Inside Amwell’s New Virtual Psychiatric Care Arm

Each year, about 4.8 million people end up in the emergency room because of behavioral health conditions. However, ER clinicians don’t always have the skills necessary to treat those patients.

Amwell (NYSE: AMWL), one of the nation’s largest telehealth companies, has created a new psychiatric care offering to help. Called Amwell Psychiatric Care (APC), it virtually delivers psychiatric specialists to ERs and health care providers across the country in an effort to bridge behavioral health gaps and connect patients to the care they need.

The move is yet another positive sign for the behavioral health industry, as a growing number of medical providers begin to integrate care and tackle the nation’s mental health and substance use disorder (SUD) needs.

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“People come into ERs with psychiatric needs, but much of the time, there’s really nobody there to help them,” Miles Kramer, vice president of APC, told Behavioral Health Business. “There isn’t a psychiatric professional, and there isn’t a real ability for the ER to assist in the psychiatric emergency.”

That often means long wait times for patients — and bed burdens for the ERs treating them.

Part of the problem is the shortage of mental health professionals nationwide. While millions of American have serious behavioral health needs, the country has less than 30,000 psychiatrists to help them, according to a 2018 report from Merritt Hawkins. Plus, 65% of rural counties lack a single psychiatrist, according to a study that appeared in the American Journal of Preventive Medicine that same year.

APC aims to help with the supply-demand mismatch, bringing psychiatrists to ERs and primary care providers all over the country.

Currently, more than 100 facilities are using APC, according to Kramer, who joined Amwell just over a year ago as part of the company’s acquisition of Aligned Telehealth and Asana Integrated Medical Group, which provides the behavioral health support and clinical expertise for APC.

Overall, APC has about 200 doctors enrolled in its network who are actively working, and about 300 who are participating at some level. From there, psychiatric providers are assigned to facilities based on each entity’s needs. For example, APC might consistently assign the same psychiatrist to a primary care facility user, while setting its ER partners up with a rotating bench of doctors. 

Additionally, each facility uses APC a little differently.

“Some of them use us 24/7,” Kramer said. “Some use us to extend their clinics. Some use us for specialty consults only. It’s really a fairly wide variety.”

Take Dignity Health, for example, which is currently treating about 1,000 patients per month with APC. 

Dignity is one of the largest health systems in the country, with facilities in three states. Plus, it also operates one of the nation’s largest hospital-based telehealth networks, aptly named Dignity Health Telemedicine Network (DHTN). 

Dignity is currently using APC in about 23 of its 35 facilities, according to John Mackenzie, RN clinical coordinator for the telebehavioral health program for DHTN. There, APC is being deployed on-demand in emergency rooms.

Here’s how it works: First, an ER physician determines whether a person is a primary psychiatric patient. If that patient needs a psychiatric consultation, the doctor can use APC to virtually connect with a specialist, who quickly does an evaluation, assessment and disposition.

“From the time an ED physician says, ‘I want a consult,’ and they make that phone call to activate our psychiatrists, we can be at the bedside within 30 minutes,” Mackenzie told BHB. “Most often, it’s anywhere between four and … 24 hours before they would see an in-person psychiatrist — if it’s available at all.”

After that, it takes about another 30 minutes to treat the psychiatric patient and get a signed note into the hands of the ER doctor for action. Overall, average total case time is about an hour and seven minutes, according to Mackenzie. 

That’s much faster than psychiatric patients in the ER would typically receive care — and that’s the point, according to Kramer.

“ER patients generally have a decision at around four to five hours for a medical pathway, and 18 to 22 hours for a psychiatric pathway,” he said. “Our being able to come in and dramatically reduce that 18 to 22 hours is really what it’s about.”

Amwell’s new behavioral offering comes just a few months after the telehealth company hinted at potentially acquiring a behavioral health startup to build out its portfolio of offerings. 

“You cannot do everything yourself.” President and CEO Roy Schoenberg told Business Insider in November. “And I see behavioral health needs growing in the foreseeable future.”

Given those comments and Amwell’s new APC offering, it’s likely we’ll see more action from the company on the behavioral health front in the future. 

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