While most eating disorder treatment providers first dove into virtual care around March, Eating Recovery Center (ERC) had a head start.
The national eating disorder treatment provider debuted its virtual IOP offering about three years ago. Back then, the service was mostly leveraged to treat patients on college campuses who might otherwise go without care.
Today, amid COVID-19, ERC is delivering all of its IOP virtually. Plus, the pandemic has prompted the company to add new virtual partial hospitalization programming (PHP) to supplement its in-person offerings. Next up, ERC wants to expand its virtual footprint into uncharted territory.
Specifically, the goal is to bring virtual IOP into states where ERC doesn’t currently operate, according to Anne Marie O’Melia, chief medical and chief clinical officer at ERC and Pathlight Mood & Anxiety Center.
The two businesses comprise the only licensed, national behavioral health care system dedicated to treating eating disorders and mood and anxiety disorders, respectively.
ERC boasts 30 physical locations across eight states, as well as the aforementioned virtual service offerings. Meanwhile, Pathlight — previously known as Insight Behavioral Health — specializes in treating mood and anxiety disorders such as obsessive compulsive disorder, panic disorder, depression, mania and others. It has 16 locations across six states, according to the company’s website.
O’Melia recently spoke with Behavioral Health Business to discuss her ambitions for virtual IOP expansion, which presents partnership opportunities for behavioral health providers nationwide. Plus, she’s got big plans for Pathlight, with her sights set on growing the business to replicate ERC’s success.
You can find BHB’s conversation with O’Melia below, edited for length and clarity.
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BHB: Eating Recovery Center and Pathlight are giants in the spaces they operate in. Still, what do you bill as your biggest differentiator over competitors?
O’Melia: The first is that we have unparalleled family support.
We have a whole family institute that provides education, therapy and other support. We have concierge services that help families get the resources they need to support their loved ones. We have a system called family days, where families are provided access to leaders within our organization to ask questions. We also provide post-treatment resources for families after the loved one has returned home.
The second is we have the best psychotherapists. Our treatment modalities are very innovative. They’re all evidence-based.
The third thing is we have more doctors than anybody else in the space. We have the most expert and innovative medical staff that can be imagined.
Our doctors are highly, highly skilled at providing medical interventions for highly complex patients. Then also, we have amazing and innovative psychiatrists who are really at the cutting edge of psycho-pharmacologic interventions, as well as other innovative measures of neuromodulation services.
Just a few weeks ago, you renamed your mood and anxiety arm Pathlight. What prompted that rebranding?
On a practical level, we changed our name to make it more easily recognizable.
We had held on to two semi-separate arms of service, Eating Recovery Center and Insight Behavioral Health. But the names were often confused, and there are a lot of other organizations that call themselves Insight.
It became clear to us that we needed to avoid confusion and be able to tell a more distinct story of who we are and what we offer to non-eating disorder patients.
Pathlight was chosen as our name because it describes our promise — to light the way for our patients.
The coronavirus has been hard on everyone, especially eating disorder patients. What impact has the virus had on the company?
We have seen a dramatic spike in calls to our center. And the National Eating Disorder Association (NEDA) has had about a 75% increase in calls to their helpline compared to this same time last year.
So it’s critical we continue to be able to provide virtual and on-site care, especially for eating disorders.
We had to quickly develop and implement new safety and infection control measures, and we continue to adapt these measures.
For meal monitoring, we’ve had plexiglass barriers created for each of our cafeterias so we can keep patients closer together. That is such an important part of treatment — that time in the cafeteria, with supportive staff, coaching and as much of a social context we can get.
Our big challenge has been increasing our virtual capabilities.
We had 400-something IOP patients, and in the course of a week, we put them all into virtual services. We did it quite effectively, but it was quite a risk and quite a heavy lift.
Have you had any issues with virtual IOP? For example, some programs have seen attendance drop because not everyone is interested in remote participation.
Our actual number of IOP patients has gone up and down, but as we get better and better at it, it’s gone up. We’re learning more about this as we go.
We had a big head start because we’d already done three years of virtual IOP. We were using virtual IOP on college campuses in some regions, but not like we do now.
We already knew the key factors necessary for success.
To have insurance pay and to safely medically monitor patients, we have to be able to follow vital signs and weights. If patients come into our centers, that’s fairly easy to do. But at home, we’ve had to rely on electronic blood pressure cuffs.
Also, we have formed a partnership with a company called Shapa, which was developing a blinded weight scale, ClearStep. The patient can step on a scale at home, and they don’t see the weight, but it goes to a program that the dietician and other members of the IOP team can see. We use it for virtual PHP, too.
Every one of our virtual PHP patients get them.
For our IOP patients, we would prefer they go in for a weight check with their primary care provider every week, but we do offer it to them on a case-by-case basis.
What have you found are the key factors to success for virtual programs like this?
The main key is that we have to have licensed and well-trained clinicians. That’s where I see it not working in some other places.
