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Medical Care

A Data-Driven Approach for 2025 and Beyond in Mental Healthcare

2024-12-02

For decades, mental health professionals have relied on subjective diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, this approach often leads to imprecise treatments and poor outcomes. A data-driven approach, known as "precision psychiatry," is gaining momentum, aiming to personalize mental healthcare. One promising method is the use of event-related potentials (ERPs), which are functional brain measurements. ERPs have been studied since the 1960s but have not yet been widely used in clinical practice. In recent years, ERP biomarkers have shown great potential in understanding and treating mental health conditions.

Unlocking the Potential of ERPs for Precision Psychiatry

The Search For Reliable Biomarkers

Biological measures are driving the growth of precision psychiatry. Researchers have been studying various biomarkers for decades, including memory, genes, cognitive performance, speech, hormones, and gut microbes. While some associations have been found between these biomarkers and mental health, few have been used to categorize patients in clinical trials. ERPs, on the other hand, have shown high test-retest reliability and interpretability across different mental health conditions. They can be used to measure brain responses to rewards, emotional content, and decision-making, and have been linked to specific subtypes of depression and the prediction of treatment outcomes.

For example, a 2023 study of adolescents with depression found that an ERP associated with the response to emotional stimuli predicted a response to cognitive behavioral therapy. This suggests that ERPs could serve as neural biomarkers for predicting outcomes in adolescent depression. Another study published in the Annual Review of Clinical Psychology in 2019 concluded that ERPs can be used clinically to identify psychopathology and chart the potential development of conditions starting from childhood. The error-related negativity ERP was found to be instrumental in understanding the development of anxiety disorders and treatment opportunities.

The History Of ERPs

ERPs have been studied since the 1960s primarily in psychological and academic research. They have been used to study a wide range of cognitive domains, including memory, attention, vision, and emotion. In recent years, ERP biomarkers have helped uncover insights into mental health, especially in challenging conditions like schizophrenia. Promising ERP biomarkers of depression have focused on brain responses to rewards, emotional content, and decision-making. These ERPs have not only been linked to depression but also accurately predicted individuals' risk for depression and its development over time.

For instance, a 2019 meta-analysis found that ERPs can be used clinically to help identify psychopathology and track the potential development of conditions. Later research showed that ERPs associated with receiving rewards were closely tied to depression and could predict remission. Combining emotion- and reward-related ERPs could help differentiate subtypes of depression and improve treatment precision.

Applying ERPs To Clinical Trials

ERPs measured through EEG have been shown to be instrumental in scientific research. There are significant opportunities for pharmaceutical companies to incorporate ERPs in clinical trials to develop more personalized treatments. Compared to functional magnetic resonance imaging (fMRI), ERP data is easier and less expensive to capture. EEG studies are relatively simple to administer, and electrodes do not require messy conductive gel. ERP measures of brain function are also more reliable than fMRI-based measures, which can help pharmaceutical companies develop novel therapies in less time and with fewer resources.

Investigators can use ERPs to measure brain function at every phase of a clinical trial. At participant recruitment, a quick ERP assessment can identify appropriate participants who would benefit most from a drug. This helps ensure homogeneity among different cohorts and supports more streamlined clinical trials. In addition, ERP data can be used to monitor treatment responses and predict outcomes.

A Data-Driven Future

With advancements in data science techniques like generative AI, ERPs are becoming more accessible and affordable. Technological progress has simplified EEG studies and ERP data analysis, making these biomarkers more practical for clinicians and patients. Given the growing evidence in peer-reviewed journals, we can expect ERPs to become more incorporated in mental health clinical trials in 2025. ERPs are poised to move from academic labs to real-world importance and become a standard method of assessing brain function in precision psychiatry.

In a significant cyber attack on the Veterans Health Administration (VHA), it has come to light that potentially 616 Minnesota veterans may have had their personal information placed at risk. This is a matter of great concern as the agency is now taking proactive steps to inform the affected veterans.

Protecting Veterans' Information in the Wake of a Cyber Attack

Details of the Cyber Attack

According to a spokesperson for the Minneapolis VA Health Care System, the cyber attack has had far-reaching implications. Over 2,300 veterans across the country are set to receive letters informing them that their health information, which includes their full name, medical records, and social security number, may have been stolen. The stolen information was housed on a server managed by contracted medical transcription vendor DBP, Inc. Thankfully, the company was able to quickly take action by shutting down the server and disconnecting it from the internet, thereby preventing further attacks. In addition, DBP has purchased new hardware and implemented new security controls to enhance the security of the system.

For the impacted veterans, receiving a letter with detailed information about the at-risk information is a crucial step. It allows them to be aware of the situation and take appropriate actions. If veterans have further questions, they can reach out by calling 1-844-838-5433 and leaving a message from 8 a.m. to 4:30 p.m. on weekdays. Calls will be returned within two business days, ensuring that veterans receive the support they need.

