Telepsychiatry Aims to Combat Patient Drop-Off

One New York startup says a faster, sleeker approach to telemental health has the potential to decrease the missed appointments, patient drop-offs, and readmissions costing the U.S. health care system billions.

Telepsychiatry Aims to Combat Patient Drop-Off

At 12 years old, Melissa Thompson knew her mother suffered from major depression. Yet she told no one.


“I saw her lay… for weeks at a time and watched as she was hospitalized,” she blogged recently.

But talking about it or seeking therapy herself? That was simply too taboo.

These days, Thompson spends the majority of her waking hours talking openly about mental health in hopes of broadening access to care for the 9.8 million adults in the United States suffering from a serious mental illness and the 41% of those sufferers who go without treatment, according to National Institute for Mental Health data.

With her fledgling startup TalkSession, the former Goldman Sachs trader is betting on tablet-enabled telepsychiatry’s potential to make mental health care not only more efficient, but more effective and less costly to the health care system. Instead of the traditional model, where a patient may wait weeks or months for an available appointment with a psychiatrist after receiving a primary care doctor’s referral, Thompson’s on-demand strategy aims to connect patients in need with available mental health care providers in real time using tablet devices and proprietary technology that allows for digital conferencing among primary care doctors, patients, and mental health care providers at network speeds she describes as significantly faster than Skype. (TalkSession is not alone in this field: Breakthrough, another telepsychiatry company, secured $5 million in series A funding yesterday.)

“One, they don’t leave with an appointment in a months’ time, get lost in the system, and end up in the hospital anyway and, two, in the moment, the primary care doctor can make a more informed decision in that there is collaborative care,” says Thompson.

On the flip side, while patients face wait times for appointments, high rates of no-shows or missed appointments burden providers and leave them with unexpected windows of time, time that Thompson says can be used to serve other patients.


“A doctor might be available at that moment because of the high no-show rate,” she says.

Some sources calculate that missed patient appointments account for as much as $150 billion in unnecessary health care costs each year, and estimates for missed appointments in the mental health care landscape range anywhere from 50%, according to one case study conducted by Philadelphia-based COMHAR, to 80%, the no-show rate at private clinics within a New York hospital system, according to internal statistics provided to Thompson for use in a clinical trial of TalkSession technology now underway. (She declined to name the institution, as doing so might impact the controlled nature of the trial.)

“We can change the delivery model of health care to provide quality health care to a larger population, and we can drive down unnecessary costs,” Thompson says.

It’s true that telepsychiatry–or virtual access to psychiatrists and psychologists by computers and mobile devices–isn’t a new concept. It’s widely used to provide mental health care in prisons, and there have been numerous attempts over the last decade to implement telemental health care options, usually involving video-conferencing, in hospital emergency departments, among rural populations and in the private practices of psychiatrists and psychologists with the help of companies such as Breakthrough and its scary-sounding competitor Pretty Padded Room. But the use of telepsychiatry has failed to be widely adopted, at least in part due to startup costs and the need for ongoing training and support to effectively use the systems and surmount technical difficulties, according to findings from the California HealthCare Foundation.

“You have a webcam that’s separate from a computer that’s on a cart, and it needs a tech support person standing next to it, there’s a T1 line. There are so many moving parts and there’s a significant delay between the video and the audio,” Thompson says of traditional telepsychiatry setups in hospitals and clinics.

TalkSession’s approach is different. Instead of relying on the “clunky technology” of the past, Thompson aims to approach the practice like Apple might, were it in the health care business. That means providers testing TalkSession’s platform receive small tablet devices charged and ready for use right out of the box and over-ear headphones connected via Bluetooth. The platform operates using “heavily encrypted HIPAA-compliant technology that requires no downloads, no plug-ins, no Flash,” says Thompson.


To be sure, telemental health has plenty of critics ready to question its effectiveness, the privacy issues it raises, and the practical legal and regulatory hurdles in its way.

“Traditional psychology and psychiatry, as a field, has been very hesitant, if not paranoid around digital communication…both from a medical and legal standpoint,” says Dr. Greg Dillon, a New York psychiatrist and TalkSession advisor.

But with the electronic health records requirements of the American Recovery and Reinvestment Act of 2009 ushering in penalties for Medicare-eligible providers who are not meaningful users of electronic records starting on January 1, 2015, Thompson sees yet more opportunity on the horizon.

“These are pen and paper people. That’s another central reason why we’re concentrating on servicing providers, because it’s going to be required that they participate in some form of technology,” she says.

To that end, TalkSession also operates a closed network of 50 providers and technology offering provider-patient matching, as well as assistance for psychiatrists and psychologists hoping to build online presences.

With state laws, licensing requirements, and the changing insurance landscape, it’s fair to expect telepsychiatry’s widespread adoption to take years. But Thompson and TalkSession have already garnered notable support. The company was one of 13 tapped earlier this year for the three-year GE and StartUp Health Academy program piloting innovation in consumer health care. Along with that, Thompson won a 2013 Life Sciences award from Springboard Enterprises, an accelerator for women-founded ventures in biopharmaceuticals, medical devices, and health care technology.


“We are prepping to be ahead of the curve of a big change,” Thompson says.

[Base Image: Wavebreakmedia via Shutterstock]