How Virtual Care is Changing Behavioral Health

We were delivering thousands of psychiatric visits monthly with no waiting rooms. The secret wasn't technology. When I co-founded Frontier Psychiatry, there was significant doubt that virtual care would work in rural areas. "You need to see patients in person for mental health," many insisted. Three years later, we had better outcomes than traditional clinics. Here's what actually made it work: 1/ We eliminated the right friction ↳ No commute for patients in rural areas ↳ No time off work for appointments ↳ No sitting in stigmatizing waiting rooms ↳ But kept the human connection rituals 2/ We added human touches ↳ Providers know the patient's history when they sign on ↳ Same provider every visit (98%+ continuity) ↳ human touch with intake and scheduling ↳ effortless to reach the care team 3/ We refused to play the typical game ↳ No cherry-picking "easy" cases ↳ Took Medicaid, uninsured, complex conditions ↳ Built wraparound services - psychiatry to social work ↳ Became the provider of last resort (proudly) 4/ We created psychological safety at scale ↳ Same provider team for everything ↳ Therapy, meds, care coordination - all in one place ↳ No bouncing between specialists ↳ Patients finally had a behavioral health home The technology was just Zoom. Nothing fancy. But we discovered something profound: removing physical barriers allowed us to add emotional presence. Our no-show rate dropped to 10% (industry average 25-50%) Patient satisfaction hit 94%. Hospitalizations decreased 38%. Not because of innovative technology. Because we used basic technology to be more human. The biggest surprise? Our providers preferred it too. No commute meant they could do a morning yoga class. Seeing patients in their home environment revealed context impossible to gather in sterile offices. The flexibility reduced burnout. We thought we were building a telehealth company. We actually built a connection company that happened to use video. The future of virtual care isn't about better technology. It's about using technology to be better humans. --- ⁉️ What makes virtual healthcare feel human to you? What ruins it? ♻️ Repost if you believe healthcare needs more humanity, not just more technology 👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for lessons from scaling virtual care

Telehealth only leads to over-utilization of care. It does not actually replace in-person visits, it only costs us more money. 🤨 Sound right? That concern has shaped the policy conversation for years. It began due to a widely cited study demonstrating DTC telehealth increased total utilization. It became a benchmark for both caution and debate, especially in Medicare policy debates (can read here: https://lnkd.in/erZ4qYXV) Btw, that study was from 2017. Yet we still had that story ingrained and was hard to shake despite some research showing different results. Well in a new study, we have new evidence to may get rid of this belief once and for all. This study analyzed 100% of Medicare Fee-For-Service (FFS) claims from 2019 to 2024 to assess how telehealth has affected outpatient visit volume. It focused on evaluation and management (E&M) visits across three specialties with different levels of telehealth use: 🔹 Low: Orthopedic surgery 🔹 🔹 Medium: Primary care 🔹 🔹 🔹 High: Behavioral health Here’s what stood out: 1️⃣ Telehealth stabilized: After its initial spike, telehealth found its place. In 2024, it made up 38.4% of behavioral health visits, 6.3% in primary care, and just 1.2% in orthopedics. 2️⃣ More telehealth didn’t mean more visits. Total E&M visits were actually lower in specialties that used telehealth more: 📉 Behavioral health: 4.1% relative decline 📉 Primary care: 7.2% relative decline (Compared to orthopedics as a baseline) 3️⃣ Telehealth was substitutive, *not* additive: This is a key difference. Virtual care mostly replaced in-person visits rather than creating new demand. It met patients where they were without overwhelming the system. 4️⃣ Overall utilization stayed steady: Despite new care models, visit rates held consistent. Telehealth expanded flexibility, but capacity constraints and clinical workflows still shaped how care was delivered. These findings challenge long-held assumptions (I can't believe that it has been 8 years). We now have strong, early data suggesting that broad telehealth adoption doesn’t drive overutilization in Medicare. That’s a meaningful shift. It is time to move beyond outdated fears and into more thoughtful, evidence-based policy. As someone who’s worked in both emergency medicine and telehealth, I’ve seen how virtual care can meet real needs without excess. I hope we continue building systems that reflect that. Not just in theory, but in how we support access, quality, and sustainability in practice. 🧠 Curious to hear your thoughts especially if you're working in policy, digital health, or any corner of the system where these questions come up daily. 🔗 Read the full study here: https://lnkd.in/eyam4jHF Note: this is a preprint so might be more to add post peer review #digitalhealth #telemedicine #telehealth

