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Recapping the news from behavioral health companies that are B2B (business-to-business).
Many behavioral health practices recognize that verifying patients’ insurance information is a key factor in their success. But most operators are forced to under-resource this critical set of activities due to its inherent complexity and scale requirements.
The problems created by these broken benefit verification processes ripple through almost every function of a practice - from lower initial conversion and retention of new clients to impacted cash flow and overall practice health.
The challenge, particularly in behavioral health, is in prevention at scale. It’s extremely time consuming for administrative teams to perform accurate benefit verification throughout the patient journey. And without a highly sophisticated technical solution, benefit structures in behavioral health are too opaque and complex to easily automate.
There are two main reasons benefit verification is extremely time consuming for behavioral health practices: inaccurate data provided by patients and higher prevalence of complex benefit structures.
In reviewing a large data sample pulled from Nirvana’s behavioral health provider groups, it was found that an average of 18% of patients had incorrect information at intake, and even when patients provide the correct information it’s difficult for operators to parse complex benefit structures that vary across the hundreds of thousands of unique plans in the country.
Further, the complexity of benefit structures in behavioral health often requires the verifier to possess institutional knowledge and years of experience in order to succeed. Nirvana partners find that across their teams, a biller’s average accuray sits at around 75%. Even experienced billers who understand the opaque structures of mental health benefits, lack the out of the box tooling needed to act on insights like collecting new insurance cards, changing copays, and complex carve-outs.
Unsurprisingly, most patients seeking care won’t move forward without a clear understanding of how much it will cost. In mental & behavioral health, any additional barrier to care vastly increases the chance a patient will have a negative experience or forgo treatment altogether. An industry leading telehealth practice found that 30% of prospective patients drop out of the booking process once they are asked to input their insurance information online, further evidence that a lack of insurance literacy is a significant barrier to care.
The complexity of benefit structures in behavioral health makes getting a good cost estimate very difficult. When these errors occur, it adversely impacts patient care and retention due to delays and confusing, unexpected out-of-pocket expenses. In an analysis of top providers’ google reviews, over 20% of reviews referenced billing issues as points of contention.
Strong operators monitor their cost estimate accuracy proactively and build systems to improve over time, but the problem only scales as volume increases, contract structures become more complex, and administrators turn over, costing providers critical institutional knowledge.
The most common type of claim denial, representing roughly 20% of all denials in the Nirvana partner reviews, are due to data entry issues at intake. Errors as simple as using a preferred vs. legal name, spelling errors, or transposing two numbers in the member ID are consistently rejected by payers. Strong verification practices will compare the information that the patient gives the provider with what’s on file with the insurance, allowing issues to be corrected before a claim is filed.
Unfortunately, even a strong initial intake process doesn’t insulate practices - every month, 3-5% of patients’ policies terminate due to changes in employment, Medicaid eligibility, or other impacts. These transitions in coverage require an entire new intake process, but are often invisible to providers until after claims have been submitted.
The strongest operators build systems that mitigate the issue with periodic checks, but lack of integrated workflows and overburdened admin teams often leave the practices reacting to the errors, rather than preventing them.
Whether a provider has incorrect information for a new patient at intake or outdated information for an existing patient, the result of submitting a claim is the same: preventable denials.
As referenced above, an average of 18% of patients had incorrect information, which would lead to a claim denials. This incorrect data is the number one cause of claim denials for any behavioral health practice. Increased claim denials lead to RCM inefficiencies and collection problems.
Today the healthcare industry average is 45-60 days Days Sales Outstanding (DSO)1 which is a burden for many practices. In stark contrast, Nirvana partner data shows provider networks that implement advanced verification systems in combination with pre-session collection dramatically reduce DSO, sometimes as low as to 8-10 days.
After understanding the importance of accurate benefit verification in boosting patient satisfaction, reducing claim denials, and increasing revenue, the question arises: what are providers doing about it?
Today, many providers attempt to verify benefits through a combination of online portals, EHR solutions and a manual calling process. This generally takes place at intake, and often requires a 30-45 minute call with the patient’s insurance.
This has three fundamental problems:
The response time problem: Patients looking for a new provider are trying to make decisions quickly. With manual benefits verification, wait times to learn how much therapy will cost are often measured in days due to task backlogs and communication disconnects. This delay is an impactful barrier to care, and it also drives patients to seek alternative providers, reducing conversion.
The accuracy problem: Behavioral health benefits are complicated, and it’s difficult to train practice administrators on the nuances of thousands of distinct plans. Nirvana partner studies reviewed trained-biller accuracy in cost estimation, finding error rates between 6% to 34% depending on plan complexity and biller experience.
The shifting eligibility problem: Unfortunately, while manual benefit checks can be made for new patients, monitoring patients’ shifting eligibility over time is far too costly. If an average clinic of 10 providers were to attempt it with purely manual resources, they would require ~2 full time administrative staff doing nothing but benefit verification full-time. This leaves most practices relying on their patients to proactively report changes in insurance status, resulting in substantial ineligible policy denials and wasted biller time.
It is easy to see how a reliance on manual verification via phone calls can quickly overwhelm a benefit verification and billing team. Nirvana observes that providers utilizing this manual structure may recognize the problems it creates but often underestimate the downstream impacts of backlogged claim payments on their business. This underestimate, along with a status quo bias against implementing new systems, seems to be why many practices don’t seek alternative solutions.
1 Health Rev Partners, 2023
2 10 providers x 7 patients per day = 350 benefit verifications per week at an average of 12 minutes per verification = 70 hours per week.
Regrettably, patients seeking mental health care have grown accustomed to a lengthy and cumbersome process for verification, appointment booking, and payment. But there is a better way.
Consider how financial services companies have embraced technology, enabling quick and frictionless payments for everyday items like a cup of coffee with credit cards and Apple Pay. Why can’t we make verifying insurance eligibility just as effortless for something as critical as mental health care? That is Nirvana’s mission. Achieving this level of harmonious integration in benefit verification, would significantly reduce barriers to patients receiving quality mental health care.
This is where creative applications of technology like AI and Machine Learning can help solve the downstream problems of manual patient verification.
AI assisted workflows and flexible API solutions have proven to be the best way to get accurate eligibility and reliable cost estimates into the hands of providers and patients as quickly as possible and will be a paradigm shift for all. Nirvana’s AI assisted verification workflows prioritize urgent tasks and can eliminate unnecessary manual work entirely.
Illustrated under the heading “How the Patient Journey Differs When Providers Use Nirvana”, one can see the stark contrast between a manual vs. AI assisted intake verification workflow.
At Nirvana, we recognize the opportunity to revolutionize benefit verification by leveraging AI and ML technologies.
Our solution allows behavioral health teams to quickly and accurately verify patient information with 94% accuracy. Nirvana’s technology has enabled providers to instantly approve over 3 million sessions with full cost transparency every month for provider groups like Lifestance, Nystrom & Associates, and Geode Health, alongside EHR partners AdvancedMD and Valant, among others. Nirvana is a solution that benefits the provider network, their internal teams, the clinicians and the patient receiving care.
With Nirvana, practices are able to reduce claim denials, increase revenue, and boost patient satisfaction by helping them receive the care they need with full cost transparency prior to treatment.
By embracing innovative patient benefit verification technologies, practices overcome the hidden costs of inaccurate verification improving the overall efficiency, financial health, and patient satisfaction of their behavioral health practices. The impact of fast and accurate patient verification has massive impacts for all parts of behavioral health practices.
We believe that by creating better systems for behavioral health practices, patients receive better care. As is our Motto: Better Systems, Better Care.
If you are looking to improve your operational efficiencies, explore Nirvana’s Intake, Continuous Coverage Monitoring and Custom Solutions here.
The author of this piece, Akshay Venkitasubramanian, is the Co-Founder & CEO of Nirvana
Measurement-based care (MBC), or the practice of incorporating client feedback on progress in therapy into treatment decisions, is a highly impactful tool — but one that less than 20% of behavioral health providers integrate into their care.
Historically, this has been due to various concerns: Even if clients are asked to participate, they may not understand how providers use the data; therapists tend to believe that measures are no more effective than clinical judgment, despite the prevailing evidence.
At Two Chairs, we’ve found that therapy is most effective when therapeutic alliance is strong and when clients have tools to reflect on their progress and take an active role in their care. So we’ve put MBC at the core of our care model.
More behavioral health organizations should adopt MBC to achieve better outcomes and improve the therapy supply and demand issue we’re all witnessing. Hear from our Chief Clinical Officer Colleen Marshall to learn more about why and how to do it.
Colleen Marshall: There are several measures that providers can use to see how a client is progressing in therapy, and they should be chosen based on their ability to assess client symptoms, quality of life, and therapeutic alliance.
At Two Chairs, we use the following measures taken through brief — but comprehensive — client questionnaires prior to each session to capture the best data to inform a holistic and collaborative care approach.
For symptom assessment, we recommend the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) to measure anxiety and depression, respectively. These are clinically validated, industry standards that are reliable, well-established, responsive to changes in symptoms, and easy to compare across payers and markets. Because anxiety and depression are two of the most common mental health problems, and because symptoms are comorbid with other issues like posttraumatic stress disorder (PTSD), using the GAD-7 and PHQ-9 enables you to capture progress in a large breadth of clients.
Beyond symptoms, it’s also essential to look at quality of life to help you see how your clients are doing overall. Often, the impact of mental health problems on a client's overall quality of life is more salient than their specific symptoms. Although changes in symptoms are related to changes in quality of life, they do not always change at the same rate and may vary in importance to clients.
High-quality therapy will treat the person as a whole. So we need to include measures that assess overall functioning beyond specific mental health symptoms to create a truly comprehensive MBC system. To do this, organizations can include measures like the Mental Health Quality of Life (MHQoL), which captures things like self-image, independence, mood, relationships, and physical health, and is a relatively new measure. We recently adopted it and we’re looking forward to evaluating its impact on the care we deliver — already, our therapists applaud it for its ability to assess things that are important to their clients’ well-being not captured by our symptom measures.
And finally, because therapy is a relationship-based intervention, it’s essential to constantly monitor therapeutic alliance, or the relationship between the client and therapist. While a strong match is the first step in establishing strong alliance, it’s crucial to monitor alliance throughout care. By doing this, therapists can identify when there has been a rupture in the relationship that needs to be repaired, give the client the opportunity to provide feedback and have targeted conversations about their relationship with their therapist, and ultimately make adjustments to care that are responsive to this feedback.
While these measures cover the basics, there are more out there, and we continually evaluate our own MBC model to ensure that it is meeting the ever-evolving needs of our providers and clients.
Colleen Marshall: MBC provides clients and providers with the ability to monitor progress in real time and make collaborative and data-informed decisions. However, it’s crucial to implement it well and embed it into the organizational culture so that clinicians feel prepared and supported to use it in a way that creates true value for their clients.
MBC gives clients an opportunity to reflect on their well-being week-to-week with our mental health snapshots and see progress in care, which can be empowering. Through MBC, they get a deeper understanding of their progress and a shared language for communicating about it with their therapist, which is difficult for many.
By engaging in MBC, clients also have a chance to take a more active and involved role in their care. Importantly, MBC gives clients a way to identify connections between changes they’ve made and how they’re progressing in therapy, which is key for achieving desired outcomes. Most people can tell they’re getting better generally, but the data can help support that observation.
When clients are actively engaged in their mental health care, it helps them get clear on goals and desired outcomes and enables a strong collaborative process. The information, discussions, and collaborative decision-making that are a part of MBC can also strengthen the therapeutic alliance, which research has shown leads to better outcomes.
At Two Chairs, 100% of our clinicians engage with MBC, which has helped give us clear insights into the clinical outcomes our care is achieving. You can learn more about how our care model is driving exceptional behavioral health outcomes — with 74% of our clients showing clinically meaningful improvement at the end of care — in our 2024 Clinical Outcomes Report.
Colleen Marshall: First and foremost, we want our clients to achieve their mental health goals and reach a point where they no longer need therapy, and MBC is a critical component of the collaborative path to graduation from care. When implemented well, it gives both therapists and clients tools to engage in conversations about care that can help clients achieve their goals in a data-driven way.
Additionally, MBC plays a role in improving accessibility of care: It can help clients progress more quickly and gives clinicians a better sense of when someone is done with care, or if they need a higher level of care. All of this can contribute to reduced dropout rates and overall time in care.
And finally, when data is aggregated across an entire behavioral health organization, it can provide invaluable information about the effectiveness of its services. This data can be used to help an organization improve its effectiveness by allowing it to better diagnose a population, highlight strengths and weaknesses, and identify needs for supervision and training. It can also demonstrate the value of behavioral health services to payers, which can inform reimbursement policies and improve funding allocated to mental health care across the country.
Colleen Marshall: To improve adoption of MBC, organizations need to look at things like software and data teams, organizational culture, and culturally responsive care.
First, it’s important to have great software that’s easy for both clients and clinicians to use — that means partnering with clinicians in software design to ensure it supports their work, as well as conducting multiple rounds of user testing. You need to make sure it’s part of the entire system and that managers and their managers are all bought in. Having strong product, engineering, and data teams can help you create the tools you need and look at data in a psychologically safe way.
While it starts with software, you also need to create a clinical culture that works to point everything in the right direction and embed MBC in the care model. We know that there is a lot of clinician skepticism around MBC, which is understandable. To overcome that, it’s important to create a sense of safety, hire therapists who have the right mindset for working with MBC, and communicate clearly how the different measures are used. It’s critical to listen to clinicians and create a culture where their voices actually matter.
You also need to look at your MBC model through a holistic and cultural lens and delve into clients’ lived experiences. While data can offer valuable snapshots of someone’s symptom severity, functioning, and progress, these are only one facet of a client’s complex reality. It’s essential to practice culturally responsive care and acknowledge the diverse ways different cultures express and experience mental health challenges. By applying cultural humility and acknowledging holistic needs, we move beyond a narrow focus on scores and embrace the collaborative journey that uses data as a starting point to explore the depths of clients’ unique stories.
Once all these pieces are in place and moving, your clinicians can see how useful the tools are and how they help evolve their care plans for their clients.
At Two Chairs, we look forward to evolving our own MBC model and look forward to wider adoption among more providers so we can reach better mental health outcomes for all.
Telebehavioral health (TBH) changed the way clinicians provided services over the course of the COVID-19 pandemic. In response to the public health emergency (PHE) that ensued, federal and state governments adjusted regulations so that individuals could more easily receive behavioral health services. This resulted in fewer access disruptions, lower care costs, and helped establish TBH as a viable treatment modality.
Although the PHE has ended and in-person visits have increased, TBH remains popular. Providers and regulators are now working to establish how TBH can best serve individuals who need care, while also supporting providers in a post-pandemic world.
A behavioral health services gap existed in the U.S. long before the COVID-19 pandemic. On average, one in five adults experiences mental illness annually. However, fewer than 50% receive treatment.1
Many factors have contributed to this gap, including cost of services, travel expenses, stigma, and a lack of practitioners. Currently more than 160 million people live in areas with mental healthcare provider shortages.2
While TBH usage and acceptance rose significantly during the COVID-19 pandemic, TBH had already existed in some form for decades. Providing psychiatric services via videoconference, for example, began in the 1950s.3 However, TBH scalability pre-pandemic was hindered by misconceptions about efficacy as well as regulatory and reimbursement challenges.
Movement decreased dramatically during the pandemic as buildings closed and people stayed home. As a result, TBH underwent rapid adoption, as it became the only viable behavioral health treatment modality for many individuals.
American society adopted TBH so quickly that by March 2020, utilization had increased by 154% compared to March 2019.4 In Medicare populations, TBH visits increased from 1% of all BH visits in 2019 to 50% by the end of 2020.5
Carelon Behavioral Health was poised to respond to the pandemic’s challenges, as it was already providing expanded access to care with national provider groups.
Acting on the changing regulatory and policy landscape, Carelon Behavioral Health quickly implemented TBH in multiple states and markets. Changes included:
These changes supported Carelon Behavioral Health’s mission to improve population health outcomes and behavioral health integration. Patient and provider experiences were enhanced, and costs were reduced.
Additionally, Carelon Behavioral Health supported the 988 Suicide & Crisis Lifeline rollout by operating backup call, text, and chat services nationwide.
Today, TBH utilizes a variety of software, devices, and connectivity platforms. Providers use TBH in in-patient, outpatient, and community settings. Services including evaluations, consultations, medication management, psychotherapy, and provider training can all be performed using TBH. Other benefits include:
In 2021, approximately 35% of 14.1 million adults who experienced a serious mental illness did not receive treatment.6 For several reasons, this gap is even wider for vulnerable populations. Stigma associated with seeking treatment, a lack of culturally competent providers, and an uneven distribution of clinicians between urban and rural areas can keep people from getting the help they need. Populations that are often disproportionately affected by gaps in care include:
LGBTQ+. According to a recent survey, 60% of LGBTQ+ youth could not access mental health care in 2022, and nearly half contemplated suicide.10
TBH helps address the challenges that vulnerable populations face when seeking treatment for mental illness.
In recent years, the opioid epidemic has grown into a public health emergency. Medication assisted treatment (MAT) has emerged as an effective care option for individuals experiencing opioid use disorder (OUD). MAT, which includes the use of methadone, naltrexone, or buprenorphine, shows better clinical outcomes when compared to abstinence-based approaches.11
When MAT is combined with TBH, barriers such as provider shortages, stigma, and geography are reduced. This treatment became even more effective during the pandemic when regulators removed in-person requirements prohibiting prescribing medications via TBH. Patient outcomes improved with higher MAT retention rates and a reduction in overdoses.11
Telebehavioral health utilization continues to increase and gain societal acceptance. In 2021, 37% of adults over 18 reported using TBH in the past year.12 Individuals received treatment for issues such as anxiety disorder, severe stress, and major depressive disorder. More than 88% of facilities offered telebehavioral health services in September 2022, compared with just under 40% of facilities in April 2019.13
Carelon Behavioral Health strives to continually improve the quality of care that members receive. The main goal is to make TBH as effective and accessible as possible by:
“Carelon Behavioral Health is committed to incorporating information and communications technologies to support expanding care access. We intend to do so in a manner that meets our members where they are, while offering increased choices and conveniences in access,” says Dr. Hossam Mahmoud, Regional Chief Medical Officer for Northeast/Southeast, Carelon Behavioral Health.
Carelon Behavioral Health expands access to care by supporting providers who would like to incorporate TBH into their practices. TBH helps reduce wait times, increases provider availability, and makes in-person services more available to those who prefer a face-to-face intervention.
Carelon Behavioral Health uses the latest advances in technology to support telebehavioral health service delivery including:
Leaders at Carelon Behavioral Health believe that TBH should include measures to improve access to and quality of care. “The data has demonstrated the effectiveness, cost-efficiency, and scalability of TBH. The discussion now focuses on leveraging TBH technology to enhance quality and outcomes, mitigate health inequities, and improve costs,” explains Dr. Mahmoud. He recommends the following:
The U.S. Department of Health and Human Services allowed several telebehavioral health flexibilities during the COVID-19 pandemic. Some changes have become permanent while others are temporary.14
During the PHE, the Drug Enforcement Administration (DEA) allowed providers to prescribe selected medications via TBH, suspending the in-person evaluation requirement and issuing additional flexibilities. The DEA and SAHMSA issued an extension on TBH prescription flexibilities through November 11, 2023. These flexibilities are extended through November 11, 2024, for provider-patient relationships established before November 11, 2023.
The Bipartisan Safer Communities Act provided the Health Resources and Services Administration an additional $80 million in multi-year funding for the Pediatric Mental Health Care Access grant program. The program funds pediatric mental healthcare teams that provide consultations via teleconference to practitioners working in primary care practices, emergency departments, and schools.
The COVID-19 pandemic served as a catalyst to expand telebehavioral health utilization. However, many barriers remain that keep patients from receiving care. Transportation costs, potential loss of pay due to missed work, child and elder care issues, provider distance, and wait times are all obstacles that TBH can work around. Additionally, TBH removes hurdles for individuals who live in rural communities or need specialty care, and leads to improved outcomes.
By continuing to advance TBH, with the appropriate HIPAA safeguards in place, we can enhance the behavioral healthcare delivery system, advance treatment access, and improve care.
1 National Alliance on Mental Illness, Mental Health by the Numbers (accessed September 2023): nami.org.
2 Health Resources & Services Administration, Health Workforce Shortage Areas (accessed September 2023): data.hrsa.gov.
3 National Library of Medicine, National Center for Biotechnology Information, Telemedicine and psychiatry – a natural match (accessed September 2023): ncbi.nlm.nih.gov.
4 Centers for Disease Control and Prevention, Trends in the Use of Telebehavioral health During the Emergence of the COVID-19 Pandemic (accessed September 2023): cdc.gov.
5 JAMA Network, Increased Use of Medicare Telebehavioral health During the Pandemic (accessed September 2023): jamanetwork.com.
6 National Institute of Mental Health, Mental Illness (accessed September 2023): nimh.nih.gov.
7 National Center for Biotechnology Information, National Library of Medicine, A call to action to address rural mental health disparities (accessed September 2023): ncbi.nlm.nih.gov.
8 U.S. Department of Health and Human Services Office of Minority Health, Mental and Behavioral Health – African Americans (accessed September 2023): minorityhealth.hhs.gov.
9 NAMI, Hispanic/Latinx (accessed September 2023): nami.org.
10 The Trevor Project, The Trevor Project: 2022 National Survey on LBGTQ Youth Mental Health (accessed September 2023): thetrevorproject.org.
11 National Institute on Drug Abuse, Increased Use of Telehealth for OUD Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose (accessed September 2023): nida.nih.gov.
12 Centers for Disease Control and Prevention, Telemedicine Use Among Adults, 2021 (accessed September 2023): cdc.gov.
13 JAMA Network, Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022 (accessed September 2023): jamanetwork.com.
14 Telehealth.hhs.gov, Telehealth changes after the COVID-19 public emergency (accessed September 2023): telehealth.hhs.gov.
15 American Health Law Association: Health Law Connections, Behavioral Health Integration: Opportunities and Advancements for Primary Care and Beyond (accessed September 2023): americanhealthlaw.org.
Symptom reduction has been the primary, and oftentimes sole focus of mental health care for years. But is that enough? In this conversation, we spoke with Modern Health's Dr. Jessica Watrous, Director of Clinical Research & Scientific Affairs to explore how focusing solely on symptom reduction may overlook certain areas of mental health concerns. We will also look into the role of workplace culture and environment in influencing mental health outcomes and the innovative strategies and solutions that Modern Health provides to support employee mental health beyond traditional methods.
Symptom reduction is one of our strongest indicators of whether or not mental health treatment works - if we want to know if a specific intervention for depression works, then we have to measure depression and see how those symptoms change as a function of our intervention.
That being said, symptom reduction alone does leave a gap in our understanding of the impact of mental health concerns. First, most of what we’re doing in healthcare focuses on specific mental health disorders like depression, anxiety, or posttraumatic stress disorder. This is important, and it may leave individuals out who are either experiencing symptoms of these specific concerns or whose distress is showing up in other ways, like relationship problems or difficulty motivating themselves.
Second, reducing our outcomes only to symptom reduction prevents us from truly providing patient-centered care. For example, maybe I want to go to therapy for treatment of PTSD, but ultimately, it’s not that I want to see my symptoms change; it’s that I want to be able to go to the grocery store without feeling distressed or attend my children’s sporting events without getting overwhelmed. Symptom reduction can help us as practitioners understand if we’re moving toward those goals, but ultimately, we have to incorporate measures that are meaningful to the patient themself.
And last, mental health concerns aren’t occurring in a vacuum. Even if someone is presenting for depression treatment, only focusing on the reductions in their depression symptoms may not tell us if their functioning is improving in other domains like at work or at home. If we want to deliver holistic care, we have to understand the impact that care is having on all facets of a person’s life.
To tie this back to the workplace and factors that are important to employers as they’re investing in mental health benefits, symptom reduction is a piece of the puzzle they should be evaluating. Does the solution you’re providing drive meaningful improvements in clinical outcomes should be the first question. And you can take it a step further: are employees demonstrating meaningful engagement? Can they build skills that help them in their personal and professional lives? Are they engaging in strategies that will set them up for long-term health? In order to answer these questions, we need other data points from multiple modalities of mental health and well-being care and support.
Ultimately, we have to acknowledge that, similar to many health domains, individual change, like going to therapy, is a small aspect of improving mental health. Work plays a big role in many of our lives, which means that if things are not good, they can take a toll on us both mentally and physically.
The US Surgeon General’s report on workplace well-being from a couple of years ago really did a wonderful job of highlighting how the workplace directly impacts our well-being and mental health. The framework from that report really creates an actionable guide for employers to make changes across the pillars (Protection from Harm, Connection and Community, Work-Life Harmony, Mattering at Work, and Opportunity for Growth) that can result in improving employees’ experience at work.
The first thing that I would call out is that our core benefit, which includes access to evidence-based digital content, Circles (our group offering), coaching, and therapy, are already impacting outcomes beyond just symptom reduction. We have peer-reviewed papers that demonstrate that our platform helps members reduce symptoms of depression and anxiety and we have papers on other outcomes. One of our papers demonstrated that after using Modern Health for 3 months, members improve their loneliness. To me, this finding is amazing because loneliness could be as detrimental to people’s health as smoking 15 cigarettes daily! We’ve also presented data that Modern Health members improve their physical activity after engaging in the platform, which is another key health behavior that improves long-term mental and physical health outcomes.
My team, the Clinical Research team, is focused on examining what other types of outcomes we’re impacting because that helps us know if we are having a holistic impact, and it helps us innovate in the product about areas where we can really optimize our care. This leads to a more direct answer to the question: at Modern Health, we are taking our programs beyond just those that are only focused on symptom reduction. That could look like working with a coach on issues like financial stress or maybe improving health behaviors. It could also look like engaging in one of our Pathways, which are a combination of 1:1 meetings with a Pathways specialist paired with digital content specific to the topic you may be working on. Modern Health Pathways is the first of its kind in the digital mental health industry and the only modality of care that guides members through specialized topics with an evidence-based structure, ongoing 1:1 support from a dedicated Pathway Specialist, self-guided experiences, and topic-specific assessments to measure impact. We have a full set of Pathways that are specific to the workplace, like those for managers, and we have some for parents, too. I’m most excited this year that we’ll be going deeper in how we’re focusing on the intersection between physical and mental health. We already know Modern Health helps members improve their physical activity; now, what would happen for members who sign up for a Pathway specifically focused on improving that key health behavior?
In my mind, employers should be looking for initiatives that maximize value. What I mean is that you don’t want something that drives a lot of engagement but doesn’t actually move the needle on mental health. You also don’t want something that’s VERY effective at improving mental health, but no one at the organization uses. You’re looking for that sweet spot of something effective that drives high engagement.
This may mean, when it comes to mental health, making sure that it delivers clinical outcomes like symptom reduction. And then taking a broader look from there at other indicators that are relevant to more of your population. So, can members learn skills that help them manage better? Can they gain a sense of community in the offerings? What about modalities of care that support them in mental health adjacent domains like parenting stress? I think other areas where we can get quantifiable metrics are things like retention (i.e., is retention improving for members that engage in the initiative?) and satisfaction (i.e., do members like the initiative).
Over the last 12 months, we have given dozens of keynotes, moderated main stage sessions, co-hosted national and regional industry events, lead webinars, published white papers, and provided strategic guidance to providers, digital tech startups, investors, state departments of human services as well as the Department of Justice. Over a total of 200 days on the road, traveling to an array of healthcare conferences, we’ve had the chance to immerse ourselves into the latest trends, insights, and innovations shaping the behavioral health industry. This week, we had the opportunity to converge our experiences and reflect on our findings at the MHCA conference. We shared controversial event sessions, recurring themes, which conversations were most surprising, and what keeps thought leaders in mental health up at night. We covered the macro trends impacting our sector, M&A news across nonprofit and for-profit behavioral health, and our personal takes on what executive teams should expect to see in 2024 and beyond. Here’s what you missed…
All Stakeholders Are Moving Beyond Telehealth and EHR
Across the board, providers, payers, digital health companies, and investors are starting to expect more with the technology we have at our fingertips. We are beyond table stakes operating systems like EHR. Now, more condition-specific and population-specific solutions are rising to the forefront.
Evolution of Solutions and Support for Patients and Physicians
Ongoing advancements in digital solutions are providing better support for both patients and physicians. The aim is to improve the overall efficiency and effectiveness of health care services through technological evolution.
Digitization and Automation Offering Potential for Improved Health Outcomes
The process of digitizing and automating health care systems holds tremendous potential. This potential is expected to translate into better health outcomes for individuals, with streamlined processes and improved access to care. (Greater margins!)
Other Trends:
Funding and M&A
Behavioral health startups experienced a funding slowdown last year, but venture investors remain optimistic about the sector's future despite the anticipated consolidation in the space, due to valuation cuts or business closures. The pediatric behavioral health crisis is garnering increased attention, driving more investment toward youth mental health initiatives. Meanwhile, the industry continues its shift toward value-based care, necessitating adaptations from providers and payers to embrace risk-based contracting models. As demand for behavioral health services rises, providers and health systems are expanding through joint ventures (JVs), recognizing the potential for substantial benefits despite the complexity and patience required to establish these partnerships.
Non-Traditional Entrants — New Competition from Big Retail
CVS/Aetna, Walmart, Amazon, Google (GV), and Best Buy are examples of large retail companies entering the healthcare industry, who are finding their “dance partners” for mental health and physical health.
Value-Based Care for Substance Use Disorder
The Substance Use Disorder (SUD) treatment landscape is shifting towards value-based revenue models aimed at improving outcomes. To address challenges such as fragmented care and escalating costs, providers are increasingly turning to case rates, bundled payments, and capitated rates. The Shared Risk Revenue Model, offering advantages to providers like advanced payments and bundled care continuum payments, while also delivering benefits to payers through reduced administrative expenses and enhanced member value. However, successful implementation of a value-based model necessitates organizational efficiency and alignment of stakeholder interests for successful SUD treatment.
VR Outlook
Virtual Reality (VR) combined with large language models is rapidly evolving in healthcare, particularly in behavioral health, for conditions such as anxiety, PTSD, and autism. However, despite its potential, VR in healthcare faces hurdles such as reimbursement issues, logistical complexities, and regulatory pressures. Nevertheless, the recent approval of the first-ever CPT code for VR-mediated therapy by the American Medical Association signals progress in this area. The Department of Veterans Affairs is incorporating VR in care delivery and staff training, showing decreases in stress, anxiety, and PTSD symptoms. Looking ahead, future developments in VR healthcare are expected to integrate AI and surmount operational challenges for further enhancement.
Policy and Advocacy
The White House's AI Executive Order guidelines focus on safety and security, urging federal departments to prioritize AI advancements and implement directives within their authority. The order mandates developers of significant AI systems to disclose safety test results to the U.S. government and advocates for the creation of AI safety and security standards to mitigate risks. Emphasis is placed on privacy protections for Americans and equity and civil rights advancements. Promoting responsible AI use in healthcare and education, the order advocates for the development of a safety program for AI-related healthcare incidents. The order highlights support for workers against negative AI impacts and aims to foster innovation and competition in the AI sector.
Emerging Microtrends:
Caution and Realism in Digital Health:
Our 200 days on the road have given us invaluable insight into all of these trends and more. While there are challenges to be faced, we are predominantly optimistic about the potential 2024 holds for the behavioral health industry.
We are excited to share the news that Dario acquired Twill to create the most comprehensive digital health platform that addresses the broad range of mental health challenges from wellbeing to the most costly chronic conditions. Both Dario and Twill share the same commitment to a consumer-centric approach to engaging people on their overall health and wellbeing to meet each person where they are in their health care journey. Together, we have a vision for transforming the way people access support and care to optimize engagement and outcomes.
As Dario and Twill come together, we believe our ability to provide solutions across a broad set of needs in the market answers the growing demand for consolidation of point solutions. That ability to deliver more impact through a single platform – especially with a more robust ability to address behavioral health – will help accelerate growth. The addition of Twill’s wellbeing community will also add a unique ability to create stickiness around our chronic condition solutions with a more engaging approach to improving overall health through the addition of condition-focused peer-to-peer support.
Our unified set of solutions, delivering best-in-class outcomes, are now ready to optimize and scale for greater impact. Dario and Twill combine a wealth of data and insights across individual care journeys that will help guide strategy across member activation and clinical engagement. That starts with the ability to deliver a streamlined and holistic member journey that can be adapted more effectively as needs and wants change.
You can learn more about Dario on our website: www.dariohealth.com. To hear more about what the future holds, check out a blog from our CEO Erez Raphael and co-founder of Twill Tomer Ben-Kiki where they share their vision of our combined companies in a new blog post.
It remains difficult to access therapy. According to NAMI, less than 50% of adults experiencing mental illness received treatment in 2021. And if you were from a community of color, it is even harder to access care. In 2021, fewer than 40% received treatment and for some historically marginalized communities, it was less than 25%. While so many companies, health plans, and providers are rightfully working on the issue of increasing access to and quality of mental health care, one critical way to achieve this shared goal is upping clinicians’ cultural competency skills to meet the needs and expectations of clients from all cultural backgrounds.
Right now, most clinicians receive training on multicultural competence, but only limited opportunities for feedback on how well they are applying the skills in real world patient and client encounters. Anyone can sit through a training, but the goal has to be demonstrated improvements. Historically, receiving feedback on multicultural competency skills required a human evaluator to manually observe the clinician and offer feedback, which is not scalable nor could produce useful data across organizations. And the status quo for multicultural training has largely been unsuccessful for changing racial/ethnic disparities in therapy outcomes, or to offer any innovative solutions to evaluate or improve population-wide quality. Given the vast need for this type of training, we have to find impactful solutions that can be deployed to thousands–not dozens–of clinicians at a time, and that actually make a difference for individuals.
This is where AI comes in. SonderMind and Lyssn.io will be partnering with Dr. Jesse Owen at the University of Denver on his grant, just shy of $500,000 from the John Templeton Foundation, to increase mental health clinician cultural competence using AI/ML and deliberate practice via a randomized controlled trial.
We have brought together an interdisciplinary team of intellectual humility researchers, computer scientists, psychometricians, and Ph.D level counseling/clinical psychologists to conduct a comprehensive project designed to improve multicultural training. We are proposing that intellectual humility is an ideal framework for training the acquisition of knowledge regarding therapists’ multicultural orientation (i.e., cultural humility, cultural opportunities, cultural comfort). The training, delivered through Lyssn’s innovative platform (validated across 60+ peer reviewed studies), will include learning modules delivered by a multicultural orientation instructor, written content, followed by deliberate practice videos with immediate intellectual humility feedback. This feedback will be delivered via artificial intelligence, informed by previously established machine learning models and based on industry wide gold standard quality metrics.
We expect this innovative approach to produce new training outcomes for two reasons:
First, randomized control trials rarely engage with independent practice therapists. In our study, 175 active SonderMind providers will participate. Second, participating clinicians will practice in the privacy of their own spaces without fear of saying the wrong thing to another human. Through the trial, they will get repeated, real time feedback and coaching via the AI tools developed for this study. We expect skills improvement when clinicians are comfortable saying what they would naturally say to a client, combined with actionable and appropriate feedback.
We believe that involving practicing clinicians in this trial and offering them this low-stakes way to improve their cultural competency skills will demonstrate the efficacy of this training and the impact we can have on therapy outcomes for individuals from all backgrounds and walks of life.
The goal of our trial is to improve access to quality care for individuals from historically marginalized groups, ethnic backgrounds, cultures, and identities. Ideally, the learnings from this research will be scaled to thousands of clinicians in just a matter of months after the study is completed.
So how will we know if it works?
We will assess outcomes for the participating SonderMind clinicians both at the therapist level, as well as their client therapy outcomes. We will also conduct qualitative interviews with select participants about their training experiences. Ultimately, our hope is that we will empower therapists to increase their multicultural orientation and intellectual humility, thereby improving their clients’ therapy outcomes–and allowing them to serve a more diverse population of clients.
Addressing the mental health provider shortage and improving access to quality care requires innovative, outside-the-box thinking, one tailor made for a partnership between academia, healthcare technology companies, and a philanthropic organization. By thinking about ways to increase cultural competency amongst practicing clinicians and those who are currently in training to become clinicians, we can better meet the needs of individuals who are acutely underserved right now.
We look forward to undertaking this important work.
“The fusion of physical and mental health services is poised to create a more comprehensive and cohesive health care experience.” – Sarah Reilly, SVP of Product & Strategy, Lucet
In 2023, the mental health crisis in the U.S. became a dominating topic of national discussion and led to a greater understanding of the challenges in connecting individuals with behavioral health resources. In the year ahead, Lucet foresees an even greater industry focus on expanding access to the behavioral health care Americans require, more emphasis on measurement, and greater care coordination between payers and providers. In 2024, we also anticipate:
“The pending Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act is set to cast a spotlight on the persistent problem of ghost networks — inaccurate and outdated provider directories and referral workflows that lead members to a dead end. This development not only signifies a heightened focus on rectifying these discrepancies, but also will bring about a shift in how we approach behavioral health care delivery – specifically around network management. Health plans will need to focus not only on maintaining accuracy in their listed networks, but also ensuring that those providers are able to offer availability to patients.”
—Shana Hoffman, President & CEO
“Addressing the accessibility challenge of behavioral health care goes beyond mere connectivity. Health plans will require a nuanced approach that considers individual needs and preferences. In 2024, the industry can expect an increased emphasis on connecting people to resources, providers and technology that align with their unique requirements. Tailoring care to factors such as modality (in-person vs. virtual treatment) and provider specialties and characteristics (gender, race, sexual identity) will become paramount. This personalized approach has proven effective in fostering trusted care team relationships, ultimately enhancing patient engagement and treatment adherence.”
—Bernard DiCasimirro, DO, Chief Medical Officer
“A key trend shaping behavioral health care has been the integration of physical and mental health services. In the coming year primary care providers will be under increased pressure to conduct more behavioral health screenings and ensure interventions align with current standards of care and value-based initiatives. This opens avenues for technology-enabled behavioral health organizations to support primary care practices by facilitating access needs and providing consultation services. This fusion of physical and mental health services is poised to create a more comprehensive and cohesive health care experience.”
—Sarah Reilly, SVP of Product & Strategy
“As the upcoming election looms, the administration is expected to finalize the proposed rule regarding mental health parity. This initiative will likely increase compliance costs for health plans and employer groups. However, the stringent nature of the proposed rule may lead to disruptions, as meeting its requirements poses a challenge that no health plan has yet surmounted. The repercussions of these changes will undoubtedly reshape the landscape of behavioral health coverage in the coming year.”
—Carlos Lindo, SVP of Legal & Compliance
“From a market perspective, employers and health plans are increasingly recognizing the importance of addressing behavioral health needs. In 2024, we can expect a growing demand for comprehensive solutions that seamlessly integrate medical and behavioral health services for employees and members. This holistic approach acknowledges the interconnected nature of mental and physical well-being, reflecting a more nuanced understanding of the factors influencing overall health.”
—Amy Kazmierczak, Chief People Officer
“The broader health care landscape is undergoing a fundamental shift, driven by digital solutions, mega-mergers and a surge in private equity investment in providers. Large health systems are facing challenges as various entities chip away at their business. The trend toward delivering health care at home is likely to persist, necessitating integrated solutions that span diverse settings to meet patients where they are and provide seamless care.”
—Shana Hoffman, President & CEO
“The COVID-19 pandemic catalyzed a significant shift in behavioral health care delivery, with virtual services gaining prominence due to the need for safe treatment options. In 2024, we anticipate a reckoning for companies that took advantage of the relaxed regulations during the state of emergency. Regulators are now tightening controls, with the Department of Justice expected to act against companies that exploited the Public Health Emergency to the detriment of members. This marks a critical phase of accountability and a return to a more regulated and secure behavioral health landscape.”
—Carlos Lindo, SVP of Legal & Compliance
“From a technology perspective, the need for seamless integration into existing systems is paramount. Whether digital solutions are offered by insurance providers or independent tech platforms, the ability to integrate into practice management suites and electronic medical records (EMR) is crucial. This integration will ensure a streamlined and efficient workflow for health care providers, facilitating the adoption of new technologies without disrupting established practices.”
—Brian Stenson, Chief Information Officer
Navigating 2024 trends will require our industry to take a holistic approach to address the intricacies of mental health while embracing the technological advancements shaping the future of health care delivery. As we progress further into the new year, let us continue to lay the groundwork for a more connected, responsive and patient-centric behavioral health ecosystem.
With the nation facing a mental health crisis marked by a shortage of providers and the increased incidence of depression, anxiety, substance use disorder, and suicidal ideation, the direct impact of behavioral health on physical well-being is increasingly known. Primary care providers (PCPs) are often best positioned to address behavioral health issues before they escalate into the more severe mental health issues that dramatically impact patient outcomes. However, most PCPs lack specialized behavioral health expertise, referral resources, and the time needed to effectively assess, treat and manage such conditions.
To address this reality and the singular impact that mental health has on overall patient health outcomes, Magellan Health created a solution based on the evidence-based Collaborative Care model. Our solution integrates behavioral healthcare in the primary care setting, supporting providers through both high touch and high-tech care. Already proven in use, the solution provides PCPs with the technology-enabled access to behavioral health experts to support them in screening and evidence-based treatments founded in measurement informed care. Patients are supported with an app-based solution that delivers digital cognitive behavioral therapy and other targeted solutions based on their needs.
In this Q&A, Caroline Carney, M.D., President of Behavioral Health and Chief Medical Officer, Magellan Health, will provide readers with a primer on the need not just for an integrated approach, but also how it works, how it impacts patient outcomes and value-based approaches, and how it will help to alleviate the shortage of mental health professionals.
Primary care physicians (PCPs) are the foundation of our healthcare system, serving as the primary point of care for a myriad of conditions ranging from well-child visits to complex chronic illness. They also prescribe more behavioral health drugs than other providers, indicating the need for accurate screening, diagnosis and treatment of mental health and substance use disorders. Because they deliver whole person care, they are uniquely positioned to be the frontline providers for persons who need behavioral health services. Why? Data show that nearly half, 44%, of patients did not receive behavioral healthcare in the six months prior to being admitted for inpatient behavioral healthcare, but more than half – 56% – visited their PCP in the six months prior to being admitted. Further, PCPs are present throughout patients’ mental health journeys – Magellan’s own data shows that 64% of those who died by suicide saw their PCP within the last four weeks of their lives.
Primary care providers are simply too overwhelmed to do everything well, to keep up on the changes with everything they are responsible for, and under the time pressures they have to deliver care for acute and chronic needs. The schedules, the training, and the pressures don’t allow for adequately addressing mental health and substance use needs, especially across the population.
I am a board-certified physician of internal medicine and psychiatry and I have cared for patients in integrated settings the whole of my career. I currently support a team of nurse practitioners and therapists who provide behavioral health care in a rural Federally Qualified Health Center (FQHC). I am often exposed to the predicament PCPs face today:
In the U.S., there continues to be a rising need for mental health services, a demand that far outpaces provider availability. In order to address the access to care need, models such as collaborative care provide an excellent solution for the delivery of holistic primary and behavioral healthcare in an integrated setting.
Our own data, and data from sources like Milliman and other companies, shows the impact of behavioral health conditions on overall health, and the costs associated with the care of persons with co-morbid or co-occurring conditions. In addressing both physical and behavioral health, we can provide individuals with needed care, deliver evidence-based mental health treatment, and lower overall total cost of healthcare costs. For instance, if I address and treat a patient’s anxiety or depression, tend to their psychosocial needs, and ensure they make medical visits and engage in medical care, it follows that lower use of emergency services and inpatient health services occurs.
Collaborative care models are all based on an integrated care model developed at the University of Washington that has been validated in more than 90 randomized and controlled trials. They have been hard to scale because of challenges in managing patients over time, having the right teams of support, and lacking reimbursement from payers like Medicare. However, in recent years, Centers for Medicare & Medicaid Services (CMS) approved paying for collaborative care codes and many states have followed. Collaborating with NeuroFlow as Magellan’s technology platform, we’ve built a scalable model based on the key components of collaborative care:
Our experiences are still early, but have been very positive. Our initial pilot was in a rural FQHC that provides primary care services in a behavioral health underserved area. In the first year, we’ve grown from supporting one PCP to three and found:
In another use case in a large health system’s pediatric clinic, we have enrolled a high number of children who otherwise would have waited weeks to months for behavioral health concerns to be addressed.
In the behavioral health arena, we are seeing more demand for services than ever before. I consider this one of the best upsides of the COVID pandemic—people are seeking services and stigma against mental health has declined. It’s been incredible to talk openly with people about the need for care. Unfortunately, we do not have enough behavioral health professionals – a reality that will not change materially for several years. This collaborative care model ensures that primary care providers can be reimbursed for identifying and managing conditions that might have gone unrecognized or untreated. The model supports providers and patients in a time of limited resources.
I am highly confident that Magellan Health’s Collaborative Care Management solution addresses this by enabling PCPs to address low and moderate level behavioral health concerns while routing more serious cases to in-network psychiatrists for diagnosis and treatment plans. Because our solution is scalable and creates the perfect triangle of care supporting the patient through the primary care, care management, and psychiatry consultation, we will be able to implement in many settings across the country, especially primary care clinics, Accountable Care Organizations (ACOs) and specialty settings with a high burden of mental healthcare needs. The more people who receive the right care early in the course of their mental health need will ultimately relieve pressure on the specialty mental health providers, and ultimately reduce expensive and preventable utilization.
As a longtime provider of integrated care, the ability to scale collaborative care means one primary thing: people of all ages will get the right care at the right time and the downstream morbidity of mental illness will decrease. PCP burden will decrease. Stress on the behavioral health system will decrease. It’s a no-brainer. Let’s get the best care out there!
In this interview, Lindsay Cowee, a leader in behavioral health with recent experience at the largest Medicaid MCO in Colorado, dives into the profound impact of behavioral healthcare engagement on the total cost of care. Cowee was extensively involved in a project with Owl to implement measurement-based care throughout the state of Colorado (read more about the project below, including the results of a measurement-based care impact study).
Cowee’s extensive experience and insights shed light on the pivotal role that proactive behavioral health engagement plays in driving healthcare savings and improving overall well-being. Read more to explore the compelling narrative of better healthcare outcomes through active participation in behavioral healthcare, as seen through the eyes of a Medicaid MCO leader.
A fundamental connection exists between measuring behavioral health outcomes and increased patient engagement (learn more about measurement-based care here).
In traditional healthcare, treatment has often been focused on addressing visible symptoms or physical ailments. As the understanding of healthcare has evolved, it’s become evident that mental health is intrinsically linked to physical well-being. We now understand that to achieve holistic health outcomes, we must engage patients not only in their physical treatment but also in managing their behavioral health.
Measuring behavioral health outcomes through evidence-based assessments provides a structured and quantifiable approach to monitoring and understanding an individual’s progress in treatment. This measurement goes beyond the subjective, such as asking “How are you feeling today?” or “How has the last week been?” –instead it provides a more systematic evaluation to help inform the behavioral health treatment over the course of time. It empowers both patients and healthcare providers with concrete data, allowing them to track progress, set goals, and make informed decisions about treatment.
Measuring outcomes leads to higher patient engagement through:
In essence, measuring behavioral health outcomes transforms mental health treatment from a passive experience into an active collaboration between patients and healthcare providers. It places the patient at the center of their care, making them partners in the process. This shift in perspective is a driving force behind higher patient engagement.
“The more invested you are in your healthcare, the more engaged you are with your provider, and the more health literacy you have, the better your outcomes tend to be. Which is why I think behavioral health education is so important,” said Cowee.
“When someone is struggling with their behavioral health,” she continued, “It can often easily take over everything else. Even tasks like monitoring your blood sugar or your blood pressure–they both seem a lot less important when you’re struggling just to get out of bed every morning, for example.
