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Recapping the news on policy that affects behavioral healthcare.
Bill Smith started Inseparable two years ago, at the beginning of the pandemic. Inseparable aims to empower Americans from every town, city, and home to better care for one another by demanding and winning policy that cares for us all. Bill says, “the health of our minds can’t be separated from the health of our bodies.” Inseparable fights for a future where mental health policy, no longer an afterthought, helps our country thrive. Bill’s experience of losing his brother to mental illness encouraged him to create a movement to change the broken approach to mental health in the United States.
Inseparable’s mission is to focus on three core areas to improve people’s mental health:
The Treatment Gap
Bill explains how access to treatment is difficult for several reasons. First, there is a shortage of workers to meet the demands for mental healthcare. “Having a culturally competent and diverse workforce is really important so that you have people who understand your life experience,” Bill says.
Telehealth is a solution that addresses unequal access to healthcare services. Bill says, “we think technology and the role that it can play in addressing the workforce is a really important one to focus on.”
Integrating mental healthcare in different areas of one’s life is another pivotal solution to reducing the mental health treatment access gap. Bill explains, “integration is about making sure we talk about mental health everywhere they show up in life. Whether it is school, or work, or places of worship.”
The last part of the treatment gap Bill mentions is mental health parity. Bill describes this as “a fancy word for making sure that mental health issues are reimbursed and paid for the same way other health issues are. We know that people either individually or through their employers or where they go to school have access to health insurance that doesn’t always cover mental health services.” Inseparable aims to ensure people get the treatment they paid for and access to services they paid for through their health insurance.
Early Interventions
Bill discusses the urgency to address youth mental health early. He explains how reaching children through schools is the best approach. “One of the things we focus on specifically is the use of comprehensive School mental health systems. It’s a model that was put out by the National Center for school middle help, and it’s a series of things that you need to do so that a school is not just a safe place for people experiencing mental health challenges, but it’s a place where kids can thrive.”
Inseparable started the Hopeful Futures Campaign to implement comprehensive mental health in American schools. This Campaign equips activists with a series of tools to change mental health and school policies state by state. Bill says, “one thing we want to do is normalize that conversation about mental health from a very early age so that we are sending people out into the world who are OK to talk about their mental help when they need to and who will help people access care.”
Stopping the Criminalization of Mental Illness
The third issue that Inseparable aims to eliminate in mental health care is the criminalization of mental health. Bill explains the three-legged stool for mental health crisis response as “someone to take a call or message in a crisis, someone to show up if need be, and somewhere to go.” He says, “the real issue with our crisis response system is after that what happens if someone needs to show up and who are we sending and are they trained in crisis response and helping someone get access to the care they need and the.
Inseparable is currently focused on producing a report to show where states are on all three legs of the crisis stool. Bill states, “we are looking at specific legislation right now that would define price response services and make sure that they’re covered by Insurance in the same way that if you had a physical health crisis.”
Policy Changes
Inseparable is moving bills forward and proactively changing the policies to fix the mental health crisis in the U.S. Just a few of the recent bills that Inseparable has helped to pass include:
You can listen to Bill Smith’s whole conversation here and read more of our insights here.
It seems like every time we look at a calendar, we see another national or world holiday. There are some silly ones, like National Talk Like A Pirate Day and National Lipstick Day. But there are also some that do more than provide a reason to act out or go shopping. Any day that brings our health and safety to attention can make an impact. World Mental Health Day falls into that exact category. Can you think of a better day to take some time and focus on your mental health?
History
World Mental Health Day falls on October 10th each year and takes place immediately after Mental Illness Awareness Week. This week is dedicated to focusing on mental health and well-being. In 1990, Congress officially decided to make the first week in October Mental Illness Awareness Week. This was a major step forward in the care and treatment of mental health. Mental health affects everyone, and it was time to make it known.
This year's World Mental Health Day will focus on making mental health and well-being for all a global priority. This focus comes off the back of the pandemic, as many mental health illnesses, such as anxiety and depression, have seen a rise of over 25% during the first year of the pandemic. Unfortunately, while mental health crises rose, access to mental health services fell fast. The mental health field took a massive hit with providers leaving, offices shutting down, and treatment programs being halted. Access for treatment of new mental health concerns was pushed back due to scheduling problems and a severe lack of mental health providers. New mental health patients had to wait upwards of six or more months in some places due to scheduling issues. While treatments were delayed and more triggering issues arose, mental health became a hot topic worldwide.
The World Health Organization hosts World Mental Health Day and works with many different partners to launch the campaign with the theme of the year. This day boosts awareness and gives the world a chance to focus on policy change, creating better conditions for people with mental health, allowing the opportunity to recognize progress in the field, and researching what else can be done.
Over the last two years, the mental health field has been hit with a massive blow. However, the future of mental health is bright. As we are rounding the last portion of the third year of the pandemic, we can see a beacon of hope on the horizon: technology is that beacon.
Technology
Technology is at the forefront of the advancement in access to mental health. While COVID-19 did some irreversible damage, it also presented the mental health community with a unique opportunity. With a large portion of the world quarantined in their homes, a need arose to access mental health services virtually. This was not something that generally existed before the pandemic.
The lockdowns opened the door for technology to be created in order to connect people with their providers without ever entering a medical facility. Innovations in the field have created not only digital platforms for pre-existing companies but also have allowed virtual pioneers to develop digital platforms for companies to exist in a fully digital environment. There has been an increase in mental health apps available for phones and tablets, bringing the care we need directly into the hands of those who need it. It is now possible to have comprehensive mental health care, treatments, programs, and medications monitored and maintained entirely online. You can receive mental health care almost immediately in an emergency and know your needs will be met.
This leap into the digital world has positively impacted the mental health field and the needs of so many individuals. In addition to the ease of access, this virtual care has also allowed the opportunity to seek treatment for those who otherwise would not or could not get the help they need. The elderly and teens have been especially vulnerable to the increase in mental health challenges, and they now can receive care and treatment in a manner that fits their unique circumstances. The elderly do not have to worry about transportation needs with virtual care. Youth and teens can now receive care without worrying about the stigma around seeking treatment. Another benefit of virtual care is that people with irregular schedules or crises that fall after regular business hours can now receive care in a 24/7 manner. College students can especially benefit from this, as they often deal with mental health concerns while being bogged down with school and work and usually would not have time to seek health.
We have so much to be thankful for this World Mental Health Day in the mental health field. Advancements in technology are making some significant strides toward access for all. There is still more we can do. This day allows us to take a step back and evaluate how far we have come and how far we still need to go. So this World Mental Health Day, let's ask ourselves, what is our next step to make mental health and well-being for all a global priority?
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.
Veterans' mental health always seems to be a hot topic. For such a large population – a population with its own designated health care system – we should not see any gaps in the care of their behavioral health. There are many Veterans who struggle with their behavioral health. Some may have started to have issues while they were on active duty, while others do not start to have issues until after they have separated from service. What are some of the causes for this specific group of people to struggle so much? Is there any way we can fix the system?
