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Inside Behavioral Health Care’s Remote Patient Monitoring Opportunity

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Remote patient monitoring (RPM) and similar technologies may help behavioral health operators track patients outside of a provider’s office.

These vital data are key to a number of increasingly present market trends that have to do with bringing more data and greater objectivity to the practice of behavioral health.

For example, the slow but inexorable advancement of value-based care arrangements often demands close tracking of patient care, retention or other specific measures. Apart from tracking the outcomes themselves, remote patient monitoring tools and similar technologies provide a way to ensure positive care outcomes.

An ever-expanding panoply of technology tools provides behavioral health operators with potentially scalable solutions that gather the data needed to improve. This applies to both the operations and the care clinicians provide.

RPM and similar technologies also help the behavioral health industry overcome an inherent challenge that has hampered its development: measurement-based care.

“Measurement is something that’s an unsolved problem in [behavioral health,]” Nick Allen, CEO and co-founder of Ksana Health, told Behavioral Health Business. “So we rely extensively on what people self-report. Of course, self-reports are a very useful part of the picture, but it’s only part of the picture — and they wouldn’t be considered adequate in any other area of ​​medicine.”

Allen said patients “wouldn’t be happy” with their oncologist “if all they did was ask you how you felt.”

“You would want some objective measurement of your health condition,” he continued.

Eugene, Oregon-based Ksana Health is a remote patient monitoring company that, in part, gleans objective insights into the mental health of participating patients by tracking insights into sleep, movement and language patterns from cell phones. Ksana couples those insights with industry-standard self-reported data and machine learning.

“New consumer digital technologies actually open up the door for a new approach to the measurement of mental health,” Allen said.

As Ksana Health accumulates patient data, providers can then use that information to demonstrate longitudinal improvements in individual patients and across patient populations, Ksana Health Chief Business Development Officer and co-founder Will Shortt told BHB.

“That obviously drives to a metric-driven outcome that then can be used for value-based reimbursement,” Shortt said.

He added that Ksana Health can also help support better coordination between mental health and physical health providers. For years, the behavioral health market has seen increased conversation that has included government-back health model innovation around bringing behavioral health into primary care settings.

RPM and similar tools can also better support primary care providers, many of whom feel they lack the training to address mental health issues, according to a report by the Bipartisan Policy Center.

“They can detect people who maybe have needs in that area, and then obviously refer them for specialist care,” Allen said. “A constant challenge for people who are in doing primary practice … is knowing who needs that extra help. The provision of objective data about functioning and symptoms is a way to help that doesn’t create a lot of burden on the clinician in their appointments.”

Remote patient monitoring in addiction care

Medication-assisted treatment (MAT), considered by some the gold standard for treating opioid use disorder (OUD), is a vital tool for recovery from addiction. However, the most effective medication to treat OUD, methadone, comes with a significant risk of misuse.

As a result, the regulatory environment dictates that most people using methadone make daily trips to a clinic to have a practitioner observe them take their medication. Some practitioners have patients do this for the first 30 days of treatment.

At some point, clinicians can make the determination that patients are stable enough to do take-home doses of methadone. This allows patients to progress in their recovery while opening up the capacity of the clinic.

But until a patient can get take-home doses of methadone, in-office doses are the only option available. This creates a number of barriers to care, Sonara Health CEO and founder Dr. Michael Giles told BHB, naming transportation challenges, family obligations and distance from a methadone clinic.

“All these socio-economic determinants of health that really predict how well the patient is going to do in treatment shouldn’t: It’s not fair,” Giles said. “It also helps them when they have cravings because they know that they can prove to the physician that they’re taking their medicine, and they’re more likely to get-take homes quicker.”

Founded in 2020, Sonara Health uses a mobile web page optimized for the low-quality smartphones provided via federal and state assistance programs — often known as Obamaphones — and taper-aware labels to track methadone medication compliance.

Patients scan a unique QR code on the label before opening the dosage bottle. Then they film themselves taking the medication and read a prompt to prevent the medication diversion practice of “cheeking” and ensure the patient actually swallowed the medication.

Jason Kletter, president of Lewisville, Texas-based BayMark Health Services, told BHB that Sonara’s medication monitoring service helps ensure compliance, track progress and allows communication with methadone patients.

“How do we stem the opioid epidemic? How do we increase access, but do it safely … with a medication like methadone that is so effective when used correctly, but so unforgiving when misused,” Kletter said. “[Sonara] allows our prescribers at the clinic … to have patients that they have experience with feel comfortable giving folks take homes sooner than they would otherwise.”

BayMark Health Services says it’s the largest provider of addiction treatment services in North America, with about 400 locations in the US and Canada. It treats about 75,000 patients a day in ranging modalities from outpatient offices to residential treatment settings.

Using tools that remotely monitor patients can allow clinics to focus on growing through more patient inductions, enable better social productivity in patient recovery, support patient retention and better outcomes, all the while ensuring patient safety, Kletter said.

The Sonara Health tool also helps BayMark Health Service navigate the “constant scrutiny” methadone clinics face from state and federal regulators.

“If we miss on any of those, we can get cited by any number of regulatory agencies and even have reimbursement monies recouped if we do things incorrectly,” Kletter said.

While Sonara doesn’t directly play a role in value-based care, tools such as this that generate patient data are vital to moving toward that model of reimbursement.

Getting patients the right care at the right time

Orem, Utah-based Videra Health operates an automated, AI-backed video assessment platform that operators use to triage patients at intake or between visits.

Large behavioral hospital systems, employer health plans and substance abuse treatment providers use the platform to gather self-reported qualitative data as well as quantitative data from video analyzes of patients using the app, according to co-founder and Chief Clinical Officer Brett Talbot.

“How do we get better outcomes? Good outcomes come from good treatment, valuable treatment,” Talbot said. “And valuable treatment only comes from data-driven clinical decisions.”

Acknowledging the historical lack of a data focus, Talbot said behavioral health providers had no option when treating patients but to “do an intervention and then say, ‘Good luck,’ and then cross our fingers.”

“We can use technology to enable greater insight into the patient’s journey now that we have more data across the whole experience to see what’s working, when it’s working, for whom it is working, and then really get at value,” Talbot said.

Remote patient monitoring and similar tools can automate the process of gathering robust data, alleviating the potential administrative burdens of tracking data for value-based care arrangements or other data-tracking requirements, he added.

Using technology to survey and triage patient needs helps bring greater efficiency to a behavioral health system that is facing severe restrictions in access to providers. From the payer’s perspective, making the most efficient use of a limited care network is vital, Talbot said.

“Part of this is making sure, for example, that if somebody needs a psychiatrist that they see a psychiatrist,” Talbot said. “But if somebody doesn’t need a psychiatrist, [we need to make sure] they’re not ending up on the psychiatrist schedule because that is just time inefficiency and a waste for everyone.”

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