“The more we can get people engaged in their treatment and in their behavioral health care, the more we’ll see positive impacts on their physical health. You don’t always see the inverse effect. For example, you can be engaged and checking your blood pressure regularly, but that doesn’t automatically mean that your anxiety is getting any better. When your mental health is in a better space, you’re more equipped to take care of things on the physical side.”
Colorado Access has been at the forefront of managing the behavioral health benefit for Colorado Medicaid for over 25 years. Their experience sheds light on the significant impact that improved engagement in behavioral healthcare can have on the overall healthcare system.
Aurora Mental Health & Recovery (AMHR), a certified community behavioral health clinic, adopted a measurement-based care (MBC) approach with Owl to enhance their clients’ treatment experiences. When Colorado Access collaborated with AMHR and Owl to analyze client spend, utilization, and outcomes using MBC, the results were astounding:
These results demonstrate that consistent use of measurement-based care has not only clinical impacts but also substantial cost-saving benefits. The significant reduction in psychiatric inpatient admits and emergency room visits directly translates into lower healthcare expenses.
Read more about the measurement-based care data impact study.
“What makes these findings so exciting is that they go beyond the narrative of trying to keep patients out of the emergency room. While that is undoubtedly important, the data shows that getting clients genuinely invested and engaged in their behavioral health care leads to improved overall health,” said Cowee.
“For clinicians, this shift in focus can be monumental,” she continued. “Instead of asking clinicians to focus on reducing emergency room utilization or inpatient admissions, they can just concentrate on the tangible goal of engaging clients in their healthcare journey. When clients are actively involved in their treatment, the rest naturally follows.”
In the realm of healthcare reimbursement, value-based care is gaining traction as a more holistic and outcome-focused approach. It contrasts with traditional pay-for-performance measures, which often rely on process indicators rather than true assessments of how patients are responding to care.
While pay-for-performance measures have their merits, they can be limited in their ability to gauge the effectiveness of treatment. They often miss the broader picture of patient well-being, focusing more on checking the box to indicate if providers complied with specific processes, such as if a patient remained on antidepressants for an acute and continuation phase. In contrast, value-based care prioritizes actual health outcomes, such as knowing if a patient who is on antidepressants is actually experiencing a decrease in depressive symptoms and increase in functioning, making it a more comprehensive approach. Measuring behavioral health outcomes allows providers, patients, and providers alike to understand the effectiveness of care–providing the foundation to make value-based care a reality.
The evidence is compelling: better engagement in behavioral healthcare leads to savings across healthcare. As we strive to improve the well-being of individuals, we must recognize the interconnectedness of behavioral and physical health. Engaging individuals in their behavioral healthcare journeys not only enhances mental health but also yields substantial cost savings by reducing hospital admissions and emergency room visits.
Colorado Access’s successful collaboration with Owl and Aurora Mental Health & Recovery showcases the transformative power of measurement-based care. It’s a testament to the potential of proactive, patient-centered approaches in healthcare.
The shift towards value-based care represents a step in the right direction, emphasizing measuring behavioral health outcomes to understand the effectiveness of care. As we continue to explore innovative ways to improve behavioral healthcare, engagement is the key to unlocking value.
To learn more about Owl, measurement-based care, or the efforts by Colorado Access to better manage outcomes across the state, contact Owl.
Social determinants of health (SDOH) account for as much as 80% of person’s modifiable health factors and 50% of their overall health outcomes. Thankfully, the healthcare community now understands that access to quality food, primary care services, safe housing, and transportation all significantly impact health outcomes. Those societal challenges are rightly now the focus of large-scale government programs and community-based efforts.
But what about mental health?
Traditional social determinants such as housing and food are certainly critical to consider. However, we also know this: Two children with the exact same health and demographic profiles could respond very differently to behavioral health treatment. Why? One of them may be impacted by a more challenging home environment—an unsupportive parent, a stressful relationship with a sibling, a cultural difference in attitudes toward mental health treatment.
In this context, the traditional social determinants are a starting point. But for significant improvement in mental health, they don’t go far enough. Achieving equity in behavioral health care requires that we define the social determinants of mental health (SDOMH).
Where traditional social determinants of health are broad building blocks that may impact mental health, the social determinants of mental health include the granular non-medical drivers of health that are unique to individuals.
In other words, everyone in a particular neighborhood will be experiencing the same broad social determinants of health, and a ZIP code-based intervention—such as adding bus routes or expanding food pantry hours—may improve physical health for all residents in the same manner.
However, the brain is much more complicated. To make a meaningful impact on an individual’s mental health, we must understand all the additional factors that combine to create the individual’s unique experience.
Some examples:
These are questions not only to ask, but also to measure, track, and incorporate into day-to-day care.
This approach to social determinants of mental health enables clinicians to provide what Roshni Koli, MD, refers to as trauma-informed care. I shared a stage at HLTH 2023 with Dr. Koli, Chief Medical Officer of the Meadows Institute, to discuss how incorporating SDOMH data could change the way patients are managed in the clinic. As she explained: To understand a patient’s clinical presentation, we must consider two things—what happened to them, and what their environment looks like.
Collecting this type of historical and environmental data has proven elusive to the behavioral health community, however. Environmental observations typically exist only in unstructured physician notes or paper forms, where they cannot be easily accessed or integrated into diagnoses and treatment plans.
The Trayt platform was built to bring this type of data into day-to-day care. The platform tracks and measures 750 different factors that all influence mental health, including physical symptoms, behavioral symptoms, broad social determinants of health, granular environmental factors, and Adverse Childhood Experiences (ACEs). Clinical data from providers is assimilated with critical between-visit symptom and environment data, which is collected through a patient- and caregiver-facing application from the people who know the individual the best. Together, the data develops a 360-degree personalized view of the patient.
Behavioral health treatment looks very different through a 360-degree lens. It takes into account a person’s entire experience rather than treating one symptom at a time. It enables providers to collaborate with caregivers and social services agencies in putting individualized support systems in place—not broad band-aids—to ensure treatment success. And, it empowers patients with respectful, holistic care.
Going forward, the challenge for all of us in the behavioral health care community is to ensure we are using SDOMH data in ways that contribute to care rather than hinder it.
From a clinical perspective, Dr. Koli reminds us to approach patients with cultural humility to avoid implicit bias in the ways we treat patients. From a technological standpoint, Trayt is focused on making the data meaningful by tracking patient outcomes. It is not enough just to collect SDOMH data. We must be able to demonstrate that we’re using it to help patients get better.
Article written by Malekeh Amini, Founder and CEO, Trayt Health.
In my two decades of working in mental health policy, I have never been more hopeful than I am today.
Mental health is truly the “bipartisan issue of our time.”
Indeed, there has never been a more opportune moment for transformative actions to advance quality mental health solutions. The stigma around mental health is receding, more people in need are asking for help, and more organizations are raising their hands to be part of the solution, as evidenced by recent record-setting investments from the public and private sectors.
One of the solutions my colleagues at the Meadows Mental Health Policy Institute and I are most excited about is the integration of specialty behavioral health care into primary care and pediatric settings.
The Collaborative Care Model, considered the “gold-standard” of integrated care, provides for the routine screening and early detection of mental illnesses (just like other conditions such as high blood pressure), and enables intervention when conditions are easier to treat.
Over 90 randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses such as anxiety and depression.
I am especially enthusiastic about Collaborative Care’s potential to alleviate the country’s youth mental health crisis, as my colleague Melissa Rowan and I recently wrote in a joint blog post with Rachel Nuzum of The Commonwealth Fund.
To capitalize on this positive momentum, however, we must address our antiquated behavioral health technology infrastructure, a theme I heard echoed throughout November’s Going Digital: Behavioral Health Tech Conference.
With the passage of the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act, in 2009, the federal government mandated the creation of electronic medical record systems throughout health care facilities.
This modernization of our technology infrastructure catalyzed health systems’ ability to support busy clinicians in assessing risk, prescribing medications, and monitoring care protocols and outcomes, by allowing doctors to instantly access and review patient history and leverage care supports and prompts, such as automated reminders for screening and risk factors. It also facilitated population-level understanding and advancements in what was more likely to be working—and not working—in health systems across America. Patients now experience direct benefits as their medical histories and records can now follow them more easily between different clinical settings. Moreover, individuals have seen notable improvements in outcomes for major illnesses such as heart disease and cancer over the past decade.
But unfortunately, that landmark legislation did not include behavioral health care providers. As a result, today, more than a decade after the passage of the HITECH Act, many behavioral health providers still use recordkeeping systems that rely on rudimentary technology such as paper and fax machines and cannot be integrated with other health care records. The past decade has also seen dramatic declines in behavioral health.
In partnership with Going Digital: Behavioral Health Tech, and with funding from The Commonwealth Fund, the Meadows Institute produced a white paper last May recommending that the Office of the National Coordinator for Health Information Technology (ONC) develop security, interoperability and privacy standards to address this gap.
During one of the policy track sessions I moderated at November’s conference, I was encouraged to hear ONC announce a partnership with SAMHSA to invest $22 million into behavioral health tech integration. While this is an exciting development, a significantly larger investment will be critical.
That is why my organization is proud to be leading an effort to unite a diverse coalition of partners from across the health care spectrum, including Going Digital: Behavioral Health Tech, Hopelab, and GreyMatter Capital, behind a plan to generate a legislative solution to this challenge.
To that end, we sent a joint letter last month to the United States Senate Committee on Health, Education, Labor and Pensions urging it to include provisions to support behavioral health providers’ adoption and use of electronic health records as part of the SUPPORT for Patients and Communities Reauthorization Act.
We are grateful that the HELP Committee passed the SUPPORT Act, which included language to require the ONC to convene an expert roundtable to “examine how the expanded use of electronic health records among mental health and substance use providers can improve outcomes for patients in mental health and substance use settings and how best to increase electronic health record adoption among such providers.”
This language is a positive step toward modernizing information systems for behavioral health providers and integrating behavioral health with primary care. But we must not stop here.
We cannot ensure proper care for people with behavioral health needs when providers are not able to use advanced technology to coordinate patient health records.
With the help of our partners, we look forward to pushing for the full passage of the BHIT Coordination Act, S.2688/H.R. 5116, which supports behavioral health providers’ efforts to adopt health information technology systems.
I invite more behavioral health technology companies to join our coalition. Together, we can achieve a transformative solution for this challenge and grasp the unprecedented opportunities that lie within reach for the behavioral health system.
Kacie Kelly is the chief innovation officer at the Meadows Mental Health Policy Institute. @KacieAKelly
Within this care transformation, Ceras Health and Ellipsis Health began a partnership to better understand and support the mental health of chronically ill patients by using artificial intelligence (AI).
Ceras Health is a renowned player in the healthcare industry, known for its commitment to improving patients' lives through innovative approaches and technologies. With an extensive track record of serving a vast number of patients with its Digital Transitions of Care and AI/ML-enabled monitoring technologies, Ceras Health excels in patient engagement. Ellipsis Health is a healthcare technology company that uses AI-generated vocal biomarker technology to harness the human voice for earlier and better identification, assessment, and monitoring of clinical anxiety and depression. Its proprietary models and AI solutions – that use both the words people say and their acoustic properties – have been developed to accurately identify and assess depression and anxiety symptom severity from patient phone calls. The companies have partnered to analyze patient calls at scale to identify and address undiagnosed depression in individuals participating in care management.
“By tapping into voice, Ellipsis Health anchors into a physiological marker that is readily available, time efficient, and valid,” said Victor Carrion, MD, a clinical leader at Ellipsis Health and Vice-Chair of the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. “This approach will contribute to improved access to care for vulnerable populations.”
A multitude of barriers exist that make early detection and monitoring of mental health conditions extraordinarily challenging. These challenges lead to lengthy delays and gaps in care, negatively impacting healthcare organizations and, ultimately, patients and their families.
In response to these challenges, the partnership between Ceras Health and Ellipsis Health harnesses the power of AI to provide a revolutionary solution for detecting signs of depression at scale. Through the partnership, a significant number of patients in care management have been evaluated, shedding light on the true prevalence of undiagnosed depression within this population and opening the door for patients to heal sooner.
This study screened 465 patients who had a care management call with a Ceras care manager via the Ellipsis Health technology. Detailed medical information on the patients was collected - including age, gender, chronic conditions, and geographic locations - allowing for a comprehensive understanding of the interplay between demographics, chronic diseases, and mental health.
The patients' ages ranged from 37-98 (M = 75, SD = 9.52), with 59% female (n=276) and 41% males (n=189), over a range of social vulnerabilities as expressed using the Social Vulnerability Index.11 These individuals lived in the northeast and southern regions of the United States, with 98% of the study sample from four states (Pennsylvania, New York, Alabama, and Tennessee).
Based on the companies’ analysis, many patients had more than one chronic condition and as many as ten. The most common chronic conditions experienced by patients were Hypertension, Hyperlipidemia, Diabetes, Rheumatoid Arthritis, and Depression.
Depression symptom severity was obtained using Ellipsis Health AI-enabled technology that takes into consideration the words people say (Natural Language Processing model) and how they say them (acoustic model). Of the 465 individuals screened by Ellipsis Health using just patient voice, 110 (24%) were identified as having signs of depression that could potentially be contributing to poor health outcomes and high costs of care. Of these individuals with depression, 79% had two additional chronic conditions and 22.7% had between four to six additional chronic conditions.
Mimicking depression severity distribution of the general US population, a higher number of individuals were identified with mild depression symptom severity and the fewest with severe symptom severity. It is important to note that mild depression is still serious as it can be debilitating and negatively impact individuals’ ability to function.
Co-morbid depression and chronic conditions increase with age. According to Dr. Jules Rosen, a renowned psychiatrist, geriatric psychiatrists are aware of the concept of masked depression. He explains, “Instead of complaining of sadness, hopelessness or anhedonia, these elderly patients complain of worsening physical symptoms such as pain, GI distress, or weakness. Seniors complain of ‘feeling sick’ when they are depressed because that is what they actually feel. Identifying a mood disorder in seniors complaining of worsening symptoms of chronic illness is a clinical challenge that could benefit from AI and other technological advances.”
In other words, a majority of the individuals identified live in a community that makes them vulnerable to poor health outcomes. The number of chronic conditions and type of living environment indicated by the SVI distribution indicates difficulties patients face in not only getting to their appointments, obtaining their medications, and having a safe place to live but also in dealing with their depression, which makes it more difficult to think clearly, have energy, and perform basic activities of daily living.
This AI-powered analysis has yielded crucial insights into the prevalence and severity of depression. The population health implications of implementing this solution on a larger scale are far-reaching.
Scaling this solution could prevent a significant number of hospitalizations, reducing the burden on healthcare systems and improving patient quality of life. Moreover, a reduction in hospitalizations could lead to substantial cost savings. Ceras Health has proven outcomes in reducing hospital readmissions from 20.1% to 13.1% and length of patient hospital stay from 5.9 to 3.2 days, thereby delivering significant financial savings for the patients and the hospital systems. The World Health Organization estimates that for every $1 invested in treating depression and anxiety, there is a return of $4 in improved health and productivity.12 Additionally, behavioral utilization is associated with medical and pharmacy savings of up to $2,565 in the 15 months post-diagnosis.13 The numbers speak for themselves but the impact of early detection also has unquantifiable and significant effects on the individual, caregiver, family, and community who care for the individual.
Supporting the behavioral health of a person supports their overall health and wellness. Identifying and treating depression contributes to increased life expectancy among individuals with chronic diseases, enabling them to enjoy more years of good health. The literature also reveals that treating depression and anxiety can lead to an increase in life expectancy for individuals with comorbid chronic diseases.14 15
This collaborative process demonstrated by Ceras Health and Ellipsis Health can be utilized by healthcare organizations to provide additional information and resources to care teams managing patients with chronic conditions. This project may be used as a blueprint, helping providers to understand their patient populations better by identifying those who may be dealing with depression and anxiety along with chronic conditions, and thus, offering much-needed support to those who are not raising their hands for help or do not even realize they are struggling with mental health.
Illustrating the transformative impact of technology in healthcare, the partnership demonstrates how voice technology acts as an early detector and preventative tool to support not only behavioral health but whole-person care, specifically within the domain of care management for individuals with chronic diseases. By harnessing the power of AI to identify and address undiagnosed depression in individuals with chronic medical conditions, this partnership establishes a revolutionary new model for approaching mental health in healthcare.
[1] Daré, L. O., Bruand, P. E., Gérard, D.,Marin, B., Lameyre, V., Boumédiène, F., & Preux, P. M. (2019).Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis. BMC public health, 19(1), 304.https://doi.org/10.1186/s12889-019-6623-6
[2] Sporinova, B., Manns, B., Tonelli, M., Hemmelgarn, B., MacMaster, F., Mitchell, N., Au, F., Ma, Z., Weaver, R., & Quinn, A.(2019). Association of Mental Health Disorders With Health Care Utilization andCosts Among Adults With Chronic Disease. JAMA network open, 2(8), e199910.https://doi.org/10.1001/jamanetworkopen.2019.9910
[3] Momen, N. C., Plana-Ripoll, O., Agerbo, E.,Christensen, M. K., Iburg, K. M., Laursen, T. M., Mortensen, P. B., Pedersen, C. B., Prior, A., Weye, N., & McGrath, J. J. (2022). Mortality AssociatedWith Mental Disorders and Comorbid General Medical Conditions. JAMA psychiatry,79(5), 444–453. https://doi.org/10.1001/jamapsychiatry.2022.0347
[4] Voinov, B., Richie, W.D., & Bailey, R.K.(2013). Depression and chronic diseases: it is time for a synergistic mental health and primary care approach. The primary care companion for CNS disorders,15(2), PCC. 12r01468. https://doi.org/10.4088/PCC.12r01468
[5] National Alliance on Mental Illness California.(n.d.). What is mental illness? Retrieved fromhttps://namica.org/what-is-mental-illness/#:~:text=Without%20treatment%2C%20the%20consequences%20of,and%20poor%20quality%20of%20life.
[6] World Health Organization. (2021). World HealthOrganization: Mental health action plan 2013-2020.https://iris.who.int/bitstream/handle/10665/343206/9789240030749-eng.pdf?sequence=1
[7] National Academies of Sciences, Engineering, andMedicine (2020). Social Isolation and Loneliness in Older Adults: Opportunitiesfor the Health Care System. The National Academies Press.https://www.ncbi.nlm.nih.gov/books/NBK557964/.
[8] Yokoya, S., Maeno, T., Sakamoto, N., Goto, R.,& Maeno, T. (2018). A Brief Survey of Public Knowledge and Stigma TowardsDepression. Journal of clinical medicine research, 10(3), 202-209.https://doi.org/10.14740/jocmr3282w
[9] American Psychiatric Association. (n.d.). Stigma and discrimination. Psychiatry.org.https://www.psychiatry.org/patients-families/stigma-and-discrimination
[10] Malpass, A., Dowrick, C., Gilbody, S., Robinson,J., Wiles, N., Duffy, L., & Lewis, G. (2016). Usefulness of PHQ-9 in primary care to determine meaningful symptoms of low mood: a qualitative study.The British journal of general practice: the journal of the Royal College ofGeneral Practitioners, 66(643), e78-e84. https://doi.org/10.3399/bjgp16X683473
[11] The Centers for Disease Control and Prevention used US census variables to locate areas where individuals are more likely to be vulnerable to negative effects on their health due to external stressors and disasters. The use of zip codes helps identify communities where individuals may need more support and extra attention to care planning to ensure that they get what they need for good health outcomes. The SVI has a 4 tier stratification system with level 1 being the least vulnerable and level 4 being the most vulnerable.
[12] Elsevier Ltd. (2020, November). Mental health matters. The Lancet Global Health, 8(11), E1352.https://doi.org/10.1016/S2214-109X(20)30432-0
[13] Bellon, J., Quinlan, C., Taylor, B., Nemece, D.,Borden, E., Needs, P. (2022). Association of Outpatient Behavioral HealthTreatment With Medical and Pharmacy Costs in the First 27 Months Following aNew Behavioral Health Diagnosis in the US. JAMA Netw Open, 5(12),doi:10.1001/jamanetworkopen.2022.44644
[14] Voinov, B., Richie, W.D., & Bailey, R.K.(2013). Depression and chronic diseases: it is time for a synergistic mental health and primary care approach. The primary care companion for CNS disorders,15(2), PCC.12r01468. https://doi.org/10.4088/PCC.12r01468
[15] Korhonen, K., Moustgaard, H., Tarkiainen, L.,Ostergren, O., Costa, G., Urhoj, S., Martikainen, P. (2021). Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy.Journal of Affective Disorders, 295, 831-838.https://doi.org/10.1016/j.jad.2021.08.076
Article written by: Melita King, MA, MD; Julie O’Brien, BSN, RN, MS; Michael Aratow, MD; Michelle Hoy LPC, CAS; Nina Roth, MPH
Behavioral healthcare currently exists in a unique historical moment. Healthcare costs continue to rise, and healthcare spending is growing faster than the average annual growth rate in the last decade.
Simultaneously, there is a growing demand for behavioral healthcare, making it the “bipartisan issue of our time” with broad bipartisan support in Congress.
Historically, affordability and behavioral health access issues have been viewed as conflicting. The rise in healthcare costs often led to restricted access to behavioral healthcare as a cost-cutting measure.
However, it’s crucial to recognize that affordability and access are intertwined rather than contradictory. By enhancing access to quality behavioral healthcare, affordability can be improved.
What challenges does this approach aim to tackle, and how did we come to believe the myth that affordability and increased access are mutually exclusive?
While rising healthcare costs are not a new issue, what presents a fresh challenge for health plans, employers, and individuals is the surging demand for access to behavioral health care, coinciding with historically high healthcare costs.
Notably, spending on behavioral health services among Americans with private insurance experienced a significant 53% increase from 2020 to 2022.
Despite the growing need for quality behavioral healthcare, there’s a persistent need for improvements in both affordability and access. In the past year:
Adding to the challenge, health insurance premiums for employer-sponsored plans increased by 7% in the last year, with expectations of further increases next year. This year, individuals, on average, paid $8,435 in premiums, while families faced a substantial $23,968 in premiums for employer-sponsored health insurance.
Along with affordability challenges, individuals encounter difficulties reaching behavioral health providers or services, with ghost networks becoming prevalent.
A secret shopper study by a senate committee staff found that more than 80% of listed, in-network behavioral health providers are inaccessible. They either aren't accepting new patients, are unreachable, or are not in-network as listed. Another study discovered that over half of all mental health providers listed on the Oregon Medicaid managed care providers’ network dodn’t see patients.
Almost half of Medicare Advantage online provider directories have at least one inaccuracy, often related to behavioral health services.
During a recent Q3 earnings call, Cigna’s President and CEO David Cordani said, “In addition to affordability, one of the top priorities for many employers is expanding access, coordination, and overall effectiveness of behavioral health programs and solutions.”
Employees are demanding access to robust, high-quality behavioral health benefits from their employers—who are, in turn, demanding better behavioral health benefits from their health plan providers, while voicing concerns about cost.
This puts health plans in a tough spot. They aren’t in a position to stop healthcare inflation and can’t create new behavioral healthcare provider networks out of thin air.
The current state of affordability and access has led to the biggest myth in behavioral healthcare—that there’s a choice between better access to behavioral healthcare and health insurance affordability.
The origins of this myth trace back four to five decades. Behavioral healthcare was initially treated as a cost center and largely ignored. Health plans were reluctant to provide coverage. Multiple rounds of congressional legislation addressing mental health parity laws ensued, compelling insurers to cover treatment, with pending parity regulation currently under consideration.
Many health plans have sought to reduce access to behavioral health services as a cost-cutting measure to enhance the affordability of health insurance.
But what if that reasoning is wrong? What if solving access and getting people into high-quality care improves costs for health plans and individuals?
Behavioral health is proven to drive medical spend. Suppose an individual has diabetes, cancer, or a heart condition. In that case, medical spend is two to three times higher for those individuals who also have a behavioral health condition than for individuals without.
A groundbreaking study by Milliman found that a small group of high-cost individuals are responsible for a significant percentage of total healthcare costs. These high-cost individuals were mostly people with behavioral health conditions, and yet many of these individuals had minimal or zero spending on behavioral health-specific services.
Stakeholders are starting to recognize that behavioral healthcare is not simply a driver of costs. It’s integral to people’s health and well-being. Neglecting it results in escalated healthcare costs. There is a path forward where medical spending is reduced, and people get better access to quality behavioral healthcare, mitigating two of the most significant issues in behavioral health.
Shifting the narrative on this myth involves connecting the dots between better access and affordability, aligning business motives—such as growing revenue and market share for health plans—with the importance of better access to behavioral health for the growing population seeking these services.
Merely broadening access to behavioral healthcare doesn’t address affordability. The missing components are quality of care, including clinical outcomes, patient-provider matching, measurement-based care, and member experience.
Taking a broader perspective on the approach to behavioral healthcare in the last three decades reveals that implementing these fundamental building blocks—access, quality, member experience, and cost reduction—has largely fallen short. For many individuals, the behavioral healthcare experience has been far from satisfactory.
At Spring Health, we think we’ve figured out how to balance these fundamental aspects of care. Let’s explore how we’re doing it.
In behavioral health, bettering clinical outcomes starts with better access. If someone seeking care has to wait for a prolonged period to meet with a provider, they probably won’t engage in care in the first place. So, let’s start with access, and then we’ll cover the other pillars of this framework: quality of care, member experience, and cost savings.
Elevated access to behavioral health providers goes beyond giving employees a list of providers. Individuals need the ability to make an appointment quickly with a provider who is accepting new patients, has a specialty that suits their needs, and has matching availability.
Spring Health members have direct access to our entire provider network’s availability within our member platform, and can see all of a provider's upcoming time slots, which are updated in real-time.
Our members are also getting:
Another important pillar is hiring quality providers and ensuring they are helping people get better. During the recruitment and selection process, Spring Health completes the following steps to ensure provider quality:
The provider's clinical outcomes are monitored and measured throughout the care process so we can know, using data, that they’re providing high-quality care.
The Spring Health app, where all our behavioral health scheduling and services are centralized into a single front door, has a rating of 4.9 stars out of 5 in the app store. Our providers have a 9.4 out of 10 rating from our member populations.
Here’s a snapshot of what it’s like to access a provider with Spring Health:
Connecting members quickly to high-quality care, using measurement-based care and precision mental health, leads to members getting measurably better, faster, and translates into cost savings through a reduction of overall medical spend.
The Validation Institute, an independent third-party organization, recently found that:
The myth that it’s impossible to address behavioral healthcare affordability and access simultaneously has been destructive to both costs and human well-being.
People are hungry for better behavioral healthcare and rising healthcare costs, and it’s time for new ideas and pathways. This is a rare nexus where business motives and bettering human well-being come together.
Learn how to successfully break down barriers to behavioral healthcare for marginalized groups.
Article written by Todd Hill, Senior Vice President, Payer Strategy, Spring Health.
In this post we chat with Cynthia Grant, PhD, LCSW, Head of Clinical Excellence at Grow Therapy, about the work being done to raise the bar on quality in the telehealth space and how Grow is partnering with payors to collaborate on moving the industry forward. Cynthia shares her thoughts on the intersection of clinical practice and data as a way for payors and providers to tell the story of the impact of care delivery in a way that benefits all.
Quality means very different things depending on who you ask. It may be a concept as simple as a client having a feeling that their therapist is helping, while a payor may view quality through a formal, value or performance-based lens defined by HEDIS measures. Providers tend to understand quality of care as delivering evidence-based, patient-centered care that leads to positive client outcomes.
Ultimately, I believe that quality refers to how good something is — the degree of excellence it possesses. High quality behavioral healthcare (or what we call clinical excellence) leads to the achievement of the quadruple aim of better outcomes, lower per capita costs, improved patient experience, and clinician satisfaction.
Tracking quality is one of the ways we can transform behavioral care delivery for the better. Although many of us never imagined it would be possible pre-COVID, research consistently shows that telehealth can produce equal or better outcomes than in-person behavioral healthcare if implemented appropriately. We need transparent quality data to show that.
Data can drive accountability and value by tying payment and reimbursement rates to quality indicators like symptom improvements and client satisfaction. This incentivizes providers to deliver better care. It allows us to identify gaps in care and opportunities for improvement related to important factors like timeliness, documentation practices, and client engagement.
We need to be mindful of the wide range of provider perceptions of quality. For some people a quality program is seen as an opportunity to recognize clinical excellence and the impact their work is having on clients. Others view quality as a prescriptive or punitive approach imposed by organizations and payors. We don’t want to create an us vs. them mentality but want to be sure quality is viewed as a way to elevate and improve the work.
When I started at Grow I went on a listening tour and held focus groups with providers to hear about their perceptions of quality. I also used a survey to collect feedback from more than 150 providers on what quality indicators they felt would be good measures of their work. It was great to hear about provider beliefs of what quality means to them! This work allowed me to identify blind spots and potholes I could anticipate, to find quality champions among our provider group, and to plant seeds about the upcoming expansion of the quality program at Grow.
We started by sharing quality with celebratory initiatives to let providers know of things we were tracking that they were doing right. We gave top performing providers information about their performance on key quality indicators and collected input from this group on how best to message quality results to others. One comment from a provider gave us a good indication that we were approaching this correctly. A therapist wrote to me: “It’s helpful for me to learn what areas I'm doing well in and what areas I'm struggling in so that I can improve my overall craft. Thank you Grow for all you've been doing and creating. It's greatly appreciated!”
Great question! We’re getting closer and closer to standardizing what measures we should be tracking in behavioral health. The combination of client satisfaction, symptom change scores, functional assessments, hospital/ED usage rates and measurement-based care over time provides a robust picture of quality. The items we should be measuring aren’t behind the curtain anymore and are things we should all have at our fingertips. Here are some of the most common areas in behavioral health:
Sharing data lays the foundation for mutually aligned provider and payor goals. It builds trust and transparency regarding clinical results and how dollars are being spent on interventions that work. It’s a win-win arrangement.
Quality data allows for providers to demonstrate the value of care delivered by objectively showing the efficacy of treatment. This evidence can justify reimbursement rates and support contract negotiations by providing tangible metrics that care leads to reduced risks and lower costs over time through elements like decreased ER visits. It’s powerful for providers to be able to see the impact of their work on the total cost of care.
Having quality data enables payors to incentivize quality through value-based arrangements that tie reimbursements to outcomes via bonuses or shared savings plans. In addition, collecting and sharing quality measures allows for payors to compare providers, driving competition based on client experience and efficacy rather than cost alone. Access to quality data benefits all stakeholders and is something all of us should strive to offer.
For strategic partnership inquiries, please contact: contracting@growtherapy.com
For general inquiries, please contact: support@growtherapy.com
Grow Therapy (“Grow”) is building the highest quality system for mental health professionals to deliver care to patients. Grow has taken cues from health plans and other partners to develop a provider group and design a platform that enables the quadruple aim of enhancing the patient experience, improving the work life of providers, advancing population health, and reducing care costs.
Valera Health is a leading telemental healthcare practice known for its high-quality, accessible and innovative care. We take a comprehensive and team-based approach that includes therapists, psychiatrists, nurse practitioners and physicians working closely together to provide holistic care for our patients. At the cornerstone of this approach is measurable quality.
From practicing internal medicine to leading and advising healthcare organizations, I’ve seen firsthand how critical quality measurement is when it comes to informing care practices and optimizing patient outcomes. This is especially true when it comes to high-acuity patients.
In order to best serve high-acuity patients—including those suffering from a serious mental illness (SMI)—those in the healthcare ecosystem must evolve how we think about and measure standards of care.
While performance measurement standards included in the Healthcare Effectiveness Data and Information Set (HEDIS) remain a gold standard measure of value and diagnostic measurements such as PHQ-9 and GAD-7 can be highly effective tools for measuring depression and anxiety outcomes, we miss critical insights into effectiveness of care for SMI and high-acuity patients when using these quality measures alone. More complex disorders require a unique assessment strategy.
Recently, the Centers for Medicare & Medicaid Services (CMS) updated its “Universal Foundation” in order to streamline quality measures and programs for the adult and pediatric populations it serves. An important CMS topic of discussion is measuring patient-centric care through patient-defined care goals (a.k.a. self-determined goals). This can be particularly challenging for high-acuity patients.
At the heart of everything we do at Valera Health is a patient-centric approach to clinical care and quality measurement. After all, no two individuals are the same—nor are their behavioral healthcare needs.
As a pioneer of utilizing virtual care to treat SMI and high-acuity populations, Valera Health has always embraced data-backed strategies in order to optimize patient experiences and outcomes, clinical processes, and system changes.
With this in mind, I’m excited to announce an important advancement in Valera Health’s quality measurement standards.
In 2024, Valera Health will incorporate World Health Organization Disability Assessment 2.0 (WHODAS 2.0) into our clinical model for SMI patients. A globally verified quality measurement standard, this clinical assessment meets current CMS selection criteria1 and furthers our patient-centric approach.
Moreover, this assessment is applicable to broader categories of disability and functioning beyond just mental health. Thus, it enables a deeper understanding of the impact of severe mental illness on other chronic or comorbid conditions.
When measuring clinical outcomes for underserved populations, implementing universal, comprehensive, and clinically validated assessments takes on a new importance. WHODAS 2.0. applicability cross-culturally in both clinical and general population settings and its versatility—the assessment is designed to be used across all mental, neurological and addictive disorders—made it appropriate for the diverse range of populations we serve.
Additionally, the assessment is short and can be both self-administered or administered by a clinical professional, which removes tech-literacy barriers and aids in ease of use.
This assessment is likely to provide additional actionable insights to clinicians and care teams by sharing which aspects of a patient’s daily activities are impacted the most by their condition. These measures are especially pertinent for improving treatment outcomes for SMI and high acuity patients, as difficulty with daily functioning is a hallmark of these conditions.
As we move forward, Valera Health remains steadfast in its commitment to continually setting new standards in mental health quality through patient-focused care. Integrating the WHODAS 2.0 advances our clinical model by helping us better address the needs of the highest acuity patients rather than over-relying on assessments–such as PHQ9 and GAD7–that are designed for depression and anxiety but are often used as proxies for overall mental health.
Valera Health’s mission is to provide compassionate mental healthcare to those who need it the most, when they need it the most. Doing so requires continually evolving our care model so care teams have detailed insight into their patients’ functioning, and can deliver personalized, effective treatment tailored to their unique needs and challenges.
For more information, please contact our director of Business Development, Cassie Dawalt, at cassie.dawalt@valerahealth.com
1 Additional Universal Foundation Selection Criteria Include:
Research continues to show that perinatal and postpartum mental health issues have long-term adverse effects on babies, siblings, and spouses.
Clinicians are increasingly discovering that maternal mental health treatment is a community effort, as well. Statewide Perinatal Psychiatry Access Programs are connecting OB/GYNs, family and internal medicine practitioners, and other specialists to reproductive psychiatrists who can help them manage their patients. As a result, families are getting the help they need, wherever they are, and much sooner in the process.
Trayt Health is the technology company behind some of the country’s most successful maternal mental health Access Programs, including the Perinatal Psychiatry Access Network (PeriPAN) in Texas.
Whether it’s pre-pregnancy, during pregnancy, or postpartum, an OB/GYN is often the first point of contact for an individual experiencing a mental health challenge—and a first resource for a spouse seeking help for a partner. Most OBs, however, are not equipped on their own to treat reproductive mental health.
The Access Program model is designed to connect OBs and primary care providers to psychiatry specialists who can help them manage their patients in their own clinics. Far too often, maternal mental health issues are not treated until they become severe postpartum depression with long-term impacts for the entire family. With education and support from a reproductive psychiatrist, OBs can learn to recognize early signs of distress and provide effective treatment right away.
First, the Trayt platform provides connectivity between the providers. Mental health is always a team effort, addressing complicated issues that require collaboration and coordination.
The most effective Maternal Mental Health Access Programs are statewide, connecting OBs and other primary care providers throughout the state into the major health systems and research institutions where reproductive psychiatry specialists are standing by to support them. From a technological standpoint, it’s a significant accomplishment to break silos and connect organizations and institutions that do not typically work together.
Additionally, statewide programs need technology that can track treatments and measure patient outcomes. The Trayt platform enables programs to measure success not just by engagement metrics, but by whether or not their patients are getting better.
Together, connectivity and measurement enable an effective model for early intervention that prevents maternal mental health challenges from progressing into family crises.
Many state program leaders may not realize that maternal mental health and child mental health are closely connected. You cannot treat a pregnant or postpartum individual and not think about the child. OBs and pediatricians must coordinate care so that mental health treatment extends to address the long-term mental health needs of the developing child.
A key consideration for a maternal mental health program is to acknowledge the interconnectivity and facilitate seamless transitions between the two types of programs. In other words, the technology platform must facilitate seamless coordination between providers and between Access Programs. Unless you build an integrated program, there will be gaps in care between the mom’s depression and the child’s health and development.
As another example, a pregnant teen would receive care from both a pediatrician and an OB. From a mental health perspective, this individual would need the expertise of a child and adolescent psychiatry specialist, as well as a reproductive psychiatrist to ensure prenatal and postpartum medications are safe for fetal development, compatible with breastfeeding, etc. A technology platform supporting these providers would need to move smoothly between programs—without gaps or friction—to ensure they can collaborate and coordinate care.
Where do we begin? Maternal mental health issues can be incredibly debilitating for a mom, and the impact can be devastating for families. Tragically, suicide accounts for 20% of postpartum deaths. Among individuals who develop the most severe postpartum psychosis, 5% will commit suicide, and 4% will also kill a child.
Even in less severe cases, postpartum depression affects lactation, alters the parent-child bond, creates stress for partners and older siblings, and increases the risk of long-term mental health challanges for the baby.
Maternal mental health programs may sound narrow and targeted at first glance, but when deployed community-wide, they can change the trajectory for an entire generation.
Please visit our website at Trayt.Health to learn why our technology is the only platform with the scale and functionality to fully support statewide Access Programs.
You can also find a video at this link that explains how we are supporting the work of the Texas Child Mental Health Care Consortium. Trayt-supported programs are expanding access across the state, bringing equitable behavioral health care to patients where they are. To date, TCMHCC programs and services are available to more than 3.5 million students, and they support more than 11,500 enrolled providers. A successful pilot program in maternal mental health was just expanded statewide.
And, we’re proud to be a Platinum Sponsor of Going Digital’s Behavioral Health Tech 2023. Come see us in Booth 203!
One in five American adults are unpaid caregivers to someone in their life, whether that be a friend with special needs, an elderly parent or some other loved one who needs care. With so much time spent caring for others, caregivers' own total health becomes less of a priority, with their mental and physical needs often falling by the wayside.
November is Family Caregivers Month, a perfect moment to recognize caregivers' dedication – and sacrifice – and offer them a helping hand, just like they do with others.
A Caregivers Experience
Caregiving can be a demanding and stressful experience that looks different to each person. One thing is certain: caring for a loved one often impacts a caregiver’s personal obligations.
A caregiver’s role is one that requires a flexible schedule, which can be difficult when simultaneously balancing other aspects of life. According to the National Alliance for Caregiving and AARP’s research report, Caregiving in the U.S., 70% of employed caregivers reported suffering work-related difficulties due to their dual roles, and 60% of caregivers had to make changes in their work schedules overall. In some situations, they may have to miss days from work to handle a health emergency or because there is simply no one else there. This group also tends to miss more time from work than their counterparts.
According to CVS Health and The Harris Poll survey data, caregiving can also significantly impact a person's mental health. The survey showed that 49% of American adults who identified as caregivers have said their mental health has suffered from being a caregiver. Having to make sacrifices in their personal lives can also lead to deteriorating mental health. With 45% of respondents also having said they spend less time participating in their hobbies and 28% reporting having formed unhealthy lifestyle habits (such as eating poorly or drinking more) due to caregiving, recognizing and addressing the issue is of utmost importance.
Whether becoming a caregiver by choice or due to situational circumstances, they face several challenges, from physical and emotional stressors to financial burdens, which can grow into more significant issues if not addressed. We can all foster and create a network to help those caring for some of our most vulnerable.
Getting Caregivers the Right Support
There are several positive aspects of caregiving. For instance, a caregiver may discover new purpose, enjoy giving back and appreciate closer ties or improved relationships. However, for a full-time caregiver, stepping away from responsibilities can also feel daunting. Support from employers, loved ones or the community can alleviate burdens and encourage caregivers to prioritize their well-being in tandem with their caregiving role. This support can materialize in various forms:
Chances are that everyone knows at least one caregiver in their life. This is why we must work to provide a sense of connectedness, understanding and appreciation, as well as viable resources to best assist this growing population. Together, we can ensure that those caring for others are also cared for.
Written by Cara McNulty, DPA, President of Behavioral Health and Mental Well-being, CVS Health, and Taft Parsons III, MD, Vice President and Chief Psychiatric Officer, CVS Health.
In just a few weeks, thought leaders, innovators, and change-makers are converging for the 2023 Behavioral Health Tech (BHT2023) conference.
BHT2023 creates an environment where ideas flow freely, solutions abound, and a shared mission unites attendees - the mission to improve access to mental health and substance use care through technology, while promoting health equity and inspiring innovation.
From November 15th to 17th, 2023, the conference will take place at the Arizona Biltmore Waldorf Astoria in Phoenix, with virtual attendance options, bringing together a diverse range of participants.
BHT2023 brings together a mosaic of stakeholders, including health plans, health systems, employers and benefits consultants, digital health companies, investors, policy and advocacy organizations, and more.
The list below is a glimpse into the array of companies and organizations set to play a role at BHT2023.
Health Plans
Health Systems
Employers & Benefits Consultants
Digital Health Companies
Investors
Policy and Advocacy
Together, these companies and attendees will help pave the way for a future where mental health and substance use care are not just accessible but truly transformative, offering hope and healing to individuals worldwide.
For the full list of companies attending BHT2023, click here.
There are more mental health and substance use point solutions than ever, so how are health plans, employers, and, most importantly, patients to know which solution they should use to forge a path to meaningful behavioral health outcomes? We brought together health plans, providers, investors, and more at HLTH 2023 to learn how the healthcare ecosystem can better bridge the supply-demand conundrum in behavioral health while prioritizing affordability, access, and seamless patient experiences.
Deb Adler, CEO at Navigator Healthcare Inc., discussed what employers and health plans are doing to address addiction in the workplace with Salma Sparklin, MPH, Business Strategy and Transformation Manager at CareFirst BlueCross BlueShield, Dr. Stuart Lustig, MD, MPH, National Medical Executive for Provider Partnerships at Evernorth Behavioral Health, and Manny Arisso, Chief Network Officer and President of the Employer Division at Carelon Behavioral Health. This was the only panel at HLTH that revolved around substance abuse this year.
Read highlights from their conversation below. The following has been edited for length and clarity.
There are a lot of reasons somebody might not be able to complete treatment and stay in treatment—and though cost is not the only barrier to care, it's a major one. CareFirst BlueCross BlueShield's program is the gold standard for intensive outpatient care for substance use disorders. There may be a financial barrier to that care for some of our members, so we created a cost-sharing waiver that goes with the program. For members who have plans that are eligible for this, if they start their care for substance use disorder at the IOP level, their outpatient costs are waived. It's helped keep members in that level of care. Even though intensive outpatient care is a huge time commitment, they can still remain within their work and home environments, allowing them to marry what they're learning in treatment with their actual life and sustain what they got from the program.
People are more aware of substance use disorder and opiate use disorder now, but people are still resistant to entering care. Yet demand for care has gone up, as there are more people who need care. When we partner with employers, we first help them come to the realization that you can't treat every employee the same way. It's about helping them understand their benefits and creating pathways for employees to get into clinical care. Getting people into care early is especially important, so we use predictive models to help with early identification. Our models use not just healthcare data but also zip codes and social drivers of health – as we know different areas and communities have varying prevalences of substance use disorder. Using data this way allows us to be proactive and work with partners to address gaps in care.
You have to meet people where they're at, and you especially have to meet kids where they're at. You need to be there when people with substance use disorders call in or when they call in for someone else – their kids, spouse, or friend. We're there for our clients (small and large employers) 24/7, 365 days. We have to be willing to talk to people anytime – day, night, Christmas Day, whatever it is. We see that as our opportunity to help people get the proper care. When dealing with something as complicated as behavioral health and dealing with something as terrifying as substance use, you absolutely need to be there the moment they need you, whether digitally or in person.
We always try to create and maintain an ecosystem of care around the person needing support. In some cases, we’ll have an employee side by side with their employer and a behavioral health clinician who has expertise in substance use disorder. The clinician is equipped to have a conversation with both of them to understand what's happening, ask the right questions so they get the information they need, and respond with empathy and compassion and without judgment. Once they understand what's happening, the employer and employee can discuss their care options, benefits, any barriers to care, and whether virtual or in-person care is most appropriate for them based on the employee’s clinical acuity or where they are on the recovery journey. The clinician can also help find specific providers and make an appointment, helping ensure the employee shows up for it.
It's a collaborative effort. PCPs are often the front door for a lot of people with substance use disorder, but they should certainly have adequate support and backup as well. The silver lining in the pandemic is that about 50% of our patients are getting here virtually—before, it was about 1.5%, so this is a massive shift. In my 20 years as a psychiatrist and thinking about some of the advancements we've seen, this is big. Because people are coming in virtually, they are more likely to get in treatment earlier and are more likely to stay in treatment. These are all good shifts that we're seeing, and more good things are to come – but we still have a lot of work to do.
We’re developing strategic alliances that focus on early engagement. There’s an opportunity to make things easier, right? People don't know where to go or what to do for substance abuse disorder, so how do we make it simple from a navigation perspective? In our case, we work with partners like yourself, Navigator Healthcare, and with unique providers specializing in substance abuse disorder treatment so that the pathway to care for members is easy, seamless, and effective.
The Behavioral Health Tech Conference in November will continue to shine a light on ideas and solutions that improve access to mental and behavioral health care, pulling in perspectives from health plans, employers, behavioral health providers, digital health companies, investors, policymakers, and more so that we can continue making progress for people in need of care.
We’re looking forward to more discussions like this one, and we hope you’ll join us either in person or online. Register today!
Motivo’s mission is to solve the therapist shortage by providing clinical supervision services to behavioral health employers. This allows them to fill their vacant positions with associate therapists who can develop into licensed professionals equipped to have long careers helping people heal.
48,000 students graduate from master’s level counseling programs every year. 57% of those graduates never attain licensure because of difficulties navigating employment, finances, and state regulation barriers. Motivo is changing this.
We’re excited that Jon is joining us to further this mission and we wanted to share some of his experiences and insights with our behavioral health colleagues.
In my early days at AbleTo, back in 2015, we had to tell people that mental health matters. It sounds silly now, but a lot of big health plans didn't even have mental health departments. We had to say to them "Hey, if you don't treat these behavioral health needs, all these other things are gonna happen.
We had to educate the market. And I feel similarly here.
Nobody else is talking about the fact that almost 60% of the 48,000 graduates per year — for a variety of reasons, are choosing not to continue to licensure. Nobody else is working to solve this provider supply problem.
We need to educate the market — Even with so much incredible innovation happening as we try to solve the mental health crisis, we're ignoring the fact that we're not bringing new providers into the marketplace. A lot of downstream benefits will come if we can unlock that 60%. Let’s go after that!
And then how about the ones who do make it through — but in one, two, or three years they’re so burned out that they can't keep going or they choose to leave the profession?
We're sending our new grads to our most vulnerable populations. In what other universe do you do that? In no other clinical specialty does that happen.
Being able to tell that story, and then have a solution to solve that problem --- it's gonna go a long way.
Yeah, it’s been an incredible journey and not a path that I could’ve ever predicted when I started.
I studied accounting in college at Seton Hall University. I was the first kid in my family to go to college, and I wanted it to pay off. When I asked “What’s the best major to have a job when I get done?” I was told “accounting.” So I said, “Okay, I’ll study accounting.”
After college, I jumped into the accounting world as a young consultant at Deloitte here in New York City.
It was a wonderful learning experience. I was thrown into problems with no real experience and little supervision — I just had to figure it out. It was a great start to my career.
