Prioritizing Mental Health Through Automated Patient Screening
By Brian Lee
In the aftermath of COVID-19, the United States has experienced unprecedented increases in anxiety and depression¹, highlighting the need for advancements in patient behavioral health screening and diagnosis. In response, last year, Oscar Medical Group’s Virtual Care team (which provides Primary Care and Urgent Care virtually for Oscar’s members) introduced a new screening mechanism within our existing patient intake process to better identify these conditions and enhance the quality of care for the 1M+ patients we serve.
A Brief History of Oscar’s Patient Intake:
Patient intake refers to the process of gathering and reconciling a patient’s medical history and current health concerns before or during their virtual appointment. Since 2023, our goal has been to make this process as efficient and automated for both our patients and providers as possible. Our efforts towards automation aim to (1) maximize the time providers can spend face-to-face with patients and (2) minimize the time providers spend on administrative tasks, thereby increasing efficiency and preventing burnout.
In September 2023, one of the features we implemented in our intake automation efforts was “24hr Check-in”, prompting patients to provide health information 24 hours before their virtual appointments (similar to checking in before an airline flight). While our long term goal is to automate all pre-appointment data, our MVP included medications and allergies as they are most pertinent for our providers. Thanks to Oscar’s fully integrated in-house Electronic Health Record (EHR) system, the collected patient information flows directly into the patient’s digital medical record. Prior to the virtual appointment, providers can see what medications and allergies the patient has confirmed, edited, added, or removed. This means that by the time of their visit, the provider is armed with the right information to facilitate a focused and efficient appointment, where the provider can spend more time with the patient instead of charting.
As of February 2024, approximately 70% of patients complete check-in for Oscar Primary Care appointments, meaning providers can leverage prepopulated patient medication and allergy information for the majority of their appointments. While this is good given the optionality of check-in (and higher than we expected), the team is exploring ways to increase check-in rate and expand the check-in flow to more surfaces (such as Virtual Urgent Care).
Bringing Mental Health assessments into the picture
After the successful launch of our first iteration of the check-in flow, we worked with our clinical partners to identify the next area of patient data collection automation. In December 2023, we incorporated anxiety and depression screenings into 24hr Check-in, designed to trigger for patients that need to be screened, such as new patients and those not screened in the past year. We also worked with our clinical team to identify additional visit reasons to trigger the screenings for, where there’s a higher probability the patients may have underlying mental health risk (such as insomnia, substance abuse, and PTSD).
For anxiety, the GAD-2 assessment is used initially, expanding to the full GAD-7 for patients who screen positive. Similarly, the PHQ-2 is used for depression, leading to the full PHQ-9. (PHQ and GAD questionnaires are the gold standard for screening anxiety and depression.)
This screening information, like the medication and allergy data, is directly incorporated into the patient’s EHR chart. Screening scores then feed into patient care workflows, such as automated patient goals and referrals to Oscar’s in-house Behavioral Health program.
Patient safety is important!
As with all healthcare related patient information, collecting behavioral health data requires utmost regard for patient safety. One of the key considerations for the product team when building out this feature was how to ensure the safety of patients who identified as suicidal, as the final question of the PHQ-9 screening addresses suicidal thought.
In the 24hr Check-in flow, any patient expressing suicidal ideation (via the last PHQ-9 question) is immediately recommended to contact the Suicide and Crisis Lifeline. The patient is then flagged as potentially suicidal in the EHR, visible to providers before, during, and after the appointment. During the appointment, the provider will review the screening responses with the patient, ensure they are safe, work with them to develop a safety plan, and provide referrals or additional resources if needed.
Additionally, if such a patient cancels their appointment post-check-in, a suicidality indication (SI) outreach task is generated for patient outreach, ensuring that no patient is left without a human clinical follow-up. This type of human follow up makes a huge impact on the quality of care and member experience that is delivered, as illustrated in anecdotal feedback from providers:
“I wanted to share with you all an interaction I had with a patient originating from a 24hr check in SI task. This patient is new to [Oscar Health] and has not yet established care with his provider. Unfortunately, the appointment he had scheduled was canceled due to the provider being out of office, but we were able to reschedule him for Monday. I was able to contact the patient to follow up on his responses and he was extremely grateful that we cared enough to call and follow up with him. He was provided with resources, we discussed his access to [behavioral health] benefits, and confirmed he was safe and able to await his scheduled appointment on Monday.”
- Oscar Primary Care Provider
Evaluating the impact on Care Quality and Provider Efficiency
As with most product launches at Oscar, this feature first ran as an A/B experiment to understand the impact of the changes before fully launching to all patients. Results showed a 25% increase in patients screened for depression and anxiety, with over 80% of patients screened for both since launch. This moves us closer to our HEDIS metric goals (standardized benchmarks for evaluating healthcare quality) for patient screening coverage. Furthermore, 50% of screenings are now completed pre-appointment, significantly improving provider efficiency and satisfaction while increasing provider patient face-to-face time.
Continuous iteration on Patient Intake
As we move into 2024, Oscar’s Virtual Care tech team remains committed to enhancing quality of care, provider efficiency, and patient safety. Continuous iteration on the patient intake process, including the potential integration of new technologies like Large Language Models (LLMs) to collect and decipher unstructured patient information, will be a key focus.
¹ https://news.gallup.com/poll/505745/depression-rates-reach-new-highs.aspx