The Veteran community is notorious for having high rates of anxiety, depression, addiction, and suicide. Unfortunately, even with better access to care, these issues seem to plague the community constantly. It seems like every day, we hear of another Veteran who committed suicide. In addition to the diagnosable mental health problems Veterans experience, many outside influences can exacerbate these issues. Unemployment, physical handicaps, and homelessness are common issues within the Veteran community that can worsen mental health.
Unemployment is a fairly common problem in the Veteran community. There are many reasons for this. One of the biggest reasons is that military skills do not always transfer fairly to the civilian world. One example of this barrier is a hospital corpsman who, while active, performed many duties that would typically be done by a nurse or other licensed medical provider. Once this hospital corpsman leaves active duty, they are no longer qualified to perform these same tasks without receiving a college degree. For some, this means 5 to 10 years of experience is no longer valid and cannot be performed until the Veteran attends and graduates from college. This can be very disheartening and extremely depressing, especially when they love their job. This can set the Veteran back several years from obtaining a comparable salary to what they made in the service. The skills don't transfer over, and that is a huge problem. It may also be hard to obtain or hold down a job for many Veterans because of their former work environment behaviors. The service truly has a different lifestyle than the civilian world, and the two worlds do not always match up perfectly.
Physical handicaps are also a huge problem for the Veteran community. Many former service members receive a disability rating from the VA. While this is not a big deal for some, depending on the physical health problems they have been diagnosed with during or after active duty, this can severely impact their life. Active duty can take a toll on a Veteran's body. Deployments and years of active-duty service can often leave members with chronic health problems. Bone and joint conditions, especially in the back, knees, and shoulders, are common, along with respiratory and neurological problems. Generally, those who enter active-duty service are in good physical condition. Those who leave usually have some permanent physical and mental reminders of their service. Being diagnosed with a physical handicap can cause or increase depression. Some Veterans are even deemed totally and permanently disabled and labeled as unable to work. This, again, can cause major depression and homelessness. Even if a Veteran only has a few disabilities following their service, there is a high chance this will cause issues for them in the future.
Homelessness is another significant concern for Veterans. Unemployment and physical handicaps can increase the chance of a Veteran becoming homeless. Mental health also plays a prominent role in this. Poor mental health and untreated conditions can keep a Veteran from obtaining and maintaining a home or living space. Paired with unemployment, this is a bad combination. Once a Veteran is homeless, receiving proper health and behavioral health care becomes much more difficult. This will cause their issues to worsen, and the cycle of homelessness will continue. Mental health would likely significantly decline once a Veteran becomes homeless. These issues increase the likelihood of depression and suicide risks in the community.
There is a statistic floating around social media that 22 Veterans a day commit suicide. This has prompted several rounds of the 22-a-day challenge. This "challenge" involves doing some sort of physical workout, usually pushups, and filming it to post on social media. The idea behind this is to bring attention to the dramatic rate of suicide in the population. According to the 2021 National Veteran Suicide Prevention Annual Report, the actual rate is closer to 17.2 Veterans a day committing suicide. While this number is lower than the 22-a-day from social media, this number is not something that should be brushed off. The annual rate has been increasing since 2001, even though access to crisis care has expanded.
There are some higher-profile Veteran suicides, as well as ones that have gained national attention. In several instances, Veterans have committed suicide on VA campuses, some even in the parking lot of those campuses. While the VA explains that these individuals were very disturbed, many blamed the VA for the suicides. Many voice concerns that the VA does not do enough to support behavioral health care and suicide prevention.
Veterans have many outlets for help in a crisis. For starters, there is the Veteran's Crisis Line, which as of July 16, 2022, is even part of the prompt for the new (988) national mental health crisis line. There is also a prompt for the Veteran's Crisis Line whenever you call any VA official phone number. This option is always given at the beginning of a voice option, usually option 1. The VA has a special call center for the Veteran's Crisis Line, and the people working the line are trained to handle the sensitive issues Veterans struggle with. There are also screenings that take place at every VA doctor's appointment. They will always be asked if they feel safe or have any thoughts of suicide, homicide, or attempts of suicide. There is also a depression screening typically done. These can help get Veterans the care they need. The problem from here is keeping up with the need for mental health care.
Once a Veteran is diagnosed with a behavioral health concern, there needs to be a firm or set care plan. This could include therapy, medications, rehabilitation programs, etc. A VA care coordinator is often provided to Veterans with several issues or a care plan with many parts. The care coordinator usually helps with scheduling appointments, testing, and general advice based on the next steps in the care plan. These care coordinators are very helpful if they are used properly or if they are available.
The most significant problem in the VA care community is access to care. The VA system is bogged down. It can take months to get appointments. If one needs to be canceled or is missed, it can be just as long until the Veteran is rescheduled. If they are in a crisis or having a flare-up of mental health concerns, it is impossible to wait such a long time. Even once they are in a care system, say for therapy, the appointments can be spread very far apart. This is counterproductive in the treatment of behavioral health. When a Veteran is in crisis, they can feel helpless. If they go to a VA facility in a crisis, they often have to wait based on the volume of patients already being seen. There never seems to be enough providers. Veterans in crisis are a frequent occurrence at a VA facility.
Another significant problem with the VA is understanding. Many Veterans feel that their providers do not care or believe what they are saying. This heavily comes into play when they are being evaluated for their disabilities. Each disability is assessed and must be justified. If the Veteran cannot prove that a health problem impacts their life to the evaluator's level, then they may not receive a disability rating for those issues. This can mean that it will not be treated or taken seriously. The VA has a set of standards that each disability must meet in order to have it rated. Many evaluators are callous and can try to underplay the disability so that the VA does not have to compensate the Veteran for it. This seriously impacts the mental health of a Veteran. Being told that a chronic health issue they have been dealing with does not meet their criteria for being a covered disability can drive anyone to have depression and feel that their needs are not being met. As for female Veterans, there is often a feeling of not having their needs met or being told that their concerns are not valid. Being told that a situation that happened while active shouldn't give you PTSD or should have just been ignored are some of the most common responses female Veterans hear when discussing their active-duty service. Many female Veterans face a divide when they are talking about the trauma and can end up feeling rejected by the system that is supposed to support them. All of these concerns combine to increase poor mental health in Veterans.
Mental health will always be a concern for the Veteran community. While the VA is making strides to increase care for those in crisis, upkeep of care, lack of providers, and other barriers will always create dividing lines for those that need help the most. Changes to mental health care treatment should be at the forefront of the VA community.
You can learn more about the Annual Reports for the National Veteran Suicide Prevention here.
To learn more about the new (988) Lifeline, click here.
Project 2025 is the American Foundation for Suicide Prevention’s initiative to reduce the annual rate of suicide by 20% by the year 2025. This project focuses on four targeted critical areas: healthcare systems, emergency rooms, corrections, and firearms. The strategy will be to impact change at each system level, at the community level, as well as the national level, inspiring and creating change. They see the role as catalysts for implementing change by working with their 73 partner organizations and implementing life-saving work.
Background
Mental health has always been an issue in our country. But, COVID-19 created the opportunity for change by highlighting and exacerbating the problem. There are disparities in how care is delivered and where it is delivered. Depression and anxiety have increased since the pandemic’s beginning and disproportionately impact minority communities. While suicide rates have not increased over the pandemic, at least through 2021, there is concern about mental health data. At the same time, more attention is focused on mental health than at any other time in our history. There is a chance to leverage that into systematic change.