Impact on Veterans

The potential exposure of veterans' personal information is a serious issue that can have long-lasting consequences. Veterans rely on the VHA for their healthcare needs, and having their sensitive data compromised can lead to various risks, such as identity theft and potential misuse of their medical records. It is essential that the veterans are informed promptly and provided with the necessary resources to protect themselves.

The VHA's response to this cyber attack is commendable. By taking immediate action to contain the breach and communicate with the affected veterans, they are demonstrating their commitment to safeguarding the well-being of those who have served our country. The efforts of DBP, Inc. in securing the server and implementing new security measures also play a vital role in preventing future attacks.

Steps for Veterans

Veterans who receive the letter should carefully review the information provided and take the necessary steps to protect their personal information. This may include monitoring their credit reports for any unusual activity and taking appropriate measures to secure their online accounts. If they have any concerns or questions, they should not hesitate to reach out to the VHA or the designated contact number.

It is also important for veterans to stay vigilant and be aware of any potential signs of identity theft or security breaches. By staying informed and taking proactive measures, they can minimize the impact of this cyber attack and protect their privacy and security.

With the recent conclusion of the 2024 election, the focus now turns back to Congress as it enters the final weeks of the 118th session. Time is of the essence, yet Congress holds a crucial chance to reshape health care affordability, enhance transparency, and reduce costs. This can be achieved through the Lower Costs, More Transparency Act (LCMT) and the Health Care PRICE Transparency Act 2.0. Taking action during the lame-duck session could act as a catalyst for addressing issues like health care consolidation, cost disparities, and opaque pricing structures before a new legislative chapter begins.

Key Provisions and Their Significance

The LCMT's Central Provisions

The LCMT aims to build on the hospital and insurer price transparency rules enacted in 2019 and extend price transparency throughout the health care system. A poll conducted in September 2024 showed that 92% of likely electorate voters nationwide supported these requirements. There is strong bipartisan and bicameral support for these initiatives. The legislation mandates that hospitals and insurers disclose real prices, including cash rates and negotiated insurance rates, making data clearer and more accessible for researchers, consumers, and employers. It also extends these requirements to clinical labs, ambulatory surgical centers, and imaging service providers in Medicare.This is a significant step as, for decades, data on health care prices have been opaque. Rising health care costs often erode worker wages and other benefits, especially for lower-income Americans, and can strain government finances. Price transparency initiatives can inform policymakers and enable employers to design impactful programs to reduce spending.

Transparency in Medicare Advantage (MA)

The LCMT bill goes further by mandating that Medicare Advantage (MA) organizations disclose specific information to the Department of Health and Human Services regarding their shared ownership with health care providers, PBMs, and pharmacies. While it doesn't include full ownership transparency yet, this call for ownership transparency is a start. Full ownership transparency should be considered in the future as it can help prevent conflicts of interest, enhance accountability, and promote competition, as shown in research.

Addressing Site-of-Care Payment Differentials

One key provision of the LCMT not included in the Health Care PRICE Transparency Act 2.0 is addressing site-of-care payment differentials. The provision aims to ensure that Medicare beneficiaries and the Medicare program pay the same administration rates for physician-administered drugs in off-campus hospital outpatient departments as in physician offices. Our research has shown that these payment differentials contribute to the rise in Medicare spending and fuel provider consolidation. By mandating equal rates regardless of the care setting, this provision could help reduce unnecessary costs and prevent incentives to drive care to more expensive settings, opening up opportunities for broader site-neutral policy options in the future.Despite these payment differentials, our research has found that many non-hospital settings have equivalent or better quality. This shows the potential for these policies to not only control costs but also improve the quality of care.

The Importance of Passing These Bills

A busy legislative agenda and other pending priorities have pushed both bills to the lame-duck session. However, Congress has the opportunity to end on a high note in health care by passing provisions from the Lower Costs, More Transparency Act and the Health Care PRICE Transparency Act. These policies represent a crucial step toward potentially reducing costs, improving competition, and leveraging data to control health care spending growth. This presents a unique opportunity for Republicans and Democrats to unite on an important issue as we approach the new Congress and a new administration.Passing some of these provisions could provide immediate benefits while laying the groundwork for future reforms. Site-neutral payment initiatives, expanded reporting requirements on health care consolidation, and greater scrutiny of vertical integration could all build upon the foundation set by this legislation. The next Congress could further advance these efforts to ensure that our health care system remains accountable, competitive, transparent, and patient-centered.Jared Perkins is the director of Health Policy Strategy at the Center for Advancing Health Policy through Research (CAHPR) at the Brown University School of Public Health. Christopher M. Whaley is the associate director of CAHPR and associate professor of health, services, policy, and practice at the Brown University School of Public Health.