From the time I was 16, I battled a digestive disease known as ulcerative colitis. Like many chronic diseases, UC has a significant impact on one’s quality of life and takes tremendous effort, organization and resolve to manage in coordination with doctors. In fact, I started a company to address this very issue. My company, WellApps, helped people track health events to provide accurate information to doctors and to discover correlations between symptoms, diet, medications and other treatments. While this was valuable to many, it was a very small part of a much larger problem that continues to persist nationwide.
The WellApps platform was a social community for people with similar chronic diseases. I participated in the digestive disease community and it quickly became apparent to me that people were having trouble managing their physical disease because of underlying mental illness. I decided to conduct an observational study using patient-reported data we collected on the platform. The study showed a clear correlation between patient reported stress and disease activity in ulcerative colitis patients. Upon researching this more, I discovered that there is a significant comorbidity of mental illness within the digestive disease prevalence. Digestive diseases are extremely difficult to manage and control when you’re mentally well. For those with comorbid mental illnesses, it must be nearly impossible.
I thought about my experience: I’ve seen plenty of physicians in my lifetime and none of them has ever given me a mental health screening. So, I asked myself - what could be done here? A good first step would be to encourage mental health screenings so that physicians are aware of implications on the digestive disease, and vice versa. Then, perhaps the Internists and Gastroenterologists could team up with mental health specialists to treat patients together.
Serendipitously, my phone rang in late 2015. It was a recruiter from a company called Quartet that enables primary care physicians to collaborate with mental health clinicians for optimal patient outcomes. Life is funny that way -I am now Head of Product at Quartet and pursuing this reality.
A nationwide collaborative physical and mental healthcare delivery system is inevitable. The problem is way too big to ignore. Quartet has made significant progress towards this reality with the help of the physical and mental health providers on our platform. However, a mission like this requires participation from the very people whose lives we want to change. For this reason, we launched the Quartet Ambassador Program (QAP).
The QAP will bring together people who have personal experience with physical and mental illnesses that require collaborative care. These ambassadors will reach into their respective communities and gather perspectives to guide our mission. We will work together to understand challenges, battle stigmas, and build an integrated healthcare platform that will change lives.Interested to learn more about the QAP? Email email@example.com.
Today we’re proud to announce our Quartet Ambassador Program (QAP), a hand-selected group of individuals whose experiences with physical and mental illnesses guide Quartet’s mission. Ambassadors will help surface the needs, motivations and mindset of our target patients, which will in turn provide valuable insight on Quartet's products and technology.
Meet the Ambassadors:
A blogger, poet and medical professional from Florida, Emily experienced a severe spinal injury almost seven years ago. After losing her career because she could no longer work, Emily became severely, clinically depressed. Emily fought hard through physical and mental therapy for close to a year, and then returned to her career as an Orthotist/Prosthetist with an employer who is accommodating her disability.
A best-selling author, Lisa is a resident of Southern California with a husband and three kids. As someone who lives with two autoimmune diseases, Lisa understands how challenging it can be to handle chronic illness on your own. Coordinating work, family, multiple doctors appointments, insurance issues while feeling lousy can be overwhelming. Lisa believes how important it is to have access to behavioral healthcare.
A Philadelphia-based former broadcast journalist, Kara departed her job in broadcast news because of high stress, depression, anxiety and an eating disorder. Kara had to find help on her own, and encourages others to feel comfortable doing the same. Kara, now a digital marketing professional, blogs about her experiences to help others feel less alone, and cultivate a healthy relationship with food.
Molly lives in San Francisco and works in educational research and evaluation. In 2004 she was diagnosed with ulcerative colitis and has had an ileostomy since 2015. Since 2011, she has facilitated the San Francisco CCFA (Crohn’s and Colitis Foundation of America) support group.
Molly believes that access to quality behavioral healthcare that takes into consideration the issues surrounding the chronic condition(s) can make a difference in people’s lives.
Interested to learn more about the QAP? Email firstname.lastname@example.org.
According to a 2017 report released by MedScape, 51% of U.S. physicians feel burnout. But what exactly does “burnout” mean? In the report, it is defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.
If 1 out of 2 physicians feels burnout, odds are that some patients may not receive optimal care.
Physicians across this country are experiencing burnout, and it’s impacting the care patients receive. In fact, a systematic review of 46 studies found consistent associations between poor well-being plus moderate to high levels of burnout in physicians and higher numbers of self-reported medical errors.
Furthermore, physicians typically are only able to spend 7 to 10 minutes with each patient, which seems barely enough time to have an in-depth conversation about all aspects of patient health - both mind and body.
Various other factors also contribute to physician dissatisfaction, including the overload of bureaucratic tasks, such as paperwork and insurance; too much time spent in the office; and pay not commensurate with workload.
At Quartet, we believe the most efficacious care focuses on both physical and mental health, and the need for holistic care is as important as ever. There is simply not enough time to discuss outlying factors which could potentially prolong patients’ ailment(s). In essence, it is time that hinders some from engaging in a more in-depth conversation with patients involving their mental health. And, in turn, some physicians are only able to manage care more reactively - as symptoms or illness pop up over time.
Proactive, holistic care can be achieved by complementing care with a program like Quartet’s. Physicians can easily connect their patients with appropriate mental health care and track patient progress over time. At Quartet, we are here to support physicians in working as efficiently as possible and ensuring their care is effective and focused. By providing physicians with the tools they need to holistically manage their patients’ health, we hope to help improve patient care, and aid in the reduction of burnout.
Antidepressants work. As first-line treatment for distressed patients having difficulty getting through the day, their efficacy is proven. When you look at long-term maintenance, however, are antidepressants the best first line regimen for patients? A review of studies published in the Nature Review of Neuroscience (1) suggests that for long-term remission, patients who complete a 16-week program of cognitive behavioral therapy (CBT) with regular assessments have significantly improved outcomes when compared to those treated with antidepressants, alone.