Horizon Blue Cross Blue Shield of New Jersey was trying to go public and working on its IPO. They were building a finance team and I thought it would be an incredible way to get into an actual business and work on a really cool project.
I stayed 12 years at the health plan, from when I was 25 to 37 years old — so really formative years in my career — learning how to be a professional, how to treat people, how to run meetings, how to lead and delegate and do all those important things.
I worked for some amazing, incredible leaders, people that I still keep in touch with and consider to be mentors and friends. I feel so privileged to have had that 12-year run there.
Six years into my run there, the COO was moving into the CEO role and he tapped me on the shoulder to be his chief of staff. He was creating a new role and he wanted me to do it. I did not see it coming. It meant I could transition out of finance and into a bunch of different things. I was excited.
Over the next three years, we built a healthcare value strategy for the health plan. You may hear terms like “value-based contracts” and innovative approaches towards reimbursement… that’s what this was. But back in 2013, no one was talking about it yet. Horizon was really on the front edge of doing it.
Once we designed the strategy, I was selected to run it. I was the first member of our value-based program team. By the time I was done three years later, we had 30 or so people on the team, building contracts with our provider systems and hospital plans.
This was where I really started being out in the field, representing the business. Before that, most of my work was internal. Now, I started encountering startup founders on a regular basis.
The early-stage organization experience drew me like a magnet — where every decision matters and you feel the impact of what you do on a daily basis. Success or failure is due, in large part, to your focus, effort, and strategic mindset.
To leave this big, safe job where I had this super-clear path, and maybe could’ve been CEO someday — It was the hardest decision I've ever made. To then say, "No, I'm gonna move to this early-stage startup that has a couple of months cash in the bank and one product, one client. And you know what? I think we can figure it out…"
Thankfully, we did.
It was an amazing six-year run at AbleTo before we sold the business. We experienced so many ups and downs throughout the different phases.
The first two years, it was like “I don't think this is gonna work, I don't know what we're gonna do.”
Then it was two years of "Okay, we got this figured out, let's just go execute."
And then the last two years were "Okay, we're on this path. Now, let's get this thing sold."
That six-year run with my friends and colleagues and our clients was just a truly remarkable and special period that I think forever will be one of the highlights, if not the highlight of my career — and I think we did a really good job recognizing that in the moment.
There were a lot of sleepless nights, upset stomachs, and really anxious moments when my phone would ring when I wasn’t expecting it. But there were more good days than bad days — and the successes were amazing.
As much as I love building, I wasn’t ready to just jump back into another startup — but I always had a sense that I was going to end up back in an early-stage business.
Optum Ventures had been one of our early investors in AbleTo, so I already knew firsthand the power they bring to a business and all the great reasons why OV is a special place. It has been a great honor to work with them. My time with OV was like getting an MBA in venture financing. It was truly a blessing to learn while also helping our companies grow.
I met Rachel very early in my days at OV. Right away, I felt like there was something different here — in a good way. There's no BS.
How many of us deal with problems, we get through it, we move on, and we just don't ever think about it again? Or we’ll think about it and talk about it, but then we don't ever actually do anything? Most of us, right?
Rachel saw the problem — she experienced it personally. To understand what it takes to get through licensure and then to want to solve this problem for other people… and then actually do it? That’s remarkable.
The overwhelming majority of people can't do anything like that, or they won't do anything. They're too afraid to. And for her to do it, it’s amazing.
That kind of vision, tenacity, and grit right away resonated with me sitting on the investing side. I found myself thinking “I would love to jump into a place like this where I feel like the things that I’m good at could be helpful to the things that Rachel’s good at.”
Back in college, my professor explained that accounting is like chess. You can’t memorize every potential move in chess because there are billions upon billions of moves based on how the board is laid out.
But if you're a master chess player, you can look at a board that's three quarters of the way completed, and work your way back to the beginning — because you understand the logic and the rules behind it.
Same with the financial world. If you can understand that logic and reason, you can understand how things work together… and I think that has served me very well.
I also just naturally lean towards discipline. In mental health businesses, most employees are genuinely nice, caring, thoughtful, people who always want to do what they perceive as the right thing.
Of course, we always want to do the right thing, but we’re not a charity. We don’t take donations. We’re running a business. If we’re not focused on managing that business well from a financial perspective, we won’t be helping anyone.
That’s exactly right. Winning enables us to do more.
So when we grow in the market, we bring in the business, then we can hire more people and do these things we want to do. But until such time as that happens, we watch every dollar… so that’s where my financial discipline naturally helps.
At Motivo, we’ve got a dynamic, infectious CEO who people want to be our brand. And Motivo is at a stage where we've figured out how to grow. Rachel has built very responsibly and prudently, in my opinion. So we've got some exciting choices in front of us. It’s going to be a great ride!
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Motivo solves clinical supervision for behavioral health companies. We match therapists with top-rated, vetted clinical supervisors for all license types in all 50 states. Our platform helps your company increase recruitment, encourage retention, and ensure overall quality of care for your patients.
Solving for the impact of behavior on mental health at scale is a huge challenge - one that Omar Manejwala, Chief Medical Officer of Dario Health, faces every day. We spoke with Dr. Manejwala about how digital solutions can improve behavioral health and reduce costs by making engagement and retention the path of least resistance. He shared his thoughts about how personalized support delivers the best possible clinical outcomes and highlighted recent research as a real-world application of this approach.
Our behavioral health solution uses an evidence-based triage screener to assess individual mental health needs and recommend the right type of care for each person. The Cognitive Behavioral Therapy (CBT) based programs offer members self-guided programs designed to teach proven techniques for managing emotional health. Members can work with a coach for goal setting and motivation and are able to access digital resources such as coaching and breathing exercises at any time through Dario’s app.
I could go on about this all day, but I’ll focus on what I think are two things that make what we would do stand out from the crowd. The first is personalized treatment recommendations. Integration with Dario’s AI-driven behavior change engine ensures that each participant’s journey is tailored to their unique needs and preferences, adapting as circumstances change to keep people on the path to better health. We optimize engagement at every point for better program adherence, motivation, and sustained behavior change.
The second is our rigorous study methodology. We’re constantly testing and refining our solutions, as demonstrated by our 45+ published research studies. We want to know the value of the innovations that we introduce - how do they perform out in the world? If a solution is designed to manage anxiety or help with work stress but there’s no adoption or engagement, it’s essentially useless.
Sure. We just had a study published in the Journal of Medical Internet Research (JMIR) demonstrating the impact of coaching and breathing exercises as part of our digital behavioral health program for members living with depression or anxiety, two of the most common mental health conditions.
We looked at the data of participants in two cohorts engaged in Dario’s digital self-guided programs who started at a moderate or high level of depression or anxiety. These study participants engaged in Dario’s digital programs alongside the use of a coach or digitally delivered breathing exercises over the course of 16 weeks.
Here’s what we found:
This study shows the value of personalizing the solution for each member over a one size fits all approach. We’re proud to be able to deliver these kinds of results and help our members live happier and healthier lives. Because many of our members are dealing with chronic conditions like diabetes, hypertension, and musculoskeletal pain, we offer one integrated platform that addresses both physical and emotional needs, when relevant.
At the forefront of suicide prevention stands healthcare professionals such as Dr. Julie Goldstein Grumet, the Vice President of Suicide Prevention Strategy and Director of the Zero Suicide Institute at the Education Development Center. We sat down with Dr. Goldstein Grumet who addressed the concerning trend of rising suicide rates despite increased funding and awareness. She shed light on the challenges and opportunities in suicide prevention efforts, highlighting the transformative potential of the Zero Suicide framework. Read our conversation below as we explore the need for proactive intervention and the path toward a future where suicide is preventable, offering hope for individuals in crisis.
In 2021, over 48,000 people lost their lives to suicide making it the 11th leading cause of death. There were 1.70M attempts in the U.S. in 2021 and over 12 million adults report thinking about suicide annually. These numbers have been steadily rising despite increases in federal and private funding, research investments, and awareness raising. Polls suggest that 94% of Americans think that suicide is preventable, suggesting opportunities for earlier identification and intervention exist and perhaps a willingness to get more involved. So with a growing national commitment to suicide prevention, why are the numbers rising?
There are many hypotheses about increased suicidality – access to lethal means, escalating societal challenges, lack of connectedness – these are but a few of the many risk factors that exist and contribute to the rise in suicide. While more than half the individuals who die by suicide have seen a health care provider in the year before their death, many are never assessed for thoughts of suicide and therefore are not identified as being at risk. These are missed opportunities.
Recently, I went in to urgent care to address what I assumed was a broken finger. So why did they take my height, weight, and blood pressure? Because the assessment of these indicators would reveal underlying, more urgent health care issues and provide an opportunity for intervention. Had my blood pressure been through the roof, they would have pivoted from examining my finger and turned towards determining the cause of my high blood pressure, ultimately hoping to thwart an adverse event.
We should screen all individuals for risk of suicide when they enter the health care system in the same way that blood pressure is assessed. This is one way to find and support people who otherwise might not share their risk with anyone. It also normalizes and opens up conversations about suicide. The more conversations are routinized and destigmatized, the more likely people who are at risk will feel comfortable asking for help. And it teaches the general public how to ask. All health care workers need to feel comfortable, confident, and prepared to ask about suicide - no one apologizes for taking patient’s blood pressure.
Evidence-based screening tools such as the PHQ-9 and Columbia Suicide Severity Rating Scale exist and if someone reports increased risk for suicide, then all health care providers should have knowledge of basic interventions and a plan of action at the ready. This would include conducting a standardized risk assessment that asks the individual questions and determines their level of risk and helps to determine the right level of care. Providers should know how to develop a collaborative safety plan and talk about lethal means safety, ensuring that when risk is heightened, individuals safely store or have no access to lethal means. All providers should have a strong plan to refer someone to a mental health provider who has training in suicide specific interventions. And then follow up with caring contacts. These clinical interventions comprise the Zero Suicide framework, which is a quality improvement model that transforms how health care systems recognize and respond to suicide risk. You can learn more about Zero Suicide at ZeroSuicide.EDC.org.
We are honored to partner with Behavioral Health Tech for the 2023 Zero Suicide Institute Global Forum. Zero Suicide has been operationalized now by thousands of health care systems across the globe. We will kick things off in person in Phoenix with a panel discussion about the various policy and practice levers that need to be activated in order to reduce suicide. Additionally, the Forum will provide an opportunity to virtually bring together health care leaders, suicide prevention, and lived experience experts from the U.S., United Kingdom, Australia, and elsewhere to share innovations and adaptations, accelerate Zero Suicide implementation, and activate progress. Topics to be discussed include the role of leadership to create lasting and meaningful system-wide change; implementation journeys and pathways for various sectors and settings; data, evaluation, and outcomes; hope and recovery as guiding principles for people at risk for suicide; and restorative just culture as a foundation for Zero Suicide. This event will offer a great opportunity to better understand and advance suicide care whether you have been deeply involved in suicide prevention for decades or are just getting started.
To understand and address the rising number of suicide rates, we need to make changes—and the Zero Suicide Institute framework offers a strong path forward. At the upcoming Zero Suicide Institute Global Forum at the 2023 Behavioral Health Tech conference, we are bringing together a variety of experts to discuss system-wide transformation toward safer suicide care. Together, we have the ability to change the way we prevent suicide, so that it becomes a thing of the past and create a future full of hope and healing. Come join us at the Zero Suicide Institute Global Forum at the 2023 Behavioral Health Tech conference—register here.
Workplace burnout is a pervasive issue that can have severe consequences for both employees and organizations. It's essential to debunk misconceptions about burnout and explore strategies that go beyond treating the individual. In this article, we will delve into the nature of burnout, its relationship with workplace culture, and innovative solutions that prioritize systemic change over quick fixes.
In today's demanding work environments, burnout is often characterized by feelings of energy depletion, exhaustion, and negativism. Employees transition from peak performance to mere survival mode, diminishing their professional efficacy. It's crucial to acknowledge that burnout is not a medical condition but a typical human response to chronic stress, primarily stemming from the workplace itself.
The World Health Organization defines burnout as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed." To tackle this problem effectively, organizations must grasp the essence of burnout and learn to recognize its manifestations within their workforce. Addressing burnout necessitates a comprehensive approach—one that considers workplace culture and explores new procedures and alternative strategies.
Supportiv, an peer-to-peer support network, is making strides in addressing burnout by interpreting employees' expressions of their feelings and connecting them with the right resources. However, the issue extends far beyond individual experiences—it encompasses the work environment as a whole.
Drs. Christina Maslach & Michael Leiter conducted research that has identified six key areas of work-life that influence the engagement and burnout of an employee. These areas are crucial for understanding what makes a job suitable for an individual based on their psychological state:
To foster a positive work experience, organizations must actively manage these areas.
Supportiv addresses burnout by addressing the complex interplay of these work-life areas within the systemic workplace environment. While change may not occur overnight, Supportiv leverages technology to provide real-time peer support that allows individuals to express their concerns and receive advice and resources to address these issues effectively.
Ultimately, solving burnout requires changes at the organizational level. Organizations should actively engage with their teams to identify and implement systemic changes that are customized to the specific workplace culture and persistently evaluated and adjusted until they yield positive results. To ensure optimal performance and satisfaction among employees, organizations must take responsibility for their role in creating a healthy work environment.
If you're interested in exploring burnout further, consider reading Drs. Maslach & Leiter's book, The Burnout Challenge, available on Amazon.
To watch the full conversation about this topic in a Behavioral Health Tech webinar, watch the recording here.
The COVID-19 pandemic fundamentally changed the landscape of behavioral health in the U.S. According to a recent study published in the JAMA Health Forum, utilization and spending rates for mental health care services among commercially insured adults increased by 38.8% and 53.7%, respectively, between 2019 and 2022. While it’s of course critical that individuals are actively seeking the care they need, this uptick is indicative of a seismic shift in population risk that requires a more holistic evaluation in the post-COVID era.
This “new normal” of increased demand requires a foundational shift in the way payors predict and address risk within their population. Effective risk management hinges on the ability to identify high and rising risk populations sooner and in an ongoing way. Rather than waiting for annual claims data to provide a picture of BH utilization, an adjusted risk management approach that incorporates real-time BH intelligence is essential to efficiently utilize existing resources and lower costs. Providing access to BH point solutions alone is not sustainable in supporting ever-changing needs within today’s member populations.
The delta between pre-pandemic and post-pandemic risk means the traditional actuarial model health plans use is no longer sufficient to enable predictable population risk. Legacy processes and systems rooted in physical health have led to limited identification and decision support for complex BH management even though BH is a significant risk contributor. Evernorth reported that the 22% of members with a behavioral health condition drove 44% of the health plan’s costs. Despite its impact on total cost, many health plans have managed BH in a silo or carved out the operations completely.
Because BH is not fully taken into account when predicting risk, many critical activities have become more challenging for health plans. Those include optimizing benefit design models, staying competitive with employer customers, measuring network performance, and—in managed Medicaid and Medicare populations—receiving the correct reimbursements based on CMS guidelines and calculated risk scores. Failing to adapt foundational components of risk management to address this titanic shift in BH will significantly drive up costs for health plans well into the future. That’s why adopting a new risk playbook is so critical.
The acuity spectrum for BH is continuous and dynamic, which is why real-time insight into population needs is key. The ability to effectively manage risk relies on the ability to identify rising risk BH populations earlier, supply interventions along the severity spectrum that lead to more appropriate utilization, and implement these new risk factors into the actuarial equation to remain competitive. The combination of identifying risk and applying the right resource levels is how risk is controlled.
NeuroFlow’s solution for health plans is designed to accomplish holistic risk management. The platform provides real-time intelligence on member behavioral health to offer more accurate pictures of population risk, enabling reliable cost predictions, program and network adjustments, and interventions at the member level before costs rise. Leveraging universal screening, guidance to relevant resources, clinical decision support, as well as suicide prevention interventions, NeuroFlow surfaces and supports members across a spectrum of acuity.
For example, one individual who joined NeuroFlow suffered for many years with severe depression and suicidal ideation. They tried unsuccessfully for years to find an in-network therapist who specialized in their diagnosis and also had availability for new patients. After gaining access to NeuroFlow and triggering an alert, a suicide prevention professional contacted this individual. They took the time to understand the person’s unique needs, and within half an hour, helped them navigate to an in-network therapist, specialized in their diagnosis. The NeuroFlow user described this level of proactive support as the “difference between living and not.” That is the impact that a holistic risk management solution can provide.
The ability to identify, engage, and risk-stratify members earlier in their care journey creates a slew of downstream benefits. Those include more accurate CMS reimbursements thanks to greater visibility into BH conditions. Payors will also experience improved utilization of programs and benefits, which not only prevents member escalation, but informs payors where to further invest. With richer insights, behavioral health providers and care managers can operate at top levels of efficiency, spending time with the members who need it most. Finally, robust risk management leads to lower total cost of care because behavioral health needs are more effectively addressed, keeping these members out of costly settings like the ED and inpatient hospitals.
As health plans approach this new precipice of risk, innovative solutions can help them adapt more quickly, utilize resources more efficiently, and most importantly, help members lead happier and healthier lives.
Learn more about NeuroFlow’s solutions for health plans.
Robert Capobianco has extensive strategic and operational experience with tech startups and large corporate organizations. He has a proven history of developing innovative strategies that drive revenue growth and market leadership resulting in multiple exits through strategic acquisitions - collectively exceeding $200M in acquisition value. Robert has over 20 years of experience in the healthcare technology industry, helping health plans access and activate robust population analytics to build more comprehensive alternative payment solutions that reduce costs and improve outcomes. In his current role, Robert is the Chief Commercial Officer at NeuroFlow. He is responsible for defining and executing NeuroFlow’s long term commercialization and business development strategy.
Suicide is the 11th leading cause of death in the United States. According to the CDC, 130 Americans die every day by suicide, about one every 11 minutes. Our ever-shrinking mental health professional workforce continues to decline, while demand for mental healthcare has never been more acute. We are in critical need of highly scalable suicide prevention solutions. The last several years have seen a wide array of digital mental health solutions. Still, unfortunately, the vast majority of virtual mental health services only treat patients with low-to-moderately severe conditions. This critical gap in care leaves lives at risk and increases healthcare costs due to avoidable ER visits and hospitalizations.
Traditional brick-and-mortar solutions to suicidality are not optimal. A single emergency room visit cannot properly treat suicidal ideation. The literature consistently shows that it takes at least six therapy sessions to reduce ideation, which only highlights the need for scalable solutions. While the emergency room can provide much-needed care for those in crisis, there are degrees of crisis care that are not accounted for. There is far too much demand for services, and the emergency department can not cover all patient needs. This is where digital mental health solutions fill in the gaps between standard outpatient treatment and crisis care in an ED. Creating plans for universal screening and supplementing this with effective treatment plans can drastically improve the lives of millions of Americans.
COVID-19 presented new complications to mental health, such as increased isolation, higher rates of substance abuse, family conflicts, and social media use. These factors affect people differently, resulting in higher rates of depression and suicidality in youth. Studies show that adolescence is characterized by an increased need for peer interaction, which can make isolation more harmful. Additional research shows that adolescents are more likely to act on impulse and engage in risky behavior.
Gender differences must also be taken into account when determining how to administer care. While 3/5 of adolescent girls feel persistently hopeless, in 2021, men’s suicide rates were four times higher than women’s. When determining where to increase access to mental health services, it is crucial to consider which groups are underserved to truly address the shortage of services. 45% of LGBTQ youth contemplate suicide, which is twice the amount seen in youth overall. Programs need to be customized to meet the unique needs of people.
Simply treating those already in crisis is not enough to effectively address high rates of suicide. An increase in mental health screenings is necessary to identify if a patient is experiencing symptoms of depression before they ever reach a point of crisis. While the shortage of mental health professionals can pose complications to extending care beyond its current scope, it is necessary to address the root causes in order to have effective treatment. Technology helps automate and streamline workflows with respect to screening. Natural Language Processing (NPL) and Artificial Intelligence (AI) technologies such as Crisis Care by Brightside and NeuroFlow can increase the rate of patients screened and provided with services without drastically increasing the need for personnel.
How exactly do digital mental health services treat patients at higher risk for suicide? NeuroFlow and Crisis Care by Brightside are able to integrate crisis care into a patient’s existing healthcare system. NeuroFlow uses combined suicide prevention technology and compassionate human outreach to identify and support at-risk individuals before a crisis occurs. At-risk individuals are identified through regular, remote assessments through AI-powered severity scoring models and Natural Language Processing (NLP). If triggered, the suicide prevention technology alerts the care team and immediately delivers crisis resources to the individual within the app. If care teams don’t have the necessary staff to perform these interventions, NeuroFlow’s Response Services team will reach out to at-risk individuals and help connect them to the resources they need. Suppose therapy, psychiatry, or treatment from other behavioral health specialists is the next best step. In that case, NeuroFlow works with partners who provide these services and accept a wide range of insurance plans. This referral process can also incorporate and prioritize any partners or resources an organization has already invested in.
Crisis Care is specifically designed for individuals with elevated suicide risk, including those who are actively suicidal and/or have had a recent suicide attempt and those needing follow-up care after hospitalization. This program delivers medically necessary care to patients often excluded from outpatient treatment (both in-person and telehealth) because of elevated risk. Brightside offers both psychiatric and therapeutic services to best address one’s situation. The combination of their standard treatment and the Collaborative Assessment and Management of Suicidality (CAMS) allows them to identify, target, and treat patient-identified suicidal drivers and triggers. Patients with elevated suicide risk access specialized treatment quickly and begin a structured, time-limited program that lasts between 4-12 weeks and requires them to be actively involved in their treatment. Patients are matched with a dedicated CAMS-trained clinician and provided with escalation pathways to follow-up treatment when a patient requires a higher level of care, as well as step-down pathways once the patient is no longer at risk.
Both services emphasize the integration of crisis care into standard mental health treatment. Training existing mental health professionals in these crisis care techniques can ensure that no patient falls through the cracks. Not all providers have sufficient skills and resources to develop treatment plans or next steps. Considering existing mental health professionals alongside new technologies in this strategy for expanding crisis care is vital.
Solome Tibebu, CEO of Behavioral Health Tech, had an engaging conversation with Kristian Ranta, the CEO and Founder of Meru Health, and Dr. April Richardson, an Adult, Child & Adolescent, and Forensic Psychiatrist and the current VP & Chief Operating Officer of Companion Benefit Alternative at BCBS South Carolina. Together, they shared their insights and perspectives on transforming the field of mental healthcare. Stay tuned as we explore their insights and dive deeper into the world of mental healthcare.
In today's fast-paced and demanding world, mental health has become a widespread issue, affecting approximately one in every eight people in the population on a regular basis. This alarming reality highlights the urgent need for improved mental healthcare services that effectively meet the needs of consumers. The pandemic and its long-lasting effects have also worsened the situation. According to a Forbes article, there has been a significant increase in depressive symptoms worldwide. The number of people experiencing these symptoms has risen from approximately 193 million to 246 million, reflecting a 28% increase due to COVID-19.
The Access Barrier:
Despite the growing recognition of mental health as an essential aspect of overall well-being, numerous barriers obstruct individuals from receiving the care they need. Kristian Ranta highlighted the persistent issues of access and waiting lists, which hinder many from seeking timely help. These barriers contribute to prolonged suffering and potentially worsen the mental health conditions of those affected.
The Mind-Body Connection:
Recognizing the connection between physical and mental health is crucial when addressing patient care. Kristian Ranta emphasized the importance of accounting for both physiological and mental aspects during the treatment. He stated, “We are not just the body or just the mind so it is very natural to integrate the matter.” For instance, mental health conditions often coexist with chronic illnesses, making it essential to provide comprehensive care that supports patients as a whole.
Measurement Care:
During the insightful discussion, one notable concept that emerged was the significance of measurement care. Kristian Ranta stressed the need to measure aspects of mental health to effectively manage them. By implementing data-driven approaches, healthcare providers can gain insights into patient progress, tailor treatments, and make more informed decisions. This approach not only enhances patient satisfaction but also empowers individuals by providing them with real-time data and fostering meaningful engagement with their healthcare providers as mentioned by Dr. April Richardson.
Empowering Clinicians:
Supporting clinicians in implementing measurement care and utilizing objective data is significant in delivering higher-quality care. Dr. Richardson emphasized the importance of equipping clinicians with the necessary tools and resources to integrate measurement care successfully. By doing so, clinicians can provide evidence-based treatment, leading to more positive outcomes and better patient satisfaction. Additionally, embracing objective data can open doors to new reimbursement models that incentivize high-quality care and encourage continuous improvement.
The Role of Employers:
Employers play a significant role in promoting mental health support within the workforce. As emphasized during the discussion, there is a real opportunity for employers to understand the importance of fast access to therapists and psychiatric care. By prioritizing mental health benefits and providing resources for employees to seek help, employers can create a supportive environment that fosters overall well-being and productivity.
To watch this webinar, view the recording here.
Behavioral Health has seen significant changes over the past few years in every area of health care. In a recent webinar with Behavioral Health Tech’s Solome Tibebu and Trilliant Health’s Sanjula Jain, the current state of behavioral health has shown to not only change within the healthcare system but has affected the US health economy as well.
Sanjula Jain, Ph.D., is the SVP Market Strategy and Chief Research Officer at Trilliant Health. She has an extensive background in health economics and overall research within the healthcare world. Working with the research team at Trilliant Health, Jain and her colleagues developed a behavioral health trends report aiming to gain more insight into what has changed in behavioral health as a result of the COVID-19 pandemic. Because the pandemic has seen such drastic changes in patients utilizing digital behavioral healthcare, seeing how it has affected the health economy in the United States is crucial, as that ultimately affects us as patients.
The study examined over 300 million Americans from all areas of the country, ages, ethnicities, etc. It also considered the following aspects of their healthcare as well, including what healthcare service people were using, what prescriptions they were taking, who are the patients receiving healthcare services, who was providing the healthcare services, how is utilization changing, and where are the patients receiving healthcare services. The study also broke down the behavioral health trends into various diseases and disorders such as eating disorders, ADHD, alcohol and substance abuse disorders, etc. Considering all these aspects aided in receiving the most accurate data and analyzing the effects of behavioral health trends on the health economy.
Within the study's executive summary, Jain and her colleagues came up with eight key insights into their work, which helped to determine what the pandemic changed and what stayed relatively the same. They concluded:
A few other vital notes found within the study that brought up great discussion points in the webinar included the fact that mental health-related prescribing is increasing among all patients nationally, which raises the discussion of whether that is a positive or negative thing specifically for the younger population. Jain and her colleagues also found that Adderall prescribing for adults ages 22-44 is outpacing ADHD diagnoses, which raised the point about outpacing prescriptions for other diagnoses as well.
Overall, Trilliant Health’s study has shown just a few ways COVID-19 has affected the behavioral health world, and Sanjula Jain’s webinar truly shows Trilliant's dedication to researching America’s health economy. One of the main discussion points within the webinar included the fact that all this data has shown how barriers and stigma have affected the behavioral healthcare community greatly, and the accessibility to providers has prevented numerous people from getting help. “Behavioral health accounts for 20% of GDP,” Jain notes within the webinar, which is just another way of showing how crucial behavioral health care is post-pandemic, and why removing these barriers and stigmas within the community is so important.
Watch the full webinar here.
Click here to read Jain and her colleagues’ study in full, or click here to learn more about Trilliant Health.
With rising costs and still limited access to safe, effective, and affordable care, healthcare companies and insurers are taking steps towards fighting back the costs. We spoke with the Evernorth Health Services team about their strides following the increasing demands on the healthcare systems and received their input on how to navigate the constant evolution of the behavioral healthcare ecosystem, issues and journey.
Doug: Through the pandemic, and even since its acute impacts have subsided, we continue to see an increase in the number of people with behavioral health conditions who are in need and reaching out for help, with a 4% increase in prevalence from 2021 to 2022 alone.1 From a cost perspective, 22% of those people with mental health conditions drive 41% of the total medical spend2 , with significant cost driven by individuals with comorbidities. We know from our studies that 87% of people with behavioral health conditions also have physical medical conditions.2 When someone has a comorbid condition combined with a behavioral health condition, their spend is 2-3x higher than those who have the same medical conditions that do not have a behavioral health condition.3 Because of this, we want to make sure that we get people to high quality behavioral healthcare treatment to improve their vitality and to decrease costs. In another study conducted by Evernorth last year, it was found that when newly diagnosed individuals connected to outpatient behavioral treatment, there is an associated medical and pharmacy savings up to $2565 over the 15 months after they receive their behavioral health diagnosis.3
Melissa: Yet 32% of individuals are still unhappy with their behavioral health solutions. 5 This is why we developed and invested in our Evernorth Guided Behavioral Care solution which helps an individual understand the behavioral health options available to them, starts them on the journey and follows up to ensure the care and treatment selected is right for them will drive improved clinical outcomes. At the population level, it is addressing total medical cost and member satisfaction, key concerns of employers and health plans who buy behavioral solutions.
Melissa: While we are cheering for the fact that people are speaking more openly about therapy, we know there are options for those in need of care that are less clinical like meditation/mindfulness, peers support and coaches. Most people don’t know where to start on their behavioral healthcare journey. They often do not know what providers to go to and may not know what is best for them. We’ve found that only a portion of individuals go to behavioral health specialists for assistance, while many seek treatment with their medical providers. When this occurs, there are individuals who typically get a behavioral medication from their medical provider and more than half have just one behavioral health encounter a year.6 There are other individuals who see their medical provider primarily for their physical condition, typically for a chronic medical condition, and their behavioral condition surfaces multiple times. Our studies have shown that effective behavioral health treatment can improve medical spend. For example, patients with type II diabetes and major depressive disorder (MDD) who receive sufficient behavioral treatment show $1,649 PPPY medical savings compared with the patients who receive insufficient behavioral care.7
And lastly, there are silent sufferers who either go undiagnosed or their behavioral condition surfaces once with a medical provider, but their likelihood of engaging in behavioral treatment is low.8 These customer journeys highlight the importance of early identification through predictive modeling and collaboration with medical colleagues, so we don’t have to wait for people to ask for behavioral assistance, but use our data and relationships to meet them where they are.
It's also important to move away from conceptualizing behavioral care as outpatient therapy only. That’s why we have cultivated different options for individuals and work with our behavioral health navigators who work with individuals to help them understand which of these options will work best for them based on their condition and their current needs.
Doug: The opportunity we see now is to truly personalize care for individuals as we leverage our data, including what we know about individuals across pharmacy, medical and behavioral health, along with what we have learned directly from members about their preferences. We are focused on how we help individuals access the best care for them to meet their needs and optimize their health outcomes, then collecting data to understand their ability to then engage and get that care they need.
Melissa: We continue to expand our network, especially with a focus on diversity in order to meet every individual’s preference and clinical needs. We are able to demonstrate quick access to virtual and in-person care and report on that to clients so they can see that individuals are getting quick access to care.
In addition to that, we have said it prior, but section partnership is critical. We are trying to make sure that the care provided is helping people achieve their goals and making fundamental improvements that enhance their quality of life and engagement in their communities.
Doug: Measurement based care and access to high quality care are the fundamentals to making sure everyone is getting the best possible behavioral health care. By partnering in new ways with the right providers, and offering the full spectrum of supports, we can help everyone and meet their needs and have optimal behavioral health care by capturing data to make sure people are getting the care they need, when they need it, and achieving the desired outcomes.
References:
Provider burnout is a critical issue impacting a provider’s well-being and the quality of care they deliver. The American Medical Association defines provider burnout as a long-term stress reaction characterized by emotional exhaustion, depersonalization (lack of empathy for patients), and decreased personal achievement. These elements reflect the complex and multifaceted nature of burnout experienced by healthcare professionals, underscoring the urgent need to address this pervasive issue in order to preserve the well-being of providers and enhance the quality of patient care. Recognizing the signs and symptoms of burnout is crucial to addressing the issue and preventing its detrimental effects on providers and patients alike.
Burnout among behavioral health providers is a combination of physical and emotional exhaustion that hinders their effectiveness in providing mental health and substance use care. The demanding nature of the profession, compounded by the challenges of the COVID-19 pandemic, has heightened the risk of burnout.
According to the American Psychological Association, in 2023, psychologists' workload significantly increased during the pandemic. A survey conducted in September 2022 revealed that 38% of licensed psychologists in the United States reported working more hours than they did before the pandemic. This highlights the substantial impact of the pandemic on the professional demands and workload experienced by psychologists.
Research has demonstrated that increased emphasis on administrative tasks and paperwork significantly contributes to burnout among behavioral health providers. In fact, a study conducted by the American Medical Association and Dartmouth-Hitchcock Medical Center revealed that during their office hours, clinicians allocated only 27.0% of their total time to direct clinical face-to-face interactions with patients, while a staggering 49.2% of their time was consumed by electronic health record management and desk work.
Dr. Michael Parmacek, MD, Chair of the Department of Medicine at Penn Medicine and a CHIBE Internal Advisory Board member, highlighted potential solutions to prevent provider burnout. He mentioned the development of commercial products that could alleviate time-consuming tasks like charting and documentation, which often require more time than direct patient interaction. These products aim to streamline the process so that providers can focus on meaningful patient conversations. Additionally, Dr. Parmacek discussed the potential of generative AI programs that can answer a significant portion of straightforward patient inquiries received via inbox messages. By automating responses to such queries, providers can save time and prioritize more complex questions that require their direct attention and expertise.
A. Self-Care and Work-Life Balance:
To promote well-being, providers must prioritize self-care practices, such as mindfulness practices . Establishing healthy work-life boundaries is essential, allowing time for rest, relaxation, and engaging in activities that replenish their energy. Incorporating self-care into daily routines enhances resilience and helps manage stress.
B. Building Supportive Networks:
Research has shown that peer support programs, along with self-care and relaxation techniques, can reduce burnout and improve provider well-being. Providers should develop professional relationships and networks, fostering a sense of connection and shared experiences. By creating a culture of support within the workplace, providers can lean on one another during challenging times.
C. Continuing Education and Professional Development:
Exploring new areas of interest within behavioral health expands knowledge and fosters a sense of fulfillment. Engaging in professional development opportunities, such as conferences and workshops, encourages providers to stay updated and motivated in their practice.
D. Implementing Organizational Changes:
It’s essential to look at the source: Why is the provider experiencing burnout in their workplace? Healthcare organizations must prioritize creating a supportive and healthy work environment. This includes fostering open communication channels, providing resources for stress management, and offering flexibility in scheduling. By implementing such changes, organizations empower providers and promote their overall well-being.
To learn more about clinician burnout, read this blog written by Dr. Quidest, "Dr. Kiki" Sheriff. The article sheds light on the challenges experienced by mental health professionals, especially in the context of the COVID-19 pandemic. It emphasizes the significance of addressing this issue and offers valuable insights from Dr. Kiki, a respected physician and the founder of Doctors Under the Radar, an organization focused on supporting the mental health of physicians.
For more information on burnout in the workplace, register for this webinar on June 27th, 2023, with Dr. Christina Maslach –creator of the renowned Maslach Burnout Inventory, Professor Emerita at UC Berkeley, and co-author of The Burnout Challenge: Managing People’s Relationships With Their Jobs– as she sits down with Helena Plater-Zyberk, CEO & Co-Founder of the peer-to-peer emotional health service Supportiv. You can still register after the event has taken place to view the on-demand recording.
Real-world data (RWD) are becoming increasingly critical to clinical research. The FDA has put forth definitions surrounding RWD, as well as issued guidance around its use in research emphasizing the principle of data being “fit-for-purpose”—selecting the data needed to answer the question at hand. Meanwhile, stakeholders engaged in clinical development have increasingly recognized that RWD will enable them to conduct studies faster, at a lower cost, and often, with a more representative and diverse population.
However, not all RWD is fit-for-purpose—that is, captured and stored in such a way that the data is ready to address the question at hand. In order to move forward with using RWD in a way that is efficient and effective, we need to build a shared understanding of the different types of data within the broad umbrella that is RWD and make clear which type of RWD is fit-for-purpose for a specific question.
The longest used, and most widely recognized, form of RWD is claims data. Although claims data can help identify important pieces of information, such as healthcare utilization and total cost of care, claims data also has limitations.
By working with claims data, we can understand when a person checks into the hospital, initiates treatment, or switches treatment. But what isn’t available in claims data is the layers of context and meaning, a true understanding of the patient’s journey. What led them to check into the hospital? If they were having a mental health crisis, did they have suicidal ideation or intent? Did they switch treatment because it wasn’t working, because it wasn’t tolerable, or another reason? Additional limitations of claims data include a lack of outcomes assessment. The data typically collected within an insurance claim does not provide information on disease severity, symptomatology, or changes in either over time—all of which are insights that can be gained through analysis of EHR data.
In many situations, claims data can be an important piece of the puzzle—but I want to emphasize it is only one piece, and often not the critical piece that finally brings the image into focus. As a leader at a company that works primarily with de-identified data from electronic health records, or EHRs, I propose that the behavioral health field needs a paradigm shift. A portion of the focus that has traditionally been centered on claims data should be reallocated to prioritization of EHR data–especially when these data types can answer our questions in a more targeted way than claims data can.
EHR data provide the clearest, most complete picture of what is actually happening when a patient receives care. Holmusk’s NeuroBlu Database contains EHR data from over 1.5 million patients across more than 30 health systems across the U.S. Many of these health systems use different EHR systems, meaning the data is captured in a variety of different ways.
Our teams ingest the data from these disparate sources and map the data to a common data model, using standards set by the Observational Medical Outcomes Partnership (OMOP). Once these processes are complete, the data are harmonized and ready to be used for research.
At a baseline, EHR data provides information on diagnoses, treatment prescribed, and any behavioral health assessments or other structured measures taken during each clinical encounter. Holmusk’s NeuroBlu Database extends far beyond this baseline. Our data science teams have developed natural language processing models to unlock key insights from unstructured data like clinical notes. These clinical notes are recorded each time a patient visits the clinic–far more frequently than structured behavioral health assessments are measured and recorded.
The ability to pull insights from these clinical notes equips the NeuroBlu Database with dense and robust data on each of its patients, enabling the creation of research cohorts with very specific inclusion/exclusion criteria. This deep context and granularity is especially important in behavioral health, a field that has long relied on subjectivity and does not have a standardized way to measure conditions.
EHR data can answer the same questions that have traditionally been addressed solely with clinical trials—and can also provide benefits that are extremely difficult to achieve in clinical trials. Traditional recruitment methods for a clinical trial may turn up several hundred patients for the study, while filtering on the same inclusion/exclusion criteria in the NeuroBlu Database would produce thousands. In addition, EHR data ensures a more representative population, while clinical trials often disqualify certain populations, such as patients with comorbidities.
However, EHR data, often is discredited because of a widely used term known as “data missingness.” The idea is that because clinical practice is a less controlled environment than a clinical trial setting, it may result in inconsistent data collection and missing data that will impact research down the road. Some researchers favor clinical trial measures not traditionally found in EHR, leading them to consider the absence of these measures as “missingness.”
As a RWD expert and a mental health clinician, I’m here to say that “missingness” is a misnomer. The measures that are often collected in traditional clinical trials simply will not be found in the EHR—because it is not feasible to administer an assessment that takes an hour during a 45-minute patient appointment, especially when you also want to provide the best care for your patient.
Though efforts to increase the frequency that clinicians use these assessments and psychometric measures are helpful, there is a severe overreliance on these efforts as a panacea to “data missingness” in RWD, especially given the paucity of resources and myriad theoretical orientations present in behavioral health settings. I propose that a much more cost-effective way to address this issue is increased investment in technologies and quantitative science solutions to make the best use of existing data and the measures already in place across systems.
Where fit-for-purpose can be established using EHR-derived RWD, one need not be blindly adherent to the preferred clinical trial measure where a number of other validated measures are available that measure nearly identical constructs (e.g., an overreliance on the antiquated though validated MADRS and HAM-D vs. the PHQ-9, where numerous studies have demonstrated robust validity of all three measures when assessing changes in depressive symptomatology). The call by FDA to choose a data source based on its “fit-for-purpose” is to find data to answer the question at hand, not to strategize about how to systematically change data sources to satisfy preferences that have little basis in data.
All of this to say: EHR data isn’t suffering from “missingness.” It simply is different from clinical trial data—and many of these differences are beneficial. Studies that leverage EHR data are more cost effective, can be completed more quickly, and do not expect patients to shoulder the burden of conducting research. In many cases, EHR data also rises above its RWD counterparts, such as in the availability of outcomes data. Across the field, behavioral health stakeholders would benefit from further investment in systems that make EHR data readily accessible and fit-for-purpose.
We all know that there are more demands on our time and attention nowadays. There is a need to promote healthy behavior and healthy living on a regular basis in order to help lower stress levels and improve how we feel overall. Mental health is no different than physical health, so it should not be prioritized any differently than our physical health. “It’s ok to not be ok, but it’s important to talk about it.” We need to be having caring conversations and foster psychological safety so that people can feel safe and confident to ask for help and to recognize when those around them need help. Reducing the stigma, increasing access, and allowing people to connect better with their mental health needs are all very important aspects of mental health.
Togetherall is a digital mental health care platform that is working with several different companies to provide well-rounded care in a supportive, anonymous setting with licensed clinical professionals. PWC, ProtoCall, and an independent consultant all work with Togetherall to supply their care networks with the care they need.
The challenge is reaching people and helping them stay accountable for themselves. Helping them focus on their well-being and realize that not everything is ok while making sure they realize that their care needs have to be continuous. Getting people to understand the importance of continuous care is a real challenge.
Togetherall working with PWC is a valuable piece of the care puzzle. Working with people and allowing them to realize that they are not alone is crucial. Working together now, when everyone is working from home alone, is a significant change in helping people seek care. People are realizing that this form of care applies to them, and they are accessing it the way they need to access the proper care. They are providing a safe space in the way of anonymity while still providing a support community and being supported by licensed professionals. This is another way to complement the various forms of community that exist within PWC, with the added benefit of anonymity and access to clinicians.
One of the main challenges was to reach people and convince people that mental health care was applicable to all. Access to all was a benefit of working with Togetherall. The care doesn’t feel clinical–it feels personal. It allows you to come in and observe or come and be a part of the journey. Regardless of what community you come from and what your struggles are, there is no pressure when accessing this form of mental health care.
The first challenge is always accessing. 24/7 access is super important and was the first topic addressed. Students are arriving on campus with increasingly complex needs. Supporting access to the brick-and-mortar centers that already exist on campus is a necessity, but there was something missing; there needs to be more. There needed to be 24/7 crisis response available to the struggling students. A digital well-track app is now being used with over 500 colleges. This app is expanding access for students to be in contact with instant care access and connecting them with providers in terms that fit their needs. These connections help to prevent students from falling between the cracks. This continuum of care between smartphones, counselors, and providers, in one seamless journey for students, helps prevent them from falling behind.
There is a peer-to-peer aspect of the care network that has been utilized since 2015. Allowing the connection between the student and the providers and the use of peer support is an exceptional tool not only in the care itself but also in reducing the stigma associated with seeking mental health care.
Working with Togetherall has increased this access to care and this bond between the students and assessing their care needs and seeking help within a digital platform. The digital peer community had to have enough depth to be credible and sustain the needs of the students. The combination of these two allowed schools to evaluate how they provide support to their students.
ProtoCall’s goal is access for all who require access to the right care at the right time.
The overall goal is how to deliver high-quality care at a reasonable cost. There is huge complexity in the ranges of care that are required. There is a high need for interdependence for families with each level of care. There are also barriers that can be caused by politics that can prevent people from accessing care and the care supporting them in the way it needs to.
There have been other barriers and blockers that have come into play regarding access to mental health care. Using digital tech for care was not accessible until recently. High-quality care in a sustainable model was fairly unattainable, with all of the blockers and barriers in the field. Togetherall has really helped to connect the dots in the care system and allow for the high-quality care needed for those who are really struggling.
Peer-supported care is also starting to become a major role in care in Canada. This benefit has a lot of positive outcomes. The benefit that Togetherall provided was by improving your own mental health outcome while being supported by a community of supportive peers and providers. There is this freedom as part of recovery with Togetherall, with the anonymity and the access to providers, with your own working recovery and care plan.
Finding a well-researched, effective and equitable digital health solution is only one component of building a behavioral health ecosystem. Making it work within an organization is equally essential. How do stakeholders see success? Are the metrics clear and the path to success well outlined? And what are the best referral methods when clinicians have such limited time with patients?
These are just some of the questions that Trina Histon has honed to guide behavioral health implementations during a two-decade career at the forefront of digital mental health. At Kaiser Permanente (KP), Trina shaped the strategic direction of the group’s wellness and prevention activities and scaled its digital mental health ecosystem. Now, Trina is advancing the software transformation of psychiatry, behavioral health and primary care as Vice President of Clinical Product Strategy at Woebot Health.
We spoke to Trina about their previous work at KP, and what they learned about integrating digital tools into care pathways.
To start, by knowing what’s happening in the real world. In primary care, most doctors have 17 minutes with their patients; during this visit, on average five topics are covered. In that small window, patients have the opportunity to share the deeper context of their health so a care plan can be built. It’s important to be deeply respectful of the context of how those 17 minutes are being spent in a primary care setting. We know from a recent Health Affairs paper that primary care doctors have experienced a 50% increase in patients presenting with mental health concerns. While medications and referral to therapy are in their clinical toolbox, more health systems, payors and providers are looking to augment care with digital mental health solutions like Woebot that can offer support to patients as they move through their lives. I’ve been at Woebot Health for a few months now and see this firsthand: 77% of conversations users have with Woebot are outside of clinical office hours.
You must understand how mental health concerns actually surface during a visit. What are the usual referral options? Do clinicians already refer to digital tools? How receptive are they to using this modality of support? Clinicians spend their time with patients doing a variety of things. Doctors may be in the EMR documenting the reason for the patient’s visit, noting symptoms and the impact of ongoing issues. In this dialogue with patients, they are expressing empathy and probing on areas that may inform a plan of care and how that will fit in with a patient’s life and lifestyle. Therapists, depending on their practice, will assess how a patient has been since their last session, review any updated assessments the patient has completed, and probe and reflect on any changes. A lot of the time will be leveraged to hold space for what is happening in the patient’s life; this will likely include some problem identification and checking in on aspects of a patient's life that may support or hinder a path forward.
In my experience, you can have the best evidence-based product and even a compelling user experience, but the product is never used because the work to integrate it into the clinical workflow didn’t happen. For me, integration also includes clinician training. From the literature, we know barriers to adoption include workflow considerations but also low confidence and a belief that apps may not help patients. Clinical enablement must address all these concerns if clinical adoption is going to be achieved.
While clinicians in specialty care may have more time with patients, the opportunity to frame the value of adding digital mental health to a plan of care must be additive to the visit, in terms of referral pathways in the EMR, and the ease of receiving that information as a patient. Being able to text the patient the link to get the app from your organization is the optimal referral path. It’s also good to send it via secure message as a backup. Lastly, printing the instructions on an After Visit Summary (AVS)/patient instructions may also be relevant for health systems that don’t have texting capabilities.
First and foremost, trust is imperative. The trusted patient-clinician relationship is the fulcrum to deploying digital mental health products. Patients are more willing to try a tool if their clinician recommends it, the referral is personalized, and how the product can help them is contextualized to what that patient is experiencing. It’s also important to have a multi-stakeholder partnership that includes senior leadership, IT partners, innovators, change management experts and, critically, front-line teams who can inform workflow design and reflect the optimal patient match.
I’d also say that too often, the rollout phase isn't carefully planned. Some people anchor to their first experience with digital tools; if that hasn’t been positive, there could be more resistance with subsequent efforts. Additionally, if people had a positive experience and the toolbox was then taken away from clinicians, this can also impact efforts. Being clear about the phases of work, from pilot to scale within teams, and communicating clearly at each phase, will increase buy-in and create curiosity for those who may be part of later rollouts.
