Oscar Health, One Medical Execs: Regulatory Changes Necessary to Close Behavioral Health Care Gaps

Behavioral health is in higher demand than ever before, with the pandemic, an economic downturn and social unrest causing nationwide spikes in anxiety and depression. Amid the chaos, one bright spot has emerged: Regulatory flexibilities have made telehealth services commonplace, giving behavioral health providers another tool to treat patients who might otherwise be unable to receive care.

In the future, more state and federal flexibility will be necessary to help providers further address the behavioral health supply-and-demand gap. That was the sentiment shared by health care executives during a recent virtual webinar hosted by HLTH GoLive, a health innovation conference company. Overall, regulatory changes are key to fixing the problem for good, they said.

Panelists praised the disruptive benefits of technology as an effective — and hopefully lasting — way to dispense behavioral care.

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“When I think about technology, I think it’s really good at two things,” Sean Martin, the senior medical director of Oscar Health, said during the discussion. “One is enhancing access … and then the second is enabling scale.”

Oscar Health is a New York-based, technology-driven health insurance company. The startup recently announced that it raised $140 million in a funding round led by Tiger Global Management, bringing its total funding raised up to $1.6 billion. Plus, last month, Oscar confidentially filed for an initial public offering (IPO).

While telehealth has improved organizations’ ability to deliver behavioral health services, there’s still room for long-term improvement, according to panelist Jenni Vargas, the chief strategy officer of San Francisco-based One Medical (Nasdaq: ONEM), a membership-based primary care practice that aims to make health care more accessible. 

As an example, Vargas said that providers could better scale their services if states pursued licensure reforms to allow therapists to provide services to clients across state lines. Currently, the medical licensing of professionals is the domain of each state, although some states have relaxed restrictions during the COVID-19 pandemic.

“Anything we do in the virtual space, we’re limited by licensing,” Vargas said during the discussion. “And the fact that you can’t treat across state lines is a real problem for expansion. We could really scale up the supply if we didn’t have that problem.”

Meanwhile, scale is an important part of Ginger’s business model, according to the company’s Chief Clinical Officer Dana Udall. Based in San Francisco, Ginger is a virtual behavioral health care system that partners with employers, health plans and strategic partners to deliver coaching, therapy and psychiatry to members all across the country via text and video.

During the discussion, Udall talked of her past experience as a hospital clinician, when she would encounter patients in need of various behavioral health services who were unable to get them.

“I came to Ginger… because of the supply/demand mismatch and the burnout that I was experiencing as a clinician,” Udall said. “I remember coming out into the waiting room, seeing so many people just packed to the gills and thinking, ‘Our system doesn’t work. We’ve got to find a way to scale care and innovate to really solve the mental health crisis.’”

Like Udall, Martin believes companies like Ginger can help meet the nation’s behavioral health care needs by addressing smaller behavioral issues before they spiral into bigger ones. Lower-level clinicians such as the coaches at Ginger work to do just that.

“Any cardiologist worth their salt will tell you the best way to reduce morbidity and mortality from heart attacks is to prevent them from happening in the first place,” Martin said. “I think of that as the potential role for coaching.”

By teaching coping skills, resilience and mindfulness on the front end, the hope is that behavioral health providers will be less burdened in the long run.

“We won’t need as many advanced clinicians on the back end because we’re managing mental health more holistically in this country,” said Martin, who also stressed the need for various regulatory rule changes for the sake of improving behavioral health integration.

For example, Martin believes current HIPAA regulations make it difficult to integrate different kinds of services for patients. He advocates for some relaxations of the rules to allow for more collaboration among providers to better coordinate patients’ care.

Martin isn’t the only one with that opinion. In December, the U.S. Department of Health and Human Services (HHS) proposed making some changes to the HIPAA privacy rule, with the goal being to “support individuals’ engagement in their care, remove barriers to coordinated care, and reduce regulatory burdens on the health care industry,” according to a press release from HHS.

“Loosening of the HIPAA restrictions I think are going to go a long way,” Martin said. “HIPAA was written well before the tech revolution that we’ve had today, and … I think, at times, serves as a decelerant to some of the integration and collaboration that can happen.”

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