In the study, 240 patients with severe depression were divided into separate cohorts with one group treated with a short course of antidepressants and the other with CBT. The authors’ findings show that during the period of treatment, medications and therapy are equally effective at treating the symptoms of depression (2). When each treatment was stopped after 16 weeks, however, each cohort’s story diverged. One year after stopping antidepressant medications, 76% of patients relapsed, as opposed to only 31% relapse in those patients who completed CBT.
These results demonstrate CBT has a more durable therapeutic effect than antidepressants alone.
These findings make one re-think those patients who are “maintained” on antidepressant medication. What will happen if they lose their prescription coverage due to financial hardship? Or they struggle with medication compliance due to unpleasant side effects?
CBT offers a short and effective course of therapy that makes patients feel better without untoward suffering due to psychotropic medication side-effects.
At Quartet, research like this guides us every day. We are here to support primary care physicians focused on giving patients the best possible care. We are committed to helping individuals get better, stronger, and in control of their lives.
2. Approximately 60% of patients respond to treatment
The Quartet team wasted no time in 2017, kick starting the new year by exhibiting at the Consumer Electronics Show 2017 (CES) for its 50th year celebration in Las Vegas. Since 1967 CES has been at the forefront of innovation, with the first peek at pivotal products that have changed the way we live our daily lives. Known as the largest consumer electronics show in the world, CES draws tech enthusiasts from across the globe. This year, nearly 200,000 people attended; several of whom brought their products to share and demo with others.
Gary Shapiro, President and CEO of the Consumer Technology Association (CTA), launched this year’s show with the “Let’s Go Humans” campaign to encourage humanitarian technological innovations - a concept truly aligned with our patient-oriented mission to make behavioral healthcare more accessible and integrated into primary care.
Quartet was honored to participate as one of the few healthcare tech exhibitors this year, and attend the conference’s Digital Health Summit, an affair dedicated to the role of technology in advancing modern medicine, healthcare and wellness.As Quartet continues to expand in 2017, we are incredibly enthusiastic after a great start with CES. We shared our platform and solution with industry constituents, media, fellow innovators and problem solvers. With this momentum, we are psyched to continue improving behavioral healthcare for those who need it most.
Every day, people walk into their primary care physician’s office seeking help with known or underlying mental health conditions. Did you know that at best, only one out of three will receive an intervention that actually works? Successfully treating the other two thirds of patients is not just the right thing to do; it’s a $162 billion medical savings opportunity - but it’s also one of the most difficult problems for our health care system to solve.
As an inpatient nurse on a medicine/oncology unit, the care teams I worked on were multidisciplinary - doctors, nurses, pharmacists, and social workers coordinating care for our patients. One of our goals was ensuring that before a patient was discharged, they had all the services they needed to remain healthy. Our social workers would spend countless hours to set up everything from specialist appointments to home visits with a dietician. Mental health care was always a challenge, no matter what they tried.
Despite the best efforts of a dedicated team, calling in favors, and being in the center of one of the most densely packed cities in the US, more often than not, we would find mental health care specialists booked up months in advance, unable to accommodate our patient needs or insurance. When we discharged patients without being able to address their mental health needs, it was with a head-shaking acceptance that we readmitted them weeks or months later.
Healthcare can be better, and the solution is clear: a tech-enabled patient-centric view of physical and mental health, from inpatient care to specialists, where information transfer and communication is easy, secure, and fast. Today’s reality is anything but that: physicians are faced with fragmented EMRs, where fax machines are still the gold standard of communication. Mental health specialists, frequently isolated from their primary care peers, are chronically underutilized. And despite decades of research showing that addressing mental health early and often is tied to better outcomes and decreased costs, our healthcare system has yet to catch up and we struggle to execute on that goal.
At Quartet, we use technological resources strategically by identifying patients with unmet needs, screening for behavioral health issues, offering a seamless in-network referral to mental healthcare, and easy communication between those providing care. To learn more, visit quartethealth.com.
In April, we announced a $40M series B funding round, led by GV (formerly Google Ventures) with participation from series A funders Oak HC/FT, F/Prime Capital Partners, and Polaris.
In June, we announced a partnership with Highmark, Inc. that brought us to Pennsylvania; in October, we launched in Washington with Premera Blue Cross. Together with these forward-looking insurers and continuing partners Steward Health Care Network and Lahey Health in Massachusetts, our solution is going nation-wide.
Our team has more than doubled in size, and our New York headquarters have moved into a bigger, beautiful new space.
While a lot has changed, important things remain the same. We are unwavering in our mission to change the way healthcare is delivered in this country, by making behavioral healthcare more accessible and integrated into primary care. We continue to build an incredible team from a range of disciplines and backgrounds - driven by a shared commitment to our mission.
2017 promises to be an even busier and bigger year for Quartet, and for the movement to bring mental health into the healthcare mainstream. We are humbled and excited to be tackling this critical issue - and we’re growing! Check out Quartet job opportunities here.
A patient enters your office - it’s someone you know well, and have been treating for years. No matter what you do, they never quite feel “well.” Occasionally they admit to stress at work, or note family issues, but their primary symptoms are both frustratingly persistent and maddeningly vague. Unusual pain, GI issues, swelling, and persistent headaches are common. Prescriptions you write are filled but inconsistently refilled. Chronic issues are managed poorly, despite the patient’s best intentions.
These patients require more of your time than most others, and despite your best efforts, they are frequently frustrated by their lack of response to first-line treatments.
Research shows that these traits, along with many other symptoms, are actually common presentations of behavioral health issues that are frequently overlooked by primary care physicians. These days, most physicians are spending less time with patients than ever before and finding time to comprehensively screen patients for behavioral health issues can feel impossible given schedule constraints.
This is where Quartet can help. We recognize that screening for behavioral health is rarely at the top of your list of things to address with your patients. It would actually take a PCP 18 hours per day to offer all recommended services to a group of patients. This is obviously impractical, which is why we're here to help ensure your patients feel their best, take control of their health, and have the quality of life they deserve.