Last, applying human-centered design and empathy-based problem-solving ensures user needs are what get scaled. For example, in exploring what helps or hinders patients in caring for their mental health, it is possible to probe where digital tools might fit into their day, asking how they already use their phones, if they use apps for day-to-day things, etc. Answers to these questions can provide insight into how to frame a referral to a digital mental health app. Getting to what matters to patients in how their clinician frames the referral can then be codified in the training materials.
Otsuka is responsible for some of the major mental health medications on the market: Abilify and Rexulti. But really, they are involved in a lot more than that. Otsuka focuses on improving the health and wellness of as many people as possible, with a strong focus on mental health. They are also focused on the digital space, using standalone and complementary digital therapies. We spoke with Jeffrey Weness, the Head of Digital Opportunities and Business Intelligence of Otsuka Pharmaceutical Companies, U.S. Operations, on the importance of investment in digital tech for mental health and wellbeing.
There are a couple of approaches that they use to help tackle the digital world. One way is by looking at the market and trying to understand where there is opportunity for growth. As we know, COVID-19 has posed many challenges over the last two years. This gave them a chance to research how to connect people better with the care they need. Otsuka looked into how to invest in and improve the therapeutic alliance. They wanted to see how telehealth and telemedicine could be used in that relationship. They have also looked into access and how telehealth can help reduce the number of barriers to access that many patients have. Many have experienced having a family member in need. During the weeks and months it takes to get in to see a doctor, that family member is suffering.
They are very excited to provide digital offerings to care with a therapeutic benefit. It could be care that is ongoing, prescribed, or quick and easy for immediate care. They are looking to focus on disadvantaged populations, where they can truly make a difference for the most amount of people.
They are interested in partnering with different organizations that can help develop tech to meet the needs of those in need. They are looking for partnerships with good people with good ideas and who want to make a change.
Digital biomarkers solutions are being used to give real-time updates on the progression of care. These help tie together what is actually going on in a person’s life and how it is affecting them with the care they are currently receiving. They are working with different companies to bring digital biomarkers into play, with the idea that a well-rounded and concise look at a patient is the best possible way to help them. There are many products and companies that can do this, but it is about finding the right company for the right reason.
There is no future in healthcare without the integration of digital tactics being a component. Digital tech is being integrated into all healthcare and will continue this progression. There is a desire to use more digital therapeutics in care and treatment. The goal is not to completely replace the pharmaceutical therapies that are on the market but to be used as complementary strategies. There are things that can be done with modern therapies early on in mental health care that can keep people from progressing to serious diseases and serious illnesses.
Otsuka’s hope with digital therapeutics is to be able to work across a spectrum, ranging from non-prescription care to easy-to-access and easy-to-download care and strategies that can help them manage the challenges of daily life more effectively. This would continue through the spectrum to prescription medications that would be used to treat serious mental illness or serious illness under the supervision of a doctor but would also have a strong therapeutic impact without access barriers.
There are two different aspects of digital therapeutics. There are directional issues that can impact the success of patient progress. These directions are seen as the digital prescription and the digital non-prescription method. The idea behind this is that if prescribed a medication, you are familiar with how the process of obtaining and taking a prescription works. If you are prescribed a digital tool, there is a foreign aspect associated with using apps and how they can work for you. Digital non-prescription methods are used more for overall wellness and mental health wellbeing. These non-prescription methods tend to have a higher rate of adoption in the community vs. the lower adoption rate of the prescribed manners. The better the rate of digital adoption in the community, the better the overall success of treatment for patients.
Digital tech has made a huge impact on our society. The key is looking at how to use digital tools to connect to the public. By incorporating digital tech, digital biometrics, and digital therapeutics into our community, we can conquer these barriers to mental health and take a stand for our mental health.
According to the 2020 National Survey on Drug Use and Health, 40.3 million Americans aged 12 or older had a substance use disorder (SUD) in the past year.1 And SUDs in the workplace have reached a crisis point in the U.S., costing billions in direct medical costs and related productivity impacts.
New research from the Centers for Disease Control and Prevention (CDC) has found that the annual minimum direct cost of SUDs for employers is $35 billion annually, or $15,640 per affected employee enrolled in employer-sponsored insurance.2 This does not include productivity-related costs exceeding $250 billion annually and workers with alcohol use disorder missing more than 232 million work days annually.3,4 Alcohol use disorder (AUD) at $10.2 billion annually was the single costliest SUD according to the study.
Since the COVID-19 pandemic, alcohol consumption in the U.S. has increased by 25%, which, if sustained for even one year, is estimated to cause over 18,000 new cases of liver failure and 8,000 additional deaths from liver disease.5 Unfortunately, many suffering won’t seek help, with studies showing that only 1 in 10 people with a substance use disorder gets treatment.6
Because of this, Quit Genius is working on innovative new approaches to treating alcohol use disorder, in particular through substance use management supported with virtual care and medication-assisted treatment.
Quit Genius, the world’s first digital clinic for treating multiple substance addictions recently discussed results from a pilot study of integrated AUD treatment. Published in Telemedicine Reports, the trial looked at the feasibility, acceptability, and preliminary outcomes of a virtual intervention combining cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) plus naltrexone for individuals with AUD.8,9
Naltrexone is an FDA-approved medication that blocks opioid receptors in the brain to help reduce dependence on alcohol and opioids. The authors found that integrated digital health treatment of AUD combining evidence-based psychosocial and pharmacological treatment is feasible and may produce improvements in both alcohol use and psychiatric symptoms.
Suzette Glasner, Ph.D., Vice President of Clinical Affairs at Quit Genius and lead author of the study, said new, innovative approaches to AUD are needed to address significant barriers to care. These barriers include poor access to evidence-based care, social stigma, lack of motivation to change, and cost of treatment.
“We know from research that less than 11% of individuals who are in need of treatment for substance use disorders actually receive treatment, and a large proportion of those who fail to engage do so because of limited access to care,” explained Glasner. “Moreover, in recent years, only 16% of specialty treatment programs offered any single medication for alcohol use disorder treatment. Though we are gradually seeing improvement as awareness of the efficacy of medications for alcohol and other substance use disorders increases, the greatest advancement that our pilot study offers is the capacity to expand access to underutilized and well-studied, efficacious treatments for alcohol use disorders.”
Although this was a small pilot study, reductions in alcohol use and improvement in health were encouraging, with a fully powered randomized controlled trial (RCT) now underway. Engagement and completion rates were promising, and significant decreases in alcohol consumption were reported. Furthermore, even though the Quit Genius alcohol intervention content did not address psychiatric symptoms directly, reductions in depression and anxiety were reported along with increased resiliency.
Adults with AUD (N = 26) were recruited through online, social media-based advertising and enrolled in a 12-week, integrated telemedicine intervention that combined psychosocial treatment with medical management using the Quit Genius virtual alcohol program. Feasibility, acceptability, perceived helpfulness, treatment engagement, retention, completion, and clinical outcomes—including alcohol use and secondary mental health outcomes—were assessed.
Primary outcomes were the proportion of days abstinent and drinks per drinking day. The proportion of days abstinent in the past 30 increased from 13.8% to 59%, and more than two-thirds (68%) of study subjects reduced their alcohol use by one or more WHO risk drinking levels.10 Depressive symptoms were reduced from moderately severe at baseline to the mild range, and anxiety severity declined from moderate to the mild range.
Overall, participants found the Quit Genius virtual intervention to be acceptable and helpful in facilitating action toward their therapeutic goals concerning alcohol use.
Considering the low rates of AUD treatment and the troubling rise in alcohol use associated with the COVID-19 pandemic, study authors believe that innovations in telemedicine and m-health (use of mobile phones and other hand-held devices) “have the potential to be transformative, expanding access to evidence-based therapies.”
The authors also cite several professional health organizations and national agencies that recommend using telemedicine to expand the availability of qualified addiction medicine providers, particularly among populations with limited access to specialty treatment.
Although AUD populations are often difficult to engage and retain in care, preliminary evidence gathered in this study suggests that an m-health approach can overcome these challenges. Although recent efforts to expand telemedicine for addictions have concentrated on medications for opioid use disorders, the findings from this study suggest that broadening access to evidence-based behavioral and pharmacological treatment for AUD through telehealth is feasible and potentially effective.
The Quit Genius substance use management alcohol program takes an evidence-based approach that combines technology, medication, and qualified professionals to address the high cost of AUD in the workplace, including absenteeism, health complications, injuries, and other losses in productivity. Within the first 30 days of care, Quit Genius program members see a 62% reduction in alcohol use frequency, and 80% of enrolled participants reduce alcohol use frequency by 30% or more.
Quit Genius integrates with health plans, pharmacy benefit managers, and wellness platforms to deliver a turnkey implementation experience. Quit Genius recently partnered with pharmacy benefit manager Evernorth and B2B health insurance company Evry Health to make its tobacco, alcohol, and opioid addiction solutions available to members. Visit quitgenius.com for more information.
6. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health
8. ColumbiaDoctors - New York. Treatments and Conditions: Cognitive Behavioral Therapy
9. ColumbiaDoctors - New York. Treatments and Conditions: Motivational Enhancement Therapy
Right now, hundreds of millions of people around the world are stuck in an ongoing struggle with their mental health. They’re overwhelmed in their daily lives and underserved in their options for care. Big Health’s pioneering work in clinically proven digital therapeutics is on course to tackle the challenge of delivering effective care at scale to help millions back to good mental health. We sat down and talked with Big Health’s CEO Arun Gupta about the growing mental health epidemic and why the timing is so right for digital solutions that are scientifically developed and clinically proven.
In the US and UK, more than 130 million adults suffer from insomnia, anxiety or both.1-6 And, the sad truth is that the current default approaches are just not working. Nearly 70% of anxiety and insomnia patients are treated with prescription drugs only.7 More than three quarters of so-called “rescue” prescriptions exceed the recommended duration of 30 days, despite concerns about abuse and physical dependence.7 Regrettably, less than 10% of those treated receive the widely recommended first-line treatment, cognitive behavioral therapy (CBT).7 This may well be the most glaring case within our medical system where the widespread, ongoing practice is so divergent from what’s indicated by the data and clinical guidelines.
Mental health is emerging as the first large-scale use case for digital therapeutics because: irst it encompasses a number of highly prevalent conditions such as insomnia, anxiety, depression, PTSD, and chronic pain that, taken together, impact one in three human beings; second, the preferred treatment option of therapy is generally unavailable, which leads to reliance on prescribed medications that show mixed results and carry significant side effect profiles; and third, through the pandemic it has risen to a top-three issue for employers, health systems, and governments to address more effectively. Adding to these factors and market dynamics are patient preferences, which indicate that 75% of individuals would prefer a non-drug treatment.8
Not to be confused with the growing range of wellness apps, digital therapeutics are real medical treatments that are defined by a number of distinct characteristics:
They’re evidence based — Based on proven models of care, such as cognitive behavioral therapy (CBT)
Learn more about the W.H.A.T criteria for evaluating digital therapeutics
Big Health is leveraging its decade-long commitment to building clinical-grade digital treatments that are deeply science based and research validated. Underlying our products, Sleepio for insomnia and Daylight for generalized anxiety disorder, is an industry-leading body of peer-reviewed research and randomized controlled trials. Our guideline-recommended digital treatments have the most evidence in the industry, supported by more than 80 peer-reviewed publications and 14 randomized controlled trials. Our products are proven to drive significant clinical improvement with 71-76% of participants having been shown to achieve remission.9,10 Importantly, we do this while also enabling meaningful cost reduction of $6,400 annualized decrease in per patient spend.11
Based on our pioneering work in the category and the magnitude of the opportunity ahead, I was both humbled and energized last year when Peter, Colin, and Big Health’s leading investors, including Softbank, Octopus, Gilde, and Morningside Ventures, came together and asked me to lead the company’s scale-up as CEO.
I firmly believe that evidence-based, research-validated, fully automated digital treatments can have a huge impact in addressing the mental health crisis by providing a clear pathway to meaningfully scale and accelerate access to guideline-recommended care.
Looking across all the evidence, it's clear that the world is moving in our direction. Big Health has already been approved for reimbursement by numerous employers, large prescription benefit managers (PBMs), the National Health Service (NHS) in Scotland, and multiple payers. We concluded 2022 as the most successful year since our founding, achieving significant business milestones including: Series C Funding round for $75 million with SoftBank; Daylight and Sleepio products added to a second national digital formulary; National Institute for Health and Care Excellence (NICE) approval of Sleepio as first-line treatment for insomnia ahead of medication; development of a strategic partnership with a major payer for medication-based targeting; and enrolling our 300,000th patient in treatment.
The time is right and our momentum is strong as we drive forward in 2023. We continue to build out a diverse and talented team with a number of recently named senior executives focused on finance, product, people, sales, and marketing, joining many long-standing Big Health employees who are experts in digital treatment development. We’re already on pace to add more covered lives this year than any in recent years, including several new strategic relationships. And our industry as a whole is maturing to understand the role that evidence-based digital treatments will play as the first-line mental health treatment of any modern health system. We look forward to sharing further progress and inviting more collaboration on the road ahead.
We’d love to hear from you. Contact us to learn how you can unlock coverage to clinically validated digital treatments for your population.
Article written by Arun Gupta, CEO of Big Health.
Neil Leibowitz, MD, JD, is a dynamic and results-driven senior healthcare executive. Dr. Leibowitz shares his experience in the digital behavioral health space and adds insights into ways we can improve and innovate within the industry. There are many pockets of opportunity at a large scale to both innovate and pilot things.
Measuring success in behavioral health is often more complex than what we see for medical care. Typically, many companies utilize validated measures such as the PHQ-9 for depression and GAD-7 for anxiety. For behavioral health, success can sometimes be more nuanced. Success measures for someone are: What do they want to do that they’re not doing today? It could range from going to work, getting along with a family member, or getting out of bed. Unfortunately, these qualities are difficult to quantify and measure and can’t be captured by a survey. Dr. Leibowitz suggests recording occasional sessions as a quality measure. So what do you look for in these sessions? When reviewing these recorded sessions, technical proficiency is only a piece, but empathy is the most valuable metric. This ties in with the research that shows that a strong therapeutic relationship is the strongest predictor of a positive therapeutic outcome.
Finding a way to measure success can help providers understand what they can do better. Dr. Leibowitz shared, "for a payer, it becomes, who do I want to send the hardest people to? Am I willing to pay more for a great outcome? And that’s where I want to go. I want to pay people more if they’re doing great work." As we think about ways to innovate in behavioral health, rewarding providers for great outcomes may be difficult, but it’s a great way to move forward.
As a licensed Psychiatrist, Dr. Leibowitz mentions that all of the current innovation appears to be focused on outpatient care, but “for anyone who’s been in an inpatient unit in the last five years, their experience probably would have been just about the same as if they were in an inpatient unit in 1960.” And this isn’t surprising. The barrier to entry is much more difficult in terms of understanding, appreciating, and innovating in inpatient care.
Inpatient mental health care is really difficult to innovate. It requires a level of technical knowledge and expertise that not many people possess. Additionally, most people have no exposure to inpatient care, and those who may have visited relatives were only exposed an hour a day.
For current behavioral health companies to set up a practice or develop an app, you can go to market in six months. However, if you want to really change the thorniest most complex problem, it’s going to take a little more time and more money. Innovation in inpatient care will take a larger investment from all stakeholders in order to really see change.
Dr. Leibowitz makes it clear that the most important thing is that you have something that fits within a reasonable framework of what we do today. In other words, any digital behavioral health solution must be built for the current American healthcare system.
“Think about how your solution can work within the framework of healthcare. Whether we think healthcare in this country is delivered correctly or not is not the discussion to have. What the discussion to have is your version one. Explain to me how it’s going to work in the insurance-based system. How’s it going to get paid for? How does it get implemented?” While it’s great to have ambitious long-term goals and think creatively about how healthcare in America can be better, startups that think practically about how to work within the current healthcare system in terms of payment and implementation will be the most successful.
To hear more on this conversation, watch this conversation in our video library.
Dr. Michael Aratow, Co-founder & CMO at Ellipsis Health , which is a leader in AI-generated vocal biomarker technology pioneering a new standard in mental health by harnessing the unique power of voice for earlier and better detection, assessment and monitoring of the severity of clinical anxiety and depression.
COVID-19 brought to the fore a mental health crisis in America. Recent studies have found that four in ten adults in the United States reported symptoms of depression or anxiety, up from one in ten in 2019. Yet up to two-thirds of all cases of depression in the United States go undiagnosed, much less treated. The crisis is equally dire for young people: more than 10 percent of America’s youth suffer from major depression each year, and 60 percent of them receive no treatment.
Today, more than three years into the pandemic, tens of millions of people in the U.S. are on their own, without professional help, suffering needlessly. It is more than time to create a new paradigm for mental health care. Just as the introduction of MRIs some 40 years ago transformed medical diagnostics, surgery and cancer care, emerging technologies can revolutionize the current inadequate standards of screening, diagnosing and treating mental health disorders.
The most common screening tools currently used are imprecise patient-reported surveys, in which people may minimize or exaggerate symptoms. In-person clinical assessments are more effective, but a nationwide shortage of mental health care providers means there simply are not enough professionals trained to identify depression, anxiety, and other conditions, especially at the early and most treatable stages. Studies have found that primary care providers, the first medical professionals that most people with mental health disorders visit, correctly identify depression only 50 percent of the time.
Artificial intelligence and the unique power of the human voice can bridge this gap, offering the opportunity to reimagine new standards in mental health care. Researchers have long recognized that a person’s voice can convey state of mind, not only through words and ideas but also through tone, rhythm and emotion. When a person is depressed, speech patterns typically become more monotone, softer and lower in pitch with frequent pauses. Anxiety creates a different pattern, causing people to speak faster and breathe harder. It isn’t easy for a physician to pick up on these often-minute vocal features, even with extensive training. Computers can.
With diverse data collected from the vocal samples of thousands of individuals, artificial intelligence algorithms can analyze voice patterns and identify characteristics that may indicate a change in mental health. These objective and scalable algorithms offer a way forward that addresses both the lack of accessibility and the imprecise nature of current screening methods.
Such a machine-learning solution is being developed by Ellipsis Health, a company I co-founded to help create a new standard of mental health care. The company’s machine learning scientists started by taking thousands of voice samples of depressed and nondepressed individuals and coding their speech patterns, including pitch, cadence, and enunciation. They then added data collected at the same time from the standard PHQ-9 and GAD-7 mental health questionnaires, and professional mental health assessments. The software was trained to identify vocal features indicative of depression and anxiety after listening to short samples of patients’ speech. The feasibility of the technology was demonstrated in a recent study published in the peer-reviewed journal Frontiers in Psychology.
The AI system isn’t meant to make a final diagnosis. It is instead a valuable support tool, alerting a clinician that further assessment may be needed to determine if a patient needs mental health interventions and to follow that patient’s condition over time. Notably, such an AI-based tool doesn’t require a clinic visit—an important advantage for patients who aren’t able to physically travel for an initial evaluation due to distance, cost, or even a lack of awareness that treatment is available or needed. The technology can be integrated into mobile apps and telehealth consultations, making screening accessible and economical for patients, providers, and payers. Clinicians can also use it to regularly check patients’ voice samples remotely in order to monitor them over time for improvement or the need for more intensive interventions.
Artificial intelligence can never fully replace a clinician’s interactions with a patient, nor is it meant to. But it does offer an easy-to-use and affordable method for reaching and caring for people who would otherwise be adrift. This new technology starts us on a path toward an improved standard of mental health care that can help end the suffering of millions.
Behavioral healthcare has a problem: most health plan members seeking care face significant hurdles prior to ever being connected.
Today, when a person makes the decision to seek mental health care, many do not know where to start. For those searching their health plan’s online directory of providers. This list of providers is often outdated and members have no guidance regarding which provider or type of care is right for their needs. Members contacting their health plan are often provided with a similar list, and are then on their own to cold-call providers to find the right one. Wait times to schedule a first available appointment can be as long as three months. Over half of adults with mental illness never make it to care.
It’s crucial we rethink this first point of contact. The initial conversation that health plans have with a member should act as a switchboard that launches them on the most direct, efficient and accurate path to improved mental health outcomes. This requires evaluating which care is the right match for member needs, connecting them to it and escalating high risk members to care quickly.
At Lucet, we ensure that health plans make the most of that first call. Our care navigators greet members who call into our Care Center, then guide each one through a standardized risk screening and matching process using our technology platform. Every member across the acuity spectrum receives the same screening, which has been backed by nearly three decades of clinical research. With this knowledge, care navigators can immediately determine a member’s risk level and either warm transfer them to an appropriate clinician or schedule a first appointment with a covered provider—all in one call.
Using this universal screening model, Lucet saw a massive 152% increase in the number of members identified as at-risk who were triaged to a clinician for further assessment and safety planning. The Lucet technology platform has proven critical to effectively implementing a solution across the acuity spectrum. It allows care navigators to both inform low-risk members about direct scheduling and identify at-risk members who were previously overlooked. In fact, up to 5% of callers to our Care Center were members asking about benefits who were identified as needing risk escalation in the same phone call. When implemented at scale for all members, this differentiator ensures we can identify the need for immediate intervention with a clinician and potentially avert a catastrophic event.
In an analysis across 5,000 members screened by our Care Center, 21% of total members were low acuity, 47% were moderate and 32%—a third of the entire population—were identified as high acuity (based on our Behavioral Health Index). As a significant number of members reaching out are screening as high risk, establishing a connection and appropriately triaging within the first call is crucial. Standardized risk screening gives health plans the ability to identify all patient needs, especially the high acuity population, at the onset of their care to route them to the right treatment as quickly as possible.
Over time, data gathered from these clinically informed screeners provide health plans with a holistic view of behavioral health needs across their total member population. This enables plans to evaluate demand and address provider supply issues across their network and meet total member population needs.
In our analysis, 15% of all calls to our Care Center needed immediate clinician intervention. Interventions are required immediately for these members, and include face-to-face evaluation within one hour for imminent, life-threatening situations and within six hours for non-life-threatening situations.
To manage the needs of these members, Lucet maintains a team of licensed clinical staff who are available 24/7, 365 days of the year. For escalated members, these clinicians conduct a complete clinical screening, ensure member safety and coordinate with the referred provider to ensure follow-up screenings and treatment success.
As a result of a more effective first call, Lucet has been able to connect 26% more members to care, and has demonstrated 40% improvement in outcomes.
If you’re a health plan interested in transforming your behavioral health first call or learning about Lucet’s screening and escalation process, contact lucetsales@lucethealth.com.
If providers agree that integrating physical and behavioral health delivers better outcomes, why isn’t every health plan doing so? One of the main reasons is: Their resources are stretched too thin. Suppose care managers had the resources to screen at-risk members and improve care coordination. In that case, they could more effectively guide members to appropriate resources, help identify co-morbid conditions sooner, and preempt emergency room visits.
Fortunately, technology can help with this. Technology can scale to offer care managers support for a larger member population and provide the insights Medicare Advantage plans need to identify risks and prevent behavioral health crises. Dr. Tom Zaubler, MD, MPH, Chief Medical Officer at NeuroFlow, shares more about the challenges faced by Medicare Advantage plans and how technology can help integrate behavioral and physical care management.
Many Medicare Advantage plans fail to deliver on improved outcomes due to their outdated and siloed approach to care. Providers agree that integrated care, assessing and treating physical and behavioral health together, delivers better outcomes, but many plans are still managing their members’ health needs separately. Many members with chronic conditions have underlying behavioral health needs that can prevent or hinder recovery. In fact, over one-third of individuals with chronic conditions also struggle with behavioral health conditions. Managing these health needs separately is not only inefficient; it’s ineffective.
Care management is also reactive. Many Medicare Advantage plans provide care management to their members based primarily on claims data. That means members have already submitted a claim for an emergency room visit, for example, before they receive support from their Medicare Advantage plan. A preventative approach can lower utilization, helping plans meet their cost savings goals and improve clinical outcomes. Preventative measures like regular behavioral health screening and providing access to relevant behavioral health resources are critical components of this effort.
Medicare Advantage plans have another unique challenge that calls for urgent preventative measures. Older populations are at a higher risk for suicide than many age groups. In fact, men over 65 years old face the highest overall rate of suicide. It’s especially important in these instances to manage physical and behavioral health needs together and proactively screen populations to mitigate behavioral health crises.
Delivering improved outcomes and lowered costs isn’t achievable if physical and behavioral health aren’t managed in tandem. For example, someone with diabetes is two to three times more likely to have depression than someone without diabetes, according to the CDC. Depression can lead to unhealthy habits like not checking blood sugar or skipping critical doctor’s appointments. It’s clear that overlooking the underlying behavioral health needs of a diabetes patient prevents physical recovery.
If care managers can integrate the physical and behavioral health data of their members into a single view, they can more effectively guide those members to appropriate benefits and resources that can support their recovery. Screening Medicare Advantage populations more regularly can also help identify co-morbid conditions sooner and preempt an emergency room visit or suicide attempt.
One of the main reasons care managers aren’t proactively screening at-risk members or improving coordination across physical and behavioral health care management is that their resources are stretched thin. Calling large volumes of Medicare Advantage members simply isn’t feasible, and many care management platforms don’t connect physical and behavioral health data. Technology can offer the scale care managers need to support a larger member population, prioritize outreach to their highest-risk members, and unify physical and behavioral health data.
For example, NeuroFlow screens members enrolled on its platform at a regular, monthly cadence. The digital engagement platform delivers clinically-validated assessments to screen for depression, anxiety, substance use disorder, and more. AI technology analyzes these assessments, along with other user signals, to inform a proprietary Severity Score. Depending on the severity of an individual’s behavioral health needs, NeuroFlow will either direct that person to relevant self-care resources or flag the member as at-risk to their care manager, prompting further outreach. Connecting members to self-care resources or care management can have major upstream impacts on clinical outcomes and costs of care.
Technology infrastructure can streamline integration by making it easier to identify and manage co-occuring conditions and enhance efficiency. To make a meaningful impact on clinical and business outcomes, care managers need a comprehensive and proactive approach to member wellness. Rather than waiting for worsening symptoms or for members to seek help, technology can provide the insight Medicare Advantage plans need to identify risk and prevent behavioral health crises.
To learn more about how technology can improve and scale integrated care management, visit NeuroFlow.
Dr. Tom Zaubler MD, MPH is the Chief Medical Officer at NeuroFlow, the leading SaaS solution for integrated behavioral health. He is also the Founder & Medical Director, Pegasus Psychiatry Associates. Prior to joining NeuroFlow, he was the Chair and Medical Director of the Department of Psychiatry at Morristown Medical Center for 21 years.
Mental health can be a complex subject to crack. With so many issues surrounding it, it can be hard to navigate and know what is up or down. Issues like stigma, lack of providers, and access to care can all inhibit our ability to prosper in a healthy nature. Below are three companies working to close the gaps and break the barriers to accessing mental health care through digital solutions.
Ellipsis Health started off as a desire to connect the dots between physical and mental health. They saw the opportunity to do so by using voice. Voice is how we connect with each other, and healthcare is all about connecting the dots and building relationships. They created the world’s first clinically validated vital sign for mental health using voice to measure stress, depression, and anxiety levels.
There must be a way to be inclusive and ethical about how to build the technology and who will build the technology. And the people willing to build the technology must actually represent the people they are building it for. Ellipsis has built its digital solution using people from various backgrounds and understanding, gathering data, and utilizing a good representation of the market.
One crucial factor in the success of this technology is early intervention. Starting even with kids – realizing there is a problem, getting treatment, and the road to recovery – all start with early intervention. According to data, 50% of all lifetime mental illnesses begin at age 14. About 75% begin by age 24. By engaging in a fun and informative way with early intervention, there is a much better success rate.
Optum Labs is expanding access to mental health care by bringing care into a person’s home. Care in the home can also cut down on the stigma of mental health care. By allowing the care to be private, in the comfort of their own home, more people are willing to seek out this form of health care.
The biggest challenge in mental health is that there is no universal diagnostic tool that can be as simple as a blood test to diagnose conditions. Digital health companies are starting to use digital tools and biomarkers as a method to help diagnose illnesses. By bringing in technology, Optum Labs is increasing access to biomarking tools, thus increasing access to care overall. This is becoming part of holistic care and bridging the physical and mental health care gap. Another way this is increasing access is by connecting the patient to their care team in a more seamless and universal way. Optum Labs is using technology to meet people where they are.
Headspace is looking to ensure that patients have diverse options to provide a range of treatments that is right for each individual. Since choosing can be a burden, the goal is to have personalization and assessment engines that ensure that they are serving the right piece of content, providing the right connection to a coach, and the right escalation to clinical care, at the right time.
Headspace uses technology to open the front door to care. Some people know they need care but are blocked by stigma from seeking out the care they need. They are intersecting people with informativeness as well as readiness.
COVID-19 gave people the unique circumstance of being locked in their homes, watching tv. Headspace partnered with Netflix to bring to life a series of specials that focused on mental well-being, meditation, and good sleep. When you work with technology, there’s a way to introduce and interrupt to get the point across. Headspace also partnered with TikTok to create a segment with a teacher, Dora, about mindfulness and help you take a break and breathe. There was success with this segment that caused people to exit the app and shut down TikTok after the break. The more you can embrace the playing field–in this case, technology–and meet people on their level, the better the outcome and success rate will be. This has been a great way to reach the younger generations.
You can watch our full panel and hear more of these conversations here.
Over the past few years, the news, medical literature, government and healthcare industry has increasingly discussed addiction and called attention to the massive negative impacts it has on our country. Still, things do not seem to be improving, and our past efforts are not sufficient to meet the vast need. Addiction, a serious, chronic and treatable condition continues to be underdiagnosed and undertreated. This is unacceptable.
It is not possible to overstate the “entry to care” crisis for those living with substance use disorders (SUD). I took a spin through the recently released 2021 National Survey on Drug Use and Health (NSDUH) and the numbers remain devastating: 60 million people with past month binge alcohol use, 29.5 million people with an alcohol use disorder of which nearly 20 percent (1 in 5) had a severe use disorder, 8.7 million people who misused prescription pain medications in the past year and, remarkably, an estimated 1.8 million who initiated misuse of pain relievers in that time.
Against a backdrop of 43.7 million people – sons, daughters, spouses, parents, friends and colleagues – who needed substance use disorder treatment in the past year:
In the context of NSDUH, any treatment includes any intervention at any location such as life-saving care in an emergency department that may or may not involve follow-up treatment or participation in self-help support programs. Unlike any other serious and chronic illness, we seem to tolerate addressing the acute phase of this illness without sufficient early intervention or ongoing care.
Today, individuals in need and their families often determine their own level of care by accident and occasionally, it’s the right care. Lacking knowledge of treatment options and worried about sharing concerns with others, people may enter care following a legal or medical crisis or they may quietly search online without necessarily knowing what they need. It’s like spinning a wheel of fortune “weighted” in the wrong direction and getting lucky with the right care by chance.
If this was someone who had severe heart disease or suffered a heart attack, neither the lay nor the professional community would tolerate the risk of further harm from an unchecked health condition. In fact, with any other medical condition that has the morbidity and mortality of substance use disorder (SUD) this idea of uninformed, self-navigation would be unacceptable.
Admittedly, the factors associated with substance use conditions that contribute to the “entry to care” challenge include ambivalence and readiness for change. With conditions that require effort by the patient beyond taking a pill to get better, they need to initiate and maintain lifestyle changes. We see this behavioral component to treatment across a range of conditions, including obesity and its implications for diabetes or heart conditions. For a person with alcohol or other substance use disorder, the risk of serious harm can be imminent – accidental overdose or serious accidents due to impairment. Still, the desire for continuing to attend social events where friends are gathered but where there may also be significant use of alcohol or other substances can overshadow such concerns. For those who are ready for change, the efforts involved in finding and entering the right care are daunting – especially when they know that the therapeutic work may be difficult. Unfortunately, we often hear about the experience of “slogging” through the system: long wait times for appointments (4-8 weeks), higher than expected costs (“wasn’t in my network, I was stuck with a big bill”), time away from work or family (“I thought I had to go away for treatment’), and similar pain points. Sadly, many – despite the ongoing risk of harm – simply give up.
It is time to act.
We need to step in and render aid quickly – the reality is that SUDs are treatable and now we’re armed with a range of therapeutic goals and treatment options that did not exist a decade ago.
How can we help? We need to change and drastically improve the entry and access to care. Efforts to self-navigate online are painful. The system will serve up too much information, too many options – much of which is not applicable to the person needing services. It is hard to know what treatment to pursue when you are also working to understand your health condition, the associated treatment options (including both levels of care and types of care), and how insurance coverage for different services and levels of care works. When a decision is made to make a call, the problem of timely appointments becomes another hurdle.
Now is the time to support timely entry to care with attention to sustained engagement in treatment. We should continue to actively lean into whole person care because medical, behavioral, social, and environmental factors all play a role in health outcomes. Let’s approach SUD intervention and care with the urgency and duration that such a serious, high-risk, chronic and treatable condition warrants. Collaboration is a good word, but it requires understanding of the different and essential purposes, processes, and strengths that each stakeholder brings to the solution. Such informed collaboration is the pathway to improved outcomes driven by effective, simplified, and efficient care.
At Navigator, we know and understand the system of care and we build bridges. Working across the health system, we:
Facilitate collaboration within the health care system (among payers, medical and behavioral providers, and members/patients)
Address Social Determinants of Health, including:
Instill hope through human engagement by:
The need for early and effective entry to care for treatment of SUD is both well-documented and, unfortunately, experienced every day in every community. For that reason, Navigator’s door is open 24/7 providing simple, compassionate navigation and informed collaboration within the healthcare system.
Article written by: Deb Adler, CEO of Navigator Health, Inc.
Traumatic life experiences seem to be escalating in frequency, and our mental health system cannot support enough individuals to prevent post-traumatic consequences.
To combat this trend, health plans and employers can enable post-traumatic growth at population scale. An investment in post-traumatic growth may help secure the wellbeing of your members or your workforce in an increasingly uncertain and trauma-filled future.
Helena Plater-Zyberk, CEO of Supportiv, shares how online, on-demand 24/7 access to a national peer-to-peer support network can assist the coping and healing process of millions.
We are all going through traumas at an increasing frequency, collectively and individually:
All of these traumas decrease our population’s ability to work productively, attend to personal physical health, connect meaningfully with others, and function fully in daily life. Trauma impacts social determinants of health (SDOH), directly and indirectly, via mind-body health effects and behavioral consequences such as increased substance use.
Because of its SDOH impact, trauma in all its forms is a major target for reducing costs, improving outcomes, and securing population health at large. Given the right resources, individuals can experience unprecedented growth in the face of trauma, rather than a worsening of mental and physical symptoms. That’s what post-traumatic growth is all about.
In many cases, trauma can be transmuted into growth, allowing people to reach improved levels of wellbeing, even compared to pre-trauma. Post-traumatic growth at its best can spur “self-discovery, integration of illness-related experiences and active self-management of well-being” that did not exist prior to one’s trauma.
That’s not to say that trauma is a good thing! However, if we are armed with the right tools to respond effectively to traumatic experiences, we can avoid many of their worst-case outcomes.
A conscious emphasis on post-traumatic growth is a worthwhile avenue for health plans and employers to boost SDOH and keep individuals healthy, engaged, and functional.
Post-traumatic stress disorder is associated with
Post-traumatic growth, on the other hand, is associated with
Disclosure to others is an important part of processing trauma. Additionally, many of trauma’s negative effects stem from inadequate perceived support immediately after a destabilizing event.
One of the biggest factors in whether someone develops long-term PTSD following a trauma (vs. growing through the trauma), may simply be: how supported they felt in the immediate aftermath of the event.
Therefore, health plans and employers need to keep immediacy, human connection, and genuine empathy top-of-mind as they include innovative post-traumatic growth resources for covered populations and workforces.
In order not to get stuck in trauma, in order to move toward post-traumatic growth, research clearly points to a major protective factor, post traumatic social support: “It is widely accepted that poor perceived social support is one of the most important risk factors for the onset and maintenance of PTSD symptoms (Brewin, Andrews, & Valentine, 2000; Ehlers & Clark, 2000; Holeva, Tarrier, & Wells, 2001; Ozer, Sr., Lipsey, & Weiss, 2003; Robinaugh et al., 2011).”
Post traumatic social support can be defined as immediate, helpful attention after a traumatizing event. Unfortunately, traditional wellbeing benefits like therapy struggle to offer this on-demand experience of social connection following any of the daily occurrences one might find traumatizing.
People who experience trauma (all of us nowadays), are unlikely to receive immediate care and attention through traditional channels. According to Psychology.org reporting, “The National Council of Mental Wellbeing reports the average wait time to access behavioral health services is about six weeks. But if you're looking for a specialist in a certain area or with specific attributes, wait times can stretch into months.” That wait time is only relevant if you can afford behavioral health services, and if you aren’t part of a population segment disenfranchised from therapy (Center for American Progress).
We have a compound problem, here. Traditional care pathways cannot accommodate most care-seekers within the timeframe necessary to avoid post-traumatic symptoms. And, many who experience trauma avoid traditional care pathways to begin with.
Existing solutions, like therapy, that offer individually-tailored support, require a high investment of manpower, funds, organization, and scheduling per individual helped. These solutions clearly work, but they require clinical manpower and other resources that continue to dwindle as population needs increase. (See the flood of articles on America’s provider shortage).
So, I invite decision-makers in health to consider the opinions of the Chief Medical Officers of NAMI and the American Foundation For Suicide Prevention. Christine Moutier, M.D. and Ken Duckworth, M.D. recently pointed to an oft-overlooked approach to population mental health care shortages, offering immediate attention in the face of traumas big and small: peer support.
The mental health provider shortage hampers our ability to heal through successive traumas, as individuals and as a nation. Peer support is a care modality that can fill the provider gap due to its broad community appeal, even among those less likely to pursue traditional mental health care –namely vulnerable populations, men, and all ranges of the age spectrum.
We, at Supportiv, are flipping the script on the post-traumatic growth barriers associated with traditional care modalities. Supportiv is enabling post-traumatic growth at scale, by harnessing the care-providing power of individuals who are, themselves, seeking care.
The Supportiv approach is not just trying to help yourself, but also helping other people in the process. In this manner, we see exponential returns on each individual’s self-help efforts, and support population mental (and thus physical) health at scale, regardless of the provider shortage.
To many, peer support is more conceptually accessible than therapy due to its less paternalistic approach toward traditionally disenfranchised population segments. Additionally, online peer support is more tangibly accessible to many, given its low price point, anonymity and literal 24/7, on-demand availability.
A service like Supportiv provides the immediate, anonymous, non-intimidating, compassionate attention to put someone on a path to post-traumatic growth after a trauma–which even tele-therapy solutions simply cannot provide.
To learn more about collective trauma recovery, post-traumatic growth, addressing the mental health needs of disenfranchised populations, and innovative digital health workforce solutions, watch Supportiv’s CEO & Co-Founder discuss this on Vimeo, here.
Or, contact Supportiv at info@supportiv.com for more information on implementing digital peer support for your health plan members or employees.
Over the past few years we have seen a tremendous increase in the amount of investment (both private and government-funded) in behavioral health solutions and services. Yet, despite all this investment, the mental health crisis continues. Gaining access to quality mental healthcare is still extremely difficult for many in the U.S. and we haven’t made a significant impact in addressing members’ mental health needs.
We believe that a big part of the problem we are facing in the U.S. is that the behavioral health ecosystem is out of alignment.
There are two sides to the behavioral health ecosystem: Demand, driven by patients’ need for mental health care, and supply, which refers to available, accessible delivery of care. To be in equilibrium, demand and supply need to be in balance and the flow between supply and demand needs to be frictionless, unhindered and efficient. This is not happening in behavioral health. Demand is increasing at an unprecedented rate. Despite the explosion of behavioral health startups and point solutions, supply remains fragmented and dispersed. The systems don’t exist to seamlessly coordinate, at a macro level, the influx of members’ needs with the output of care.
The departments at health plans responsible for managing member behavioral health needs have limited real-time visibility into their provider networks to ensure adequate access. As a result of relying on lagging data, they don’t have the ability to effectively connect members to care. Instead, the onus is often on the member to identify their mental health needs, look up a list of covered providers and resources, then cold-call providers to find an available appointment. Members often must figure out for themselves if they need medication, therapy or some other approach; digital or in-person treatment; a young male or an older female provider. Even where health plans have expanded their solution set, members are not connecting the dots between these point solutions, and struggle to find the right provider or solution to treat their needs in a timely fashion.
The lack of alignment across BH member demand and provider supply is compromising our ability to get out of the crisis phase in mental health. Members either don’t get treatment, or they pick the first treatment available rather than the right treatment that will appropriately address their concerns. Not having the right treatment can exacerbate symptoms and cause loss of functioning. Members then need to restart their search for care, delaying health resolution and driving up cost. Providers, in turn, are frustrated and dissatisfied, because they’re not proactively managing their patient pool to drive positive outcomes. The quality of care and outcomes go down, and the upward ripple effect on the total cost of healthcare continues.
Health plans need a central ‘switchboard’ that aligns supply with demand and optimizes the flow of care. Optimization means making effective use of a situation or resource. In behavioral health, it means that members have the most direct path to finding the right treatment for their needs, when they need it. It means that providers are managing the profile and number of patients they treat, leading to a higher likelihood of positive outcomes and immediate visibility into those outcomes.
People with deep domain expertise who can screen and triage members, personally navigate them to the right care, and provide the necessary case management and ongoing support.
Technology with real-time operational capabilities in pooling across all types of providers (independent, small group, large group, aggregator, point solution and specialty) to centrally manage appointment scheduling, outcomes measurement and care management.
Real-Time Insights to understand the interplay across demand and supply for better matching of members to care, capacity planning and network management.
Health plans can clinically assess all members needing BH care–from the mildest to the most complex–and direct them to care quickly. Some point solutions or provider networks do this, but there’s no consolidated ‘front door’ for all health plan members.
Plans can match and connect members to the most clinically appropriate and immediately available treatment solutions based on their level of acuity and clinical profile. With consolidated visibility into overall provider capacity and provider-level appointment availability, they can directly schedule appointments in pockets of time when providers are available.
Using standardized measurement-based care tools, the patient profile, provider profile and outcomes data, health plans can fine-tune assessment, triaging and matching of members to care. They have real-time insight into macro demand and supply trends, which they can use to dynamically expand or contract their provider networks to be responsive to member needs.
Lucet is building an optimization infrastructure to align the flow of behavioral health services across health plans and provider networks, and allow for timely access to high-quality, value-driven mental healthcare for all who need it. In our work supporting health plans’ efforts to optimize their behavioral health systems, we’ve uncovered 44% additional provider capacity without adding a single additional provider and connected 55% more people to care. By improving the connection to behavioral healthcare, we’ve saved a prominent health plan client over $90 per member per month (PMPM) in total cost of care for each connected member, with savings sustained over three years. For each person in care, we’ve improved their mental health scores by 40%. Plus, we’ve connected members to their first therapy appointments in an average of five days, and as little as one day, using our scheduling platform.
Most health plans’ behavioral health systems are running inefficiently. By simply aligning and coordinating the way member demand and provider supply work together, health plans can unlock significant levels of potential value waiting to be utilized. Find out what that opportunity and value is in your health plan. To learn more, contact us here.
Article written by Sarah Reilly, SVP of Product, Strategy & Innovation of Lucet.
For college students, obtaining healthcare when and where they need it can be a never-ending challenge. One company, Caraway, is addressing the current tsunami of health care needs college students are experiencing. Caraway provides on-demand access to mental, physical and reproductive healthcare that is tailored to Gen Z women and individuals assigned female at birth. Below is a conversation between our CEO Solome Tibebu (ST) and Caraway's Chief Health Officer Dr. Cheryl Baggeroer, M.D. (CB).
CB: Navigating healthcare in the US is an onerous task for everyone, and particularly stressful for those doing so on their own for the first time. Most women+ face this daunting challenge in or soon after the college years when many common mental, physical and reproductive health concerns arise.
Access to developmentally appropriate and culturally sensitive mental health care is essential to this group as women struggle with double the rate of depressive disorders, have nearly twice the likelihood of being diagnosed with an anxiety disorder, and two-to-five times greater likelihood of eating disorders. Confidential, consistent and judgment-free birth control options as well as STI testing are equally essential for this patient population. They also need care for common physical concerns like migraines and UTIs, which affect women+ students more often than their male peers.
Gen Z women+, in particular, are facing additional challenges with their mental health and reproductive health. They are growing up in an age with higher stress and anxiety levels than prior generations with intense academic pressures, climate change, social unrest, gun violence and social media as their childhood backdrop. The social isolation, health anxiety and grief elicited by the COVID-19 pandemic added further stressors. With pauses in and closures of high schools and colleges, many are now playing emotional, social and intellectual catch up. According to a recently released report by Gallup and the Lumina Foundation, mental health is now one of the top reasons many college students are considering dropping out of school.
Following the recent Dobbs v. Jackson decision, young women also find themselves worrying about accessing reproductive healthcare including birth control, emergency contraception and abortion services. Per a recent Best Colleges survey, 43% of college students are questioning whether they want to remain in the state where they attend school or transfer in response to lack of access to reproductive healthcare, yet another disruptive and often anxiety-provoking experience.
Still, despite the very clear healthcare needs of this patient population, there is a dearth of women+-focused solutions for mental, physical and reproductive health - and an even larger gap for solutions at the intersection of all three.
At this critical moment of developing their independence, Gen Z women often don’t know where to turn when they have a problem, have trouble getting appointments for routine health needs, spend days waiting for appointments at student health, or wait hours at urgent care facilities or ERs inconveniently located far from campus. Often students must decide between taking the time to take care of their health or keeping up with their classes and college activities.
At Caraway, our purpose is to redefine healthcare for a generation of women+ — to no longer allow the healthcare system to overlook or underestimate their needs, to care for them mentally and physically, to help uncover early diagnoses and reduce the risk of future health conditions, to support the development of their own health care agency, and to set the course for lifelong health care habits.
CB: Gen Z has grown up with phones in their pockets, and when it comes to receiving content and services, immediacy is the norm. On-demand everything - including healthcare - can lead to positive and negative consequences. Caraway is striving to address both with evidence-based care and information provided directly by medical professionals.
For example, for a Caraway patient anxious about a possible STI, our 24/7 chat feature allows them to immediately text with a clinician to discuss symptoms, have an at-home STI testing kit sent directly to them to collect the samples needed, send the kit back, and then when ready, discuss the results and ask any follow-up questions —all from the privacy of their dorm room.
Simultaneously, Caraway is challenging the steady stream of health misinformation a patient may encounter when seeking immediate answers on “Dr. Google,” Instagram, or TikTok. The gynecologists, adolescent medicine doctors, family practice clinicians, therapists and consulting psychiatrists who make up the Caraway Care Team use social media as well as in-app content to separate fact from fiction on health topics currently circulating online.
Thankfully, Gen Z women+ also appear to be more willing to talk about and seek help for their mental health, and more often view mental health and physical health as inextricably linked. Our 24/7 chat feature allows students to connect with an actual human clinician to get answers immediately and avoid the all-too-common health anxiety spiral. Our integrated care model offers multiple opportunities for both mental health and physical health needs to be addressed and connections between the two to be explored.
Much more so than prior generations, Gen Z expects to receive healthcare on their own terms – an experience that is personalized, equitable and digitally accessible. From the beginning, Caraway has had a robust presence of Gen Z leaders within our company. Caraway was built with and for Gen Z women+ and incorporates their feedback directly into our care model.
CB: Most student health centers mirror traditional health care settings with mental health and medical health in separate locations. Despite evidence showing better outcomes when care is integrated, changes to these systems are slow and complicated. Creating a fully integrated care model with mental, physical and reproductive healthcare available in one “place” was the first priority for Caraway. Every decision since then has been intended to emphasize interactions that allow mental health and physical health to be addressed simultaneously.
We use the Collaborative Care Model as one of our foundational care components, given its extensive evidence base for improving treatment outcomes for patients with depression and anxiety. Our Care Team includes medical and mental health clinicians from diverse backgrounds, varied care delivery experiences and broad clinical expertise. Both patients and clinicians benefit from our care team’s ability to immediately leverage one another’s expertise.
