Bright Heart Health is a telemedicine mental health service provider offering therapeutic services for substance and addiction disorders; a wide variety of mental health concerns, pain management and chronic pain issues; and eating disorders. The organization provides services to thousands of clients each year in 47 states across the United States and accepts Medicaid and Medicare. With approximately 300 employees, Bright Heart has a strong focus on measurement-based care.
“We’re a telehealth company but come at it from a different standpoint from some other providers,” said Jonathan Ciampi, CEO of Bright Heart Health. “We have a metrics-based care model with a robust health informatic system in place that captures a lot of data. We actively analyze staff and patient engagement on a regular basis. We wanted to look deeper into linguistic analysis on Motivational Interviewing (MI) to try and ascertain individual clinicians’ competence in that area and derive from that how it affected patient care. We looked to academic research for studies around this, and that’s how I became aware of the people behind Lyssn. When I came across the company, I realized these were the same people whose research I’d been reading. So, I reached out to Lyssn to see if they could help us.”
Initially Bright Heart provided a sample set of data to Lyssn to analyze and provide reports. “Based on the Lyssn team’s academic background we never questioned the validity of the tool set, but we wanted to verify that they were capable of accurately identifying when MI was being used appropriately,” said Ciampi. “We have this range of people and Lyssn right away pulled out this one appointment with a patient as a top example of MI being used really well. As I was reading the transcript file of that session, I realized I knew what staff member it was based on her vernacular – she has a very unique way of speaking. That provider also happens to teach MI in our organization. So right off the bat Lyssn identified literally the best person in our company when it comes to MI. They also identified the worst, though I wasn’t able to recognize that person from the transcripts!”
Integrating with existing systems
Lyssn was integrated into Bright Heart’s workflow and the systems that were already in place for telehealth, recording and transcripts. “Lyssn has a good transcript system, and it is actually higher quality than the one we currently use, but it wasn’t feasible for us to integrate that at this time. Same with the telehealth – the Lyssn one is great, but we already had a system in place so didn’t need that function, so we hooked into their API. The big value for us is in their MI analysis. That’s something we didn’t have before.” Bright Heart sessions are pre-processed and automatically sent to the Lyssn Platform, which gives nearly instant feedback with a metrics report. Clinicians and supervisors can listen, annotate, share, and analyze the session all within the platform.
“There will always be some work to incorporate technology with a new system, but there weren’t any challenges or safety issues integrating Lyssn. Being able to grab that data and give it to Lyssn to analyze was actually pretty easy. They were also very responsive and helpful,” explained Ciampi. “I think the harder part was once you have the data – now what do you do with it? That was what is so great about Lyssn: they were able to show us where we need to focus and what the components are that we need to be evaluating. It wasn’t just the idea of looking at Motivational Interviewing, which is this great big umbrella, but helping us to start breaking that down and understanding it in greater detail. As we evolve as a company, the Lyssn data, and how it interacts with our other data, continues to give us real insight.”
Improving outcomes via metrics
With the new Lyssn measurement tools, Bright Heart took a deeper look at their providers to better understand where competence levels were with Motivational Interviewing. They looked at things like empathy, engagement, advice, confrontations, and other sub scores. They then looked at how they could provide trainings to help individuals improve their scores.
“At this point we’ve identified the people we want to focus on,” said Ciampi, “and Lyssn has helped us do that. Now it is a matter of getting our providers any trainings they need and monitoring that their skillsets have improved. Obviously, if we can move all of our providers and staff up in their overall competence, outcomes will improve. And with Lyssn we have definitely seen an impact on our outcomes.”
By making use of machine learning to better understand patient care and its connection to other metrics, Bright Heart is better able to track their patient outcomes – which are much higher than the standard research rates. Bright Heart is currently engaged in the largest National Institute of Drug Abuse (NIDA) study in the country in which telehealth data from Bright Heart, including the Lyssn metrics, is compared to in-person care at many clinics across the country. The aim of the NIDA study is to see how telehealth can address rural opioid use disorder.
“If you look at the field of research on behavioral health – which is mostly in substance use disorders, but it applies to other areas of mental health – MI is treated like a hammer, because it is a tool that works. But the use of MI can be very situational and sometimes you need a different tool. For MI to be really effective the client needs to be fairly ambivalent. If they are already engaged with the process, then you get out of their way you don’t use MI at that point as it just slows them down. This is really important because often when clinicians get trained you get told ‘here is this evidence-based strategy, use this’ so you have it in your tool chest to use – but when you use it is just as important to how you use it. So, knowing when our people are not just using MI, but using it appropriately, is another huge component of what we learn via Lyssn.”
Along with the integrated Lyssn Insight product, Bright Heart is working with Lyssn to build custom analytics to track MI across their organization, find additional ways to aid providers in diagnosis and coding of sessions, and learn how the platform can further align with other well validated tools to get further clarity into a patient’s needs. “Behavioral health is full of a lot of discussions around the magic that happens in a therapeutic conversation, but unfortunately as with anything, it is really hard to improve magic. You have to peel back the layers and put some quantification to it. It can’t all be qualitative and certainly there is not enough funding for us to physically or manually oversee every clinical encounter to assess them—or even do a portion of it—as that is really expensive. Lyssn makes this possible. They are really opening up a lot of eyes to how we must start thinking about behavioral health the same way we think about physical health in terms of quality control and management.”
Bright Heart is also hoping to use the Lyssn platform to analyze data outside of clinical encounters. “Evidence shows that MI is most effective with new patients in the initial encounter – but the clinical encounter isn’t the initial encounter, it’s when they first call, and a customer service member picks up the phone. Since MI works best in initial encounters, we’re asking: Should we be tracking that data and training our customer service people in MI and other factors like emotional regulation? For the future we’re really interested in using the Lyssn platform to see if getting MI into the customer service level could be even more beneficial to our patients.”