The next time you see a patient who could use a little extra time, or who just doesn't feel as well as you think they should, consider Quartet. We'll contact them, connect them with the resources they need to get better, and keep you in the loop.
Nearly half of the US population suffers from at least one chronic health condition, and as anyone working in healthcare can tell you, managing a chronic health condition is no easy task. On top of dealing with difficult symptoms, patients with chronic health conditions are asked to follow challenging treatment plans and to quickly learn new behaviors to manage their health effectively. This is inherently stressful and can make engaging in treatment even more difficult.
Early behavioral health interventions are the solution for patients with chronic health conditions. These interventions reduce stress, decrease symptoms, increase adherence to treatment plans, promote self-management, and lead to better patient outcomes. Yet, these interventions are not included as standard of care for chronic health conditions. This needs to change. For all chronic health conditions, behavioral health interventions should be considered first-line adjunctive treatment.
There is ample evidence demonstrating that behavioral health interventions can improve patient outcomes. For example, a stress management-focused cognitive behavioral therapy program was shown to reduce recurrent stroke and mental illness by over 40% for those with coronary disease (Archives of Internal Medicine).
And, more generally, patients in general behavioral health focused self-management programs for chronic physical health conditions saw a reduction in common symptoms; improved medication adherence, communication with physicians and quality of life; and fewer ER visits and hospitalizations (Medical Care).
Why is this important?
Stress management and disease self-management are not quick fixes, and there simply isn’t enough time in a primary care provider's schedule to deliver all the care patients need. In fact, to provide all of the recommended preventive services and provide best practice care for patients with chronic conditions, the average PCP would have to work 18 hours per day. Adding in the time needed to provide care for acute health conditions brings the total hours per day to 22.6 hours (Institute for Healthcare Improvement). Let behavioral health specialists lighten the load.
Screening all patients for depression and anxiety with validated instruments like the PHQ-9 and GAD-7 is a starting point. Quartet provides this service. In addition, when a patient is newly diagnosed with a chronic health condition, struggling to manage their current condition, or has a decline in their health, physicians can refer their patients to behavioral health providers who can support in the management of their condition.
Brian Costello MD is a Clinical Program Development Associate with Quartet. Prior to joining the Quartet team, he developed Aging Well, a wellness program for seniors, and worked as a healthcare consultant.
The polls have been closed for nearly a week, the ballots are almost all counted, and the electoral college has spoken: Donald Trump is our president-elect.
The web is bursting with analysis, commentary, and prognostication from every conceivable point of view. A new administration always raises questions about what the next president’s path will be and given the areas of focus from Donald Trump’s campaign, many of us are looking forward to additional clarity around policies that will be set into action, especially around mental health and healthcare in general. Right now, the country is watching and waiting with some uncertainty, yet forward-looking anticipation of what’s to come.
This deep breathing exercise went viral the night of the election. It is actually a visualization of controlled breathing - an effective tool employed by patients suffering from Generalized Anxiety Disorder.
A high degree of uncertainty can actually have a negative effect on our collective mental health. A Vox survey of 7,000 voters on election day found “anxious” to be the single most common feeling among their readers, even before election results started coming in. In the weeks leading up to the election, mental health care providers were seeing a drastic increase in patient volume owing to “presidential election anxiety.” Most alarmingly, in the days following the election, calls to suicide and crisis hotlines increased 200% in some areas of the country.
The need for easily accessible mental health care is as great now as it has ever been, and at Quartet we are committed to helping everyone get the care they need.
So what does Trump’s election mean for us, and for mental health care in general? Without policy specifics, it is hard to say. At Quartet, we were encouraged when Hillary Clinton released a comprehensive mental health agenda, which promised to go far towards further integrating mental and physical health care in the US. Obviously we acknowledge that Trump and Clinton’s policies and priorities differ, but we hope that the Trump administration looks to the very real need identified by the Clinton campaign. Regardless of political affiliation, mental health is a non-partisan issue that affects everyone.
At Quartet, we also understand that the Affordable Care Act has both allies and enemies in Washington, but despite its challenges, a great many more Americans have health insurance today than would have without it. More people with health insurance means more people who we can connect to excellent mental health care. We hope that the next iteration of the ACA continues to offer all Americans the health insurance plans they need to stay healthy.
Moving forward, Quartet continues to approach the future with optimism and the knowledge that we are growing rapidly and helping thousands of people every day.
Ben Duchac, RN, is a member of the Product team at Quartet.
those of you who attended our "Expanding Access to Integrated Behavioral
Health through Technology" physician event last night, thank you
for being a part of the conversation! The event was a huge success, and we’re
so excited to be building the future of collaborative care with our provider
partners. Read on for a summary of what went on, some key takeaways, and
lessons from our speakers.
At Quartet, we spend a lot of time explaining what we do, and helping people see why our mission is one that GV (formerly Google Ventures) believes in deeply. At our event, Dr. Krishna Yeshwant of GV shared insights from his clinical background and expertise in order to shed some light on those questions. GV has begun to invest heavily in health tech companies, allocating more than one third of their investments to health and life sciences.
We understand that level of investment—we believe forward-looking experts like Dr. Yeshwant are at the forefront of a health tech revolution. As we work towards seamlessly connecting the millions of patients in need to mental healthcare, we have begun to see that mental health is going to be one of the giant public health challenges of the next decade, on the scale of diabetes, smoking, or obesity. To truly drive the scale of the problem home, we heard from Dr. Charles DeShazer, a physician executive at Highmark Health. He showed us that things are truly coming to a head in this space—mental health care costs are over $200 billion annually in the US, and primary care physicians have simply too short of time to adequately address this incredibly complex problem. We intend to be at the heart of the elegant solution that gets great mental healthcare to everyone who needs it, and we are thrilled that GV and Highmark see the same future we do.
