Threats to Psychotherapy Practice and Patient Privacy
Beware for-profit companies that offer referral services or combined referral, contract and administrative services.
Tridiuum
Managed Behavioral Health Care Redux
Tridiumm was acquired by New Directions in 2021 for $9.5 million. Their goal is to provide member access to “the highest quality behavioral health solutions when demand is incredibly high,” says Shana Hoffman, CEO of New Directions.
Tridiuum is powered by an Atlassian software, a multibillion dollars development software company based in Australia. The software is a legacy software system that is 20 years old. They have an office in San Francisco.
Tridiuum claims they can accelerate patient access to the most appropriate care by automating behavioral health screening, triaging, matching and online scheduling through its easy-to-use system that can be seamlessly integrated with existing platforms.
They offer a limited number of questionnaires and do not offer questionnaires for specific diagnoses, symptom burdens and functional problems. Their progress and outcome measurements are essentially the same as ACORN system.
Contracting an Oregon Health, Tridiuum believes they will be able to serve more members “by combining Tridiuum's proprietary technology with New Directions' care management experience resulting in accelerated access to quality providers,…"
Offering managed behavioral health contracts to providers, Tridiuum is a digital health company led by a nationally recognized team of (un-named) experts in behavioral medicine, software engineering, digital health technologies, health insurance, and behavioral health clinical research. Their research and findings have been published in more than 40 peer-reviewed journals and other scientific publications (Note: None of which are not relevant to independent and private psychotherapy and counseling practice.)
Tridiuum’s software was created by Atlassian, Inc. The software is a legacy system that is 20 years old. Tridiuum offers a limited number of questionnaires and does not create custom questionnaires for specific symptoms, functional problems or cultural differences.
NOCD - Treat My OCD
Here is an emerging national model paid for by Healthplans. NOCD is paid by Healthplans, as are other online services. Contracted therapists are paid by NOCD.
“NOCD delivers more than 12,000 live telehealth visits per month through a nationwide network of exposure and response prevention (ERP) specialty-trained professionals. Within 90 days, consumers have a 40% improvement in outcomes. NOCD’s partnerships with leading health insurance companies gives about one-third of Americans access to the platform as a covered benefit.”
For more information see:
https://www.amha-or.com/private-practice-is-transformed-to-highprofit-managed-care
https://www.amha-or.com/valuebased-contracting-for-psychotherapy-healthplan-games
Headway
Intrusion of for-profit network builders
A network builder is an organization that offers therapists services such as contract applications and administration, billing services, screening, outcome measures, referrals and guaranteed payment in exchange for accepting their contract with a Healthplan. You become, in effect, a contracted employee. Some network builders are contacting with providers close to retirement and offer to provide administrative services to reduce providers’ overhead. As part of their for-profit venture, the programs’ will eventually sell their network (and your contract) for their profit. Headway offer a $300 “headhunter-fee” to Headway providers who refers providers who join their network.
Related:
Blue Cross NC taps Headway to expand mental health access for underserved members and children
Mental health startup Headway hauls in $70M series B, expands to 10 new states
Companies similar to Headway: www.GrowTherapy.com www.ChooseTherapy.com
Venture capital investors working with Healthplans are betting that psychotherapists are dumb
One consequence of the SARS-CoV-2 pandemic is extremely high demand for counseling and psychotherapy services. Ironically, the integrity and privacy of counseling and psychotherapy practice is being challenged by a growing number of venture capital funded companies with disruptive marketing strategies that include:
Bait-and-switch referral practices, lucrative contracting offers, promises of administrative services, plus provider referral and signing bonuses, that are effective and deceptive.
Building and flipping networks for millions in profit.
Requiring patients and businesses to pay for referrals in order to find low cost providers.
Creation of ghost referral networks that can deny services without being accountable to state health authorities or insurance commissions.
Requiring providers to use specific measurement systems which gather performance data about providers as well as patient health information that is worth millions to Healthplans.
