At a time when some virtual mental health providers have decided to tack on brick-and-mortar clinics, Charlie Health is sticking to its guns. The company’s CEO and co-founder, Carter Barnhart, is committed to maintaining the operations strictly via virtual platforms.
“The magic of our program is group matching,” Barnhart told Behavioral Health Business. “We have hundreds of thousands of patients and data points that we’re able to look at and say, ‘This is who you will do best with.’”
Upon intake, Charlie Health patients go through an assessment and then, using the data points from the assessment as well as their past and present patient population, the provider determines what treatment track is best and can personalize group therapy sessions based on that information.
“You lose that if you’re in an in-person setting, because you can’t have that same scale to find people who are similar to you, who are available at the same time, who have transportation to and from the clinic and have the same schedule,” Barnhart said. “That would be impossible.”
The virtual provider of high-acuity behavioral health treatment currently operates in 37 states and recently added substance use disorder (SUD) care to its swath of offerings and plans to keep its growth momentum moving forward.
Recent legislative moves to expand telehealth access are likely to further that trajectory. While these efforts may remove some barriers to care, maintaining and demonstrating the efficacy of virtual intensive outpatient programs (IOPs) is no small feat.
“Working with high-acuity patients in any setting is really challenging. Working with them virtually is in some ways even more challenging,” Barnhart said. “As we’ve scaled, we’ve had to overcome this Zoom fatigue and help people really believe that they can get well online. So many of our patients struggle with technology addiction. When they’re isolating, they turn to their phones for unhealthy coping mechanisms, and we have to reeducate them that they can actually receive support through the same device that can be so toxic for them.”
BHB recently sat down with Barnhart for our Perspectives podcast. Highlights from that conversation are below, edited for style, length and clarity.
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BHB: What inspired Charlie Health to go all in on virtual care for high-acuity youth and young adult populations? Was there a turning point or unmet need that really stood out to you?
Barnhart: I started virtual alumni groups for people who had left residential treatment, and saw that people really liked engaging virtually. So I had this idea for creating a virtual high-acuity care model, pre-COVID, pre-anyone doing therapy online. I started talking to people about it, and most, when I told them about this idea, thought I was crazy. They would say, “How are you ever going to get teenagers and young adults who are profoundly struggling to be in front of their computer for 11 hours a week?”
I would laugh to myself and tell them, “They’re already in front of their computer for 11 hours a week at a minimum.” We just need them to engage with good, helpful content that will actually help them feel better.
Then COVID hit, and the people who were questioning if this model would even be possible called us back and said, “Hey, we need you, and we need you now. We’re not sure if we’re going to pay for this forever, but we need to add this to our fee schedule for now, because we are in a mental health crisis, and we have more high-acuity patients showing up in the ER than we know what to do with. We need a virtual solution.”
That’s really how Charlie Health was born. It was through this COVID crisis that we were able to prove the efficacy of our treatment model. Over the past five years, we’ve proven that this method of treatment is more effective than any other type of intensive outpatient treatment.
How have you, as a virtual provider, continued to balance the human element of therapy via digital delivery, especially for high-risk populations?
While I recognize that how we deliver our care is virtual, I try not to think of us as a virtual program; that’s just the medium through which people receive care. Really, our program is about connection, and we are building connections for people who are profoundly struggling.
How we are doing that, yes, is through a virtual platform, but what that connection looks like is putting people into groups with others who look and sound like them, who have similar lived experiences, to help them build community.
It also looks like having boots on the ground with teammates who are local in communities and forming relationships with the school counselor, with the librarian and with local employers. So when people are in crisis, they’re able to come to Charlie Health because they know about us. Our clinicians are local to their communities, even though they’re delivering care virtually.
As a virtual intensive outpatient provider, what are some of the specific business practices you keep in mind as you grow that may differ from other providers?
It’s important to ensure that we maintain a facility license in every state where we operate. So even though we’re delivering care virtually, we actually follow a lot of the same guidelines that an in-person clinic follows. We have a physical facility, and we’re Joint Commission-accredited in every single state where we deliver care, because we think that’s important.
What are some of the ways you’ve helped patients overcome virtual fatigue?
We deliver group therapy, and in those groups, we do three hours of group therapy. Each hour has a different type of content. It’s not just lecture-based with people just sitting there listening.
Instead, we incorporate elements of movement; we do art therapy, and add different types of modalities to get people really connected to their bodies, even though they’re engaging through Zoom. We’ve found that to be really helpful. Having different facilitators each hour is also helpful to keep the content engaging.
But mostly it’s about forming the connections. We need to be particular and precise with who goes into what group, and make sure that the five, six or seven other clients who are in that group are similar so they can form a relationship.
A couple of years ago, Optum was reducing coverage for virtual IOPS. Why do you think some insurers have sometimes pulled back on coverage for this care model?
I think there are a lot of bad actors in this space who are not delivering high-quality care. Unfortunately, they make it challenging for people who are delivering really great care to continue to offer access. It leads to just general payer skepticism regarding virtual IOPs and how specific populations will be served.
I think it’s our job as the largest provider of this type of virtual care to educate payers on how effective high-quality care can be by publishing our outcomes, sharing claims data and by really collaborating so that we can demonstrate how effective virtual, intensive outpatient care can be.
Do you think virtual IOPs could eventually become the standard of care across the board?
I do. I think beyond just enabling increased access. Virtual IOPs like ours are already delivering outcomes that rival or exceed in-person treatment for high-acuity clients, due to the scalable treatment models. What we really need in order for this trend to continue is alignment across the entire system related to behavioral health.
Too often, people fall through the cracks during transitions like an ER visit, or between school-based support and clinical care. It’s important that we build that connective tissue – that virtual IOPs partner with health systems, integrate with school networks, and that they work with Medicaid and commercial payers to make access seamless. But that’s actually also only possible in a virtual setting.
I do see a world where this becomes the standard of care for these complex patients who need more connective tissue in the system. It’s not just about proving that virtual treatment works. It’s about making sure that no one gets left behind because the systems failed to talk with each other.
Where do you see trends going for the future of virtual IOP programs?
Our mission is so deeply rooted in connection, and AI can help us deliver that more efficiently, equitably and at scale.
We’re also exploring how to use AI to further personalize treatment plans, how to better optimize that group therapy and how to match and identify early signs of risk and care. I think AI can really help us provide the right care to the right person at the right time.
But we have to be deeply intentional. Any AI has to be developed with clinical oversight, ethical guardrails and a deep commitment to equity. It’s not about being able to make faster decisions. It’s about being able to make smarter and more compassionate ones.