So how do you develop technology for physicians who are overworked, under-supported, and tired of technologies that come between them and their patients? Brett Shamosh, Head of Product at Quartet, walked us through the physician-facing product and showed Quartet’s role in arming physicians with a tool that connects patients with behavioral healthcare.
After the product demo, Jeff Soffen, General Manager, Pittsburgh, Quartet showed how far we’ve come, and how where we have to go. Despite our best efforts, today’s medical society is still divided into silos, and integrating care across specialties takes tremendous effort. We recognize that our partner providers are going the be the vanguard into true collaborative care, reaping the benefits of both healthier patients and more time in which to see them.
We’ve been on an incredible journey in Pittsburgh, and we’re a long way from where we were when we first launched. We are still pushing forward every day—learning, building, and pushing forward for our incredible providers and their patients. We have so much more that we’re excited to do, to share, and to achieve—and we can’t wait to share it with you.
excited to share that our very own Jeff Soffen, General Manager, Pittsburgh, is
featured on Highmark
Health's blog for our partnership with Highmark Inc., and the
role we play in bringing integrated behavioral health to Pittsburgh.
In addition to being personally driven by Quartet’s mission, Jeff is a passionate champion of Quartet’s partnership with Highmark.
"I decided to join Quartet after seeing the health care system fail my family members who were struggling with behavioral health conditions. After meeting our founder and CEO, Arun Gupta, I was convinced he had the mission orientation, passion, and industry experience to build a company that would change the way behavioral health care is delivered in this country."
One in five Americans experiences a behavioral health condition each each - a fact that continues to motivate Jeff on a daily basis.
"Tens of millions of individuals experience behavioral health issues each year, and a large proportion of them have co-occurring chronic physical issues. So, for example, a person is battling depression or alcoholism, which impacts their ability to manage type 2 diabetes — and maybe having a chronic disease contributed to developing depression or alcoholism in the first place. People with multiple challenges like that understandably tend to have poor health outcomes across the board, and tend to incur high health care costs as well."
To learn more about our partnership with Highmark Inc., click here.
To read the blog post, click here.
Today we announced our partnership with Premera Blue Cross, the largest health plan in the Pacific Northwest. Together, we will deliver integrated behavioral healthcare to individuals across Washington state.
“The Premera team understands the value of integrating behavioral health supports into the primary care setting, and the importance of behavioral healthcare to the overall health and well-being of its members,” said Arun Gupta, founder and CEO of Quartet. “We are excited to partner with such a market-leading innovator to bring Quartet’s services to the state of Washington.”
This is the third geographic market for Quartet, which is active in Pennsylvania with partner Highmark Inc., one of the ten largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company, and in Massachusetts with leading provider systems Steward and Lahey Health.
Today we're excited to be featured on Pittsburgh's NPR news station 90.5 WESA for our partnership with Pittsburgh-based insurer Highmark and our work to make behavioral healthcare more accessible and integrated into primary care in Western Pennsylvania.
The story features the voices of Highmark executives, primary care and behavioral health providers, and Quartet CEO and Founder Arun Gupta.
"Quartet offers a program (to Highmark providers) that can bring behavioral and physical health together in one streamlined process. The system is best designed to send the patient to the mental health provider who can best serve their needs," summarizes reporter Mark Nootbaar.
Quartet and Highmark, one of the largest health insurers in the United States and the fourth largest Blue Cross and Blue Shield-affiliated company, launched our partnership in June 2016.
Quartet works in partnership with payers, primary care physicians, and behavioral health providers to get patients engaged in the right behavioral healthcare - dramatically reducing the complexity and wait times for patients.
To read and/or listen to the full NPR story, click here.
Quartet is honored to announce that we’ve ranked in the top 100 of Modern Healthcare’s list of Best Places to Work in Healthcare for 2016.
The recognition program, now in its ninth year, honors workplaces throughout the healthcare industry that empower their employees to provide patients and customers with the best possible care, products and services.
Over the past year and a half or so, we’ve been fortunate to assemble an amazing group of talented Quartetians who care deeply about our mission to reinvent the way healthcare is delivered to millions of people. People are our greatest asset and would not be where we are without enormous contributions from the team.
We’re dedicated to making Quartet an even better place to work in the years to come. If you’re interested in joining us on this journey or want to learn more about what it’s like to work at Quartet, please visit https://jobs.lever.co/quartethealth or e-mail Talent@quartethealth.com.
This is the final of a series of patient stories written by Quartet’s team of clinical leaders in recognition of Mental Health Month.
My daughter is a strong, funny, energetic person with great friends and a wonderful sense of adventure. When she graduated from college a few years ago, she and her best friend headed off for Spain to walk the Camino de Santiago before settling into their jobs and adult lives. As parents, we were so proud, a bit anxious and envious for what lay ahead.
The walk was a huge challenge – blisters, bad beds (with bed bugs), snoring neighbors and unsettled weather – but also one of the most formative experiences of their lives. They met amazing friends, had great adventures, drank cheap wine and ate well. They came back incredibly strong – physically, mentally and emotionally.
After returning to the States, our daughter headed off to Washington DC to start the next great phase in life. About a month later she started to have symptoms of depression and anxiety. While we were worried, we were not too concerned, as she had experienced similar issues for several years – usually coinciding with the change of seasons and shorter days. She also started a course of SSRIs (Selective Serotonin Re-uptake Inhibitors), to which she had responded very well to in the past.
It quickly became apparent that this was not to be one of her “typical” episodes. Within weeks, she became very despondent and showed significant impairments in performing her usual daily activities. Luckily, her friend’s family lived in DC and they knew a well-respected psychiatrist in Washington who agreed to take her as his patient. Offering both counseling and medication management, he diagnosed significant anxiety and prescribed clonazepam, a benzodiazepine.