Creating contracts with part-time providers who are more than 65 (paying $500 or more to the new contrator) in order to create the appearance of a referral network so Healthplans will contract with these commercial managed care networks.
Requiring treatment plans and charting processes based on definitions of medical necessity that (1) ignore 40 years of research, (2) undermine patient outcomes ,and (3) increase patient dropout.
Offering patients and Healthplans online software that automatically
screens patients,
“match” patients to providers,
submit claims,
gather screening and progress information directly from patients,
provide feedback to providers,
recommend medication pathways,
electronically audit chart notes,
gives payers visible access to psychotherapist and patient records,
rates patients and providers.
make use of AI to determine the quality and reasoning in chartnotes.
Below are several examples of a growing number of puffed up and unqualified phantom networks manipulated by venture capital investors who ae interested in growing networks by any means possible only to “Flip” the network for profit, leaving providers and patients to deal with the consequences.
Cerebral: Teletherapy companies glitter, but are not gold
Cerebrals has raised 1.4 billion dollars and has a recent “valuation” of 4.8 billion dollars.
Cerebral has the money, technology, methods and ambition to manage every aspect of psychotherapy practice.
Medication and Therapy: $325 per month. The first month is $139 .
Medication and Care Counseling: $85 per month. The first month is $30 .
Therapy: $259 per month. The first month is $99.
Cerebral’s telehealth platform provides an online screening and health questionnaire that automatically matches patients with the most appropriate care team and care plan based on patient preference and clinical need.
Cerebral provides clinicians with personalized monthly reports with actionable and relevant data in an effort to continually empower them to improve their care. These reports include their patients’ ratings of care and written feedback, patient’s adherence to care, and clinical outcomes, among other metrics.
Patient engagement levels are quantified by patients’ participation in surveys, meaningful use of Cerebral’s smartphone app, and adherence to appointments and treatment plans, among other measures. Metrics for clinical processes such as wait times for appointments, response times to patient outreach, and patient satisfaction, are closely monitored.
This audit assesses for quality of clinical reasoning and completeness of documentation, with a focus on providing actionable feedback. Each chart is audited using a proprietary scoring system.
Update: June 2, 2022
Can psychotherapists entrust their licenses and reputations to VC companies?
Cerebral announces layoffs as part of operational restructure amid federal investigation
Ethically, psychotherapists must retain 100% control over confidential health information to protect and advocate for patients. So, ask: What does this company’s contract stipulate concerning responsibility for clients’ private information? (i.e., their symptom reports, and their clinical change data.)
For more information see:
https://www.fiercehealthcare.com/health-tech/cerebral-announces-layoffs-part-operational-restructure-amid-federal-investigation
Therapeasy
“wants to Help You Find Your Perfect Therapist…”
Reportedly free for now, Therapeasy is “matching” services suggesting it matches patient and therapists “like” a dating service.
According to the owners, “:Whatever it is, the way you tell your story online can make all the difference.”
Therapeasy was formed and went on line in 2020. As of July 2022, Therapeasy has three “employees.” The company decided in 2022 postpone all subscription fees and continue to offer their services for free. There business plan was to gain enough referral traction that they could begin to charge referral subscriptions.
Therapeasy’s head of product stated, that they have “…developed a matching algorithm that will pair you up with available therapists who are most compatible with what you are looking for. Because we believe that a strong personal connection is a basis for successful therapy, we incorporate non-demographic elements into our algorithms, such as communication style and cultural competency. These connections are packaged into an online dating-like experience in which you can communicate directly with your matches once you receive them. We would like to be the Match.com for finding a therapist.
Therapeasy is not incorporated. They have provide no contact information on their website. They do not provide a cookie policy, website terms of use, or HIPPA assurance for information they gather that is sensitive, personal, private and healthcare related. Their terms of use does not provide ethical informed consent.
Talkspace
A single text message can help you feel better
We offer comprehensive online mental health treatment options to meet all your needs. This include online therapy, couples therapy, teen therapy and psychiatry. Services are provided by video, messaging and phone. They report 5 star reviews for over 60,000 patients and proudly post their patient satisfaction with images to boot.
