December 5, 2022

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Morgan Stanley, Optum, Talkspace Execs: Behavioral Health Tech Must Standardize Outcomes

The burgeoning behavioral health tech segment is still defining its boundaries.

The lack of clarity calls for interindustry collaboration and a total focus on patient needs. The behavioral health tech industry should quickly coalesce around industry norms and standards, according to stakeholders.

“I think innovation is great,” Dr. Yusra Benhalim, senior national medical director at Optum, said during a panel talk at HLTH. “I think we’re getting swept away, which is exciting. But we’re missing a collective agreement to hold ourselves accountable to make sure that this is happening in a safe way.”

Establishing industry standards and norms in behavioral health tech will likely 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 process measures and care outcomes.

This is notably painful in the move to value-based care, which presumes a standardized set of care and process outcomes.

Yet, the technology sector’s norm-crushing approach has entered behavioral health more than ever. COVID drove this in at least two ways. First, the pandemic revealed the potential of telehealth and other tech tools in behavioral health. Second, it drove a wave of capital into the space. Yet, the funding has somewhat receded in the last year.

However, the two industries hold differing and often opposing ethics. This can be problematic given the relative immaturity of behavioral health. Behavioral health suffers from gaps in scientific knowledge, sub-scale systems and data and systemic isolation from the rest of health, a 2021 Deloitte report states.

Still, behavioral health tech holds promise in addressing several big-picture problems, the panelists said.

More health care stakeholders point to nonclinical staff as a way to resolve staff shortages. These roles include peer support specialists and coaches. The payor-provider conglomerates Aetna and Cigna each include coaches and peers in their behavioral health strategies.

“In the context of the shift in behavioral health over the past two years, it has sort of become a Wild West,” Benhalim said. “We have to be intentional about defining the words that we’re using. A coach can mean lots of different things.

“As an industry, I think, we want to learn together but we want to make sure that we’re doing it in a very safe way.”

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

Talkspace itself only provides services from licensed clinicians, e.g., psychiatrists and therapists, he said.

Patients can, however, send text, audio or video messages to their providers and get asynchronous services. This system increases a patient’s access to care and increases the reach of therapists. Choudhary maintains live sessions and asynchronous messaging is an effective mode treatment, citing company studies.

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

“There is no replacing licensed therapists … That human touch, 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 for investment bank Morgan Stanley (NYSE: MS), said he sees behavioral health tech like chatbots and artificial intelligence services having the greatest impact on administrative and customer service processes.

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

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

Tech tools that communicate or gather patient information present a notable gray area for behavioral health tech, the panelists said.

AI and other data tools could shift 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 take care of themselves.

Stark said that remote patient monitoring and using personal device data raises several troubling questions

“The risk with talking about this stuff is it can be very creepy,” Stark said. “So as we embark on this, we have to remain very, very focused on those issues and not let the tech excitement get ahead of the needs.”

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

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

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

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

“That’s the biggest challenge; we are at least five to 10 years behind medicine in how we conceptualize these measures and how we utilize them for value-based care,” Choudhary said. “And that’s going to be the real thing that we need to [address] over the next few years because as we know our fee-for-service system really doesn’t cater well to the mental health realm.”

Behavioral health tech is ultimately limited by the behavioral health sector’s problems, especially around data and outcomes, Benhalim said.

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