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Recapping the news from behavioral health companies that are B2C (business-to-consumer).
Addressing access for the whole patient
It’s starting to sound cliche, but everyday it’s true. The numbers continue to climb and more people than ever are struggling with their mental health. As of 2020 in the U.S., 52.9 million people, or 1 in 5 adults, experienced mental illness. During the pandemic, 4 in 10 adults reported symptoms of anxiety or depressive disorder. Unfortunately, in our current paradigm that views mental and physical health separately, there’s a shortage of services that address mental health issues as part of a comprehensive care plan, which holds us back from making sustainable progress. More than one third of the U.S. population, about 130 million people, live in areas that have a dearth of mental health workers, and about 80% of rural counties lack access to a single psychiatrist.
We’ve swung the pendulum on stigma and people are raising their hand for care, but now what? Employers are still grappling with a sea of apps and the best path for integrating care delivery. While yes, society has embraced broader acceptance of digitally-enabled care models, are they really going to “solve” the mental health crisis? Particularly when they work in isolation?
More and more today the term “whole-person care” is used. While, yes, there is some debate about what that is, in mental health, it’s technology application that is supported with integrated care along a continuum; not an app in a silo. Certainly there are use cases for apps, but without an integrated primary care provider, there’s no single care partner to guide patients on their mental and physical wellness journey. Fragmented, siloed care actually restricts the visibility of caring providers and further contributes to the stigma associated with mental health challenges.
Providers who are on the front lines of care provision are speaking up about how the healthcare system can improve quality of care and expand access to services. Many solution providers (aka vendors) are talking about their ability to deliver new technology that achieves whole-person care, though some of that remains more promise than actuality.
The American Medical Association published a report earlier this year highlighting the severity of the mental health crisis and the vital need to reach people who require timely access to treatment. The organization asserts that the solution is found in behavioral health integration (BHI), which incorporates both mental and physical healthcare into delivery of services, in part, through digital enablement. In tandem with traditional interaction between providers and patients, technology that leverages digital tools for functions like screening and intake, telehealth services, and clinical decision support will help engage more people in mental health treatment and aid providers in its adoption and delivery. The report references ample evidence that BHI produces superior patient outcomes, improves patient experience and access, and can generate cost savings.
Further, the AMA and other leading medical associations established the BHI Collaborative, a group “dedicated to catalyzing effective and sustainable integration of behavioral and mental health care into physician practices.” The cohort’s objective is to empower physicians to expand access to mental health services through primary care settings and take a holistic, integrated approach that focuses on the well-being of the whole person.
The AMA has brought to light a very serious issue of which many employers and benefit designers are already aware: the current paradigm – which silos physical and mental health care – is not working. Companies are using employee assistance programs (EAPs) as a mental health front door, which has proven to be ineffective and simply not good enough to address the severity of these problems. Patients require care that incorporates visibility, collaboration, and integration among providers. So why do employers continue to settle for less? It’s about to change.
Turning the need and research into actionable care delivery
Member-centered primary health is a straightforward path for patients to see their primary care clinicians and mental health providers in a truly integrated fashion. More and more, employers are embracing an integrated model that engages patients and facilitates adoption by providers throughout the entire patient journey. It’s the journey from access to results. By incorporating technology to engage patients in mental health services such as screenings, diagnosis, and treatment, employers can see how proven integration models within primary care workflows are yielding positive results. Employers should both imagine and demand a world where success is being reported as improvement scores vs. visit volume.
Assuredly backed by data - supporting a new model of care
My experience-based assessment of the U.S. approach to mental health care does not stand alone; the numbers tell a troubling story about failings of mental health delivery and the impact of mental health disorders. The recent poll that found that two out of every five adults suffered from moderate to severe mental health issues during the pandemic also found adults reported difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%). Isolation, job loss, health concerns, and excessive worry during this unprecedented time has had a major impact on well-being. Further, according to the National Alliance on Mental Illness, one in six U.S. youth experience mental illness each year, and suicide is the second leading cause of death among people aged 10-34; half of all lifetime mental illness begins by age 14. A lack of treatment for mental health conditions costs the U.S. more than $100 billion annually. Yes, this is a major problem, one that disrupts lives, livelihoods, relationships, and our basic human desire to find joy.
When desiring help, patients often turn to primary care providers who report that 70% of all visits include a behavioral health component. In fact, nearly two thirds of people experiencing depression and other common mental health conditions are treated exclusively in primary care settings. While these clinicians provide the majority of mental health care for these patients, only about 3% of the encounters are coded for primary diagnoses of depression and anxiety. These providers may not be trained on optimal treatment methods, underscoring the need for collaboration with and among mental health clinicians.
From a whole-patient view, mental health conditions are associated with significant morbidity and mortality, and these individuals have a higher likelihood of developing cardiovascular and metabolic diseases. Those experiencing both physical and mental health conditions also incur higher health care costs and experience worse overall health outcomes. The whole patient and how we treat them really does matter. An integrated Primary Health team—in line with BHI strategies—enables partnered care toward holistic health, and the data shows it.
Crossover recently evaluated the effectiveness of its integrated approach in responding to the mental health crisis. When comparing the clinical outcomes of more than 3,000 Crossover members to patients in the community, study results showed Crossover to be significantly more effective than the community in improving overall mental health outcomes.
The data from our study and throughout this post reaffirms that an approach to interdisciplinary care works and the urgent call for inclusion of mental health within primary care models rings loudly. Mental wellness is a relational pursuit and cannot merely be managed by isolated transactions or singular care episodes. Instead, personalized care of each member, backed by healing relationships between doctors and patients, has the power to improve overall quality of life. Isn’t this the result every patient deserves?
Health care has its share of buzzwords, especially in the mental health realm. Measurement-based care (MBC) is one of them. People talk about its importance in enabling quality care. Research shows it produces strong outcomes and ensures that providers are delivering personalized, data-driven care to each patient. When you add on that more people than ever are experiencing problems with anxiety, depression, and substance misuse, effective mental health care is more important than ever.
MBC is intuitive and conceptually straightforward. But what does it mean to do it well for patients living with mental health issues? Some point out the challenge of measuring and quantifying mental experiences like thoughts and emotions, especially when compared to measuring physical outcomes like insulin levels or blood pressure. Providers can easily measure physical functions, monitor them, and connect patient progress to ongoing interventions.
The reality is we can do the same with mental health experiences. We have clinically validated assessments that capture the severity and nature of mental health symptoms. We can directly observe patient behaviors related to mental states. With the advent of mobile technology, we can even measure smartphone use and behavior and link it to the experience of mental symptoms. This measurement is not only possible, it is essential for providing effective treatment through an MBC approach.
It is one thing to collect data, it is another to leverage it in care delivery in a tailored, systematic way that produces strong patient outcomes. Technology is key to accomplishing this. Mindstrong is a virtual mental health platform that combines evidence-based care, data, and technology to empower people with mental health challenges. MBC is not only the foundation of our approach, it powers delivery of care every step of the way for each of our members and providers.
Data empowered care plans (DECPs) are a primary vehicle for delivery of MBC to Mindstrong members. First, members complete clinical assessments on their smartphone, wherever they are, at a time that is most convenient. These assessments identify and quantify symptoms and functioning. For example, for a member experiencing depression, these assessments measure whether symptoms relate to thoughts, behaviors, mood, or all 3 areas. The severity of each type of symptom is quantified. Second, the Mindstrong platform analyzes the data and surfaces the most relevant information to the patient's multidisciplinary care team. Members can also observe and track their data through the mobile app. Third, providers partner with members to review their data and create treatment goals based on reducing and resolving symptoms. Fourth, these goals are quantified and tracked over time, and treatment is adjusted to ensure progress and attainment of goals. In sum, DECPs hardwire MBC to care planning and delivery with each member.
Mindstrong’s DECPs also focus on areas outside of mental health. Many individuals with mental health challenges also experience problems with social determinants of health (SDoH). These include stability of housing, social support networks, and financial stability. Like mental health issues, these challenges place patients at risk if they are not resolved. Mindstrong uses DECPs to assess, understand, and provide support for SDoH in our members. We help them resolve these challenges as part of whole-person care.
Technology is essential for an efficient MBC approach. It facilitates data collection and makes it more seamless and engaging for the patient. It powers the analytics that make sense of the data and surface the most important information to providers and patients. It allows for streamlined tracking of patient progress and helps clinicians tailor treatment to maximize outcomes. Through Mindstrong’s virtual care model, these activities can be accomplished by patients and clinicians anytime, anywhere.
Two more things are critical to providing tech-enabled, measurement-based care. First, healthcare organizations need to study how their MBC approach is impacting patients. Treatment for mental health isn’t a one-size-fits-all approach. Certain patients with shared experiences and clinical profiles may respond differently than others to a particular intervention. At Mindstrong, we are agile in our MBC approach. We continually research which aspects of care work best for which types of members and why. We have the in-house clinical and applied science expertise to take this knowledge and continuously evolve our approach.
Second, MBC allows us to determine when members reach goals and can transition to another level of care. For example, when mental health goals are achieved, a member can transition from a therapist to a Mindstrong care partner and coach, who focuses on SDoH support and longer-term recovery goals. MBC is used to determine the right provider and level of support at the right time.
At its most fundamental level, MBC for mental health is about constantly collecting data about what is working for patients and having the willingness to change course to optimize engagement and outcomes. Not only is this approach possible, technology can power it in a way that is accessible and efficient for patients and clinicians. When this happens, people living with mental health issues begin their journey toward healthier, happier lives.
Article written by: Audrey A. Klein, PhD, Senior Director of Clinical Design and Operation, Mindstrong, Inc.
We’ve all been there, we get a little depressed or anxious and then, while in that mindset, we make choices like skipping our usual morning walk, having an extra handful (or two) of potato chips, and staying up late to scroll our phones or watch some mindless TV. The truth is, mental health conditions, no matter how minor, impact our ability to engage in self-care. For someone living with diabetes they don’t get too much time off from monitoring thier self-care. So even a short rut where they’re choosing foods that may not be the most nourishing, not sleeping well, or getting in enough physical activity can exacerbate factors related to healthy blood sugar management.
Effective treatment needs to start with an acknowledgement that the two are closely intertwined. You can’t treat one without the other and with the prevalence of depression in people with diabetes being 2-3x higher than in people without diabetes, it is clear that in order to move the needle on outcomes and improve quality of life for people who are suffering, a holistic approach needs to be taken. The fatigue of caring for a condition like depression or diabetes can be improved when patients learn important coping tools and skills that help them build resilience to manage the daily demands of both conditions.
For those with diabetes, subclinical and clinical mental health challenges often present itself as something called diabetes distress. Diabetes distress is basically when someone with diabetes has an emotional state where they’re overwhelmed by feelings of grief, shame, or mental exhaustion which impacts their ability to care for themselves and their disease. Certainly, more severe mental health conditions can impact a person’s ability to cope with the daily demand of managing a chronic condition like diabetes. But the whole spectrum of mental health conditions needs to be considered because even subclinical mental health challenges can have an impact on diabetes outcomes.
I work with a lot of people who Vida treats for both mental health conditions and cardiometabolic conditions — the biggest concern for me is usually that stigma will get in the way of someone receiving the mental health care they need. Untreated mental health conditions can lead to significantly poorer outcomes and greater risks of complications. When both untreated depression and diabetes coexist, health outcomes are worsened for both. This can mean lasting complications like damage to kidneys, eyes, nerves, and can sometimes lead to amputations and other costly complications. One of the biggest concerns to be aware of is that depression is frequently missed, undiagnosed, or when diagnosed, patients often don’t receive the care they need.
This article was written by Vida's Sr. Director, Cardiometabolic and Prescribing Gretchen Zimmermann. To learn more, visit vida.com or watch Vida’s session from the Going Digital: Behavioral Health Tech 2022 summit.
Event recap: Senior leaders from Alliance Signature Series Sponsors, representing organizations across the healthcare industry, discussed the opportunities and challenges of developing an evidence-based and innovative mental healthcare system. Panelists explored how their organizations propel change to accommodate person-centered needs and what the future holds for transformative mental healthcare.
Mental health diagnoses are treated far differently than physical health concerns. Mental health is treated like an episodic condition rather than a chronic disease. At this point in time, mental health needs are skyrocketing, and our healthcare system is falling behind. The lack of parity between mental and physical healthcare calls for new innovations in the healthcare system.
Unfortunately, there are many barriers to treating mental illnesses, as there is a growing shortage of specialized psychiatrists. It has become critical to prepare the primary care setting to be able to care for mental health patients. We know that 50% of mental health patients come to primary care settings. The first step to innovating the mental healthcare system is improving care accessibility. We can’t help people with mental health conditions if they aren’t able to access care, to begin with.
There is a significant lack of access to proper healthcare treatment and services, especially in underprivileged communities. The lack of equitable health care support significantly impacts how people perceive and obtain care. This contributes to mental health stigma. What we are doing is not working. Luckily, there are many opportunities for improvement.
Change and innovation are desperately needed. Trying to provide mental health services at scale can be challenging. Many new players and solutions are emerging in the behavioral health industry, but innovating an entire branch of the healthcare system involves a lot of trial and error. The history of psychology is deeply rooted in work that has gone on for over a hundred years. Much of the thinking is conservative. As the field grows, the thinking becomes locked in the thinking. Because of this, new solutions need to consider how to bring policy innovation that will support the clinical innovation that is taking place. Innovation is also rapidly changing with the help of digital tools. The challenge with that is ‘how are we going to integrate those advancements effectively going forward that can really maximize the capacity for people to take advantage of it in the best way and weave it together in a way that keeps people falling between the cracks?’ There is an enormous need for advancement, but without innovation, we will have a hard time getting there.
Innovation and technology are one way to fix some of the problems created over decades. Technology is a great way to help us find new modalities of care and help keep track of patient retention, engagement, and progression of care more efficiently. The only way we will improve the mental healthcare system is if we figure out how the field can move into the future as we have in every other field.
Equity in the space of behavioral health is an essential factor of innovation. We know that expanding the funding opportunities would help enhance equity in mental health providers’ training and credentialing. Another aspect of this equity issue is incorporating mental health access in schools. Providing more mental health services in schools can help pave the way for proper care for those who have not had access in the past. Offering the right kind of access for the people who need it can change how behavioral health helps heal everyone.
Innovation is how we progress into the future. There are many disparities in the mental health field, but there are many positive ways to make the right change to impact the most people. Innovation is not always about creating new things. It can also be taking an existing system and making it more effective by using data to our advantage and what we have available in the field of medicine. Innovation is the future; the future is better care for mental health.