Clonazepam is effective in treating anxiety and panic disorders, and it worked really well for our daughter. However, while clonazepam is a very effective drug to treat acute anxiety, it is not a great long-term drug. Her doctor determined that fluoxetine (Prozac) would be most effective for her on a longer-term basis.
After carefully titrating her fluoxetine to get to an effective dose, our daughter returned to her usual driven, engaging and funny self! We were so relieved!
A few weeks later, my daughter’s psychiatrist decided that she no longer needed to be on both fluoxetine and clonazepam. They made a plan to stop the clonazepam beginning on the first of the month – and she was ready. Unfortunately, neither the doctor nor my daughter wrote down the plan, just the date for putting it into motion. The first of the month came, and our daughter started the plan as she remembered it…
Two days later she called me and said she was feeling “funny” but seemed under control. A day later she called and was starting to panic – she felt ‘weird,’ anxious, and was having a very hard time coping. It seemed to me that she was having clonazepam withdrawal symptoms. I asked her how she stopped her clonazepam and she said she was told to just stop it…so that is what she had done. I asked her to call her doctor and tell him about her symptoms and to ask him what she should do. Over the next day we spent a lot of time talking to her on the phone, checking in, and making sure she was managing things okay. We learned her doctor was taking a long time to respond to her despite multiple messages to his office.
The next day I got a call a parent never wants to her: “Dad, I need a plan.” I immediately called her doctor’s office and got a voicemail that said “If this is an urgent issue, please call my mobile.” I called that number and got another voicemail - to which I said “This is Dr. Wennberg and I need to talk to you urgently about your patient – my daughter.”
I received a call within an hour of leaving the voicemail with the doctor. I described what my daughter was feeling, what I was worried about and that she had stopped her medication on the first of the month. He said “I didn’t tell her to stop it, I told her to taper it…”
After our conversation, my daughter’s doctor started her back on clonazepam and she immediately experienced resolution of her severe symptoms. Once she was stabilized, he started her on a long-term clonazepam taper that worked without causing any withdrawal symptoms.
So what did this clinician Dad learn? First, it isn’t what your kids say, it’s what they hear AND if it’s really important, you should write it down. Second, there needs to be a shared space where patients and their providers can develop and carry out a mutually-understood treatment plan.
And finally, most doctors – particularly the good ones – have busy schedules and are oftentimes booked with back-to-back patient appointments. Due to this, many doctors and their practices could benefit from tools and supports in managing patient interactions that need to occur in between appointments. These types of tools will ensure their patients receive the advice and care they need to get better.
Mental illness touches us all. It’s time to start talking about it.
I am the Founder and CEO of Quartet, a clinically-guided technology company that is improving access to needed mental health services by integrating the physical and mental health care worlds.
Virtually every one of us has witnessed the heartbreaking consequences of a healthcare system where mental health services have been kept in the shadows - disconnected, stigmatized, expensive, and spectacularly difficult to navigate. Improving access to care for those in need was the motivation for me to start Quartet.
Mental Health Month is all about eradicating the stigma associated with mental illness, a key piece of the puzzle. The growing number of high-profile voices speaking out about mental health - celebrities like Kristen Bell, First Lady Michelle Obama, Duchess of Cambridge Kate Middleton, and former Congressman Patrick J. Kennedy (who serves on Quartet’s Board of Directors), to name a few - underscores the fact that mental health is coming out of the shadows, finally.
An estimated one in five Americans lives with mental illness, and about two-thirds of them have co-occurring medical conditions. The consequences of failing to treat mental health issues are particularly disastrous for this group, who are seeing the healthcare system a lot yet rarely receiving effective treatment for their mental health conditions.
There has to be a better way. Mounting research tells us that goal-oriented treatment pathways delivered in collaboration between mental and physical health providers leads to dramatically better outcomes for patients. What’s more, many mental illnesses are treatable - not in years, but in months. In other words: mental illness is not a life sentence. Integrated care is taking hold as a movement - one to elevate the practice of behavioral medicine out of the shadows, and into the fabric of primary care as equal parts of the team.
Quartet was designed to meet those in need where they are. We do this by equipping primary care physicians with a host of resources for their patients, such as access to a curated and collaborative behavioral specialist network and convenient, technology-enabled care channels like telemedicine, online cognitive behavioral therapy, and asynchronous texting-based therapy. It’s a huge step forward toward improving access in an integrated fashion that addresses total health.
Over 50 million Americans live with mental illness - it is literally everywhere. It’s time to start thinking about it no differently than diabetes, heart disease, or any other chronic condition. To me and our growing band of collaborators at Quartet, it is a moral imperative that we put our best creative, engineering, product, clinical, data, etc. talents to work on increasing access to care for all those in need. We are constantly on the lookout for amazing team members, provider partners, and individuals who share our passion and sense of urgency around this work - if you are any of these, please connect with us: email@example.com, Twitter or Facebook.
This blog post was originally published on Medium on May 25, 2016.
This is the first of a series of patient stories written by Quartet’s team of clinical leaders in recognition of Mental Health Month.
Keep Hope alive - and help her thrive
Just another case of “medical non-adherence”
Meet Hope, a woman in her 30s from the Tenderloin in San Francisco where all too often so many get deeply drawn into years of heroin dependency and the inevitable downward spiral of destruction. Fortunately, Hope worked very hard and remained clean for over a year. Unfortunately, during her recovery, she was diagnosed with HIV – the reason she came to me, an infectious disease specialist. It was 2007 and, at least in the U.S., HIV was treated as a chronic illness. Hope only needed to take her medications and she would be just fine.
Every clinic visit conversation would be the same: “How are your medications going?” “Oh fine – yes, I’m taking all my medicines,“ Hope would respond. But her numbers said otherwise. HIV counts were high and her immune system started to shut down – she was at risk of developing serious infections. We sent viral DNA sequencing tests but there was no evidence of drug-resistant mutations. I called her pharmacy and learned that Hope missed refilling her prescription a few times. I asked her about this and she said she was struggling to remember when to take her medication given multiple pills at different times. We started a new, one-pill once-a-day drug but still no progress. In her chart, we recorded Hope’s case as one of “medical non-adherence” – someone who simply does “not follow doctor’s orders.”