How they can treat everything with texting is not supported by research or credible training.
Talkspace claims80% or patients found Talkspace to be as effective or more effective than traditional therapy. 98% found Talkspace to be more convenient than traditional therapy.
Research indicate “evidence for the effectiveness of the intervention (GHQ-12, Cohen's d = 1.3). Twenty-five (46%) participants experienced clinically significant symptom remission. Therapeutic alliance scores were lower than those found in traditional treatment settings, but still predicted symptom improvement (R(2) = 0.299). High levels of satisfaction with text therapy were reported on dimensions of affordability, convenience, and effectiveness.”
For more information see:
https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.1056
https://www.liebertpub.com/doi/abs/10.1089/tmj.2016.0114?journalCode=tmj
PsychPros
“Headhunters” that are hired to find psychotherapists and counselors for venture capital funded and managed healthcare where there is high demand and few providers.
So… are you looking for a great behavioral healthcare job?
PsychPros is a national job placement services that offer free registered job candidates. Your job search is easier with the help of our specialized recruiters and access to newly-open jobs in behavioral health, addictions, and social services throughout the United States.
Receive e-mail alerts about newly-open jobs matching your preferences
PsychPros ranks in the top 2% of professional recruiters in the U.S.
They say their expert recruiting staff handle the hiring process for providers.
Get customized help finding your dream job in behavioral health!
VIDA
VC companies that are focused on low cost coaching for chronic illness with psychotherapy as needed
“Vida Health is a virtual care platform that provides health coaching from experienced health care providers and medical institutions.”
Vida has added psychotherapy as an ancillary service to health coaching programs with expectations that therapists are assigned patients with serious and chronic health condition.
Vida claims that across Vida’s book of business, patients experience rapid and sustained improvements in mental health. VIDA guarantees their outcomes will show a 50% improvement. The value proportion of Vida is same as every other digital platforms.
There are not enough psychotherapists available to meet new demands for treatment of stress, depression, anxiety, adjustment disorders, not to say anything of trauma, isolation and fear.
Healthplans that make low reimbursements for psychotherapy are faced with having to increase their fees-for-services to compete with Healthplans that pay more.
Healthplans that pay less cannot create value and improve outcomes without paying psychotherapists more. Healthplans want to pay psychotherapists less, not more.
BetterHelp
Contracts, Appointment Scheduling & Claim Management
20,000 part therapists translates to less than 2,000 full-time providers. Healthplans are desperate to get access for their customers. They even offer signing bonus and small health insurance stipends.
BetterHelp does not bill insurance or contract with Healthplans. They offer unlicensed quality of services to customers who reside in states where providers are not licensed. Clients pay out-of-pocket. Rates range from $35 to $65 per hour.
Better Help
Commercialization of referrals
For-profit business paid by patients to find referrals for mental health services. The service gathers protected health information from potential patients. The patient is referred to a therapist based on screening criteria that is rudimentary and potentially invalid as an appropriate referral. Healthplans that fail to provide an adequate network rely on commercial referral services to reduce their operating expenses and allow them to operate with smaller networks than their plan members require.
AbleTo
Enticing signing bonuses and an 8 session financially driven utilization restriction
AbleTo offer providers a $1000 signing bonus ($3000 in NY and CA) to join a network that reportedly has an 8 session success goal after which provider are managed/required to demonstrate medical necessity. Marketing of services and success claims while appealing, demonstrate positive bias and are highly suspect because there is no independent oversight or endorsement. Claims of network quality, access and size attestations are not backed by identifiable qualified clinical leadership. AbleTo claims to be one of the largest networks in the U.S. with +2000 providers.