You can watch our full panel here.
How does companion care address Social Drivers of Health?
Social drivers of health (SDoH) impact upwards of 80% of health outcomes—and have been largely ignored by the health care system…until recently. Health plans and other industry players are increasingly recognizing the opportunity for non-traditional models of care to drive impact. One of those models is companion care, the new category of care created by Papa, which was designed to address individuals’ unique SDoH, including loneliness and social isolation.
Working through health plans and employers, Papa brings vital support and human connection right to a person’s front door when and how they need it, via our national network of vetted companions, called “Papa Pals.”
Papa Pals meet health plan members’ social needs that promote health, but are non-medical in nature, like transportation to a doctor’s appointment or grocery shopping, caregiving support, and of course, social interaction. As Papa Pals gain access to members’ homes and hearts, they’re able to build trust—the greatest asset we have in health care.
While health plans and other stakeholders have generally struggled to access and understand people’s barriers to health, the bonds Papa Pals form give them much deeper insight. With this insight, Papa and/or a member’s health plan are able to connect members to vital services that can advance their health and well-being, addressing issues like food insecurity, home safety, and medication adherence.
I think the best examples of how companion care addresses SDoH are the personal ones. Take Papa member Lacey, a young mother of four on Medicaid in Michigan. Her Papa Pal, Michelle, provides child care support, advocates for Lacey and Lacey’s family at the food bank, and helps provide transportation to doctor’s appointments. It took Lacey time to be comfortable accepting help from a Papa Pal, but now she says that because of Michelle, she has a better outlook on life. “It’s like we fill a hole in each other’s hearts,” she said. “I’m really thankful for this relationship and I feel like it’s something everybody needs.”
At large, what impact does companion care have on the healthcare system?
Addressing SDoH through Papa’s companion care model enhances members’ health and quality of life, improves health care utilization, and reduces overall health care costs.
We’ve seen a 64% increase in individuals reporting severe loneliness as part of our initial assessments from 2020-2022. Yet in the face of this loneliness epidemic, 60% of severely lonely individuals who actively participated in their health plan's Papa program experienced clinical improvements and moved to a lower category of loneliness, as determined by the three-item UCLA loneliness scale. We also reduced mentally unhealthy days by more than six days, per the CDC’s Healthy Days measure.
Knowing loneliness is linked to increased risk of heart disease, stroke, diabetes, depression, and dementia, and that unhealthy days are associated with multiple chronic conditions and predict both hospitalization and mortality, these improvements are significant—and they refurberate through the health care system.
In an analysis of Papa among Meridian’s Medicaid population aged 45+ with a high rate of emergency department (ED) utilization, active Papa participants experienced a 25% reduction in ED visits, 14% decrease in hospital readmissions, and a 33% reduction in overall health care costs. Preventive cervical cancer screenings, diabetic eye exams and HbA1C testing for Papa participants also rose by 50%, 46%, and 35% respectively. While Papa is known for its work with older adults in Medicare Advantage, these results released just last week demonstrate the power of personalized, human help for historically hard-to-reach populations.
We’ve seen similar results across Medicare Advantage and socially isolated patient populations as well (stay tuned for these claims-based study results over the next few weeks!). Through trusted relationships and proactively addressing SDoH, companion care helps close social and clinical care gaps, supporting members’ well-being and reducing health care costs.
By addressing gaps in healthcare for older adults and families, can you share more about the improved member experience with companion care?
With companion care, members receive truly personalized support—when, where, and how they need it most—improving health plan perception and satisfaction, as well as overall health care experience.
We recently found that members who are severely lonely are less likely to view their health plan favorably, compared to those who are not lonely. Lonely individuals also reported they find it more challenging to get needed care right away and rated ease of getting prescription drugs and tests/treatments lower. After participating in Papa, the average member’s rating of their health plan moved from a 4-Star ranking to above the 5-Star threshold for the “health plan rating” CAHPS measure. Not only does this change have significant financial implications for health plans, but it demonstrates the far-reaching effects of proactively addressing loneliness.
Companion care has also been shown to reduce the number of members who leave their health plans voluntarily, also known as member churn. It’s estimated that of the 28 million Medicare Advantage enrollees today, approximately 3.6 million will churn this year alone and, subsequently, $36 billion in revenue will be exchanged between health plans and/or traditional Medicare. Notably, in a study of a Florida-based health plan using Papa, Papa participants had a churn rate that was 15.8% lower than members who did not participate in Papa. Put differently, the study results indicate that Papa increased overall member retention by 2.8%.
Another component of improving member experience comes from Papa Pals’ ability to help members navigate their health plan benefits to resolve issues and enhance utilization, while removing complexity and confusion from their health care experience.
This example always stands out to me: One of our Papa Pals recently worked with a member to resolve a $10,000 medical bill. The Papa Pal learned of the issue during a visit and escalated it to our care navigators, who coordinated between the insurer’s claims department, the hospital, and billing company, ultimately resolving the issue and saving that member from an unimaginable amount of stress and anxiety.
Put simply, people need people. Personalized, proactive support delivered where health happens—in homes and communities—is key to reaching people across plans and geographies, and has a dramatic impact on member experience, health and wellbeing, all while reducing health care costs and improving health care utilization.
Article written by Papa's Vice President of Health and Social Impact, Ellen Rudy, PhD
Harnessing telehealth for better mental health care
The silver lining of the COVID-19 pandemic is that seeking mental health treatment became much less stigmatized, and mental health care access has expanded through more available tools. In fact, since the start of the pandemic, most people agree that society has become more comfortable using telemedicine for therapy (63%), using digital tools to improve mental health (58%), and engaging in mental health discussions (56%). October 10 was World Mental Health Day, which is an important moment to recognize this achievement, but also to highlight that we must do more to expand access to all communities in need.
Meeting the demand for care
For many, the pandemic introduced and magnified health anxieties, catalyzed major lifestyle shifts and increased isolation. A CVS Health and Morning Consult study found six-in-ten (59%) Americans have experienced concerns about either their own mental health or that of family and friends, a 9%-point increase since April 2020.
As the need for care increased, digital tools played a crucial role in closing access gaps – especially in mental health. For instance, among Aetna’s commercial members, 58% of outpatient mental health visits were done via telemedicine in 2021, up from 49% in 2020 and less than one percent in 2019. Year to date in 2022, the use of telemedicine remains strong at 55%. It is not surprising that this trend has continued as telemedicine has proven to be particularly effective for mental health care as it allows for greater convenience in connecting with a provider, and it can be a good option for those who may be apprehensive about receiving this kind of care in person.
Reaching those in need, equitably
However, while the pandemic sparked a dialogue about the importance of mental health, not every community has been able to obtain care equally. While use of mental health services among White adults (with any mental illness) was 46.3%, only 29.8% of Black and 27.3% of Hispanic adults with any mental illness used mental health services. This is a gap that we need to close. To help, CVS Health has launched several efforts to expand access to care, especially digitally.
For example, during the pandemic we launched a program called Here4U, which is a virtual peer support group, facilitated by a licensed clinician, that addresses the importance of mental wellbeing. These groups, which we’ve tailored toward specific communities such as Black women, LGBTQ+ youth and working moms, allow participants to discuss life challenges, changes at home, or other pressing issues and events. Following participation in a Here4U group, individuals have expressed that they felt heard and understood, and appreciated the ability to connect with their peers. Being able to discuss life’s challenges with others in similar situations can be extraordinarily helpful and encourages those in need to seek further care.
We’ve also continued to expand access to therapy within local communities across the country. Patients can get same-day depression screening appointments at all CVS MinuteClinic locations, as well as in-person and virtual mental health counseling services in select states. These professional mental health care providers can conduct an assessment and offer personalized treatment plans and counseling that address feelings of stress, anxiety, grief, depression and more. CVS Health also provides a wealth of publicly available mental health guides – with an emphasis on Black, indigenous and people of color (BIPOC) youth - screening tools to help anyone get a quick read on their emotional health and other resources on CVSHealth.com.
Leveraging today’s tools and knowledge for a brighter tomorrow
Americans are more open to accessing mental health resources, and technology makes them more accessible than ever before. Still, there is more work to be done in eliminating the stigma of mental health and expanding access to all populations. Members of the healthcare system, employers and other community leaders can help by initiating conversations about mental health, prioritizing treatment as they would for a physical ailment and using all available resources to ensure factors like income, location and mobility don’t impede access to critical care.
Article written by: Cara McNulty, President, Behavioral Health and Mental Well-being, CVS Health; and Taft Parsons III, MD, Vice President & Chief Psychiatric Officer, CVS Health.
Across the world, there is a mental health care treatment shortage; we are in a crisis. Mental health care has never been in such high demand. In fact, by 2025, shortages are projected to get worse for psychiatrists, clinicians, counselors, and psychologists. Today, in the US alone, thousands of people are sitting on waiting lists for evaluation, treatment, and just someone to talk to. Clinical depression is one of the most common mental health diagnoses in the US, with more than 21 million adults reporting a clinical episode in 20201. In 2022, 9 out of 10 therapists reported “the number of clients seeking care is on the rise”1. This demand is magnified in rural areas. A family therapist in Georgia reported “I live in a rural town, but I still get approximately seven to 10 inquiries a week that I have to turn away”1. This is one of many other examples that show the gap in the mental health care system is increasing every day.
It is important to remember this gap in supply and demand can not be solely addressed through increased accessibility, which has been the focus of most innovative solutions over the last few years. While this “Room to Zoom'' approach, widely adopted recently, would potentially provide access to care for someone living in rural areas, it would not guarantee care availability. Too often patients and clinicians are restrained by factors out of their control: time, money, and policies. Even when a patient can see a mental healthcare provider, their insurance coverage, time, and geographic location impact their path to treatment. These factors are more critical when social determinants are also considered, making marginalized groups at higher risk for long-term mental health concerns. The current health care system keeps patients, and clinicians, trapped in a circle of inaccessibility.
Problems in Care Model And Resource Allocation in Mental Health Care
During the COVID-19 lockdowns, clinicians heavily relied on virtual communication to connect with their clients. While using these virtual communication tools made it easier for clients to access their clinicians, what limited their access was clinicians time, leading to longer wait times. In fact, in 2021, 75% of clinicians reported an increase in wait times for basic mental health services1. That is, the technological access innovation did not solve clinician availability. That is because our industry has not been optimized for scale.
The question then becomes, how can we make mental healthcare more scalable?
Furthermore, while there has been an increase in differentiation of roles for managing patient interactions, we need to reimagine these roles by equipping individual clinicians with the right tools to effectively manage the population waiting for care. For instance, there is only 1 psychiatrist for each 1,960 patients in need of mental healthcare. Given that a psychiatrist can only handle 200-400 patients per year, inappropriate referral of all patients to a psychiatrist would cause extensive backlogs. In fact, in the United States the average wait time to meet with a psychiatrist, for an initial evaluation, is 50 days1, almost two months. Research has shown that longer waiting time for treatment leads to poorer health outcomes1. This means that when patients are waiting for treatment, their mental health concern, no matter how minor, could become more severe and therefore more difficult and expensive to treat. Nevertheless, not all patients need to see a psychiatrist. According to a clinical trial we are performing at OPTT Health, ~85% of the patients could be handled by a combination of supervised online CBT plus weekly engagements by lower cost personnel like social workers and mental health coaches. The remaining 15%, which translates to 294 patients out of 1,960, would definitely benefit from psychiatrist intervention. This model of assigning different resources to different patients can perfectly work in the new collaborative care models1.
But how can we measure each individual patients’ needs for such optimized resource allocation?
The Answer: AI-Powered, Digital-First Approach
There is not one solution to solve this macro problem, however many experts suggest that well developed and clinically validated digital care can be a key part of the solution set. There has been a shift towards virtual care, telehealth, and asynchronous digital care. Research shows that this trend has been expedited by the pressures of the COVID-19 pandemic. Digital care reduces patient and provider costs, allows care to reach those living far from resource centers, and connects patients to clinicians in a timely manner. Also machine learning and AI (ML/AI) algorithms have been developed to support clinicians in making efficient and effective decisions in their practice. The use of technology drives a better experience for both patients and clinicians, and in fact has been shown to improve professional engagement and job satisfaction for practitioners.
There are a few cautionary notes in using digital technology for care delivery though. First, is the question of clinical validation. It is important to remember that mental healthcare, like any other field of healthcare, needs to follow a rigorous validation process. Not every solution that works in person, works digitally, and not every solution actually helps. Any digital solution therefore should be clinically validated in proper clinical trials and meticulously adjusted to meet patients’ diverse needs. Second, is the challenge with care adherence. This means that, even if a solution has been shown to reduce symptoms in a clinical trial, patients should actually go through the process to see the outcomes. Many digital mental health solutions have +80% patient attrition past sessions 3-4 of their care plans. This means that most of the patients would not benefit from them, even though they have been validated.
On the analytical and ML/AI side, there is always the question of whether these algorithms can be trusted. Most of the ML/AI algorithms are black boxes, that crunch in an array of variables and spit out a decision. As such, it is not clear for a clinician what this decision was based on and how they can trust its outcome. This lack of transparency and accountability therefore can hinder their use in the clinical process. Furthermore, many clinicians consider such use of AI in decision making as a competing factor for their job security.
I firmly believe the answer to both these concerns is technology backed care delivery by clinicians. A hybrid model of care delivery in which digital technology is used to transfer the main time consuming parts of therapy to the patients and to save clinicians for short, personalized feedback, could both scale up the number of the patients each clinician can handle, and keep patients accountable and adherent to treatment. Additionally, ML/AI algorithms should become like any other medical tool, that while they might be technologically advanced, they provide intuitive information that are easily comprehended by clinicians (e.g. MRI imaging). Therefore, any ML/AI in mental health should also follow an explainable ML design so their functionality is transparent and trustable. For instance, algorithms could compile a big range of unstructured data (including patients’ use of language and speech, their activity and sleep patterns, etc.) to produce a few clinically relevant variables that help clinicians in their decision, rather than making the decision for them. At the end of the day, tools are not replacing clinicians, but empower them.
