- Hello everyone.
I am Mariah Mohammed with Becker's Healthcare.
Thank you so much for joining us for this podcast.
We are absolutely thrilled to be joined today
by Andy Flanagan, CEO of Iris Telehealth.
Andy, thank you so much for being here today. How are you?
- Thank you, Mariah. Wonderful to be together.
- Yeah, of course. Uh,
today we will discuss integrating behavioral healthcare at
scale and how health systems can set themselves up
for long-term success.
So with that, let's dive right into our conversation today.
So Andy, what are you hearing from health system leaders
as their biggest challenges
to providing effective quality behavioral
healthcare to their communities?
- Yeah, thank you, Mariah.
It's a such a localized question,
whether you're in Manhattan
or you're in Visalia, California, you know,
the answer can seem different,
but I would just say that it's not, uh, the integration
of virtual and physical is no longer an option.
It's an imperative. The patient journey requires it.
Uh, there are financial incentives for a health system,
no show rates, uh, value-based care arrangements
that would say you don't want somebody to not present,
especially for behavioral health, where it can, um,
it can escalate quickly and it's hard to diagnose.
It's not a blood pressure
or that's something you can measure in a
traditional biometric sense.
So I'm hearing loud
and clear from health system leaders across the country
of all, uh, service lines, C-F-O-C-E-O, uh, oncology,
in addition to the head of behavioral health, that a true
fully integrated virtual
and physical environment, uh, is required for success.
- Yeah, absolutely. I completely agree.
I love how you said it's essential
to a patient's health journey.
Um, and I, I agree.
I think even those hospitals
and health systems, I'm not trying to do telehealth,
definitely know that it's coming.
Um, the next thing I wanted to ask you is
how can leveraging virtual behavioral healthcare
help health systems integrate beha behavioral health
services across our patient journeys?
- You know, we, we, we've heard consistently that
the patient request for virtual encounters
of behavioral health has maintained a covid level of demand.
All other service lines has returned roughly to the
pre covid utilization rate of virtual.
So we should take away that the patient journey is best
served by meeting the patient
where they are in behavioral health.
But we don't need biometrics.
We don't need labs except in prescribing.
And so it's a successful encounter modality, virtual
as is physical, and it can effectively close time
and distance gaps, not just in, you know,
Texas here where I am.
It's a huge state. Uh, could be in New Hampshire,
it could be in Rhode Island, super dense Manhattan.
And we all live our lives
and it's hard to fit in clinical encounters of all kinds.
So, you know, I would say that very clearly,
the patient is speaking, they're voting with their feet.
And from a health system perspective
and a provider perspective,
maintaining patient continuity can be served
by having a virtual and a physical option available.
Virtual can be turned on in an instant, if you will.
If it's present and it's been mapped
and it's integrated, you can move me from a physical
encounter to a virtual encounter.
If I just can't get across town,
I can't get outta my meeting, I can switch modalities
on my phone safe.
It's HIPAA compliant. It's effective in behavioral health.
So it is really, uh, as we all think about cost in addition
to the, the quadruple aim,
it can also deliver a substantial lift to the bottom line,
which all health systems need right now.
It's a very tough environment, operating environment
for health systems and for physicians.
- Yeah. Thank you so much for sharing, uh, that fact
that virtual health is not dropped after, after COVID-19.
Uh, I think that definitely says a lot.
Can you share some examples of
how HO hospitals have successfully adjusted their strategy
to better meet the behavioral
health needs of their community?
- Yes. And you know, Mariah, uh, you're in New York
and I'm in Dallas, and so you would clearly say
that the patient journey is very different.
Therefore, Montefiore, uh, uh,
would have a different strategy than, uh,
Texas Health Resources, large health system down here.
Uh, they really don't.
And, and the nice thing about virtual care is
that it can evolve with your physical strategy.
And so I'll give you two examples.
Uh, the most common scenario for a health system is
that the referral queue coming from primary care
is a four to six month wait.
It's just not acceptable for anybody.
The health system, the payer, the patient, their family, uh,
there's nothing about the quadruple aim that is served
by a four to six month wait for any specialty,
but, you know, directly behavioral health.
Uh, so the ability to reduce
and, you know, drive the referral queue
to an acceptable level can easily be a six month
to nine month project for a virtual care strategy.
And so once that's done, you say, great,
now I have 3000 encounters instead of 20 waiting.
Well, I can manage 3000 as a health system.
Okay, that's great. So what do you do with the clinicians
that have been working on this backlog of 15,000?
You move them downstream, you move them into the outpatient.
When somebody no-shows, you have an on-demand pod
or seven day 30 day, you know,
star ratings just got released.
Every payer in the world is feeling pain associated
with their behavioral health achievement
of a seven day or 30 day follow-up.
How is that possible when you have excess physician
capacity and behavioral health?