Caraway’s virtual health services meet students where they are and at the level they want to engage - from answering general health questions to addressing urgent medical needs to engaging with ongoing mental health care and interactive digital tools. We are proactive in our approach and aim to engage with patients before they get sick or need a higher level of care. When we are not able to address a patient’s needs in a virtual setting, our clinicians work alongside our health advisors to appropriately refer them to in-person settings.
Another core differentiator for Caraway is our focus on teaching healthcare as a life skill. Each clinical interaction is viewed as a teachable moment and informs future clinical app content. Our health advisors help students get the specific support they need, while also teaching them how to seek their own appropriate support in the future. Given how high the stakes may be in terms of future health and financial outcomes, developing an ability to navigate healthcare may be one of the most important life skills we can offer this patient population.
CB: We launched the company on July 26th, and we began rolling out the product and services in New York and California and are now in Ohio and North Carolina with plans to continue expanding nationally in 2023. The initial member response has been everything for which we hoped and planned:
Our clinicians have been equally pleased, which is a metric essential to the long-term success of Caraway. All have years of experience working in traditional healthcare systems with siloed medical and mental healthcare. Our doctors, nurse practitioners, and registered nurses love having immediate access to their mental health colleagues and vice versa. Our integrated care model allows them to offer more comprehensive support for our patients and, with the guidance of our health advisors, reduce the likelihood that a patient will fail to get needed care.
CB: Caraway’s healthcare services are available via its mobile app in the Apple App Store and on Google Play. We are happy to answer any question via our website! Our care team is instantly accessible for members. For more information, visit us at Caraway.health which includes FAQs and a section specifically for parents. And, you can follow us on LinkedIn and Twitter and on Instagram and TikTok.
It likely comes as no surprise—we’re in the midst of a behavioral health crisis.
Rising behavioral health costs, surge in demand for services, increasing staff turnover, and a lack of evidence-based treatments have intensified the need for change. In fact, at $225 billion, behavioral health accounts for nearly 5.5% of all healthcare spending.
As behavioral health leaders grapple with these issues and prepare for the future, it’s important to consider how payers and providers can better partner to deliver high-quality, cost-effective care which reduces symptoms, improves health outcomes, and delights patients.
Patient outcomes data from evidence-based practice is the foundation of strong partnerships between payers and providers. After all, you can’t manage what you can’t measure. Yet, behavioral health still lags in objectively measuring patient outcomes.
In this article, we’ll explore how providers and payers can partner to truly define what quality means in behavioral health (hint: It’s not just HEDIS measures), adopt measurement-based care to create evidence-based standards, and invest in data-sharing technology infrastructure.
Physical health has well-established, clear outcomes data that both providers and health plans agree indicate quality of care. Physicians systematically measure blood pressure to monitor hypertension and A1C levels to monitor diabetes, for example. Unfortunately, measurement and definitions of quality care in behavioral health aren’t status quo.
In behavioral health, the only consistent data that health plans gather are duration and type of treatment through claims data. Some health plans try to measure quality with HEDIS measures–which may include readmission rates, utilization, follow-up, and screening measures. While HEDIS measures are useful for measuring processes, they don’t measure patient outcomes, nor do they measure how a patient is responding to and progressing through care.
Similarly, most behavioral health providers aren’t systematically evaluating patient outcomes using measurement-based care (MBC) despite its proven ability to increase response rates to treatment, reduce required sessions, and lead to more patients in remission.
Research supports, and leaders in behavioral health advocate for, the use of MBC to measure behavioral health outcomes to indicate quality of care. With greater alignment on behavioral health quality and how to measure it, plans and providers can help members improve their overall health, increase efficiencies in care, and reduce total cost of care. (Learn more about how to use MBC to maximize the value of your behavioral health network from Companion Benefit Alternatives, the leading behavioral health plan in South Carolina.)
Research consistently shows that the practice of MBC improves clinical outcomes across all treatment approaches, populations, and settings. MBC enhances clinical decision-making and quality of care, enriches communications between patient and provider, and objectively documents the value of treatment to health plans.
Clinical studies have shown that patients who receive measurement-based care are 2.5 times more likely to reach remission, and treatment response time is reduced by half. Real-world data support these clinical findings. In fact, patients using Owl see a 56% faster time to remission and a 30% increase in capacity with existing resources (learn more here).
Unfortunately, MBC is still not the standard of care in practice. A 2019 MBC literature analysis revealed that less than 20% of behavioral health practitioners are integrating it into their practice.
Let that sink in–despite the proven and documented value of MBC, less than 20% of behavioral health providers are using an evidence-based approach to care. We wouldn’t find this acceptable for physical health. We argue it no longer makes sense for behavioral health.
Common barriers to using MBC in practice include the potential impact on clinical workflows, lack of technology to implement assessments, and the perception that capturing patient measures are time-consuming, cumbersome, and/or complicated. Yet innovative technology, like Owl’s measurement-based care platform, removes all of these barriers.
When providers adopt a consistent practice of MBC, they’ll have the data to demonstrate they are providing quality care to their health plans. This data empowers providers to hold meaningful discussions with their payers regarding how they are providing higher-value care and, therefore, should be reimbursed at higher rates (hint: payers want to incentivize better value for their members).
While there’s been a lot of buzz in behavioral health about the promises of value-based reimbursement for years, we’ve seen limited success. When providers and payers are working together with the same, mutually agreed upon outcomes data, everyone wins, including (and most importantly) patients.
Currently, many providers don’t have the technology to systematically measure if their patients are getting better. In turn, payers are unable to objectively assess their behavioral health network. With no true transparency or understanding of care quality, health plans don’t have the necessary data to have meaningful reimbursement conversations–leaving many providers feeling dissatisfied with payment rates.
With the availability of easy-to-use measurement-based care solutions like Owl, it’s time for payers and providers to collaborate on deploying the software infrastructure that supports gathering and sharing outcomes, data, and insights to measure and improve quality of care.
When health plans invest in MBC solutions, they can assess their network in areas of care quality, therapeutic alliance, and outcomes-driven treatment length benchmarks, which will incentivize and attract providers to deliver high-quality, cost-effective care for their members–a win-win for both providers and payers.
“We’re working on moving our behavioral health network to value-based reimbursement and away from fee-for-service models. We didn’t have a great way to choose quality metrics that make sense in behavioral health. Now, Owl gives us the evidence-based outcomes metrics we need and a platform that reduces burden for providers and easily integrates into their workflows. Owl also allows us to share data in a way that isn’t a burden on the providers.”
- April Richardson, M.D., Medical Director, Companion Benefit Alternatives
While payers and providers will continue to be challenged by the behavioral health crisis for years to come, the opportunity is now to better align on improving health through a well-thought-out partnership that redefines quality and elevates outcomes measurement and transparency.
The McKinsey Health Institute is a non-profit entity within the McKinsey firm that is focused on humanity, adding 45 billion extra years of higher quality life over the next decade. Their focus areas include brain health, healthy living, infectious diseases, equity and health, healthcare worker capacity, healthy aging, and sustainability and health. We spoke with Kana Enomoto, Manager Director at the McKinsey Health Institute, to hear about their ongoing initiatives, research, and thought leadership. You can find the entire conversation with Kana here.
The behavioral health system in America needs leaders as it transforms. There are 50 million Americans who experience a mental illness, and it takes an average of 11 years from the onset of mental illness symptoms to treatment. The silver lining of COVID-19 is that the past two years have brought on an increased appreciation of behavioral health, leading to a decrease in stigma.
In our discussion, Kana emphasized these growing shifts in behavioral healthcare, including:
She noted that we’re seeing a “drive to more access to care and also seeing lower levels of stigma related to mental illnesses and substance use disorders. With increased access, however, we are exacerbating what were already really difficult workforce challenges.” We’ve also seen incredible digital health innovations “that are complementing and providing alternatives to in-person care so that we’ve been able to keep pace with increased demand to some degree.”
As Kana explains about the above graphic, “there’s some really clear kind of hotspots for where there’s significant need, where we’re grossly understaffed, and really, I think the moral of the story is that there’s nowhere that has a sufficient number of mental health providers per 100,000 population.” This follows the data that 64% of counties in the United States have a shortage of all mental health providers. Additionally, 60% of people in the US live in a county with a shortage of Psychiatrists.
Furthermore, the public sector is finding it challenging to retain clinicians. Kana explains, “a national council survey, where 82% of public sector providers are saying that it is very or somewhat difficult to retain their employees, and 97% are saying that it’s very difficult to recruit new employees. And so when we’re seeing the growth, a lot of that growth that we’re seeing is on the commercially insured population side.” Even with growth on the commercially insured population side, only 40% of Psychiatrists accept any form of insurance.
The McKinsey Health Institute has a few strategies for addressing the stark provider shortage. These strategies include expanding telehealth services for rural communities and other communities with provider shortages and expanding community-based crisis services.
Kana mentioned that “four in five working parents in a survey that we conducted expressed concern over their child’s mental health. And 1/3 of these parents were extremely concerned, leading the Surgeon General to issue his advisory on protecting Youth Mental Health – a level of awareness and support across the health spectrum that we haven’t seen before.” McKinsey stated in a recent report that Gen Z reported the least positive life outlook compared to older generations, and 25% of Gen Z respondents reported feeling emotionally distressed. Additionally, the behavioral health system isn’t meeting Gen Z’s expectations.
Kana believes that “with the policies and the funding that came throughout COVID, I think we’re going to see even more school-based mental health services for young people. I think that’s a good thing as long as we can keep up with the workforce demands and the innovation that we need there.” Schools are the first place kids often go for help, but they don’t always have the resources to help their students. However, during COVID, 38 states passed nearly 100 laws to support mental health resources in schools.
The McKinsey Health Institute has partnered with other organizations to create resources that the public can use. One of those resources is the Crisis Resource Need Calculator, which allows states and counties to estimate the cost of crisis care system needs. Additionally, the Vulnerable Populations Data Hub gives state and county-level information about vulnerable populations. Each state or county can be examined by COVID-19 data, age, behavioral health, pediatric behavioral health, and many other metrics.
You can listen to Kana Enomoto’s entire conversation here.
The modern workplace has shifted significantly, creating new challenges for employees as they work remotely, in a hybrid policy, or full-time in the office. Burnout has become more prevalent as employees face increased workloads, a lack of staff, and a diminished work-life balance.
Investing in mental health is beneficial and necessary for employees, as well as employers. According to the National Safety Council and NORC at the University of Chicago, employers spend an average of more than $15,000 annually on each employee experiencing mental health issues. This cost stems from days of work missed, employee turnover and replacement costs, and greater healthcare use by workers and family members.1
At a time when employers are facing a tight labor market and budget cuts, implementing a mental health and mindfulness program can be a game-changer. When employees have the tools to improve their well-being, employers have the potential to benefit from increased engagement and productivity, less absenteeism, a higher level of job satisfaction, and improved employee retention.
To guarantee that employers are supporting each employee at every level of mental health need, it’s important that mental well-being offerings are easily accessible and comprehensive. Headspace Health offers mindfulness and meditation tools rooted in science, combined with behavioral health coaching, therapy, and psychiatry.
Through our digital products Headspace for Work and Ginger, we provide companies with end-to-end mental health support for their employees, ensuring they have the resources to improve their everyday well-being and access personalized, one-on-one care when needed. A multi-level, collaborative care model makes sure that employees are using higher-cost care only when clinically appropriate, and that they’re supported at every step of their mental health journey.
56% of employers want to do more to improve staff well-being, but they don’t feel they have the right training or guidance to make it a reality.2 How can employers ensure that the mental health benefits they offer to their employees are driving value, both for employee well-being and for the company’s bottom line? With data-driven, science-backed solutions with proven ROI.
Mindfulness has been proven to help employees feel more present and engaged at work. It doesn’t take long for employees to see improvements to their mental well-being while engaging in a meditation and mindfulness practice using the Headspace app:
And, when science-back meditation is partnered with comprehensive, quality mental healthcare, employees see the benefits. Through our research, we’ve found that when employers implement Ginger’s on-demand mental health system, they see significant outcome improvements for their employees, including:
What’s more, Headspace Health recently developed a real-world cost impact model with Accorded (formerly Cerebrae), an actuarial consulting firm, in order to reliably infer how much an employer can expect to save by implementing the Ginger solution for their employee population. Applying the model to a sample engaged population5, an employer can expect between $101,000 – $302,000 in savings per 100 engaged employees by implementing the Ginger care model, in comparison to the amount they would spend implementing a traditional care model.6
When employers support their employees’ mental well-being with comprehensive tools that meet employees where they are, both individuals and businesses see the benefits, including improved engagement, productivity, and reduced absenteeism. At a time when employees are seeking more support from their employers, mental well-being solutions can be a tool to build happier, healthier, more resilient teams.
If you're interested in learning about how a comprehensive mental well-being offering can benefit your organization, contact Headspace Health here.
1 National Safety Council, 2021. “New Mental Health Cost Calculator Shows Why Investing in Mental Health is Good for Business.”
2 Mind. Taking care of your staff. (2022). https://www.mind.org.uk/workplace/mental-health-at-work/taking-care-of-your-staff/
3 Follow-up in this study was between 6-16 weeks.
4 Follow-up in this study was between 6-16 weeks.
5 McKinsey & Company, 2021. “Using digital tech to support employees’ mental health and resilience.”
6 Headspace Health, 2022. “The Value of the Ginger System.”
With ongoing provider shortages being seen and felt globally, healthcare organizations are under tremendous pressure to quickly fill openings, provide quality services and generate revenue all while avoiding overwhelming providers.
While the shortage has created a competitive market for recruitment, this high demand means it's critical that the provider journey be as quick and seamless as possible. Providers and organizations alike are heavily burdened by paperwork, long wait times for delivery of credentialing packets and an inability to provide crossover of information throughout the onboarding process. These issues create delays in start of care, affecting billing and payments on a long term scale.
Today’s Credentialing Landscape
While the process of credentialing has become more refined and thorough over the past few decades, some organizations still rely on providers printing out a PDF, filling it out by hand, then scanning or mailing it back in. This process is time-consuming and outdated, and not to mention a cumbersome first touchpoint for providers.
A recent study found it can take healthcare employers an average of 49 days to fill a position, and with a one-day delay costing a medical group $10,122* we can see speed is of the utmost importance (*according to a 2019 Merritt Hawkins survey on physician inpatient/outpatient revenue).
Verifiable on Salesforce
Verifiable, through partnership with Salesforce, has developed a streamlined and efficient way to onboard providers through the hiring and credentialing processes, eliminating unnecessary steps and creating a pressure-free transition for providers from recruitment to patient care, and therefore providing an accelerated path to revenue.
Verifiable helps reduce credentialing costs by automating many of the processes, lowering the amount of work done in-house, while preventing unnecessary work on non-ideal candidates.
Provider Onboarding & Intake
To make the data intake process simple and seamless, Verifiable has built customizable forms right on top of Salesforce to capture core provider data which flows directly into Salesforce. This creates a single system of record that can be managed within Salesforce, allowing organizations to monitor their provider network and share provider information across departments. This centralization of data is pivotal in moving the process along quickly, as well as unburdening providers and organizations alike.
In addition, these intake forms come with out-of-the-box automations and workflows, allowing organizations the ability to create a system of engagement powered by real-time, automated primary source verifications. Such workflows and verifications can be used to optimize the onboarding process and move ideal candidates through the pipeline quicker, while ruling out non-ideal candidates with stage gates.
For example, several Verifiable clients run a license check on a candidate before progressing them to full credentialing. This prevents unnecessary credentialing costs for non-ideal candidates, and can save credentialing and hiring teams thousands of dollars each year.
Credentialing
For many providers, the credentialing process can make or break the relationship with an organization. Timelines, updates, complexity and being asked for information multiple times, may lead providers to look elsewhere. However, Verifiable automates and centralizes the entire process making it easier and quicker for providers; from collecting primary source documents to tracking statuses in real-time for both the organization and provider.
Verifiable’s real-time automation of the credentialing process also greatly reduces the organization’s workload associated with provider credentialing, reducing human error and enabling automation of monitoring for downstream network operations.
Enrollment
The sooner providers have been onboarded and credentialed, the sooner they can be enrolled with health plans and seeing patients. Whether you have a delegated or traditional agreement with payers, the data centralization provided by Verifiable allows organizations to speed up payer enrollment by providing necessary data, forms and reports for health plans.
Verifiable enables providers to be onboarded, credentialed and enrolled with payers quicker because of the collection of data, automation of verifications and centralization of data. This speed gives providers a better experience, enables organizations to collect revenue sooner and allows providers to focus on patients and provide higher quality of care.
Conclusion
Provider credentialing has the potential to be a major roadblock in onboarding. But, with Verifiable’s Salesforce app, the process is 70% faster than other leading systems. Utilizing automated, real-time, primary source verifications and being the only NCQA-compliant credentialing workflow within the Salesforce ecosystem, the Verifiable platform accelerates the revenue cycle while ensuring a stress-free process for organizations and each potential provider.
Verifiable is on a mission to drive efficiency, quality and compliance across the healthcare system, and has built a modern program for the provider journey. Hospitals, commercial practices, clinics, groups and specialty providers can benefit from the speed and accuracy of Verifiable’s platform, allowing them to get to the business of providing care and generating revenue more quickly than with outdated onboarding techniques. Furthermore, the continued monitoring and accuracy of each phase ensures that provider-organization relationships will continue long-term, and allow for maintenance of continuity of care.
In the ever-expanding global healthcare community, Verifiable’s dedication to the creation and conservation of this advanced system for managing the multi-faceted relationships between organizations, providers, consumers, and payers is both exceptional and necessary and will continue to contribute to the community worldwide.
Our healthcare ecosystem acknowledges that people with chronic conditions account for a majority of costs. Organizations have reacted to this by dedicating more funding to treat these individuals. However, behavioral health conditions have not yet been entirely included in this group. People with substance use disorders (SUD) are searching for care in hospitals and health systems that are not properly equipped to treat their conditions. Nick Mercadante, CEO of PursueCare, an online addiction and mental health counseling provider, is sharing more on this issue and what options like PursueCare can do to help.
How and why does PursueCare partner with hospitals and health systems?
Starting with the why for better context of the crisis we are facing is really important.
Most health care starts locally to the individual experiencing either an acute or chronic health condition. That usually means a health system, hospital, or community health provider is the reference point for most individuals needing any sort of help, physical or otherwise.
Recent studies have shown that roughly 10% of patients account for 70% of total healthcare costs. 57% of the highest cost group of patients have SUD and behavioral health diagnoses. Yet SUD and behavioral health treatment only represents 4% of the total spend in that high-cost group. Unfortunately, most hospitals and health systems have historically been set up in every respect to tackle health issues for the physically sick as a primary concern.
Let’s face it, healthcare is a business. Primary care is often a loss leader itself, but it’s a gateway for other more lucrative services – surgeries, specialty care, and chronic care for the physically ill. Financial incentives to refer and then treat SUD remain paltry in comparison to other areas of medicine that systems specialize in. Preventive SUD care is virtually non-existent. To make matters worse, populations experiencing social determinants of health suffer disproportionately from SUD. That often means Medicaid, which in most states reimburses very poorly for first-line treatment like therapy and prescribing medication for opioid use disorder (“OUD”).
So health systems, and the treatment teams that make them tick, are often only minimally set up to help patients with SUD directly. They mostly just do their best to send the patient somewhere outside their four walls. In rural regions – the options are lacking. But treatment availability, and quality, outside of the health systems and hospitals that drive most community care, is a problem almost everywhere at this point.
The result of all this is that local healthcare almost entirely misses the progression of SUD from mild, to moderate, to falling out of all healthcare infrastructure. They usually rediscover the individual in the emergency room when a crisis occurs. Opioid-related overdoses and emergencies have pushed physiological aspects of substance use disorder to the doorstep with more regularity. EDs, medical-surgical units, and other settings are facing daily crises. But they still regularly lack integrated resources or even clear next steps for care after stabilizing patients.
PursueCare is a Joint Commission-accredited virtual clinic that treats SUD and behavioral health. PursueCare’s mission is to make comprehensive services accessible to everyone, everywhere, by removing traditional obstacles to treatment that patients frequently encounter. Critically, PursueCare treats not only patients that have SUD, but also patients that exhibit symptoms of possible dependence, require deprescribing from pain management medications, or may be at risk for SUD. PursueCare also treats patients with co-occurring mental and behavioral health disorders, or those in need of therapy or psychiatric medication management, forming a holistic solution for what patients might face.
Predominantly all care is initiated through assessment and/or referral by a collaborating healthcare facility on-site. Partners are trained to successfully conduct basic screenings, brief interventions, and referral to treatment (“SBIRT”). Intervention is frequently driven by PursueCare’s partner portal and help from field patient access specialists. Opportunities for preventive care at primary care and specialty care offices come from the confidence in knowing that there’s a full virtual suite of specialists ready to collaborate. Thereafter, ongoing longitudinal treatment continues at home through PursueCare’s patient-centric app experience.
What’s unique about what PursueCare offers to patients and partnering organizations?
Maybe as a result of the COVID-19 pandemic, or the inherent complexity of mental health and SUD, or competitive walls being put up within the health care industry, a lot of virtual health is fairly siloed to being a direct-to-consumer single-point solution. Consumers can and should have choices when it comes to how they engage with care, and the plethora of services out there help to bring those choices right into the palm of our hands. But often times patients, particularly chronic care patients, have fairly complex and multi-faceted physical and mental health needs. Furthermore, I have a growing concern that the siloed nature of various solutions leads to what I like to call “digital whiplash.” Going to four different places to handle your six or seven health issues is hard.
PursueCare’s integration with health system and community health ensures continuity and success both in engagement with the patient and long-term outcomes. Ongoing collaboration with health partners and health insurance plans ensures continuity and success both in engagement with the patient and long-term outcomes. In some cases, such as with primary care, pain management, and obstetric care, the treatment is also preventative in nature.
This form of collaboration is what is known as Behavioral Health Integration (“BHI”), and more specifically, the Collaborative Care Model advanced by the American Psychiatric Association. In this model, psychiatry, mental health, and other resource professionals are integrated into primary and specialty care settings to form a collaborative care team. This brings both physical and mental health care through frequent and familiar front doors for populations suffering from mental health and SUD, often resulting in a better holistic health experience, destigmatizing seeking help, and improving patient outcomes. The Collaborative Care Model has the most evidence among integration models to demonstrate its efficacy and efficiency in terms of controlling costs, improving door-to-treatment time, improving clinical outcomes, and increasing patient satisfaction.
From there, PursueCare aims to be as comprehensive as possible as a virtual clinic. Services include medical care with medications like buprenorphine for reducing withdrawal and cravings, counseling and therapy, psychiatric treatment, treatment with FDA-approved digital therapeutics. Patients can access 1-to-1 care with members of their treatment team, but PursueCare also specializes in virtual group therapy combined with breakout 1-to-1 medical and psychiatric services. The efficiency mimics an outpatient clinic but without the travel, time off work, and long wait times. Patients can obtain medications directly and discretely from the in-house pharmacy. Whether or not they do, all patients have access to a pharmacist for pharmacological consultations that is either covered by insurance or free.
Targeted case management helps tie treatment and partnerships together. Patients have one-to-one support for the treatment journey. They can conduct toxicology screens from home. Case Managers promote access and support for social and other needs patients with SUD often have. The comprehensive approach helps reduce treatment gaps, coordinate other aspects of patient health, such as primary care, and increase engagement.
Lastly, treatment is affordable. It is frequently covered by insurance, and PursueCare is in-network with Medicare, Medicaid, managed care, and commercial insurances. The goal is to never let cost be a determining factor in whether or not a patient can access and stick with a treatment program. Because PursueCare works with insurance directly, health partners also do not have to support the cost of care, instead experiencing a significant ROI for their collaboration: meeting critical health access and quality metrics without increasing their own costs.
Why is it important to offer full mental health as well as addiction treatment?
Forming a more cohesive team-driven approach to care not only helps to address more of the underlying and intrinsically intertwined causes and symptoms of SUD, but it also helps reduce the complexity experienced by collaborating physical health providers who need to refer a patient, and the patients themselves.
Most SUD can be considered a chronic condition, and treatment requires a longitudinal approach. Additionally, studies show 43% of people in treatment for substance use disorder have a dual diagnosis of mental health disorders. As many as 70% of individuals experience trauma. The “front door” settings that PursueCare collaborates with, on their own, frequently lack those comprehensive resources at their points-of-care, or even at their fingertips when it is time to refer. Treaters may not have confidence in solving for the multi-faceted nature of SUD and mental health, which requires treatment planning between a number of often disparate specialists, with conditions that require different treatment plans and goals. and medications that may have contraindications.
Forming a more cohesive team-driven approach to care not only helps to address more of the underlying and intrinsically intertwined causes and symptoms of SUD, but it also helps reduce the complexity experienced by collaborating physical health providers who need to refer a patient, and the patients themselves. It can improve patient education and understanding of their own conditions and the benefits of all clinically-indicated treatments for those conditions. It can also improve safety, particularly when SUD and psychiatric medications are controlled substances or have contraindications.
Finally, team-based care ensures that the patient is receiving access to the care they need, and that the specialized treaters themselves are communicating around the patient.
Behavioral health in America is in a state of crisis. Individuals meeting the criteria for a mood disorder has never been higher at 40% of the US population. This prevalence is met with a pervasive stigma that holds many people back from seeking treatment. Those who do must overcome the challenge of access to quality care. As America’s first integrated behavioral care organization, NovaWell was created to breakdown the systemic barriers that prevent people from getting the care they need. Last week at HLTH, I had the opportunity to host 13 behavioral health leaders to discuss these challenges and potential solutions in greater detail. Takeaways from the discussion included:
Close the say-do gap: A misalignment exists between behavioral health as a strategic priority and the reality of implementing behavioral health solutions. Competing priorities, which demonstrate measurable short-term results, often gain favor and funding over holistic solutions where the value is recognized downstream via improved whole person outcomes and reduced total cost of care.
Breakdown siloes: Incorporating behavioral health into the fabric of an organization requires systemic change. The technology, processes and measurement of physical and behavioral health remain siloed. The first step to breaking down these barriers is internal. Organizations must undergo a cultural shift that emphasizes the benefits of whole person health, in order to fully realize the benefits.
Move beyond the network: Access remains a clear challenge for most organizations. Access was previously defined by the size of an insurer’s network. The larger the network the easier it was to access care. Our behavioral health crisis, pressurized by the healthcare staffing shortage and a movement towards direct-pay providers, requires the definition to change. Today, access is defined by how quickly a member can get the care they need. Solutions must be grounded in reaching people when they’re in the right headspace and quickly connecting them to care.
Redefine success: Behavioral health is currently measured against a framework that rewards the reduction of discrete behavioral health costs and perpetuates members cycling through the health system. Measurement should be framed around driving affordability long-term through upstream interventions – not short-term gains of reduced costs. If behavioral health is truly a strategic priority and improved outcomes is our North Star, it’s time we are measured against it.
Insist on sustainable financing: Currently there are too few billable codes attributed to those with behavioral health conditions. Existing CPT codes don’t provide enough insight into a person’s condition at traditional points of care - oftentimes leaving ED claims as the only source of data. Under this system, sustainable financing starts to unravel, resulting in limited career pathing for those in the field.
Advocate for policy changes: Regulation has the potential to make new inroads into the value of behavioral health. For example, students are required to get vision screenings prior to school, why not mental health screenings? With this type of data, school-based solutions could be funded that reach young people and teach them how to find care.
While the obstacles are great, I am heartened by the passionate, innovative leaders working to improve the lives of those with a behavioral health condition. The lively discussion demonstrated that behavioral health is a priority for many organizations, but delivering on that priority requires a shift in how we think and operate.
FOR IMMEDIATE RELEASE
Going Digital: Behavioral Health Tech (GDBHT) Opens Its Doors to Payers, Providers, and Digital Health Companies for Their First In-Person Conference
Announces a Partnership with PESI to Co-Market Content and Provide Continuing Education Credits to 600,000+ Mental Health Professionals
San Francisco, CA, November 16, 2022: Today, Going Digital: Behavioral Health Tech (GDBHT) – the largest virtual conference focused on expanding access to mental health and substance use services through technology and innovation – announces that it will now also be live and in-person. GDBHT is furthering its mission to connect and accelerate mental health and substance use access by bringing together stakeholders in-person in addition to online: health plan executives, employers, benefits consultants, behavioral health providers, mental health startups, VCs, policymakers.
“Over the last three years, we have convened thousands of stakeholders passionate about behavioral health and health equity, and I am thrilled that we will now be able to connect in-person next year, in addition to our traditional online experience a few weeks after.” - Solome Tibebu, Founder & CEO, Going Digital: Behavioral Health Tech.
The conference will take place in-person on November 15-17, 2023 at the Waldorf Astoria Biltmore Hotel in Phoenix, Arizona. The traditional mass online GDBHT conference takes place virtually three weeks later. All online attendee revenue will be donated to their 2023 non-profit partner, to be announced.
In partnership with PESI, a nonprofit organization dedicated to providing accredited continuing education for mental health and substance use professionals worldwide, GDBHT will offer CE credits for mental health professionals who attend either the in-person or virtual conferences.
“We are excited to partner with GDBHT to provide continuing education credits for mental health professionals at this essential summit,” said Tiffany Richter, Vice President of Marketing. “Expanding access to mental health and substance use care and supporting clinicians who do this important work has never been more critical.”
The conference will showcase the changing technological, reimbursement, and policy landscape for telehealth and other virtual behavioral health solutions. Join thousands of other healthcare professionals working to make mental health and substance use care more accessible for all. Visit the Going Digital: Behavioral Health Tech website to request an invitation and join the weekly newsletter, and follow along on Twitter and LinkedIn for updates.
About Going Digital: Behavioral Health Tech
The Going Digital: Behavioral Health Tech conference is the largest conference focused on expanding access to mental health and substance use services through technology and innovation. The conference convenes health plans, employers and benefits professionals, health systems, behavioral health providers, investors, startups and policymakers to share best practices for deploying effective, scalable behavioral health solutions to all individuals.
The conference will showcase the changing technological, reimbursement, and policy landscape for telehealth and other virtual behavioral health solutions. Join thousands of other healthcare professionals working to make mental health and substance use care more accessible for all. Visit us on Twitter and LinkedIn.
About PESI:
Founded in 1979, PESI is the world’s leading provider of continuing education for mental health, healthcare, and rehab professionals. Our nonprofit mission to connect knowledge with need guides us in creating powerful trainings that give clinicians techniques to help people on their healing journey. PESI proudly partners with experts in the field, conferences, publishers, associations and institutes to support the betterment of mental health and healthcare worldwide.
When Heritage CARES (Comprehensive Addiction Recovery Education & Support) was founded in 2021, the company was primarily focused on supporting and educating people struggling with substance misuse and its underlying causes such as depression and trauma. By mid-2022, the company had expanded its focus to include additional mental health concerns like grief, stress management, and anxiety, and as a result rebranded the company name to Youturn Health to reflect its commitment to providing more holistic mental health education and support.
“We’ve seen a tremendous focus on overall mental health in recent years,” says Hamilton Baiden, CEO of Youturn Health. “The stress of the pandemic really forced Americans to confront the fact that mental health needs to be treated at every level in every home.” Youturn Health’s virtual program combines peer coaching support with online education and family support to help people understand the nature of their struggles and make meaningful steps toward recovery.
Mental health concerns like depression, substance misuse, and suicide were issues before the pandemic, but added stressors like isolation during lockdown, grief from suddenly losing a loved one, financial insecurity, and job instability pushed more Americans to their breaking point. Additionally, recent movements like the Great Resignation forced employers to address stress management and burnout as employees rebelled against toxic workplace environments and Hustle Culture.
According to the CDC, 50% of Americans will be diagnosed with a mental illness or disorder in their lifetime. Despite this, Mental Health America’s The State of Mental Health in America report states that half of adults with mental illness do not receive treatment, amounting to over 27 million Americans. There are myriad reasons people may not seek treatment for mental health such as stigma, fear of judgement, and the belief they can fix it themselves. The impact of untreated mental health issues include:
This gap in treatment inspired Youturn Health’s leadership to act. “Through some phenomenal partnerships, we’ve been able to expand our focus to add support for issues like grief, stress, and burnout,” says Baiden. “For example, we had experience supporting people through grief tied to substance misuse – losing a loved one to an overdose or using drugs or alcohol to numb the pain of grief – but in teaming up with Taylor’s Gift, we can now also offer emotional and grief support to families after the sudden loss of a loved one for reasons beyond substance misuse.”
Taylor’s Gift is a nonprofit organization helping families of organ and tissue donors navigate the grief process and was founded by Tara and Todd Storch after the tragic loss of their 13-year-old daughter, Taylor, following a skiing accident. “Grief is different for everyone,” says co-founder Tara Storch, “there is no right way to grieve, but so often we find people don’t know what to do with their pain. No one should ever have to grieve alone.”
Following Taylor’s accident, doctors approached the Storches about Taylor being a candidate for organ donation. Tara and Todd agreed, and Taylor’s generous donation saved and improved the lives of five people. This left the Storches in a complex emotional state. They felt grief over the sudden loss of their young daughter but also felt gratitude that her final act helped improve the lives of others.
Knowing firsthand how complex the grieving process can be for organ donors, the Storches created the Kindred Hearts Program to offer free grief support to donor families. The program is the signature program of Taylor’s Gift Foundation and offers one-on-one and family support with Caring Guides (trained peer coaches from Youturn Health), and support groups to help navigate the grief process.
Caring Guides all have lived experience with grief and loss; they combine that lived experience with education and evidence-backed techniques to help grieving individuals and families develop coping skills to better understand and manage the loss of their loved one. "None of us choose to go through deep periods of grief but I found when I did, I was encouraged when I talked with others who had also experienced deep grief,” said Annalyn, a Caring Guide for the Kindred Hearts program. “It gave me hope that although my life would never be the same, it would go on. I hope to give others a glimmer of hope in their darkness as well."
“The experience of the sudden loss of a loved one combined with the sense of gratitude you feel when that loved one becomes an organ donor – being able to offer a second chance at life to someone else – it’s a complicated mix,” says Storch. “It can be paralyzing, cause depression, affect your relationships, and put a stop to everyday life. The Kindred Hearts program gives families a safe place to talk about what they’re feeling, and the Caring Guides help them learn to take care of themselves while grieving.”
And the program has been a resounding success. Since launching in 2022, The Kindred Hearts Program has 11 Caring Guide peer professionals and has had over 120 people reach out for grief support. Just over the past few months, the program has provided support to over 75 people. Perhaps most impactful is feedback from Kindred Hearts program participants:
“I was set up with [my Caring Guide] to help with the loss of our daughter,” wrote one anonymous participant. “I've done talk therapy off and on for many years and found it helpful to a point. But I have to tell you I am flabbergasted that she has helped my soul feel lighter and move through things in an unbelievable way. It has been so transformational for me. I would love for my son to be able to visit with her too. This thing you do to help people is the most beautiful thing I've ever been a part of. Thank you!”
“It’s time to destigmatize seeking help for mental health issues like grief and stress,” says Baiden. “People shouldn’t have to ‘tough it out’ at the cost of their health and happiness. Education and support are proven to help and thanks to forward-thinking companies like Taylor’s Gift, we’re able to reach more people and help.”
Article written by Richard Jones, Chief Clinical Officer, Youturn Health.
In digital behavioral health companies, clinicians should be included in the early stages of startups in order to ensure clinical quality from the very beginning. However, clinicians transitioning from a clinical role to joining a digital behavioral health startup often find it challenging to navigate the new terminology, culture, and norms. But clinicians have essential expertise and skills crucial to a behavioral health company’s success.
When building a mental health startup, it’s important to utilize clinicians’ skills and expertise and to pay them appropriately. A survey by Therapists in Tech found that clinicians who did not use their clinical license in their current positions tended to earn more (about $20k) than respondents who did utilize their clinical license in their current role. Mental health is historically poorly reimbursed, but low pay in the corporate world can also hinder progress as a mental health company. In addition to paying clinicians appropriately, there are several ways to effectively utilize mental health clinicians in behavioral health startups.
Listening to Clinicians
When asked about the differences these clinicians see between companies that have a strong clinical voice versus those that do not, licensed clinical social worker Jaclyn Satchel points out that not having a strong clinical foundation can lead to a lack of clinical quality standards. She continues, “I believe that the lack of clinical quality standards turns into ignoring patient safety.” Patient safety and care should be baked into each company from the very beginning, and this happens organically when clinical leaders are involved from day one.
In the same panel with Jaclyn, panelists also dove into the balance between tech and touch and what both patients and providers think is the right balance. Dr. Hannah Weisman mentions that the field is still trying to understand, “how do you get people to engage with kinds of technology solutions, because the thing I keep seeing is that consumers still want the high touch support, regardless of their level of acuity. So I think there’s this mismatch in a way between being more efficient, but that’s not necessarily what the consumers are demanding.” Dr. Jessica Jackson echoes, “my humble prediction is that we’re going to get to a point where we need to integrate touch with tech. The reality is that no matter how far we get with technology, humans still want connection. “Finding the right balance will lead to better patient retention.
Dr. Grin Lord explains, “there are business decisions that are being made to make care efficient and to increase reach, but they may not be the appropriate clinical decisions. Every step of the way, you need a clinician helping you to understand how to balance those business needs and scalability with the appropriate clinical care.” Having a clinician on your leadership team can help you navigate multifaceted decisions where your team has to consider both profit and appropriate clinical care.
Clinicians Transitioning to Tech
One thing that stuck out during our conversation is that clinicians who are working at digital health startups are looking to use their clinician expertise, but they are interested in work beyond just the clinical scope. However, Dr. Lord mentions, “so unfortunately… there’s still stigma or perceptions that you can’t both be a caregiver and have business acumen.” In her experience, she has found many clinicians excited to be involved and trusted with business decisions, but they can sometimes be overlooked as true business partners.
Advice for Startups and Employers
Dr. Lord mentions, “there seems to be a predominant business model that’s based on the commodification of therapists. And at the end of the day, the unit economics of basically doing cheaper sessions… It’s ultimately not going to work. So the business that figures that out… how to retain clinicians and make them happy, I think it’s going to be – long term – very successful.” Dr. Lord further explains that clinicians have active licenses and can individually contract with insurance companies, so in order for companies to retain their clinical talent and reduce churn, they have to keep their clinicians happy and well-paid.
Additionally, panelists talked about the relationship between rapid growth and clinical quality. Dr. Lord mentions that many companies are relying on the “lifetime value of…both the provider and the patient. And right now, what we’re seeing is high churn in both areas, when this quality problem hasn’t been solved.” She continues that patients look for a therapist-like relationship that is continuous over time, and “if your company can’t retain your therapists, you will lose…the patients.” This patient-provider relationship has to be a core part of the business model, and “it has to be viewed as a continuous one and one worth investing in intentionally. And once you can figure that out… I think there’s going to be huge impact and successes from a business standpoint.” True leaders in this field will be able to recognize this from the beginning and not try to approach clinical quality as an afterthought that can be solved while expanding.
Top Tips for Startups
There is so much valuable and actionable insight from our conversation with the Therapists in Tech team. To hear our full conversation, please visit our video library.
In a world where behavioral health has been siloed for so long, is it really possible to find behavioral healthcare outside of point solutions? Is coordinated pharmacy, medical and behavioral care feasible? We spoke with Chief Growth Officer, Melissa Reilly, and Chief Medical Officer, Dr. Doug Nemecek, about Evernorth’s goal to make this utopia a reality.
By now, we all know that unaddressed behavioral health conditions can negatively impact co-occurring physical health conditions. But first, Melissa and Doug dive into the ramifications that affect payers. They will also touch on Evernorth’s approach and key considerations in behavioral healthcare.
Melissa: Over the last few years, there has been such an increased focus on mental health and behavioral health needs and payers that we work with have a unique spectrum of needs that is often based on their unique populations. Across that spectrum, we have seen firsthand, when members do not get the behavioral care they need – it increases the total cost of care and their members' ability to live the lives they want.
With the average delay between symptoms onset and treatment being 11 years, time to quality care has a huge impact on a payer’s total outcomes measures and also an individual’s ability to be a productive member of their community.
The other thing we tackle every day is that data across the care ecosystem is fragmented. Access to care is limited. Health equity and cultural concerns are often overlooked. Navigating behavioral health care without the right partner can lead to overspending. Members may start and stop care and/or switch providers a number of times before they find the right provider or the type of care that meets their unique needs. A first-of-its-kind analysis completed by Evernorth found that people diagnosed with a behavioral health condition, such as anxiety, depression, or substance use disorder, who receive behavioral outpatient care had lower total health care costs by up to $1,377 per person in the first year compared to those who didn’t. Not only that, the savings impact was sustainable over time with a two-year cost reduction of up to $3,109 per person.
Our behavioral health solutions support the reduction of overspending by addressing behavioral and mental conditions before they further complicate health. We also can help payers solve some of their biggest challenges by leveraging our suite of Evernorth assets. Our data and collaboration with our partners allow us to proactively identify and engage with members early before it leads to a bigger issue. By matching members to the right level of resources more quickly, our next-generation experience delivers data-driven, personalized care on demand. We partner with our clients and those we help every step of the way to guarantee results.
Doug: Unaddressed behavioral health conditions also play a large role in a person’s other medical comorbidities. Someone who is struggling with diabetes, for example, is significantly more likely to be struggling with depression. 92% of adults living with behavioral health disorders also suffer from physical conditions and cost approximately 3-6x more.
Our approach is focused on whole-person health, and it’s imperative to pay attention to both mind and body – that is where we see the most success.
Melissa: At Evernorth, elevating behavioral health means providing a set of services that help to stabilize and improve a person’s wellbeing (body, mind and spirit) along with creating awareness, positive coping skills and tools to build resiliency—reducing the burden of their issues, big or small. Enabling people to contribute productively and effectively to live their life with peace of mind.
We are always innovating and connecting cohesively across the ecosystem – we don’t wait for the call – we are proactive in identification, engagement, and network outreach tailored to a member’s needs- like providing quick access to care and looking at medication impacts, how and when our employees used it, with measurement to ensure your population is on the right pathway to optimal health. We elevate behavioral health through a data-driven approach that meets members where they are across the healthcare ecosystem, like when filling scripts or visiting PCPs. We leverage capabilities like accurate and early identification, in-the-moment engagement and quality of care on connected platforms to deliver personalized behavioral health with the right resources and level of care at the right time, reducing total cost of care - with an emphasis and focus on measurement throughout the member journey.
Our goal at Evernorth is to break down the silos to provide coordinated pharmacy, medical and behavioral care – we strive to provide the right care, at the right time, in the right place.
Doug: What you may not realize is that access is only a small piece of the problem - the member's individual needs are not the same for everyone - from the time to first appointment, matching to the right provider and delivering quality outcomes. Our provider matching is second to none, we have the ability to guide members to find the right level of care for them, the right provider that meets their needs and preferences, and makes them feel comfortable seeking and continuing with care. We also follow up to ensure members get the care they need and that no one falls through the cracks.
We’re also always looking for ways to improve and expand our network. We identify providers that will meet members’ diverse needs. For example, we are actively working on contracting virtual providers that focus on using evidence and cultural competency to improve access and efficacy for people in BIPOC (Black/Indigenous/People of Color) communities.
19.4% increase in the number of providers specializing in addressing cultural/ethnic issues
Our large network focuses on quality providers, with capabilities to deliver all modalities and acuity levels of care from text coaching to acute inpatient care, virtual and face-to-face appointments, across all specialties, with our provider match based on preferences, and need. Navigation support along with our data insights to proactively identify and engage members – access is not just quantity of providers but the right care at right time with the right provider throughout the journey. Clinical models are built to engage members early based on our data and ensure every individual is getting the immediate support they need.
96% of Evernorth customers would recommend their in-network provider
It’s important to address lack of access and high total medical spend and to choose a BH partner that challenges the status quo, delivering innovative BH care holistically and comprehensively without the need of added point solutions. Evernorth is the partner to do that.
Melissa: Engaging the member early and often is where we’ve seen the most success. We can understand where the member is on their behavioral health journey and identify issues and engage the member earlier on.
Holistic care and measurement throughout are also critical. We can see how a member’s overall behavioral health is improving and provide the right level of care when the member needs it.
Doug: Helping each member to find the right level of care is so important. Whether that is coaching or an in-person therapist – every member is unique and we need to personalize the care journey for them. This approach is more affordable and prevents behavioral health issues from developing into more severe and costly conditions.
To learn more about Evernorth’s suite of behavioral health solutions or its approach to behavioral healthcare, visit Evernorth Behavioral Health | Evernorth or contact winningbehavioral@evernorth.com.
Our past article touched on the difference between the treatment of mental and physical health conditions. However, what we didn’t mention are the innovative companies that are addressing multiple chronic conditions, including behavioral health diagnoses. Integrating the care of mental and physical health leads to better outcomes. Lyn Health, a human-centric healthcare provider created for people with multiple chronic conditions, has seen improvement in patients first-hand. Chief Commercial Officer, Steve Andrzejewski shared more about the benefits of prioritizing behavioral health conditions, simplifying the healthcare experience, and offering polychronic care for employees.
Lyn Health believes all chronic conditions are of equal importance and often impact each other. Any attempt to address one, while not taking into account the others can put both the clinician's care plan(s) as well as the member's overall wellbeing at risk. Additionally, we must also account for the member's personal goals alongside their clinical needs as we develop a singular, holistic care plan for all the member's chronic conditions.
Lastly, we continue to see the benefits of prioritizing BH conditions, early. This focus can both help build patient/clinician trust as well as prepare the patient mentally to tackle other chronic conditions they are burdened with, many of which have been for years.
Lyn Health firmly believes that for the polychronic population, the current healthcare ecosystem is less than ideal. After decades of 'status quo", we are seeing a rise in the loss of hope throughout this population. These polychronic patients are attempting to manage a PCP, 3-7 specialists, health plan, provider system, TPA and in many cases a host of single-point solution vendors. We have created a model that makes it nearly impossible for someone to manage both their clinical needs as well as their personal life
Lyn Health innovates around love, empathy and compassion and ensures that the member is in the middle of our work. Wrapped around each member is Lyn's Care Circle, a team of clinicians that not only delivers virtual care, but also provides; care navigation, care advocacy, care management, virtual PCP and urgent care, integrated behavioral health and community and social support resources, 24/7. If we are to address each patient's health in totality, providing a single point of contact for all clinical and administrative needs is crucial to success.
Employers today face many challenges as it relates to their benefits portfolio, including cost. As an industry, we know that roughly 40% of US adults are defined as being polychronic. Financially, this group drives 70% of our annual healthcare spend and is expected to grow to 84M people by the end of this decade. If we continue to ignore the rise in prevalence rates, we are guaranteed to see a continued escalation in both condition severity and spend.
With college-age young adults facing a myriad of stressors, from student debt to social isolation, we’re seeing more severe mental health acuity and higher rates of help-seeking behaviors. As a result, higher education institutions are taking action by investing in more robust mental healthcare resources and searching for a new model of care for their students driven largely by the inability to recruit and retain on-campus mental health providers.
“More severe mental illnesses start to present themselves during this age group and research has shown that identifying these disorders early and treating them effectively has a huge impact on outcomes,” says Nora Feldpausch, MD, Medical Director at Mantra Health, the preeminent digital mental health clinic for young adults. “College-age young adults are just starting to become independent and think for themselves for the first time, but many have no prior experience with the mental health system. They don’t know where to begin or how to navigate their mental health needs.”
There’s a growing demand for more student mental health care, as more students face higher levels of stress, anxiety, and depression, and it's becoming increasingly clear that every campus has a different need. Massachusetts Institute of Technology, a private institution known for its prestigious academic programs, partnered with Mantra Health, in part, to secure more providers of diverse backgrounds, training, and specializations. Alfred State College, in contrast, wanted to widen access to psychiatric care, which was difficult to find in the remote New York town – and found that Mantra Health’s telepsychiatry program offered the most comprehensive clinical care.