Dr. Mohsen Omrani is Co-Founder and CEO at OPTT Health. OPTT is a provider of comprehensive hybrid digital care plans augmented by AI for proactive triage and monitoring of patients to simplify the digital-first delivery of mental health services for care teams. Learn more at www.OPTT.Health
A chronic disease is one that lasts three months or longer, may get worse over time, and may not be curable. Some chronic diseases include cancer, diabetes, heart disease, stroke, arthritis, and many others. As of 2014, 60% of American adults had at least one chronic condition, and 42% had more than one. In fact, Americans with five or more chronic conditions make up 12% of the population but 41% of healthcare spending. Additionally, chronic diseases are America’s number one cause of death and disability.
People with chronic diseases are more likely to have or develop a mental health condition. In 2012, the CDC found that 51% of Parkinson’s patients, 42% of cancer patients, 27% of diabetes patients, 17% of cardiovascular patients, and 11% of Alzheimer’s patients also had depression. Additionally, people with diabetes are 2 to 3 times more likely to develop depression than those without diabetes.
Also, the COVID-19 pandemic has introduced a new set of patients with chronic disease, the COVID long haulers. A study from May 2021 reported that one-third of COVID patients had been diagnosed with neurological or psychological symptoms in the six months after infection. In fact, patients with long COVID rank cognitive function and mental health as their top concerns. COVID has increased the prevalence of chronic conditions and behavioral health conditions.
What is the problem?
Not only are people with chronic conditions more likely to have mental health conditions, but people who have depression and another medical illness are more likely to have more severe symptoms of both illnesses. As Rick echoed in our session, when “people do not address the behavioral health condition, that exacerbates all the other conditions that they are carrying.”
Treating mental health and chronic conditions together can help people manage both conditions better and improve outcomes. As Rick mentions, “mental health is a critical component of whole-person care,” and it’s important to integrate mental health services when addressing chronic conditions.
What Tools Can Help?
There are many point solutions available for tackling chronic conditions, but to appropriately address chronic conditions and mental health simultaneously, integrated solutions are key.
Lyn Health is a digital clinic for those with two or more chronic conditions. Lyn Health utilizes a Care Circle, which is a team of physicians, clinicians, and social workers, to offer virtual primary care, care navigation, medication management, behavioral health services, and social support. A key part of the model is the Care Partner, who acts as a navigator and liaison, and Erica explains that a large part of that is about “meeting members where they are, understanding what is going to suit their unique needs, and being able to set ourselves up accordingly.”
Dario Health is a digital platform to address chronic conditions such as diabetes, hypertension, weight management, musculoskeletal health, and behavioral health. Dario offers connected devices such as glucose monitors, scales, and blood pressure cuffs in conjunction with a mobile app and live coaches to address chronic condition management. Data analytics allow patients to review their metrics over time, and a provider-facing online platform gives providers insight into their patient’s progress.
Vida Health is a mobile app with a modular platform designed to treat chronic conditions, such as diabetes and hypertension, and mental health conditions, such as anxiety, depression, and stress. The app can sync with scales, blood glucose meters, fitness trackers, and other smart devices. The app also offers asynchronous messaging, digital content, and video visits with a personalized coach and therapists as needed for a full care experience.
Main Takeaways for Integration
Please check out our video library to hear our entire conversation with Rick and Erica from Lyn Health.
Ryan Hampton is the organizing director of the Recovery Advocacy Project and founder of the Voices Project. He is the author of Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis and American Fix: Inside the Opioid Addiction Crisis - and How to End It. In our conversation with Ryan, we discussed his journey in recovery and his work advocating for people with drug addictions, others in recovery, and family members of those impacted by addiction.
Background
Substance use disorder is a complex condition that affects the lives of millions living in the U.S. According to Ryan, “there are 23 million people in long-term recovery in the United States. There are about 40 million to 45 million Americans currently struggling that need help right now based on statistics from 2020 to 2021 by 1 and 3 American households that are directly impacted by substance use disorder.” The Centers for Disease Control and Prevention estimates that in the United States, more than 106,000 people died due to a drug overdose in the 12-month period ending November 2021.
Ryan emphasizes the lack of funding and resources for addiction treatment. He says, “We don’t have a robust addiction treatment workforce in this country. We don’t have the capacity to train that many people if we needed to. We don’t have funding for recovery community organizations, and we don’t have funding or infrastructure for recovery housing.”
In the Recovery Advocacy Project
The Recovery Advocacy Project (RAP) was founded in 2019. It is a nonprofit organization that is the sister partner of the Voices Project. RAP is committed to giving people in recovery, family members, and recovery supporters the grassroots organizing tools to think and act locally. Over the past few years, RAP has made “substantial” growth, according to Ryan. He says, “We had 115 listening sessions to hear from the community what their needs were…We had over 20,000 unique action takers on pieces of legislation that we worked on in different states…, [and about] 1400 organizing meetings took place between 2020 and 2021.” He credits the grassroots volunteering efforts for RAP’s successes in these few short years.
Significant Milestones in Addiction Recovery
Ryan speaks about his personal experience recovering from drug addiction while highlighting the role the addiction treatment drug buprenorphine has played in his recovery. He says, “Today, my Pathways accident, I’ve been absent since 2015. I was on buprenorphine for the first part of my recovery, it quite literally saved my life, but we now have civil rights protections in place… just a few short weeks ago that will keep medical providers, housing providers, and others from denying access to people care because they are on addiction treatment drugs such as buprenorphine.” For example, Ryan says, “it took a lot of advocacy and a lot of time meeting with the Biden administration and the DOJ to get them to really specify opioid use disorder as a protected class under the Americans with Disability Act.”
Harm reduction is another essential component of the drug recovery continuum. Ryan says, “Fentanyl overdoses are now the primary driver of accidental death for teens in this country,” He continues by saying, “We have got to start recognizing that fentanyl testing strips, broad access to Naloxone, mutual aid groups for people who use drugs… these are all things that will work and the Biden Administration has recognized harm reduction as its own leg on the stool essentially in their drug strategy.”
Books About Substance Abuse and the Overdose Crisis
In 2017-2018, Ryan wrote the bestselling book, American Fix: Inside the Opioid Addiction Crisis - and How to End It, in which he describes his personal struggle with addiction, outlines the challenges that the recovery movement currently faces, and offers a concrete, comprehensive plan of action towards making America’s addiction crisis a thing of the past. In the summer of 2016, Ryan took a road trip and traveled across 28 states over 30 days to speak directly with policymakers, people in prisons, drug users and their families, the homeless, and people in long-term recovery. He described American Fix as “my story of going across the country and learning from these different community members.”
Ryan’s most recent book is titled Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis. This book gives a shocking inside account of reckless capitalism and injustice in the Purdue Pharma bankruptcy case. Ryan says the book, Unsettled “gives you a glimpse into the power struggle that we face every day as people in recovery, as people who are directly impacted by this crisis.”
Ways to Get Involved
Ryan hopes that addiction treatment can become more mainstream in the future and reduce barriers to minimizing the treatment gap. 9/10 people who need treatment don’t get it. “It is my hope that through our advocacy and collective work with providers and scientists and policymakers that we can get to a place where it is streamlined right into the Primary Healthcare System.”
Mobilize Recovery is a free movement from September 29th- October 1st, 2022. It is an initiative of the Recovery Advocacy Project and the Voices Project, where attendees will learn innovative strategies & tactics for grassroots organizing & recovery solutions.
You can access our 2022 virtual sessions with employers, benefits consultants, telehealth leaders, health plans, and more within the Going Digital: Behavioral Health Tech free video library to hear more conversations like this.
Founded in 2017, Two Chairs is a mental health practice built for clients and therapists. We start with a research-backed matching process to ensure the ideal client-therapist fit, offer hybrid care to maximize choice and access, and employ a diverse, collaborative team of licensed clinicians across 90+ areas of expertise.
At Two Chairs, hybrid care is a flexible care model that allows for a seamless combination of virtual and in-person sessions. For clients and clinicians alike, hybrid care is about tailoring the experience of therapy to something that will work for each individual person.
What are the benefits of virtual vs. in-person therapy for both the client and clinician experience?
Over the past couple years, virtual care has come to prominence out of necessity, but it has many benefits. For clients, it provides access to therapeutic support quickly and with little hassle. It can also lower barriers to care associated with physical spaces, eliminate the need to travel and associated costs, and save time to fit therapy into life more easily.
For clinicians, it can make work more convenient by eliminating a commute and allowing them to work on a more flexible schedule, as well as enabling them to reach patients they otherwise may not be able to.
On the other hand, many people still want the option of in-person care and find more benefit in doing therapy face-to-face—66% of clients want the option of seeing a clinician in-person for behavioral health purposes, according to Rock Health’s 2021 Consumer Adoption Report. With in-person therapy, clinicians can better read nonverbal cues that support verbal communication, and different therapeutic methods like art and music can bolster support. In-person therapy also provides a safe space away from everyday life for clients and allows clinicians to connect with their clients more directly and without technical glitches.
Hybrid care combines the best of both worlds, and it gives people the option to get care when and how they need it, whether it’s all in person, all virtual, or a little bit of both.
What is Two Chairs' approach to the design of in-person clinics?
At Two Chairs, we believe in spaces as sanctuary. Whether our clients are virtual or in-person, we want them to feel safe and comfortable.
All of our therapy clinics across the Bay Area, Los Angeles, and Seattle are warm, welcoming, and open spaces, reflecting the core tenets of therapy itself. They incorporate trauma-informed design with simplicity, privacy, safety and a sense of peace, with natural elements weaved throughout to calm senses and have a positive impact on psychology.
How does hybrid care connect to the matching process at Two Chairs?
Research shows that a strong client-therapist relationship is the key to successful therapy, so we’ve invested in perfecting the match.
Part of the matching appointment that every Two Chairs client goes through involves a discussion around how they want to receive care, whether that’s in-person, virtual, or both — and how important that factor is to them.
Whatever they decide, that is taken into consideration with hundreds of other data points covering symptoms, goals, preferences, demographics, and other factors to match them with a therapist who is just right for them.
How does hybrid care improve access to exceptional mental health care?
We aim to center the client in everything we do, and that includes offering options for care delivery to provide quality and well-tailored care to a wide range of populations.
Offering virtual care gives access to folks who may live in more remote areas in the states we serve, or those who can’t easily get to a clinic on a regular basis. Alternatively, providing immediate and effective in-person care gives an option to people who want in-person therapy but are having a hard time finding the right therapist for them with availability. And a hybrid option gives people flexibility to receive care when and how they need it, allowing therapy to more easily fit into their lifestyle.
To us, providing hybrid care is one of the best ways to improve the mental health system. By giving both clients and clinicians the option of where and how they do therapy, we’re building a practice that enables a strong therapeutic alliance and improves access to exceptional mental health care for all.
The toll of opioids on rural America
The opioid crisis in America is at an all time high, with a tragic and record-breaking 100,000 deaths each year now attributed to drug overdose. In a 2021 report, the Substance Abuse and Mental Health Services Administration noted that 2.7 million people in the US struggled with an opioid use disorder (OUD). The burden of drug use and overdose is particularly high in rural communities. The good news is that safe and effective treatments exist and can be life-saving. But in rural America access to those treatments can be painfully difficult. For starters, rural communities lack providers. Over half of U.S. counties, most of them rural, have no DATA-waivered physicians to prescribe buprenorphine. That means 28 million Americans live more than 10 miles from the nearest buprenorphine provider. To make matters worse, the rates of naloxone use for opioid overdose are lower in rural communities than in urban and suburban communities. Rural areas also have high rates of poverty. Although some rural states have adopted Medicaid expansion, many addiction providers do not accept it. For example, a 2017 study found that 50% of the active buprenorphine prescribers in Ohio accepted only cash. The amount of suffering is staggering. The challenge is how to make evidence-based care for opioid use disorder both accessible and affordable.
Workit Health’s telehealth solution
Workit Health offers whole-person care for opioid and alcohol use disorders using a virtual first approach. Founded by two women in recovery, Robin McIntosh and Lisa McLaughlin, who grew tired of seeing friends fall through the cracks of traditional treatment systems, Workit Health offers video visits with a medical provider, counseling and psychosocial support, and an interactive curriculum of skills-based courses. Almost a quarter of Workit Health members live in rural areas, where this virtual program bridges the gap between what we know works for these serious health conditions and who actually receives it. Through Workit Health’s mobile and web applications, members have a frictionless experience attending video visits with dedicated clinicians and picking up their prescriptions, including buprenorphine, at their local pharmacies. People who once had to travel hours every day to receive medication are having their lives transformed by receiving the gold standard in opioid use disorder care from the comfort and privacy of their own home. This innovative approach to delivering care not only reduces stigma, it makes care more affordable, which is critical to serving rural communities. For instance, a core component of Workit Health’s mission is to serve the Medicaid population, and today roughly 60% of Workit members are covered by Medicaid.
The Upper Peninsula of Michigan as a microcosm of rural America
Workit Health’s CEO’s Lisa and Robin have Michigan roots and witnessed the lack of access to care for substance use disorders impacting their communities. In response to this, they launched Workit Health and first began serving the residents of Michigan, well before the onset of the COVID-19 pandemic. At first, the majority of Workit members were from metropolitan Detroit and Ann Arbor. But a large portion of the state of Michigan is rural. In the Upper Peninsula, the northern-most landmass of the state, the average distance to a buprenorphine clinic is 63.3 miles, and Michigan counties lacking an emergency department are all located within the Upper Peninsula. Although the Upper Peninsula is adjacent to Northern Wisconsin, it has nearly double the prescribing rate for opioid pain medications as its Wisconsin neighbors. The Workit team turned these challenges into inspiration.
Since 2019, the number of members in the Upper Peninsula of Michigan who have attended an appointment for opioid use disorder with a Workit Health clinician has soared 300%. In rural zip codes across the Lower Peninsula of Michigan, the number of residents Workit Health is serving has increased by more than 200%. The members report that the change is life-altering. One member posted a public review of Workit that said, “[the] program has been a complete life changer! I used to have to drive 50 minutes to my clinic where I was overcharged and judged…they take my Medicaid so it's WAAY cheaper… and most importantly, these people treat you with dignity and respect!”
Encouragingly, Workit Health’s impact on rural areas is not confined to Michigan. Similar growth has taken place in rural areas of Ohio, Virginia, and California. As the opioid epidemic rages on, solutions like Workit Health are a testament to the power of innovation to achieve dramatic and sustained reductions in harm from opioids, particularly in some of the hardest hit areas of rural America.
Dr. Justin Coffey is a neuropsychiatrist and an innovative physician leader whose career efforts to improve behavioral health care have focused on the intersection of technology and improvement science. He leads Workit’s clinical and scientific teams, who combine patient-centered design with evidence-based practices to develop and deliver high-value, whole-person behavioral health and addiction care.
