The PRMS Blog

Guest Blog: Finding Novel Ways to Support Adults with ADHD

 


As a part of PRMS’ ongoing commitment to behavioral health, we invited Jacob Behrens, MD, in Milwaukee, WI to be featured as our guest blogger this month.

ADHD, or attention-deficit/hyperactivity disorder, often conjures images of rambunctious young boys running circles around a classroom. It is generally more difficult to spot in adults, many of whom have more subtle symptoms and suffer silently for years before they get a diagnosis.

Jacob Behrens, MD, CEO and medical director of Envision ADHD Clinic in Milwaukee, is passionate about changing that for adults with ADHD. Behrens said he sees ADHD as a “positive diagnosis and a potential gift” to hone via treatment rather that fight as a negative that should be eradicated.

“Having ADHD is like having a Ferrari engine but fiat brakes,” Behrens said recently. “I don’t want to turn down your horsepower. I just want to fine tune your brakes and put you in better control through all of life’s inevitable curves, road construction, traffic, etc.”

October is ADHD Awareness Month. An estimated 2.5 percent of U.S. adults have ADHD, and without treatment, they can struggle with motivation, staying organized, being on time, and impulsivity. Depression and anxiety are often related, particularly when someone is not performing at a level they know they can and getting constant negative feedback from coworkers and significant others.

In adults, documented risks of non-treatment or under-treatment of ADHD include the potential for increased rates of criminality, motor vehicle accidents, accidental death, substance abuse, obesity, divorce, being fired from a job, homelessness, earning less than colleagues, as well as numerous other psychiatric comorbidities.

Some providers balk at making an ADHD diagnosis, Behrens said, because of lack of time/resources to make a confident diagnosis and concerns/difficulty prescribing controlled substances. While there are certainly risks of misuse and abuse, thorough diagnoses and careful fine-tuning and monitoring are key. ADHD is one of the most readily-treatable conditions in psychiatry and the risks of not treating should be looked at as well, Behrens said.  

For more information about ADHD Awareness Month, visit https://add.org/adhd-awareness/

More about Dr. Behrens and Envision ADHD:

As an outpatient specialist and chief resident at his alma mater, the University of Wisconsin School of Medicine and Public Health, Behrens worked to find new and better ways to expand care to ADHD patients – many of whom were high-functioning professors, lawyers and project managers from the area. He began using technology to build tools for more thorough evaluation and outcome tracking, which included use of in-session ipads and web/phone based home solutions for patients to collect and monitor data.

Envision ADHD, which he founded in 2016, works to evolve with emerging technologies and research to tailor adults’ clinical experience. One significant way is by recognizing the conflict between demanding lifestyles and commuting to an office each month to pick up paper prescriptions or to have an in-person follow-up visit when the patient is stable.

Before founding Envision ADHD, Behrens already knew a lot about e-prescribing, telemedicine, health records systems and patient portals through years of policy involvement with the American Medical Association and American Psychiatric Association and advising technology start-ups. He studied various models and even contacted PRMS for regulatory and risk management advice. “PRMS has been a great resource. I don’t think I would have felt comfortable starting out on my own without their guidance,” Behrens said.  

Much of how the Envision ADHD Clinic is set up is similar to the direct primary care model, which offers an alternative to fee-for-service insurance typically by charging a monthly, quarterly, or annual fee that covers all or most primary care services. Patients, in turn, often have a greater access to, and time with, their providers.

Patients – limited for now to Wisconsin residents – can schedule initial visits on Behrens’ website. The relationship begins with a comprehensive two-hour, in-person evaluation that includes a clinical history, rating scales, and computerized testing to determine diagnosis followed by extensive education and review of a large menu of treatments, including medications, coaching/therapy, supplements, diet, exercise, and potential for further lab testing. Insurance is not accepted. Initial evaluation and testing are key to beginning treatment. Through the clinic’s monthly subscription model, patients have unlimited online video follow-up appointments access and direct messaging communication with Behrens. “My goal is for my patients to be more productive and enjoy their own lives, not take time away from work/relationships/home simply to travel to me.

“I want my patients to think of me like their Netflix subscription. Binge when in need and know that I am just a message away regardless. No need to think of copays, extra fees, surprise bills, or wondering if they should reach out,” Behrens explained. “I feel like these are ‘my patients.’ They chose it because they wanted to and not because their insurance offered them the next available slot. I want to be available to my patients and to help outside of simply old fashioned visits. I want to be an educator/guide/consultant/advocate for my patients and this model incentivizes this more than ever before.”

When going through conventional health insurance for an initial ADHD diagnosis, many prospective patients are told they may have to wait as long as six months to see a psychiatrist, but Envision ADHD can get them within 1-2 weeks. Behrens said what he likes best is the flexibility to immediately respond to and connect with patients. Unlike at a large university where his caseload was about 1,200 patients, he plans to cap it at about 200 at Envision ADHD.

Behrens is continuing to test different software and tweak workflows for scheduling and billing and has even offered his model – including the website template and various software – to area non-profits and healthcare organizations for free. “The model doesn’t just work for ADHD, but through team-based care, the various setups can be used to connect psychiatric expertise to all types of patients in need.” To better address the ever growing psychiatrist shortage, we need to think beyond the typical “in person, synchronous visit, fee-for-service model.”   

“It’s so exciting how patients describe the changes they are feeling in very elaborative and imaginative ways,” Behrens said. Three months into treatment, he recalls a once fairly reserved male patient reporting: “I just see things clearer and I’m more calm. I’ve already been promoted at my job and I’ve moved in with my fiancé. I don’t know what’s going on but I’m just happier. My fiancé can’t wait to meet you and thank you.”

That makes Behrens very happy. Because in the end, he said, getting treatment for ADHD is about much more than “can you focus and sit in your seat in a meeting.”

To learn more about Envision ADHD, visit http://www.envisionadhd.com.

To learn more about the superior insurance program and comprehensive services offered by PRMS, click here.

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