Mantra Health knows the importance of campus-tailored care and has recently partnered with institutions including Juniata College, University of Tennessee at Martin, and Siena College, and recently signed a multi-year contract with one of the largest state systems in the country. Since raising $22m in Series A funding in December 2021, Mantra Health has grown exponentially and now serves 105 campuses and approximately 800,000 students. Aiming to serve over 40 million young adults over the next decade, Mantra Health explores the reasons for investing in a company that specialize in young adult mental health care.
Not only is suicide a leading cause of death among young adults, but 75% of all lifetime mental health disorders develop by the age of 24, which means there are thousands of college students seeking treatment for suiciditality and symptoms of anxiety, depression, borderline personality, mood, persistent attention deficit/hyperactivity, and other mental health disorders for the very first time.
“To properly care for this generation, we must invest in mental health providers that understand the brain of young adults, the daily challenges they face, and the systems of care in which they live, work, and study,” says Andrew Hermalyn, an independent Board Member at Mantra Health, and the President of Partnerships at 2U, an online education company that partners with 230+ campuses to serve 45 million higher education learners globally.
Building a system of care within the college community that focuses on the specialization of young adult mental health care is vital. A recent study reveals the importance of this, as young adults experiencing serious mental health problems require a specific philosophy of care that supports them into the transition to adulthood in which independence is expected. This type of care may not always be provided by adult psychiatry, as young adults are dealing with emerging and pre-existing mental illness while at the same time undergoing significant life changes.
In addition to being transitional age youth, students also identify as LGBTQ+, parents, part-time workers, international students, first-generation students, athletes, among other identities. These specialized populations require specialized care and Mantra Health understands this firsthand and is working with industry-leading partners to support these students. Recently, for instance, Mantra Health conducted a nationwide survey of athletic leaders with the NAIA, finding that 92% of respondents want to make psychiatry services available to student-athletes, and published a white paper on best practices for athletic departments.
“The mental healthcare system today isn’t designed for young adults. Many college students are still covered under their parents insurance, living on their own for the first time, and putting their trust into an institution that has promised to support them during this transitional period of their life,” says Ed Gaussen, Co-Founder and CEO of Mantra Health.
Historically, many institutions turn to medical providers or community mental health providers to try to fill the gap. At a rapid pace, higher ed institutions are shifting their resources to digital mental health companies as a full campus well-being solution. One challenge is finding a diverse group of mental health professionals who have experience working with young adults within the college setting. The second is designing and building the workflow and data integrations to ensure the care team is knowledgeable about the campus environment where this patient lives, and can tailor care accordingly, and at scale.
“Not all care is created equal,” says Dr. Feldpausch. “If you’re going to invest in additional mental health resources, make sure you’re getting access to a team of mental health providers who can provide equitable and culturally-informed evidence-based care to all of your students, no matter their background, race or ethnicity, gender identity, sexual orientation, ability, religious belief, socioeconomic status, mental health condition, or circumstance.”
“Beyond patient-specific care, Mantra emphasizes campus-tailored care, where we have custom tools and product features that empower providers with campus-specific knowledge and protocols that will be most impactful to a patient’s care. This is how we can keep expanding our diverse pool of providers while maintaining a personalized care model for each of our institutional partners,” says Gaussen.
Good assessment and progress monitoring is foundational to evidence-based care. Mantra Health starts with a holistic assessment of student symptoms, as well as their clinical history and social situation. Students who receive Mantra Health care are assessed regularly for common mental health symptoms with an additional focus on psychological well-being, flourishing, and factors that may hinder a student’s ability to stay in school.
“Mantra Health screens for a broad range of social determinants that can derail a student’s academic career. This model gives us a much fuller picture of how each student is doing so that we can support them in moving beyond just surviving toward thriving in college and in life,” says Carla Chugani, PhD, LPC, the VP of Clinical Content and Affairs at Mantra Health, who specializes in DBT and recently joined from the University of Pittsburgh.
When it comes to the health and safety of students, clinical partners and student affairs leaders on campus need real-time communication and on-demand reporting to manage patient progress, and clear evidence of program ROI and population analytics to make the case for continued investment in campus mental health resources. At Mantra Health, we have a partner success, care navigation, and medical and therapy supervision team who use a variety of clinical measurements, screening tools, nationally standardized clinical protocols, and evidence-based practices to support counseling and psychiatric services, fill gaps in care, and meet the diverse needs of students.
Far too many college students are battling undiagnosed and untreated conditions, avoiding help-seeking behaviors, or refusing care because it doesn’t fit into their schedule or match their preferences or needs.
“There are only really a few specialized mental health companies that work exclusively with colleges and universities who genuinely understand the challenges faced by college students and know the value of embedding mental health services into the campus community that these students call ‘home,’” says Matt Kennedy, Co-Founder and COO of Mantra Health. “The average higher education buyer is much more discerning around population specialization and quality than when we entered the market in 2020.”
Young adults aren’t just students. They are also part-time workers, parents, athletes, and individuals battling homelessness, financial insecurity, the justice system, and other hardships. If higher ed institutions want to encourage help-seeking behaviors, build resilience, and protect their mental health, they need to be willing to invest in their overall well-being and provide them with quality care that’s tailored to their specific needs.
Colleges and universities have a unique opportunity – and arguably, an obligation – to build more comprehensive mental health offerings that safeguard the health and well-being of their students, all of whom are on their way to becoming the next generation of leaders and stewards of our world.
Mantra Health is a digital mental health clinic improving access to evidence-based mental healthcare for young adults. Learn more about the company and how they work with higher ed institutions here.
Thanks to our contributors Andrew Hermalyn, President of Partnerships at 2U and Mantra Health’s Co-Founder and CEO Ed Gaussen, Co-Founder and COO Matt Kennedy, Medical Director Nora Feldpausch, MD, and VP of Clinical Content and Affairs Carla Chugani, PhD, LPC.
Lyssn.io offers a clinically-validated AI platform capable of accurately assessing the use of evidence-based practices such as Motivational Interviewing and Cognitive Behavioral Therapy. With more than 54 metrics on everything from expressed empathy to open questions, Lyssn’s AI can help practitioners of all kinds hone their skills. On the organization side, Lyssn empowers them to better support staff and improve patient/client engagement and outcomes. In addition, Lyssn’s platform delivers draft clinical notes after every session and includes additional functionality for use in the hiring and training process. Rooted in over a decade of scientific inquiry, Lyssn’s technology has been validated in over 50 peer-reviewed academic publications, and it is in use in clinical, social services, academic, and population health settings across the US and in the UK.
Lyssn’s founders created the field of AI-supported quality improvement for behavioral health, wellness, and other healthcare conversations during their academic careers. Lyssn’s AI is built on more than a decade of their research and over 20,000 human-rated psychotherapy conversations (millions of labeled utterances). It’s been published in more than 50 peer-reviewed publications and secured $15 million in NIH funding. The core: We use the same established, gold-standard measures of fidelity as human raters in academia, healthcare, social services, and clinical practice everywhere – and we have trained our platform to do it at least as accurately, way cheaper, and way faster than the humans do.
The Lyssn platform can help at every step. Our hiring tool quickly and immediately assesses a candidate’s skills on gold-standard metrics for MI and CBT, giving hiring managers immediate insight into a candidate’s actual skills, not just their credentials.
Lyssn's easy-to-access training programs provide the most effective form of education: instruction, followed by practice, followed by direct feedback. While most programs offer only instruction, Lyssn's proprietary evidence-based artificial intelligence, Lyssn AI, gives clinicians and others the chance to practice their skills. In addition, the Lyssn AI platform allows comprehensive measurement and reporting not just of participation but of actual improvement in skills.
Our notes tool drafts clinical-quality notes from sessions, saving clinicians time on their most-hated task.
And our always-on quality assurance measures those same metrics during sessions – with the accuracy of a human rater but at a far lower cost. This way, supervisors and clinicians both have access to specific feedback on where they are and are not using evidence-based tools, which then can feed right back in to use of the training modules.
The first is savings from having the platform do the work that humans would do. Very few people have the staff to do mock sessions with new hires – but with our tools, you can quickly measure skills to avoid the costs of retraining or turnover. Our training tools are available any time and fully self-service, so there are no additional costs for workshop trainings, and new staff don’t have to wait. One customer says Lyssn Notes has increased efficiency in that area by 100%, with room for more improvement! And our quality assurance replaces expensive review/supervision by highly-trained staff (usually of a small portion of sessions) with continuous review and feedback at a fraction of the cost.
But the quality return is even more important, and why we started Lyssn. Evidence-based practices work when they are implemented with fidelity. This is very hard to monitor, and many payers, patients, and others often wonder how well quality is being managed in behavioral health. Our metrics strongly predict both engagement and outcomes and are continuously available to help document the use of EBPs and keep improving fidelity so that people get better more often. This can be a strong selling point and is also a requirement of certain contracts, for example, in the Family First Prevention Services Program.
Digital wellness is a $4.5T market, and mental health has a $6T global economic impact, with 970m individuals suffering with mental illness. There is a $132B expected growth of the U.S. behavioral health market by 2027. For digital wellness, we see prevention, sleep, nutrition, and activity as key. Telosity, a venture capital firm that invests in pre-seed and seed stage startups focused on digital wellness and mental health, has several exciting opportunities for our community. Read on to learn more about their newly-release digital wellness and mental health trends report, along with upcoming events below:
Telosity released a comprehensive market guide in Q3 that provides extensive industry research and actionable insights about the Wellness & Mental Health Opportunity. It serves as a tool for founders and investors to categorize and assess opportunities in the mental health digital arena.
The full report is available here.
Below are key themes that the market guide addresses:
Increasing innovation and technology are moving beyond teletherapy, with tech-enabled solutions having an impact at scale.
Expanding needs are stimulating the rapid growth of mental health and digital wellness.
The needs and market are growing globally with estimates of:
Growing investments and venture capital in mental health and digital wellness since 2018 with record-breaking years:
There is an urgent demand for mental health solutions for young people. For investors and startups, there is an unprecedented opportunity to build significant and sustainable business models while doing good and making an impact.
Learn more in the complete market guide available now to download, including in-depth analysis, opportunity areas, startup guidance, and additional resources for you to explore.
Mental Health Forum: Join leaders in the mental health field to discuss both front-line experiences and investment opportunities. “Mental Health Front Lines and Investment” is brought to you by Sheri Mac Enterprises, Soul Centric Counseling, and Telosity Ventures. The hybrid event will feature keynotes and leaders in both the field of investment and mental health. At the in-person location, there will be networking as well as refreshments.
Telosity Happy Hour: This invite-only event is designed to foster new connections and meaningful discussions on the latest happenings in digital health and investments. In addition, this is a great opportunity to chat with the Telosity Ventures team about their recent market guide highlighting investment trends in companies targeting digital wellness and mental health.
Contact the Telosity Team to learn more: anish@telosity.co and faye@telosity.co
Increasingly demanding, stressful, and overwhelming. These terms are usually used in conjunction with college students expressing their emotions and feeling associated with college life. In addition to Part I of student resources, here are six tech companies that can help navigate the college experience.
BetterMynd
BetterMynd is a social impact startup that provides access to mental health services for America’s 20 million college students. They serve over 50 college campuses nationwide to supplement mental health and well-being. Through a network of providers and the power of teletherapy, BetterMynd is empowering college students to get the mental health care they need. Students can sign up for an account through their college’s unique BetterMynd portal.
The Zone
The Zone provides a personalized wellness platform designed for athletes’ mental health. You can be proactive with a state-of-the-art mental wellness platform that integrates perfectly into your organization’s wellness program. Their access to support makes reaching out for help more accessible and streamlined than ever before. The Zone provides an accessible and scalable platform for anyone wishing to improve their well-being.
PursueCare
PursueCare welcomes those in need of support and will always meet them where they are in the process. They treat a broad population group ranging from people with opioid, alcohol, or other substance use disorders, pregnant women needing addiction treatment, and those who have relapsed. They also offer complete psychiatric treatment and counseling/therapy for people with mental health issues. PursueCare has partnered with ChristianaCare to provide virtual mental health solutions to participating college campuses. Participating students can access ChristianaCare’s internal and family medicine providers and PursueCare’s mental health, psychiatric, and medication-assisted treatment providers through a single digital portal.
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META
META provides the mental health support students need when they need it to improve engagement and retention. Students can choose from a diverse provider network. Monthly reporting helps to predict student needs, track outcomes, and gauge impact. META is trusted at 170 college campuses.
MindSpark
MindSpark programs deliver extraordinary professional learning experiences for educators, the community, and industry partners who take their new skills back to the classroom and beyond. They cultivate whole-person growth and sustained organizational outcomes through the world’s most extensive, customized, and extraordinary professional learning experiences. MindSpark aims to help leaders confront fundamental challenges and foster transformational progress by embedding key practices and strategies within your school. They draw on the expertise of impassioned researchers and practitioners such as former educators and industry leaders to solve critical issues around educator retention, cultural evolution, and school re-design.
Ocelot
Using AI Communications, including two-way texting, AI chatbots, and live chat, every student gets the answers they need and deserve, so no student is left behind. Ocelot’s comprehensive, AI-powered SaaS platform enables colleges and universities to proactively and reactively reach students and guide them through all aspects of the student journey to increase access, enrollment, retention, and wellness.
There has been a great deal written over the last two years about the increase in demand for behavioral health services (sometimes referred to as “the silent pandemic”) and the rise of virtual care like tele-behavioral health services. As it gets easier than ever for consumers to reach out for help and seek care with less stigma and more social openness, we are simultaneously facing a paucity of professional behavioral healthcare providers. Several recent publications by SAMHSA indicate we need 4.5M more clinicians to keep up with demand. The proliferation of virtual solutions and increased demand have exacerbated the shortage of clinicians and caregivers. In addition, the behavioral health market is moving to a quality-oriented model characterized by measurement, outcomes, and value-based reimbursement. In this article, we will propose a framework behavioral health providers can use to reconceptualize their care delivery models to both respond to the increased service demands and the shift to measurable quality.
It is called the Donabedian model. The Donabedian model provides a helpful framework for understanding the components of delivering quality care. The model consists of three main components: Structure, Process, and Outcome. It has been widely applied in general healthcare since its inception in the 1960s, and efforts have been made to apply the model to behavioral health (e.g., NCQA, efforts with PCMH with distinction in behavioral health, HEDIS, etc.) but not very broadly or effectively.
Structure = The Infrastructure Layer
Structure refers to the fundamental foundation for enabling the delivery of high-quality care, including facilities, equipment, and human resources, as well as policies for overseeing how care is administered and monitored. This layer is often described as the "availability of competent service providers and adequate facilities and equipment" (Donabedian 2005). It can be broken down into four main areas, or what we like to call "The Five C's":
1. Clinicians
2. Compensation
3. Clinics/Community
4. Consumers
5. Communication
In most cases, the structure layer is easier to measure, as its characteristics are binary - you either have it or you don't. For instance, it is pretty straightforward to describe a typical community behavioral health organization that has 350 social workers and 10 MDs. The center has an EHR and delivers 60% of its services through telehealth. This center serves Medicare/Medicaid patients primarily, but they are also in-network with a few commercial plans. It has 10 locations, and 90% of its volume of services is through intensive outpatient programs (IOP).
Process = The Treatment Layer
While the presence of key structural elements suggests the capability of providing evidence-based, high-quality care, process elements assess whether the care being provided adheres to evidence-based criteria. “Several studies have conceptualized Process as the actual treatment stage in mental health service” (Badu et al., 2019). The Process is the heart of treatment; it is where the consumers and the behavioral health providers engage in a therapeutic conversation as a means of therapy. A few key areas to highlight are:
Consider the area of “Setting personal goals.” For most behavioral health providers, this involves identifying intra- or inter-personal conflicts and addressing them through various forms of psychotherapy. But recent research and our own experience have shown some interesting trends. For example, in our analysis of more than 20,000 real-world anonymized conversations, we found that 90% of behavioral health conversations cover at least one topic relevant to Social Determinants of Health (SDoH), and over 50% of those conversations cover more than four. These topics also take up a lot of time in therapy conversations. Based on our analysis of commercial populations, the clinician and member discussed SDoH topics 23% of their time together. Clearly, it's not just the traditional inter-and intra-personal problems that are important to consumers. They need - and deserve - a comprehensive approach to address many problems simultaneously.
Additionally, the Process layer includes the operations associated with care. An example would be developing a treatment plan and accurate documentation of intakes, progress notes, and discharge plans that conform to evidence-based care.
The Process layer helps behavioral health providers to answer questions like: Are standard care guidelines being followed? Why is the member dropout rate so high? Which interventions are being used? How accurate is the documentation?
In some ways, the Process allows us to codify the best practices and replicate them across the organization. It helps clinicians focus on what matters most (providing quality care) and ensures every conversation counts.
Outcomes = The Improvement Layer
Today, different organizations measure different outcomes. For example, some organizations measure patient-reported outcomes (such as the PHQ-9 and GAD-7), and some measure consumer goals, hospital readmissions, or medical loss ratios. The goals outlined in Crossing the Quality Chasm (Institute of Medicine, 2001) will not be possible without measurement.
In the Outcomes layer, we ask ourselves: Do consumers get better? “The outcomes measure the effects of episodic mental health services on the well-being and health of individuals and populations” (Donabedian 2005). According to Dr. Harold Pincus, Vice-Chair of the Department of Psychiatry at Columbia University and a world-renowned expert in the field of quality improvement, behavioral health outcomes include:
A recent survey found that only 16% of behavioral health providers use measurement-based care (“MBC”). The reasons for this are varied. For example, clinicians are not compensated for tracking these measures, consumers find them cumbersome, and clinicians question their value, especially when their time is already limited. This means that most of our outcomes data is partial at best and largely based on claims data, which is limited in only noting an event/encounter has occurred (does not provide information on the encounter's content, nor a clinical assessment of the patient).
In behavioral health, a significant part of treatment is administrating evidence-based interventions in the form of a conversation. Compared to traditional medical care, which has a plethora of measurements and biomarkers, behavioral health care includes large amounts of unstructured data, much of which does not reside within the EHR. However, with advancements in Machine Learning (ML), encrypted and de-identified conversational data can be fully embedded into the clinical workflow providing a wealth of previously unavailable data and new insights to clinicians - without creating additional work for overburdened clinicians.
We at Eleos are in the business of providing Augmented Intelligence tools through technologies like Natural Language Understanding (NLU). As such, we’re strong advocates of these technologies. Our experience has shown that we can use this untapped resource of unstructured data to provide clinicians with perspectives on their treatments that were heretofore unavailable – we do so with superior accuracy and privacy.
From Structure to Process to Outcomes, where do we stand? It seems like much of the $5.1B of dollars spent on digital behavioral health in 2021 was focused on building a Structure - like developing networks and aggregating clinicians groups. But lately, we have seen a greater emphasis on Process and Outcomes. Marc D. Miller, President and CEO of Universal Health Services (one of the country's largest providers), mentioned in his 2022 outlook to Behavioral Health Business that “2022 will mark a new focus on quality and outcomes. Digital and virtual-only point solutions in mental health and addiction will be commoditized as more comprehensive, multi-modal solutions deliver the quality and outcomes that are becoming the standard. Value-based care will continue to increase as quality and outcomes can be measured and rewarded by payors and patients alike” This shift has been articulated by payers and investors as well.
In the behavioral health space, the next big differentiation will be quality of care - a measurable Process that results in lasting Outcomes. While no one knows exactly how this will develop, the following framework might provide some direction:
1. Measure the Process
2. Measure the Outcomes (see above)
3. Extract and identify the relevant Process measures and codify best practices
4. Incorporate Process measures into the Structure
5. Demonstrate measurable Processes and lasting Outcomes
In summary, the pandemic's ripple effects will remain for some time - with more people needing health care services, but the supply will not increase anytime soon. Behavioral health providers are in short supply. To create a meaningful change, we must shift our focus from systems structures to measurable Processes that will provide real impact and real Outcomes.
Thank you, Dr. David Shulkin, Dr. Harold Pincus, Eric Larsen, Dr. Dennis Morrison, Dr. Dale Klatzker, Douglas Kim, Roy Wiesner, Dr. Nadav Shimoni, Jennifer Gridley, and Dr. Shiri Sharvit, as well as everyone else who contributed to this article.
We are in a world of changing technologies. Many new inventions and uses for technology are shaping how we treat and adapt the treatment of patients. We questioned a few companies on how they are using technology and voice AI to address mental health concerns. We heard from Ellipsis Health, Lyssn, Kintsugi, and OPTT Health on their technology and how it has impacted their care.
Ellipsis Health
Mainul Mondal, Founder and CEO of Ellipsis Health, gave the following responses.
Today, we are leveraging our technology specifically for the early identification of the severity of anxiety and depression - either of these, left untreated, can lead to a deterioration in condition or crisis, including suicidal ideation. We do this by leveraging the unique power of the human voice and artificial intelligence to identify people in need and then connect them to integrated behavioral health services and personalized care pathways.
Now, through our groundbreaking technology, we have pioneered the only clinically-validated vital sign for mental health. Our solution generates a clinical-grade assessment of the severity of anxiety and depression by analyzing a short voice sample - creating the first objective, personalized, and scalable clinical decision support tool for mental health. With the use of our technology, we can help payers, providers, and digital care platforms shorten the time to diagnosis, increase efficiencies, reduce costs and improve patient outcomes.
Triage/Risk Stratification: Our partners look to us to improve risk stratification as we are able to quickly triage people into appropriate care pathways, improving patient outcomes and efficiency and reducing costs. In the clinical setting, care teams lean on us for early identification of mental health conditions to ensure the patient is triaged for the right care at the right time. Also, through partnerships with digital health platforms that offer self-help tools like meditation and stress management apps, we can identify those in need of more clinical care and help introduce them to options like telehealth and/or teletherapy provided by these platforms.
Longitudinal Measurement: Through our technology, care teams are able to remotely monitor treatment efficacy and be alerted when a person is experiencing a significant change in the severity of their anxiety or depression - eliminating gaps in care by providing ongoing/in-between visit monitoring. We are also seeing our technology being used by care teams to support those with comorbidities before and after a major medical event, such as surgery, so the individual can avoid costly readmission or ED visit.
Increased Engagement: The current status quo for measuring the severity of anxiety or depression is self-reported paper surveys (PROs) which are impersonal and unengaging. Our technology creates higher engagement than the current paper assessment. For a large partner, 70% of users surveyed were satisfied with our technology compared with only 30% on a paper survey.
We have partnered with a large behavioral health provider organization that has implemented our technology within their clinical treatment workflow to determine its effectiveness and ability to identify emerging crisis events. The study had 90 participants who had a Depressive Disorder diagnosis and were in treatment, and the treatment team and participants utilized our technology before and/or between sessions. The results were utilized to inform care providers of patient progress or lack thereof in treatment as well as to allow clinicians to prioritize patient safety during the study period.
Additionally, in a recent pilot with a digital health provider, users give a short voice sample and, based on their scores, are provided with digital interventions like education and mindfulness activities. Users were highly satisfied with this experience. One found that “answering the questions felt comfortable and inspiring,” while another reported that they were “almost amazed at how good it made [them] feel.” Another user found that “This is easier and more personal. I didn’t feel examined in a non-empathetic way.” Ellipsis Health aims to meet people where they are at, asking low-stigma questions geared towards making users feel like they are speaking to a friend. Whether we engage patients actively through an app or passively layer onto care calls, we are providing a simple, comfortable way to improve mental health outcomes through early detection, triage, and monitoring.
Once large healthcare companies, payers, and providers adopt innovative technologies, like ours, the impact of the technology becomes greater - reinforcing the financial impact and improved patient outcomes. Armed with the power of data, physicians will be able to drive measurement-based care for mental health - shortening the time to diagnosis, increasing efficiencies, reducing costs, improving patient outcomes, and saving lives.
OPTT Health
Moshen Omrani, MD, PhD, CEO & President of OPTT Health, gave the following responses.
To address this challenge, OPTT has developed a novel Natural Language Processing (NLP) algorithm by combining a custom classifier with a publicly available deep learning Transformer model. This innovative algorithm compiles clinically relevant Natural Language Comprehension; meaning it evaluates the relationship of a textual statement to a set of CBT-relevant concepts. These concepts include depression, anxiety, and the five-part elements of CBT: situation (positive or negative), thought (positive or negative), emotion (positive or negative), behaviour, and physical reaction. For instance, when the algorithm is given the statement: “I feel my life is challenging most days. I feel irritable and down,” the following output is provided: this statement is 73% related to depression, 68% to anxiety, and 59% to negative thoughts. The observed percentage in the output is referred to as the “Symptomatic Score” and indicates the probability that our algorithm considers the provided statement to belong/relate to the CBT-relevant concepts (i.e., depression, anxiety, and the five-part elements of CBT). This algorithm allows us to objectively evaluate clinically relevant variables reflecting a patient’s mental status, which is essential in developing algorithmic and evidenced-based decision-making processes.
There is a huge mismatch between mental health demand and resources, and yet there is no reliable method of matching the scarce resources to those with the most needs. For instance, there are around 1,960 patients with mental health problems per 1 psychiatrist in the US, which is 4-5 times more than the number of patients they can handle per year. This means patients should endure long wait times for their initial evaluation, whether they have a mild problem that would have benefited from lower-level resources faster or those with severe problems which should wait a long time to receive appropriate care. We have designed a triage module that relies on patients’ personal narratives of their problems and challenges to provide clinicians with an accurate diagnosis, predict patient compliance, and suggest courses and levels of treatment.
For instance, an important challenge in mental healthcare is the low compliance of patients in completing their course of treatment. Using our proprietary NLP algorithms, we were able to predict patients’ dropout with 70% accuracy, 4 weeks in advance of them dropping out, in a group of +250 patients across 4 clinical trials. This information could help the clinicians increase the level of their engagement with the patients to encourage them to finish their therapy. In fact, in our latest clinical trial in which the level of patient engagement was adjusted through their treatment, the number of sessions completed by patients increased by 20%, and the number of patients completing the whole round of therapy increased by 35%.
Given the absence of robust and precise quantitative measures, evidence-based practices, which are the cornerstones of all progress in the rest of medicine, have been largely missing in mental health. It is essential for the field to focus its attention on developing and using data-driven practices, which makes way for innovative solutions like ours.
Kintsugi
Prentice A. Tom, MD, Chief Medical Officer of Kintsugi, gave the following responses.
Kintsugi is the global leader in leveraging AI voice biomarker analytic technology to screen for depression and anxiety across populations. We have developed the technology to quantitatively assess any person’s mental health across these two common conditions and can provide a fully automated and unbiased* assessment of whether the user of our technology suffers from any degree of depression or anxiety. Because our technology is completely non-invasive and scalable, it can be used to truly move the needle in the early identification of these mental health conditions.
*(with respect to gender, educational level, language spoken, ethnicity, or other patient demographics)
Our Kintsugi Voice Analysis Technology is currently being used in the spectrum of clinical settings. We do not own the patient data, as that information belongs to clinical partners who are using the technology. Also, because the technology is not dependent on the content of the conversation but rather analyzes the impact of psychiatric conditions on human voice generation, IE: the production of the sounds that make up the components of speech, we do not require any patient-specific information. Thus, for the above reasons, we do not have access to nor archive any individual patient stories. We can say that we are currently working with some of the nation’s largest healthcare entities, and our customers have found their clinicians truly appreciate how our technology augments their ability to identify patients suffering from depression and anxiety disorders. In fact, we are currently ramping up to greatly expand the availability of our voice analytic tool to meet the growing demand of our healthcare industry customers.
Depression in the elderly, anxiety disorder in our nation’s youth, and burnout in our working-age population are now recognized as serious and growing health concerns. The impact of mental health conditions as an independent risk factor for diseases such as heart disease is a primary factor contributing to the cost of care in the US (65% of all recurrent emergency department users have been shown to have some mental health condition), and as a comorbidity to other diseases, such as post-partum depression -- is garnering much greater national attention. To date, our inability to quantitatively screen for these conditions and our inability to easily identify those who may be suffering from these conditions has led to mental health conditions being one of the most frequently, if not the most frequently, underdiagnosed conditions in healthcare. We need to create policies requiring our primary care clinicians to screen for mental health just as they screen for high blood pressure and diabetes, and we need to reimburse clinicians for performing this screening.
The fact that literally millions suffer needlessly or have worsening other medical problems because of their untreated mental health conditions is unacceptable. As patients, we need to demand that we be assessed and screened for our mental wellness, just as we are for many physical health conditions. As clinicians, we need to take the lead in making it the standard of practice that all patients receive appropriate mental health screening. On the government and commercial insurance side, we need to recognize how early identification of mental health conditions reduces the total cost of care and appropriately incentivizes mental wellness screening for everyone.
The future is bright for the use of voice AI in the behavioral health industry. We look forward to seeing the opportunity expand into other common areas of the health field. This advancement has a major opportunity to help in the evaluation of people in crisis, as well as different levels of care needed at different levels of intervention. Let’s hope this leading technology makes a change that can alter how we view and treat mental health.
Two months ago, we talked with Michael Susi, the Director of LinkedIn’s Global Wellness Program. We spoke about how LinkedIn has been caring for its employees by centering initiatives and outreach around the pillars of wellness: thought, breathing, hydration, nutrition, movement, and rest.
Some of the wellness services LinkedIn provides to support employees include:
Michael explains how there is a big push to inform managers of ways that they can support the mental well-being of their employees. For example, LinkedIn equips managers with the tools to implement 2-minute breathing exercises at the beginning of work meetings. Michael recalls a time last year when all employees were given a week off from work to “catch their breath.”
Michael decides what services are delivered to employees by making use of quarterly employee voice surveys (EVS).” He emphasizes the importance of “being present and being responsive about what people share with us while we are taking our time to listen.” Making employees aware that Linkedin is available to support them is integral and achievable through outreach and strategic marketing.
After implementing these solutions, LinkedIn sees positive outcomes overall, especially on a micro-level. When asked about the strategies and efforts that have not worked in the LinkedIn Global Wellness program, Michael says, “the biggest thing is overstretching. Going too fast too soon.” It is essential to “really understand what outcome you are trying to achieve. With that, it allows you to be more methodical.”
Michael does not feel like much is missing in the market; however, many people are unaware of the mental wellness market opportunities when facing stressors on a micro- or macro-level. With many solutions available, it should be up to the individual to use the wellness tool of their choosing. “We have an app behind the scenes that people can sync their data to. We can reward these behaviors by doing this minimally amount of times a week.” Michael says, “Ultimately, it is a very personal decision on how we care for ourselves.”
Michael recognizes the challenge some non-profit organizations and early-stage startups encounter due to a lack of resources. He says, “ultimately, it is about bringing these folks together for shared learning. Sometimes just letting people know that they are not alone in whatever it is that they are going through.” It is important to plant seeds of wellness in the workplace and, more importantly, listen so we can hear a little bit more about their specific needs.
Michael explained that when he joined LinkedIn, he focused on promoting the wellness program and thinking like a business owner. He says, “having that strategy of what your approach is… helps you, not only to stay on track but make what you’re doing teachable.” This technique empowers employees to be a part of the solution design and allows programs to be widespread in different regions of the world. “With guidelines, you equip an army of wellness champions, mindfulness champions. You equip them with so much that they do a lot without [you getting too] involved.”
According to Micheal, the most significant change needed regarding employee benefits is utilizing what is available. We would benefit more significantly if services were used more within companies. For employees to take advantage of these services, the offering, marketing, and promoting what is available must be increasingly personalized.
You can watch our entire conversation with Michael here.
In light of COVID-19, employers are making changes to their existing benefits packages. Employers are focusing on work flexibility in response to feelings of burnout that many employees have experienced. In an attempt to retain employees, 70% of employers have focused on expanding behavioral access in their strategic roadmaps for the near future, according to a Mercer national poll.
A 2021 survey from Indeed found that 67% of workers believed their burnout worsened during the pandemic. “Burnout is often confused with personal stress,” however, the International Classification of Disease classifies burnout as an occupational phenomenon. “It is not an individual issue. It is very much an organizational culture issue,” Carrie Bergen, Senior Behavioral Health Consultant at Mercer, says. Carrie named a lack of connections, unsustainable workloads, and a lack of rewards for work are some of the issues that define the burnout culture in different work environments. She emphasizes how burnout is not solely the responsibility of HR professionals. The company leaders should encourage time off, embrace work-life balance, and promote mental health benefits to reduce burnout in the workplace.
There is a large ecosystem of vendors who pitch their solutions to employers. All of the pitches begin to blend together for employers, which presents issues for both the vendors and the employers. In a very simplified manner:
Mercer delivers innovative solutions addressing their clients’ and employees’ health and wellness needs. “We work with small, multinational, and large businesses and focus on delivering an array of health benefit solutions. We have a really large team of different types of experts,” Carrie says, “Within total health management, I provide subject matter expertise around behavioral health… to help support our clients.”
Carrie advises to “start with the basics” when implementing scalable mental health solutions quickly and effectively. Mercer does this through qualitative and quantitative research methods. They use data to help determine what problems their clients are attempting to solve.
Evaluating vendor fit is another critical element in this process. “We look at vendor experience and fit. Do the vendors we are evaluating offer services that create the ideal emotional wellbeing culture for the organization and fit within the client’s priorities,” Carrie states. Accessibility and promotion of the services are other elements Mercer evaluates when developing solutions.
For employers who have already implemented solutions for employee mental health, Carrie gives several suggestions on how they can ensure they receive a return on the investments made in the past few years:
Carrie also advises how startups and established vendors can successfully partner with employers to offer behavioral health services:
For more on this conversation about workplace mental health, check out the full interview with Carrie, found here.
The original article can be found on NeuroFlow's website here.
Many of us are now familiar with the “digital front door” concept which came out of a desire to increase access to traditional care through advancements in technology—making it easier to schedule appointments, find a doctor, or review personal medical records. The digital front door was an important first step in using technology to increase access; however, it’s just the beginning.
Today, technology can extend an organization’s ability to identify needs, triage, and even deliver care with efficacy and scale that increases access, improves outcomes, and reduces the burden on staff. Paired with the growing understanding of how closely mental and physical health are linked, technology is creating new opportunities for providers to deliver care differently to their community in ways that add more value and frequency to patient interactions.
While there is massive potential, aligning diverse technology solutions to effectively serve the needs of a population is challenging. That’s why NeuroFlow is setting a “new standard of digital care,” a high-tech, high-touch approach to behavioral health that we believe health systems should and can incorporate. This standard of digital care creates a behavioral health infrastructure across enterprise health systems, enabling care teams to serve populations with varying and evolving needs in a unified way.
In this blog, we’ll explore how each of these core functions enables comprehensive behavioral health at the population level, and support other critical population needs like identifying and addressing SDOH and managing comorbidities.
Behavioral health is inextricably linked to population health, but most health systems struggle to identify and support the behavioral health needs of their populations. Behavioral health typically remains siloed in a department that is understaffed and overloaded with demand, while scores of patients remain on lengthy wait lists, don’t follow through on referrals, or are never properly identified as needing behavioral health support at all.
Technology plays a pivotal role in scaling behavioral health measurement and support population-wide, but to date a lack of consistent, principled approach to digital care has made it difficult to know where to start. The standard of digital care aims to resolve these persistent issues that have prevented behavioral health technologies from making the greatest impact on population well-being.
Before health systems can provide behavioral health support, they need a way to identify unaddressed needs, risk stratify their population, and identify the appropriate level of care. NeuroFlow accomplishes this by delivering regular behavioral health assessments via app when an individual begins using NeuroFlow and throughout their journey. Assessments include clinically-validated questionnaires like the PHQ-9, GAD-7, and WHO-5. These initial assessments achieve a 65% completion rate on NeuroFlow, creating a much clearer picture of population health. Plus, patients’ ability to take assessments on their own time, in the comfort of their home, is believed to improve response candor.
NeuroFlow’s measurement-based care approach provides longitudinal data that alerts care teams when a patient’s wellness is trending downward and an intervention may be needed. NeuroFlow’s proprietary Severity Score takes into account assessment scores and other user-reported data to generate a unique risk baseline for each patient, which enables detection of worsening conditions and prompts action by care teams when necessary. Changes to Severity Score are monitored over time in NeuroFlow’s Manage platform, helping care teams identify and prioritize who may need support on an ongoing basis.
A critical way to meet the diverse needs of a population is to empower individuals with evidenced-based behavioral health resources that they can discover at their own pace. Built on the tenets of digital cognitive behavioral therapy (dCBT), NeuroFlow provides a wide range of dCBT curricula, known as journeys, on topics like worry and tension, substance use, healthy relationships, parenting wellness, and more. Individuals have 24/7 access to journeys, and can explore the topics that interest them most in our Journey Gallery.
The platform also assigns relevant content to individuals based on changes to Severity Score. A notable increase in severity levels would not only trigger an at-risk alert to care teams, but would also assign the patient a depression journey, for example, to receive self-guided support.
Engagement is a critical part of NeuroFlow’s standard of digital care. Using a mixture of gamification, reminders, and notifications, NeuroFlow has achieved industry-leading engagement rates. After one month, 57% of registered patients remain active on the platform, compared to the industry standard of 6%. At the six month mark, 33% of these patients are still completing at least one activity per day on average.
Access to behavioral health specialists remains a huge barrier to improved population health. 45% of the U.S. population lives in an area with a shortage of mental health professionals, and 70% of all psychiatrists are 50 and older which will result in an even greater shortage as they retire. Teletherapy and telepsychiatry can help alleviate this burden, which is why NeuroFlow is excited to partner with four of the leading behavioral health organizations in the country: Array, LifeStance Health, Marvin, and Brightside Health. With these partnerships, NeuroFlow can leverage its Severity Score-powered triage engine to guide the right individuals to the right higher level of care when appropriate, either directly through the app or through care coordination.
Referrals can also be customized by population. If post-traumatic stress, for example, is prevalent within a population, NeuroFlow can prioritize therapists who specialize in PTSD. Alternatively, the app can refer only to therapists that take an individual’s insurance. This level of versatility helps NeuroFlow adapt to the unique needs of a health system and its population.
Suicide is a leading cause of death in U.S., claiming over 49,000 lives in 2020. Tragically, 45% of individuals who took their own life had contact with primary care providers within one month of suicide. That is why suicide prevention is an essential part of a comprehensive behavioral health solution for populations. NeuroFlow offers Response Services, a network of certified mental health professionals who proactively contact individuals when they trigger an at-risk or urgent alert. These alerts could be triggered by a recent assessment or through natural language processing technology which analyzes and flags free text shared in the NeuroFlow app that indicates self harm or suicidal ideation. The combination of identification through technology and high-touch, compassionate care provided by our response services coordinators makes a significant impact on suicide prevention.
“We actually had a woman who had been treated by doctors for years for a chronic illness, but had never been able to disclose that she’d had suicidal thoughts for years,” says Faith Best, NeuroFlow’s Clinical Services Senior Manager, “So using the app gave her the opportunity to identify that, and then NeuroFlow was able to respond, and we got her connected to therapy, which was huge for her. She actually said, ‘This might be a small thing for you, but it’s a big thing for me.’”
Partnering with CAMS-Care, an organization that provides suicide prevention training and resources, NeuroFlow incorporates an industry-leading suicide prevention protocol into our platform. We provide valuable assessment tools to care teams along with population monitoring and proactive crisis outreach. In addition, NeuroFlow offers easily accessible crisis resources, including the new mental health and suicide prevention lifeline, 988, which patients can contact directly through the app. With Response Services, NeuroFlow is able to intervene before individuals reach crisis and refer them to the appropriate level of care.
A unified, holistic approach to behavioral health will make the greatest impact on population well-being. We’ve seen this time and time again at NeuroFlow. The more that health systems can engage, monitor, and proactively respond to their populations’ needs, the better they will be able to elevate and standardize quality of care across the population. A high-touch, high-tech approach can eliminate inconsistent behavioral health approaches across different sites and ensure high-quality care. According to the American Medical Association, the benefits of high-touch and high-tech behavioral health care include improved outcomes, greater access to care, lower costs, and improved provider satisfaction. To learn more about NeuroFlow’s unique approach to population behavioral health, check out our resources hub.
References:
https://www.nimh.nih.gov/health/statistics/mental-illness
https://www.aafp.org/pubs/fpm/issues/2021/0500/oa1.html
https://www.mhanational.org/research-reports/2021-state-mental-health-america
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852925/
The Going Digital: Behavioral Health Tech team just released a white paper, "Creating the Ideal Digital Behavioral Health Vendor Portfolio: A 4-Step Blueprint." In parallel, we spoke with Trina Histon, PhD Senior Principal Consultant in Prevention, Wellness, and Digital Health at Kaiser Permanente's Care Management Institute, about how Kaiser Permanente has adopted digital behavioral health tools. A similar conversation came to mind from the 2020 Going Digital: Behavioral Health Tech Conference with Tom Nix, CEO of Ria Health, and Kristian Ranta, CEO and Founder of Meru Health, about successfully partnering with health plans and health systems. With all this in mind, let's dive into how health systems can successfully integrate behavioral health apps.
Health systems can utilize digital behavioral health solutions to augment and extend traditional services such as prevention, detection, support and treatment, and management or recovery. These tools can help patients with skill-building and self-care techniques and even help with symptom relief and resilience. Giving patients on-demand psychoeducation and support benefits everyone, from stakeholders to the patients they serve.
Additionally, when these tools are used at scale, health systems and other stakeholders are able to identify areas of improvement, such as service gaps and utilization barriers. If the digital solution offers validated measures, health systems and providers can receive detailed standardized, longitudinal data about each patient. Digital tools can also empower patients as they become more aware of their specific symptoms and triggers. Integrating digital health solutions can also increase behavioral health diagnosis and treatment rates if incorporated into existing workflows.
Under Dr. Histon's leadership, Kaiser Permanente has successfully integrated a few digital behavioral health solutions over the past few years. Dr. Histon explains that Kaiser Permanente originally wanted to use behavioral health solutions to target patients that were considered subclinical. But they found that digital solutions are "good for everybody. So if somebody has moderate or even severe depression and is in a comprehensive kind of care that includes medication, psychiatry, and therapy, at least tools can be a way to complete homework between sessions." These tools can be a way to keep patients engaged with their treatment and a way to track progress in between in-person interactions.
Startups need to integrate both clinical evidence and user experience. Health systems will always prioritize digital solutions that can show sound clinical data. Tom explains that it's helpful for startups to acquire the outcome data first to demonstrate their worth to health systems sufficiently. He continues that it's essential to be "able to show people really good, clinical data and how it impacts the lives of their members. [Then you have the] opportunity to kind of think through the solution that makes the most sense, not only for the health system but for the patients and for the providers." Remember that each health system has unique needs and requests to cater to its specific patient population.
Dr. Histon also emphasizes the importance of creating a user-friendly experience and explains, "we're providing health care, and that's a very vulnerable relationship for somebody, and it's not the same as other consumer experiences. At the same time, consumers are expecting a seamless [digital] experience, like going shopping or taking transportation, and they're expecting that of healthcare as well." Younger generations are accustomed to a digital experience, and healthcare leaders need to think about creating a product that is easy to use and navigate. Having a user-friendly experience also leads to increased user engagement. Dr. Histon explains, "I think engagement is just critical. Because if you just open the app and download and you never do anything else, that's not going to work for us in healthcare."
Dr. Histon adds that due to the diverse populations your health system serves, there "is no one app that rules them all." Health systems need to consider their diverse member base and recognize that multiple digital solutions may be utilized to meet everyone's needs. Additionally, it's crucial to consider how these apps can foster trust with the patients using them. Having the right balance of tech vs. touch can help patients feel more at ease. As Kristian explains, "we're seeing that [including clinicians in the app] makes a whole lot of difference when people know, and hey, that's a provider that's now reaching out to me. I'm…engaging with a provider versus a kind of technology." Health systems and startups can partner to find the appropriate balance of technology and clinician interaction.
1. Focus on clinical data AND user experience
Both aspects are essential to creating an effective app that patients want to engage with.
2. Digital solutions can support patients across the care continuum
Consider ways to support the diverse populations you serve through various digital solutions.
3. Check in along the way and ensure the digital solutions you choose are working for your population
As a health system, you have a lot of information about the patients you serve. Proactively talk to digital health startups about your specific needs and how your patients will feel most supported.
To hear our entire conversation with Dr. Trina Histon, visit our video library.
During Going Digital: Behavioral Health Tech 2022, we were fortunate to be joined by two Google Health executives, Megan Jones Bell, PsyD, and Ivor Horn, MD. Dr. Bell is the Clinical Director of Consumer and Mental Health, and Dr. Horn is the Director of Health Equity and Product Inclusion. We discussed Google Health’s strategy, how the digital health industry is changing, how to wire digital health products for inclusion, and their hope for the future of digital health.
Google Health explains that they are “building products to empower people with the information they need to act on their health. We’re developing technology solutions to enable care teams to deliver more connected care. And we’re exploring the use of artificial intelligence to assist in diagnosing cancer, preventing blindness, and much more.” Google houses multiple companies, including Google Search, Youtube, and Fitbit, and each of these tools offers many specific services for consumers, caregivers, communities, and researchers. One of the tools they provide for consumers is clinically validated self-assessments available through Google Search for conditions like depression, anxiety, PTSD, and postpartum depression.
Source: Google
Dr. Jones Bell recently published a blog where she discussed Google Health’s resources and how they analyze Google Search terms to give them more information. Searches for “mental health therapist” and “mental health help” reached record highs in 2022. And searches for “local rehab centers near me” have also reached record highs in the past few months. Google has a Recover Together page where people can find information about rehab centers, fentanyl overdose, and the importance of naloxone. Some Fitbit devices also offer apps for breathing exercises. Additionally, The University of Oregon is partnering with Google Health Studies to study how smartphones impact wellbeing.
Before Dr. Jones Bell was an executive at Google, she was one of the earliest leaders in digital health with roles at Lantern and Headspace. She has seen the industry grow and change. We wanted to hear her perspective on where the industry has been and where it’s going. She reflected that “investment has historically come from two ends of the spectrum first, with some investment in telehealth solutions and in self-help apps. So largely CBT or mindfulness, things that are evidence-based but appropriate to do yourself. And I think over the last three to five years, we’ve seen more filling in in the middle so more connected services that bridge different levels of care, that integrate across the spectrum.” As we see more innovation in this middle section of the spectrum, digital health can become more cohesive across all aspects of care.
She continues, “these moments of care transitions [are] really where we see people fall through the cracks. So seeing more investment across these levels of care…more of these integration investments, I think are really important for our industry to actually, sustainably make a health impact on users, not just meet them in this fragmented, ad hoc way, as individual point solutions, so there’s a key maturing point for the industry.”
As the Director of Health Equity and Product Inclusion, Dr. Horn thinks about integrating inclusivity into Google’s tools. Dr. Horn explains, “for example, when we think about Search and we think about food insecurity—because health is beyond specifically healthcare—we want to make sure that when someone searches for food, they are also finding food pantries or grocery stores near them that are affordable.” Google Search can be a really powerful tool when built for all users.
Dr. Jones Bell notes room for improvement where there are limitations of Google and the industry as a whole. She talks about the industry’s ability to provide information about conditions such as anxiety and depression and Search’s ability to populate relevant information. “When you start to get more specific [such as looking into schizophrenia warning signs], we realize that our ability to help people is fairly thin, as an industry overall.” There has been recent excitement about SMI funding, which shows promise, but as an industry, we still have a ways to go.
As we think about inclusion, we also discussed the interplay between tech vs. touch and how digital health can strike a balance between the two. Dr. Jones Bell expresses that they try to approach health in three ways:
Dr. Horn echoes that a focus of Google Health is “meeting people where they are with the resources we can provide.
The digital health field has taken many strides, but what do we want the future to look like? Dr. Horn says, “My hope for digital health in the future is that we just call it health, and it is a part of what we do. And that we are building for everyone, everywhere.” Digital health is steadily becoming ubiquitous, but we must ensure that we are creating inclusive products and platforms accessible to all. Dr. Jones Bell agrees and says, “My thesis for digital health has always been: improve access, affordability, and effectiveness for people.”
