By Mary Butler
For healthcare organizations to be successful right now—amidst a pandemic and nationwide protests against police brutality—they need to meet patients where they are, both physically and emotionally.
Heal, a unique healthcare model that combines house calls and telehealth, is doing both. The five-and-a-half-year-old company, which operates in seven states and the District of Columbia, added virtual mental health services services to its roster of primary care services this spring to help individuals manage the anxiety, depression, and other mental health impacts of COVID-19.
Heal’s cofounder, Renee Dua, MD, spoke with the Journal of AHIMA recently to discuss teletherapy, the pandemic’s impact on emotional wellbeing, and racial disparities in healthcare.
JAHIMA: Heal recently announced the launch of teletherapy services to help people deal with the impact of the pandemic. How did the COVID-19 pandemic spur the need to offer mental health services?
Dr. Renee Dua: It’s always been on our roadmap and the business of offering different services in a regulated and compliant way takes time. With COVID-19 we really felt confident that we had built a platform to support it [teletherapy] and roll it out compliantly. We felt we could offer that high-touch care that we’ve always wanted to be a part of.
Classically at Heal, when it comes to the medical portion of what we do, we initiate the doctor-patient relationship via a house call first. But with the pandemic, we’ve been doing more telemedicine to initiate that relationship, so we’re not necessarily going to send a psychologist to the house.
JAHIMA: What types of mental health treatments are you able to deliver through telehealth? How is it the same or different from in-person treatments?
RD: A lot of the things that therapists do in the way of biofeedback and breathing exercises, guided meditation, has been successfully done [with] tele-therapy. What I’ve observed is, patients are really dedicating this session to a private time where they are really focused on that mindfulness piece and they’re really getting a lot out of it. That’s not necessarily happening in a setting where they’re taking the time for granted like an office setting.
JAHIMA: Which populations are at a higher risk of mental health issues in a pandemic?
RD: It’s all comers, honestly. It’s folks who are seniors who can’t see their grandchildren. It’s kids who are like ‘Where are my friends,’ or ‘Why aren’t I in school?’ or ‘What’s going on?’ It’s frustrating for kids who want to interact with their parent or guardian who’s home all day but are working. You have seen the rise in spousal and domestic abuse, and child abuse cases right now. It’s folks who work from home now but miss the collegiality of their team. I’m seeing this in my own business model—I work very closely with our HR and operations and finance teams and we miss each other. I don’t have a simpler way to say it. That loneliness has set in for all of us and so I can’t tell you it’s one group more than the other. It’s a lot more people than we even realize.
JAHIMA: The cost of therapy is often prohibitive for people seeking mental health care since insurance doesn’t cover it in many places. How do you account for that in telehealth where reimbursement for telehealth is also spotty?
RD: There’s a lot of regulation around healthcare, so to offer anything for free you need to be very careful. The one cool thing that we did do, because of the pandemic and during this period of time, even if we don’t offer a house call in your market or area, we can help with telemedicine and teletherapy. That’s been a very valuable offering. We’re a very charitable service and we want to be able to deliver on our promise to provide accessible care. For example, right now we have a discount on teletherapy and we have Black Lives Matter promotion. People who have been involved in Black Lives Matter protests are able to use our services with this promotion.
JAHIMA: Can you talk about the racial disparities you’ve seen in terms of access to care or health outcomes? How can telehealth help address some of these issues?
RD: As much as our pandemic is a public health issue, racism is a bigger—in some ways—public health issue. I’ve seen it, in practice, for years. I happen to be very heavily trained in our county systems so I have firsthand knowledge of how frustrating this particular conversation can become.
When we started Heal five and a half years ago, we were not starting a concierge practice that delivers to those folks who have a doctor on speed dial. It’s never been a subscription service. We’ve always kept our prices as low as we can honestly afford and delivered in markets with the understanding that we want to deliver access to people who might be waiting 90 days to see their primary care physician.
A great example is in downtown or South Central Los Angeles. These are areas in which we’ve worked very diligently to deliver access—we’ve tried working with Medicare Advantage and Medicaid, and commercial plans so that we are able to reach patients who need our services.
JAHIMA: How are you able to provide telehealth services to individuals who may not have a smartphone?
RD: We think about these things all day. In the beginning, Medicare was saying ‘We’ll pay you X for video chat and Y for phone.’ We were a part of the conversation to say: That’s ridiculous, people don’t have Wi-Fi or a phone or a computer. Let them use their phone.
To this day we have patients who book on our toll-free number. We will always -have a toll-free number for exactly this reason. Our video-chat platform allows you to dial a phone number. And instead of a video conference we have a phone call. I’ve taken care of patients who tell me ‘I don’t have all this stuff. All I can do is talk to you on the phone’ and we make it work. We are very thoughtful about that. Because at the end of the day, we’re a software company and software does eliminate a certain percentage of the population.
By and large, what we’ve focused the experience on is the guardian. Many times an older person or a child needs access to care and we’ve tried to help the parent or the son or daughter or caretaker, whoever it could be, who might be able to deliver access on the software platform get involved. And that’s also helped with efficiency and the understanding of billing, referrals, and all this. It’s an enormous point. It’s such a huge endeavor of ours. I can’t say we’re doing it perfectly now but five and a half years ago when we started this was always in the works.
JAHIMA: Following up on the Black Lives Matter promotion—have you seen any clear examples where racism has prevented someone from getting the care that they need and how does that typically manifest?
RD: The examples are endless but the most important thing I’ll say is, as a physician, when I get up in the morning and I’m focused on patient care, the thing that I must do is check my own privilege.
You made a good point earlier—not everyone has a smartphone or is looking on Google. Not everyone knows what I’m talking about when I’m discussing glucometers and blood sugars. Not everybody has a ride to the doctor’s office or gets their meds filled on time. There are so many biases we have as doctors because we’re not thinking about what our patients might be going through to get care. I’ve learned how important it is, when I’m thinking about my patients, to know that they don’t have all the privileges I have. I cannot say that enough times.
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