Phone home

September 07, 2004

THE LATEST FORM of therapy that looks effective in treating depression also adds a new dimension to the term "house call" -- one that challenges insurance companies to think a little creatively. We hope they can see the profit in it.

Psychotherapy sessions over the telephone, paired with antidepressants, can significantly help patients with moderate depression, researchers in Washington state have found. Eighty percent of those who received the eight half-hour- to hour-long consultations every week or two reported their conditions much improved; 55 percent of a control group felt the same. A third group got brief calls once a month just to check in and remind them to take their medicine; 66 percent reported much improvement.

Practitioners still consider face-to-face therapy the best approach. But because of the nature of the illness -- feeling overwhelmed, without motivation or energy -- many depressed patients don't keep their appointments or continue taking their medicine. Others can't get past the stigma of such an illness, and fail to make an appointment at all. Some think they are not depressed enough to warrant treatment.

Such thinking is costly for themselves, their families -- and their workplaces. About 9.5 percent of adult Americans suffer some kind of depressive episode each year, and about 17 percent experience major depression at least once during their lifetimes, according to the National Institutes of Health. Depressed workers cost companies more than $12 billion in lost work days, decreased productivity and medical costs if the sufferers self-medicate with alcohol or illegal drugs, according to a RAND Corp. study.

Aggressive outreach -- including multiple calls just to reach patients -- is a new tactic. Phone-based therapies are not covered under current health insurance policies -- there's no ready-made way to bill for them.

But there are examples from within and outside the field. Insurers are starting to reimburse for e-mail consultations, and some doctors charge a minimal fee for such phone transactions as renewing a prescription. Perhaps phone therapists could track billable hours similar to the way lawyers do it, which could work for people without insurance as well.

The process could be easier for an HMO, which keeps its tracking and billing in-house. A Seattle-based HMO provided the 600 test subjects for the study, which was financed by the National Institutes of Health. Medicare, for example, already covers phone consultations for physical ailments for people who live in rural areas.

Health insurers should find a way to offer this service to their clients. Reaching out by telephone, at one-quarter the cost of a standard office session, could bring with it a significant rate of return -- for everyone involved.

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