As we look to the future of digital health, we’re glad leaders like Dr. Horn and Dr. Jones Bell are in charge.
You can watch Dr. Horn and Dr. Jones Bell’s session here.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
There are various mental health solutions available from which employers can choose. But what exactly are they looking for in these offerings? We spoke with Dylan Landers-Nelson from the Business Group on Health, a non-profit association for large self-insured employers, about employer-sponsored mental health benefits and the 13th Annual Employer-Sponsored Health and Well-being Survey. We also look back on a conversation from the 2021 Going Digital: Behavioral Health Tech Conference with Barbara E. Wachsman, MPH, who is a Senior Advisor at Frazier Healthcare Partners, and former VP, HR, and Benefits at the Walt Disney Corporation.
The COVID-19 pandemic has shifted numerous viewpoints regarding how we think about mental health in America, especially in the workplace. A November 2021 survey found that nearly one-third of companies with more than 50 employees increased the ways their employees can receive mental health services and 46% of companies with more than 5,000 employees saw an increase in employees utilizing mental health services. A survey conducted by Calm found that 76% of employees think mental health benefits are crucial when evaluating new jobs. A McKinsey survey found that 80% of employers reported concern about employee mental health.
Barbara mentioned the positives and hurdles for startups working with large employer groups, saying the “good news about employers like Disney is that they are always looking for new, interesting, innovative ideas. They’re always looking for ways to have more healthy, productive employees. The bad news is you’re working with these big brands, who are very conservative, and kind of apply the same techniques that you would to purchasing other things.” Barbara continued that while employers are interested in adopting new solutions, they may be slow-moving.
In the Business Group on Health’s recent survey, 91% of employer members said mental health was their employees’ top priority. Additionally, 75% said that in 2022 they are moving to implement low or no-cost virtual counseling. Also, 42% said they are implementing or considering centers of excellence for mental health services, and 31% said they are implementing mental health navigators.
The Business Group on Health found that in their 2022 survey, access to care was the number one focus area for employers, with 76% of employers saying it was their top focus area. Barbara echoed this idea by saying employers “want access. They want to know that if someone needs care, that they can pick up the phone, they can log in, they can go through a portal, and they will find someone to talk to and someone who will either guide them or be able to provide care when they need it.”
Some employers may have contracted with several mental health solutions over the past two years, so now it’s essential to reflect on those solutions. As Dylan Landers-Nelson mentions, it’s time for employers to “take stock of what they have in place and… focus on programs that are successful.” The past two years have provided data on solutions that may or may not be working, so employers can make informed decisions about what works best for their employees.
Additionally, large employers are thinking about affordable solutions that appeal to a large population. As Barbara explains, “equity is extremely important. We’re offering the same benefits at the same price to everyone. So you want to ensure that what you’re offering will really appeal to that broad range of employee base.”
In the United States, employers can considerably influence how their employees receive care. Barbara emphasizes, “the employer in this country is the one that determines the kind of care delivered, how it’s delivered, how much it costs, and they have such a huge role to play in helping customers deal with things like mental health.”
As Dylan mentions, one thing medium and large employers look for is the “ability to practice across state lines, certainly virtual services help with that, but there are a lot of specific state laws.” Multistate employers will likely look to launch services for all of their employees at the same time.
Additionally, Barbara confirms that employers often think about “how can this be integrated into the overall ecosystem of healthcare?” There is a genuine concern about integration with other solutions and how all of them will fit together to create a cohesive healthcare experience for their employees. In fact, employers are starting to feel fatigued over multiple solutions that are administered in various ways.
1. Mental Health is a Priority
The majority of employers are focused on bringing mental health solutions to their employees.
2. Integration with Other Vendors
As employers feel fatigued from multiple health solutions, consider how your solution can integrate with other vendors.
3. Access and Cost are Top Priorities for Employers
Employers want their employees to have low-cost solutions that give them more access to care.
Please sign up for our video library to hear our entire conversation with Dylan Landers-Nelson.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
We hosted a panel discussion about neurodiversity moderated by Tom Cassels, the President and General Manager of Rock Health’s Advisory business. One of the incredible leaders Tom spoke with is Marissa Pittard, Co-Founder and CEO of Beaming Health, a company focused on helping autism families find resources, get advice from families and experts, and learn about their child’s diagnosis. The conversation also featured Rebecca Egger, Co-Founder and CEO of Little Otter, a company that provides virtual mental healthcare for children 0-14 and addresses concerns such as anxiety, aggression, tantrums, attention difficulties, sleep, sadness, and relationship conflicts.
Neurodiversity refers to the concept that brains have developmental differences that result in normal differentiation that lead to different strengths and differences. In other words, there is no “right” way of thinking, learning, or behaving. The term came about in the 90s to promote acceptance for people with autism spectrum disorder. But, the term now refers to a range of conditions, including autism, ADHD, dyslexia, dyscalculia, Tourette’s, Down syndrome, epilepsy, bipolar disorder, obsessive-compulsive disorder, borderline personality disorder, anxiety, depression, and others. Some people may not have a formal diagnosis but self-identify as neurodiverse and may have difficulty navigating social relationships, group environments, or sensory processing.
An essential part of working with neurodiverse children is helping them work toward their own goals, rather than having a standardized set of benchmarks. For digital health companies working with this population, it’s important to work toward long-term relationships with therapists to help keep kids engaged.
Marissa mentioned, “a parent told us recently, getting a diagnosis right now it’s like being pushed off a cliff and told to find your own parachute.” These companies are trying to create a supportive community for these families to land. Rebecca explains that “the end game for us is let’s support people as early as possible. And so we can have the biggest impact on their lives.”
In supporting these families, Rebecca and Marissa have both built their companies to focus on helping families in unique ways. Marissa explains how Beaming Health is “really focused specifically on autism families at the earliest part of this journey…how can we stand up a care model where families get access to the right care and resources as soon as possible?” Beaming Health emphasizes early intervention for autism families.
Rebecca explains that Little Otter “released a mental health toolkit. [Which] are free resources that provide really personalized feedback for parents…[and] our mental checkup that gives an entire 360 view of the entire family.” Little Otter emphasizes engaging the entire family unit in care to better understand total family mental health.
In our conversation, we discussed the importance of quality and choice in behavioral health care. Marissa remarks, “every parent or caregiver is the expert on their own family. Who are we to tell you what might be best for your family, because you as parents know it so much better than us. Our job really is empowering parents and families with the information and resources they need.” She says that the team at Beaming Health they have found that “families have different preferences and communication styles, [and] the relationship between the family and the therapist, may not be quite right.” They have found that giving their families a choice has empowered them to find the best fit for their family needs.
Rebecca agrees that families know their kids best, and they should be able to make decisions that are best for them, but she also emphasizes that quality has to go along with finding a match for each family. She says, “We’ve seen many families who’ve tried up to 10 interventions before coming to us. And so, even though that’s great that there’s access out there, something we talk about is we’re improving access to actual quality care. And we need to add that quality bit because access for access sake does more harm than good in young children.”
Tom echoes a common refrain among neurodivergent families: “If I can get an appointment, I don’t want it.”
Of course, these companies do not work alone in trying to help these families. Tom asked each panelist who their most important partners are in this work. Rebecca mentioned that “70% of all the mental health meds for young children are prescribed by pediatricians,” so they can be a significant partner in first recognizing that help is needed.
She also mentions that “teachers who are interacting with the children every single day, they have the most impact on the child’s life… They’re often the first to realize something’s going on.”
Marissa talks about the role that payers play, saying, “there’s just so much power in how the reimbursement flow impacts coverage, the appropriate amount of coverage and thinking about new types of resources and services that are covered, to me is one of the most powerful forces for solving a lot of the problems we’re seeing with our families.” Rebecca echoes the power that payers have and emphasizes, “the most impactful for us would be if insurance companies can really wrap their minds around this whole family care model.” These startups cannot do this work alone and rely on other stakeholders and partners to create a community of care for neurodivergent families.
These are just a few insights from our conversation with Tom, Marissa, and Rebecca. To hear the entire conversation, check out our video library.
Ria Health is a tech-enabled telehealth clinic that treats alcohol use disorder (AUD). Their team is singularly focused on helping people change their relationship with alcohol. As mentioned at this GDBHT2022 session, their evidence-based program combines science-backed methods alongside technology to improve accessibility and affordability. Ria Health has helped close to 5,000 people experience successful outcomes and is available in nearly all 50 states. We sat down with their team to get more specifics on their virtual alcohol use disorder solution.
About half of heavy drinkers concurrently suffer from anxiety and/or depression, a problem that alcohol makes worse. People often drink to self-medicate for these underlying anxiety or depression problems but are left with worse symptoms when they withdraw from alcohol. This pushes people to drink again, perhaps even more often or more per session, perpetuating the cycle.
Misusing alcohol can also result in real-life consequences that can negatively impact someone’s mental health. This includes relationships, work-life balance, and can even result in legal problems (such as DUIs). These stressors can impact social settings and experiences, driving people to isolation, worsening a person’s mental health, resulting in anxiety and depression.
Significantly reducing, or stopping, alcohol consumption leads to an overall better mood and an improvement in levels of anxiety. Some patients will also benefit from counseling and/or an evaluation for anti-anxiety or antidepressant medications.
Ria Health’s medical staff includes both physicians and nurse practitioners that conduct a thorough initial assessment to tailor an individualized program for each Ria Health member. Our program combines both counseling as well as medication-assisted treatment (MAT) which, evidence shows, results in the best outcomes for those struggling with AUD.
Our initial medication assessment takes into account an individual’s unique medical and psychiatric history as well as a member’s own goals. We’re not an abstinence-only program and understand that members may only want to reduce their drinking and overall consumption. We help align on a goal that is likely to result in a member sticking with the program and achieving the goal they want.
Depending on the individual’s pattern of drinking, our team members will prescribe one of several medications available for those struggling with AUD. Different medication is best suited depending on whether a member wants to abstain from alcohol or is looking to reduce consumption.
This includes medicine that can reduce cravings (Naltrexone, Topiraamate, Baclofen), treat symptoms related to withdrawal symptoms, anxiety issues, and lack of sleep (Gabapentin), as well as assist in maintaining abstinence (Acamprosate).
On the counseling side, patients are able to match with a coach of their choice who helps them develop goals as part of a collaborative approach to treatment. These coaches and counselors provide ongoing accessible care that’s tailored and suited for a patients’ schedule to maximize support and availability. Depending on the member, coaches will pull from a myriad of tools, techniques, and options such as 1-1 counseling, workbooks, and group therapy that is aligned with a member’s preferred treatment and learning style.
AUD isn’t just a personal problem — it’s a problem that can affect a person’s employment and work environment as well. Employers also experience negative consequences as a result of an employee with AUD issues. Productivity, work satisfaction, presenteeism, and absenteeism are all issues that can worsen over time without AUD treatment.
By helping employees become aware of their relationship with alcohol, an employee can begin the work towards addressing AUD which starts with an understanding of how alcohol can affect them across interpersonal relationships, home, and work life. When AUD is properly managed in the workplace, employers can save an average of $8,500 per employee per year.
Ria Health helps employers give a treatment program that empowers employees to manage their AUD, resulting in increased productivity and performance while decreasing healthcare costs, bringing savings to both the employer and employees.
By offering a focused AUD program, as opposed to a one-size fits all approach, employers can expect better engagement, adoption, and overall program success. We know that employees are specifically looking for specialty providers that offer more accessible options. Ria Health’s telehealth-based program is much less disruptive to employees' lives and doesn’t require a major uproot compared to a residential treatment facility or an IOP/PHP.
In many cases, the employee doesn’t even need to take time off of work to obtain treatment. The lack of disruption makes program adoption much easier and reduces the burden on the employer of having to cover for an employee who may be taking an extended period of time away.
Lastly, Ria Health is vastly more affordable compared to traditional inpatient programs — costing just a quarter as much. These savings are passed on to both the employers and employees.
We recently participated in Nice Healthcare's event with the Minnesota Vikings, “How an Integrated Approach Can Best Address Mental Health.” We talked with an incredible group of leaders, including Dena Bravata, MD, Co-Founder of Lyra Health and Advisor to many health tech startups, Kendra Ripp, DNP, VP of Clinical Services at Nice Healthcare, Lindsey Young, Staff Writer and Editor at the Minnesota Vikings, and Vikings linebacker Eric Kendricks. We discussed how to create a workplace that promotes and honors mental health, how benefit managers can foster a supportive work environment, and what employers need to know about employee mental health.
Think about barriers to care: Look at your employee population and discuss its unique barriers to mental health care. How can you help address those barriers?
Create awareness around your mental health services: Make sure employees know what services are available to them so they know where to turn before they are in a crisis.
Create an open and empathetic work environment: The most important thing you can do is create a work environment where employees feel supported and able to be open and vulnerable. Employees want to hear from peers, managers, and the C-Suite about mental health.
In the past two years, mental health has become a greater focus for all of us, especially in the workplace. The Mind Share Partners 2021 Healthy at Work Report found that 84% of respondents reported at least one workplace factor that negatively impacted their mental health. Additionally, they reported that the most desired “resource” for mental health was an open culture about mental health at work. Employers can help create a mentally healthy culture at work by providing flexibility, promoting autonomy, establishing boundaries, and emphasizing the importance of empathy and authenticity. Additionally, the biggest influence on a company’s mental health program is engagement from the CEO and other top executives.
Some benefit managers wanted to better understand why people may not access mental healthcare. The truth is, as Dr. Bravata deftly explained, “every population has a different barrier to accessing [care].” She explained that many individuals in the military fear that accessing mental health services would be visible on their military records. For others, the cost is a barrier, and some people live in mental health deserts or the 570 counties in the U.S. that do not have any psychologists, psychiatrists, or therapists. Additionally, Eric mentioned that many of his teammates feel that time is a barrier for accessing mental health care.
"Dr. Bravata emphasized that each "employer needs to understand the biggest access barriers for their own population. Once employers understand what is keeping their employees from accessing care, they can build tailored solutions to address these barriers. For example, Dr. Ripp explained that at Nice Healthcare, they are “seeing people who are accessing mental health care for the first time because of cost.” Nice Healthcare is an employee benefit that gives people a variety of primary care services including mental health therapy, at no cost to the employee.
Another barrier to accessing mental health services is stigma, which can feel like an even bigger burden in the workplace. According to a recent McKinsey report, 75% of employees think mental health stigma exists in the workplace. Lindsey detailed a time she shared her mental health journey at a previous job, and her manager approached her afterward, saying, “I hope you don’t expect special treatment.” Flippant comments like this, especially from leadership, can discourage people from sharing their struggles and accessing mental health care.
Eric explained his perspective on a football team, and he’s found that “men in general bottle things up, [we’re told to] tough it out and handle your business.” He emphasized that luckily we’re starting to see other athletes around the world, such as Michael Phelps, Simone Biles, Naomi Osaka, Kevin Love, and many others, using their platform to talk about their mental health struggles. And talking about these issues can tremendously reduce the stigma associated with them. This is what helped spark the idea for Lindsey's Getting Open Series, which showcases members of the Vikings organization speaking openly about mental health.
Seeing others be vocal about their mental health struggles lessens the stigma associated with mental health. Eric explained, “We’re all going through these things. It’s important to not only acknowledge it but reach out to those around you.”
If we can understand the barriers to accessing mental health resources and how stigma plays a role, we can consider how employers can be part of the solution. Dr. Ripp encouraged employers to incorporate and advertise “more preventative solutions so people can have treatment or coping skills before there’s a crisis.” Dr. Bravata explained that many people don’t know what mental health benefits they have until they experience a crisis, at which point it is incredibly difficult to navigate. In fact, Mental Health America found that only 47% of employees know about their mental health services, and only 38% would feel comfortable using them. Employers should invest in mental health solutions for the workplace. Furthermore, they should embrace and advertise available solutions to create a company-wide culture of mental health awareness and support.
The most important thing that employers can do, as Lindsey explained, is “[make] sure that the workplace feels safe.” Dr. Bravata emphasized the importance of “having vulnerable leadership…to normalize these feelings for the employees and [to] have an explicit policy around non-retaliation.” Leadership sets the tone for the rest of the company, and a recent Ginger report found that 90% of employees appreciate a CEO that discusses mental health.
Panelists advised that a multi-pronged approach to discussing mental health in the workplace is most effective to help employees feel more comfortable with seeking out and using the mental health tools that employers invest in. The best way those conversations can take place is through open communication about mental health from all stakeholders who interact with employees: peers, direct managers, and leadership.
To hear more conversations like this, you can access all of our 2022 virtual sessions with employers, benefits consultants, telehealth leaders, health plans, and more within the Going Digital: Behavioral Health Tech free video library here.
Our last blog discussed insights from innovative serious mental illness startups. One of the featured companies was Mindstrong Health. Their CEO, Michelle Wagner, gave a hope-filled opening session at Going Digital: Behavioral Health Tech 2022 this year
We wanted to dive deeper into Mindstrong’s process, including how they are revolutionizing serious mental illness care, measuring outcomes, and partnering with payers. You can read our conversation below.
SMI populations are hard to treat, hard to engage, and as a result, are populations that are overlooked and underserved. Supporting this population requires not only outstanding clinical care, but also the creativity and nuance to meet members where they are on their mental health journey.
Mindstrong's blend of proven science, state-of-the-art technology, and dedicated care teams are the secret sauce behind our ability to help members feel better, do better, and stay better. We believe in mental health care for all and specialize in serious or complex challenges. It may take more work, and we’re committed to better outcomes for everyone.
The Mindstrong App & Care Platform includes measurement-based clinical care, customized interventions, case management and resources for SDoH needs; 24/7 support for all acuity levels, with a specialization in SMI gives our members the safety net they need to build confidence in their care. Our integrated care team includes Care Partners, Therapists, Psychiatric NPs, and MDs. Each Care team is a tailored blend of provider(s) based on members’ specific needs and preferences. Mindstrong is mental health care with the strength to tackle anything.
Care delivery at Mindstrong relies on data to inform our Measurement-Based Care (MBC) approach to enable progress tracking and aiding in clinical decision making.
Bringing together technology, data, and care, we measure member progress on an ongoing basis to ensure that member needs and changes are continually assessed and met.
Our proprietary platform sends intelligent, clinically-informed symptom surveys to members automatically, in between sessions.
We use clinically validated assessments including DSM-5 and Level 2 PROMIS. Providers use the Level 2 PROMIS Assessment information to better define the qualitative nature of the problems, determining a more accurate diagnosis, and developing measurable treatment goals.
We complement the clinical assessments with post-session assessments and ongoing Care Plan reviews, to ensure we’re constantly meeting the needs and evaluating progress of members in a truly personalized way.
In addition, we are constantly measuring through member surveys like mood surveys and therapeutic alliance.
All assessments are automated based on smart logic that is built into the backend. This reduces the burden for our providers to have to manually send or administer questionnaires to members.
MBC has been shown to outperform treatment as usual, where data is a powerful tool in amplifying care effectiveness.
MBC also empowers and engages the member in their care by giving them the ability to track their progress toward their health and wellness goals and openly discuss their progress with providers.
We partner with payers who are shaping and leading the way in value based care. Mindstrong specializes in payers’ high-cost and often overlooked members, including those with SMI conditions and older populations.
In our partnerships, we reduce TCOC for payers and improve clinical outcomes for members. We do this by focusing on outstanding clinical care, high-touch acquisition, whole-person care including SDoH and care coordination, predictive analytics based on passive data from members, and care teams that partner with members to eliminate roadblocks members experience in achieving their mental health goals.
Our start-of-the-tech, proven science, and dedicated care teams enable high member engagement, real-time crisis intervention, and ongoing monitoring.
The results are improved financial outcomes for partners and improved outcomes for members.
For those interested in learning more, please reach out to Ceili Cascarano at ceili.cascarano [ at ] mindstronghealth [dot] com.
During the 2022 Going Digital: Behavioral Health Tech Conference, the venture capital panel featured healthcare investors such as Chrissy Farr, a Principal and Healthtech Lead at OMERS Ventures. Farr remarked that startups focusing on anxiety and depression “will continue to be a tricky funding environment in the next couple of years. But more investors I'm talking to are thinking about severe mental illness…I think those companies will do quite well in the coming years because it's a space that has not been invested in in the same way.”
As investors and innovators in the mental health space start focusing their attention on serious mental illness (SMI) focused startups, they need to keep some critical concepts in mind if they hope to successfully engage and serve patients managing severe mental illness. Hear from leading SMI startups on their unique approaches to engagement and partnership in this week’s blog.
The National Institute of Mental Health (NIMH) defines SMI as “a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.” SMI can include conditions such as major depressive disorder, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder.
As of 2017, there were 11.2 million adults in the United States with an SMI. Because SMIs involve serious functional impairment, these impairments can lead to difficulty maintaining employment, poor social support, multiple psychiatric hospitalizations, homelessness, incarceration, and co-existing substance use disorders. In fact, about 1 in 4 adults with an SMI also have a substance use disorder. The SMI population also has a life expectancy that is 20-25 years lower than those without SMI. People with SMI also have worse medical outcomes, higher rates of suicide, and greater levels of stigma than those without SMI. Even further, there is a shortage of providers who treat SMI.
We spoke with Dr. Holly DuBois, the Chief Clinical Officer at Mindstrong, during our Going Digital: Behavioral Health Tech Conference and she emphasized, “We know that those social determinants [of health], for folks, especially with a serious mental illness, they're profound, and they have a huge impact on their ability to engage and then sustain any outcomes.” Watch her session here.
There are a growing number of startups focused on SMI care, such as Amae Health, aptihealth, firsthand, Mindstrong, and NOCD.
Amae Health utilizes psychiatry-led, integrated care providers for outpatient physical and behavioral health services delivered within in-person clinics. Amae Health focuses on caring for the highest need individuals who are experiencing unmanaged acute episodes or chronically unstable severe mental illness. Often these individuals are seeking care through Inpatient Psychiatry and ERs and unfortunately are met with months long waitlists to get any kind of specialty-related SMI care. For this population, piecemeal solutions or relying on the existing fragmented network has proven to be insufficient.
Amae Health’s solution is designed based on real world evidence and research from their CMO’s integrated care model at the VA, which demonstrated industry leading clinical and financial outcomes. Their tech-enabled integrated outpatient psychiatry-led behavioral and primary care services are delivered via our in-person clinics and community centers. Each patient has a dedicated care team who in addition to providing clinical care, focuses on basic needs, healthy living, social, and community components impacting the patient, helping them stabilize their lives, have community support, and rebuild purpose.
aptihealth matches members ages 12 and older with a collaborative care team including a licensed therapist and psychiatric prescriber, if needed, and focuses on those with mild symptoms to those with SMI.
aptihealth’s mission is to improve behavioral healthcare for underserved populations—one member at a time. To accomplish this, they operate fully within the healthcare system, partnering directly with health plans, health systems, physician practices and community-based organizations to intelligently integrate care. With domain expertise in patient engagement, behavioral and medical care, virtual-first care delivery and unprecedented data and insights; their care model reliably impacts the most important behavioral health drivers of outcomes and cost. Their technology guides care using workflow best practices and data insights to enable right care, right modality, right time. Their modern design creates an intuitive experience for members and robust capabilities for providers to optimize engagement. Insights from their treatment data drives breakthroughs in mental health understanding, treatments, and outcomes. All of this results in informed, organized, coordinated, collaborative and successful care, evidenced by unprecedented member experience, clinical outcomes and return on investment.
Mindstrong offers telehealth and virtual care using therapists and psychiatrists. Mindstrong also users AI-powered digital biomarkers, collected passively as members use the Mindstrong app, to monitor patients' mental health status.
Mindstrong's blend of proven science, state-of-the-art technology, and dedicated care teams are the secret sauce behind our ability to help members feel better, do better, and stay better. They believe in mental health care for all and specialize in serious or complex challenges. It may take more work, and they’re committed to better outcomes for everyone. The Mindstrong App & Care Platform includes measurement-based clinical care, customized interventions, case management and resources for SDoH needs; 24/7 support for all acuity levels, with a specialization in SMI gives our members the safety net they need to build confidence in their care. Their integrated care team includes Care Partners, Therapists, Psychiatric NPs, and MDs. Each Care team is a tailored blend of provider(s) based on members’ specific needs and preferences. Mindstrong is mental health care with the strength to tackle anything.
NOCD is a telehealth provider for the treatment of OCD, utilizing therapists who are trained in Exposure and Response Prevention (ERP) therapy, the gold standard for OCD treatment.
There are 179 million* people with Obsessive compulsive disorder (OCD) around the world. Never before has there been a dedicated platform to identify people who are suffering from OCD, bringing them to care, helping them navigate the healthcare industry, and providing in-between care support in order to make sure they maintain their care journey. This member-focused approach that was built from the consumer backward is truly groundbreaking in the behavioral healthcare space, arguably in the healthcare industry in general. People suffering from OCD no longer have to feel alone as they continue to reduce the social stigma surrounding OCD. Reducing this stigma & identifying people in need allows us to enroll patients into the largest telehealth network of OCD-specialized therapists.
NOCD has reinvented the front door to healthcare and revolutionized OCD treatment & patient experience. They have developed a discreet way of identifying a serious mental illness community through innovations such as finding those suffering where they are in their journey by engaging with consumers and helping them navigate the healthcare system in order to receive the right care.
As well as utilizing technology to create an experience from treatment seeking to receiving treatment through our telehealth platform and offering in-between session care & support through peer communities, direct access to experts and self-help tools.
NOCD’s telehealth platform enables patients to schedule live face-to-face therapy sessions with licensed clinical therapists specializing in ERP therapy. In between visits NOCD’s member tools empower them to better manage their OCD and practice therapeutic techniques. The combination of therapy, and care management support between sessions is an innovation in the behavioral healthcare industry. They have created an integrated platform between consumer engagement, healthcare treatment, and in between care, an integration that is unique in the behavioral healthcare space. NOCD has designed this entire experience from the consumer backward in order to meet a suffering and underserved demographic where they are in their care journey, bringing them to affordable, accessible and insurance-covered care, and working with them to maintain their journey in order to regain their lives.
*Based on a global population of 7.8 billion people and a recognized OCD lifetime prevalence of 2.3%
What do SMI startups steeped in care delivery want payers and providers to know? Here are some of their thoughts:
Amae Health: “[Payers and providers] know that consistent high quality SMI+SUD, medical, and social integrated care are deeply necessary to effectively help this population. However, being able to bring these pieces together in an equitable, measurement, evidence based and incentive-aligned manner has been the primary challenge. Amae Health seeks to do just that in order to provide integrated care.”
aptihealth: “When care is clinically integrated with health plans and systems across all points-of-care; patients can be engaged whenever and wherever they touch the system, with insights that create the opportunity to navigate the patient to the optimal course of care, reducing ED visits and admissions. That’s the challenge, and it’s our job to make sure payers and providers know that there’s a solution.”
firsthand: “Real support can only be financed if we truly integrate the medical and behavioral risk dollar. Without that integration, there is not enough savings to substantiate investment in appropriate whole-person clinical models at scale.”
Mindstrong: “These populations need more than an episodic fix; they need support that balances mental health care with whole person care, with a goal of building resilience and empowerment. With the right blend of data, technology, and care, SMI members can experience sustained outcomes and Payers can reduce [total cost of care].”
NOCD: Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. It is imperative that those suffering from OCD require specialized treatment: Exposure & Response Prevention (ERP). Lifetime prevalence of OCD is approximately 2.3%, affecting nearly 1 in 40 people (~8M Americans). OCD is debilitating; those suffering are 10X more likely to commit suicide, it is ranked by the WHO as 10th leading casue of disablity, and approximatly 1 in 4 people with OCD develop substance abuse. Despite the prevalence, OCD is widely misunderstood & misdiagnosed. This, combined with a lack of mental health resources, causes a 14-17 year patient journey to find appropriate care. Limited access to proper care at the appropriate time creates a burden on the healthcare system. Per 1M commercially insured, OCD generates $104M+ annually in behavioral health costs; of which, 96% is associated with inappropriate care.
To read more articles like this, read more of our Insights here.
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We recently hosted a webinar with Talkspace and Aetna titled, “Advancing Mental Health through Asynchronous Therapy.” We were joined by Dr. Derrick Hull, Research Director at Talkspace, Dr. Varun Choudhary, Chief Medical Officer at Talkspace, Pablo McCabe, SVP of Healthcare and Account Strategy at Talkspace, and Brooke Wilson, the Head of Resources for Living, a division of CVS Health/Aetna. In the session, we discussed the newly-released, impressive research on asynchronous, text-based therapy and how Aetna and Talkspace successfully executed their partnership.
With a growing need for mental health support, it is important for people to think creatively about how mental health care should be delivered in the United States. There is a mental health provider shortage and 55% of US counties have no psychiatrist, psychologists, or social workers. As we consider new ways to offer mental health resources to those who aren’t able to easily access care, text based asynchronous therapy is one solution.
Text therapy can be convenient for those with busy schedules, it’s cost effective, accessible, and allows people to be in the privacy of their own home. As Dr. Hull explains, “even if you have the money to seek care, some people don't. Scheduling the sessions can be a challenge, the travel, the commute, all of that can be a challenge,” and text therapy can help with that. Additionally, it may be helpful for people to look back on the conversations with a therapist to reflect on helpful tips and talking points. Some people may even find that writing difficult things in text might be easier than saying them aloud. Text therapy has also been shown to be a great way for people to be introduced to therapy, and some studies show that people then decide to seek face-to-face therapy after a positive experience with asynchronous text therapy
Talkspace is a HIPAA compliant app where members have access to therapists through texts, voice messages and/or video visits but most of the interaction with providers is done through asynchronous text messaging. As Dr. Hull explains that Talkspace makes sure to use “licensed professionals who can structure the treatment with the same kind of clinical frame that you would expect if you were going face to face.” In other words, their aim is to provide as similar a treatment as possible.
Additionally, some mental health providers have seen the benefits of using asynchronous text based therapy. As Dr. Hull explains, “because messaging is unfolding daily, you almost have more insight into what's going on with the client than you do [if you’re meeting] weekly.” In their early research studies, Talkspace has also seen “that people engage more frequently, and they also tend to stay longer [than traditional therapy], and our assumption here is due to convenience.” More of their studies have also seen that as patients' improvement slows down, therapists are reaching out more, to keep members engaged.
In a Talkspace study, they found that over a 12 week period of treatment, patient GAD-7 scores, measuring anxiety, decreased 48% and patients PHQ-9 scores, measuring depression, decreased 53%. In studying their effect on workers, they found that Talkspace users missed 50% fewer hours over a 90 day period, compared to prior to treatment, 64.7% increase in employee activities outside of work, and 56% increased work productivity.
Brooke Wilson mentions that the Talkspace partnership started as a pilot in 2018 as a new way to engage members. As she explains “we thought it would allow people another choice and preference in how they might like to access care.” As the pandemic started, Brooke mentioned that they had an increase in demand for mental health support and that traditional providers didn’t have appointments.
Brooke continues, “we also were able to offer these different modes of connection beyond async. So for our customers, we have that option of a telephonic session, a video session, a live chat session as well as that asynchronous.” She echoes that giving their members choice and lots of different watts to connect opened up options for care. She adds, “we did think that this could attract new members who maybe weren't engaged with traditional means because it reduced barriers and was less stigmatized.” Brooke concludes that after adding in Talkspace, some members have seen utilization of their EAP jump 20% in one month.
Asynchronous text based therapy is a wonderful option for many people, including those who cannot talk freely such as those experiencing domestic violence, those with complex schedules such as airline workers, healthcare workers, and young parents, and for those who are new to therapy because it offers a low barrier to entry. Typically, clients with more serious mental illness or more severe symptoms such as those dealing with psychosis or mania may need more treatment than text based therapy can provide.
Pursuing text-based asynchronous therapy is an individual choice and can be an excellent way of accessing mental health care.
You can watch the full webinar here and to hear more conversations about digital mental health, please join us for the Going Digital: Behavioral Health Tech conference on June 8-9, 2022. Registration for the conference is free, or consider making an optional donation to our 2022 non-profit partner, the American Foundation for Suicide Prevention.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
Students are dropping out of school at alarming rates. While the overall dropout rate is 40%, 30% leave before ever reaching their sophomore year – and as of 2021, 71% of student drop-outs cited “emotional distress” as the reason. To say there’s a growing mental health crisis among youth is an understatement, as more and more students face anxiety, depression, and severe mental health concerns. Campus counseling centers are adapting quickly to meet the growing need for quality mental health care, but are often constrained by their own limitations. This is why Mantra Health, a leading provider of young adult mental health care, is working with leaders in higher education to expand service offerings, remove care barriers, and close mental health equity gaps.
Most colleges and universities have a counseling center and this is often the go-to resource for students in need of on-campus care. Often they exist independently of a school’s health center and include licensed counselors or therapists who are responsible for outreach efforts, preventative care, and one-one-one counseling sessions with students. Counseling centers provide vital services, but are often unable to meet student demand because of administrative responsibilities, limited resources, staffing challenges, budgeting constraints, and other factors.
Counseling centers don’t usually have the bandwidth to provide care on weekends, breaks, or over the summer months, nor do they have expertise in specializations, such as psychiatry, making it difficult to treat different states of acuity. To address these concerns, colleges and universities need to expand their mental health offerings to include more diverse and comprehensive care, such as teletherapy, telepsychiatry, crisis care, or unique therapy specialties, which are accessible at any time throughout the year.
Mantra Health has a diverse provider team, 50% of which identify as people of color and majority of whom are trained in unique specialities. Mental health needs are personal – and can occur at any time and place – which is why virtual offerings, flexibility, and personalization are necessary for college mental health care. University students are battling numerous stressors, including work obligations, financial strains, academic pressures, and busy social lives. We can’t expect students to wait three weeks to be seen by an on-campus counselor. More comprehensive needs require more comprehensive care.
Mantra Health, a clinically-informed digital mental health provider, offers colleges and universities a variety of telemental health services, along with an innovative, student-focused platform that supports flexibility, collaboration, and ease of care coordination. Mantra Health works with colleges and universities to provide teletherapy, telepsychiatry, and crisis care to students, but the major difference is Mantra Health’s willingness to work intimately with counseling centers to fill in gaps, provide additional services, continue care through breaks and summer months, and ensure students’ needs are met in whatever capacity they are needed.
On-campus counseling services are necessary to the overall health of a campus and Mantra Health has no intention of replacing them. Rather, the telemental health provider offers an extension of services, working closely with on-campus counseling centers to provide additional care to college students. If students don’t have a car or if they can’t visit the center due to work commitments, academic obligations, or other reasons, they can access teletherapy or telepsychiatry through Mantra Health’s interactive, easy-to-use platform. This is where counseling centers, care navigators, and providers can maintain regular means of communication, ensuring that a student’s care is managed most appropriately and effectively. Should a student need care beyond the academic school year, Mantra Health’s team of providers can work with the counseling center or student directly to extend the student’s offerings, preventing unnecessary disruptions.
Mantra Health takes an evidence-based approach to mental health care. All providers are held to the highest quality standard of care and must maintain clinical and cultural competence. They are highly trained experts who understand the unique needs of college students. Mantra Health’s providers have their own diverse backgrounds, specialities, and perspectives, making them well positioned to work with many different populations of students, many of whom are seeking providers who understand their personal experiences and mental health challenges.
Mantra Health is also one of the leading providers of telepsychiatry for young adults, a specialty area that is hard to find on college campuses, but incredibly important for the well-being of high acute students who face severe mental health conditions. Trained psychiatrists can work with on-campus clinicians and medical providers to assess the physical, mental, and psychological needs of a patient. This is incredibly beneficial when prescribing or managing medication or preventing a crisis situation from developing.
If you want to bring mental health services to your campus or learn more about Mantra Health, schedule a call with our partnership team today.
As stakeholders in behavioral health, we’re all familiar with the importance of access, cost, and quality of care. Access to care has been especially difficult in the field of behavioral health – from the fragmented healthcare system to a shortage in providers. But in recent years, companies have been utilizing technology to innovate how people access care. Although in some cases, this isn’t enough because the cost is too high. And if someone finally finds accessible care that is within their budget, is the quality of that care even worth it?
In an attempt to make the best of all three worlds, AbleTo has various strategies in place to increase access and quality, while reducing costs. We spoke to the team from AbleTo about these strategies and how they are advancing and innovating behavioral healthcare.
AbleTo is continuing to meet the increased need for behavioral healthcare across the nation by ensuring access in 3 ways:
AbleTo partners with insurers to offer our programs as an eligible benefit, allowing us to treat a broad range of members across the socioeconomic spectrum, serving those on commercial, Medicare and Medicaid health plans. Due to the strong health outcomes and medical cost savings, health plans know there is a high value in removing barriers to care to improve the total care of cost such that AbleTo is a fully covered benefit with $0 cost share for 95% of our participants.
We also understand the importance of treating across the mental health spectrum, expanding our platform to meet the recently increased demand amidst the pandemic to enable a population-based approach to deliver the highest quality mental health care to members. Our technology helps us identify those individuals for care, including those who are especially vulnerable to mental health issues due to social determinants of health and comorbid health issues that show up in claims data. Through technology, we’re able to provide high quality, evidence-based care to people when and where they need it most across all 50 states to an eligible population of over 50 million lives. In fact, in 2022 we hit a milestone of delivering over 2 million therapy sessions.
AbleTo also ensures that care being accessed is high-quality and delivered in a culturally competent manner. AbleTo’s network of 2000+ providers includes therapists and coaches across all 50 states. The network is reflective of the culturally diverse landscape of our participant population and is trained to address factors stemming from race and race trauma, racial stress, and issues that may be specific to individuals that identify as LGBTQ+. Many providers in our network are bilingual so participants can converse in the language that is most comfortable for them. Delivering the right care means recognizing that no one patient is the same. Providing the highest possible quality care ensures every patient gets the care they need for lasting improvements in their mental and physical health.
We know mental health isn’t one-size-fits-all. That’s why AbleTo’s suite of solutions ensure individuals get support that is truly personalized to their needs, from program intensity to the mode of delivery. Our 8 week long, Cognitive Behavioral Therapy (CBT) programs are proven to reduce depression, stress and anxiety for those with mild to complex behavioral health needs. With weekly 1-on-1 support from a licensed therapist, behavioral coach, or both, combined with digital tools, we help put learned techniques into daily practice.
AbleTo’s approach to care is simple yet effective. We pair the human connection of empathy, understanding and expertise with digital tools and program resources that advance real life application between sessions. Ultimately, solutions that address the individual complexity and nuances of mental health result in greater positive health outcomes and patient satisfaction, and that’s what we see in AbleTo’s data. We are creating and adhering to a quality standard of care using an evidence-based approach, navigating people to the right programs, and simplifying the member experience through our app. These elements are central to our mission to ensure better outcomes and move the needle for health care.
Our members experience our 8-week programs and return to their lives feeling like they can manage. And for many of our health plan partners, AbleTo is a covered benefit that is 100% free for most people. Our outcomes show decreases in depression and anxiety symptoms along with other health benefits like stress and loneliness score reduction, increased medication adherence, reduced pain severity, reduced in-patient hospitalizations and more. And with a 98% program satisfaction rate among graduates, we know members feel the program works for them.
Demand for care continues to outweigh the availability of quality providers, leaving companies to compete to attract providers to their network. At AbleTo, we are setting ourselves apart on the basis of quality standards of care. As the first behavioral health solutions provider to receive URAC accreditation, we’re constantly adopting the latest tools and best practices to support our providers, allowing them to deliver the right interventions to the right participants, grounded in quality care.
We also value the ability for our providers to grow and develop both professionally and personally. AbleTo's clinical roles expand with opportunities to supervise providers, train and develop providers, oversee network quality, support risk/escalation, shape our therapy programs, and more. Providers are encouraged to seek out and take advantage of any opportunities that interest them such as volunteering, mentorship, training and development, educational resources, and more. Driven by our collaborative culture, providers are equipped with comprehensive training and tools, as well as ongoing support from our skilled clinical supervisor.
Member engagement is a crucial component to achieving positive outcomes for patients. There’s a reason why payers value this statistic so highly. Members must be engaged in the care they are receiving if they are going to change behaviors and reach positive outcomes. If they are not engaged, new solutions may remain unused or underutilized.
Another influential part of quality care is the relationship between the member and the provider (you know we talk quite a bit about therapeutic alliances around here!). A good relationship between the two may look different for each member, depending on what they value most. Some patients may value the use of plain, jargon-free language so they can better understand their provider. Others may seek validation.
mPulse Mobile addresses these two key pieces by measuring and optimizing their Conversational AI platform. mPulse recently interviewed me(!!!) about promoting mental well-being and health literacy by leveraging technology. And now the roles are reversed!!... I sat down with the mPulse team and asked a few questions about their recent collaboration, their member engagement, and actionable conversations. Join us in the blog for another exclusive interview with a key leader in member engagement:
Through our new collaboration, we have enriched our use of an omnichannel communication platform to connect payers, providers, and health systems to their members and patients. Through digital-first health engagement, we combine the power of our conversational AI platform, streaming health education and deep expertise, to deliver personalized health experiences and improve health outcomes.
We have united to strengthen our shared mission of improving health outcomes through market leading health engagement solutions. Together we have unmatched health engagement capabilities that transform how healthcare organizations improve both outcomes and the consumer experience through digital touchpoints, at-scale.
Our teams bring a combined passion and deep expertise in designing and delivering health engagement solutions that unlock enormous value for our healthcare customers. Through this union, we have more resources to deliver an even better service to our customers that retains our focus on innovation, agility and close collaboration.
Over the past few months, we have been focused on identifying the best practices and our most impactful capabilities. This discipline will allow us to optimize our offerings to bring the market even more impactful engagement solutions.
Every member engages differently, so it’s integral to understand which channels are effective with which members, and where you may need to optimize, adjust or give more nudges. Today’s health care consumers have more choices, greater accountability and a wealth of information at their fingertips. They want their health care experience to be simple, personalized and convenient — anytime, anywhere.
Member engagement is the foundation of payer success. With so much at stake, how do we know that our engagement tactics are making the mark?
Innovative engagement technology, complete with accurate measurement, enables continued improvement of engagement. Payers should count on engagement technology that provides reporting which illustrates what is impactful for member programs to achieve best practice member retention and satisfaction, improved health outcomes and cost reduction.
mPulse’s Behavioral Data Science team and Conversational AI platform combine the acumen and automation to intelligently tailor conversations to build stronger, more impactful relationships with members and patients. Natural, plain-language conversations create understanding and trust. This trust makes people more likely to take key actions to improve their health and help payers reach their organizational goals.
Relationships are the key to activation and behavior change that ultimately drives positive outcomes. It's also about data and insights. That's how we get to know the consumer and honor their preference.
We have patented technology that facilitates this key differentiator. mPulse partners with more than 150 healthcare organizations including 9 out of 10 of the nation's largest payers and many local and regional plans. We have engaged more than 50 million consumers with 1 billion automated conservations each year.
The current mental health care system unfortunately is not adequately addressing the roughly 50 million Americans who experience a mental illness. In fact, it takes on average 11 years from onset of mental illness symptoms to treatment. Additionally, 55% of US counties do not have a single practicing Psychiatrist and 148 million people live in a designated Mental Health Professional Shortage Area. With these statistics, the current US model for mental health treatment needs to find new ways to address the disconnect between the need for mental health services and the lack of available providers.
Integrated care, which is the partial or full blending of behavioral health services with general medical care, is one solution for addressing this problem. We recently hosted a webinar on “How Technology can Support your Journey Towards Integrated Care” with panelists Dr. Frank Webster, the Behavioral Health Chief Medical Officer at Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, Kacie Kelly, Senior Vice President for National Policy Implementation at the Meadows Mental Health Policy Institute, and Dr. Tom Zaubler, Chief Medical Officer at NeuroFlow. On the webinar, we discussed how integrated care overall could solve for several key challenges the behavioral health industry is facing. More specifically, we talked about the benefits of one model of integrated care called collaborative care.
Collaborative care is a specific type of integrated care using a team-based model of treating behavioral health in the primary care setting bringing primary care and behavioral health clinicians together to provide treatment. All patients in a primary care clinic are universally screened for psychiatric illness as part of their visit. Collaborative care has been studied in more than 80 randomized control trials and has been shown to improve patient outcomes, patient and provider satisfaction, and reduce healthcare costs.
Collaborative care in practice may have primary care physicians meeting with patients and prescribing medications, while Psychiatrists are often used as a caseload supervisors. Dr. Zaubler explains that “this allows Psychiatrists to manage a much larger caseload of patients than if they were seeing them individually.”
Offering behavioral health interventions in primary care settings is convenient, can reduce stigma, can deepen the patient-provider relationship, and can improve care for those with co-occurring mental and medical conditions. In our webinar, Dr. Zaubler noted that “95% of all mental health providers are practicing in siloed settings. And yet, when patients present with their psychiatric problems, roughly 80% either present in medical settings for their psychiatric care. There's a huge disconnect here in terms of where people are seeking care and where the care gets delivered.” Collaborative care attempts to bring together where people are already seeking care and the need for greater behavioral health care.
While the evidence supporting collaborative care continues to grow, uptick and adoption remains scant when it comes to implementing collaborative care across providers.
We have evidence that collaborative care is beneficial, but what challenges do health systems and providers face when trying to implement collaborative care? To start, some primary care physicians may have anxiety about a new way of doing things and disrupting current workflows. There is particular concern around prescribing psychiatric medications, which is why it's important to create an environment where primary care physicians feel supported by their behavioral health team and clinical decision support tools.
Additionally, creating a sustainable model of collaborative care requires an upfront investment. Health systems may be hesitant to adopt a new way of working that includes upfront costs. That’s where partners such as the Meadows Mental Health Policy Institute can be beneficial and Kacie Kelly remarked that, “we come in and oftentimes leveraged philanthropy to offset transition costs or startup costs and then help the practice with the operational workflow changes that need to happen, help them understand the changes with billing and reimbursement, and overall practice changes.” In fact, Kacie remarks that collaborative care “can be cost neutral around 6-9 months of utilization, and cost savings at the 9 month mark.” Collaborative care ultimately leads to cost savings through decreased medical utilization, emergency department visits, and inpatient stays.
An important component of collaborative care is measuring patient symptoms using validated measures such as the PHQ-9, a questionnaire screening for depression, and GAD-7, a questionnaire for anxiety. However, this can be time consuming and can create more paperwork for the front desk staff members.
Finally, there can be challenges for health plans reimbursing properly for behavioral health. Dr. Webster noted that “behavioral health typically makes up 3-5% of healthcare costs for commercial insurance. However, it's important for people to understand that 3-5% has a huge impact on medical costs.” Additionally, providers need to understand that they can bill and be reimbursed for these behavioral health assessments.
We’ve seen the reasons why collaborative care is so important and obstacles to pursuing it, but how can technology help us implement this strategy? Digital solutions can plug into various parts of an integrated care model, as shown in this diagram from Raney et al.
One digital solution, NeuroFlow, is a two-sided behavioral health platform that leverages technology to both remotely assess and identify patients appropriate for collaborative care as well as increase the efficiency of the care teams managing the patient panel. NeuroFlow’s engagement platform allows patients to quickly and easily complete assessments such as the PHQ-9 and GAD-7 in the comfort of their home and immediately engage with relevant clinical content based on their scores. At the same time, their providers and supporting BH care team collaborate on their treatment through a tech-powered registry that populates information directly into electronic medical records, allowing providers to track patient progress over time and be alerted to patients who are at risk. Their combined offering of technology and clinical services showcases the exciting road ahead for empowering care teams with technology to help scale proven models of care.
Another example is Valera Health, which acts as a practice extender and telepsychiatry option. Patients access Valera Health through a mobile app and are triaged by health connectors and then routed to therapists and/or psychiatrists as needed for telehealth visits. Patients then access appropriate self-guided programs and exercises to stay engaged.