Well, you don't if you're,
you're a hundred percent physical,
but you could, if it were virtual,
you can fractionally allocate a medical group if it's part
of your overall strategy.
So I'm not advocating that you outsource that,
and I'm not advocating that you insource it.
I'm advocating that it has to be part of the design of your,
your strategy as a service line leader.
It can deliver profitable, high quality patient encounters.
And so that's really, I think the, the goal
that we should all be focused on, uh, much
as the stigma associated with behavioral health has dropped,
you know, during the covid and post covid period of time,
the stigma associated with virtual is dropping.
I mean, Iris won't be called iris telehealth.
There will be no telehealth in three to four years.
It'll just be health, right?
'cause we're all virtually
speaking, whether we know it or not.
And tele is not a different thing.
So that, that's, that's the exciting part.
I mean, I really do have great optimism for us as, as humans
that we can bring care to us as opposed
to us stopping our lives and driving
however many miles, blocking off our calendar, managing,
you know, family, daycare, taking care
of my dogs while I go get a checkup, checkup of any kind
and behavioral health, uh, is the research is very clear
that the, the quality of the encounter virtually can match
the physical encounter.
So it's just really a another tool
and toolkit for a health system.
- Yeah, yeah, absolutely.
Thank you so much for sharing that.
And, uh, you are definitely right.
I definitely thought that, uh,
the patient journey will be
different depending on where we are.
But you made a lot of good points on how they are similar.
Um, for you,
how do you see behavioral health fitting into the
value-based care strategies for health systems?
- Yeah, virtual behavioral health is the secret weapon
for anybody carrying risk clearly.
And it's, it's poorly understood.
I mean, risk in behavioral health is hard.
It's usually carved out.
The software that's deployed in a health system usually
carves out behavioral health for a lot of reasons.
We, we won't go into.
But when, when somebody says that they're carrying risk for,
say, me, you know, anybody with a behavioral health, uh,
challenge has 2.2 higher total cost
of care than anybody who does not.
And, and so if you think about it in any quartile,
the highest quartile of total medical expense
to the lowest quartile, half of each of those quartiles,
the high end of that quartile would be people
that have some mental health challenge in their lives.
And we're just starting to understand that we're just,
you know, we, we've, we've started to go virtual
for cardiology and for
EE every other care pathway for chronic disease.
But the persistent unaddressed issue
for value-based care is behavioral health.
And you just can't meet all of us
where we are 350 million people spread
across the country with covid.
We just got released to the wild, you know,
we're working in New York from Idaho, right?
So value-based care requires a very aggressive, uh,
innovative behavioral health strategy.
It doesn't mean it's expensive
or that it's heavy, it doesn't mean that,
but virtual allows the dexterity in a value-based care
arrangement that every payer
and every health system that carries risk would want.
You can move clinicians in the click of a button,
if you will, from Idaho to Montana to Arizona.
And so, uh, I, I am having a, a large number
of conversations with people who are, you know,
managing value-based care risk on
how they address behavioral health.
And I really do think that we'll look back over
the next two years, you know, in 2030,
I believe the stat is that, uh, 70% of all
of us will be in some form
of a VA value-based care arrangement, you know,
per CMS 70%, huge number.
And virtual has to be part of that.
Otherwise, the economics will never work.
And it is in other modalities,
we're catching up in behavioral health.
- Yeah. Yeah, absolutely.
Thank you so much for sharing that statistic.
And Andy, before I let you go, the last thing I wanted
to ask you is, what role do you think virtual care plays
in the future of behavioral healthcare?
- Yeah, it, you know, we're learning so much.
You know, you have psychedelics, uh,
you have neuroscience catching up
and starting to participate.
We have AI starting to listen to my voice.
And, you know, none of these are gonna solve the problem.
None of these are gonna in
individually gonna solve the problem.
But just as research in behavioral health has been low,
innovation in behavioral health has been low historically.
And with, uh, a lot of the reimbursement, um,
levers being pulled by CMS
and the economics we just discussed around value-based care,
uh, I think that we're gonna see virtual care become,
you know, kind of the bedrock of behavioral health.
And it's the one thing that you can commonly count on,
as opposed to, I'm on vacation, I'm in New York,
I'm business, I'm in Japan.
I travel all over the world,
and I can always rely on, on
a virtual, uh, experience.
So I, I just feel like, you know, we're seeing the beginning
of integration, we're talking about it,
and, um, you know, I'm, I'm just excited to be
somewhere in the periphery, uh,
involved in this evolution for our industry.
Yeah,
- Absolutely.
Andy, thank you so much for joining me
today for this discussion.
It's been an absolute pleasure speaking with you.
And I'd also like to thank our sponsor, Iris Telehealth.
You can tune into more podcasts
and virtual events from Becker's Healthcare
by visiting becker's hospital
review.com. Thank you again, Andy.
- Thank you, Mariah.