring.

Tech tools that communicate or collect patient information represent a notable gray area for behavioral health technology, the panelists said.

AI and other data tools could change the paradigm of care from reactive to proactive, Stark said. He highlighted the potential impact of “nudges”, or messages sent to people to remind them of ways to look after themselves.

Stark said the remote monitoring of patients and the use of data from personal devices raises several troubling questions

“The risk of talking about these things is that it can be very ominous,” Stark said. “So as we go into this, we have to stay very, very focused on these issues and not let the technology excitement overtake the needs.”

Krishnan hypothesized that mining social media provides an opportunity to create new measures of behavioral health, risk screening, and progress.

While the additional data can be useful, it can also raise privacy concerns.

“Where do you have to draw the line and say, ‘This is an invasion of privacy; it is not purely beneficial etc.,” said Krishnan.

Not knowing where to draw the line comes from the lack of standardized outcome measures across the industry, Choudhary said.

“This is the biggest challenge; we are at least five to 10 years behind medicine in how we conceptualize these measures and how we use them for value-based care,” Choudhary said. “And that will be the real thing we need [address] over the next few years because, as we know, our fee-for-service system really doesn’t take good care of the mental health field.

Behavioral health technologies are ultimately limited by the behavioral health sector’s issues, particularly around data and outcomes, Benhalim said.

“This is a time to be inspired, to be really creative, let’s say [that] we may not know what the metrics should be, but we are starting to release some new ones,” Benhalim said. “Let’s test and learn together. And let’s start infusing more of that human experience, which is hard to measure but possible.”

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