Finally BCBS utilizes the Learn to Live program. Health plans have unique challenges because they use claims as healthcare information, but they cannot tell what is happening today, or predict future care. Additionally, health plans have billions of clinical data points but as Dr. Webster mentioned, “getting claims organized and sorted is really difficult.” To address some of these issues, BCBS utilizes the Learn to Live program, which is an online platform where individuals can take assessments and then receive web-based CBT lessons and live clinician coaching. Patients receive treatment and health plans can capture their assessment information as clinical data to help them get targeted resources to the people that need them.
1. Work with experts
Look for behavioral health providers who are well versed in collaborative care to help you with your founding team. Having technical expertise will make a huge difference in the success and longevity of your program.
2. Think creatively about startup costs
Ultimately, collaborative care leads to cost savings, but look into philanthropic options if you need help with startup costs.
3. Remember your CPT codes
Have your staff start getting used to billing CPT codes for all behavioral health assessments to ensure proper reimbursement.
4. When integrating technology, focus on measurement
As Kacie Kelly noted in our webinar, “I would encourage you, as you’re trying to figure out how to extend your workforce and how to get people tools between sessions, to really prioritize those tools that are measuring the outcomes and the impact” of your intervention.
To dive deeper, check out the full webinar, review a helpful collaborative care Q&A from NeuroFlow, and please join us for the Going Digital: Behavioral Health Tech conference on June 8-9, 2022. Registration to the conference is free, or consider making an optional donation to our 2022 non-profit partner, the American Foundation for Suicide Prevention.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
Is the answer to the mental health provider shortages more humans or robots? Perhaps a lil of both!
Artificial Intelligence (AI) has been a hot buzz word for years now, but things have really been picking up when it comes to AI specifically in behavioral health. Some companies are leveraging AI to evaluate the emotional state of an individual user and then automatically triaging them into the appropriate level of care, whether that be a lightweight self-guided solution or hands-on intervention with a professional.
The team from Wysa, a popular app that uses AI to support mental health, shared insights on how they are helping users self-manage stressors by blending AI-guided listening with professional expert support. Read more about their approach and what’s on the horizon next at their startup:
Artificial intelligence provides a unique opportunity to provide support on an individual level by understanding the user and determining an appropriate intervention based on the user’s expressed needs. Wysa is the world’s leading AI-based digital companion for behavioral health. Wysa scales access to mental health support with 365/24/7, anonymous, quality care delivered via an easy-to-use app interface. Wysa supports the broad care spectrum; at a subclinical level Wysa bypasses the need for human intervention thereby reducing provider burden and ensuring immediate access to mental health support. For those at a clinical level, Wysa’s digital assessments and e-triaging ensure real-time escalation to the appropriate level of care, including access to Wysa licensed coaches and therapists, thereby improving provider productivity and reach.
Wysa’s clinical efficacy has been measured in real-world studies, clinical trials and now, in RCTs. For the past three years, Wysa has consistently ranked as the highest-rated app on ORCHA (the digital health app rating agency in the UK), on the basis of an evaluation that examined - the evidence surrounding it, the quality of evidence-based content within the app, usability and accessibility scoring, and its capacity to protect the data of its users. In the review, Wysa’s compliance with ISO standards as well as DCB 0129 (NHS Clinical Risk Management Standards) were also noted. The techniques used within Wysa are based on proven evidence-based paradigms of psychology and mental health, such as cognitive-behavior therapy and mindfulness-based therapy. In an independent analysis, Dr. Wasil at Harvard University (2019) had examined all popular apps for anxiety and depression, and concluded that Wysa was the app with the highest number of evidence-based elements.
In 2018, Inkster et al. (University of Cambridge) looked at the effect of Wysa on users with different degrees of engagement. They found that the high users of Wysa had significantly higher average improvement (mean 5.84 [SD 6.66]) compared with the low users group (mean 3.52 [SD 6.15]) on their depression and anxiety levels.
This is a very exciting time for Wysa! In conjunction with psychologists around the world, we are creating dedicated new programs to serve individuals with specific concerns of worry, anxiety, depression, social phobia, substance use, and maternal health. We are also beginning to release a version of the app in Spanish. This year, Wysa is dedicated in its focus to curate specific and targeted interventions and increase access to mental health support globally. In an effort to make things easier, scalable, and more effective, we are also building out our new therapist companion which will greatly improve the in-person therapeutic experience based on insights gained from Wysa.
Wysa also currently has solutions for both health systems and insurers with a focus on both population and person-centered care. We've learned a lot in the past few years from our research about important use cases that could really move the needle in terms of things like chronic pain and adolescent care. We are excited to offer these solutions to our valued partners.
The FDA explains real-world evidence as “the clinical evidence regarding the usage and potential benefits or risks of a medical product derived from analysis of RWD. RWE can be generated by different study designs or analyses, including but not limited to, randomized trials, including large simple trials, pragmatic trials, and observational studies (prospective and/or retrospective).”
While many a mental health or chronic disease startup can generate conclusions about their solutions in a clinical trial, but evidence gained out in the harsh real world can provide a true picture of a clinical intervention’s impact on people’s lives day to day.
This week, Holmusk's Chief Medical Officer, Dr. Scott Kollins, shares more about Holmusk’s approach to leveraging data to transform mental health care measurement, delivery and quality:
Holmusk is building the world's largest real-world evidence platform, starting with behavioral health. There is a critical need for better evidence in this space, where measurements and assessments are often subjective. Holmusk provides a range of digital solutions to help generate evidence in studies examining a range of behavioral health conditions, including major depressive disorder, opioid use disorder, schizophrenia, and ADHD.
Our NeuroBlu Research platform enables pharmaceutical companies to build cohorts from a database that contains more than 20 years of data on over 1,000,000 patients, as well as perform advanced analytics to generate new insights about these patients. NeuroBlu Research has been used for applications ranging from developing new understanding about how to treat young children with ADHD to building a predictive model to ascertain which patients are most likely to stop treatment for opioid use disorder.
One of the data sources that feeds our continuously growing behavioral health database is our MindLinc EHR. We have designed MindLinc specifically for behavioral health settings, aimed at providing real-time analytics to behavioral health providers and their clinics and creating stronger, clinically meaningful ways of increasing engagement between patients and their providers. MindLinc's unique emphasis on high-quality data capture not only fuels stronger research, but it also enables evidence-informed care that leads to improved outcomes across the behavioral health ecosystem.
MindLinc's unique emphasis on high-quality data capture not only fuels stronger research, but it also enables evidence-informed care that leads to improved outcomes across the behavioral health ecosystem.
We recently entered into a collaboration with Metrocare Services, the largest provider of mental health and developmental disability services in North Texas. The agreement will play an important role in advancing both behavioral health research and value-based care by enhancing Holmusk's RWE platform through secured, de-identified AI-powered analytic models that help drive improved clinical outcomes. In addition, Metrocare will have access to Holmusk's data analytics tools to provide insights that will improve delivery of care within its health system.
Behavioral health technology companies are innovating solutions left and right to address the supply and demand issues prevalent in our industry. One unique solution that has surfaced is VoiceAI. VoiceAI saves time for clinicians by passively generating data and identifying best practices during sessions.
VoiceAI saves time for clinicians by passively generating data and identifying best practices during sessions.
By minimizing the administrative work that mental health clinicians have to do, VoiceAI is creating more availability dedicated to actually providing care. The reported data can be transformative to individuals, providers, and companies.
Alon Joffe, CEO of Eleos Health, provided some further insights on VoiceAI capabilities and its impact below.
The behavioral health field is struggling to keep up with the surge in demand for services. We need four times the number of clinicians that we have today just to keep up with individuals requesting care. The workforce shortage puts extreme pressure on clinicians creating large caseloads and a high administrative burden. Clinicians do not get into the field to do paperwork, they get into the field to help individuals.
There has not been a solution until this point, mainly because no one has ever built modern tools dedicated to clinicians in behavioral health. In our space, a big part of the treatment is the conversation. With the advances in voice and natural language processing (NLP) in the last five years, these technologies are approaching human levels of accuracy of 95%. Coupled with our ability to identify the information to make sure it’s HIPAA compliant, safe, and secure — we believe it is time to leverage those conversations to make a difference.
Eleos believes the advances in these technologies will allow clinicians to focus more on care delivery and less on operations. This is why Eleos Health is about to introduce a new category to the market.
This new category will empower clinicians to focus on what matters most while optimizing the workflow by offering insights into sessions while assisting with operations all the way from documentation to reimbursement. Stay tuned.
The synchronization of medical, behavioral health, and social determinants of health (SDoH) data is considered the holy grail to drive outcomes for the whole person. Behavioral health comorbidities with physical health conditions are a key driver for the total rising costs of care (2-6x on a per member per month basis) and are often linked to other socio-economic and SDoH issues.
By running in the background of calls/meetings/sessions, Eleos Health allows providers to generate performance data right from the conversation passively. The data is then used to provide insights on the use of evidence-based practices. At the same time, it automates the collection of consumer-reported outcomes providing the basis for measurement-based care. Together these give clinicians actionable insights to help individuals get better, faster.
To get at the heart of value-based care, Eleos Health’s use of unstructured data points provides a unique solution to integrate medical, behavioral health, and SDoH domains by closing gaps in care, identifying best practices and infusing them back into the clinical workflow, managing care longitudinally, increasing consumer satisfaction, and lowering medical loss ratio – all while improving outcomes.
For clients, we can improve treatment outcomes. When using the Eleos Health platform, depression symptoms, as measured by the PHQ-9, as well as other symptoms such as anxiety and more, have decreased faster compared to treatment as usual (48% throughout treatment compared to care as usual settings, where depression symptoms decrease 30-35% throughout treatment).
One of the main benefits for clinicians is a 35-40% reduction in documentation time. Eleos writes a base note for the clinician based on data collected in the session. Eleos Health can also automate manual EHR clicks and, for one clinic, reduce manual click time by 90% for group sessions.
For compliance staff, Eleos Health identifies compliance risks and helps avoid clawbacks. Unlike a human, Eleos Health’s artificial intelligence reviews every note generated for billing for red flags such as mismatched CPT codes, generic or copied notes, and wrong session duration times. In an analysis of 5,000 notes at a large telehealth company, Eleos Health was able to identify 95% of improper documentation, identifying over $70,000 in potential clawbacks.
As a teenager, I recall the dreaded experience of what felt like I was surely dying. Or so, I thought at the time. In fact, I later learned that it was my first panic attack. Panic disorder is a debilitating condition that stops individuals from work and life, and the NIMH says an estimated 4.7% of U.S. adults experience panic disorder at some time in their lives.
My experience only made me more excited to learn about interventions supporting people struggling with panic attacks and PTSD. GDBHT partner Freespira is the first FDA-cleared digital therapeutic that significantly reduces or eliminates symptoms of panic attacks, panic disorder and post-traumatic stress disorder (PTSD) in only 28 days.
As a refresher, digital therapeutics are a non-drug alternative to treat, manage, and prevent various disorders. Some digital therapeutic companies cover a broad spectrum of conditions. However, others choose to focus on specific conditions. Those digital therapeutic companies which pursue a narrowed focus conduct deep dives into research on clinical outcomes, cost savings, and overall impact for a specific condition.
Those digital therapeutic companies which pursue a narrowed focus conduct deep dives into research on clinical outcomes, cost savings, and overall impact for a specific condition.
This week, I’m joined by Freespira’s Chief Clinical Officer, Bob Cuyler, PhD, to discuss this new digital therapeutic treatment in the blog this week:
Freespira has the first FDA-cleared digital therapeutic to significantly reduce or eliminate panic attacks, panic disorder, and post-traumatic stress disorder (PTSD) symptoms. You have some exciting study outcomes with partners like Highmark. Tell us about it.
Freespira collaborated with Highmark Health and Allegheny Health Network on a study of patients diagnosed with panic disorder (Kaplan et al., 2020). Researchers measured clinical outcomes and cost reductions over a full year following treatment with Freespira and the results were notable.
In terms of outcomes, 91% of patients reported significantly fewer symptoms at the one-year mark, and 68% were in remission as measured by the Panic Disorder Severity Scale (PDSS). These long-lasting results also contributed to cost savings. Overall medical costs were down 35%, pharmacy costs dropped 68%, and emergency department costs were 65% lower.
Another Freespira client is a managed Medicaid plan. In less than 12 months, the plan is seeing positive clinical and financial results. Of the patients treated with Freespira, 70% have achieved clinically significant reductions in their panic disorder and PTSD symptoms after the 28-day treatment – an outcome that compares favorably with traditional treatment via medication or psychotherapy. Early data point to a nearly 40% reduction in medical costs, which we expect will improve further when measured a full 12 months after treatment. Both clinical studies and real-world results are vitally important when health plans and providers evaluate digital therapeutic treatments as part of their behavioral health strategies.
Both clinical studies and real-world results are vitally important when health plans and providers evaluate digital therapeutic treatments as part of their behavioral health strategies
It’s great when research demonstrates impact, but the treatment has to work in real life, too. Freespira has shown benefit in both in studies and everyday practice, which is contributing to our growing adoption.
Freespira does a lot of work with the Veterans Administration. How are you supporting veterans to reduce or eliminate panic attacks and PTSD symptoms?
Yes, veterans are very important to us. Freespira is available through Veterans Healthcare Administration benefits and as you might expect, the need is high. An estimated 11-20% of veterans have been diagnosed with PTSD (U.S. Dept. of Veteran Affairs) while more than 8% meet the diagnostic criteria for panic disorder (Gros et al., 2011).
In trying to treat these conditions, veterans face challenges ranging from transportation for appointments to finding qualified providers nearby to feeling stigma around behavioral health issues. And psychotherapy and medication don’t work for everyone. Medication side effects and reluctance to take part in exposure-based therapies are significant hurdles.
In a survey we conducted with veterans, we found that 77% expressed interest in trying a PTSD treatment that does not involve additional medications or long-term therapy. The Freespira alternative is a medication-free, at-home, adjunctive treatment. Our 28-day treatment is convenient. It’s supported by virtual coach visits and the equipment ships directly to patients.
A study of PTSD patients at the Palo Alto Veterans Affairs Health Care System showed that 89% had a clinically significant reduction in PTSD symptoms after the 28-day Freespira treatment, with 50% of participants still in remission six months later (Ostacher et al., 2021).
I am looking forward to the upcoming webinar with you. What can audience members expect to learn?
Yes, we're excited to have you moderating a panel discussion on Mar. 1, 2022: “An Rx for Behavioral Health Equity—Digital Therapeutics.”
As most of us know, the pandemic has affected mental health and changed the ways patients receive care. The need for new, accessible behavioral health solutions has ramped up significantly, and digital therapeutic treatments help address critical gaps.
We’ll discuss how to evaluate and deploy digital therapeutic treatment solutions, which transcend common treatment barriers while effectively addressing access, adherence and symptom management.
Attendees will learn about five key characteristics of digital therapeutic adoption:
AHIP, the national trade association representing the health insurance community, is co-sponsoring this timely and fascinating conversation. We invite your readers to register for the webinar on the AHIP site with this link.
In 2022, digital therapeutics continue to make headlines. As defined by the Digital Therapeutics Alliance, digital therapeutics (DTx) deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.
While there are many digital therapeutics solutions on the market today that target a specific condition, few companies have developed a comprehensive suite of digital therapeutics to integrate a variety of physical and behavioral health issues. One such company is DarioHealth. They develop digital therapeutics to provide a holistic approach to care, and they have seen increased attention from employers in the past year. The DarioHealth team shared with us more about their digital therapeutics, why it’s advancing the way they provide care, and the outcomes they have seen thus far.
Dario was created for one purpose: to make it easy for people to manage chronic conditions. Our digital therapeutics platform was originally designed for diabetes but has since expanded to other commonly co-occurring conditions and those that are reactive to behavior, including diabetes, weight management, musculoskeletal and behavioral health. Today, our platform can monitor the patient’s entire journey and adjust the experience and support as necessary using real-time data from apps and our connected devices.
Dario Digital Therapeutics are designed with a user-centric approach that provides an integrated experience for people with multiple chronic conditions, looking at their whole health for the best overall results. This is something that is attractive to employers as well. We are hearing from employers of all sizes interested in lessening the burden of managing chronic conditions for their populations and seeking solutions that can provide a better, more holistic experience that can deliver on the promise of lasting results.
Digital therapeutics are accelerating progress in both digital and traditional health care by shifting the paradigm from provider-centric to consumer-centric. When Dario launched as a direct-to-consumer solution, we had to design an experience that would keep people engaged with our solution and ultimately, their health, by offering highly personalized support for everyday life. This fundamentally changed how people access and experience care by creating value for the users as well as our partners.
Dario’s digital therapeutics solutions combine real-time data, technologies, and human expertise in a single platform helps create a more effective way to improve whole health. By scaling our consumer-centric approach across multiple conditions, we can deliver a truly holistic approach that addresses the common underlying behaviors for more sustainable change and longer-lasting results.
Dario’s approach is anchored in billions of data insights from more than 10 years of engagement, enabling a hyper-personalized experience for each person on our platform that adapts to changing needs and preferences to keep people on track. This allows us to effectively attract and retain people in our solutions and on our platform year-over-year. In fact, 80% of our users stick with Dario after the first year.
That ability to keep people engaged with healthier behaviors leads to outcomes that last, and our 28 clinical studies with plenty of evidence that demonstrates how we can help people sustain positive clinical outcomes for more than two years.
Seeking behavioral healthcare can sometimes be challenging due to long wait times to see a provider. However, one revolutionary partnership is changing that for over 15 million members. GDBHT partner New Directions Behavioral Health has acquired Tridiuum, another GDBHT partner, creating a leading provider of technology-enabled behavioral health services. This partnership will decrease wait time, increase access to care, and improve quality of care. Shana Hoffman, President & CEO of New Directions Behavioral Health, and Mark Redlus, CEO of Tridiuum, spoke with me about their partnership. Read our exclusive interview here:
Shana: By integrating Tridiuum’s leading technology platform with our best-in-class care management team, we are able to immediately schedule members with our comprehensive network of behavioral health providers. In the behavioral health ecosystem, current average time to care sits at around 25 days, with some patients waiting over 90 days for their first appointment. Achieving an average time to care of just four days is game-changing for our members. With increased speed and ease of access, we are able to eliminate many of the barriers faced by individuals nationally, while expanding the number of untreated and undertreated members in care. More than 100 providers groups have joined this program already in its first phase, and we look forward to expanding our reach even further.
Mark: At a time when the need for behavioral health services is incredibly high, this combination allows us to set a new standard of care. Our technology utilizes population analytics to enable value-based contracting and maximize network quality. Jointly, we will be providing users with real time information to support improved clinical decision making while also measuring quality of care. The result is accelerated access to the most appropriate care for New Directions’ members. At Tridiuum we’ve reimagined how to deliver timely care in the past, so to be able to do that again – and to now do so with the support of and in partnership with New Directions – is special.
Shana: It’s important to remember that Tridiuum’s technology is already used by nationally recognized medical and behavioral health plans. Likewise, at New Directions, we support our over 15 million members in partnership with health plans, employers and higher education institutions. By now fully integrating Tridiuum’s suite of solutions with our existing care navigation and human services capabilities, we will be able to together deliver even smarter outcomes at scale to both new and existing members. Our health plan partners will now be able to have access to Tridiuum’s products and New Directions services to replicate the experience we’ve already demonstrated with our customer Florida Blue.
Shana: One of the reasons why this is so exciting is that our two companies share similar missions. This became clear as I got to know Mark in recent months as we launched our partnership and worked to close this transaction. His passion and vision to advance behavioral health aligns with that of mine and New Directions. I look forward to together building a new path in behavioral health that will revolutionize access to quality care for all.
For those who are interested in more information about our combined offering, please contact communications@NDBH.com.
When it comes to conditions such as depression and anxiety, there is no one-size-fits-all treatment. Each treatment plan must be personalized and data-driven in order to achieve better outcomes.
Precision treatment models use data to personalize care to the individual and their symptoms. Dr. Mimi Winsberg, CMO of Brightside, shared with me how effective their precision care model is and why it's intriguing to payers. We discussed shifting trends in behavioral health and what payers are looking for in behavioral health solutions. You can read our conversation below.
As the pandemic continues to drive unprecedented demand for depression and anxiety treatment, patients are finding that access to quality providers is severely limited. They may have to wait weeks or even months to find a specialist, and the treatment they do receive often comes from primary care providers who are not set up to deliver successful mental health care. In addition, very little measurement-based care is practiced, so efficacy is hard to demonstrate.
The widespread adoption of telemedicine and reabsorption of behavioral health benefits by payers has certainly increased access, but access alone is not enough. Delivering the quality of care that payers, employers, providers, and patients demand requires a data-driven approach to diagnosis and a closed-loop treatment model—both of which are uncommon in the mental health space. Because “what gets measured gets managed”, it is only by quantifying outcomes that we can work to improve them.
Of course, it’s difficult to measure or assess a treatment protocol that hasn’t been standardized. Telepsychiatry and teletherapy have followed a somewhat haphazard approach—we really don’t know what’s happening in Zoom rooms. What are providers communicating? What are patients absorbing? How is the right medication selected? And what are their therapy sessions accomplishing? Effective and quality mental health treatment is evidence-adherent and follows standardized, measurable protocols.
Also, most telehealth solutions are designed for people with mild to moderate anxiety and depression but don’t provide options for those higher on the severity and complexity continuum. Only a data-driven approach can significantly improve the quality of care, enabling treatment that’s both convenient and personalized—which today’s consumers demand of all service industries. Addressing these limitations in access and quality is what drives Brightside’s founding mission. By driving superior outcomes and addressing the segment of the market with more clinical burden, Brightside has all the rigor of a healthcare company in addition to all the innovation of a technology company.
Mental health conditions like depression and anxiety are highly heterogeneous—they can present in hundreds of ways: for example, two patients can share just one symptom and get the same depression diagnosis. Selecting and delivering the right treatment for each individual is critical in order to achieve the best outcomes.
Brightside’s precision care model enables its psychiatrists and therapists to quickly match each patient with the appropriate treatment, resulting in better outcomes, faster. Rather than simply bucketing a patient into a general diagnostic category, and then spending precious time on trial and error treatment selection, Brightside providers leverage data-driven, evidence-adherent solutions for both assessing and treating each patient’s unique symptom clusters. Progress is tracked continuously, and follow-ups are proactively scheduled when a member may need support. This efficient approach allows providers to minimize administrative tasks and focus on delivering quality care to those who need it most.
Offering patients nationwide access to precision psychiatry and therapy within 48 hours dramatically streamlines the care journey. Brightside’s proprietary algorithm, PrecisionRx, optimizes initial treatment selection, and our smart platform allows patients and providers to track the progress of personalized protocols on a granular level to achieve outcomes far superior to traditional treatment.
By delivering access to high-quality personalized care at scale, Brightside’s world-class providers help patients across the severity and complexity spectrum feel better, faster, and stay that way. Our next-generation platform is delivering life-changing depression and anxiety treatment and establishing a new standard of care for the telemedicine age, while also leading the transition from fee-for-service to value-based care.
For many years, a large portion of behavioral benefits were outsourced from payers to MBHOs (Managed Behavioral Health Organizations), similarly to how pharmacy is outsourced to PBMs (Pharmacy Benefit Managers). But this period included longstanding and pervasive problems with access, measurement, care integration, and quality. Vocal employers, members, and providers have long been demanding better solutions.
Payers are listening. Beacon, Magellan, and New Directions have now all been acquired by payers, as payers reinvest in behavioral health care and demonstrate commitment to better access, quality, and cost. Telemedicine has been both a catalyst, and an accelerant, offering new tools and approaches to help payers achieve these goals.
Payers are looking for a few key factors beyond access to behavioral health care providers. First, they want effective care with better clinical outcomes and lower cost. Data is of course essential to driving better outcomes and reduced costs, including measurement-based care delivery, deeper insights into member needs, and cost impact analysis.
Second, payers want to stand out based on their behavioral offerings. This means offering integrated solutions that meet the needs of their employer customers, ensuring that employers can get all of their solutions through the payer, obviating the need for ancillary siloed service providers.
Third, payers want to support their large provider networks, particularly those that are risk bearing, like ACOs (Accountable Care Organizations). These ACOs are taking on behavioral health risk without strong tools and skills to manage it.
Brightside was built to deliver measurably better care at scale, even among the hardest to treat member populations. We deliver industry leading outcomes - 50% better rates of treatment response and remission than a leading US health system, or our closest competitor, nationwide, with appointments available within 48 hours.
In doing so, Brightside is opening up the path to true value based care. Because we stand behind the quality of our care model, we’re happy to put our dollars behind delivering outcomes, not just care. We’re collaborating with our payer partners to finally open up value based care in mental health.
I’ve talked frequently about the need for more personalization and access to the right specialists in mental health and substance use care. Personally, I recall the struggles my family faced with finding an adolescent OCD and anxiety specialist. This week, we have an exciting interview with one company who is making leaps and bounds towards improving provider data accuracy to support patients in getting the exact right care they need. Ribbon Health just raised $43.5 million in series B financing from General Catalyst, Andreessen Horowitz (a16z), BoxGroup, Rock Health and an investment from Sachin Jain, president and CEO of SCAN Health Plan. Join me for an exclusive interview with Ribbon Health and some of their investors in the blog:
Ribbon Health offers the most comprehensive, accurate API data platform that is the infrastructure for a future where every patient care decision is convenient, cost-effective, and high-quality. Built to integrate seamlessly into existing healthcare workflows, Ribbon offers a reliable and straightforward way for health plans, providers, and digital health solutions to develop and maintain accurate provider directories and competitive networks, simplify referral management, and ensure efficient care navigation — all in one platform.
At Ribbon we power more intuitive provider searches and better matches between patients and behavioral health specialists. As part of our Focus Areas data set, we provide information on almost 500,000 behavioral health specialists, including the type of specialists, conditions they treat, and treatments they offer. One example would be someone who treats sleep disorders and also conducts sleep studies - this is something very detailed that would be hard to find without Ribbon's data. In addition, data on behavioral health specialists is often inaccurate, and Ribbon seeks to get people to not only find the right care, but also show up at the right place.
We are incredibly proud and excited to share our $43.5MM Series B funding round, led by General Catalyst and joined by previous and new investors that include a16z, BoxGroup, Rock Health, and Sachin Jain.
This funding will enable us to accelerate and scale Ribbon Health, creating even more value for our partners with exceptional talent and technology. We will expand our reach across health plans, provider organizations, and digital health solutions. Ribbon will improve the health plan member experience with enhanced provider matching and data management and strengthen health plans’ competitive moat by delivering unique insights on network adequacy and design. Ribbon will continue to solve key navigation and referral challenges, improve care operations, and drive meaningful growth for our customers. Importantly, by investing in our platform’s distribution and ease of use, Ribbon will seek to eliminate the problem of data inaccuracy altogether and ultimately partner with all healthcare companies that seek to build solutions that drive positive patient experiences and better healthcare outcomes.Ultimately, Ribbon will become the connective tissue that allows patients to find the care they need across any touchpoint in the healthcare system.
Accurate provider data, delivered through our flexible and intuitive API data platform, is the infrastructure for a future where every care decision is convenient, cost-effective, and high-quality. Delivering on these goals will require an experienced, passionate team, and so today, we say – join us. We’re ready to simplify healthcare.
Interested in Ribbon’s data? Contact us to learn how we can help.
We are excited to have Holly Maloney, Managing Director at General Catalyst, join the Ribbon board given her strong connection and dedication to our mission and vision. "Ribbon is on a path to power the next generation of care navigation for both patients and referring clinicians,” said Holly Maloney, managing director at General Catalyst. “What Ribbon Health has built is not only a leading healthcare data platform that solves the decades-old issue of not being able to easily find the highest quality and most affordable clinician but a mission-driven culture that has set them up to scale and succeed. General Catalyst is thrilled to be leading Ribbon’s Series B, as they share our vision of healthcare as a powerful, connected ecosystem.”
We are also thrilled to have continued investment from Julie Yoo, General Partner at a16z, who is equally as dedicated. "That's one of the attractive factors or dimensions of infrastructure bets is that you truly get an index on what’s happening across healthcare. One of the reasons that Ribbon stood out to us was its ability to create network effects. Every single day, every single minute that organizations use Ribbon, the data gets better and better. And, it almost becomes one of the only sources of truth, because there really is no source of truth for provider data at a national scale,” said Yoo.
We look forward to partnering with all of our investors to help grow and scale Ribbon into the future.
Last month at the HLTH conference in Boston, I got to meet with Dr. Caroline Carney, CMO of Magellan Health, and Chris Molaro, CEO of NeuroFlow. After so much time without in-person gatherings, it was refreshing to reconnect with members of our GDBHT community. We talked about how NeuroFlow and Magellan Health are working together on an initiative to support a health plan for suicide prevention efforts, using technology to proactively identify individuals needing support and getting them access to mental health support. Read more about their collaboration via the Q&A with Chris and Dr. Carney below.
Chris: It had been quite a while since our last in person event, so it was even more exciting to reconnect with partners, customers, and team members. The agenda called for two separate workstreams dedicated to mental and behavioral health which I think is a great indicator of not only the increased focus on the topic but all the exciting work being done to address the challenges of truly integrating behavioral health.
Dr. Carney: The event really showcased how far we’ve come as a country and as innovators in reducing stigma against those with mental illness and in bringing forward innovative solutions to address the needs of persons with behavioral health needs, physical health support, and integration of these.
Dr. Carney: Magellan rolled out our new model earlier this year, focusing on transition of care and care management needs. We know in real time when a person has entered a higher level of care because of suicidal ideation or an attempt. Our care managers identify those members and outreach to the member to be enrolled on the NeuroFlow platform. Through the platform we can push out evidence-informed content, send messages, and interact to better meet the member’s needs. The 30-90 days following a suicide attempt is when it is most critical to provide support and keep an individual linked to care. During the early months of the pilot, nearly a dozen individuals were provided resources and offered to connect with a care coordinator. Those are precious lives that could have fallen through the cracks and not gotten the level of direct support provided through this collaboration.
Chris: Put simply, we’re coming together to get the right people to the right level of care at the right time by building the first of its kind operating system centered around behavioral health. And the engagement has been outstanding, 92% percent of registered users have completed at least one assessment in the last month, but as Dr. Carney mentioned, the real value add here is in the link between the engaging, personalized experience for the end user back to a clinical dashboard that helps to risk stratify individuals and flag those who were marked needing elevated levels of support.
Chris: Just recently, a member triggered an at-risk alert and a team member responded by emailing her resources and an offer to provide more support. She then emailed NeuroFlow requesting support in connecting with mental health treatment that led to a phone call where we found a psychiatrist who she could see through telehealth who was also in-network for her. We scheduled an appointment for her that was just 8 days away, entered her insurance info on their website and she received a confirmation email right away. To me, that’s a great example of technology and human support coming together to help achieve our mission. That’s one person that may not have received the support they needed.
Dr. Carney: The care manager feedback has also been very positive. Their role to this process is critical as they serve as a liaison between the member, the provider and the Magellan psychiatric consultant who recommends the best course of action. Here was a review we received from one of the care managers trained on NeuroFlow:
“I offer [NeuroFlow] to every individual. I love that this is an option and all feedback has been positive. Members love mindfulness and the education available.”
Chris: We initially rolled it out to a subset of Magellan’s population, specifically for people that have recently been discharged from an in-patient stay or emergency department visit but the impact and feedback has been so impressive that we’re planning to expand the project. There are also product enhancements we’re considering around the behavioral economics and gamification for the mobile app as well as customized reporting and dashboarding for the care team platform.
Dr. Carney: Our collaboration with NeuroFlow has shown how creative and collaborative organizations can be when focused on the right things. We value this relationship and are excited about new opportunities rolling out in the near future!
It has been wonderful to see these two GDBHT organizations work together towards integrated collaborative care, and we can’t wait to see how they continue to address accessibility to care in the future. Take time to watch the full Magellan Health and NeuroFlow sessions from Going Digital: Behavioral Health Tech 2021.
The mental health industry is overflowing with innovations. At the same time, the need for more scalable mental health interventions has also grown more than ever. Many companies are attempting to meet the high demand for mental health services with teletherapy and online education, but few have truly unique and high-quality models to address the growing need.
This week, I got a chance to talk to Kristian Ranta, Founder and CEO of Meru Health, about their evidence-based approach to mental healthcare and their recent funding announcement. You can read our conversation below.
At Meru Health, we’ve found that the human element is essential. Having a human connection drives significantly better engagement and clinical results when compared with technology alone.
However, many of the teletherapy-based solutions we’re seeing in the market right now are basically just an online version of the traditional care, with a therapist talking with patients online either via video or chat. This leads to two main problems: 1. There aren't enough providers out there to help everyone in need. 2. The quality of care is not standardized. If you scientifically analyze the treatment outcomes, they’re actually quite poor. What mental healthcare needs is true innovation – not a new version of an outdated system.
At Meru Health, we’re doing things differently. Each participant has a personal therapist, who serves as a guide throughout the program. But the program isn’t just delivered from the therapist to the participant — the participant takes an active role in their health. Participants are empowered to complete weekly/daily lessons independently and gain critical insight about their health and wellbeing through biofeedback tracking. While the program is self-guided, their therapist will regularly check in to discuss the practices, and participants can always reach out for support. One therapist is able to treat up to 8x more patients with this model compared to traditional therapy.
With this model, we’ve seen engagement rates of 80% and remission rates of 60% (meaning participants have no symptoms at the end of treatment). Importantly, these rates are sustained 12 months after starting the program. The idea is to empower people with the skills they need to care for their mental health both during and after the program. Meru Health’s treatment isn’t a “quick fix” — it’s about building lifelong wellbeing.
An important factor I'd like to add here is that mental healthcare isn’t going to improve just by bringing therapists online — the care itself needs to improve. At Meru Health, we’ve created a comprehensive and holistic program that looks at a person’s whole experience: Are they eating nutritious food? Are they practicing sleep hygiene? Are they getting enough exercise? Is there inflammation behind their depression symptoms? Mental health is about someone’s entire experience, and their treatment should be, too.
Gladly! We’ve published 8 peer-reviewed research papers to date. Our most recent paper, currently under peer-review, examined the effect of the Meru Health program on suicidality. As you might know, this topic is a personal one for me. I lost my brother Peter to suicide. He had been struggling with depression for a long time and eventually it led him to take his own life.
In this study, we assessed participants’ reductions in suicidal ideation by tracking their PHQ-9 (Patient Health Questionnaire-9 item scale) scores. This data was combined with a published study that estimated the changes in suicide attempts and deaths from changes in PHQ-9 assessed suicidal ideation.
We found that through using the Meru Health program, participants’ suicidal ideation fell from 22% at the start of treatment to 9% at its end, 8% at 3-month follow-up, and 7% at 6-month follow-up. Estimates showed that suicide attempts and deaths by suicide fell over 30% over the course of the program and continued to slightly reduce over the course of follow-up, indicating a sustained effect up to 6 months after treatment. From this data, the Meru Health program is estimated to prevent 1 suicide attempt for every 438 patients we enroll and 1 death by suicide for every 5841 patients. I could not be prouder to be part of the solution to help prevent suicide.
Thank you! We’re thrilled to keep expanding nationwide access to our Meru Health Treatment solution as well as our new coaching solution. The new coach-led prevention solution is an important step towards preventive mental healthcare. We’re able to help people who are showing early signs of depression, burnout, anxiety, or stress and keep their symptoms from worsening. We can teach people the skills they need to care for their mental wellbeing, so they won't reach clinical levels of depression or anxiety. On top of this, we plan to continue building our in-house research team and partnering with top universities to continue developing the new standard of mental healthcare.
World Suicide Prevention Day was on September 10. According to the World Health Organization, more than 700,000 people die due to suicide every year. I want to highlight some of the great efforts taking place within our Going Digital: Behavioral Health Tech community to prevent suicide, starting with our friend, colleague and employee benefits guru, John Hansbrough:
Solome: “John, addition to your work with employers and mental health and wellness benefits, you've also held leadership/governance roles at American Foundation for Suicide Prevention. What do you think is the most misunderstood aspect of suicide and what can or should employers do to play a role?”
John: “Leadership in the workplace are the single most important force multiplier when it comes to suicide awareness and prevention.
Stigma and awareness continue to be misunderstood and undervalued aspects of suicide prevention. Given that 80% of those who die by suicide are in their working age years, employers have a particular opportunity to prevent, intervene, and respond to suicide and signs of distress.
The non-profit Workplace Suicide Prevention, a collaboration between AFSP, the American Association of Suicidology, and United Suicide Survivors International, provides employers a roadmap of 9 recommended practices, all of which require an awareness of the stigma associated with suicide and workplace mental health. Leadership plays a pivotal role in this process, and leaders must step forward when it comes to reducing job strain, communicating with employees and “going first” when it comes to authenticity and personal experience.
When leaders go first, express authenticity, and encourage and support others, they multiply their own efforts throughout their organization to prevent suicide and increase mental health awareness."
We have some amazing individuals and organizations in the Going Digital: Behavioral Health Tech community who are driven to doing all they can to prevent suicide. Kristian Ranta, Founder and CEO of Meru Health, started the company after losing his brother to suicide. As Ranta described earlier this week, “For years, I wondered why he could not be treated effectively and how people like him could be helped in the future, before it’s too late.” In a peer-reviewed study, researchers found that 48 percent of patients responded to the Meru Health anxiety, depression and burnout intervention, and 60 percent of participants did so at 12-month follow-up.
Other Going Digital: Behavioral Health Tech partners are doing important work towards suicide prevention, including
The World Health Organization offers some steps for employers and managers to prevent suicide in their workplaces:
"Measurement-based care" is a term that has grown in popularity in the past year, but in behavioral health, it has not been without its challenges. I spoke with Eric Meier, President and CEO of Owl, about the latest methods for measuring outcomes in our field, why it’s important, and how an organization can implement measurement-based care in behavioral health successfully.
We are at the point of undisputed realization that behavioral health issues are very real and at times, serious. With $225 billion spent on behavioral health treatment and services in 2019, according to OpenMinds, and $1.5B in VC funding towards behavioral health technology and services in 2020, we must ask ourselves, are we making progress?
It’s promising to see the increase in resources being deployed into the field, but I still believe there is a critical missing component to the conversation - how are we measuring quality and outcomes?
After all, how can one improve something that they cannot measure?
Though widely understood that measurement-based care, the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment, is clinically validated to increase treatment effectiveness and improve patient outcomes, only 18% of psychiatrists and 11% of psychologists use it in routine practice (Jensen-Doss et al., 2018).
One of the biggest reasons why the adoption rate of measurement-based care has been so slow is because until very recently, such tools and approaches have not been easy to use. They were complex and would not integrate easily with existing clinical workflows and health care IT infrastructure, giving clinicians great pause. The good news is that today we have some incredibly user-friendly measurement-based care solutions that seamlessly integrate with clinical workflows so that clinicians can easily incorporate measurement-based care into their care model without any wasted time or disruption of their regular routines. Furthermore, these solutions are very simple for patients to use, delivering highly engaging experiences.
With measurement-based care, clinicians receive patient-reported information on their moods, behaviors and feelings prior to their appointment throughout the entire course of treatment. This gives clinicians powerful context to focus on with the patient during the encounter, leading to a more personalized, targeted and efficient session. By answering evidence-based, clinically validated questionnaires delivered automatically to their phone, patients provide valuable data that can be tracked longitudinally to monitor progress and measure outcomes. Measurement-based care is proven to improve clinical outcomes and efficiency, and improve the therapeutic alliance between the clinician and patient.
The more we measure care, the more we can show improvement and ultimately accelerate patient recovery times and improve patient access. The more we speed up patient recovery times and open up access to care, the better off for everyone.
Another way to answer this question is to flip it around a bit: Imagine if there was no widely adopted form of measuring treatment effectiveness for physical medical issues including hypertension, diabetes, and cancer. The concept of measuring patient progress is so tightly embedded within the practice that the term “measurement based care” barely exists. It’s just part of the everyday routine. After all, can you think of a situation where an oncologist or cardiologist would not rely on measurements to prove patient progress and guide care? Of course not, so why should it be any different with behavioral health?
And as we are seeing the move from fee for service towards value-based reimbursement contracts in many segments of behavioral health, measuring and proving outcomes will be a necessity.
Based on experience helping many organizations successfully implement measurement-based care, here are my four critical success factors:
High patient engagement: measurement-based care only works if patients are engaged, so you have to provide them with an easy approach to access and complete the clinical assessments with the user-friendly experience they have come to expect from every other online or app experience that they use daily. I’ve seen well over 80% patient engagement rates when this is done right.
Ability to track treatment throughout the course of care: measurement-based care isn’t a one or even two-time occurrence at the beginning and/or end of treatment. It is a continual, regular part of the ongoing treatment approach to track and monitor progress and achieve the desired treatment target. If you need to adjust care, you can do so with confidence. With an automated solution, you can ‘set it and forget it,’ so that the right assessments are sent to the right patients at the right time based on the nature of the condition, symptom severity, and treatment approach.
Data that not only looks at the individual patient level, but the population in aggregate for the organization: Today’s behavioral health executives need analytical tools to understand their patient population and any trends and insights that can help them further improve clinical care and financial results. Understanding treatment and clinician effectiveness by individual and group empowers leaders to make decisions that improve clinical outcomes.
Data to communicate effectively with payers: As payment models move towards value-based care, behavioral health executives need critical data on patients, their conditions, and effectiveness of care to share with their payers to inform accurate reimbursement models based on a patient’s condition, treatment progress, and not simply based on time.
The integration of physical and behavioral health services is increasingly becoming a priority for health insurance companies, employers and providers. And yet, behavioral health has been siloed from the rest of the healthcare world for so long. However, there are many revolutionary organizations changing that, and Vida Health is one of them. Vida Health addresses chronic and co-occurring physical and behavioral health conditions. They are integrating care by treating the whole person and have measurable results of its success.
This week, I talked to Stephanie Tilenius, Founder & CEO of Vida Health, about their polychronic design and strong outcomes. You can read our conversation below.
Basically, we believe that point solutions miss the point. Nobody wants to switch between three different programs on three different apps to manage their obesity, depression, and diabetes. We built Vida from the ground up to manage multiple chronic conditions simultaneously. We do this with a balance of machine learning that personalizes each person’s treatment as well as the human connection of real life therapists, health coaches, and providers who bring the empathy and accountability people need to reach their goals. We think it’s always been important to treat the whole person, not just the symptom, but it’s especially important today because nearly half of Americans have more than one chronic health condition and in order to successfully treat them, you need to not only address the full range of conditions they have but also the behavioral conditions – the stress, the habits, and often the depression and anxiety – that accompany and fuel these health conditions.
Yeah! We have so many exciting things happening right now. BCBSIL is certainly one of them — in July we announced that we joined Blue Cross and Blue Shield of Illinois’ network as their only on-demand 100% virtual mental health therapy and coaching practice. Going in-network is something we’ve thought about for a while and when the BCBSIL opportunity arose we knew it was a great fit both for us and for BCBSIL’s nearly 6 million covered lives. Some other exciting announcements for us are the Validation Institute reports that confirmed health improvement and cost savings for our diabetes and therapy programs, new partnerships with Humana, as well as a program that serves Kentucky’s Medicaid population. As with most virtual health companies these days there’s a lot going on so really no shortage of things that I’m excited about.
Vida rigorously tracks our clinical outcomes and we stand by our claim that we have some of the best outcomes in the industry across mental and physical health. As for how we demonstrate outcomes to our clients — for both our health plan and employer clients we provide comprehensive reporting that spans enrollment, engagement and outcomes. Some clients also provide claims data, which allows us to do claim-based measures like medication adherence and total cost analysis. We also publish our outcomes in peer-reviewed journals, we have more than 15 publications and case studies that demonstrate our outcomes across our programs. Ultimately we’re so confident in our ability to get meaningful outcomes we put participation fees at risk if mental health outcomes aren’t achieved for the population.
You can check out our video library for more discussion on Vida’s virtual continuous care model and measurable results here.
There is a lot of activity happening in digital therapeutics right now. Happify recently announced Ensemble, the first and only transdiagnostic prescription digital therapeutic for the treatment of patients who have Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD). Pear Therapeutics went public through a $1.6B SPAC deal. Freespira's FDA cleared digital therapeutic is the first to significantly reduce or eliminate symptoms of panic attacks, panic disorder, and PTSD. Woebot announced a $90M series B funding round.
At the Going Digital: Behavioral Health Tech conference, I sat down with Dr. Chris Wasden, Head of HappifyDTx, to discuss the rise of the digital therapy platform for the mental health pandemic and how Happify is supporting health plans, pharma and employers with their suite of digital therapeutics. I caught up with him again to learn about their latest announcement, the launch of their Ensemble digital therapeutic:
Wasden: You will be guided through 112 therapeutic interventions over the course of 10 weeks, with 2 activities to complete each day which consist of CBT, mindfulness and positive psychology based interventions (aka activities). Every two weeks you will complete both the PHQ-9 and GAD-7. All your data is collected and shared with your clinician to support you in your treatment journey. We would expect you to spend 15-30 per day on these activities.
Wasden: Payers, and providers, are aligned with the Triple Aim of healthcare: affordable care with greater access and high quality. DTx products like Ensemble improve a payer’s ability to deliver on the Triple Aim. Most patients must wait weeks or months to get an appointment for mental health disorders, with Ensemble, the patient can start treatment immediately while they wait to see a physician or therapist. Clinical trials and studies have demonstrated that these products are safe and effective at treating these disorders. We estimate that using a DTx product like Ensemble improve the physician and therapists management of the patient, but having the patient spend 10 hours on therapy on their own time for every hour they spend with the healthcare professional, thus allowing the healthcare profession to spend more time with the patient on specific healthcare activities that are of high value and can only be done through face-to-face interaction.
One concern some people have about digital therapeutics is that if individuals need a prescription to access them, will that make mental health support less accessible than if they were like many of the other online CBT tools that are freely available online.
The reality is that there are thousands of online CBT apps and tools available online, and most are not efficacious. The majority of commercially available apps make claims related to mental health that they cannot back up with scientific evidence, per Dr. John Torous and his team at the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center. Those apps must go through the very rigorous process of FDA approval if they want to claim to actually treat a patient with a specific diagnosed disease with a digital therapy. If those solutions aim to achieve the FDA approval, they must be a prescription therapy per FDA guidelines.
Be sure to watch my robust #GDBHT2021 conversation with Dr. Wasden here, where we covered everything from creating “value beyond the pill” for Pharma companies, FDA changes, business models for digital therapeutics, point solutions vs platforms, and here the future of digital therapeutics is going.
Collaborative care has been taking off lately in behavioral health. In fact, many speakers at our conference talked about how they are launching new Collaborative Care initiatives, including Dr. Udall from Ginger, Dr. Benders-Hadi from Doctor on Demand, Spencer Hutchins, CEO from Concert Health, Ken Fasola from Magellan Health, and finally, Chris Molaro, CEO from NeuroFlow.
Collaborative Care Management (CCoM) is an evidenced-based model proven to improve behavioral health conditions such as depression and anxiety within the primary care setting. Because there is significant drop-off between a PCP making a referral to a behavioral health specialist and the patient actually being able to see that behavioral health specialist, many virtual care providers are finding ways to implement some version of CCoM into their solutions to address that gap.
For example, one of our GDBHT partners, NeuroFlow, is a digital health company combining workflow automation, patient engagement solutions and services, and applied AI to promote behavioral health integration in all care settings. NeuroFlow’s suite of services and HIPAA-compliant, cloud-based tools simplify remote patient monitoring, improve risk stratification, and facilitate collaborative care.
"Healthcare is at last acknowledging that behavioral health is not in a silo- it not only impacts but is directly correlated to physical health. The clinical and financial benefits of CoCM have been proven repeatedly in the past in addressing this integration. Now, an increased adoption of digital health tools to facilitate the model combined with skyrocketing demand for behavioral health create a unique - and timely - opportunity for mass adoption of the integrated model in our healthcare system.” - Chris Molaro, CEO, NeuroFlow.
