Opportunity Costs of Prioritizing Tech (Techniques and Technologies) Over Clinicians

Business owners in behavioral healthcare might want to reconsider their investment priorities. A priority has been to fund the best clinical techniques and technologies. This may lead to under-investing in people, probably a serious business mistake given their capacity for performing complex clinical tasks.

Many believe superior psychotherapy results are ensured when clinicians faithfully provide specific therapies. Despite evidence from research, they view systems built to evaluate and improve the effectiveness of each clinician as unrealistic or unnecessary. Such a bias towards prescribed techniques is rooted in the medical model. 

Whether treatments are biological, surgical, or psychological, the medical objective is to have reliably successful methods independent of the clinician. Our field is torn by conflicting loyalties. Decades of evidence suggest that people (therapists) are more critical to success than therapeutic techniques, yet allegiance to the medical model drives an enduring commitment to techniques.

Digital tech investments in our field promote clinical techniques as the drivers of improvement.  These digital products are engaging, interactive, and educational. Despite their benefits, we must wonder what valuable services lack funding as such digital therapeutic platforms multiply. What opportunities are lost, or in business terms, what opportunity costs are we incurring as we prioritize tech?

A Lost Behavioral Health Opportunity

Clinical trials have found psychotherapy to be remarkably efficacious. It is fair to wonder if real-world therapists are as effective as clinicians trained as experts in specific therapy models. This is knowable.  We find the answer by implementing Measurement-Based Care (MBC). It uses well-established statistical analytics and provides reliable clinical results. Unfortunately, it is little used today.

Our loss is actually greater than this since MBC provides more than retrospective results. MBC involves continuous care monitoring because it 1) predicts clients at risk for prematurely ending treatment; and 2) improves overall results. This last point is too little appreciated and reflects a critical opportunity cost.

A recent randomized trial found clinical improvement with an MBC system to be 25% greater than care as usual. Results like this are not new, but MBC is still minimized as a discretionary, incremental enhancement.

This study had a large sample size and provided strong evidence that the “addition of systematic client feedback to outpatient psychological treatment can have a beneficial effect on treatment outcome (symptoms and wellbeing), particularly in the first three months.” The authors offer some caution—implementing MBC systems “requires a careful plan of action.” That is, it requires an investment.

What rationale has reduced therapy enhancements like this in priority level? MBC has tech components, but it is not a simple plug-and-play system. It also requires clinicians and executives to attend to its feedback for optimal results, and it is complicated to explain to investors, but it is worth considering how a digital therapeutics product differs from MBC. 

Digital platforms are quite self-sufficient in comparison with MBC. While MBC still depends on clinicians delivering care, digital therapeutics are reliable, scalable tech products. We face a choice—help clinicians become 25% more effective or create a more limited yet self-sufficient piece of technology. No leader may have explicitly considered these alternatives, but these are real strategic choices. 

We should not blame investors for preferring self-sufficient tech products.  Our healthcare system has long rewarded technology solutions over the more labor-intensive work of behavioral health or primary care. It should not be an either-or dilemma. Let us invest without bias and be sure to consider enhancing the remarkable value of people. How long will we pass up 25% more improvement?

Executives Must Balance Priorities

While US healthcare will continue to pursue cures, blockbusters, and tech solutions, behavioral executives have alternatives. Many valuable incremental improvements involve people—hiring more, providing guidance systems like MBC, and staffing primary care settings for brief, scalable therapeutic conversations. Investing in people also means boosting pay to attract and retain the best talent.

Technology is not the problem. It can produce more efficient and effective care.  The problem is being so focused on tech that clinician-centered improvements are neglected. Tech is a powerful problem-solving bias. It is hard to question the value of tech solutions when millions of dollars are being invested in them. This is reinforced further by the extraordinary valuations small tech companies are achieving.

Let us instead balance our priorities as former NIMH Director, Dr Tom Insel, exemplifies today.  His journey is a textbook study of gaining awareness of opportunity costs. He funded potential biomedical cures at NIMH through 2015 and then transitioned to advocating well-established biopsychosocial solutions for serious mental illness. Let us hope for cures but never shortchange today’s patients or clinicians.

Leaders cannot afford the venture capitalist mindset—they fund 10 ideas knowing only 1 will succeed.  This means over-valuing many products and spending time and money that could be better used.  Healthcare executives cannot wait for big tech successes. Patients need the best help possible every day—tomorrow’s cure is irrelevant to them. Let us prioritize and fine-tune what clinicians do each day.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as President at ValueOptions and Chief Clinical Officer at PacifiCare Behavioral Health.