In this episode of Healthcare Americana, we welcome John Cray, the Chief Technology Officer at Mental Health Technologies, a company at the forefront of revolutionizing mental health testing and screening. Host Christopher Habig delves into the world of mental health, where headlines often feature extreme cases or celebrity admissions, shedding light on an issue that affects countless lives. They explore the impact of these headlines and how they have, in some ways, made discussions about mental health more accessible and normalized.
The conversation goes deeper as John Cray discusses the challenges in mental health screening and the need for a more comprehensive approach. He shares insights into how Mental Health Technologies is changing the game by providing automated testing solutions that not only offer convenience to patients but also empower physicians with actionable data. Discover the importance of early detection, the frequency of mental health screening, and how technology can strengthen the physician-patient relationship.
Join us for a thought-provoking episode that touches on critical issues in healthcare and the innovative solutions that are making a difference in mental health treatment and care.
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[0:00:38] Christopher Habig: Welcome to Healthcare Americana coming to you from the FreedomDoc Studios, I am your host, Christopher Habig, CEO, and co-founder of Freedom Healthworks. This is a podcast for the 99% of people who get care in America. We talk to innovative clinicians, policymakers, patients, caregivers, executives, and advocates who are fed up with the status quo and have a desire to change it. We take you behind the scenes with people across America that are putting patients first and restoring trust in American healthcare.
Anybody who’s listened to this podcast over the last few years, understands my opinion about the mental health crisis in America, specifically, how it really isn’t being addressed. Also, the role that primary care physicians, specifically, those who work with Freedom Healthworks in the direct primary care world have an ability to start making impact in people’s lives when it comes to mental health and mental illnesses. Catching conditions before they become really bad and catching conditions before people become really a threat to themselves and to society on the far end of the spectrum. But there’s so many other everyday mental health things, it just kind of weigh on our mind. It’s almost like a death by a thousand cuts in a sort of sense.
Please welcome to our show, John Cray, the Chief Technology Officer at Mental Health Technologies, a firm that is really revolutionizing mental health testing, and screening, and making it more accessible so that everyday Americans can get the care and the treatment that they need, and they deserve. John, welcome to our show. Welcome to Healthcare Americana.
[0:02:23] John Cray: Chris, thank you. Thanks for having me out. You said it very well, I think that’s exactly what we’re trying to accomplish. So thanks for the intro.
[0:02:29] Christopher Habig: It’s my pleasure. It’s either I knock the intro out of the park, or I really screwed it up. We spent the first part of the episode sitting here, kind of backtracking, and trying to make me not look like a complete idiot. But I swear, I do my homework most of the time. John, all joking aside, I do want to dive into really, I guess over the last few years, we hear mental health, we hear that phrase in the news so often, and so many times it’s linked to really bad things happening in our society. Tell us where mental health technologies in the work you’re doing, how those headlines impact every day when you go to work.
[0:03:09] John Cray: That’s a really good question. I think because it is in the news so much, and to your point, I mean, in the news, it’s often an extreme case, some kind of violence, situation. Or maybe it’s a celebrity or an athlete saying they need to take a mental health break, and that becomes news, whatever it might be. But I think what it’s done is, it’s drawn attention to the topic, and made it a little easier for people to talk about mental health situations. They see it at other places, maybe it becomes a little more normalized. I think people are more willing to share and talk about their own situations. But really, even though we tend to see it in these extreme situations, there are mental health conditions pretty much everywhere in our society, including in primary care.
[0:03:59] Christopher Habig: We see this in so many different people. We still don’t know what the pandemic, and the shutdowns, and mask-wearing have done to children and teenagers. But so far, from what I’ve seen, a lot of the numbers aren’t great from self-esteem issues, communication issues, behavioral issues. When we talk to our physicians through Freedom Healthworks, and the different types of specialists for mental health, there’s some serious things going on. It’s almost like we don’t know how to react to it from a medical profession. It’s like we don’t know how to talk with kids, teenagers, middle-aged people. We don’t know how to screen them effectively.
Give us an idea of what used to happen as far as screening and trying to figure out where people landed as far as what is going on between their ears. And then, juxtapose that with what you’re working on at Mental Health Technologies.