This is a unique time for mental health. During the pandemic, mental health was at the forefront of conversation, both on its own terms and with the link between physical and mental health. The two are intricately linked. The more that can be done to create systems and structures where both needs are met and ultimately cared for, the more lives can be saved. Recent data from the Harris poll, paired with the AFSP, show that 81% of Americans believe it is more critical to make suicide prevention a priority due to the pandemic. In addition, 93% of people surveyed indicated that they believe suicide can be prevented. Additionally, 69% of people indicated barriers to discussing suicide with others, including a lack of comfort and knowledge. That is a critical gap that the AFSP aims to fill with Project 2025.
Project Goals
Project 2025 aims to reduce the annual suicide rate by 20% by the year 2025. The initiative is led by AFSP and supported by the CDC, the National Institute of Mental Health, the National Action Alliance for Suicide Prevention, and many others. The strategy is to intervene in systems where we lose the most people to suicide. The losses are most significant in these four main settings: healthcare, emergency departments, corrections facilities, and firearms. By focusing on these settings, a large portion of lives can be saved. Together with local chapters, and national and local partners, the AFSP is implementing evidence-based and research-informed programs and initiatives to save lives.
Suicide is a complex public health issue and requires complex solutions. Those solutions require that we address multiple levels in multiple fields. There is a focus on increasing the infrastructure to support those in crisis. AFSP is the most prominent researcher of suicide. There is an AFSP policy team that works in federal, state, and local communities, ensuring proper training for educators, healthcare workers, faith leaders, community leaders, firearm owners, as well as the general public on how to recognize the warning signs of suicide. They also offer support for attempted-suicide survivors and family members of those lost to suicide, with support groups and more.
Health equity guides all of the work that Project 2025 does, from choosing its partners to scaling initiatives. Mental health affects diverse populations, including people of color, indigenous communities, LGBTQ+ individuals, and those who are socio-economically disadvantaged. It also impacts those at the intersection of each of those identities. The current systems were designed in a way that puts these individuals at a disadvantage. But, these systems can be redefined to help those in need. The AFSP’s equitable partnerships are vital leaders and can lead to change in support and give permission to others to step in. Project 2025 focuses on minority communities and tries to elevate the members of those impacted by suicide. We are committed to meeting people where they are and where they need help.
Technology
Technology plays several different roles in aiding Project 2025. The pandemic has highlighted the need for telehealth for both physical and mental health. It has increased equitable access to care for those with barriers to accessing care for various reasons. At the same time, there needs to be funding and legislation to be put into play to allow this access to care. There are still areas in our country that may not have the infrastructure to support access, such as phones or the internet. There is a massive gap between people needing help and people getting help. Lack of coverage should not be the reason why someone does not seek support. There needs to be a legal way of supporting these changes, which needs to remain sustainable. In 2017, patients were five times more likely to receive out-of-network care for mental health services than traditional medical health care. Care for mental health needs to be more accessible. As a result, there has been an increase in mortality rate with mental health over a decrease in mortality rate tied to physical health. Data is crucial in helping to fulfill this goal.
Other Ways to Help
While creating beneficial legislature and community programs can help the project, there is another key factor: Employers. Employers can offer training and be on the lookout for those who seem to be struggling with their mental health. They have the chance to make a positive impact. Raising awareness can help employers and employees be on the lookout for those in need. Talk Saves Live is another program employers can use to train their employees.
Many parts of this project will need to work together to accomplish the goal of the AFSP. This is a national, large-scale initiative that can help reach the most people—creating awareness and helping to create a beneficial change. Project 2025 is the voice of that change.
To watch our conversation with Renee Cruz, the Vice President for Project 2025, click here or search "Project 2025" in our video library.
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.
Who do you call when you have a mental health emergency? Do you want focused mental health care available for an immediate crisis? Mental health crises have been on the rise since the start of the COVID-19 pandemic. The world faced shutdowns, massive changes to employment levels, shortages, and an enormous shift in the availability of mental health assistance. Like all else, access to medical and crisis assistance took a hit, primarily due to staffing issues while combating an intensely rising rate of mental health emergencies.
If you live in the US, you have likely heard of the National Suicide Prevention Lifeline. This hotline has been very helpful in actively aiding those suffering from thoughts of suicide. That lifeline is now referred to as the 988 Lifeline, or the Lifeline or the National Suicide Prevention Lifeline. As of July 16, 2022, there is a new phone number to call in case of a mental health emergency. In an emergency, call or text 988 or chat on their website at 988lifeline.org. How simple is that? Help is at the tip of your fingers.
This change will take over as the primary contact phone number for the suicide help hotline, but the original ten-digit number will still exist. The Lifeline will not take the place of the Veterans’ crisis line. In fact, a Veteran or a family member can call 988 and press “1”, which will connect them immediately to the Veteran’s Crisis Line (VCL). The VCL is staffed with members of the Veteran’s Administration, trained specifically to assist Veterans and can connect them to the local VA medical center. Many positive changes are coming from this new number, but the necessary access to care is still a standard.
In addition to the change in the phone number, the hotline will now expand from just suicide prevention to include help with substance abuse and all other mental health emergencies. 988 will allow those in need to remain anonymous while still getting them the help they need. Calls will be directed to local call centers based on the area code of the callers only. As with all call centers, calls may be recorded for quality and training purposes. There may be an instance where the caller needs to be transferred to 911, who can track the caller based on their physical location if there is an imminent risk of harm to themselves. While they will be separate, 911 and 988 can work together if a caller needs to be transferred to the other emergency line. Another significant aspect is that someone can call on behalf of another person who may be experiencing an emergency but can not or does not want to call the line themselves.
One concerning factor with this change is that not all lifeline functions will be available in all areas. However, you can dial 988 anywhere in the country, and someone will answer the call. It just may not be in the area you live in. The phone number will still connect you to the national suicide prevention hotline. Overall, this lifeline does increase the range of help for those in a crisis.
A possible downside of this increase in nationwide care is that the lifeline will likely be understaffed. Community and local call centers can only manage calls based on how many team members they have. Volunteers will be needed to handle the increase in call volume. In addition to having enough people, the members need to be adequately trained to handle the delicate situations that can arise. Risk Assessment and Imminent Risk intervention training will be mandatory, but each local center may also require additional training. Because of the necessary training, it will take time before 988 is ready and able to handle all our country is going through.
With numerous mental health emergencies, suicides, and drug use and abuse on the rise, how is 988 going to be able to handle the call volume? As a nation, we can only hope that more people will step up to assist. When we call 911, we expect someone to be available. We should feel the same way about the 988 lines. We should always be able to have enough staffing to handle emergencies. Regardless of what type of emergency, be it mental, physical, or other, help should always be available. Now it can be.
To learn more about the new 988 Lifeline, click here.