The Current Market for Investment in Behavioral Health Technology
CB Insights reported that funding for digital health in Q1 2022 fell by 36% compared to Q4 2021, with mental health, particularly, experiencing a significant decline, tumbling 60% compared to Q4 2021. They also found that mental health tech raised $792M across 76 deals in the 2022 year, where the average deal size for mental health tech is down so far in 2022, and early stage rounds drop to 66% of deal share in 2022 YTD.
Digital health has seen a downturn overall so far in 2022, and there are conflicting ideas about whether digital health is in a bubble or not. There is a consensus that 2022 will fall behind 2021’s staggering funding. Many investors predict funding slowing down, lower funding rounds, and consolidation.
We spoke with an incredible panel of investors at our conference in June of 2022, including
The conversation covered the current digital health market, how behavioral health startups are doing, and what trends we should look out for in the coming months.
Will this Downturn Continue for Behavioral Health?
Chrissy remarks that after seeing so much enthusiasm for the space in recent quarters, “some investors are saying, maybe now’s not the right time to invest. I can’t get in at the valuation that I want, and I’m going to kind of wait and see what happens.” And specifically within behavioral health, Chrissy thinks that 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 the same way.” Conditions such as OCD, eating disorders, and others have not received the same attention and funding, so they could be a greater focus moving forward.
Aike mentions some outside forces that influenced the digital health industry, such as traditional tech investors that found their way into digital health during the pandemic. She says, “it was a lot of capital outside of the typical digital health investment circles. And what happened in the correction in the first quarter of 2022 is as public markets corrected, as valuations went down, a lot of that, what I would call tourist capital, left the digital health ecosystem. So the tech generalists are now going back to investing in SaaS software versus service-based digital health businesses.”
Consolidation
The digital health space is ripe for consolidation. Alyssa mentions, “what I would predict, and what we’re starting to see, is this consolidation of taking a lot of those SMI (serious mental illness) players where the bulk of the cost is, where they’re proving those outcomes. And seeing some of those players getting acquired. Or those players being the acquirers, as they tack on to the lower acuity conditions.” As the market of startups focused on lower acuity conditions becomes more saturated, we may see more consolidation.
Deena remarks that employers are exhausted by attempting to evaluate all of the different mental health solutions. She continues, “while I think we’re all excited and happy for the proliferation of funding and innovation that’s going into the space, there are only so many direct or even known employer-targeted companies that can be evaluated at scale. So I think more comprehensive solutions or integrations of mental health solutions within other platforms will continue to be a trend that we’ll see.”
Direct-to-Consumer (D2C)?
Some digital behavioral health companies are sold directly to consumers, which has pros and cons for their growth and metrics. As Aike mentions when thinking about the direct-to-consumer (DTC) space, “quality is going to win out. Quality is going to be able to help a company diversify its channels from just direct-to-consumer to employers to payers. And it’s also what’s going to give you a long-term sustainable reputation in the industry.” She continues, “I think direct to consumer yields much better products for the patients…Direct to consumer is an incredibly powerful tool in aligning incentives with patient outcomes, but there are some guard rails that we need to think about as an industry to put in place.” While the D2C experience can help companies align with patient needs, there are not always efficient quality metrics in place.
Alyssa continues the D2C conversation by saying, “where I do like direct-to-consumer, I think on the acquisition side, it’s very interesting because you start to now find people where they are… Most of digital health was built off claims data… It’s built off the lagging indicator.” Instead of using claims data to find people, you can target them much more precisely by being a D2C company.
Alyssa points out the most significant concern with D2C: “at the end of the day, the bulk of the dollars in healthcare do not live with the consumer. They live with the incumbents. They live with the health plans. They live with the self-insured employers… so there has to be a balance of how can you unlock the bulk of the dollars while still maintaining the integrity of the consumer experience.”
Advice to Startups
These prolific investors also had advice for startups moving forward. One piece of advice was to stay mission-driven. As Deena explains, “you can move that fast and break things in tech, but when it comes to health care, if you move fast and break things, there are lives at risk. And ultimately, you’re misaligning investor-fueled growth at the expense of actually improving health outcomes.” Digital health companies have a different value proposition than other tech companies, and it’s imperative that they keep patient health and safety in mind as they manage their growth.
Alyssa chimes in, “we really are different than the rest of tech, and it takes a lot of smart people around the table in healthcare to build really powerful solutions. And there’s a reason we’re thoughtful and methodical because people’s lives are in the hands of these companies.” She also reflects how transformative and powerful it is to build something new in digital health during a global pandemic. Startups and investors must remember their mission and keep patient health and safety at the forefront.
Please browse our video library to hear our entire conversation with Aike, Chrissy, Deena, and Alyssa.
During the Going Digital: Behavioral Health Tech Conference, we heard from startups, payers, providers, investors, and other visionaries in the behavioral health space. One conversation with Britain Taylor, a Ph.D. Intelligence and Systems Engineering Candidate at the Indiana University Bloomington shed some light on artificial intelligence’s (AI) role in mental healthcare. She is the creator of ShuffleMe, an AI predictive software that detects current mood and helps social media users understand what content impacts their mood in real-time.
Social Media Use and Mental Health
Studies have found that social media is responsible for aggravating mental health problems. Social media can create pressure to create stereotypes that others want to see. Social theories have found that social media use affects mental health by influencing how people view, maintain, and interact with their social networks.
According to research, since 2010, iGen adolescents have spent more time on new social media screen activities and less time on non-screen activities. This may account for the increase in depression and suicide. A Pew Research Center study found that of nearly 750 13- to 17-year-olds found that 45% are online almost constantly, and 97% use a social media platform, such as YouTube, Facebook, Instagram, or Snapchat. A cohort study found that greater social media use correlated to online harassment, poor sleep, low self-esteem, and poor body image; in turn, these related to higher depressive symptom scores.
AI in mental healthcare
Artificial intelligence (AI) refers to the simulation of human intelligence in machines that are programmed to think like humans and mimic their actions to perform tasks. Now more than ever, innovative technologies such as AI are being used in the healthcare industry to address mental health challenges. There has been an increase in funding in digital health, and with AI-powered mental health, record levels of venture capital money are flowing into the sector.
The three AI technologies transforming mental healthcare are,
Artificial Intelligence is a growing industry, and researchers constantly discover new and exciting ways to utilize AI technologies to improve health. Research has shown that AI can even be used to reduce symptoms of anxiety and depression. The study found that within the first two weeks, users of an AI therapy app, Youper, experienced anxiety and depression decreases by 24 percent and 19 percent, respectively. These levels remained low after using the app for four weeks. The approach to combining AI and telehealth capabilities encourages patient engagement, improving mental health.
What Is ShuffleMe
ShuffleMe is an AI software that utilizes computer vision through a facial mood tracking camera that takes snapshots at key moments of mood indication. Britain explains how the ShuffleMe experience works. She says that a user would first download the ShuffleMe software, then give the software permission to access the camera on their device. “Then the software does all of the work in the background,” she says. The software functions by tracking facial expressions and eye pupil detection to track the placement of what a user is observing on their screen. Britain describes how “after you browse on Instagram, Facebook, or Tiktok, for example, you would go to the dashboard, and you could toggle mood incline or mood decline to see which social media content impacted your mood. So the software takes a screenshot of what that social media content was when you emoted a negative facial expression.”
The ShuffleMe software has also expanded to give users access to therapists or psychologists via an online chat. The data from the software can be sent to mental health professionals with certification and knowledge about tech addiction and digital health. ShuffleMe’s user experience is unique because users are given as much information and resources about their passive and active behaviors on social media. “[ShuffleMe] provides access to actually receive help on the platform,” Britain says.
Britain explains how the ShuffleMe software has changed how users interact with their social media. She says, “We’ve seen our users unfollow certain users… or even deleted one of their social media platforms because their data was showing that the time they were spending on social media and the content was impacting their daily life.” Britain explains her thoughts on optimizing mental wellness through technology: “I think it depends on the individual. Some tech really helps people feel connected, find relatability and increase their sense of community. Depending on the person, the tech doesn’t support the individual or their mental health.”
Connect with ShuffleMe
The ShuffleMe software is free to users and can be downloaded at ShuffleMe.app. “We are focused on getting our software in as many hands as possible because we are focused on saving lives and making an impact,” Britain says. The ShuffleMe software is currently partnering with the American Heart Association and connecting with university students to use the ShuffleMe software. You can follow ShuffleMe on Facebook, TikTok, Instagram, Linkedin, and Twitter at @ShuffleMeApp. You can access the Going Digital: Behavioral Health Tech talks to hear our entire conversation with Britain Taylor.
Integrated care is mentioned in many of our blogs and a focus for multiple Going Digital: Behavioral Health Tech partners. Addressing both physical and mental health conditions can be very beneficial to members if all of the providers are talking to each other. Communication is much more efficient when the providers are all in one app and one care team. Vida Health’s app not only provides this, but it has just launched a new prescription service. Vida Health’s Chief Medical Officer, Dr. Patrick Carroll, tells us more about the development of this service and what members can expect.
This is the first month that Vida's prescribing services have been in action. Tell us more about how prescriptions can further support members.
Yeah, thanks for having us Solome. We launched our prescribing capabilities this month and look forward to tracking the early results. Prescribing was something we had been considering adding to our capabilities for a long time, but we knew we wanted to be thoughtful about the offering and do it in-house, so we began building the process, clinical rigor, and team at the beginning of the year.
As a physician, over the years, I've seen that some patients do well with behavior change only, and others benefit from also using medications and related devices. At Vida, we know that treatment doesn't stop with a prescription — that’s why we always pair prescriptions with therapy or coaching. That human connection helps us make sure members have the resources and relationships they need to truly be successful. The addition of our prescribing capabilities will better support our members by enhancing the care interventions Vida providers can use to help members with higher-severity conditions see greater health improvements. Not only will it help our members see greater outcomes, it’ll help our business customers achieve greater value while offering their population access to broader levels of care.
For the new prescribing services, what will personalized medication management look like for members?
Both physical and mental healthcare with Vida is always human-led – each member has a primary provider they can stay with for their entire program. That human connection, combined with our robust technology, allow Vida to deliver truly personalized care plans that put our members at the center of everything. As with all Vida services, our prescribing program follows a holistic, individualized approach — with some members starting new medications or receiving new devices, some focusing on adherence, and others reducing or removing medications and devices.
For example, a patient of ours who’s on existing diabetes meds and who has undiagnosed depression can come down on their insulin dose as the member works with us to improve their mental health, loses weight, and lowers their A1c. Now that they have one Vida care team with medical prescribing services, all that care can be done in one place, and the providers can talk to each other to create a personalized care plan.
How is Vida coordinating care across physical and behavioral health for prescribing?
One unique thing about Vida’s platform is that all of our mental health providers, like therapists and mental health coaches, are on the same platform as our physical health providers, like dietitians and certified diabetes educators. Instead of getting medications from one clinic and therapy or coaching at another, our members can receive required chronic care in the same place — using one app and one care team. That single environment for both physical and mental health lets us deliver the right level of care and helps the providers engage with each other and coordinate care effectively. That personalization also leads to better engagement and better outcomes, creating an improved experience for members and ultimately greater value for clients. Now, with the addition of prescribers to our clinical team, we’re able to offer truly integrated care where prescribers can work in tandem with our therapists and coaches.
Going back to how combined physical and mental care that’s coordinated in one platform can lead to better outcomes — we actually just had a new peer-reviewed research paper published that shows 3x greater weight loss among those who also reduced their depression compared to those who focused on weight loss alone. And then switching that around, patients who experienced improvements in their depression showed consistently better weight loss outcomes than those whose depression didn’t improve.
During Going Digital: Behavioral Health Tech 2022, we were fortunate to host two incredible talks focused on Medicaid and behavioral health. The first talk was a Keynote by Chiquita Brooks-LaSure, the Administrator for the Centers for Medicare and Medicaid Services (CMS). We also had a panel discussion, hosted by Margaret Laws, the President and CEO of Hopelab, and featured panelists including Kinda Serafi, a Partner at Manatt, Judy Mohr Peterson, PhD, the Medicaid Director for Hawaii, Anna Fagin, a Principal at Town Hall Ventures, and Jeff Luce, Vice President at Optum, and the East Coast Medicaid Channel Lead.
Background
Medicaid covers nearly 80 million Americans and produces $617B in annual spend and 20% of total healthcare spending in the US. Additionally, 42% of all births are covered by Medicaid. Medicaid also covers much behavioral health care. In 2020, 23% of adults with mental illness, 26% of adults with serious mental illness, and 22% of adults with substance use disorder were covered by Medicaid. Unfortunately, there are 2.2 million uninsured adults with incomes too low to qualify for the Affordable Care Act but do not qualify for Medicaid, and about 25% of them have a behavioral health condition.
As Margaret Laws explains, Medicaid is “an incredibly important area, particularly for historically underserved and underinvested populations and access to innovation, our mental and behavioral health services, and Medicaid has never been more important than it is today.” Chiquita Brooks-Lasure says that focusing on underserved populations is one of their top priorities continuing, “as we make our Medicare policies, we’re looking at how is it affecting the underserved people as well as the providers that serve the underserved?”
Quality Outcomes
As startups look to contract Medicaid managed care organizations, they must focus on specific quality and outcome metrics for contracts to succeed. Jeff explains that three domains for startups to focus on are: standard HEDIS metrics, consumer experience metrics such as net promoter scores (NPS), and tangible, measurement-based care metrics. Anna agrees and continues that startups that are “able to show that they’re best in class in that member experience and operational point of view, if you can be a partner in that, I think it can be a really effective strategy to get your foot in the door.”
Bundled Payments
As many startups start to utilize coaching models and other models of care that are not standard fee-for-service arrangements, they have to think about how to work with Medicaid for coverage of these services. Kinda explains, if you have a “bundled payment model, where you’re saying, I’m going to offer this set of services, this is my payment rate. And then this is how to save you money because I’m going to do this under this particular cap payment. It’s a really smart way to do it.”
Dr. Mohr Peterson explains that sometimes startups need to think about utilizing a consideration known as “in lieu of services” which means, “I’m going to provide this typically not billable service. And in lieu of this, more expensive traditional healthcare billable service in lieu of services means within a managed care environment.” Jeff gives startups hope that even in this complicated regulatory environment, “if the operational piece is super clear, I think the funding piece can get worked out.”
