Comment by ympatel | Hacker News Reader

Comment by ympatel | Hacker News Reader

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Great question, and I really appreciate you bringing that up. This is one that we get from many of our customers.

First, we have consulted with experts from across health care to implement the most rigorous quality standards for the professionals in our network. Not only do our clinicians have to pass tests of baseline quality (background check, licensure check, etc.), but they are also directly assessed based on their level of clinical expertise, years of experience, education level, etc. We even speak with all of our clinicians to do a basic sanity check and determine how they will present over video.

On the back end, we are currently creating processes to assess post-visit performance in a number of ways, including timeliness, patient satisfaction, etc. That will allow us to weed out lower-quality professionals and reward our higher-quality professionals.

Lastly, a key part of quality in mental health is continuity of care (a longitudinal patient-clinician relationship). Features in our product allow for our customers (health care organizations) to view our clinicians' availability and directly schedule their patients to match that availability, such that the relationship is maintained. Then, we have a number of ways (one of them being highly favorable compensation) to ensure that our mental health professionals stay with us.

I hope this helps, and happy to explain further.

I don't know about this. Most psychiatrists I've known have always recommended to meet in person rather than holding something over call. Always set up extra appointments and made time for them at no expense. The ones who would do anything lower than that would come off to me as sub par (and I've had online psychiatrists too, and all of them were subpar).

Interesting observation, and this very much was likely the case for private practice psychiatrists pre-COVID. Now, we are seeing that more mental health practitioners (high-quality included) have become comfortable providing care over video because care quality is actually the same (several studies show this), no-shows are reduced for the psychiatrist (equals more revenue), and patients really prefer it.

Furthermore, psychiatrists who take insurance or who are affiliated with a hospital/telehealth/other health care institution (i.e. not in private practice, plus these are the health care companies that are our customers) are more likely to bill for extra appointments because rates are lower than in private practice (although equal regardless of in-person or over video due to government mandates) and because the customer is less price-sensitive anyway as insurance is footing some of the bill. Therefore, these (still high-quality) folks just have different behavior patterns based on payment and based on response to COVID. I hope that helps.

Very true observation there is a lot of unpaid work that happens for patients in crisis

Do you have a triage system in place where you have a phd level provider that diagnoses and funnels to the appropriate level person to do ongoing treatment? Also why would Good provide join your team what are you offering that makes you competitive to a provider.

I actually really like that idea because it fits into one of our longer-term visions of providing an off-the-shelf turnkey "care team" solution, whereby a cadre of professionals work together to provide care for our customers' patients.

Currently, we don't have such as system in place, but our customer might! In that case, a customer might use a PhD or mD from us to provider higher levels of care and then a social worker or nurse to provide ongoing higher-touch treatment. We are simply providing the health care professionals (and their time) to augment a health care organization's existing staff.

Per your second question, that's actually one of our competitive advantages! Right now, we are finding that many awesome providers who are already reputably employed at a hospital, at the VA, etc are looking to make more money (by the way, the fact that they are already reputably employed is a good screen for quality too). They would like to work an additional 10-40 hours on top of their main job in the mornings, evenings, days off, and weekends. That is a large source of potential supply that is going unused and that could help so many people! Simply put, we offer these providers a chance to make more money by using their expertise to see more patients whenever they want. We provide the patient volume and the competitive rate. All providers have to do is show up and provide the excellent care that they already do.

There are a couple issues I see with this model.

1) Credentialing is super slow in medicine and probably quite expensive. It will take your provider months to come online.

2) If you aren’t paying high at 65-70% of billable rates you will have trouble finding providers that want to go through all that hassle when they can just work more hours at their regular job.

3) It’s not clear to me that you are doing anything different than what a regular private practice would do. Everyone is full online now post pandemic so they are mostly limited by availability of clinicians. They could hire parts time folks and offer the same deal I think many just choose not to. You would get stuck with all the compliance costs and little actual revenue.

Thanks for highlighting these issues.

1. Credentialing is definitely super slow. We want to get to the point where we can handle billing for our customers as well, so we'll have to create relationships with payers to speed the process up. Right now, many of our customers and clinicians are already used to this long process, so nothing is really different here.

2+3. We are providing the patient volume at 0 cost to the clinician. This is all just extra income for the clinician at the cost of their time, regardless of whether the clinician is in private practice or working for a hospital with a fixed salary. Opportunity cost requires for the private practice to do marketing, etc to drive patient volume to them. Also, the private practice, again, has the same problems around recruiting and scheduling that a hospital would have.

What you describe is not 0 cost. You take some sort of cut for services provided, that’s what a private practice does. In exchange for patient flow computing scheduling compliance and billing they charge 30-40% of the patient bill. In a modern work from home environment a provider could contract with a local urban private practice and offer part the hours for the same arrangement. The only real difference is they would have to interview and provide stable ability, the work can be fully remote otherwise. Also typically the practice takes a higher cut if you work fewer hours.

I think that's precisely why we're needed. With the scale that we plan to have, we can actually provide stable patient volume and deal with all the pains of recruiting and onboarding. Every smaller organization otherwise will have too much difficulty piecemealing different clinician availabilities together to create FTE(s)

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