How LifeStance Is Prepping for Potential Telehealth Regulation Changes, Installing Collaborative Care Models

Collaborative care has gained significant traction in the behavioral health industry since its inception in the early 2000s.

The care model, which integrates physical and behavioral health care services, is set to become the gold standard, according to Dr. Ujjwal Ramtekkar, chief medical officer of LifeStance Health.

LifeStance is increasingly implementing collaborative care across its approximately 550 centers and has brought a complete collaborative care model to two of the 33 states in which it operates.


While spearheading its collaborative care model, LifeStance is simultaneously navigating the evolving telehealth landscape. The company is prioritizing seeing its telehealth patient population in person by the end of the year.

Behavioral Health Business sat down with Ramtekkar to discuss the future of collaborative care, LifeStance’s hiring strategy and how the company is bracing for potential regulation changes.

This interview has been edited for length and clarity.


BHB: What’s LifeStance’s approach to collaborative and integrated care?

Ramtekkar: In recent years, there has been increasing recognition that for better overall health outcomes, we cannot bifurcate mental health versus physical health.

With that in mind, not only do we have internal clinical specialties that focus on chronic medical issues, cancer, health concerns and things like that, just on the behavioral health domain, but we also have all six levels of collaborative care as defined by SAMHSA in certain locations.

In Massachusetts, for example, we have true integrated behavioral health, where we have co-located clinicians in certain primary care groups. That helps with timely support to the primary care providers and provides them with education and pathways for referral for any further longitudinal care.

The other spectrum of collaborative care involves integrated therapists and support from psychiatry directly to the primary care provider and the patient. We recently developed a robust program with one of the large women’s health providers, OBGYN providers, to focus on women’s mental health specifically. It incorporates both the integrated co-located therapist and psychiatrist support.

We recently developed a special department called the Department of Specialty Services. That’s going to focus on behavioral health integration and collaborative care models, along with a very subspecialty piece on women’s mental health. We’ll have interventional psychiatry, ketamine for treatment-resistant depression, Spravato and TMS for a very select population that has exhausted everything else and is still not improving. We should be able to provide that to our patients as well.

Do you plan to roll out more comprehensive levels of collaborative care to other states?

Yes, that is the plan right now. We are currently scoping the opportunities. Demand versus supply is an ongoing challenge, so we are really taking a more comprehensive approach in making sure that when we are hiring our integrated behavioral therapists, we are hiring with relevant experience and we’re building out the internal infrastructure to then continually support and train them as well.

What would you say is the future of collaborative care in the behavioral health industry? Do you expect it to become the gold standard?

Yes, I think so. When we think about innovation in mental health, it’s not really in technology and medication management. The true innovation is really in the models of care. Obviously, there are some limiting factors or catalysts for a more positive spin. How are payers looking at it? How are the policies looking at it? It has significant value to our primary care providers. It has a lot of value for our clinicians as they are able to collaborate well with physical health in addition to delivering behavioral health.

But the true benefactors in all of this are our patient population, who are going to get care in one spot. They don’t have to navigate the complex system of behavioral health and can get everything much earlier than the typical delay of a few years until they get to care. There’s going to be a lot more will on all parts of the stakeholders to make it successful. The will has been expressed, now somebody has to really execute on that effectively.

How do payers see collaborative care?

There’s no other option but to look at it favorably. As we talk about more value-based care, the true value is going to come out of whole-person outcomes, not just mental health or physical health outcomes. The only way to go in the future is to create the platforms and develop payment models that support them.

So far, things have been fairly neutral because we have consistently provided value.

Reimbursement is currently provided for a unit of service that we deliver. There’s not much around its quality or longitudinal outcomes because the systems are not set up yet. Eventually, as we mature in the payer-provider relationships, we have to keep an eye on that.

The only challenges that we could think about are some of the regulatory pieces. If the regulatory flexibilities are completely rolled back, then it’s going to be detrimental for access, since a lot of patients are still dependent on our telehealth. Same goes with controlled substances, particularly in the pediatric population. If the in-person requirement is made mandatory to a certain extent, that could be detrimental to access and pay-for-service delivery because then the care providers will have to pivot significantly, which may be a challenge for both providers and payers, but ultimately for patients.

How is LifeStance bracing for the impact of potential rollbacks of telehealth flexibilities?

That’s where we’re going to leverage our strength. Unlike totally virtual or only in-person, we provide a very nice balance of hybrid care. Virtual care does not mean virtual-only care. We have the infrastructure to see patients in person when needed. We, ultimately, are there to serve our clients. So, if their preference is in person, we are ready for that, and we do have adequate real estate and in-person locations to support all of that.

The only thing that needs to happen is operational changes in anticipation of potential rollbacks. We are already working on all of that as well. We currently have an initiative around preparing ourselves for any potential complete rollback. There is a possibility that patients on controlled substances might have to be seen in person at least once a year. We are already seeing a good upward trend with a 5% increase in in-person visits month-over-month for controlled substances. Our goal is to see about 100% of all patients who need to be seen at least once a year by the end of this year. We will be very well prepared, unlike many other organizations.

LifeStance grew its workforce and patient base last year. What’s your current hiring strategy?

Hiring continues. Demand versus supply is always a challenge, but we have been extremely fortunate to attract and retain really good talent.

We are now looking for hires to meet the demands of certain patient populations or requirements of certain specialties on a region-by-region basis. Our strategy is not growth for the sake of growth; our strategy is growth to meet the right patient demand in the areas that it’s required.

We have a strong pipeline for recruitment, and we already have existing programs and initiatives that we are making robust for retention, work satisfaction, work-life balance and reducing burnout. Despite the struggle of the demand-supply curve, we have not had significant challenges in attracting good talent.

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