[0:05:01] John Cray: Yes. I guess the good news is that there is screening going on now. It used to be that you’d walk into your doctor’s office, you’d see a nurse practitioner, or PA, or whomever, and they wouldn’t really focus on your mental health, they’d focus on the problem of the moment. Maybe it’s your annual physical, maybe it’s some other condition, but they wouldn’t really direct their attention to any mental health situation.
Now, at least, there’s some regulatory changes that at least require some level of questioning about your mental state, at least, say, once a year. But what we’re really finding is that that really isn’t enough. Like if someone asks a couple of basic depression questions on your annual physical, which is a PHQ-2, basically. You’re being asked that kind of quickly right in the doctor’s office, they’re trying to move on to other things. Maybe it’s the nurse asking it, they really don’t ask any follow up questions, or dive any deeper. So it becomes this sort of brusque, pressured thing, and patients maybe don’t respond as honestly, and there’s no time really taken to figure out what’s really going on with the patient. I think that’s still a big challenge, and that’s a challenge that we’re directly trying to address.
[0:06:19] Christopher Habig: What you just said embodies so much of the way that modern healthcare is practiced due to reimbursements, and just the convoluted way that physicians and practitioners are paid, more of a revenue maximization. Where it’s like, “Yes, check the box, check the box, check the box.” Quality metrics don’t really mean anything.
But when we talk about these questionnaires, these PHQs, and this has to be pretty obvious that these tests are ripe for false answers, for the people being just kind of holding something back, and not being completely honest, and becoming completely forthcoming. Has that been your experience when you’re trying to create something else, create a better assessment tool, where you bring in the ability to actually get honest answers from patients?
[0:07:11] John Cray: Yes, that’s the perfect question. I think, as we were talking about, I think, will patients really think about the questions and answer them. I don’t think it’s necessarily the fault of the surveys. They’re actually pretty good. I mean, if you look at the lengthier depression survey, a PHQ-8 or PHQ-9. PHQ-9 differs from PHQ-8, and that includes a suicidality question, which is a very good question to ask these days.
The answers that the patient gives seem to depend on whether they’re able to think about the question before they answer. One of the things we found, and one of the things we do is we send our questionnaires out to patients well in advance of their appointments. We know about an appointment, we might get it from the EMR, EHR system at the clinic, that triggers us to run some rules to figure out whether the patient should receive mental health tests more than one perhaps, depression, anxiety, OCD, ADHD, alcohol dependency, drug dependency, pain levels. It could be anything. It depends on what the appointment is about and what the patient’s diagnosis is.
But once we figure out what to test, and how to test, then it becomes giving it to them where they have time, they’re in a private setting, they might get it on their cell phone at home. They can take the time to answer honestly. Chris, I want to say one other thing, because you mentioned something kind of key, right when you’re leading up to this. That was about getting compensated. Doctor’s practice is getting compensated for this. It turns out, if you do it right, mental health tests are billable. They’re actually very billable. You can’t do them every day, or every week, insurers won’t go that far. But you can do them periodically, and you can bill reasonably often for them.
If you complement your practice with these tests, you can actually do a couple of things. Number one, you can increase your billing to insurers based on the test themselves. But you can also prove certain metrics, which might reduce your insurance rates over time. It’s one of those things where if the insurers know that you’re regularly checking in on your patients in a number of these key metric areas, and mental health is one of them, you can reduce your rates. So there’s actually direct financial benefits for this as well.
[0:09:34] Christopher Habig: Coming from my world where our practices don’t deal with insurance at all. It’s a flat membership fee, flat monthly fee. In your opinion, how often should somebody be screened for mental illness?
[0:09:48] John Cray: I’m going to say something that sounds stupidly obvious, but it depends. If a patient is regularly saying, indicating no level of depression, or anxiety, or the basic checks that you would do. Checking in with them once every six months or even once a year is generally probably okay, if you don’t see any other signs of any potential problems. But if someone is clearly indicating signs of depression, or they’ve said that they’re thinking about suicide, which, believe it or not happens a lot more often than – well, maybe not than you would think. I’m sure you’re well aware of how often this happens. But than others might think.
