Brain Scans, Billing AI, and Value-Based Care

Each week brings new conversations about mental health, technology, and care. Between Sessions gathers what's worth your attention - so you can stay informed without adding to your workload.

Talkiatry launched a tool that lets primary care doctors refer a patient directly to a psychiatrist from inside their system - with automatic status updates on what happens next, no separate portal required.

👉 Why it matters: A significant number of psychiatric referrals never get completed - this kind of frictionless handoff is one of the more practical changes to how clients actually reach care.

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A new Peterson Health Technology Institute report found that health plans are increasingly using AI to automatically downcode claims - including those generated by AI scribes - creating a billing back-and-forth that raises system-wide costs rather than reducing them.

👉 Why it matters: Insurers are using AI to push reimbursement down on the same records that AI scribes help generate - documentation precision matters more now.

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Researchers scanned the brains of 311 people with major depression and found three distinct groups based on how white matter connections are structured - each group responded differently to antidepressants, suggesting brain structure may help predict medication response.

👉 Why it matters: This is a preprint, not yet a published trial, but for clients who have tried several medications without improvement, it points toward a biological basis worth knowing about as this line of research develops.

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A new APA survey of more than 2,000 psychiatrists found that 65% consider themselves only "somewhat informed" about AI, with respondents divided on whether AI-assisted therapy would be riskier or more effective than traditional approaches - and strong support across the board for new regulations.

👉 Why it matters: The APA is actively developing guidance in response to these results, so clinicians who want to engage with AI tools have a professional organization now tracking what they need.

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A study published in the Journal of Clinical Psychology and Psychotherapy found that therapists with higher wellbeing and positive engagement had clients who were less likely to drop out in the first three sessions - independent of burnout levels.

👉 Why it matters: Early dropout is one of the harder things to sit with - this study adds evidence that therapist presence and engagement are real factors in retention, which is also something that can be actively supported.

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Starting July 5, CMS will pay more than 150 health organizations based on whether their Medicare patients with depression or anxiety show measurable symptom improvement - tracked by PHQ-9 and GAD-7 scores - rather than for services delivered. The 17 organizations in the behavioral health track include SonderMind and Headspace.

👉 Why it matters: Private practice clinicians are not in this model, but major commercial insurers including United Healthcare, Humana, and Cigna have already pledged to align their own payment arrangements around it - worth knowing the direction.

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Richard Berlin, MD - who has shared a poem about clinical life in Psychiatric Times every month for 28 years - chose Joshua Clover's "I Want to Read at the White House" for April: quietly political, two minutes, and a useful reminder that the work has a wider context.

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This week, Berries shared two resources for your practice and wellbeing.

Podcast: Barbara Griswold, LMFT and author of Navigating the Insurance Maze, joins Kym Tolson on what therapists get wrong about session notes - documentation habits that create liability, what good clinical writing looks like, and how to make it sustainable. Thirty-three minutes.

→ Listen to our podcast

Meditation: Julie Ela Grace recorded a 14-minute guided meditation on trusting your clinical judgment - for the moments when self-doubt creeps in and you need to come back to what you know.

→ Try our meditation

For all the administrative and technological pressure described this week, the throughline is the same as always - the work itself, done carefully, still matters more than any of the systems surrounding it.

As always, thank you for your truly important work.

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This newsletter is intended for informational and educational purposes only. It does not constitute clinical, legal, or regulatory guidance. Clinicians should rely on their professional judgment and applicable standards of care when integrating any technology into practice.