Three months later I was on service as the in-patient infectious disease consultation physician and received a call that Hope was admitted to the ICU with Pneumocystis pneumonia (PCP), a common presentation of HIV/AIDS from the 1980s. She remained on the ventilator for a week but ultimately, improved and transferred out of the ICU to a normal hospital floor bed. It was her first brush with a near-fatal infection – something we or, more importantly, I could and should have helped her avoid altogether.
No health without behavioral health
I needed to get to the bottom of what was preventing Hope from taking her medications. I went to her room determined not to leave until I had answers. Yes, there was some frustration with Hope, but personally, I knew I was much more frustrated with myself. I started by asking why she was not taking her medications and she responded with the usual “It’s hard to remember,” or “I’m too busy to pick up my medications.” But I kept pressing – deep down I knew there had to be another reason. A good thirty minutes later, Hope opened up. Because of her heroin dependency, she lost custody of her daughter and moved back in with her mother. She told me how ashamed and depressed she felt about her HIV and struggled to cope with this in addition to all that she went through. She was hiding her diagnosis from her mom and refused to take pills in front of her. She knew this was unsafe but she was afraid to lose her mom’s support. Needless to say, I was simply blown away that Hope was dealing with all of this on her own. I never took or simply had the time to hear how she was personally dealing with her “new normal” as a person who had recovered from heroin but also with HIV. I had been so focused on treating her “medical” condition that I neglected to check and help her underlying “behavioral health” condition.
Modern medicine – maybe not so modern
Society as a whole takes strong pride in scientific progress as we should. Case-in-point: the transformation of HIV as a fatal diagnosis to a chronic condition in only about 15 years time from the emergence of first cases in San Francisco, Los Angeles and New York. However, too often physicians and clinicians fall prey to the notion that a simple pill can “make it all go away.” We become too intent on diagnosing medical conditions, prescribing medications, and then moving on to the next patient (all under 12 minutes or less). It’s all too easy to forget we are treating whole human beings with feelings and what’s more powerful - often unrecognized, emotional forces that affect behaviors so integral to that person’s health. My miss of Hope’s underlying anxiety and depression happens millions and millions of times across America everyday resulting in unnecessary disease progression, escalation of care, and ultimately, suffering for patients and their loved ones. For healthcare to truly advance we must address health of mind as equally important as health of body. We must integrate expertise and guidance of behavioral health providers (social workers, psychologists and psychiatrists) with traditional physical health providers – and do so in fast, rapid, scalable ways to create a paradigm shift in care that achieves highest value.
Endnote: Another chance for Hope
Once I learned about Hope’s predicament, I immediately informed the team of social workers, case managers, and nursing staff. After a few more conversations we helped Hope understand she had resources, support, and people who genuinely cared and were ready to help. Hope agreed to have a heart-to-heart with her mom to reveal her HIV diagnosis and it was an immense relief for her to know that her mom was utterly supportive and committed to helping her get better. From that day forward, Hope started taking her HIV medications and was never admitted to the hospital again. To date, she continues to thrive with a new, positive outlook on what lies ahead.
This post originally appeared in The Huffington Post on February 25, 2016.
Delivering health care has become too complicated.
We are screening for, discovering, and treating disease more frequently; people are living longer; and a greater proportion of the population is entering Medicare age – all leading to increasingly complex patients. It’s no surprise that health care costs have finally surpassed $3T. With increasing patient complexity and rising costs, the demands placed on physicians have increased in parallel.
Primary care physicians and specialists alike are being asked to coordinate more and more streams of information - whether from pharmaceutical companies, insurers, hospitals, or other providers. The administrative burden on those physicians has grown to rival the clinical burden. Yet even as more is asked of physicians, not enough has been done to create efficient systems to help accomplish those tasks.
Ripe for Clinical Transformation
One area of health care in need of clinical transformation is the integration of behavioral and physical health. More than 17% of American adults suffer from comorbid behavioral and physical health illnesses, translating to greater than 34 million people. Studies have shown that people with physical health issues (heart failure, for example) and an untreated or undertreated behavioral health issue (such as depression or anxiety) cost 2-3x more for treatment of their physical conditions. Per 2012 data, those patients accounted for almost $300B annually in excess and partially avoidable health care spend, mostly attributable to use of medical (as opposed to behavioral) services.
In any discussion of bending the health care cost curve,
differences of that magnitude are impossible to ignore. Such cost variation
occurs for multiple reasons, including patient non-compliance, increased
utilization of high-cost and fragmented care (i.e. emergency room visits,
inpatient admissions, repetitive/redundant treatments, etc.), and lack of
improvement in a person’s health status, amongst others.
Growing Silos in Care
Over the last 30+ years, the silo between general medicine and behavioral health has only grown. Care in both realms is often provided independently of each other. Treatment regimens and access to resources have become increasingly separate with little to no overlap. Some medical practices have tried to place behavioral health providers (i.e. social workers, therapists, psychologists, and even psychiatrists) in primary care offices, though that’s an expensive proposition and difficult to scale. Mostly, primary care physicians and some specialists have been trying to manage behavioral health issues on their own with only 1 of 4 patients receiving effective care. When formal behavioral health services are required (for example, intensive outpatient treatment), many of those providers have little idea what resources are available or how to access them.
As an attending Internal Medicine physician, I’ve lived that predicament far too many times myself. I remember one recent case of a late-30s man with a history of alcohol and IV drug addiction that had left him with end-stage heart failure. Anytime he developed anxiety or stress, he’d have chest pain and usually come into the emergency room (ER). Since this man had severe heart failure, his cardiac lab results would always be abnormal, and he would invariably get admitted for further evaluation. In one year, this man had been admitted more than 10 different times from the ER for chest pain. Cardiologists and psychiatrists alike agreed his chest pain was largely related to worsening anxiety and depression. What this man needed most was regular access to outpatient behavioral health resources and a tangible care plan to help him cope with his poor prognosis. But despite my staff’s best efforts, we had so much difficulty getting him that access and were never able to break his cycle of hospitalizations.