We’ve run some metrics recently, and we found that about 20% or so of the test we do for depression indicates suicidality, which is a stunning number one, out of five. That’s just something we see every single day. If you see that, then testing more often is more important. If the patient goes into some kind of treatment, if it’s a directly a treatment for mental health through some kind of drug regimen, or through some of the more advanced technologies that exist now for improving mental health, then checking them a lot more regularly to see whether they’re progressing is – we’re finding is absolutely key.
[0:11:14] Christopher Habig: That’s kind of that’s kind of where I’m going with that, John, because you kind of got us there without me going. To me, mental health is like a spectrum, and it changes every single day. I might be having a really bad day and that’s it. But I don’t take a PHQ test that day. My doctor’s appointment is in six months, and in six months, I might be super happy. Then totally, not even bring up the fact that there were suicidal thoughts a couple months ago, and it kind of goes in waves. I think it kind of embodies, again, going back to where we’ve really let patients fall through the cracks, is that we look at physicals, and we look at healthcare, and we look at doctor visits as this snapshot this once a day for 365 days. Even with blood tests, even with – I mean all, everything changes day to day. There’s fluctuations, mental health, that kind of stuff. We’re stressed. We’re not stressed.
That’s why I’m kind of thinking like, can Mental Health Technologies, your company here, is that creating a stronger relationship between physicians and patients, where they can stay more in tune with one another? And that physician can be a resource to that patient, if and when those cycles happen, or that stress spikes, or even on the good days, and the patient could say, “Hey, doc. I feel great today, this is amazing”?
[0:12:36] John Cray: We like to think it is. The whole key for us is putting the information in front of the physician so that they can be the best-informed they can be. That means, since the physicians live inside that visit screen, they’ve got the patient in, and right there in the visit screen where they’re taking notes, we can put our results right there in the interpretation of those results, and make it very visible. Then, the physician is informed and can guide the conversation. That’s what we’re really trying to do, and we hope that improves the relationship between the patient and the physician. We hope it allows the physician to direct their attention to zoom in on exactly what needs attention right now. That’s the goal. Like you said earlier, early detection of potential issues, and then if there are sort of regular checking in to make sure they’re stabilized or doing better, hopefully.
[0:13:34] Christopher Habig: Yes. It’s how does the patient tell their doctor when they’ve hit rock bottom, or how does the doctor identify that if there’s no annual visit coming on board for more the traditional testing? Where, what you guys have built looks like it closes the gap significantly there. John, we’re going to take a quick break. We’re going to hear from our fantastic sponsor, FreedomDoc. After our commercial break, I do want to dive in a little bit more on your services, on your products here, and really focus in on how this enables the physician once those tests are in, how that enables the physician to now approach their patient and get them the health and the treatment that they really need. But first, a quick message from our fantastic sponsor, FreedomDoc.
[0:14:17] Christopher Habig: Physician burnout is a killer, it is driving our best and brightest out of medicine. The only solution to burnout is to be your own boss. The easiest way to be your own boss is joining the FreedomDoc physician network. FreedomDoc is a unified consumer brand, it will fully finance your practice so that you can enjoy a healthier lifestyle, take better care of patients, and spend more time with your family. You focus on patients, FreedomDoc focuses on your business. So if you’re ready to be your own boss, visit our website, freedomdoc.care to learn more, and schedule a consultation with one of our experts. FreedomDoc accessible concierge healthcare.
[0:14:52] Christopher Habig: Once again, we are back with John Cray, the CTO at Mental Health Technologies in beautiful Chicago, Illinois. Just up the road from me here and wonderful Indianapolis. John, we spent the previous part of the episode really diving into mental health and how we can really help physicians and patients come together, understand really what’s going on, and be able to answer questions, and feedback forms, honestly. That’s where our mental health technologies, your company comes into the fray. When somebody uses MHT, when somebody uses your product, walk us through really how it works from start to finish.
