How we think about behavioral health decision-making
Trial and error in behavioral health care
Many effective treatments for depression and behavioral health conditions exist, from a wide range of antidepressants to multiple forms of psychotherapy to interventional options. Predicting which of them will work for a given patient is difficult, and despite the best efforts of clinicians, more often than not the first treatment prescribed isn't the one that works. The result is months or years of trial and error, and billions in spending that doesn't produce improvement.
The decision-support market doesn't exist yet
Leveraging data to predict what will work for a given patient could solve this, and the science to do so already exists. The challenge is structural: there is no real market for decision-support technology in behavioral health, because clinicians are paid for time spent seeing patients rather than for the effectiveness of the care they deliver. This doesn't mean clinicians don't want to make the best decisions possible; it means there is no budget for the technology that would help them do so.
Outcome-driven payment models change this dynamic: when dollars are tied to results rather than to activity, the system gains a real economic reason to invest in better decisions. But outcome-driven payment only works when the surrounding infrastructure exists to support it, and three pieces are required for that infrastructure to function:
Measuring outcomes
Outcome-driven payment requires outcomes that can be measured at clinical-grade quality, which in behavioral health means standardized longitudinal capture of patient-reported outcomes and treatment-response trajectories. Without this layer, no outcome-driven program has the evidence base to operate.
Attribution across providers
Behavioral health care happens across many independent providers and venues, from psychiatrists to primary care clinicians to therapists, and outcome-driven payment requires a way to attribute the resulting outcomes back to the decisions that shaped them. Without attribution, the right incentives can't reach the right people.
Decision-support tools
Even with outcomes measured and incentives aligned, clinicians still have to make better decisions in the moment, which requires technology that synthesizes what's known about each patient and supports the actual decision being made. Without it, the rest of the infrastructure has no path to better outcomes.
All three are needed, and they only work together.
The work is underway
Eiro is building each of the three infrastructure pieces, and working with leading health payers on the program design needed to put outcome-driven behavioral health care into practice. The work rests on a research foundation built over four years with Vanderbilt and the Wellcome Leap MCPsych program.
Eiro Engage, our consumer-facing R&D application, is live in the App Store today, with additional products in active development. Stay tuned for upcoming release announcements.
Working in this space?
We work with clinicians, health systems, payers, and people in treatment. If any of that's you, we'd like to hear from you.
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