Montefiore in the News

Virtual visits can expand access to mental health care

October 21, 2019 09:55 AM

A Westchester Medical Center nurse communicates from the eHealth Center with a patient’s bedside care team.

Virtual-care company Teladoc’s promotional tagline nicely sums up telehealth’s allure: “The quality care you need with the convenience you want.” As more patients show a willingness to test out the technology, Teladoc and like-minded Westchester County players have plowed millions of dollars into telehealth, betting it will transform medicine through convenient, affordable and easily accessible care.

The promise of seeing a clinician from the privacy of your own home is so compelling that even the federal government has become a cautious fan of telehealth. The Federal Communications Commission in July embraced plans for a $100 million pilot program to promote telehealth services among certain patient populations.

“Telehealth has begun to take off,” said Dr. Henry Chung, senior medical director of behavioral health integration strategy at Montefiore Health System’s care-management organization. “Millennials and younger generations are more accustomed to video from using FaceTime, so it’s a comfortable technology. There’s less travel time. And when used for mental health services, it addresses the issue of stigma, because you don’t need to leave your own home to travel to see a mental health provider.”

Westchester’s major telehealth company, Purchase-based Teladoc, has nearly 30 million paid subscribers that turn to its technology platform for colds, second medical opinions, and increasingly, behavioral health.  

“One in five people have a diagnosed mental health issue. It’s a global crisis,” Teladoc CEO Jason Gorevic said in October, speaking at CB Insights’ Future of Health conference in Manhattan. “Virtual care is really a great equalizer in mental health. It breaks down access to care, gets past the stigma and is much more anonymous.”

Teladoc’s mental health revenue will grow by 50%, Gorevic predicted. Last year, the company generated more than $60 million in revenue from behavioral health virtual visits.

Westchester Medical Center Health Network has invested heavily in a telemedicine program. The county’s only provider of Level 1 trauma care, Westchester Medical Center built an eHealth platform in 2015 that gives Westchester and the Hudson Valley access to advanced tertiary care services. The network has invested more than $10 million in telemedicine to date in technology, infrastructure, staff and other resources for its 5,500-square-foot eHealth operations center. The site’s 20 multimedia stations form a telehealth patient monitoring hub staffed around the clock by physicians, nurses and other health care professionals.

Westchester Medical Center medical staff review patient information at a pod in the hospital’s eHealth Center.

One of WMCHealth’s first eHealth programs was in psychiatry, connecting behavioral health outpatients and staff at its MidHudson Regional Hospital in Poughkeepsie with clinical psychiatry specialists at its Valhalla base.

As it pushes for new applications of telemedicine, WMCHealth recently launched a unique TeleCourt pilot in New York State that lets patients at its Behavioral Health Center virtually attend court mental hygiene hearings without leaving the hospital. The remote, secure, HIPAA-compliant real-time video conferencing lets patients attend treatment and retention proceedings.

“This pilot program is a logical extension of our significant investment in our telehealth platform in a variety of settings across WMCHealth,” Dr. Stephen Ferrando, WMCHealth’s director of psychiatry, said in a statement. “The quality of this technology allows the court to still meet its primary responsibility of providing a fair hearing for patients.”

The WMCHealth telehealth initiative also offers eNeonatology, eICU, eTrauma, eStroke, STAT mobile ICU and eDermatology. Its platform is more comprehensive than standard telehealth visits with patients in their homes. Through telehealth technology, medical personnel oversee patients in ICU beds from the centralized location. They can receive vital signs, blood test results, X-rays and other medical information electronically transmitted from bedside monitors. Electronic ICU patients are monitored through two-way video cameras that allow the eHealth team to communicate directly with the bedside clinical team, patients and family members. Westchester’s big medical groups also have expanded into telehealth. Westmed Medical Group, a multi-specialty practice based in Purchase, introduced telehealth services in 2018. The Westmed Virtual Visit debuted as a secure video conferencing platform for non-emergency illnesses or conditions. A ten-minute virtual visit is covered by most insurers and has an out-of-pocket cost that tops out at $49.

CareMount Medical launched a telehealth platform last year. The Mount Kisco multi-specialty medical group charges $99 for virtual visits through the CareMount 24/7 app for patients with non-emergency symptoms, such as sore throats, fevers, coughs or rashes. The telehealth platform also is geared to patient follow-up after a surgical procedure, and for monitoring chronic conditions such as diabetes.

Westchester entrepreneurs also see promise in telehealth. Dr. Samant Virk founded Valhalla-based MediSprout at New York Medical College’s biotech incubator, developing a virtual video product, V2MD, as a secure way for clinicians to connect with existing patients. The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital has been among the customers for MediSprout’s video conferencing technology for telemedicine visits.

Many clinicians believe telehealth is especially suited for mental health visits. Companies like Teladoc have mental health therapists in their networks. But in many communities, including Westchester County, behavioral health specialists are often out of network. Among psychiatrists, almost 60% of providers do not take insurance, noted Montefiore’s Dr. Chung. Policymakers in New York State are experimenting with ways to expand the use of telehealth for mental health among small primary care practices that lack the resources of large medical groups like Westmed and CareMount. By integrating behavioral and primary care at a small primary care practice, more people can be screened for mental health issues. Montefiore has been working on that model for small physician practices, including those in Westchester, so they can increase their patients’ access to mental health care. In recent months, Montefiore added a video component, said Dr. Chung.   

Access to the country’s limited number of mental health professionals is one of the challenges for all telemedicine providers. Teladoc’s growing business in mental health virtual visits relies on a broad group of professionals licensed to provide therapy, not just psychiatrists and psychologists. Psychiatrist visits are largely reserved for medication management, Teladoc’s Gorevic said at the CB Insights conference.

“That’s where we have the biggest constraint,” he said. “There are five visits with a therapist for every one that’s with a psychiatrist.”

Gorevic shared an anecdote about a police chief in a town who was “fearful of seeing a local therapist because of the stigma.” With virtual visits, there was no risk of local residents seeing his car parked near a mental health provider’s office.

“This person can get treatment without the fear of backlash,” said Gorevic. “When we talk about changing the dynamic around mental health, that’s what we’re talking about.”