By now, the practice of telemedicine, where doctors communicate with patients via streaming video, has become established in many hospitals. But Aligned TeleHealth found a medical niche that still needed a technological upgrade – allowing psychiatrists and counselors to offer mental health treatment to patients in emergency rooms. As more Americans have gained insurance in the five years since the passage of the Affordable Care Act, hospital ER departments have seen an influx of people seeking psychiatric care, many of them requiring specialists that are not on staff. The crush of patients often causes extended wait times and unnecessary costs to both hospitals and patients. Aligned TeleHealth’s founder, Dr. Nitin Nanda, has provided a solution to help streamline the process, using video screens to beam in on-demand mental health professionals. “We can bring in a much broader pool of mental health providers,” he said. “It doesn’t matter if the psychiatrist is somewhere in Newport Beach, he can see patients out in Fresno, Sacramento and Visalia.” Aligned, based in Agoura Hills, provides a telepsychiatry service on a contract basis, using either robots equipped with cameras and screens that personnel can wheel around the ER, or regular wall-mounted screens. Prices for the video equipment vary from $2,000 to $20,000, depending on the level of sophistication required. Aligned sells the technology to its hospital customers or they can purchase it separately. The video sessions are private and HIPPA compliant. When a hospital makes a request for a patient consult with a psychiatric specialist, Aligned provides one usually within 32 to 60 minutes, Nanda said. The time spent with the patient normally runs 20 to 40 minutes and Aligned TeleHealth bills the hospital or the patient’s insurance company for each session. The company did not disclose its prices, citing competition. In marketing the service, the company targets hospitals that lack on-staff psychiatric specialists as well as those in remote locations that do not have the resources to provide specialized care. “We have the whole gamut – the technology, the process, the doctors,” Nanda said. Aligned recently contracted with four hospitals in the L.A. region owned by Providence Health & Services hospitals, a chain based in Renton, Wash. Dr. Scott Brewster, medical director of the Providence Tarzana Medical Center Emergency Department, feels that Aligned TeleHealth’s services have made a dent in the overcrowding issue seen at his ER. “The concept of telepsychiatry has been great, because what can happen is that we are able to utilize the psychiatrist now in real time, 24-7,” he said. Aligned currently has 30 full-time employees, including support staff and doctors, and around 50 independent psychiatric professionals who video conference with patients on a contract basis. ER doctors are obligated by law to see every patient who comes through the door, which means that Brewster and his staff treat all kinds of psychiatric patients. But when one needs extra help, they call an Aligned specialist to recommend care options quickly. At hospitals that don’t have teleconferencing psychiatry capability, there is no telling how long patients might have to wait for a specialist to come in. Brewster said L.A. County hospitals face a large influx of patients brought to the ER for psychiatric-related conditions. “Every emergency department in the country has a problem,” he said. “You can probably go to any emergency department in Los Angeles and they’ll have one or two patients taking up a bed for probably one to two days waiting to go to a definitive psych facility for stabilization.” Randall Hagar, director of government relations at the California Psychiatric Association in Sacramento, said that in the last 15 years, California hospitals have lost 2,000 psychiatric beds due to local budget cuts. “The availability of a psychiatrist in emergency rooms is problematic,” Hagar said. “Telepsychiatry is something that is a promising practice that we feel can help alleviate some of this.” Even with the use of telemedicine, psychiatrists as a whole are in short supply. Nanda said that his company can meet some of that demand by efficiently keeping five to 10 doctors busy round-the-clock, 365 days a year. In the last two years, Aligned has grown rapidly. It had revenue of $6.5 million for its 2015 fiscal year, and Nanda expects revenue of $20 million by the end of the 2016 calendar year. The company’s specialists are seeing close to 2,000 patients a month right now and Nanda expects to double that by next year. Aligned grew out of another company, Asana Integrated Medical Group, a behavioral health physicians’ group. Part of Asana was reorganized to form Aligned in 2013 with $2.5 million from investors. Nanda’s growth strategy is mainly geographic. The company’s video conferencing is now available in six states and he has plans to expand it into other states, focusing on both urban and rural hospitals. “With the Affordable Care Act, there has been a lot of funding directed toward mental health,” Nanda said. “You see more and more hospitals, medical groups, and insurance companies gearing up to provide services to the mentally ill. We are able to tap into that because of the technology.”
