Ties in nicely with Mr. H's current survey question about non-competes. I posted 4 suggestions you can use to assuage…
Eric Meier, MBA is president and CEO of Owl of Portland, OR.
Tell me about yourself and the company.
I’ve been in the healthcare field for the majority of my career, both on the software side as well as the technology and medical device area. This area is probably lagging other specialties in technology, software, and analytics. This is the realm of behavioral health, which is the largest category spend in healthcare — I think it’s over a quarter trillion dollars spent on services. You can look at the impact from our productivity in our society. I don’t know the current prevalence of behavioral health conditions, but I think that an excess of 16% of the American population has suffered from behavioral health issues.
We came into the market realizing that unlike other specialties, there was really not a good way to determine and understand if care is working correctly. Behavioral health has been a people-based therapy and involves medication as well as psychotherapy. The ability to assess whether treatment is working has been lagging. Somewhere between 11 and 13% of clinicians are practicing measurement-based care, but it has been shown clinically to be extremely effective way to deliver effective and efficient care.
We were founded at University of Washington, looking to deliver an approach that would allow clinicians to understand or address the fundamental question — is care working, and to what extent? We’ve built upon that over the last five or six years.
What’s encouraging about it is that this methodology of measurement-based care clearly works. The platform was designed by clinicians for clinicians. When you take that type of approach, you can get an understanding of how treatment is being delivered and how effective it is at every step of the journey.
We are seeing engagement rates well in excess of 90%, which means it is integrated into care effectively and is able to understand what’s the patient’s status at intake from a screening standpoint, but also being able to work alongside the treatment throughout the entire course of treatment. When it’s time to discharge, step down care, or have patients transition away from receiving services, understand the effectiveness from admit to discharge, and then if needed, to see if in fact there is a relapse, being able to detect that early on so care can be administered correctly if needed down the road.
What kind of measurements are used, and how many of them reflect the patient’s perception?
Patient-reported information is a true proxy of the patient’s status, not only for screening, but throughout the course of treatment. It minimizes clinician burden and it has been shown to remove quite a bit of subjectivity or bias. If you look at the early days of capturing assessments for clinical care, a lot of these were physician-reported scales. Over time, what has been increasingly accepted and recognized is that the patient can provide a far better status of their own condition. That also avoids the pitfall of many technologies in burdening clinicians with additional work.
We adopted the approach at the outset of capturing the patient’s status using patient-reported outcomes measurements or what is referred to as PROMs, in addition to looking at social determinants of health information, which in many ways can be key indicators of the patient’s status. Often in many cases, even a leading indicator — one needs to address issues like food insecurity, homelessness, et cetera. We provide this information to clinicians to help understand the condition at the time of screening or intake, then risk stratify populations, then being able to monitor or track treatment effectiveness over time.
Will those measurements became a standard for payers, similar to prior authorization?
I would look at the issue and say, why to date has it not been broadly accepted? I think it’s because of a number of previous solutions were fairly burdensome, relying upon either the clinicians to administer these tools or not fitting into the clinical workflow. We’ve taken a deliberate approach to make it fit into the existing behavioral health practice, whether it’s ambulatory, partial hospitalization or intensive outpatient, inpatient, or residential. You have to look at the clinical workflow and make sure that whatever you’re doing to capture critical information, like what we capture in Owl, fits in the existing environment.
On top of that, I’m pleased to say that there are existing CPT codes to support the capture of information that feeds into measurement- based care. We have customers being reimbursed for this. But you could also look at this information to be critical in the utilization management process, if you want to know that effective care has been delivered or if you need to extend treatment. We have customers using this information to help provide greater transparency around the type of services that have been delivered and how effective they are.
Behavioral health providers have been reluctant to use some technologies because of privacy concerns. Is that an issue?
We really haven’t seen that be an issue. The major questions around adoption are, how does this fit into my existing workflow, or how does this help me institute change management in a way that’s not overly burdensome and can actually make the capture of information easier?
Around privacy concerns, we have developed a HIPAA-compliant system that is observant and supports conditions around privacy. There are additional requirements as it relates to substance use, but at least from our vantage point, we have not seen that be an issue around adoption of technology. It’s more about just making sure that it fits within the existing treatment model and doesn’t overly burden the clinicians, but actually give them greater information around the kind of care they’re delivering and making sure that using a platform to help improve the overall effectiveness and efficiency of care.
Who makes the decision to implement the concept as well as the technology?
If you look at our customer census — Ascension Health, Oregon Health and Science University, Texas Children’s, Inova Health System, and Carilion Clinic — it starts with leadership that is thinking strategically on how to deal with the basic questions of, how do I deliver the most effective and efficient care? How do I deal with access issues and try to address wait lists that may be occurring? How do I better understand, from a population health standpoint, the type of care that is being delivered within my ecosystem and also support alternate payment schemes, such as value-based care?
All of that hinges upon the understanding of the type of care that’s being delivered, which has been well accepted through the capture of clinical outcomes. With any new technology, getting leadership buy-in up front is crucial to embark upon measurement-based care, but also make sure it’s being utilized by the team on an ongoing basis.
We have been fortunate that our customers tend to think strategically on addressing the fundamental question of how effective is the care, how good a job am I doing? Then making sure that as we look at this from an implementation standpoint, it needs to fit the existing ecosystem, which typically consists of integration with their EHR, whether it’s Epic, Cerner, Athenahealth, or behavioral health EHR such as Netsmart, Streamline, and others. Then secondarily, make sure that information can be used on demand by the clinicians as part of an encounter, but also used by the leadership to assess the effectiveness and efficiency of care across their different clinical programs.
