An Alternative Solution to EAPs for Employee Mental Health Services

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Cerebral Inc. Apr 6, 2022

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Although physical healthcare has taken large strides to offer better access, especially virtually amidst the pandemic, to shift to value-based care models, mental healthcare has made little progress to align with physical healthcare’s technological evolution. In a competitive job market, it's more important than ever for employers to think outside the box to enhance benefits strategies, including employee mental healthcare.

This blog highlights the key takeaways from the EAP webinar, which discussed why employees need additional mental health services, beyond the EAP.

Current state of mental healthcare

There are two main reasons why mental health care innovation has not progressed at the same velocity:

The stigma around mental health
Access to mental healthcare

Stigma around mental health

The stigma around mental health has been a large barrier to quality mental health care, however, over the last few years, there has been significant headway to reduce it in order for individuals to receive the care they want and deserve.

Access to mental healthcare

Referring out patients to providers who can treat medium to high-acuity conditions leads to an average wait time of 2-3 months in many cases.

According to a Patient Engagement HIT article, even if patients are seeking mental healthcare, limited health insurance access or in-network care are keeping many patients from visiting mental healthcare professionals. And even when a patient can find an affordable provider who will accept insurance, clinician shortages, fragmented care, and societal stigma are getting in the way of adequate care access.

In fact, the study in the article investigated 8 comparable employer-sponsored health plans that found that patients only had to access out-of-network care for mental health 13% of the time.

Shift to virtual care

Employee Assistance Programs are deeply rooted in brick-and-mortar models. With the pandemic, there was a massive shift to virtual everything, including virtual care.

This recent Becker’s article broke down some data about how Americans used telehealth in 2021:

Nearly 82% of patients in a study said their virtual visit was as good as an in-person visit
91% of patients in a study said their virtual visit made it easy to get the care they needed
93% of patients in a study found the interface was easy to use.
40% of patients say they interact with their healthcare providers more because of telehealth, according to GoodRx research released in November.

The shift to virtual care has not only led to the same if not higher satisfaction rates of patients but has proven that the evolution of technology in the healthcare industry opens up avenues for better, high-quality care with a convenience factor.

The mental health sector in telehealth has experienced exponential growth. A recent Healthcare Dive article says that there was a 6,500% increase in telehealth claims for behavioral health services in 2021. When comparing traditional MH services to modern solutions such as virtual care, 25% of patients said that they interact with their virtual provider more.

Behavioral health impact on medical spend

Based on a 2021 study of Cerebral users, 10% of your workforce drives 70% of total medical spend, and over half of that 10% have a mental health condition.

Why is this happening? The issue circles back to access to high-quality mental healthcare and the stigma around asking for help. EAPs simply do not offer a full-service solution for all individuals, including those who suffer from medium to high-acuity conditions.

According to the data graph below, if 6% of your total employees are resulting in 44% of total medical spend, imagine if your benefits strategy could address issues of all severity levels, and the cost savings that the company would benefit from.

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The spectrum of care based on market saturation

The market landscape for mental healthcare solutions is expansive, and it can be hard to differentiate what sets certain companies apart from their competitors.

One of the most important elements that a solution should be able to provide your workforce, is care inclusive of moderate to high acuity conditions. Employees who are seeking mental health care beyond anxiety and depression symptoms and diagnoses often times are referred out to a specialized provider, which leads to elevated wait times (~2 months) to be connected to a provider, without the convenience of virtual visits.

Some examples of medium to high-acuity conditions include:

Bipolar
Schizophrenia
Major Depressive Disorder
Opioid Use Disorder
PTSD
PPD

There is very little market saturation for mental health care companies that have specialized conditions and customized digital tools configurable to meet unique employee needs. Since Cerebral was founded, growing a clinical workforce with diverse qualifications to be able to treat beyond low-acuity conditions is what has set us apart and allowed us to care for diverse populations.

EAP landscape

Not all EAPs are built the same. EAPs are categorized into three separate buckets, all with varying levels of support for employees.

The three types of EAPs are:

Embedded solutions

No PEPM billing
No reporting capabilities

Stand-alone solutions

PEPM billing
Reporting capabilities to see data around usage
Support for patients
More of a collaborative relationship between the EAP vendor and employer

Digital care EAPs

Digitally driven
Digital support for patients
Address low-acuity conditions
Offerings are similar to stand-alone solutions

Types of care for behavioral health

Counseling

Counseling focuses on a specific issue for a limited amount of time. This would be for one specific traumatic life event that an individual needs help to process.

A few examples of a traumatic life event would be:

Death of a loved one
Divorce or seperation
COVID-related depression or anxiety

Counseling will likely be 4 total sessions instead of the ongoing sessions with a therapist which averages 12+ sessions per year.

Therapy

Therapy can be more long-term and focuses on you as an individual. Therapy focuses primarily on behavioral changes.