[0:15:33] John Cray: It’s typically triggered by an appointment. Patient is scheduled to come in for a visit, doesn’t have to be. A clinic tells us the rules they want to operate on, if they want to base it on some time frequency of testing, that’s fine. But typically, it’s associated with an appointment. Again, partly, that’s because it’s a billable thing, and partly because that’s the timing that they want in case the patient indicates some severe mental health issue. They want to be able to see that patient right away and address it. We get a trigger, and we run some rules, and the rules are interesting. We can base whether to test on the last time they were tested on scores from previous tests, on diagnoses, on what the appointment is about, on comorbidity.
It could be that if they’re experiencing a lot of depression, there might be childhood trauma, or something else that you want to probe in on. So there could be some situations that if you’re under a lot of pain, you might want to also test for anxiety, for example. There are lots of tests that make sense together. There’s all those rules. When we run those rules, our engine then just basically says, “Okay. Here are the tests we need to send out.” We send them out to the patient in the form of a text message, an email, whatever the appropriate communication vehicle is for that patient. They get it on their mobile phone, let’s say, click on the link, take the test, usually takes a few minutes.
Even answering the questions honestly, taking your time, no more than three, four, five minutes at the most. You submit your answers, they come back into our system. We run basically the diagnostic on the test results, come up with what the test really means. Then we send that back into the EHR, so it’s right in front of the person, the provider when they’re meeting with the patient. That’s really the end-to-end workflow.
Then based on that, we can do other things. Let’s say the patient says, they’re suicidal, we can redirect them to a web page, the 988 Suicide Hotline webpage, for example, and get them the help they might need, or at least some way of getting that help right away. Another thing we can do is, if they say they’re above a certain level of depression, or whatever tests you’re measuring, we can redirect, or we can send out a notification to someone so that they’re informed. And maybe they can bring in a mental health person into the equation for that patient, so we can refer as well. There’s a lot of actionable stuff that kind of happens on the back of the testing as well.
[0:18:15] Christopher Habig: I like that you said that you can absorb these test results, and then take action and not just – and deal directly with that patient. I think that’s important. Because, unfortunately, so many physicians are still in the fee-for-service world where they might get a bad test result or a test result that indicates bad things happening to that person, and then just not have the time to actually do anything with it. That’s where you guys come in, your team comes in, really as a supplemental force to that physician that care to say, “Holy cow, this person is thinking about harming themselves. Let’s go ahead and take action right now.” Or alert the physician so they know what’s going on. But let’s make sure we take an action immediately, rather than giving the doctor something else to do.
[0:19:02] John Cray: Yes, I think that’s just – I mean, just measuring for the sake of measuring is great, and that the physician has more information for the meeting with the patient. But being able to do this kind of actionable thing out the back end is critical. One of the things we’ve done for example, as we go into, say, each geography that we’re in, and we might make sure that there’s a behavioral health practice nearby. So that any primary care practices using the testing have a place to refer. It’s often the case, the primary care doesn’t have a behavioral health expert on staff and might need to supplement their staff with access to a behavioral health expert, and our ability to kind of automate the referral to that person so that the primary care can bring them into the equation is a lot of value we think. That works pretty well.
[0:20:00] Christopher Habig: Yes. Most doctors will raise their hand and say, “Yes, please help me. Just don’t give me more burdens, more stuff to do when I know how to deal with the previous kind of –” it’s not paper and pencil, but kind of a survey format. Now, introduce something else. Is this going to layer duties on top of me, where it takes more time away from kids, and weekends, and home life? It’s always that balance. I find that when we talk to people on the show, that’s one of the biggest things that is really bubbling to this top, where people are saying, “No, this actually help the doctor save time, establish a strong relationship.” I’m always thankful when we do get to have conversations that take that line and say, “No, this is a positive, this is a support for the physician. Also, we’re going to do right by the patient.”
One thing that was interesting when I was researching this episode, you’re testing your technology also identify addictions, dependencies.
[0:20:56] John Cray: Yes, absolutely, yes. It’s done through the same approach. It’s really asking the patient a series of questions. But again, given time too, and privacy, they’re more honest, really, as we talked about. Yes, we have identified significant addiction issues in a lot of patients where the primary care folks just weren’t aware of it.
