Irving Steel is the manager for business development & population health at Prevail Health, a Chicago-based provider of adaptive online mental health treatment. He contributes this point of view on the application of new digital health solutions to depression screenings:
A couple weeks ago the United States Preventive Services Task Force, USPSTF, recommended that all adults 18 years or older be screened for depression. This issue has been widely covered and talked about from NYTimes to Tom Ashbrook’s On Point and others.
The Task Force assigns a letter grade to each recommendation based on the evidence strength and potential benefits. The Agency for Healthcare Research & Quality has been mandated by Congress to support the Task Force. In an article from The Journal of American Medical Association led by Dr. Albert L. Siu, leaders in the field recommended “B” level screenings, meaning reimbursement under the Affordable Care Act. Funding pipelines are in place but is there a clinically proven foundation to operate from?
Previously, the state of New Jersey implemented similar screening processes focused on pregnant women. The result was an overburdened system due to a lack of clinicians to administer the screenings and a lack of post-screening treatment options. Studies showed that fewer than 7 percent of the women screened followed up with services six months post-pregnancy.
There are a few reasons why the New Jersey initiative did not work well:
- Health care system and provider factors: there was funding allocated for education and outreach, however the payment for screening remained a challenge. Also, a lack of ongoing maintenance and monitoring stymied the potential for positive clinical impact.
- Patient factors: Arranging doctor visits was a significant barrier for patients, especially new mothers. The program was inconvenient and there was little incentive to encourage patient participation.
- Policy factors: A lack of robust and proven clinical efficacy. The screenings were not integrated with other aspects of patients’ overall healthcare programs. A well thought out policy must fully consider application and integration in order to facilitate patient engagement and buy-in.
While the efforts of New Jersey and JAMA to increase screening frequency and integration of mental health are commendable, the charge of the Task Force has not been met. Early detection and awareness is critical to preventative efforts, quicker recovery, and cost containment. The suggestion by the Task Force is a mandate to overcome past challenges and dramatically improve the overall wellbeing of our communities by exploring and implementing new strategies. This is the perfect opportunity to utilize clinically proven and engaging technology.
- It’s all rooted in cost. I agree with clinicians that a low-cost screening tool should be reimbursed. Research shows that reducing behavioral health issues could save 2-3x in health costs. With healthcare costs in America now exceeding social security for the first time ever it is an ideal time to use proven and effective models that reduce overall cost.
- In the age of convenience and immediate satisfaction, there is no reason the assessment shouldn’t be available at all times. We call it Anywhere Based Care. People are busy, and the stigma associated with in-person screenings is a significant barrier to participation. Internet-enabled devices are ubiquitous and provide the ideal window for anonymous screening participation.
- Accessible and affordable options are the solution. The JAMA article states “accurate diagnosis, effective treatment, and appropriate follow-up” is needed. There should be incentives for the population to screen. We use a points and reward system to provide incentives that engage populations striving for better mental health and resilience.