If you or someone you know is having thoughts of suicide, is struggling with drug addiction, or having a mental health emergency, please call one of the following anytime, 24/7:
(988) 988 Lifeline
(1-800-273-8255) National Suicide Prevention
(988) then press “1” for the Veteran’s Crisis Line
https://wellbeingtrust.org/news/988-is-now-available-nationwide/
We hosted conversations with many innovative leaders during our Going Digital: Behavioral Health Tech Conference. One of these conversations focused on women’s mental health and was led by Anjlee Joshi, the Head of New Markets at Amae Health. The panel included Jessica Bell van der Wal, the Co-Founder and CEO of Frame Fertility, Layo George RN, MHSA Founder and Executive Director of Wolomi, and Crystal Adesanya, Founder and CEO at Kiira Health. All of these leaders gave us incredible insights into the world of women’s mental health.
Background
This conversation happened before the Supreme Court’s ruling on Roe v Wade, but we must mention the ways in which this ruling has changed the landscape of women’s mental health in the United States. The United States has already been in a mental health crisis. The American Psychological Association (APA) confirms that this ruling will exacerbate the ongoing crisis, and increased structural barriers to abortion affect individuals’ psychological health. Additionally, this ruling will affect the healthcare system as a whole, telemedicine, and ethical dilemmas faced by providers. Women of color will feel the most significant impact.
This conversation discusses the pregnancy journey, women’s health, and how stakeholders can respond. Importantly, we address that women’s health is often seen as a “niche” or solely as reproductive health and is underfunded. Rock Health reported that as of 2021, companies focused on women’s health make up just 5% of digital health funding since they started recording in 2021, and companies focused on pregnancy, postpartum, and parenthood made up 37% of women’s health companies founded in the past five years. However, women make 80% of healthcare buying decisions, so there is a massive opportunity to cater to women and their healthcare needs.
Pressing Concerns in Women’s Health
Many aspects of women’s health in the United States need to be addressed. Crystal says she thinks about “how do you utilize technology to increase access, but also create services that are empathetic, one, and compassionate and culturally centered? I think that’s a big piece of what’s missing when you think about the healthcare experiences of women [in the US].”
Layo also emphasizes, “women of color, specifically, black women are three to four times [more] likely to die on their pregnancy journey, and it doesn’t matter if you’re educated if you have all the money in the world… There’s evidence that shows oftentimes we are more likely to not be listened to.” Black maternal mortality is at higher rates than in any other developed country.
Additionally, Jessica emphasizes that “there’s a lack of research and data around women’s health and fertility.” In fact, women weren’t required to be in clinical research until 1993.
Women’s Health and Mental Health
Many women have shared their challenging pregnancy journeys to show other women that they are not alone. Even on this panel, Layo spoke of her experience with perinatal depression, and Jessica explained her experience with postpartum depression. Layo explained that they have mental health screening on the Wolomi app because “there is not a lot of [mental health] screening that happens during [the pregnancy] journey, prenatal and postnatal.”
Jessica reminds us of some harrowing statistics about family planning, “42% of people that go through fertility treatment report feeling suicidal and 94% of people report feeling depressed.”
Additionally, “four out of five women experience some level of anxiety when thinking about their ability to get pregnant, and more than a quarter [is] very or extremely anxious, and that anxiety starts at around 19 or 20.” Even before many women plan to start their families, women report being anxious about how their future fertility will unfold.
Crystal also reminds us that we also need to support and encourage women to take care of their mental health actively and continuously. She remarks, “because it’s not until they have very serious problems with their mental health, and then they’re like, maybe I should get it checked.” The high cost of therapy can be one reason people don’t access mental health earlier, but some digital solutions are trying to tackle those problems head-on.
Misconceptions
One of the biggest misconceptions about women’s health is that it is not profitable. As Crystal explains, women’s health is a “very profitable industry. There are millions of women and billions of dollars that need to be made within the women’s health space, and I am positive that we are getting to that place where there is more and more of a recognition of the fact that this is an industry that has a lot of areas that needs to be touched on.”
Jessica agrees and continues, “I think there’s a temptation, for some reason or another, in women’s health, whether you’re an employer or investor, and wherever you are on the spectrum to say, ‘I’ve checked the box on women’s health, I must be done.’ And I think that means you assume that women’s health is kind of one piece of the puzzle. But I think if you flip that, the question I’d say is actually, ‘do you believe that health for women is different than health for men?’ And fundamentally, it is, and that’s why you see different vertical and deep plays in spaces of cardiovascular health for women, mental health for women, fertility health for women.” There are so many opportunities to innovate and reimagine care for women.
Crystal also emphasizes, “that’s something we need to remember in the investment communities. The fact that we can make a little go a long way does not mean that we do not need more resources.” Jessica ends with a call to action, saying, “I want to encourage employers and payers and investors to be curious enough to want to reach out to us and talk about these things.
Hope for the Future and Calls to Action
But luckily, all of our panelists have hope for the future of women’s health. Layo explains that she has seen women “have a breakthrough or they have this beautiful birthing experience or [they] change their provider because of something they’ve learned, and they know how to advocate for themselves. And that gives me hope them the word getting out there.”
Jessica agrees, “we want to help women understand more about their bodies earlier, their hormones, their sexual health, their reproductive health. And we want to make sure these conversations with their providers are happening at least annually. And there’s interest, again, from all of these parties to want to participate. So that gives me hope.”
You can watch our full panel and hear more of these conversations here.
Every July, the United States (U.S.) observes the Bebe Moore Campbell National Minority Mental Health Awareness Month to bring awareness to the mental health challenges experienced by racial and ethnic minority groups in the U.S.
Bebe Moore Campbell (born February 18, 1950) was an author, advocate, national spokesperson, and co-founder of the National Alliance on Mental Illness Urban Los Angeles. Campbell was an advocate for mental health education and support among individuals of diverse communities and outlined the concept of National Minority Mental Health Awareness Month before losing her battle with cancer in November 2006. After her passing, in May of 2008, the U.S. House of Representatives announced July as Bebe Moore Campbell National Minority Mental Health Awareness Month to improve access to mental health treatment and services and promote public awareness of mental illness.
Mental Health Disparities
Approximately 18% of U.S. adults have a diagnosable mental disorder in a given year, and about 4% of adults have a serious mental illness. Most racial/ethnic minority groups overall have similar—or in some cases, fewer—mental disorders than whites. However, the consequences of mental illness in minorities may be long-lasting.
There are also disparities in mental health service use in the U.S. People from racial/ethnic minority groups are less likely to receive mental health care. For example, in 2015, 48% of white adults with any mental illness received mental health services, compared with 31% of blacks and Hispanics and 22% of Asians.
Reasons for these disparities in mental health care include the inability to access high-quality services, cultural stigma, discrimination, and overall lack of awareness about mental health. Under diagnosis and misdiagnosis of mental illness in people from racially and ethnically diverse populations stem from a lack of cultural understanding by health care providers.
The Black Mental Wellness Lounge:
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 Brandon Johnson, M.H.S, MCHES creator of The Black Mental Wellness Lounge, shed light on the mental health crisis experienced by Black people in the United States. The Black Mental Wellness Lounge is a YouTube page committed to promoting Black mental health and healing through the promotion of Black mental health tips, education, and resources for the community.