Expanding Markets
Another complex aspect for Medicaid is that different markets operate differently and need unique contracts. Anna says that it is important for startups to remember “that markets are unique and different, states are different, populations are different, individuals are different. So being… both clear in your message and clear about the problem that you’re trying to solve is critical. But being flexible in your thinking and how you’re willing to get there… is equally critical.” Startups should have a clear vision of the problem and which market they are targeting but be flexible in their approach.
Anna continues, “the easiest way to sell your second Centene contract is to really crush it with your first Centene contract.” Startups can be most successful with subsequent contracts when they can show a first deal that worked really well. Dr. Mohr Peterson says when they are looking at new contracts for Hawaii, “We absolutely need to see that they have been successful [in other states].” Jeff also advises that startups “bring something to the table that I can react to or a plan can react to. [And] identify what about your first contract and your first deal worked really well hone in on that key success element.”
Fortunately, Administrator Brooks-LaSure tells us that “across the agencies [we] have been working together to try to think about how do we encourage states to coordinate their care to ensure that children are receiving mental health services.”
Top Tips for Startups
1. Focus on Quality Outcomes
Make sure your product provides a top-notch member experience, works well operationally, and delivers incredible clinical outcomes.
2. Work with Medicaid Plans on Bundled Payments
If you are offering services like coaching that fall out of the traditional ICD-10 code model, work with Medicaid plans to find a billing setup that works for both of you.
3. Crush Your First Contract
In order to successfully expand to additional states and markets, focus on excelling with your first contracts and having something positive to show your second market.
To hear both of these sessions, please visit our website.
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.
How does alcohol affect a member's mental health?
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.
What does your team do to individualize treatment for each member's goals?
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.
How does Ria Health help employers with long term savings?
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.
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.
How is Mindstrong revolutionizing mental health care for serious mental illnesses (SMI)?
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.
What measurements are taken to evaluate progress in members?
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.
How do you partner with payers to support SMI members?
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.
Insights from Innovative Serious Mental Illness (SMI) Startups
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.
Background
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.
Treating SMIs
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%
A Message from SMI Startups to Payers and Providers
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.
Where to learn more:
To read more articles like this, read more of our Insights here.
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Ahead of the Going Digital: Behavioral Health Tech Conference, we will be sharing some insights that you can expect to learn more about during the conference. Dr. Quidest “Dr. Kiki” Sheriff, DO, MS is the founder and CEO of Doctors Under the Radar (Doc U R), a company focused on physician mental health that engages healthcare leaders, creates transformational workplace change with mental health and suicide prevention strategies, and design health-tech data driven solutions. Dr. Kiki sat down with our very own Solome Tibebu to discuss her experience with burnout and her decision to create Doctors Under the Radar.
Clinician Burnout
As Dr. Kevin Hopkins recently explained for the American Medical Association, physician burnout is “a combination of physical and emotional exhaustion that can lead to reduced effectiveness-either real or perceived.” Doctors and all mental health professionals are experiencing extremely high rates of burnout, which has only been exacerbated by the COVID-19 pandemic. In fact, medical students are two to five times more likely to experience depression than their age matched peers.
In 2018, the American Psychological Association estimated that 21-61% of mental health practitioners were experiencing burnout, and a 2020 study found that 78% of Psychiatrists screened in the study were positive for signs of burnout. To combat the growing need for mental health treatment and due to an ongoing shortage of mental health providers, in November 2020 one third of Psychologists report seeing more patients since the start of the pandemic and 30% said they have not been able to keep up with demand for treatment.
Mantra Health, a digital mental health company, recently released a white paper on provider burnout in counseling centers. In their sample 91.4% of respondents reported burnout and 45% of clinicians agreed or strongly agreed that their workload compromises their ability to provide quality care.
How can organizations who employ physicians and mental health providers help?
Dr. Jessica Gold, a practicing Psychiatrist, so eloquently explained in a Forbes article last year, “therapists are a limited resource and cannot, no matter how much they try, make up for a broken mental health system with extra hours, night and weekend accommodations.” So in order to improve provider burnout, we have to think about how organizations and employers can make changes.
Clinician burnout has downstream effects on the entire healthcare system. Clinician burnout is costing the health care system about $4.6 billion a year. Additionally, studies show that if things continue the way they are, by 2025, 75% of healthcare workers may leave the profession.
In our discussion, Dr. Kiki stated that it's important for health systems to “create an atmosphere where it’s okay to state that you’re experiencing burnout and to ask health systems, what initiatives do you have in place to engage your clinicians?” Additionally, Dr. Kiki emphasizes that it's important to have an internal audit to “talk to your clinicians to understand what their problems are, and this will drive your solutions.”
Solutions that health systems and other organizations create must focus on three pillars that support intrinsic motivation and psychological well being: autonomy, competence, and relatedness. So solutions may involve reallocating resources so clinicians feel they have more control over their schedule, and are less burned by administrative tasks. Additionally, the Mantra Health white paper suggests creating solutions that focus on they key themes of togetherness, openness, boundaries, and increasing meaning.
What tools are out there?
Doctors Under the Radar strives to provide resources and support for all clinicians in the workplace through strategic consulting, health-tech innovation, and media. As part of their strategic consulting initiatvie, Doc U R partners with healthcare organizations to normalize mental health and suicide prevention in the workplace, including culture management, leadership engagement, and data-driven decision making tools.
Mantra Health is a digital mental health provider for university students that works with university counseling centers to support existing providers, expand capacity, and reduce administrative burdens for existing providers. Therapists employed by Mantra Health are also able to create their own schedules, for greater autonomy. Additionally, the Mantra-affiliated providers can collaborate with the on campus providers to give comprehensive care coordination to university students.
Things to remember
Burnout can lead to increased loss of empathy, impaired job performance, and increased medical mistakes. It can also lead to greater costs to the healthcare system, including clinicians leaving the workforce.
To reduce burnout, clinicians of all kinds need to feel that their time is valuable and they can have autonomy in their work.
As Dr. Kiki mentions, “and just one other thing that I would like to see is just that we change the face of medicine, in which doctors are seen as superheroes, and they constantly have to wear that cape, which dehumanizes them and makes it harder for them to be true to themselves.”
To watch the entire interview with Dr. Kiki and hear about her personal struggle with burnout, 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.
This week, we’re talking to a group that is focused on populations with complex comorbid physical and behavioral health conditions. As we’ve discussed quite a bit on the blog, we know that when mental health and substance use disorders go untreated, they can cause individuals much more difficulty dealing with their symptoms. If paired with a chronic illness, this burden only significantly increases. This combination leads many patients to seek emergency care at higher costs to health plans. These payers are eager for solutions that address untreated behavioral health conditions to reduce these costs.
When it comes to supporting patients dealing with multiple chronic conditions with underlying behavioral health issues, it is important to have a care team skilled in engaging patients with personalized plans and timely care. The team from Ontrak Health shared their approach with us.
How do unaddressed behavioral health conditions contribute to inflated health care costs?
One of the key healthcare challenges we are tackling at Ontrak Health is how to engage complex populations with unaddressed behavioral health (BH) conditions + chronic physical conditions into high-value care to meaningfully reduce medical expense.
When an individual is not receiving adequate treatment for a behavioral health issue - such as depression, anxiety, or substance use disorder – and they are not engaged with a primary care provider or proactively managing their other chronic physical conditions, their physical health will likely deteriorate until they require crisis care in an ER or hospital setting. It is well documented that preventable ER and inpatient stays are one of the main drivers of avoidable healthcare costs.
Unfortunately, in many cases the BH issue will continue to be unrecognized or undiagnosed in the urgent care setting. For example, take an individual with diabetes who has exacerbations that land them in the hospital twice. They are stabilized at the initial visits, but then a few months later are back in the hospital, and the diabetes is labeled as refractory (not responding to treatment). However, the underlying cause is actually undiagnosed alcohol use disorder that is destabilizing their blood sugar. Alternatively, it could be untreated depression or anxiety that is preventing them from participating in diabetes management or adhering to treatment plans.
It is this cycle of low value utilization that contributes significantly to inflated healthcare costs.
Our focus at Ontrak is helping individuals achieve lasting health improvements to reduce medical expenses. We do this by removing barriers to care, empowering sustainable behavior change, helping members develop self-efficacy, and connecting them with providers to address underlying behavioral health conditions. Through this proven approach, we are able to deliver a significant and durable reduction in ER and inpatient utilization and costs across our member base.
What does Ontrak's AI-driven, integrated care model look like? And how does it drive deeper engagements and better outcomes?
Ontrak recently announced an industry-first Advanced Engagement System that will enable us to deliver precision behavioral health by infusing AI into every step of the behavioral healthcare journey. Our AI-powered platform will optimize program eligibility, member identification and outreach, coaching interactions, provider visits, interoperability of data between Ontrak, providers, and health plans, and last but not least, outcomes.
Once enrolled into the Ontrak program, AI will match members with the best Ontrak Care Coach to help them work towards their health goals, and also recommend the best behavioral health provider match for treatment. Once matched with a member, our coaches take a person-centered approach to engagement, and connect in the ways that work best for the member, allowing the coach to become a trusted advocate and resource.
Our integrated platform will also facilitate collaboration between coaches and providers by offering unprecedented visibility to a member’s care journey, progress and health outcomes, and providing seamless exchange of session notes and other data.
Lastly, our AI-infused services will help coaches develop deeper engagements with members by enabling highly personalized, timely, and empathetic care, while maximizing the efficacy of treatment plans by providing, for example, real-time feedback on fidelity to evidence-based models.
Leveraging AI to optimize each step in the care journey alongside personalized, high-touch coaching means that we can deliver better outcomes that last.
How does Ontrak's high-tech, human-centered approach deliver a reduction of medical expenses for health plans?
As noted earlier, we deliver meaningful cost savings to our health plan partners by durably reducing avoidable inpatient and ER utilization. Across our Medicare, Medicaid, and commercial member base, we have reduced hospitalizations by 63% and ER visits by 42%, on average. A soon-to-be published analysis of the “treatment effect” of the Ontrak program demonstrated a $486 PMPM greater cost savings durable over 24 months for Ontrak graduates compared to a propensity-matched control group who did not enroll in Ontrak.
We are able to deliver superior outcomes by leveraging AI combined with deep human connection that allows us to identify, engage, guide to treatment, and activate previously unaddressed populations.
As the pandemic continues, substance use disorder (SUD) has been on the rise. Recent data shows over 93,000 reported drug overdoses during 2020, which is the highest on record and nearly a 30% increase from 2019. The shortage of providers in this industry has only worsened the crisis for many individuals, families, and communities. Peer support has been a widely used treatment plan for these conditions (e.g. AA programs), but even these programs are struggling to manage the high demand. An innovative company in the SUD space, Marigold Health, provides a virtual peer support network that has scaled to meet the needs of many individuals with SUD. Shrenik Jain, Founder & CEO, sat down with us to discuss the importance of the virtual aspect of peer support, Marigold’s success working in Medicaid, and what’s ahead for the company.
1. Why is now the time for this sort of solution in the market?
We face an acute shortage of behavioral health providers, and everyone is struggling with patient engagement. Millions of dollars have been invested to make proactive interventions such as counseling and medication-assisted treatment for substance use disorders more accessible, but still only a small minority of those in need receive services consistently.
Peer support, the use of trained individuals in recovery to support others on a similar journey, has been demonstrated to engage patients who may not be willing or able to utilize other services, and is reimbursed by Medicaid in over 40 states. However, the reach of peer support has been limited – grassroots groups such as 12 Steps aren’t integrated with the larger care team and existing phone-based peer coaching programs cannot serve enough individuals to impact the health of a population.
Marigold’s virtual peer support program combines intensive 1-1 supports with 24/7 access to anonymous group chats where patients support each other. When we enter a market, we build a local team of certified peers who embed in existing primary care and behavioral health providers to sign patients up for our app. Once in our online community, we have a set of technology tools that allow our peers to coordinate with others of the care team to respond to patient needs expressed in groups.
In short, we are a virtual provider focused on driving patient engagement and developing a new workforce of behavioral health providers.
2. You have some exciting health plan partnerships and study results, tell us more.
We have seen a lot of success working in Medicaid: Medicaid MCOs often have strong relationships with local providers and government stakeholders that we can partner with then rapidly enroll a large member base. One of our biggest advantages is patient acceptability: 70-90% of patients we approach are willing to enroll and give our text groups a try.
In Delaware for example, Marigold partnered with a Medicaid plan to engage members with substance use disorder (SUD) and increase their utilization of proactive services such as MAT. Within 5 months, 2 DE-based peers had provided support to 900 plan members, almost 13k messages were sent in 15 themed support groups, and we signed referral partnerships with agencies collectively delivering ~80% of methadone care statewide. We structured a bundle (alternative payment model) with the plan that allowed us to rapidly expand eligibility to all members following an initial pilot.
3. Congrats on the new funding! What is ahead for Marigold Health?
The funding is all going into growth, primarily growing the team as we enter new states. Our goal is to build the most capable peer workforce in the country, whose recovery experience includes a full spectrum of mental health disorders and challenges beyond substance use alone.
In our other departments, we are currently searching for a Clinical Director to report directly to our Chief Medical Officer and further develop programming, as well as a Director of Growth, who will work directly with the CEO to build plan partnerships.
U.S. Surgeon General Dr. Vivek Murthy has again addressed the devastating effects of the pandemic on the mental health and well-being of young people.
According to the CDC, schools have direct contact with “56 million students for at least 6 hours a day during the most critical years of their social, physical, and intellectual development.” There’s plenty of data demonstrating that for a variety of cost, mobility, and time reasons, youth in underserved communities aren’t getting the access to high-quality health care they desperately need. However, school-based health centers can be a game-changing source of access to physical and mental health services for youth who need it most.
Hazel Health is already providing fast access to equitable physical and mental health care to millions of students nationwide. Students have access to their services regardless of their financial or insurance status. I was delighted to connect with the Hazel team and discuss how they are expanding healthcare access to children and teens across the country:
Why is it important to address mental health in schools in addition to physical health?
K-12 students are facing an unprecedented mental health crisis. Before the pandemic, approximately 17% (1 in 6) U.S. youth ages 6-17 were experiencing a mental health condition each year, but as many as 60% of students (ages 12-17) with depression did not receive any treatment. Of the adolescents who did get help, nearly two thirds did so only in school. During the pandemic, depression and anxiety symptoms in youth doubled compared to pre-pandemic levels.
