How QLER and Bluestream are Writing the Future of Telepsych

The number of people seeking care for behavioral and mental health in the U.S. has been steadily increasing over the past decade, but the number of psychiatrists is dwindling. 

More than half of the counties in the U.S. don’t have a psychiatrist. Seventy percent of behavioral health patients who visited emergency departments waited over 10 hours to see a psychiatrist. And 80% of emergency department physicians believe their health systems aren’t providing the best care for those with behavioral needs. Emergency physicians believe the increase in behavioral health patients is negatively affecting the delivery of emergency medicine. (source: QLER.com) 

And this is before the COVID-19 shutdowns, curfews, and shelter-at-home orders that disrupted daily life and fueled 2020’s increase in reported anxiety and panic attacks, depression, suicide ideation, and substance abuse. We’ve yet to realize the lasting impact of these shutdowns once our typical social behaviors are no longer on pause. But it’s clear that the need for psychiatrists will only increase, outpacing the number of available mental health professionals. 

So is there a magical button to push that will ramp up production of trained, talented and experienced psychiatrists to meet this growing demand?

You’d be surprised, but the answer is almost “yes.”

No, I’m not talking about cloning doctors, rushing people through med school, or denying retirement to the 60% of psychiatrists who are over age 55.

What Is QLER?

The magical button is actually much simpler. In fact, it’s QLER (pronounced “clear”), a psychiatric medical group that uses telehealth to deliver clinical care. QLER connects highly qualified psychiatrists with the hospitals and clinics who need them, exactly when they’re needed. Hospitals, emergency departments, and community health centers who partner with QLER are only a click or tap away from connecting to a skilled psychiatrist within 30 seconds.

In 2017, QLER set out with a goal to be a physician-led organization that would make a direct impact on healthcare and systems across the U.S. From their own clinical experiences, the core founding team knew psychiatry was a growing need. They keenly felt the lack of psychiatry resources available to help their patients. As an organization, QLER wanted to create a virtual solution that would allow trained, highly qualified psychiatrists to be in many places at once, to serve a greater population and a wider range of regions. 

William Cahoon, COO, QLER, explains: “QLER gives health systems and clinics the opportunity to integrate real time behavioral health into their care processes economically and effectively. Those who partner with QLER increase access to care in a timely fashion that improves patient and clinical results. We also optimize physician schedules, making it possible for them to see more patients.”

QLER initially focused their efforts on emergency departments, where there was the most acute need for 24/7, on-demand access to behavioral health care. Because people presenting at the ED with behavioral health needs typically have serious and time-sensitive medical conditions, QLER needed to find a technology partner that could consistently provide immediate video connections. QLER also required HIPAA-compliant operational reporting to better utilize their resources. And QLER needed a platform that would allow for queueing, patient follow-up, order writing, and more across multiple locations and classes of care for their enterprise clients.

“Other vendors offered their video capabilities, but fell down in their applications of driving outcomes. We wanted to truly impact care, not just offer video conferencing with our network of psychiatrists. Effective care is what is really needed, not just a video call,” says Cahoon. “Bluestream was the logical choice because they offered us the right workflows and processes, so our partners could have access to the right providers. There’s a whole ecosystem involved.”

How QLER and Bluestream Health Partnered to Drive Behavioral Healthcare Access

Bluestream Health’s patented provisioning engine is the driving force behind QLER’s efficient, flexible workflows, enabling QLER to facilitate the connection between a hospital and a psychiatrist as soon as it is needed–within 30 seconds.

For example, if a patient in an ER needs behavioral health care, a nurse opens a tab within the EHR to request a psychiatric consult. QLER, powered by Bluestream, connects the best-suited, next available psychiatrist to this request. (If no psychiatrists are logged in, those within the network are notified about the request and can choose to take the call.) The psychiatrist connects with the patient in as little as thirty seconds in a secure, encrypted, web-based video call. In this way, the hospital, patient and psychiatrist all benefit from the efficient virtual care model.

After QLER’s initial success in helping hospitals reach their patient care goals in emergency departments, QLER expanded their offerings to support integrated clinic services on a more scheduled basis and also for inpatient unit attendings. QLER facilitates tens of thousands of virtual consults every year. They continue to attract highly qualified psychiatrists who want to work at the top of their license, providing care for people regardless of geographic location, without being hampered by complicated technology.

“Bluestream facilitates the connection points, eliminates the extra phone calls and having to go back and forth. It simply routes a request to the correct provider at the right time, which allows us to lean into our service level targets,” says Cahoon. “We’re on the path to becoming a national group of 250 psychiatrists and providers–the largest in the U.S., working within teams engaged in unique models of delivering care. Bluestream will make it possible for us to scale and impact national healthcare.” 

QLER shares Bluestream Health’s philosophy that virtual care doesn’t start and end with a simple transaction, but should engage patients throughout the entire care continuum. By participating in quality programs with their partners, tracking engagements, predicting staffing needs, and making it simpler to integrate access to psych services into every day care, delivery and wellness, QLER provides critical behavioral health services in a non-reactive way. They serve community based clinics and set up virtual clinic hours to become more longitudinal in the care spectrum versus episodic.

“If we can intercept and treat people early on, keeping them out of the emergency departments, that would be fantastic. But even if we are successful in that mission, those who do present at the ED will be the highest acuity. The sooner you can treat that patient, the better the outcome,” says Cahoon. “And we want to do more than just see the patient that one time. We want to be able to track what happened, help them achieve a better outcome in the long term. Bluestream’s technology and workflow help us achieve that.”

What’s Next in Telepsych?

As the nation emerges from our collective quarantines and assesses the damages, it’s imperative that we facilitate even better behavioral healthcare than ever. Awareness of mental health continues to be key along with greater access to available resources. 

Cahoon agrees. “The beauty of telemedicine and our delivery model is that wherever you have a patient need, we’re able to introduce those resources into your hospital,” he says. “Tele is the modality in which we can expand that access to care and the efficiency of care to where it’s needed most. We hear from our partners and our patients that behavioral health is a specialty that is served well by video—talking to a screen versus talking to someone face-to-face is a lot easier. Even the ease of the clinical encounter is better for those who are highly depressed or who simply don’t want to leave the house.”

The regulatory changes brought on by COVID are already helping telepsych and other telehealth services move from being a niche option to an accepted, meaningful care delivery model. State and federal support of telehealth, of virtual care, are critical to supporting overall health, behavioral and mental health included. Our resources—the number of licensed psychiatrists—may be limited for now, but pressing the “magic button” of virtual care will make this resource more available and accessible to many. We’re confident that the QLER and Bluestream partnership will continue to scale to meet the nation’s growing needs for mental health specialists.