Examples of reasons to go to therapy are:

Anxiety
Depression/MDD
Opioid use disorder
PTSD
Childhood trauma
Phobias
Insomnia

Psychiatry

Psychiatry uses medication to treat mental illness. Average wait times for therapy and psychiatry are 50-60 days with traditional EAP solutions. Delivering the right level of care at the right time with the appropriate initial patient evaluations, as opposed to starting in counseling and escalating after sessions exhaust is a better, proactive approach to your benefits strategy..

ROI of high-quality health care

Milliman recently released a study on the prevalence of behavioral health diagnoses in the workplace, and how it relates the total healthcare spend and productivity.

Because Cerebral has a proprietary EHR, we were able to use the Milliman study and data to calculate the ROI potential for companies who invest in high-quality mental healthcare as opposed to the traditional EAP solutions.

As a reminder, high-quality mental health can be identified by two main points:

The solution should provide the same level of care to individuals with varying degrees of conditions, including medium to high-acuity diagnoses
The average time to care. Look for solutions that can connect anyone in your organization seeking care (no matter what level of acuity) with a qualified professional in an average time of a week or less.

Personalized ROI calculator

To receive a free, personalized ROI calculator for investing in high-quality mental healthcare, click Get Started and we will be in touch.

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Telehealth and the Power to Revolutionize Access to Mental health care

The mental health care system is in crisis – overwhelmed in the pandemic’s wake, with patients nationwide suffering from rising cases of anxiety, depression and other disorders. As a result, they are frequently left unable to find psychiatric and behavioral care. Telehealth companies like Cerebral are leading the way in addressing that need, but like any new innovation in health care, there is resistance. Traditional mental health providers feel threatened by this new model, which exponentially improves access for patients across the U.S. The fact is that there’s room and need for both traditional in-person care and telemedicine. Without both modalities, there’s no way we will make a dent in the acute challenges facing people from every walk of life and across the country. Telehealth isn’t a panacea, but it undoubtedly improves access and reduces the stigma associated with services that are out of reach for far too many people. Americans do not have adequate access to mental health care. Nearly one-third of Americans live in an area that has a shortage of mental health care professionals and 60 percent of all U.S. counties – including 80 percent of all rural counties – do not have a single psychiatrist. If patients are lucky enough to secure an appointment, they often have to wait months before their first session. However, it is typical for non-psychiatrists to treat mental illness. In conventional health care, 79 percent of antidepressants are prescribed by primary care doctors, so it’s a misconception to think that psychiatrists are prescribing the lion’s share in traditional settings. Nurse practitioners have a critical role to play. A key to improving access to care is to use experienced clinicians – often nurse practitioners – who play a vital role in the health care system, especially in underserved communities. As front-line clinicians, nurse practitioners are practiced hands in dealing with many aspects of mental health care, and Cerebral’s nurse practitioners are particularly well-equipped and supported to manage mental illnesses. Besides being carefully screened and interviewed before joining the Cerebral team, our nurse practitioners receive additional training and clinical support for the treatment of the psychiatric conditions we see most frequently, including depression, anxiety, bipolar disorder, insomnia, and PTSD, among others. Should they want to discuss a challenging clinical situation, they can easily get in touch with a staff psychiatrist within minutes; this ‘second opinion’ line, which we call Curbside Consults, is an innovation that is available to our NPs 12 hours a day, 7 days a week They are well positioned to monitor and counsel patients throughout the process of initial evaluation, treatment, and recovery. A new study out this month (September 2022) found that the ranks of psychiatric mental health nurse practitioners (PMHNPs) are surging as caseloads increase. Notably, the number of PMHNPs who care for Medicare patients jumped 162 percent between 2011 and 2019, compared to a 6 percent decline in psychiatrists, which further underscores how important nurse practitioners are to match the burgeoning demand for care. By utilizing nurse practitioners and telehealth, we are democratizing access to care, and supporting patients who have historically been disenfranchised by the mental healthcare system. . Indeed, nearly 2/3 of Cerebral patients have never had the privilege of receiving mental health care prior to coming to Cerebral. We can only improve what we measure. The vast majority of mental health professionals do not measure clinical outcomes. This would be unacceptable in any other field of medicine: you wouldn’t trust a diabetes doctor who did not regularly check your labs in order to monitor the progression of the disease. Why should depression or anxiety disorders be treated so differently? Telehealth allows us to measure clinical outcomes using tools that are integrated within the care experience. By monitoring how patients are doing via surveys, we are able to better understand whether treatment plans are working, or whether adjustments need to be made. Overall, knowing how patients are doing helps us improve clinical quality and maintain patient safety. Collecting patient outcomes data at scale can also be a benefit. It can establish new baselines for what is most effective for different types of patients, paving the way for the kind of precision medicine approach that has transformed cancer care and other specialties. The bottom line is that the current mental health care system can’t improve access for desperate patients who desperately need care. While there have been missteps and necessary learnings along the way, telehealth has a vital role to play in this process. For tens of millions of Americans who need our help, their well being, and their lives, are on the line.