Brandon created the Black Mental Wellness Lounge to “have conversations about things that were impacting our communities specifically.” Brandon invites guests such as Black therapists and Black community members to give tips and resources for the community to utilize. One of the topics Brandon has covered includes the intersection between faith and mental health in the Black community. He says, “it is important for us as a faith community to really understand, how can we help people navigate this? How do we build the faith community in the Black church as a safe space to talk about these issues and challenges?” Brandon suggests that Black churches create mental health referral lists for churchgoers to make it easier for Black people to find a therapist and a safe space to discuss their mental health. Brandon highlights other organizations working to address Black mental health: The AAKOMA Project, Caleb’s Kids, and The Black Mental Health Alliance.
Brandon wants people to understand that although the topic of suicide and suicide prevention can be intimidating and can feel scary, but young people are already having these conversations. He states, “we want to be a safe place to land for our young people. To listen without judgment, to not minimize the things that they are experiencing.” He continues, “our young people have access to things that we didn't… so giving them the opportunity to talk about that in a safe environment would put them in a better position to be okay.” Brandon highlights the need for intervention strategies on the local, research, and startup level specifically for Black youth.
You can watch Brandon Johnson’s session here.
4 Ways to Get Show Support this Minority Mental Health Awareness Month
1. If you or someone you know needs mental health care, you are encouraged to seek help from professionals. The American Foundation for Suicide Prevention provides a great list of resources specific to minority communities and general, crisis, and mental health condition-specific resource lists.
2. Consider donating to the American Foundation for Suicide Prevention’s Project 2025 to achieve its goal of reducing the annual suicide rate by 20 percent by 2025.
3. Check out the National Minority Mental Health Awareness Month Facebook Page.
4. Tweet using #minoritymentalhealth to raise awareness.
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.
We are highlighting a few conversations from the Going Digital: Behavioral Health Tech Conference. We hosted a panel covering mental health policy featuring Pamela Greenberg, the President and CEO of the Association for Behavioral Health and Wellness, Charles “Chuck” Ingoglia, MSW, the President and CEO of the National Council for Mental Wellbeing, and Nathaniel Counts, the Senior Vice President of Behavioral Health Innovation at Mental Health America. We spoke about mental health policy in America and what they are excited about as we look beyond COVID-19.
Background
Millions of Americans are affected by mental health each year. Provider shortages, long wait times, inadequate insurance coverage, and the trauma of the past few years have all accelerated a mental health crisis in this country. Unfortunately, 43% of Americans who needed mental health care and 43% of those who needed substance use care in the past year did not receive it, compared to 21% of those who needed primary care who did not receive it. Additionally, 61% of Americans think there are not enough providers trained to address issues related to race, ethnicity, sexual orientation, and socioeconomic status. There are many intertwined issues that make mental health policy in America complex.
Additionally, we are on the precipice of implementing 988 as the new number for suicide prevention and mental health crises, which people can call or text for immediate help. This number will route to the National Suicide Prevention Lifeline and goes live everywhere on July 16, 2022, one of the most significant mental health policy changes to take place in recent years.
Hot Topics in Behavioral Health Policy
Chuck mentions that the number one mental health concern he hears from people around the country is “the workforce shortage…the number one issue that organizations are confronting is a lack of available clinicians in order to deliver care, not just clinicians, but staff at all levels.” As leaders think about how to mitigate this provider shortage, many are thinking about how to maintain the expanded licensing rules in response to COVID-19 that have allowed mental health providers to treat patients across state lines through telehealth. As Chuck mentions, “How do we make it easier for individuals to practice in our area, so looking at regulatory and licensing barriers and burdens, getting rid of unnecessary paperwork or other administrative barriers that take people away from clinical care. And then how do we grow the pipeline?” Another way to expand access for people around the country is, as Pamela mentions, “we are advocating for coverage of licensed marriage and family therapists and clinical social workers and peers by Medicare.” Expanding coverage for therapists is a great tool to expand access.
In addition to expanding access to mental health services, it’s also important to meet people where they are and think about where people are trying to access care. One way of doing this is by expanding collaborative care, a model of combining primary care and behavioral health care. Nathaniel goes even further and says, “people mentioned collaborative care, and I think we’re also looking at access through schools and places, [trying to] meet people where they are.”
COVID-era Policy Changes
One of the main COVID-era policy changes that seem to have broad appeal is the expansion of telehealth access and the ability for providers to work across state lines. As Chuck explains, “there are many bills introduced in Congress around extending telehealth flexibility as there are members of Congress, and yet we seem to have had very little progress. Everybody wants to offer their support and… I think it’s gonna vary considerably also by payer type. Medicaid, Medicare, and private insurance all have different policies.” It’s promising that so many people are offering their support, but real action must be taken to solidify the expanded telehealth access.
Pamela continues, “the question is, for how long? An extension helps because it gives you a glide path if you need to make a change. But I think, Solome, you’re really trying to get at, are we going to keep these flexibilities?… A two-year extension is good, but we actually want them for longer than that.” The telehealth extension has been incredibly beneficial, but in order to make a real difference, it needs to be a permanent change.
Future of Behavioral Health
Nathaniel mentions his excitement for new ways to engage different types of providers to create a community of support. He explains that he wants there to be a “broad array of providers, so peer support specialists, community health workers, a much deeper engagement of what this could look like. I think that will be critical both for improving access to care, but also engaging more people in the process of delivering care.” Engaging different types of behavioral health providers will expand access to care and could potentially create a more complete behavioral health system.
Pamela mentions that she’s excited to “see a future where we are paying for outcomes. Where we have some sort of alternative payment model [that] is much more common than a fee for service type model of payment.” Many speakers at the Going Digital: Behavioral Health Tech conference have mentioned the idea of having a different payment model that is outcome focused.
And finally, Chuck expresses excitement about the growing consensus around “strengthening the behavioral health safety net, ensuring there are standards, that there is a certain minimum level of expectation in terms of service delivery, care coordination capacity, partnership through certified behavioral health clinics… You should have access to effective evidence-based care no matter where you live.” We are seeing a growing call for effective, outcome-focused care across the nation.
To hear our full conversation with Pamela, Chuck, and Nathaniel, please visit our video library, which contains all the sessions from the Going Digital: Behavioral Health Tech 2022 conference.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
The current mental health care system unfortunately is not adequately addressing the roughly 50 million Americans who experience a mental illness. In fact, it takes on average 11 years from onset of mental illness symptoms to treatment. Additionally, 55% of US counties do not have a single practicing Psychiatrist and 148 million people live in a designated Mental Health Professional Shortage Area. With these statistics, the current US model for mental health treatment needs to find new ways to address the disconnect between the need for mental health services and the lack of available providers.
Is integrated care the answer?
Integrated care, which is the partial or full blending of behavioral health services with general medical care, is one solution for addressing this problem. We recently hosted a webinar on “How Technology can Support your Journey Towards Integrated Care” with panelists Dr. Frank Webster, the Behavioral Health Chief Medical Officer at Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, Kacie Kelly, Senior Vice President for National Policy Implementation at the Meadows Mental Health Policy Institute, and Dr. Tom Zaubler, Chief Medical Officer at NeuroFlow. On the webinar, we discussed how integrated care overall could solve for several key challenges the behavioral health industry is facing. More specifically, we talked about the benefits of one model of integrated care called collaborative care.