Hazel Health believes that one way to make sure children and teens can access mental health services is to meet students where they spend their time - at school and at home. This removes so many of the barriers that students face when trying to seek mental health care, including months-long wait times to see a provider, transportation, and the difficulty of navigating the health care landscape to find appropriate, affordable, high quality mental health services.
At Hazel we have found that the line between physical and mental health isn’t black and white, particularly when working with children and teens. We partner closely with school nurses, who have always known that their students who visit them frequently, complaining of stomach aches or headaches, often have something else behind that - depression, bullying, and other issues outside their control at home or in their communities, such as food or housing insecurity. School nurses and counselors have always identified these issues - Hazel gives them a resource to connect them with to address both their physical and, when needed, mental health. Hazel therapists can see students immediately short term, and then work to connect them with a local therapist or other resources for longer term counseling.
We have focused on providing same-day service for physical health, and very short (1-2 week) wait times for mental health, to help close the gap for the 20 million children in the U.S. who lack access to high quality health care.
Although Hazel is not a replacement for primary care providers, do you see children in rural areas using the platform more frequently due to its accessibility?
Hazel has a unique viewpoint - we work with school districts in both urban and rural communities. Transportation is a core challenge we solve, and that comes up in both rural and urban communities. In rural communities, the nearest clinic is often very far away. 23% of Americans in rural areas say access to good doctors and hospitals is a major problem in their community. However, in talking with parents and school staff, this issue is just as relevant in urban communities. In urban school districts, parents have shared with us that getting to a clinic that accepts their insurance is sometimes a 2 hour bus ride away, and costs $15. Compound that with hours of missed work to pick up their child from school, wait several days for a sick-visit appointment, travel to and from the clinic, and the cost for a family living on low wages becomes astronomical. For both urban and rural communities, entire family systems are helped when they can see a Hazel doctor or therapist right from school, and they are more likely to get care.
An additional benefit of making physical and mental health services more accessible, with less travel time or time waiting for an appointment, is that students miss much less school. In one study Hazel did with WestEd and the Department of Education, we found that nearly all telemedicine visits (94%) resulted in students safely returning to class by resolving immediate health concerns. Students who returned to class received, on average, three hours of instructional time remaining in the school day. This resulted in over 2,500 instructional hours saved over two years for this particular district.
How is Hazel addressing systematic health inequities faced by children and families in under-resourced communities?
At Hazel, addressing social determinants of health is a key component of our mission. Hazel was founded on the belief that great health care addresses not just a physical or mental ailment, but also the social and environmental context surrounding a person's health and well-being. For children across the country to experience improved health outcomes, we must consider the conditions in which they live and learn, and we must take steps to address challenges in their environment that contribute to poor health outcomes.
Economic stability is a key predictor of good health. Today, around 37 million people in the United States live in poverty and more than 16% of children under 18 years old live below the poverty line. Many people can’t afford healthy foods, health care and housing. Hazel serves all students, regardless of their financial or insurance status. This means that all children, those who have insurance, and those who don’t, can benefit from the service.
By providing access to physical and mental health care right from school, Hazel helps students remain in school, and parents at work (parents don’t have to take off work to take their child to the doctor, resulting in missed pay in many cases). Hazel’s Family Resource Managers help connect families to community resources such as food services and housing programs.
We recently developed a 1-page summary of Hazel’s impact across each of the 5 core social determinants of health for more of a deeper dive into this topic.
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To learn more about Hazel, request a demo, or view career opportunities visit us at www.hazel.co
Last week, I sat down with tech-savvy Dr. Carrie Singer, owner of Quince Orchard Psychotherapy based in Rockville, MD. Together we discussed what it's been like to be a mental health provider during the pandemic, what the typical patient journey toward finding the right care is today, how she built a successful therapist network, and where she sees the digital behavioral health industry going. You can watch our conversation on our YouTube channel, or you can read the transcribed conversation below:
Solome Tibebu (0:02): Hello everyone! Welcome back to Going Digital: Behavioral Health Tech. So excited to have our next guest here, Dr. Carrie Singer from Quince Orchard Psychotherapy. She has developed a successful practice from the ground up. And I'm super excited to talk with her today. So Dr. Singer, how about you introduce yourself real quick.
Dr. Carrie Singer (0:23): Hi, Solome. Thank you so much for having me. Hi, everyone. Like she said, I'm Dr. Carrie Singer. I own a group private practice in the Washington DC suburbs. In the last five years, we've gone from just me to 40 therapists and we still have 1400 clients on a waitlist, unfortunately. So I've just really gotten interested in the demand for mental health services and the tools and technologies that are coming out to meet that demand. I've gotten really interested in coaching and consulting in the space. So I'm glad to be here and try to lend a little bit of a clinical lens to the conversation.
Solome Tibebu (0:52): Fabulous. So how about to get started, can you tell our audience a little bit about what it's been like to be a mental health provider during the pandemic?
Dr. Carrie Singer (1:01): Sure, I don't want to speak on behalf of all mental health providers. But I think collectively we can say it's been a little rough. Because being a therapist is hard anyways, and you're carrying a lot of people's pain and suffering. There's some days where you sit and listen to people cry, or have suicidal thoughts for the majority of your day. It's hard to keep positive sometimes, especially during the pandemic, when we're all having our own collective traumas and issues, and grief and loss issues. It's just been compounded. Plus, not to mention, there's been so much more of a demand for services. Having to turn people away has been really hard. The people that are receiving the referrals tend to have more acute symptoms. So it's been a lot more time consuming to manage.
Solome Tibebu (1:40): Mm hmm. Definitely. In fact, let me ask you a little bit more from the patient perspective, what have you found the typical patient journey toward finding the right care?
Dr. Carrie Singer (1:53): Sure, I mean, the feedback that we hear is that there is a supply and demand imbalance. And that patients think it's going to be like finding a new primary care doctor. "I'll just look in my insurance directory, there'll be a lot of options. And I'll just call down the list until I find someone." And it's not really like that with finding a therapist. A lot of times the insurance directories might have incomplete information or be out of date, or they might look through therapists directories, but there's so many choices. They don't exactly know what type of treatment they need. And they start making the phone calls and emails just to realize that people don't have any openings, can't see them after school or on the weekends, don't treat the specialty condition they need help with, most significantly don't take their insurance, so the cost of care is going to be a lot more than they can afford. And so a lot of times people will just give up and not get the help they need until maybe they have a panic attack or crisis situation that leads them to the emergency room, which ends up being a real drag for the healthcare system. It's a lot more expensive than preventative care.
Solome Tibebu (2:48): Right. And yeah, clearly a lot of opportunity to evolve and augment access to care with different solutions. But I'll ask you about that next. So going back to your practice, as I mentioned earlier, you built this practice from the ground up. So many digital health companies right now are attempting to build large therapists networks. What have you found to be the secret sauce in terms of attracting and retaining talent?
Dr. Carrie Singer (3:20): Well, it's no secret, treat other people the way you want to be treated. It's nice if you can offer things like making people an employee and giving them benefits, like health care, or 401k, or especially paid time off. But above that, I think that therapists, almost as much as pay, value flexibility. They really like the ability to control somewhat: the patients they see, the hours they work, how many they see in a day. So for our therapists, that's been really critical. But I think sometimes these digital health companies too, they're sometimes led by non-clinical leadership. They don't have a long track record. People they're hiring don't know each other, don't know the management team, don't know what the company stands for. I think for us, having a personal connection with each employee has really helped us retain them and feel like part of a team and a culture where they can learn and grow professionally and personally.
Solome Tibebu (4:07): That's awesome. So bigger question, where do you see the industry heading?
Dr. Carrie Singer (4:14): Well, I think there's a lot of pockets of opportunity. But more specific to the type of work I do, we've seen a lot of consolidation of care through mergers and acquisitions, or through some big players coming into the space. And it's a little bit worrisome sometimes. You don't want there to be mental health monopolies. I think there's pros and cons. But I guess, if we want CVS and Walmart and Google and Amazon controlling our mental health care, I get a little bit worried about how that medical information is stored and used. But I think because of the access problem, if there's bigger people who can come in that have the funds to make it a streamlined process for patients to find the right care and aggregate providers to provide the care, I certainly don't have any problem with that. I think sometimes it's just the delivery of that that can be an issue. But I do I think there's also opportunities because there are so few clinicians to sometimes explore the use of non-clinicians to fulfill that need, so trained behavioral health coaches, and what does that certification process even look like? Or maybe blended care models where you're starting out, maybe offering patients some self help tools, mood tracking devices, and then maybe you're giving them some other supports, like digital CBT tools. And then you're blending that with therapy and psychiatry services that you're meeting patients where they're at and the continuum of care.
Solome Tibebu (5:29): Right. Yeah, I mean, talk about quickly changing times. I think in the last week, there was like three different mergers and acquisitions in the space and how many fundings just in the last couple of days. And so that is, of course, leading to new challenges as the industry evolves. So you started to touch on digital tools. Tell me a little bit about what are some of the ideas or tools in digital health that you're really excited about?
Dr. Carrie Singer (5:57): Sure. I mean, I really believe when it comes to like the Triple Aim philosophy of any tools that can make care affordable, accessible, and high quality are going to win. And usually you get two out of the three, but not all of them. So if there's anything that can make the care... Like us, we have care that it as affordable, we accept insurance. And I believe it's high quality, but it's not very accessible. We have a long waitlist. We see our patients for longer lengths of time. So if some of these bigger players started to get on health insurance panels and have in-network contracts, I'd be really excited about that. Because still, most of the time, they're going to be charging patients anywhere from $100 or more per month just for text-based chat therapy, whereas they could see somebody using their copay and pay nothing. So I'm also interested in like FinTech and AI solutions for making the treatment costs more apparent to the not only the patient, but also the provider at the time of care. So people go in with a better informed sense of what they're signing up for and what they can afford, so they don't drop out early. I'm also really interested in tools like remote patient monitoring tools or wearables that blend mental health and physical health data, because I believe we are moving toward a value-based behavioral healthcare paradigm in the near future. And if we can show, which research has proven, that if you treat your mental health, your physical health symptoms will improve. I think that could be some really exciting data.
Solome Tibebu (7:13): Right. I love so much that you address something interesting that helping consumers understand what it is they're actually signing up for. And now that there's just a plethora of everything from totally asynchronous text or self guided versus all the way to face to face and what kind of credential provider you're working with. I mean, I'm very excited about that aspect of continuing to teach consumers in general, what is it that they're actually getting into? So I'm glad you mentioned that. But as always, I wish we had more time to chat. Thank you so much, Dr. Singer for joining me today and your insights.
The demand for digital therapeutics has accelerated as technology has advanced, provider shortages persist, and more consumers are looking for solutions to their mental health concerns amid the pandemic. Digital therapeutics serve as non-drug alternatives to support mental wellbeing and they are also reducing barriers to care for underserved populations.
Big Health, a digital therapeutics company dedicated to helping millions back to good mental health, has pioneered and scaled the industry-leading reimbursement model for digital therapeutics via the pharmacy benefit manager. This week, the company announced its $75 million Series C funding round. I had the opportunity to talk to Celeste James, Vice President of Equity & Population Health, about the importance of digital therapeutics and Big Health’s goal for health equity, including their quest of ensuring 50% of their users come from medically underserved populations.
What is Sleepio and Daylight, your digital therapeutics?
Sleepio and Daylight are Big Health’s first two digital therapeutics for insomnia and anxiety, respectively.
Sleepio is a multi-week sleep improvement program featuring cognitive behavioral therapy (CBT) to help people fall asleep faster, stay asleep through the night, and feel better during the day.
Daylight is a digital therapeutic intended for the treatment of Generalized Anxiety Disorder (GAD). The program takes automated CBT and other techniques, including tense & release and worry time, and fully automates to provide evidenced-based care without intervention from therapists or other medical professionals.
Both Sleepio and Daylight are proven to provide safe and effective non-drug alternatives for common mental health conditions and in separate controlled studies, helped 76% of patients achieve clinical improvement in insomnia, and helped 71% of patients achieve clinical improvement in anxiety.
In light of provider shortages and subpar tools on the market today, why are these important innovations?
We are at a unique moment of opportunity as the pandemic has led to increased prevalence of mental health conditions, making mental health care a top priority for payers, health systems, and patients. As a result, the shortcomings of traditional models of care have become clear: human-delivered therapy, even when enabled by technology, is insufficient to meet the ever-growing level of need, resulting in long wait times, provider shortages, and rising costs. For this and other reasons, mental health remains one of the most inequitable areas of health care.
Further, the reality today is the vast majority of patients with a mental health condition seek care within primary care, with more than 80% receiving medication. Separate clinical research has shown that these medications are often associated with moderately severe side effects and/or adverse events, and minimal long-term benefits.
Digital therapeutics, however, provide safe, effective non-drug alternatives and evidence-based care, including cognitive behavioral therapy, through a pure software solution without coaches or clinicians – reducing barriers to care. This care delivery model allows us to reach individuals who otherwise wouldn’t have access to care due to barriers such as transportation, insurance and out-of-pocket costs. When created and implemented thoughtfully, digital therapeutics provide a consistent and equitable experience for users, reducing stigma and avoiding biases that often occur in traditional mental health treatment, and thus, improving health outcomes at great scale.
You have had a huge focus on health equity, help our audience understand how Big Health has centered on this work?
In April 2021, Big Health shared a public commitment to mental health equity, which includes a long-term goal of ensuring 50% of our users come from medically underserved populations. As part of Big Health’s commitment to increasing mental health equity, the team developed three specific goals addressing our internal structures and external impact:
Today, 38% of Big Health’s leadership team consists of women or underrepresented minorities. Although we are still shy of our long-term ambition of having the diversity of our workforce reflect that of our user base, I am encouraged by the team’s progress to date. However, we must continue improving diversity and inclusion at Big Health to ensure that Black, Latinx and LGBTQ+ communities among others are better represented within our employee base.
Big Health aims to ensure that millions of people have access to evidence-based mental health care – the north star that drives all decision-making in the organization – and that we deliver equitable outcomes regardless of ZIP code, race, or economic status. In my role as Vice President of Equity & Population Health, I am supporting Big Health’s mental health equity goals by being integrally involved in our product development, go-to-market strategies, and business operations to ensure we bring an equity mindset to all that we do to scale access to good mental health.
