Over the next few days, health care leaders and practitioners from across the U.S. will meet at the National Council for Behavioral Health’s annual conference in Washington, DC. As they discuss the pressing needs and challenges of their field, the theory of disruptive innovation points to some areas of opportunity.
Behavioral and mental health care poses a unique challenge for innovators. While other health care sectors certainly face issues of affordability, patient volume, and/or quality of care, behavioral medicine faces all three issues acutely. Mental health disorders are common, costly, and comparatively difficult to diagnose and treat. The National Institute of Mental Health (NIMH) estimates that roughly 26% of American adults—about one in four—suffer from a diagnosable mental disorder. Unfortunately, only half of those people seek professional treatment, often because of cost barriers and perceived social stigma. Trailing only heart disease and cancer, mental health is the third most costly chronic condition in the U.S., with a staggering price tag of $55 billion each year.
However, the most daunting challenge for innovators may be the unpredictability in diagnostics and treatment. All types of health care fall on a spectrum that ranges from intuitive medicine (diagnosed only by symptoms and treated with therapies whose efficacy is uncertain) to precision medicine (precisely diagnosed and treated with predictably effective rules-based therapies). The broad domain in between is empirical medicine, which uses patterns and correlations to provide favorable odds, but provides no guarantee that a given therapy will work. Behavioral medicine is decidedly proximate to the intuitive side of the spectrum, making treatment less straightforward and more expensive.
Fortunately, the theory of disruptive innovation provides cause for optimism. At its most basic, a disruptive innovation is a product or service that transforms an existing market by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation targets nonconsumers, or those whose alternative to the disruptive product is nothing at all. With 50 million American adults unable or unwilling to access behavioral care as it is currently provided, the theory suggests this is a good place to start. Significantly unmet medical needs (nonconsumption) should be addressed through innovative products, systems, and business models that enable nonconsumers to access at least a minimal amount of care. With that in mind, we suggest industry leaders and innovators consider the following areas as they work to improve care:
1. Community-based Support Groups – Given the size of the untreated population, community-based group therapies could be a cost-effective way to identify, introduce and follow up with individuals who can’t afford more sophisticated treatment. One of the more successful support programs is Alcoholics Anonymous (AA), whose model and core principles are being expanded to other addiction-related diseases. Group therapies for treating depression and other behavioral disorders are less common, but a recent study on group treatment for depression downhill suggests their potential benefits.
2. E-therapy – Telemedicine and mobile health technology could conceivably transform the way behavioral health practitioners consult and treat their patients. Advances in secure communication technologies and the widespread adoption of tablets and smartphones could provide more affordable, convenient options for counseling. The remote access component is also an attractive feature for patients who are uncomfortable visiting a clinic for mental health-related care. E-therapy could meet significant unmet needs in behavioral health care by providing more affordable alternatives for under-insured or patients with limited mental health coverage. Moreover, the convenience of remote counseling could improve the quality of care through more regular cadence of interactions with counselors.
3. Electronic Health Records (EHR) – Many mental and behavioral health issues are first noticed by patient’s primary care physicians (PCP) but often go unreported. Cloud-based, low-cost EHR solutions will enable physicians to share mental health information more effectively with patient’s other care providers. Although mental and behavioral providers were excluded from the Affordable Care Act’s “HITECH” incentives, the law’s EHR requirements for care facilities will certainly help establish new lines of communication between mental health care and other care deliveries.
4. PCP/Mental Health Collaboration – In our previous blogs we addressed the need for primary care physicians (PCPs) to innovate their roles going forward. One potential ways for PCPs to address the new care environment is to develop closer ties with mental and behavioral health care providers (e.g. social workers, psychiatrists) who could provide coordinated care services to patients.
With the significant cost burden of mental health disorders, in addition to the rampant nonconsumption, the behavioral health care space may be ripe for disruption. Fortunately, we already have technological innovations (e.g. broadband, Wi-Fi, video conferencing, EHR, etc.) that could be leveraged to deliver new and affordable solutions to non-consumers. Disruptive innovations in the current mental and behavioral healthcare sector will serve as positive force that will improve patient care across multiple care delivery platforms.