What is collaborative care?
Collaborative care is a specific type of integrated care using a team-based model of treating behavioral health in the primary care setting bringing primary care and behavioral health clinicians together to provide treatment. All patients in a primary care clinic are universally screened for psychiatric illness as part of their visit. Collaborative care has been studied in more than 80 randomized control trials and has been shown to improve patient outcomes, patient and provider satisfaction, and reduce healthcare costs.
Collaborative care in practice may have primary care physicians meeting with patients and prescribing medications, while Psychiatrists are often used as a caseload supervisors. Dr. Zaubler explains that “this allows Psychiatrists to manage a much larger caseload of patients than if they were seeing them individually.”
Offering behavioral health interventions in primary care settings is convenient, can reduce stigma, can deepen the patient-provider relationship, and can improve care for those with co-occurring mental and medical conditions. In our webinar, Dr. Zaubler noted that “95% of all mental health providers are practicing in siloed settings. And yet, when patients present with their psychiatric problems, roughly 80% either present in medical settings for their psychiatric care. There's a huge disconnect here in terms of where people are seeking care and where the care gets delivered.” Collaborative care attempts to bring together where people are already seeking care and the need for greater behavioral health care.
Challenges for implementing collaborative care
While the evidence supporting collaborative care continues to grow, uptick and adoption remains scant when it comes to implementing collaborative care across providers.
We have evidence that collaborative care is beneficial, but what challenges do health systems and providers face when trying to implement collaborative care? To start, some primary care physicians may have anxiety about a new way of doing things and disrupting current workflows. There is particular concern around prescribing psychiatric medications, which is why it's important to create an environment where primary care physicians feel supported by their behavioral health team and clinical decision support tools.
Additionally, creating a sustainable model of collaborative care requires an upfront investment. Health systems may be hesitant to adopt a new way of working that includes upfront costs. That’s where partners such as the Meadows Mental Health Policy Institute can be beneficial and Kacie Kelly remarked that, “we come in and oftentimes leveraged philanthropy to offset transition costs or startup costs and then help the practice with the operational workflow changes that need to happen, help them understand the changes with billing and reimbursement, and overall practice changes.” In fact, Kacie remarks that collaborative care “can be cost neutral around 6-9 months of utilization, and cost savings at the 9 month mark.” Collaborative care ultimately leads to cost savings through decreased medical utilization, emergency department visits, and inpatient stays.
An important component of collaborative care is measuring patient symptoms using validated measures such as the PHQ-9, a questionnaire screening for depression, and GAD-7, a questionnaire for anxiety. However, this can be time consuming and can create more paperwork for the front desk staff members.
Finally, there can be challenges for health plans reimbursing properly for behavioral health. Dr. Webster noted that “behavioral health typically makes up 3-5% of healthcare costs for commercial insurance. However, it's important for people to understand that 3-5% has a huge impact on medical costs.” Additionally, providers need to understand that they can bill and be reimbursed for these behavioral health assessments.
How can technology help?
We’ve seen the reasons why collaborative care is so important and obstacles to pursuing it, but how can technology help us implement this strategy? Digital solutions can plug into various parts of an integrated care model, as shown in this diagram from Raney et al.
One digital solution, NeuroFlow, is a two-sided behavioral health platform that leverages technology to both remotely assess and identify patients appropriate for collaborative care as well as increase the efficiency of the care teams managing the patient panel. NeuroFlow’s engagement platform allows patients to quickly and easily complete assessments such as the PHQ-9 and GAD-7 in the comfort of their home and immediately engage with relevant clinical content based on their scores. At the same time, their providers and supporting BH care team collaborate on their treatment through a tech-powered registry that populates information directly into electronic medical records, allowing providers to track patient progress over time and be alerted to patients who are at risk. Their combined offering of technology and clinical services showcases the exciting road ahead for empowering care teams with technology to help scale proven models of care.
Another example is Valera Health, which acts as a practice extender and telepsychiatry option. Patients access Valera Health through a mobile app and are triaged by health connectors and then routed to therapists and/or psychiatrists as needed for telehealth visits. Patients then access appropriate self-guided programs and exercises to stay engaged.
Finally BCBS utilizes the Learn to Live program. Health plans have unique challenges because they use claims as healthcare information, but they cannot tell what is happening today, or predict future care. Additionally, health plans have billions of clinical data points but as Dr. Webster mentioned, “getting claims organized and sorted is really difficult.” To address some of these issues, BCBS utilizes the Learn to Live program, which is an online platform where individuals can take assessments and then receive web-based CBT lessons and live clinician coaching. Patients receive treatment and health plans can capture their assessment information as clinical data to help them get targeted resources to the people that need them.
Tips for getting started with collaborative care:
1. Work with experts
Look for behavioral health providers who are well versed in collaborative care to help you with your founding team. Having technical expertise will make a huge difference in the success and longevity of your program.
2. Think creatively about startup costs
Ultimately, collaborative care leads to cost savings, but look into philanthropic options if you need help with startup costs.
3. Remember your CPT codes
Have your staff start getting used to billing CPT codes for all behavioral health assessments to ensure proper reimbursement.
4. When integrating technology, focus on measurement
As Kacie Kelly noted in our webinar, “I would encourage you, as you’re trying to figure out how to extend your workforce and how to get people tools between sessions, to really prioritize those tools that are measuring the outcomes and the impact” of your intervention.
To dive deeper, check out the full webinar, review a helpful collaborative care Q&A from NeuroFlow, and please join us for the Going Digital: Behavioral Health Tech conference on June 8-9, 2022. Registration to the conference is free, or consider making an optional donation to our 2022 non-profit partner, the American Foundation for Suicide Prevention.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
Innovation has the potential to address persistent challenges to health equity in Medicaid populations. The opportunity is especially ripe for technology and innovation to address the mental health and substance use care needs of Medicaid populations.
Unfortunately, there are many barriers for states and managed care organizations (MCOs) to adopt digital health and innovation. BUT! There’s good news: The Medicaid Innovation Collaborative (MIC) is a new initiative bringing together key stakeholders to deploy digital health and care delivery innovations to exactly these populations.
We talked with Karissa Godzik, Program Manager of the Medicaid Innovation Collaborative, about the states they are working with (Arizona, Hawaii and West Virginia) and their open RFPs for behavioral health startups to apply and partner with these states. (DEADLINE IS TUESDAY, APRIL 19TH - DON’T MISS OUT!).
What is the Medicaid Innovation Collaborative?
Medicaid Innovation Collaborative, or MIC for short, aims to enable the Medicaid ecosystem to advance health equity through high-impact innovation. We believe that health startups can close critical gaps in care access, quality, and social determinants as well as boost the great work that’s already happening on the ground. Our program focuses on reducing the barriers to adoption and scale for these companies.
Our model provides a structured approach to deploying innovation. We built a framework to define a health equity challenge, supported by data and the perspectives of beneficiaries, to identify best practices and policies that enable innovation, and to find and implement solutions that can address these challenges. For this to be successful, all Medicaid stakeholders need to be involved, and we’re building a coalition of states, health plans, community representatives, and organizations committed to this work.
