Digitizing the Pathway to a Mental Healthcare Professional Drives Improved Patient Outcomes and Enhanced Patient Care
Quartet Health is disrupting the primary care physician’s pathway to refer patient to mental health providers through the digitization of the referral network.
Mental illness affects ~43.6 million U.S. adults! [1] Furthermore, the percentage of individuals affected by mental health issues has been increasing. [2] The average cost to treat a high-cost patient with a mental health condition vs. another high-cost patient is on average 33% greater. [3] These facts support the need for increased access to mental health care and are the driving factors for companies trying to improve the ease at which a patient can access the mental health system. Quartet Health is benefitting from this trend of digitization to aid in the treatment of patients who experience mental health issues. Quartet is a platform that connect primary care doctors to mental health providers to better facilitate a handoff of the patient from the primary care physician to the mental health provider. Currently, this connection is often not being made in the healthcare industry, and doctors are not addressing the root causes for their patient’s problems. Quartet’s platform also creates a feedback loop that helps drive improved patient outcomes by requiring the mental health provider to send a report back to the primary care provider. Quartet has focused on mental health because it is an area that has become less stigmatized but has not been managed well by doctors. For payors, a patient with depression can cost ~2.6x as much as a patient who is not facing depression, so addressing the depression early on by a primary care provider referring a patient to a mental health physician can help identify any issues before they become more serious [4]
In the short term, Quartet is benefitting from an increase in use of electronic medical records (EMR) and increased penetration of handheld technology that doctors are using in their offices. These tools are being leveraged to make a quick call to a provider or quickly provide available appointments to their patients to make the transition seamless. In the future, Quartet will likely gain more access into patient’s records and be able to help prompt doctors who are treating high cost patients to consider whether mental health issues may be a root cause for the patient’s issues. Additionally, Quartet may be able to expand its suite of services from mental health to helping be an easy referral pathway for primary care physicians to help their patients quickly schedule meetings with other clinicians that have a specialty. This more team-based care can reduce per patient costs for a health plan by up to ~$115 per year which is a ~3% reduction which can drive significant profits for payors given their scale. [5]
Adoption of Quartet’s product is hampered by two key factors. First, Quartet’s product must be adopted by the physician who must be more comfortable having a mental health conversation with a patient. Primary care physicians are busy treating their patients on a day to day basis, so it is very difficult to interrupt or adjust their flow to integrate a new product into their system. Furthermore, primary care physicians have been slow to adopt EMR systems which could facilitate the use of Quartet’s system. [6] Alternatively, Quartet could continue to leverage the payor (healthcare insurance company) that is currently paying the doctor and paying for Quartet’s service to drive adoption by having the payor require doctors to sign up for the system. Secondly, Quartet need to increase the size of its marketplace for mental health providers and increase their adoption of the technology. Without a broader set of mental health providers that are inputting their availability on the system, the patients will not have the flexibility to find doctors that are convenient in terms of both location and schedule to facilitate the connection to the provider. Longer term, I am concerned about Quartet’s ability to continue to demonstrate cost savings to the payor as physicians may become more aware and comfortable with mental health conditions and find Quartet’s connection and feedback less valuable. However, I strongly believe that if Quartet can achieve scale to the point at which all mental health providers are integrated into their system, they will be tough to remove from the system if they achieve full integration.
The most important open question around this technology is going to be whether doctors will adjust the flow of their current process to integrate Quartet’s system into the flow of the patient. With low adoption of EMR’s and a general reluctance for change, Quartet will need to continue to collect evidence to demonstrate the value of the platform to all constituents involved including the patient, doctor, mental health provider, and the payor. Other risks to the success include risks around the data that they are collecting on the patient and violating HIPAA or having a data breach or not ultimately demonstrating success in reducing healthcare costs with their digitized system for referrals.
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- O’Brien, Elizabeth, Taylor Tepper, Elizabeth O’Brien, and Taylor Tepper. 2017. “What People Don’t Understand About Paying For Mental Health Treatment.”. MONEY.Com. http://time.com/money/page/mental-health-costs-depression/.
- H, Häfner. 2017. “Are Mental Disorders Increasing Over Time? – Pubmed – NCBI”. Ncbi.Nlm.Nih.Gov. https://www.ncbi.nlm.nih.gov/pubmed/4059492.
- “Reducing Health Care Costs Through Early Intervention On Mental Illnesses”. 2017. Healthaffairs.Org. http://www.healthaffairs.org/do/10.1377/hblog20160125.052822/full/.
- Bock, Jens-Oliver, Melanie Luppa, Christian Brettschneider, Steffi Riedel-Heller, Horst Bickel, Angela Fuchs, and Jochen Gensichen et al. 2017. “Impact Of Depression On Health Care Utilization And Costs Among Multimorbid Patients – Results From The Multicare Cohort Study.”
- “Integrated Team-Based Care Shows Potential For Improving Health Care Quality, Use And Costs – For The Media – JAMA Network”. 2017. Media.Jamanetwork.Com. https://media.jamanetwork.com/news-item/integrated-team-based-care-shows-potential-for-improving-health-care-quality-use-and-costs/.
- “Adoption Of Electronic Health Record Systems Within Primary Care Practices”. 2017. Scholarworks.Waldenu.Edu. http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=3331&context=dissertations.
The digitization of healthcare is always fascinating given the slow adoption of EMRs due to concerns around patients health records and the increased vulnerability of data theft. I agree that Quartet faces a challenge due to this slow adoption of EMRs but I bet they also face a challenge in being a digital product offering for health care professionals. Doctors are often no longer making decisions around programs to utilize leaving it to centralized buyers / decision makers. Would bet that due to sensitivity around digitization and healthcare, that these decisions often get escalated to CEOs who are unlikely to sign off to concerns around data vulnerability.
I am surprised that Quartet Health decided to focus on mental health as the first care episode to target for their digital referral platform. When I was working at a health insurance company, we learned that one of the most difficult aspects of supporting people coping with mental health issues is ensuring continuity of care over time. As a result, historically, we found that even after the referral from primary care physician to mental health professional has been made, it is important that the primary care physician continue to check-in with the patient to make sure they are making progress on their journey toward coping with their mental health issues. This is critical because it is very common for patients to reject the mental health professional they are referred to and relapse back to a negative outcome. As a result, it is critical that the primary care physician continuously check-in to make sure that in the event of a rejection of a referred mental health professional, the primary care physician can redirect the patient to a new provider. Thus, I think it’s critical that Quartet Health build functionality to support periodic check-ins between the patient and primary care physician in addition to the referral mechanism.
Quartet is clearly focused on a very challenging area of the provider landscape in the primary care model. As you mention, primary care physicians are extremely busy. Average visit length is only 17 minutes [1]. Succeeding in getting primary care physicians to take the time to add Quartet to their process will likely present the greatest challenge to widespread adoption. As a result, it may make more sense to target a subset of the primary care market initially, specifically the concierge primary care market. While concierge practices still number only in the thousands, it is a fast growing group, particularly among younger physicians [2]. These physicians spend much more time with patients, and have regular follow-ups and interactions, which would enable them to ensure that their patients have worked with their mental health physicians as well. In any case, Quartet is definitely providing a compelling service at a time when tracking clinical outcomes to reduce the cost of care is becoming of paramount importance.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254573/
[2] https://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015#3