Throughout his residency and his last three years as a physician in psychiatry training at Mather Hospital in New York, Dr. Tamir Aldad saw upfront how thousands of mental health patients each year were sent home from the emergency room knowing they might not get follow-up treatment for several weeks.
Despite the urgency of care needed amid the nation’s opioid epidemic and related mental health crisis, millions of Americans like the patients Aldad sees are treated first in an ER, but often aren’t able to see a psychiatrist even after being screened for anything from substance abuse or phobias to PTSD or potential risk of self-harm. Aldad says they aren’t sick enough to be admitted so they “boomerang back to the ER in a couple weeks with the same or worse problem than they came in for in the first place.”
“There are 70% of patients with mental illness who are sent home because their symptoms aren’t severe enough to be admitted, but they don’t meet criteria for admission,” says Aldad citing New York City hospital statistics.
In New York alone, Aldad says the wait to see a psychiatrist in an outpatient clinic or doctor’s office is four to eight weeks. And it may be worse in other parts of the U.S. given there is a nationwide shortage of doctors and psychiatrists in particular.
“You could go through the phone book and beg psychiatrists to see them or they could get an appointment to see a psychiatrist on Park Avenue today, but you would need $500 to $600 to see them,” Aldad says.
To fill these potentially life-threatening gaps in U.S. healthcare, the 33-year-old physician and University of Chicago Booth Executive MBA student has developed an award-winning startup called Mindful Urgent Care staffed by a team of mental health professionals including psychiatrists to increase mental health access and speed quality and affordable treatment to a population of patients with unmet needs.
For his efforts, Aldad won $140,000 in the University of Chicago Booth School of Business’ New Venture Challenge and Global New Venture Challenge competitions that have launched startups like online food delivery service Grubhub and payment processor BrainTree. He says he’s also landed another $500,000 in funding from additional backers to help him open his first 3,000 square-foot retail clinic in September in New Hempstead, NY. A second 2,000 square foot clinic will open in midtown Manhattan in 2019.
He’s also hearing from additional potential investors he’s not ready to publicly disclose, which could be key to a business plan he has to open 35 centers in the greater tri-state area surrounding New York City in New York, Connecticut and New Jersey in the next five years.
It’s a unique approach to a market not tapped yet by big retailers. Though pharmacy chains like CVS Health and Walgreens Boots Alliance are big into retail health clinics, both confirm they don’t for now have plans to build out or add mental health services.
Such facilities cannot open fast enough. For years now, the U.S. health system has lacked enough primary care providers like family physicians and internists as more Americans with a pent up demand for treatment gained the ability to pay under the Affordable Care Act. And mental health needs in communities across the country are becoming as critical, with no way of filling the void in sight. Behavioral health facilities, hospitals and addiction centers cannot find the psychiatrists they need.
“We face a broad range of mental health issues, including the acute problems of opioid addiction and increasing rates of depression and suicide,” Dr. Darrell Kirch, a psychiatrist and chief executive of the Association of American Medical Colleges said in a report earlier this year on the psychiatrist shortage. There are 28,000 psychiatrists in the U.S., but three in five are 55 years of age or older, AAMC data shows.
But Aldad’s strategy is to meet patient need through a mix of psychiatrists and “physician extenders” like nurse practitioners and physicians assistants with mental health and psychiatric specialties to better triage patients in order to replicate the consumer-friendly Mindful Urgent Care model that will be open 15 hours a day and seven days a week.
Though big chains haven’t yet jumped on the retail mental health clinic concept, there have been other public and private urgent care centers open up in the space.
Psychiatric urgent care pioneers include Broadlawns Psychiatric Urgent Care in Des Moines and a new state-funded effort in North Carolina launched by Alliance Behavioral Healthcare, a managed care organization that asked a group of therapists in Durham to create a clinic, according to a report earlier this year in North Carolina Health News.
“Because we use physician extenders and not strictly psychiatrists, we are able to scale our model,” Aldad says. “By no means are we trying to compete for business and take away from psychiatrists in their practices, but we want to get these patients treatment. We want to give medication and provide simple symptom stabilization so you as a patient has relief.”
For now, Mindful Urgent Care has contracts with more than 30 health insurance companies through the New York psychiatrists that will be staffing and supervising the staff at the retail clinics.
But Aldad is hopeful the model will be attractive to health insurers on a broader scale given the move away from fee-for-service medicine that emphasizes volume of medical care delivered. Instead, insurers emphasize value-based care that encourages patients to get better treatment upfront in a doctor’s office. Such value-based models measure and reward providers based on how well they care for patients, treating them more holistically.
Value-based models reach out into the community to make sure patients get the right care, in the right place and at the right time so it’s quality and low cost. Health insurers like UnitedHealth Group, Anthem and Aetna and many others are now paying out more than half of their reimbursements to doctors based on such value-based formulas so Aldad’s idea should have merit with health plans.
Prices Mindful Urgent Care plans to charge are expected to cost $175 for an initial visit and $80 for follow-up care based on the average of what Medicare and private insurance pays, Aldad says. Most patients have coverage so they would likely pay significantly less based on their co-payments, deductibles and related out-of-picket costs.
“In value-based care, patient outcomes really matter and what we are instead seeing now is that patients in mental health are costing more and more,” Aldad said. “It’s even more costly if that hospitalization for mental illness is preventable because they couldn’t get in for a medication refill or they couldn’t get into their doctor’s office for an appointment. We have an opioid crisis and we have to proactively trend and work on how to prevent illness.”