MIC was launched by three organizations committed to serving the U.S.’s low-income, most vulnerable and underserved communities: Acumen America, Adaptation Health, and The Center for Health Care Strategies. Our work also wouldn’t have been possible without the catalytic support of The MolinaCares Accord, CommonSpirit Health, and Hopelab.
What barriers prevent States and MCOs from adopting innovation, particularly those that drive health equity?
From states, we’ve heard that it comes down to limitations in resources, time, and ability to track impact. Federal and state administrations can change quickly and frequently, so it can make it hard to plan long term, not to mention how long it can take to propose and launch new initiatives. And when states do want to drive towards certain outcomes, they may have to wait months or years to collect the appropriate baseline data and start to realize improvements, all while coordinating with multiple managed care plans to get the right metrics and reporting in place.
On the managed care side, first and foremost, they are working to meet their contractual obligations while trying to navigate varying state requirements. They typically find it more difficult to engage members, and plans don’t necessarily have the data they need to draw conclusions about the kinds of initiatives that would support their goals. Even when interested in adopting innovation, the time and effort to source, evaluate, and onboard vendor solutions is a real obstacle for many of these plans.
Who are your program participants and what can they expect from the program?
Our program aims to engage all Medicaid stakeholders, but the program is championed by state Medicaid agencies. Each cohort begins with state Medicaid agencies who commit to 1) a shared health equity priority and 2) rallying their managed care plans to achieve this goal. For our current cohort, we have Arizona, Hawaii, and West Virginia, who selected behavioral health as their priority, and all 15 of their health plans participating in the cohort.
Central to the MIC model, we also work to elevate the voice of Medicaid beneficiaries and other community advocates throughout key phases of the program. Beyond participating in in-depth interviews, we ask community representatives to join a Community Advisory Board, which guides the areas of focus and criteria for the request for information, vendor selection, and solution implementation.
For their participation, states receive technical assistance from the Center for Health Care Strategies as well as facilitated collaboration with their peers in other states. States and their health plans both get access to the primary research conducted with beneficiaries and the organizations and providers that care for them, providing deeper insight into the lived experience and real challenges faced by those they serve. All of the work culminates in an innovation showcase, which provides states and health plans access to vetted companies and their solutions, which are sourced through an MIC-led national request for information. Selected companies will have the opportunity to be considered for contracting and implementation.
You have a new RFI open! What startups should apply and where can they go to do so?
The 2022 Cohort is looking to identify private-sector, tech-enabled solutions that address behavioral health challenges for adolescents in Arizona and West Virginia and pregnant and postpartum women in Hawaii.
For adolescent behavioral health, we’re looking for companies that provide: (1) navigation and coordination of care, resources, and services for adolescents and their families, and (2) alternative care models to address early intervention, crisis response, and ongoing follow-up services.
For maternal behavioral health, we’re looking for companies that can enable, navigate, and coordinate behavioral health care for expecting and new moms.
Selected organizations will present their solution to state and managed care leaders in May 2022, with the potential to engage health plans for future contracting opportunities.
The application closes next Tuesday, April 19th, and there is no fee to apply.
Application and additional information can be found here: medicaidcollaborative.org/apply
Last week, three youth health agencies, American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, and the Children’s Hospital Association, declared a state of national emergency in child and adolescent mental health. Several health tech companies and GDBHT partners came together to inspire a call to action.
The declaration addressed the upward trend of mental health concerns for youth. It alarmingly noted suicide as the 2nd leading cause of death for 18-24 year-olds in 2018. Given the effects of COVID-19 and racial injustice over the past two years, the mental health of our youth has only worsened--disproportionately affecting youth of color. The industry cannot keep up with the elevated demand for mental health services. Youth are waiting weeks, or even months, to access the care that they need. The children who may have waited to seek care until they absolutely needed it now have to wait even longer. This can be an incredibly frustrating process for families who are already suffering.
This state of national emergency is a call to action and advocacy for crucial changes to address these issues and provide solutions to our youth. We believe technology will support the ability to address youth mental health in a more scalable way, and we’re proud to have some amazing innovators in our network. Learn more about some of our newest and existing GDBHT partners tackling these issues below:
BeMe Health, a digital behavioral health platform built specifically for teens, today announced that it has secured $7M in seed financing and partnerships with leading commercial and Medicaid healthcare payors to transform behavioral health for teens. Backed by Polaris Partners and Flare Capital Partners, the funding will be used to help accelerate and scale operations around BeMe’s unique tech-enabled approach to teen mental health. Board members and advisors also include Alexandra Cantley, Partner of Polaris Partners; Bill Geary, Partner and Cofounder of Flare Capital; Carolyn Magill, CEO of Aetion, Inc. and me!
Bend Health is a new healthcare company launched to increase access and reduce the cost of expert mental health care for families. It is revolutionizing the treatment of mental health conditions for kids and teens through a novel data-driven technology platform and evidence-based care model that enables the first scalable and integrated care solution in mental health. They’re also one of the few mental health providers who enable access to high quality teen and child psychiatrists within 48-hours or less through a clinically-validated collaborative care model (CoCM).
Brightline is the first full-family behavioral health solution built specifically to care for kids, teens, and parents across a range of common family challenges. With multidisciplinary care teams, personalized family system care, evidence-based care delivery, and extraordinary technology, Brightline is able to support families with whatever challenges they’re facing and ultimately help them thrive long-term. They recently announced a new partnership with another GDBHT partner, Violet, as part of their ongoing commitment to continue delivering inclusive care for the many communities it serves.
Hazel Health is the largest telehealth provider for K-12 schools, partners with school nurses, counselors, parents, and local providers to bring high-quality whole child health care to every student. Nearly 2 million students use Hazel for fast access to equitable physical and mental health care. Recently, they announced the addition of Dr. Travis Gayles as Chief Health Officer, Andrew Post as Chief Innovation Officer, and the promotion of Jeannie Chen to Chief Clinical Operations Officer, furthering the company's commitment to transforming access to quality healthcare for all.
Headspace Health - Earlier this summer, on-demand mental health care startup Ginger (now Headspace Health) had announced their new offering for adolescents ages 13-17, “Ginger for Teens.” Teens who are dependents of Ginger-eligible employees can gain access to text-based coaching, self-care resources, and if needed, twelve video-based therapy and psychiatry sessions at no cost via smartphone.
Holmusk - a leading global data science and health technology company building the world’s largest Real-World Evidence (RWE) platform for behavioral health, announced its abstract was published as part of the Proceedings of the American Academy of Child & Adolescent Psychiatry (AACAP) 68th Annual Meeting. AACAP’s Annual Meeting is the world’s premier gathering of child and adolescent psychiatrists. They stated that their results generated new insights that can inform policies and guidelines around the practice of polypharmacy for individuals with ADHD.
Hopelab is building a road map to deliver hope for the next generation through targeted social impact investments, translational research, and advisory services that focus on advancing solutions for BIPOC and LGBTQ+ youth mental health. A few months ago, Hopelab announced an external investment initiative, Hopelab Ventures, a commitment to partner with innovators who advance the well-being of BIPOC and LGBTQ+ youth.
