Care in a time of crisis: Improving long-term mental health with asynchronous care

The COVID-19 pandemic increased the incidence of depression, anxiety and stress levels. Yet there’s insufficient capacity for in-person mental healthcare, and not all affected have easy access to providers or funding. In an Oct. 28 webinar, Dr. Christina Chen, medical director of Bright.md, and Jessica Remington, associate vice president of business development for Winona Health, shared insights about the growing mental health crisis and how asynchronous care using a technology platform can play a role in increasing access to cost-effective treatment.

1 Some people are more comfortable sharing mental health issues virtually.

Many people are uncomfortable admitting to loved ones and providers that they have mental health issues. A technology platform using a “smart interview” that is accessed on the patient’s own time and device can make the process easier and mitigate some of the perceived stigma. Some studies show that patients are more honest about their mental health symptoms outside of a face-to-face setting. A patient survey shows that 25 percent of patients who completed a Bright.md behavioral health interview would otherwise not have sought care.

2 Technology can make it personal.

A system like Bright.md automates the process of gathering and documenting the patient history. By relieving much of the provider’s administrative burden, asynchronous care can improve provider efficiency, increasing patient access and decreasing patient wait times. The smart interview technology also improves the patient experience because they don’t have to travel for care or find a private spot for a video visit. Patietnts can access the platform 24/7, though providers may have specified hours in which they respond.

3 Behavioral health interviews lend themselves to an asynchronous approach.

The bulk of the Bright.md behavioral health interview consists of validated screening tools for conditions like depression, anxiety and severe stress, which makes this technology an easy way to share the information. Patients are asked about their previous mental health diagnoses, current or past treatments and any family history of mental health conditions. Everything is included in a chart note for provider use for diagnosis and treatment, if appropriate.

4 Broadband? Who needs broadband?

The growth in telehealth didn’t necessarily improve healthcare access for rural communities. Individuals who live in rural areas are twice as likely to lack broadband internet access, compared to individuals who live in urban areas. Additionally, around 60 percent of the mental health professional shortages are in rural areas. Asynchronous care works well in rural areas because broadband access is not needed . Most patients using the asynchronous Bright.md platform access care on their cell phone, and most providers use their cell phones or tablets. Patients can access an asynchronous care platform wherever they are and when it’s convenient. There are no worries about video calls dropping out.

5 The technology is the first step, not the only step.

Asynchronous care allows for remote, non-real-time communication between providers and patients. The smart clinical interview is an easy entry point. If appropriate, patients may get a 30-day prescription for medications, which will be followed-up with an established protocol for future provider visits. The technology is a safe place to begin exploring how to get support. The technology supports referrals to digital therapeutics, like the Calm or myStrength apps, so patients can access free support tools through a hospital system subscription.

“You have people deciding what someone should receive as their treatment when they’ve never even seen a patient before. That doesn’t seem appropriate.” Rep. Brad Wenstrup (R-Ohio), a podiatrist

and other specialists are more likely to be registered Republicans, according to a New York Times analysis from 2016.

Among other things, this means the perspective of most doctors isn’t wellrepresented in Congress. Rep. Kim Schrier (D-Wash.), a pediatrician, is a “one-woman show” when it comes to primary care, one lobbyist for physicians said.

“Primary-care doctors tend to be more focused on expanding coverage and promoting access to preventive care, addressing health equity and social determinants of health,” the lobbyist said. “The specialty community is, in my experience, focused on physician reimbursement issues.”

The specialty versus primary care fight has spilled out into the open over the last few years after CMS proposed a pay increase for the latter at the expense of the former. At the time, primary-care doctors hadn’t received a significant pay increase in decades, but there was very little mobilizing by members to get them one. Doctors in Congress mobilized to stop the cuts to specialists, getting leaders to pass $3 billion

n in temporary funding.