Amid the Great Resignation, employers are striving to support their employees in various ways. Mental health concerns have risen during the pandemic, which has created a need for employers to support the mental health of their employees. These times have been especially difficult for parents in the workplace. These mental health concerns are not only affecting them but also their children. In an attempt to help the entire family and ease the burden on the working parents, employers are increasingly interested in behavioral health benefits that are family-focused. Brightline has been in the spotlight for providing behavioral health care that is specifically designed for children, and they have recently published a guide for supporting the mental health of employees with kids. We spoke with CEO Naomi Allen about the importance of family-focused behavioral health benefits.
Why do kids and teens need care specifically designed for youth?
Kids aren’t just small adults! When it comes to behavioral and mental health, you really can’t just replicate what’s been built for adults and have it work for kids and teens. What’s going to work for you as a parent at 35 or 50 years old just isn’t right for a 3 or 15 year old. It seems obvious, but to do it right takes a lot of factors and designing specifically to work for each age range. So even from the start, you need to consider that the way kids present with behavioral and mental health issues is different, and how to address that — for example, depression in kids can often show up as irritability. Kids and teens confront different issues, and respond to therapeutic interventions differently. Managing tantrums, developing organizational skills for school, coping with teen’s self-esteem or tough stuff with friends — you need to be able to really meet kids and teens at their level, and tailor interventions to work for where they’re at in that moment, emotionally and developmentally.
Here’s a good example of what that could look like: you may have a middle schooler who is feeling worried lately as schools are shutting down again, and is having trouble sleeping. At Brightline, we would assess where that child is, and if their anxiety meets a clinical level of need. If so, we can get them started with a therapist to work through those worries, build coping strategies, and address the impact on their sleep. But maybe their anxious thoughts don’t hit a clinical level of need — in that case, we can get them into our “Sleep Made Simple” coaching programs to build skills for tackling the anxiety and related sleep issues, alongside self-guided content with their parent or caregiver.
This is exactly why Brightline isn’t adapted for kids, it’s built for kids. Everything we do is flexible and designed specifically to work for children and families — meeting them where they are emotionally, developmentally, and literally bringing it to them with virtual care. By engaging parents and caregivers in their child’s care, giving them access to progress updates and regular check-ins, they are supported and know how their child is progressing forward. Our coaching programs, therapy, evaluation and medication support, speech therapy, and ongoing support and resources for parents and caregivers alongside their kids, and for teens, in our digital platform — we’ve designed it truly to work for them.
How does pediatric behavioral health benefits support working parents and their families?
For working parents and caregivers, juggling the demands of a full-time job and the complexities of seeking care for their child can feel completely overwhelming. Rates of behavioral and mental health needs among youth are skyrocketing. Parents and caregivers themselves are suffering too: more than half (59%) say they’ve experienced their own behavioral health challenges due to the stress of managing their children’s behavioral health needs.
This isn’t going away — we expect that the pandemic will have lasting impacts on mental health, and we need to get out ahead of this and support families so they don’t have to make the difficult decision to leave the workforce. We can meaningfully support parents and caregivers by giving them access to comprehensive behavioral health care for their children, through virtual care, coaching, and self-guided content — so that they can access what they need, when they need it.
We’ve felt this in our own company. The majority of our executive leaders, and many others on our team, are also parents to children under the age of 18 — some of whom have significant behavioral health needs. For many of our kids, those needs have been exacerbated during COVID. The ongoing uncertainty and changes during the pandemic have made it incredibly difficult to balance this all — some of us have had to cut back, or in past lives before Brightline, had to quit jobs to care for our kids. This shouldn’t be a decision parents have to make, yet it’s happening every day. We can, and must, change this by getting working parents and caregivers care that actually works for their children, and supports them, too.
Why is behavioral health support for the entire family important for employers to get through the Great Resignation?
This is all taking a real toll on working families and their employers: in fact, our 2021 Pediatric Behavioral Health Needs Survey found that one in five (21%) of parents and caregivers have either already quit their jobs in the last year or plan to quit their jobs in the coming year to better care for their children’s behavioral needs. There’s an increasing gap with women feeling burned out and leaving the workforce at higher rates than men.
We’re approaching the third year of the pandemic, and it’s costing employers. According to Gallup, replacing an employee costs half to two times the employee’s annual salary. When employees are having to spend so much time managing their kids’ behavioral health needs with limited or so support, there’s a significant impact on productivity, too. Add to that medical costs associated with employees’ own heightened mental health needs, and this has a significant cost burden for employers.
It shouldn’t be either/or for parents and caregivers. By making behavioral and mental health care for children and families a covered benefit, health plans and employers can connect families to much-needed support so they don’t have to choose between their careers and supporting their kids. Families deserve better, and companies have the power to change this situation.
What are you seeing in terms of health plans and employers making this shift in benefits?
I think we’re really seeing a shift in adoption of family-focused benefits. At Brightline, we’ve driven significant momentum in this past year to meet the needs of families. In the past year, we expanded our digital platform, Connect, and coaching programs to all 50 states, the first time comprehensive behavioral health care for kids, teens, and families was made available nationwide. We’ve now had nearly 14,000 parents and caregivers using Connect, in all 50 states. We’ve expanded our clinical services to cover 89% of the U.S. population in terms of the states where we have licensed therapists at the ready to work with families. We’ve seen fast and significant adoption by leading health plans and national employers who recognize the great need and impact bringing these services to their members will have — we’re now covering 24 million health plan lives, partnering with 35 employers, and are rapidly forging new partnerships and expanding access from here.
Want to partner with Brightline? Reach out to partnerships@hellobrightline.com or visit hellobrightline.com to learn more.
We’ve been discussing the migration to precision medicine in several of our blog posts lately, outlining how some GDBHT mental health and substance use partners are meeting patients where they are. One exciting field that is equipping providers to offer individualized mental healthcare is pharmacogenetics.
Pharmacogenetics provide additional data on a patient's response to medications. Dr. Daniel VanDorn, PharmD, Sr. Medical Science Liaison and Lead Scientist for Product Development at Genomind, enlightened us on these topics and the innovative ways that Genomind is increasing prescribing confidence, reducing healthcare costs, and improving patient experiences.
Population health is at the top of many peoples' minds these days, what is the role of precision medicine in population health?
Precision or personalized medicine is a care model designed to optimize efficiency and therapeutic benefit for patients. Precision medicine often involves genetic testing to reveal how a patient may metabolize certain medications or determine the potential impact medications can have on the body. However, it is not yet commonplace for health care providers to have access to genetic information, while other factors can be used that are more widely accessible.
In addition to genetic factors, drug-drug interactions (DDIs) are the most common, preventable cause of adverse drug events (ADEs). ADEs harm over 2 million people and cost the US healthcare industry $30B annually. Up to 22% of all patients taking medications are predicted to have DDIs, with estimates up to 31% in the elderly population. While there are tools available to health care providers that assess DDIs, they are infrequently and disparately utilized across our health care system.
Imagine if we could quickly identify, within a large data-base of health information, specific subpopulations of patients at greatest risk of drug-drug interactions, while also providing therapeutic alternatives to reduce this risk. Now imagine that we can also identify those patients at greatest risk of harm due to potential genetic factors, and thus stratify which patients are suitable candidates for genetic testing. This is exactly what Genomind’s precision technology was designed to do.
Why is pharmacogenetics important in mental health?
Mental illness impacts 20% of the U.S. population and that percentage is quickly growing across every age group. Individuals who are prescribed mental health medications often are subjected to a trial and error approach to treatment. For far too many patients, this results in months or years of struggling with unresolved symptoms with the added burden of ADEs. Real-world data suggests that 67% of people with depression do not achieve remission with their first medication trial, with the odds of remission declining after each subsequent trial. Depending on the condition, 30-80% of psychiatric patients have unresolved symptoms. Many abandon drug therapy altogether, usually due to adverse drug effects. There is an obvious need to embrace tools that limit trial-and-error, reduce risk of ADEs, and improve patient outcomes. Pharmacogenetics is one such tool.
Pharmacogenetics (PGx) refers to the study and application of how an individual’s genetics may influence their response to medications. This is far from a new concept. Other fields of medicine such as oncology and cardiology have applied PGx for years, which has since evolved into a standard of care in these fields.
Similarly, utilization of PGx in psychiatry has grown over the past few years due to its potential to decrease treatment by trial and error. A recent meta-analysis (study of studies) showed that depressed patients were 71% more likely to achieve remission when PGx was used to personalize their treatment, compared to those subjected to the standard approach. Similar studies suggest that PGx can reduce the rate of hospitalization by 50%.
PGx can provide additional data for healthcare providers to tailor treatment to the individual. The Food and Drug Administration (FDA) has identified over 270 medicines with genetic-based guidance on their manufacturing labels. Additionally, the Clinical Pharmacogenomics Implementation Consortium (CPIC) has reviewed more than 400 gene-drug pairs, and has produced peer reviewed PGx guidelines related to many mental health treatments. So how can we responsibly prescribe medication without having this information about our patients?
This more personalized and informed approach to treatment has been associated with higher remission rates, decreased healthcare costs and reduced hospitalizations. Our challenge now is to broaden awareness and increase the adoption of this practice, especially within mental health.
Tell us more about your innovative approach at Genomind and the adoption you have been seeing?
As the science of medicine evolves, Genomind feels a keen sense of obligation and responsibility to evolve with it. We maintain the latest medication guidance within our models and continually optimize our laboratory processes. We have also expanded our solutions to support not only individual patient care, but the management of large patient populations, which will continue to grow in importance and focus within the healthcare industry.
Genomind’s Population Health solution is driven by GenMed✓Pro, Genomind’s precision gene-drug-drug interaction software. The proprietary logic that drives GenMed✓Pro is now being applied to large healthcare databases to assess the full drug regimens of populations en masse. This allows payors and large health care institutions to identify individual patients at greatest risk of harm due to DDIs. The software then provides a list of alternative medications which may be less risky, as well as specific FDA or CPIC guidance where appropriate.
In addition to identifying known drug interaction risks and alternatives, we also apply a genetic prevalence algorithm that calculates the probability of gene-drug related risks. This further allows these institutions to stratify their population by probability of genetic risk and identify individual patients for whom PGx testing may be warranted. Our full platform can be seamlessly integrated into any workflow through our numerous EMR / EHR partnerships. We are making it easier and faster to personalize treatment in a way that hasn’t been done by the competition.
Genomind has served over 300,000 patients in providing personalized, psychotropic medication guidance. Our tools are accessible to over 100M covered lives including Medicare, Medicaid, and several Commercial insurers. We work with, or are actively engaged with, employer benefit brokers, telehealth/psych companies, PBMs, behavioral health carve-outs, care management solutions, and ACOs covering over 51M lives. We look forward to increased adoption in the future and plan to help lead this change.
Genomind’s value-proposition to the healthcare market includes:
This Thanksgiving, I want to recognize the caregivers who have stuck by so many of us throughout COVID-19 this year. The impact on caregivers’ mental health is a significant one, and I’m delighted to showcase two organizations doing important work to support caregivers everywhere.
I’m sure you will remember Alex Drane, CEO of ARCHANGELS, joining us with Marcus Osborne, Senior Vice President of Walmart Health, at last year’s Going Digital: Behavioral Health Tech conference (watch session free here). ARCHANGELS is a national movement and platform that is reframing how caregivers are seen, honored, and supported using a combination of data and stories, through public and private partnerships. ARCHANGELS provides communities (including states, employers, healthcare providers, and payers) with an omni-channel data-driven engagement approach that changes caregiver’s lives (as well as top and bottom lines) for the better. Check out her recent report with McKinsey about the health of American unpaid caregivers amid COVID-19 and her collab with BCBSA Health of America here (and watch BCBSA Health of American's GDBHT2021 session here, too).
I was elated to hear that Alex and her team have teamed up with CaringBridge, another organization I’m proud to support. CaringBridge is a nonprofit social network that offers simple tools for patients and their caregivers to share health updates and rally their community’s support. A health journey of any kind—diagnosis, injury, medical or behavioral health condition, pregnancy complications or other experiences—is difficult to endure alone. At a time when COVID-19 has impacted so many lives, I am pleased with how CaringBridge is leveraging technology to ensure that no one goes through a health journey alone. Tia and Alex both shared their perspectives with me on caregiving, mental health and tech:
Solome: How does technology play a role in making sure no one experiences a health journey alone?
Tia: While we’ve all read recent studies spotlighting the downside of social media and its correlation with increased isolation, technology can play a positive role in building community when going through difficult times. We’re in the beginning stages of investigating longitudinal research on how CaringBridge, a nonprofit digital social platform for people going through a health journey, specifically improves health outcomes. What we know right now is that people with social support have better health outcomes, less inflammation, and are more likely to adhere to treatment regimens. We also know that caregivers’ anxiety and depression decreases by up to 30% when using a digital tool like CaringBridge (as they know someone is in their corner offering support). And during the pandemic, we continue to work with healthcare institutions like Johns Hopkins to provide CaringBridge as a tool to manage patient communication with family and friends.
Ultimately, we believe in digital social technology like CaringBridge that enables simple and easy communication and support in one place. And with a singular focus on health journeys, we can provide a safe and private space to create community and support during a most stressful time.
Solome: Why is it important that people see themselves as caregivers and what are the mental health implications if they aren't recognized as such?
Alex: The intensity of caregiving is real – full stop. We feel its impacts on every side – the good, and the not-so-good. Then there’s this: of the 43% of adults in the US serving as a caregiver right now, around half of us don’t even identify as caregivers in the first place. It’s kinda hard to be supported in something not acknowledged. And caregiving is an area where we could all use some support. We know from ARCHANGELS data recently published with the CDC that 70% of unpaid caregivers are experiencing at least one adverse mental health symptom – it’s 91% for High-Intensity caregivers (those ‘in the red’). But we also know there is indisputable power in ‘the knowing’… as in knowing respite services exist reduces stress by 70%. How we engage with caregivers matters – and finding and using language that ‘speaks’ to the close to the one in two of us caring for a loved one is a vital part of providing support.
This year, I was delighted to join the CaringBridge Board of Directors. The board will be matching donations made on November 30, Giving Tuesday, up to $100,000. Along with the matching gift, please join me for a virtual gathering open to all on Tuesday, November 30th from 7:00-7:30 PM CST. It will be a night of gratitude and story sharing, featuring co-hosts Tia Newcomer, CEO of CaringBridge and Emmy award- winning journalist Cathy Wurzer along with Alexandra Drane, CEO of ARCHANGELS.