The other thing that really seems to matter is a group cohesiveness. Each of our virtual IOP patients is placed in what we call a therapy pod. It’s six to eight patients, with one therapist and one dietitian. A big factor is accountability and commitment to each other, so we build a therapeutic community online by having scheduled and welcoming introductions. Then as people are wrapping up their therapy, we have formal graduations and celebrations.
When we were doing on-site IOP, there were more individual specializations offered. They could be on a substance use track or trauma track or an OCD track. They might not have exactly the same peers that they were going through treatment with as a group. But online, we have found that a critical component is that group support and group cohesiveness.
I understand that you’ve also developed a new virtual program amid the coronavirus for the PHP level of care. How did that come about and how does it work?
We still have in-person PHP programming in the same numbers we had it before.
For PHP, the critical component was to have a cohesive, multidisciplinary team. So we have a psychiatrist, a therapist, the medical doctor, the nurse, the dietitian, the case manager and an admin assistant as a team that works with each of our virtual PHP pods.
It’s a much bigger team than for IOP. We didn’t want to lose any element of that.
We also have always had more intensive and frequent programming in our PHP, and we’ve always found that to be a critical component. We always offer six or seven day a week treatment. In the virtual space, there’s a fair amount of Zoom fatigue, so our day is not as long as our on-site PHP, and we take one day off a week.
Not all patients are going to be appropriate for virtual PHP. Some of them truly need to move to on-site locations. But we have been able to offer a much more intense level of care for people who can’t travel.
How have payers been to work with during this period?
We’ve been excited about virtual care for a long time. Insurance companies have not been as excited.
Our insurance companies were a little slow to get completely on board with the changes that needed to happen with COVID, but eventually, everybody really organized and pivoted. They recognized that their business model needed to change for this.
I think there’s been a good extension of grace on both sides. We’ve cut them some slack, and they’ve actually been able to help some of our patients stay in treatment longer than they would have been able to.
There have been some, what I would call, egregious denials that happened earlier.
We had a woman who was pregnant and really did not feel comfortable coming to on-site PHP care. She had a high-risk pregnancy because of the eating disorder, and we could not get that virtual care approved, which was very disappointing.
But that’s been rare. Most of the time insurance companies have gotten on board.
What do you think that relationship is going to look like post-COVID? Or rather, what do you hope it looks like?
A goal for me would be to have better, more timely communication around any phase-out services.
There have been a few insurance companies that have just posted a completely arbitrary and random date, and said, “As of this date, we will no longer provide any virtual services.” They’ve mostly backed down, but they’re doing some posturing.
I believe that a lot of virtual services will be phased out. I just think it needs to be done in a thoughtful way that is based on what the science and the risk is telling us.
That said, I believe we will be able to show that our virtual IOP is just as effective as our on-site IOP has always been. We’re collecting that data, and I believe we will have a good case for continuing IOP in the virtual space, especially for people who would otherwise not be able to receive care.
When we look at the studies, we have wonderful results with regard to effectiveness and patient satisfaction. All the outcome measures look quite good. But the comparison for me is not virtual IOP versus on-site IOP. The comparison in real life is actually virtual IOP versus no care.
Our latest innovative, exciting project is that I want to implement virtual IOP in states where we don’t have centers, especially where there are no eating disorder treatment centers. Even if it’s just a pod of eight patients in a state that otherwise has no eating disorder treatment, that could make a big impact.
We’d find licensed dietitians and therapists who work as a team to care for a pod. They’d work with all of our people — you know, our case managers and physicians — but they’d be licensed in their state. They can care for patients before they get sick enough to go to a higher level of care or for patients who are coming down from a higher level of care and otherwise would not have services available to stay well.
That sounds exciting for patients, but also for the partnership opportunities it presents for behavioral health providers in states where you don’t operate. How dependent would that project be on payers?
Very highly dependent.
I am very interested in making sure we’re getting the data to demonstrate that our care is effective and accepted. If anybody can do that, it’s going to be ERC because of the size of our program. Nobody else has 400 to 500 IOP patients every day like we do, and our data is showing that this is effective and accepted treatment.
Insurance is going to be looking at: Did it work? And is it cost effective?
How much of your care is being delivered virtually today?
It has turned out to be a fairly significant part of our finances this year.
Our virtual IOP services have probably served as around 15% of our total revenue, and 100% of our IOP services are being delivered virtually.
It’s actually a fairly small percentage of our PHP at this point, but it has gone up and down as the public awareness and hesitation around the coronavirus has gone up and down. We have virtual PHP available in about 17 states, and right now, I would say that about 5% to 10% of our PHP is provided virtually. But it is providing care to people who wouldn’t otherwise be able to access care.
I’m hopeful that virtual care will always remain available to people with eating disorders, and I am certain that we are going to be leading the best care in that space.
Anything else you’d like to add?
I want to continue to enhance and expand our mood and anxiety treatment. We’ve added more industry experts to our Pathlight team, we’re developing plans for increased neuromodulation services in our Pathlight centers and we’re opening more Pathlight centers, both at the residential and partial hospitalization level of care.
I want to take what we’ve been able to establish as state-of-the-science treatment for eating disorders and bring that into the mood and anxiety space and expand that.