With telehealth, Behavioral Diet sees many extra sufferers

Behavioral Nutrition is a holistic eating disorder outpatient clinic that treats adolescents and adults using behavioral therapy and nutritional counseling. The clinic has five locations spread out among Massachusetts, New Hampshire, Florida, New Jersey and Texas.


The provider organization had four main challenges:

  • The clinical team was looking to provide convenient nutritional support to patients who needed help but were deterred from scheduling a session due to being located several hours from a clinic location.
  • With the onset of COVID-19, the team also needed a way to provide support in a safe, socially distanced manner, ideally enabling patients to receive treatment from the comfort of their own homes.
  • The stigma around being recognized in a waiting room or in the facility of an eating disorder clinic was a challenge for some.
  • Finally, the clinical team partnered with a video platform as it began testing telehealth options, and they found it was not consistent in terms of connectivity. The headquarters facility, for example, is a retrofitted school building from the 1950s, and broadband access is not consistent on the property. The facility needed technology that was consistent and did not require a high bandwidth, while being user friendly for the staff and patients.


For virtual care, Behavioral Nutrition selected the technology from Let’s Talk Interactive. The LTI platform sends caregivers and patients a reminder with a link prior to the session.

The platform is “user friendly and professional compared with what we were using before,” commented Nicole Romano, founder of Behavioral Nutrition. “How seamless the platform experience is. Pay for your copay and immediately get into the session. That was missing from our other platform.

“Let’s Talk Interactive’s telehealth solution is proven to operate on lower bandwidth – so the platform could easily host secure video sessions with slower internet speeds,” she continued. “This solved the connectivity issues our clinicians were experiencing and enabled us to formally offer telehealth sessions on an ongoing basis, allowing our patients to attend sessions from home without any issue.”

“The platform could easily host secure video sessions with slower internet speeds. This solved the connectivity issues our clinicians were experiencing and enabled us to formally offer telehealth sessions on an ongoing basis.”

Nicole Romano, founder of Behavioral Nutrition

Staff also liked the professional experience the platform provided. They could brand the experience to have their logo and colors, and have the ability to do much more than just host a video session. They could send and receive secure emails, schedule sessions and accept payments.


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Behavioral Nutrition’s clinicians do not have much time to learn new technology, so the seamless implementation of telehealth technology was important.

“Let’s Talk Interactive’s telehealth suite is extremely straightforward,” Romano said. “Their onboarding team did an amazing job customizing the platform to fit with our workflow and get everything teed up. From there, we hosted virtual training sessions with our clinicians, with each getting unique usernames, learning easy ways to send out session invites, reminders All of it is extremely user friendly.

“Our office admin staff appreciated LTI’s ability to integrate with Stripe, the system we use to capture copayment,” she continued. “The platform is set up to take Stripe copay processing in order for the session to begin, which creates separation and removes the pressure and need for our clinicians and office staff to have to ask for payment from patients.”

The platform also interacts with staff calendars, immediately booking a session and including the session link once it is booked and confirmed by the patient.

“The whole scheduling process is very seamless,” Romano noted. “We are also able to create custom intake forms, securely send them to patients to complete before their first session, and store them safely in the platform.”

Some of the other features staff leverage on a daily basis include: e-documents for signature, patient filing, reporting, custom branding and multiple user roles within the platform.


Behavioral Nutrition has been able to see approximately 50% more patients compared to the time before telehealth sessions were offered.

Some of that increases is related to the sheer convenience of telehealth – enabling patients to attend sessions from the comfort of home – and [we] No longer experience no-shows due to weather and traffic,” Romano said.

“We have also streamlined some of our administrative processes,” she added. “For example, clinicians can complete their patient note-taking during the session while in the telehealth platform. Copayment is taken before the session is started. Scheduling occurs via secure email.”

The organization is now able to offer more treatment options for patients, resulting in a 30% increase in patients due to the distance to the facility no longer being an issue.

“We were able to expand our radius of treatment, so, where patients might have traveled from 45 minutes away pre-telehealth services, now we’re seeing people who live an hour and a half drive away using our services,” Romano reported.

“Not to mention patients outside the states we are in, because our clinicians are licensed outside the state. We were not offering this prior to using Let’s Talk Interactive’s platform. We’re now able to offer this and offer it efficiencies.”

The organization has experienced an 80% reduction in no-shows as a result of not having to worry about New England weather conditions, traffic and related scheduling conflicts that come up.

“It can be as simple as someone needs to be ready to make dinner for their family, but the session is at 5 pm and they wouldn’t be able to be home by 6 pm,” she said. “Telehealth sessions make this a non-issue; this way, patients can fit treatment into their schedule.

“We are able to track all of these results through the telehealth platform,” she continued. “The data is all there in one, secure location. Should we need additional data or support looking into various usage, we are able to work directly with an account manager who immediately supports us in that process.”


First and foremost, select a telehealth platform that is consistent in its connectivity, Romano advised.

“What kind of broadband access does your facility have? Are you in a rural area? Consider leveraging a platform that does not require high bandwidth and is proven to work well in similar circumstances as yours,” she said.

“Second, scope your clinical model and treatment model to allow for future growth and improvements due to telehealth,” she continued. “You can often capture so much more in terms of verbal and visual content.”

For example, Behavioral Nutrition is able to capture more details on the therapeutic meals it serves in this virtual environment when the patients are able to have that session from the comfort of their own homes.

There also is powerful nonverbal communication that one needs a great visible ability to see, Romano said.

“Using an HD video telehealth platform, clinicians can zoom into specific areas, focus on eye contact, et cetera, even more so than in a face-to-face setting,” she noted. “If in the future you want to add more capabilities – such as integrating with other systems, receiving live bioanalytics or including another provider in a session – working with a telehealth vendor that has a full suite of offerings allowing you to do this.”

Finally, consider telehealth as a way to increase access to care, she said.

“In the context of providing any type of counseling, there is a real potential for growth in supporting the public’s need for counseling in a much more convenient and user-friendly manner,” she concluded.

“There’s a degree of confidentiality and sense of privacy that is lent through the ability to not have to sit in a waiting room or walk through an office or the potential of getting recognized as being a patient seeking treatment at an eating disorder facility. All of This is no longer a deterrent when telehealth is added to the process.”

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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