For people who have a child or loved one struggling with OCD or disorders related to OCD, like Hoarding, Tics, or Body-Focused Repetitive Behaviors, it can be difficult to navigate. NOCD offers specialized OCD treatment, for people ages 5 and up, through live face-to-face video therapy sessions with licensed therapists. All NOCD therapists are trained in Exposure and Response Prevention (ERP) therapy - the gold standard OCD treatment - and members receive support between sessions through the NOCD platform. In addition to our live face-to-face video therapy sessions, NOCD also offers educational resources and guidance through sessions designed for family members, caregivers, and friends of those with OCD and related conditions. These sessions help them support their loved ones in their progress and provide guidance on how to assist them through difficult situations.
Telosity by Vinaj Ventures invests in companies addressing gaps in care by developing affordable and scalable solutions to support youth mental well-being. They recently published some research revealing Gen Z is leading the charge to change society’s perception and approach to mental health challenges.
Log into our library to watch the entire Going Digital: Behavioral Health Tech youth track here for free.
120/80 MKTG has powered the communications of top behavioral health brands and leaders like Headspace Health, Brave Health, Big Health, Cityblock, Papa and more. And now they’re on a new mission: reducing disinformation in the vaccine wars. Many people are talking about the COVID-19 vaccine on social media platforms, but not everything that is posted is true. Not knowing what is true or what is disinformation can lead people to feel anxious about getting the vaccine. In an effort to debunk the myths and establish a trustworthy source, 120/80 MKTG has started a new campaign, “Just the Facts on Vax: Inoculating Against Disinformation.” I sat down with 120/80 MKTG’s spokesperson and writer and director of the campaign, Jon Reiner, and his team to learn more.
What is “Just the Facts on Vax: Inoculating Against Disinformation”?
Six infectious disease doctors and nurses – including in-demand experts Dr. Carlos del Rio and Dr. Celine Gounder – are speaking up in a public health campaign, “Just the Facts on Vax: Inoculating Against Disinformation,” targeting the 14 states with the lowest vaccine rates in order to persuade people to get vaccinated. At this juncture in our two-month campaign, the results are encouraging with more than 1M impressions, 400,000 views and 2,500 visitor clicks to find out where to get a vaccine.
Overcoming COVID-19 vaccine disinformation requires going into the belly of the beast —Facebook, YouTube and other social channels. Launched on September 1st, “Just The Facts on Vax” is being streamed on Facebook, YouTube, Twitter, Instagram and LinkedIn as a short-form twenty-episode series, each of which addresses a specific vaccine-disinformation myth, such as “Getting the COVID-19 vaccine can harm my ability to get pregnant.” The campaign was born out of an urgency to win the information battle and help end the public health crisis by recruiting and providing a platform for medical experts whose knowledge and frontline experience would shift attention to where it belonged – on the facts.
Which medical experts have been featured so far and what are some of the myths they addressed?
Several of the United States’ top epidemiologists, infectious disease specialists, OBGYNs, nurse practitioners and public health officials have now presented “The Facts”:
Disinformation topics include:
Why did 120/80 MKTG start this campaign?
“Just The Facts On Vax” was created and self-funded by 120/80 MKTG as a public health initiative to increase vaccinations, differentiated from other campaigns by its utilization of medical experts rather than celebrities and its reliance on science.
As health communications professionals, it was agonizing to witness COVID-19 vaccination rates stall because of public trust sabotaged by disinformation. Facebook and YouTube, in particular, had dithered, giving visibility to conspiracy theories undermining the science so essential to combating ignorance. For me, Facebook’s silence on harboring the ‘Disinformation Dozen’ was a galvanizing moment. Our public health crisis was losing an information battle, and it demanded a response that would go straight to the belly of the beast.
“Just The Facts On Vax” has a single objective — to get more people vaccinated. So far, the campaign’s challenge to the disinformation has moved more than 2000 people to search where they can get vaccinated. If even one person’s life is saved because they listened to the experts and got vaccinated, then that’s why we are doing this. We hope others will join us.
How does anxiety play a role in the decision process of getting the vaccine?
Just as disinformation can cause confusion and the anxiety it generates, fact-based information can have the opposite effect, giving people a sense of confidence to make a reasoned decision. To that end, the source matters. In the case of the #JustTheFactsOnVax campaign, we believed it was essential to have leading infectious disease doctors, epidemiologists, OB GYNs, and public health physicians be the sources of fact-based information, who would appeal to people’s reason. Episode #19, for instance, responds to fears that getting the COVID-19 vaccine is more painful than other vaccinations. That episode’s speaker, Dr. Carlos del Rio, addresses the issue in both scientific and experiential terms, stating that COVID-19 the vaccine does not hurt more than getting a seasonal flu shot.
Find out more and share the “Just the Facts on Vax: Inoculating Against Disinformation” campaign on social media: Facebook, YouTube, Twitter, Instagram and LinkedIn.
Blue Cross Blue Shield Association’s VP of Strategy & Analytics, Mark Talluto, spoke at the Going Digital: Behavioral Health Tech 2021 summit about their data-driven approach to address behavioral health conditions and the disparities that affect communities of color (watch his session with me here). BCBSA recognizes the importance of addressing the racial health disparities that exist for mental health diagnosis and treatment in this country.
Their studies show about one-third of millennials have a diagnosable behavioral health condition. Although, Black and Hispanic millennial communities have a lower prevalence, likely due to under-diagnosis. BCBSA’s National Health Equity Strategy strives to address racial health disparities by collecting data, scaling effective programs, working with providers and communities, and influencing policy decisions.
Next week, I will be joining fellow healthcare industry professionals at the BCBSA Health of America Forum on October 20-21 (learn more here), including Briana Duffy, Market President for the West Region of Beacon Health, and Shana Hoffman, President and CEO of New Directions Behavioral Health. I'll be asking them about how Beacon and New Directions are focusing on stigma, access and cultural understanding when it comes to behavioral health service delivery.
Why is now the time to talk about mental health and what does that have to do with health equity?
Communities of color are disproportionately impacted by many of the nation’s top health conditions, including mental health. Health disparities are a multi-dimensional problem that cannot be solved by one single solution. It requires action from policy makers, providers, communities and healthcare industry leaders to raise awareness about mental health conditions, including anxiety and depression, that affect various generations and marginalized communities. By speaking openly about mental health, and the importance for leaders – no matter the industry – to address these conditions, we can explore ways to reduce stigma associated with mental illness, promote help-seeking behaviors and emotional wellbeing practices.
What is the Health of America Forum really going to cover?
The third annual Health of America Forum hosted by the Blue Cross Blue Shield Association will take a deep dive into the key issues driving the maternal and mental health crises in America, including how we can collectively address racial health disparities. Over two days, business decision-makers, community leaders, and HR and wellness officers will virtually come together to discuss what steps should be taken to reimagine a more equitable healthcare system. We will discuss the challenges we face in addressing mental health issues, particularly in black and brown communities, and as a result of COVID-19. Join us here.
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