When you think about the ability to benchmark, let’s take for example eating disorder service lines that may be spread across a health system in different locations. What you would like to understand is, how good a job am I doing? Am I seeing kind of best practices in one location that I can now, based upon the outcomes data that the Owl is generating, replicate and standardize on?
The other point that needs to be understood is that people delivering behavioral health have probably one of the toughest jobs in healthcare. It is a really challenging job. Well accepted is its ability to not only provide effective care, but get more out of existing resources. For example, we’ve seen about a 56% reduction in time to remission from those folks that implemented the Owl versus those that have not.
Secondarily, given some of the resource constraints that have unfortunately become a consistent problem across the United States, we’re seeing about a 30% improvement in staff efficiency. You take an organization that may have 20 to 25% attrition, there’s a need to backfill those positions, but also make sure the consistency of care is happening across a health system, whether it’s in one geography or multiple. The beauty of the Owl is it provides a systematic way to deliver evidence-based care, and when you think of faster time to remission, I can treat more clients with existing resources.
How are measurement-based outcomes being used in telehealth?
We are an enabler to that. We were designed from inception to support telehealth, long before the pandemic occurred. Virtually 100% of our customers, going back to probably the second quarter of 2020, by necessity pivoted to a virtual healthcare model and, there was no interruption of the use. In fact, one of the things we’re proud of is that our platform has been used to assess the overall effectiveness and efficiency of care in both the on-premise as well as virtual setting. We’re seeing a consistent response. The upside for the patients is you have the ability to receive treatment services in probably a more relaxed setting. You avoid having the transportation and having to go to your appointment. Our platform has been used to give confidence to the providers that the quality of care is not compromised.
When you think about what is happening right now with the fact that there’s been a big focus on access to care and our platform is being used to support improved access to a faster time to remission or whatever your treatment target is, as well as the ability to be able to treat more in patients with existing resources, we’ve been well accepted in providing those values. I would say as you look forward, we think there’s going to be increasing focus on quality. As the access issue begins to abate, we are seeing health plans is saying, that’s great, let’s make sure that the quality of care is not compromised. The payers or the health plans are demanding more data, in the form of clinical outcomes, to document and validate that the treatment services have been administered correctly.
That’s the work we do. Think of us as not only supporting the providers and being able to deliver evidence-based care through the Owl of the measurement-based care platform in a seamless way, but secondarily provide the health plans to better understand the performance of their networks. There’s no better way to do that than to have well-documented, patient-reported clinical outcomes and social determinants of health information to make sure that the best care has been provided at the right level to the patients.
What changes do you expect to see over the next few years with your customers and the company?
In the early days of the company, it was around providing or enabling providers to capture clinical outcomes in a straightforward way. We’ve been able to provide information capture to our customers.
If you look at the evolution of measurement-based care, the next piece of the puzzle is providing detailed reporting and analytics to support internal needs around as a health system. How good a job am I doing relative to where I want to be from a performance standpoint? I think of this as a population health support.
The next area has been in supporting clinical decision support. Not only can I use measurement-based care to determine those clients or patients that may be likely to self-harm or harm others, so looking at suicidal ideation, our platform is designed to provide a safety plan to not only notify the clinicians and staff that immediate attention is warranted, but also say, what do you do? We’re building upon that now to look at different conditions such as depression, anxiety, substance use, et cetera, to provide supportive clinical decision-making so you are administering the right care algorithm.
The fourth area I would speak to is providing greater alignment between providers and plans. Providing visibility, which to date has been opaque, around the overall care that has been delivered by both the behavioral health specialty and primary care. Having an understanding of how a health plan’s network is performing, and once you baseline that information, then it provides the opportunity to be aligned around moving towards alternative payment schemes, such as value-based care.
As we look forward, we see not only continued and growing acceptance of measurement-based care by providers, but health plans using this information to understand the quality of care that has been delivered and making sure there’s alignment around payment schemes and addressing total cost of care.
From a business strategy standpoint, where we are focused is having a balanced portfolio of customers. Not only serving health systems, large community mental health clinics, and health systems supporting both behavioral health specialty and those that move into collaborative care or integrative care model, but also making sure the health plans are able to understand the type of care that’s been delivered. Not only behavioral health, but also recognizing that these behavioral health conditions can adversely impact medical care. This whole concept of whole person care is going to be critical and recognizing you need to address the behavioral health component of it.
We benefited from taking a clean slate five to seven years ago and the ability to develop a measurement-based care platform by clinicians, for clinicians. The area we focused on was number one, making sure we integrate in the clinical workflow in a seamless capacity. This is across different clinical approaches to delivering behavioral health services, everything from ambulatory to partial hospitalization, intensive outpatient, inpatient, as well as residential. We’ve extended that to support when behavioral health is being delivered in a primary care setting as well. Secondarily, once you fit the clinical workflows, to make sure you’ve got a broad enough amount of content that support all the different subspecialties, whether it’s eating disorder, substance use, depression, anxiety, adolescent, or late-life care.
The upside of this is we’ve got a high engagement level, upwards of 90%. You need those kinds of numbers to fully utilize measurement-based care and capture the benefits of accelerating time to remission and improving effectiveness of care as well as efficiency. Once you accomplish that, you start to address one of the primary issues today, which is access to care. In other words, how do you make sure clients are receiving care in a timely capacity? As I mentioned earlier, we’re seeing compelling and supportive statistics with faster time to remission of 56%, as well as being able to get more out of existing resources.
With that in mind, with this information, then it becomes meaningful not only for providers, but also obviously those that are doing accreditation work, such as the Joint Commission or CARF, as part of their audit process. Lastly is making sure that the health plan has a better sense of the type of care that’s being delivered by their network.
We have been fortunate to have supportive strategic investors in the form of the Ascension Health Network, First Trust, Cardinal Partners, Blue Venture Fund, and the Entrepreneurs Fund.