How much better off would this man be if we could have found appropriate, timely behavioral health resources to support him outside the hospital? How many long-term health care dollars could we have saved? And what if we could have helped him with his addiction and behavioral health issues before he ever developed heart failure? I think about those types of questions almost every day – whether with this patient or others. Almost every physician can think of similar examples in their own practice.
Need for Change
Questions like those above have led to the necessary realization that current health care processes need to change - especially in ways that don’t add to physician workload or confuse patients. It’s naïve to think behavioral and physical health are entirely separate. Physical illness impacts a person’s psyche, and that person’s state of mind impacts his/her ability to manage chronic disease.
Collaborative care and value-based health care are common buzzwords and occasional punch lines in health care circles today. However, there is tremendous value in creating better, well-coordinated opportunities for partnership. Enhanced integration between physical and behavioral health is one logical target in improving the broader health care landscape. It is a very real gap in clinical care, makes complete economic sense, and is the right thing to do in promoting true patient wellness. But most importantly, patients and providers alike need and deserve it.
 I.e. traditional mental health conditions (i.e. anxiety, depression, etc.) and substance abuse
 I.e. medical conditions affecting the body
 In medicine, comorbidity is the co-occurrence of two or more disorders in the same person, regardless of the chronological order in which they occurred or any causal pathway linking them
Quartet hosted an event with the Association for Behavioral Healthcare, a statewide association representing over 80 community-based mental health and addiction treatment provider organizations, on Thursday, February 11 in Framingham, Massachusetts . Leaders from the behavioral health organizations in Massachusetts attended the event, which included the following speakers: Congressman Patrick J. Kennedy, a member of our board and author of the Mental Health Parity and Addiction Equity Act; Juliana Ekong, MD, our Chief Medical Officer; and Brett Shamosh, our Chief Product Officer.
Attendees viewed a Quartet product demo and tutorial provided by Brett Shamosh. Patrick J. Kennedy and Juliana Ekong discussed the current landscape of behavioral healthcare in our country, as well as how Quartet's technology is allowing primary care and mental health providers to collaborate and care for patients.
We will continue hosting events and partnering with state-based behavioral health organizations in order to vocalize the need for primary care-mental health integration and educate providers about our technology solutions.
There is no replacement for experience, and no perspective more insightful that of those who have been there – especially when the “there” refers to mental healthcare delivery and treatment.
As a social worker, Theresa Nguyen, LCSW, Senior Director of Policy and Programming at Mental Health America, has over a decade of experience as a clinician, educator and mental health patient advocate. Working with children and adults suffering from serious mental illnesses, including those with both behavioral and physical comorbidities, Theresa has been focused on early intervention and pushing forward improvement in mental healthcare treatment and access across the nation.
What are some of the barriers to mental healthcare improvement, and how can technology address the many challenges that patient and providers—both general medical and behavioral—currently face in terms of care delivery?
Theresa shares her perspective with the Quartet team below.
Q. What do you feel are the biggest barriers to patients seeking and receiving treatment for their mental health conditions?
A. One of the biggest factors is that it’s really confusing for people. A lot of times, patients don’t get screened, so they struggle with their emotional problems for a while before realizing that what they are experiencing is actually linked to a mental health issue. And they can often end up struggling for a long time.
Another barrier happens when patients tell their primary care physicians (PCPs) of an issue or symptom they’ve been experiencing, but those doctors aren’t in tune to how those issues might actually indicate mental health concerns. For those PCPs who are in tune, they might not feel comfortable with or know the correct protocol for treating people with more severe mental health issues. A lot of time, PCPs are not connected with a behavioral health specialist that can support them in this process.
Families, too, are often consumed with their loved ones’ issues, but don’t know how to get help for their family member and for themselves. When they get to someone who can help, it’s really confusing how to talk to a behavioral health specialist or how to navigate the mental health system.
Also playing a part are workforce shortages. Sometimes the waitlists to see a behavioral health specialist can be months long. If a PCP has a personal relationship with a psychiatrist that can help immensely with providing a warm handoff, but all too often that’s not the case.
What it comes down to is that our systems are still siloed, and yet we’ve been talking about trying to fix this problem for the last decade. There is urgency behind the problem that Quartet is trying to solve.
Q. How can technology help patients get access to the behavioral healthcare they need?
A. The internet has been pretty awesome. Before the internet, where would patients start to get help? Now we have things like MHA Screening, where people can get free, confidential, and anonymous online screening for mental health problems. You have tools, like SAMHSA’s treatment locator, where you can enter your zip code in and find help in your area. And there are websites allowing people to search for providers, look at reviews, and find someone that they feel is a good fit. It’s a lot like finding a friend, or even dating! It’s more person-centered, gives patient more access and control, and gives them a good sense of a provider’s personality and specialties.
Also, mobile solutions, mental health apps and telehealth processes have all been a huge help. Some providers offer 24 hour care where you can call a provider and they call you back either for a phone or video chat.
Technologists have been striving to share patient records electronically and link providers up with one another. From a policy standpoint, we have wanted to streamline the sharing of both behavioral health and physical health records with one another for a while. This will only help ensure people can get the care that they need.
Q. For many reasons, behavioral health specialists and general medical practitioners are not coordinated in their treatment of mental health patients. What are some of the key reasons for this disconnect and how can we fix this?
A. Historically, part of the reason for this lack of coordination in public mental health is that the funding streams were completely siloed. There are also policy problems, like no same-day billing, that create significant barriers. This means that if you came in and saw your PCP, and the PCP then referred you to a behavioral health specialist right away, you might not be able to see them immediately because of the inability to do same-day billing. We are still working on fixing these policy issues.
