Communication has changed. According to a January 2014 survey by the Pew Internet Project, 87 percent of U.S. adults use the Internet. A majority of them use the platform to seek out health-related information.
The behavioral healthcare sector has been slower than mainstream providers such as New York-based WebMD to hang a shingle online, largely due to the inherent challenges of providing support to a population often identified as unable to manage their own care—a conclusion now considered out of date.
A major barrier to entry for behavioral healthcare providers, of course, is support for online communications with clients. Several initiatives were highlighted at the recent National Council for Behavioral Health held in Washington, D.C. in early May.
A new entry into the US market is London-based Big White Wall Ltd., which identifies as a digital behavioral health and well being service. The company has seven years of experience in the United Kingdom where it works in partnership with the National Health Service, the military, employers, colleges and universities, and healthcare payers and providers.
The professionally-managed site, which is available 24/7, provides immediate access and anonymity through the use of social media to put users into a personalized route. Its seven years of collected data underpins a robust foundation that utilizes algorithms and engagement technology. Here in the U.S., Big White Wall is collaborating with US federal, state and commercial organizations, much as it does in the UK.
Robert Bosch Healthcare Systems, Inc. (Palo Alto, Calif.) takes a different approach to telehealth. Earlier this year, the company received National Committee for Quality Assurance (NCQA certification for 14 evidence-based medical and mental health programs).
The focus for Bosch is remote patient monitoring (RPM). Surveys and assessments enable patients to self-manage their conditions with ongoing communications through tools such as its Health Buddy, web-based gateway, and mobile tools.
According to Bosch Healthcare’s Desreen Dudley, PsyD, clinical product manager, behavioral health at Robert Bosch Healthcare Systems, Inc., remote patient monitoring for populations with serious mental illness (SMI) has demonstrated 80 percent fewer hospital admissions; a 25 percent reduction in the number of bed days spent in care; and a 75 percent average in adherence to RPM sessions over a six month period among a community-based population of adults.
The key aspect of care for telemental health is self-management, says Dudley. “It's not so much the device. It's the content and care and about taking an integrative approach to teach people how to take care of themselves."
Support for treatment centers
For Denver-based myStrength, the focus is on serving and supporting treatment centers through the use of web and mobile technologies to improve the consumer experience. Current uses of myStrength include during intake for wait list management, as an intervention bridge between visits, and post therapy in step down and relapse management.
“We are evolving beyond a technology company,” says Scott Cousino, CEO and co-founder of the three-year old company. Computer-assisted cognitive therapy research has been shown to improve outcomes and we’re starting to see significant improvements. Integration with EHRs is critical, Cousino adds, and conversations with software providers have begun.
Finding the evidence
“There is no way the current system can be sustainable without the us of self-monitoring,” says Terrence McNelis, senior VP, IDD Services for Philadelphia-based NHS Human Services. To identify the best methodology for integrated healthcare, he oversees demonstration projects for NHS, a community-based, nonprofit, human services provider that serves seven states and supports about 40,000 consumers oversees
There are currently 15 demonstration projects, each with a different population and in a different location. The project uses readily available Apple and Microsoft equipment to focus on remote bio-monitoring and bio-monitoring integration, protocol development, remote medication management, and computer interfaces. Ease of use and human connection are at its heart.
At this time, outcomes are being evaluated and there is very little return on investment, McNelis reports.