What You’ll Do:
Set your own schedule working from home, part-time or full-time
Have more time to focus on patients, while we handle marketing, billing, and scheduling
Follow structured, easy-to-follow clinical protocols
Conduct collaborative clinical work and care coordination to get the support you need
Conduct onboarding with clinical training with dedicated concierge support
Participate in and support multi-state licensure
Receive competitive pay
Full-time roles include medical, dental, vision benefits, paid-time off, company-sponsored Health Reimbursement Arrangement (HRA), 401k matching with immediate vesting, and annual performance bonus
Participate in expert training and free CEUs
Pace
Out-of-Pocket groups founded by venture capital investors create a network to meet high demand for mental health services where there is a short supply of licensed providers.
According to Marci Flores, PsyD, program director, “Pace is unlocking emotional connection together. We’re redefining mental health through groups that are effective, but also fun, social, and challenging. Our investors include Sequoia, SciFi VC, Next Play Ventures, SV Angel, WorkLife Fund, BoxGroup, and angel investors who lead various public technology companies.”
Article: Do Venture-Capital Investors Think Psychotherapists Are Dumb?
Services are not more affordable than therapy. The facilitators are probably not what experienced group therapists would consider “world class.” To learn about this company you need to find their LinkedIn page. You will then discover that a co-founder and principle VC investor is the former CEO of LinkedIn.
Joining for-profit therapist referral websites
Unlike member-owned non-profit referral websites, for-profit referral website are likely to be building referral networks intended to be sold to for-profit businesses that offer network contracts with Healthplan payers. Over time, as for-profit referral websites increase their number of contracted psychotherapists, the network will grow in financial value to companies that need larger networks.
A perfectly legal “bait-and-switch” strategy goes like this: First, Psychotherapists join a for-profit referral website. Next, psychotherapists are offered contracts and no cost billing services for those contracts. Once they have a significant number of contracted psychotherapists, the business can offer psychotherapists employee contracts that pay more and pay the company more. The bait-and-switch is the requirement that psychotherapists become to some degree contracted employees. This is one business model that psychotherapists were never told about.
Pathways
Healthplans that require counselors and psychotherapists to use and pay for specific screening, progress and satisfaction measures.
Providers who participate in Healthplan funded and directed data collection systems are empowering Healthplans to dictate psychotherapy interventions, procedures, processes, modalities, levels of care, duration of treatment and more. They rely on a process called regression to the mean that compares providers who work with patients who have unique needs with those patients who do not; categorizing extended services as not medically necessary. Payers have visibility and access to provider and patient data.
Shrink Space
Pass-through referral services that are contracted with education institutions
Psychotherapist providers create a simple online profile and sign the Shrink Space BAA, term of use and policy. The educational institution gives students access to their referral page. Students must sign up to access referrals. Licensed and unlicensed people can join as providers.
Healthcare operations sponsored by Healthplans that require patients to pay for referrals without the provider BAA necessary to protect patient privacy
For-Profit network builders funded by Healthplans gather protected health information from your potential patients while creating the appearance that they are your business associate. The information gathered can include screening, progress, outcome and patient satisfaction measures. Your image and credentials can be used to market their paid service. The information gathered belongs to the company (not the provider) and can be sold and/or used to evaluate your services and patients’ outcomes.
New charting requirements & audits
Creating chart notes that meet the information expectations, and needs of all potentially interested parties, is impossible given the constraints of private psychotherapy practice.
There is no empirical evidence that patients or the public benefit from disclosure of personal, intimate, or private information required in writing by interests external to psychotherapy. There are no studies that examine the benefits or harm caused by psychotherapy chart notes.
Healthplans require “new” definitions of medical necessity and treatment plans that ignore 40 years of research and undermine evidence-based practices
Psychotherapists in private practice frequently question the value of treatment plans and chart notes based on standards created by interests external to the therapy, standards which often have little to do with processes or outcomes that matter to patients. What helps bring about change for psychotherapy patients is not enhanced by documentation requirements imposed by third party payers, professional associations, or training institutions. There is no empirical evidence to demonstrate that treatment plans and progress notes as required by interests external to psychotherapy improve outcomes, patient satisfaction or the quality of outpatient psychotherapy.