Another issue is in relation to prior authorization and referrals from PCPs to behavioral health specialists. It’s like a toss of the coin whether or not PCPs and behavioral health providers communicate with one another after a patient has been referred. Essentially, getting good, coordinate care is really difficult, unless you are embedding collaboration into the framework, which is generally not what happens.
And as a practitioner, I’ve been in jobs where sometimes I had a case load of 100 people. How does a provider seeing so many people even begin to approach coordinating care well? I think that’s a role that technology can play. If you can streamline tech, and all providers can see the records, you have the ability to follow patients through their care delivery, and that’s a great help!
Q. The prevalence of patients suffering from both a behavioral and physical health condition is a growing problem. For example, 48 percent of patients who have depression also suffer from a chronic, comorbid medical condition. What steps do you feel the industry – whether providers, payers, solutions providers or policy makers – must take to better care for patients with comorbid behavioral and physical health conditions?
A. At the very least, providers need to ask patients the right questions. If I’m a behavioral health specialist, I should ask, “How is your physical health and do you think it affects your mental health?” and vice versa. General medical practitioners should ask, “Do you think your emotional wellbeing is playing a role in your physical health?” This way, patients and providers can begin a very necessary dialog. If, as providers, we don’t ask, potential conditions don’t get discussed or brought up as a treatable issue.
We can also streamline the sharing of information, remove barriers in billing, and remove the brick and mortar only structure. We can embrace the collaborative care model, which is built on integration. Any one of these steps is better than doing nothing.
When we take these actions we can ensure that we’re treating people early, before Stage 4, when things get much more difficult to treat. Every person in the system--whether you’re a payer, provider or policy maker--can identify a solution. There’s no one fix that can improve it all, but we can each do our small part to remove barriers and take action to improve it for the better.
Theresa Nguyen, LCSW is the Director of Policy and Programming at Mental Health America. Along with supporting MHA’s federal and state policy agenda, Theresa manages various programs including MHA Screening, Mental Health in the Nation, and Workplace Wellness. She was an adjunct professor in California and North Carolina teaching Mental Health Recovery, Psychosocial Rehabilitation and Social Welfare Policy. As an advocate her efforts focused on growing a consumer based mental health workforce, ensuring access to treatment, improving community based and recovery oriented mental health programs, and treatment for underserved communities.
Dr. Bob Spitzer died on Christmas day. He has been called one of the most influential psychiatrists of the 20th century. And he certainly was very influential on the way I practice psychiatry. From him, I learned how to cut through the chaos of human experience to form a diagnosis that could be understood in any part of the world. I learned how to distinguish between normal human experience and a mental disorder. And from him I learned about the importance of measuring disease progression using structured tools. In later years, I admired him from afar for his courage and example when he publicly revised his views on reparative therapy for homosexuality.
Dr. Spitzer was one of the co-creators of the PHQ-2 and PHQ-9 standard tools for screening and monitoring of major depression. The existence of such tools are arguably what have allowed for population-based, decision-tree approaches to mental disorders. They are what make a company -like Quartet Health - possible.
RIP DR. Spitzer.
Today marks the end of Depression Awareness Month. While the stigma that so often accompanies mental illnesses – even common conditions such as depression and anxiety – is decreasing thanks to increased education, awareness and acceptance, the topic of cost still gets swept under the rug. Of the nearly 15 million adults in the U.S. who suffer from depression, almost 50 percent have a co-occurring, chronic medical condition, and the cost implications are unsustainable for patients’ health and the industry at large.[i]
Did you know it costs $752 more per month to treat a patient suffering from depression and a chronic medical condition than a patient who only has a chronic medical condition? See below for more facts on the costs of depression and be sure to connect with Quartet Health on Twitter, LinkedIn or at www.QuartetHealth.com for more information on how technology is improving behavioral healthcare delivery and enabling cost control across the industry.
With the proliferation of technology in so many industries, the need for talented engineers to join software companies and solve massive technical challenges has never been greater. But the reality is that it takes more than an interesting technical challenge, a paycheck, and equity in a growing company to attract and retain top talent.
For me and the rest of the engineering team here at Quartet Health, we’re motivated by a mission to fundamentally change the way healthcare is delivered to millions of people, and this common goal has banded us together in a way I’ve never before seen in my career.
Our mission is to build a collaborative mental and physical healthcare ecosystem that enables every member of our society to thrive. Electronic Health Records (EHRs), which are intended to store and transmit patient information, have become much more prevalent in the past decade, but EHRs can’t guarantee collaboration between doctors.
In the mental health space, collaboration between a patient’s primary care doctor and therapist, psychiatrist, or psychologist is critical, and even more critical for those individuals with a co-occurring medical condition like diabetes or cancer. These patients experience poor, uncoordinated care and often get lost in our healthcare system. If you or someone close to you has ever suffered from a mental health condition, you know that these issues are not only hard on the individual, but for the family members and friends as well.
Our engineers are creating an ecosystem that allows doctors, social workers, psychologists, psychiatrists, insurance providers and, most importantly, patients to work together. We’re building tools like telemedicine, advanced online treatments, automated referral workflows, and online support communities into our platform to help patients get better. We’re also better identifying patients with undiagnosed mental health conditions and those who are at risk for developing such conditions.
Generating these insights and collecting the data we need requires highly advanced technology systems—distributed workflow orchestration services, data pipelines and analysis tools, a smattering of your favorite database technologies, and React front end apps, to name a few.
The costs of poor healthcare are too high for society, both economically and socially, and an influx of talented engineers into the healthcare environment can dramatically improve the quality of care both we and our families receive. Driven by purpose and motivated by mission, Engineering at Quartet is paving the way for the transformation of healthcare delivery, at a time when the need couldn’t be greater. If you’re into building great technology and solving meaningful problems, we want to hear from you.