Then again, they can refer, they can help the patient with inpatient, or outpatient treatment options, or whatever they decide to do, and that can all be automated. To your point about taking the burden off of the physician, we don’t want to give them more work to do. We actually want to give them more information, but provide them options to make sure they don’t have to do everything for the patient themselves. I think that’s really the fundamental key to it.
[0:21:45] Christopher Habig: John, your story, you got to this position, mental health has been something that has affected you and loved ones. Give us a little bit of background on the previous parts of your life that led you to become the Chief Technology Officer with Mental Health Technologies.
[0:22:02] John Cray: Yes, I really, I’ve had limited exposure to the healthcare field in my career. We’ve had a few healthcare customers on various products I’ve worked on over the years. But really, I was affected earlier in my life by a couple of suicides. My college roommate’s mom committed suicide. That was a very tough time, and nobody saw it coming. I had a good friend whose fiancé committed suicide. It was like one step removed from me, but also directly, kind of, in my sort of personal set of contacts and connections. It was tough. In both of those cases, there was not a lot of warning. I mean, after the fact you think was their warning, everybody can come up with, “Oh, I should have seen this, or I should have seen that. But if there would have been good diagnostics, good testing, could something different have happened?
Then my mom, as she got older, develop dementia. It was, again, one of those things where we didn’t know in advance, it was happening. She was maybe a little forgetful, or quicker to anger, or whatever it might be. But we just thought it was just, basically, she’s tired or whatever. If we would have been able to see the results of better testing, it honestly would have made a much bigger difference for us in terms of getting her the help she needed as she progressed.
So yes, personally, I was – when I saw the opportunity to get involved in hands-on helping patients with these kinds of conditions, I was all over it. It’s amazing to get up in the morning and feel like you’re doing something good for people in the world, as you know.
[0:23:54] Christopher Habig: Amen to that. I love talking to people on the show that are really mission-driven. They’re like, “We got to do right by everybody.” Because the big health systems, the government oligopolies are just not doing it. It’s up to us to go out there and actually put people’s lives first, and put their wellbeing, put their care before anything else. John, as we come to close the episode here, you guys are very, very much still in startup mode. Where have you seen the most traction, and then where’s your biggest growth potential here coming up?
[0:24:27] John Cray: Yes. I mentioned that we’re kind of attacking geographies. So we’ll go into a place like Dallas, Texas, and we’ll say, “Okay. Where are the primary care practices that are large enough that this level of automation would help them if they’re one or two providers, maybe this might not be cost-effective, especially if they want it integrated into their back-office systems. But if they’re above a certain level in the practice, then it definitely becomes cost effective, and actually becomes a revenue driver as well as helping patient’s driver for the practice.
We’ll look for a certain size, and we’ll look for a certain geography, and then we’ll kind of go after it. Again, with the combination of primary care, and behavioral health, all within the same area, and kind of link the two things together. We’ve seen – we’re starting to propagate that across the country. We’re testing patients in maybe 12, or 14 states now in the US, and we’re rapidly expanding. We’ve grown four times our size in the last year. It’s an extremely important thing to do. We’re seeing people really taking it up, and using it effectively, so it’s been great.
[0:25:37] Christopher Habig: It’s John Cray, the Chief Technology Officer at Mental Health Technologies. John, thanks for joining us here on Healthcare Americana. It has been a pleasure.
[0:25:45] John Cray: Thank you, Chris. Appreciate it.
[0:25:47] Christopher Habig: That’s going to do it for this episode. If you haven’t yet, be sure to subscribe to the show on your favorite podcast platform. Check us out online at healthcareamericana.com to catch previous episodes. Subscribe to our mailing list and visit our online store. Once again, I am your host Christopher Habig, thanks for listening.
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[0:27:07] Christopher Habig: Hi, again, everyone. This is Chris. On Healthcare Americana, we’re always on the lookout for great stories to tell in the healthcare industry. We’d like to hear yours. Check out healthcareamericana.com, and send us your ideas for episodes or if you’d like to be a guest. Thanks again for listening. Hope you enjoy it.