Finally, thank you, to all of the caregivers pouring your compassion and energy into loved ones each day. It is of utmost importance that we as a society prioritize your mental health with additional resources and support.
Integrated care has been an ongoing goal in the healthcare industry, but Included Health is raising the standards. Included Health was formed after the merger of Doctor on Demand and Grand Rounds. The company’s integrated collaborative care model is creating a space for all healthcare needs, from behavioral health to chronic care and more. They also have a few initiatives that focus on meeting the unique needs of various populations including LGBTQ+ and Black communities. Dr. Nikole Benders-Hadi, Medical Director of Behavioral Health at Included Health, talks more about the new entity with me:
Last month, you announced the merger of Doctor on Demand and Grand Rounds' new combined entity name, Included Health! Tell us more about the company’s mission to raise the standard of healthcare for everyone.
Included Health is the first virtual health company to include everything - behavioral health, primary care, chronic care, specialty care, LGBTQ+ care and more - all under one roof, for everyone. Our goal is to care for every individual, every community - no matter where they are on their care journey or what type of care they need, and ensure that their location no longer decides the type, or quality, of healthcare they receive. We’re proud to have a name that reflects that.
You also recently announced the Black Community Innovation Coalition. What is that?
There is no one-size-fits-all in healthcare. When it comes to the Black community, we know that major health disparities exist, including that only 1 in 3 Black Americans in need of behavioral health treatment receive care and that Black women are 3-4x more likely to die from a pregnancy-related death. These types of healthcare disparities for Black and African American individuals are unacceptable and we want to do our part to help improve these types of inequities in the healthcare our members experience every day.
We already have an LGBTQ+ specific solution and we wanted to launch a hyper-tailored solution for the Black community as well, so we partnered with companies like Walmart, Genentech, State Farm, Target and more to create something specifically for this community. We're using insights from these companies' employee resource groups (ERGs) to build the first dedicated care concierge and healthcare navigation platform focused on improving the healthcare experience and advancing health equity for Black Americans.
Taking this hyper-tailored approach ensures that we are addressing the very unique challenges facing the Black community in a meaningful way.
Behavioral health is often siloed from the rest of healthcare services. How is your integrated collaborative care model changing that?
We believe that mental health is health and, coming out of the pandemic, we're continuing to see increased numbers of people struggling with both chronic medical conditions as well as mental health issues. At Included Health, we've built a truly integrated practice. Our primary care doctors are specially trained to recognize behavioral health issues so they can seamlessly refer patients to our behavioral health team, and we provide a full suite of behavioral health offerings, inclusive of psychiatry, therapy, and coaching services. Our aim is to meet the member where they are, and provide the access to care they are most in need of at that moment so we help them live their fullest lives.
Included Health is taking huge strides towards an integrated healthcare system for all. Watch Dr. Nikole Benders-Hadi’s GDBHT2021 session about Doctor on Demand’s culturally sensitive care, you can view it here.
Sometimes, general teletherapy is not enough for individuals who are struggling with issues beyond mild and moderate anxiety and depression. It is time to move beyond one-size-fits-all solutions and move toward more personalization for different conditions. I met with Stephen Smith, Founder & CEO of NOCD, to discuss community-driven therapy and their unique approach to tackling issues like Obsessive Compulsive Disorder. This was particularly personal for me, as someone who has struggled with OCD since I was a teen. Read my interview with him on the blog and join us for a conversation on November 3rd here.
Employers and payers are revisiting their behavioral health strategies in order to better address the changing needs of employees/members. Why are the generic approaches to behavioral health offerings no longer good enough to differentiate benefits?
At NOCD we see that the one-size-fits-all strategy to solve behavioral health needs is not enough. Personalized approaches are imperative for conditions like Obsessive Compulsive Disorder (OCD) that are so highly stigmatized. The general approach fails to identify the unique symptoms of the individual and their specific needs. The need for specialized care is required to better serve these serious psychological conditions that are much more prevalent today.
Solutions that are more modern and innovative are meeting members where they are in their own care journeys, and NOCD works to identify those suffering from OCD where they are already searching for information - online. We then provide necessary, personalized and evidence-based care: Exposure and Response Prevention Therapy (ERP), the gold standard in OCD treatment. Delivering a more personalized treatment with a condition-specific therapeutic approach enables members to not only achieve better outcomes, but allows them to reach these outcomes efficiently. It is imperative for employer benefit strategies to adopt this specialized behavioral health care as their employees’ needs have changed.
Employees are recognizing this need for specialized services for mental health conditions as well as their physical health conditions. Furthermore, they are making career decisions based on whether or not an employer meets their needs and the needs of their families.
What is community-driven therapy and why is it important?
Community-driven therapy is a new behavioral health market category that leverages condition-specific peer communities to identify consumers in need of help, encourage them to begin treatment, and serve them in an ultra-personalized and evidence-based way. Also, providers in a community-driven therapy model are directed to deliver specific evidence-based treatment modalities based on the specific needs of the community they serve. The Community-Driven Therapy market is poised to successfully address many severe and costly needs within behavioral health, starting with OCD, given it’s so personalized in nature. Serious behavioral health conditions require a personalized setting, a level of convenience, and constant support between sessions. Crafting therapy around the patient allows them to receive therapy more efficiently and effectively, so by utilizing community-driven therapy, NOCD is able to focus on our first and foremost value which is Member-first. What that means is that everything we do at NOCD is for the members we serve and we optimize every step in our process for them. We’ve developed a new way to identify and manage people with OCD as a serious behavioral health condition.
Through the creation of the largest online OCD community, we developed a deep understanding of the wants and needs of people suffering with OCD. This understanding helps us bring people who have this serious condition to treatment much more easily and efficiently. Each member can continue their own personalized journey while seeing others in the community progress as well which allows our community members to see that they are not alone in their treatment journey.
By using a community-driven therapy approach we deliver improved outcomes, provide unique face-to-face sessions specifically designed for OCD treatment, foster deeper relationships with our patients through peer advisors and provide in-between session support with tools that patients actually want to use. All of these capabilities we have were purposely built through learning from our community and adding the personalized touch that is needed to treat a chronic and misunderstood condition like OCD. We take a deeper look at this in our upcoming State of the Behavioral Health Industry webinar with Solome on November 3rd at 12:00 PM CST, 1:00 PM EST, 10:00 AM PST.
There's a lot of confusion around Obsessive Compulsive Disorder. Why is OCD so widely misunderstood and misdiagnosed? You're doing some exciting awareness activities right now, tell us more about that.
There is often shame and stigma surrounding the OCD population due to the taboo nature of the intrusive thoughts, feelings and urges they experience. Those who are part of this severe and stigmatized population and who may not feel comfortable to share these thoughts end up going undiagnosed and left to suffer in silence. However, we’ve found these same people often search online for answers and this can oftentimes be the best place to intervene and meet them where they are, bring the proper treatment to them, and greet them with a community that understands their journey to regain their life.
This stigma occurs on a mass scale because most people think OCD is a personality quirk and don’t understand that it’s actually characterized by these recurring intrusive thoughts, images, and urges that can be debilitating. Our most recent partnership showcases NOCD’s commitment to breaking down this misconception and effort to destigmatize OCD. As part of our OCD Awareness Month programming, we’ve partnered with comedian Maria Bamford to educate more people about OCD and explain what it’s really like. Through her comedic art, she's helping others understand that OCD is not a personality quirk, but rather a debilitating condition that manifests in taboo ways and is still widely misunderstood. NOCD is on a mission to rebrand OCD through this and our continued efforts in raising awareness and providing education.
Link to Webinar Registration: https://hubs.la/H0ZN16m0
Link to OCD Awareness Month Programming: https://hubs.la/H0ZN80q0
Link to Maria Bamford Videos: https://hubs.la/H0ZNnf60
COVID-19 is driving more individuals to move from experiencing just mild to moderate anxiety to more severe mental health issues such as starting or increasing the use of substances and suicidal thoughts. The Kaiser Family Foundation outlined the impact of COVID on substance use and suicide increases in certain communities, including the fact that essential workers face greater increases of SUD than others, 42% over 30% for mental health issues and 25% over 11% for SUD. I sat down with Dr. Smita Das, MD, PhD, MPH, Psychiatry Medical Director at Lyra Health, to learn about their exciting new expansions to address these growing needs:
Lyra Health has just announced new services to address alcohol use disorder (AUD) and suicidality, tell us more about what prompted the expansion?
As a physician treating patients, I see firsthand the gaps in the current traditional health care system. People who are struggling with unhealthy alcohol use or strong suicidal thoughts—which number in the millions—often are considered too “complex” for traditional outpatient models. With the system not set up to support individuals with complex diagnoses, people unfortunately only get care when their symptoms progress to be more severe.
Even then, gaining access to relevant treatment through EAPs and health plans can be challenging, as existing care options don’t always address comorbidities that often present alongside alcohol use disorder, such as anxiety and depression. Stigma is also a factor when it comes to these areas, making it even harder for people to get the critical care they need.
With approximately 30% of Lyra’s members currently struggling with problematic drinking, and 16% having suicidal thoughts and behaviors, Lyra recognizes the critical need to address complex mental health issues, and is proud to offer outpatient care options that help employees and their families wherever they are on the mental health spectrum.
What exactly can employers expect in the new offerings?
Lyra Health’s newest offerings address problematic alcohol use, suicidal thoughts and behaviors, and personalized support for children, adolescents, and adults who need help accessing specialized mental health support. Its new comprehensive alcohol program helps people reduce drinking or attain sobriety by combining virtual therapy, group sessions, ongoing symptom assessments, peer recovery support specialists to help members stay on track, digital lessons that teach coping skills, and medication to fight cravings. Because it is delivered through Lyra’s comprehensive Blended Care virtual platform, support can be accessed from the privacy of members’ homes, helping reduce the impact of stigma and help them develop coping skills relevant to their usual home/work environments.
Lyra’s Blended Care Dialectical Behavior Therapy (DBT) for Suicidality helps members decrease suicidal thoughts and behaviors. DBT is considered the gold standard for treatment for individuals with moderate to high suicidality. Lyra DBT combines one-on-one virtual therapy sessions with therapist-prescribed skill-building lessons through Lyra’s Blended Care platform to help individuals recover quickly and effectively. Members receive flexible, ongoing support through weekly group skills training and access to 24/7 crisis support from a DBT-trained support team.
Finding care for complex mental health needs can be among the most difficult experiences for people and families due to the exhaustive process to evaluate and manage higher levels of care. Lyra Concierge: Advanced Care Coordination provides personalized support for people who need care through intensive outpatient and rehabilitation facilities. Lyra additionally provides clinical leave evaluations should short-term leave for mental health be required.
Stigma is still such a huge issue when it comes to mental health, substance use issues, and more. Even though employers have solutions for employees, sometimes they go unused only because of the stigma employees might feel to seek them out. How is Lyra supporting employees to raise their hand and actually seek out these services?
Stigma is a very important topic and one that Lyra approaches thoughtfully when developing all of its comprehensive mental health offerings. For our 2.5 million members around the globe, Lyra is a trusted mental health partner. Our newest services will be as easy to access and flexible as our other offerings. These new care options are also offered virtually. The combination of trust, ease of access, and ability to get high quality care from the privacy of home all can help overcome stigma.
As a result, employees facing more challenging and complex issues will benefit earlier in the progression of their symptoms and more durably. The support they will get for themselves and their families will give them the opportunity to more meaningfully engage in life and work once they recover.
Can a trusted consumer brand reduce stigma and draw more people into the mental health care they need? Can technology and other emotional support modalities help meet the resulting demand? How much better could things be with a full suite of services that allow individuals to access a wide array of support levels, from self-guided meditation, to text-based coaching, to teletherapy and telepsychiatry?
These were the questions many of us were asking when the big, juicy news of Headspace Health was announced: Headspace, a global leader in mindfulness and meditation, and Ginger, a leader in on-demand mental healthcare, recently announced that they will be merging to form Headspace Health. I had a chance to connect with the Headspace Health leadership team about the merger. Here is our conversation below:
1. With the combined company, Headspace Health will provide a full suite of services, including everything from meditation, to text-based coaching, to teletherapy and telepsychiatry. How does this relationship change the user experience for Headspace and Ginger? (e.g. Does Ginger use the Headspace content? Do Headspace consumers now have access to clinical services?)
As Headspace Health, we are building the most accessible and comprehensive digital health and wellbeing platform. Together, we can manage the full spectrum of mental healthcare needs and go a long way in closing what is a huge gap in the world.
In the near-term, Headspace and Ginger members will not experience any changes to our products and services. After the transaction closes, Ginger coaches and the greater clinical team will begin leveraging Headspace’s popular meditation and mindfulness content as part of the care they deliver to Ginger members. Over time, we will be integrating the services to deliver a frictionless experience for our members, beginning with our enterprise business, then moving to our consumer business.
2. As many of our readers have seen and experienced, we have a massive provider shortage. What is Headspace Health's view on this issue and what is your approach to address it?
According to the World Health Organization, close to 1 billion people around the globe are living with a mental disorder, and more than 75% of people worldwide with mental, neurological and substance use disorders receive no treatment for their condition at all. Headspace and Ginger will bring their combined expertise in consumer brand, evidence-based interventions, and technology to improve resilience, reduce stress, and provide treatment to the millions of people experiencing mental health symptoms, from anxiety to depression to complex diagnoses. By coming together at a critical moment of global need, Headspace Health - the combined entity of Headspace and Ginger - will democratize mental health and wellbeing so people around the world can access a full spectrum of affordable and comprehensive support to meet their needs — regardless of their background, location or ability to pay.
3. Where and how does prevention play a role in Headspace Health's solution and why is it important for customers?
Prevention is absolutely critical. We believe that by bringing these two companies together we can help more people get access to care sooner. There’s a huge need for people to address their mental health before it becomes acute. It is clear to us that Headspace is doing this in a very thoughtful, elegant way and its approach is proven. When you combine the range of high-quality, low-cost coaching and psychiatry options offered by Ginger with Headspace’s beloved mindfulness and meditation content, we now have the ability to dramatically improve the accessibility of mental healthcare to more people around the world. And together, we can reach them earlier in their journey, and provide higher acuity care when needed.
For example, Headspace already helps millions of individuals build successful routines and resilience that can then help when those inevitable stressful moments happen in their lives. In those moments, if they need additional support, Ginger is there to support them with text-based coaching, and video-based therapy and psychiatry. As their condition improves, they can step back down as needed and continue with their meditation and mindfulness practices.
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