A 64-bed behavioral health hospital serving a rural community had just 90 days to replace its only psychiatrist.  Without a solution, the hospital faced closure. Most hospitals in this situation rush to recruit or bring in temporary locums. It buys time, but often leads to: • High costs • Staff burnout • Inconsistent coverage This hospital took a different approach, and it paid off. Here’s what we did to help: • Launched a fully virtual program with complete coverage in 3 months • Assigned a remote Psychiatric Medical Director for clinical oversight • Covered admissions, rounding, and 24/7 on-call psychiatric support • Held weekly meetings to build trust and streamline collaboration • Delivered live training for day and night shift on-site care teams • Built a lasting virtual care model the team still relies on today Here are the results: → 31% increase in patient census → Improved team collaboration and confidence → Positive patient response to the virtual care model → Full continuity of care during and after the leadership transition Honestly, this is what makes my job so fulfilling. Real applications of high-quality solutions that impact lives. The CEO of the hospital told me, “This is the wave of the future, and we’re there! I can’t imagine that we would ever go back to on-site psychiatry.”

Me, in Behavioral Scientist in 2020: "The next decade will see healthcare begin to embrace behavioral science findings and methodologies, moving beyond the transactional one-size-fits-all delivery of care to a personalized model designed for the humans who move through it." Me again, halfway through the decade: Kind of! Let's take it claim by claim. 1. “Behavioral science has barely scratched the surface of health care. Fortunately, this is already beginning to change.” ✅ Accurate – While besci was gaining traction in healthcare before 2020, it has seen increased adoption in areas like digital health, chronic disease management & patient engagement. Nudging, commitment devices, and habit formation have been integrated into health platforms, particularly in digital therapeutics and remote patient monitoring. Still a LOOONG way to go, though... 2. “Traditionally risk-averse healthcare systems will come to terms with the emerging era of consumer-driven health care.” 🟠 Partially true – Consumer-driven healthcare has gained momentum, with retail health providers expanding their services. However, traditional healthcare systems have not fully embraced this shift, and the transition has been rocky. 3. “Value-based care will replace fee-for-service systems to better align incentives with patient health.” 🛑 Wrong – VBC has made some progress, but has not replaced FFS (which still dominates in the US due to entrenched financial incentives and administrative complexities). And with dramatic Medicaid cuts on the horizon, this feels like a pipe dream. Wishful thinking, Aline! 4. “Technology platforms will mature to foster much-needed innovation within healthcare systems.” ✅ Accurate – The pandemic accelerated the adoption of telemedicine, AI-driven diagnostics, and remote patient monitoring. (AI ftw!) • AI tools like ChatGPT are now being integrated into health workflows. • EHR systems are still clunky, but interoperability is improving. • Startups and big tech have driven innovation, though traditional systems still lag in adoption. 5. “Digital health is ripe for the opportunity to apply behavioral science — technologies that enable people to track and aggregate data from wearables and smart devices, combined with the ability for caretakers to reach patients through their smartphones, holds promise for more targeted interventions that reach people at the right time and place.” ✅ Very accurate – Wearables and digital health tools have expanded dramatically, integrating behavioral science principles: • Apple Watch, Oura, Whoop, and Fitbit now offer behavioral insights and nudges for sleep, activity, and stress. • Remote patient monitoring is increasingly used for chronic diseases like diabetes and hypertension. • AI-powered chatbots and virtual care assistants (e.g., Woebot, Wysa, Noom) provide behavioral interventions. • However, traditional healthcare delivery remains largely one-size-fits-all, especially in hospital settings and primary care.