Sep 14, 2022

For Enterprise

How Telehealth Can Increase Access to Mental Healthcare for College Students

Millions of students are set to return to college campuses all over the country over the next few weeks. While this is an exciting time for many students, it can be a challenging one as well, and one that has only been complicated by the effects of the pandemic. According to the CDC, three out of four Americans between the ages of 18 and 24 now report poor mental health resulting from the pandemic. This is among a population that is already more prone to mental health issues, with significantly greater portions of young adults in college reporting struggling with conditions such as anxiety and depression than their unenrolled peers. For example, a recent survey conducted by Fortune found that 43% of college students report struggling with anxiety and 33% report struggling with depression, compared to 29% and 27%, respectively, of US adults in general. Suicide and suicidal ideation rates are also especially high in college students: according to the National College Health Risk Behavior Survey, 10.3% of respondents reported seriously considering attempting suicide, 6.7% had made a suicide plan, and 1.5% reported they had attempted suicide one or more times in the 12 months preceding the survey. The good news is that many students suffering from these conditions see the value in seeking support from mental health care providers. According to a recent survey, 60% of prospective college students now say that mental health services are a very important factor in their search for a university, a statistic that has jumped significantly in the wake of the pandemic. University presidents and leadership also recognize the need: according to the American Counsel on Education, 68% of university presidents view student body mental health as one of their most pressing issues. The bad news is that, despite that awareness, many universities struggled for years to adequately meet that demand, making access challenging for students and creating barriers to care for many. The reason for this gap is largely due to resourcing issues. Most schools only offer in-person counseling options, and there are simply not enough credentialed providers to go around. Colleges have attempted to address this in the past by triaging patients through a “stepped care” model, under which students initially receive the least resource-intensive form of care and are only allowed a more fulsome approach if it is deemed necessary. Other schools have capped the number of sessions an individual can schedule with a provider in an attempt to free up appointment time. Either way, it is clear that there are not enough traditional mental healthcare resources to meet the needs of America’s college students. This is where telehealth and Cerebral come in. As a telemental health care provider, Cerebral can help plug the resourcing gaps that many colleges are experiencing. Cerebral provides students suffering from mental health issues with the ability to book an appointment with a provider within days, alleviating some of the historically lengthy wait times for college counseling services. Cerebral is also able to quickly adapt to a patient’s needs, allowing students to increase or decrease their care as needed and without restrictions. Furthermore, students can now receive care in the comfort and privacy of their dorm, which will lower the threshold for seeking care. Some students find it intimidating or shameful to walk into the counseling centers. We already actively partner with a number of universities to offer this kind of hybrid approach to mental health care for students. For example, we partnered with Arkansas Colleges of Health Education (ACHE) to provide all students access to Cerebral’s telehealth services. A hybrid approach such as the one deployed by ACHE should be considered the future of mental health care on college campuses as university officials continue to look for ways to expand access and meet demand among their student populations. College is a stressful and intense time for many, and adequate mental health support can make navigating it all the more manageable.

Sep 9, 2022

For Enterprise

Age Verification and What it Means for Access to Care

At Cerebral, we work hard to implement one of the best age and identity-verification processes in the telehealth industry, one that meets or surpasses legal requirements while helping patients access mental health care within days. Our process is an improvement over your typical brick and mortar facility, where ID checks are done manually by front-office staff. The verification process is not without friction, however, so it is our goal to create a seamless process that doesn’t restrict access for the patients who need it most. Improving the verification system is not a simple undertaking but we are working closely with providers and using the latest technology in-house to ensure we treat only those who are eligible for care. Our process begins with a manual ID review for new patients by clinicians, who also verify identifiers such as birthdate and address, and then compare photos to prospective patients by video. If a health care provider can’t definitively confirm the data, we direct providers to let prospective patients know we cannot serve them, and promptly cancel their account and make refunds. As an additional level of security, we ask individuals to upload images from a government-issued identification document (such as a passport or driver’s license), which we then compare to live photos of their face using Persona, a sophisticated software program that is a further safeguard in recognizing accounts of those who are under 18. This system is an important part of any new patient experience at Cerebral, but it is especially critical to ensure that we do not provide services to patients under the age of 18. Psychiatric and behavioral issues affect people of all ages, not just adults, and access to mental health care for those under the age of 18 is especially complicated. In many states, children are prohibited from receiving care without the consent of their parents or legal guardian. At Cerebral, we do not work with patients under the age of 18. The advent of telehealth has brought new possibilities to our field, but also new challenges, such as age verification. We are dedicated to improving access to mental health care services wherever we can, while going above and beyond to ensure compliance with all applicable laws. We are constantly refining and improving our safety and quality measures to ensure we deliver best-in-class care so that our patients can feel better, sooner, and so that we can help our patients achieve positive clinical outcomes.

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