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Recapping the news from behavioral health companies that are B2C (business-to-consumer).
It's no secret that frontline workers within the healthcare sector are under siege, with staff across the US experiencing unprecedented levels of violence, antisocial behavior, physical, sexual, and verbal abuse and/or harassment from patients and their families.
This alarming trend has been fueled, in part, by the pressures related to the COVID-19 pandemic, but also further compounded by staffing shortages and the rising number of individuals seeking care for mental health and substance abuse issues.
As a result, frontline healthcare workers are increasingly vulnerable to both physical and emotional harm, creating an urgent need for enhanced safety measures, effective de-escalation techniques, and the implementation of supportive technologies to protect staff and maintain the quality of care.
As someone deeply committed to improving workplace safety, I’ve witnessed the profound impact that proper techniques, technology, and training can have on healthcare environments. With this article, my goal is to bring attention to the critical need for safeguarding our frontline workers—those who dedicate their lives to caring for others, often at great personal risk.
I want to emphasize that protecting healthcare staff is not just a matter of physical security; it's about creating an environment where professionals feel supported, respected, and empowered to provide the best possible care. In turn, this creates more robust workplaces with less staff turnover, fewer cases of burnout, and improved patient outcomes that not only enhance employee well-being but also contribute to more consistent, compassionate, and effective care for those in need.
Drawing the Line — Recognizing and Addressing Unacceptable Patient Behavior
One of the primary challenges in behavioral health is managing unacceptable patient behavior. Whether it’s verbal abuse, physical intimidation, or more subtle forms of disrespect, these behaviors create a toxic and dangerous work environment for staff. As healthcare professionals, we must draw a clear line between providing compassionate care and tolerating abusive or harmful behavior.
The American Medical Association recommends using firm, clear language to address unacceptable actions, for example:
“I care about you as a person, but I will not tolerate offensive behavior. Let’s focus on how I can help you today.”
This approach allows staff to maintain professionalism while asserting boundaries. Importantly, patients are less likely to escalate when they are calmly but firmly told what is unacceptable. However, it’s not enough to simply respond to behavior reactively; staff need structured strategies to identify and de-escalate situations before they spiral into violence.
Learning to De-escalate — Techniques to Manage High-Stress Situations
Managing patient behavior starts with proactive techniques that focus on de-escalation and physical safety. Here are five critical strategies that our clients and experts in the field have found useful:
The Role of Technology and Training in Enhancing Staff Safety
Behavioral health facilities face unique challenges when it comes to maintaining the safety and well-being of both staff and patients. These environments, where professionals often deal with individuals experiencing mental health crises, substance abuse, or severe stress, can be unpredictable and, at times, volatile.
However, technology has a crucial role to play in improving workplace safety, and thanks to our experience within the field, behavioral health clients trust ROAR to enhance staff safety beyond traditional safety protocols. This means we are able to deliver panic button solutions that not only provide immediate security but also help foster a culture of respect, calm, and trust between staff and patients in the places that need it most.
Our goal is to provide technology and training that help prevent incidents before they occur, while also ensuring staff have the tools they need to quickly and discreetly summon help if situations escalate. However, technology alone is rarely enough to solve the complex and nebulous issues surrounding workplace safety, and we always recommend that our solutions always include the following fail safes:
Testing Procedure
A panic button system, whether it’s hardwired or body-worn, is not a “set it and forget it” solution. Regular testing is critical to ensure that the system functions properly in the event of an emergency. Your policy should outline how frequently the system will be tested, who is responsible for conducting the tests, how results will be documented, and how issues will be reported and resolved. At ROAR, we help clients integrate these procedures by providing self-healing Bluetooth networks and LTE backup systems, ensuring the technology remains operational even in areas with unreliable signals.
Downtime Procedure
No system is immune to potential downtime, as evidenced by the Crowdstrike outage, which left many organizations without access to critical systems. This event highlights the importance of separating staff safety systems from broader platforms. A well-prepared policy must address how to communicate outages to staff and provide a backup plan for emergency assistance, such as calling security or 911. It’s vital that healthcare workers know how to access help when the primary system is down. At ROAR, our panic buttons are designed with self-contained networks that function independently of a facility's Wi-Fi or IT infrastructure, creating resiliency and reducing the risk of total system failure.
Training
Training is the backbone of any successful panic button system implementation. If staff are unfamiliar with how or when to activate the system, its effectiveness is severely compromised. Your policy should specify the initial and ongoing training that will be provided, the frequency of this training, and who will be responsible for ensuring that all staff are up to date. At ROAR, our solution is as easy to use as pressing a single button, seamlessly integrating into everyone's existing routines. However, we recommend monthly debriefs and training sessions to keep safety top of mind and actively engage staff. We also provide engaging training materials in multiple languages to ensure all team members feel confident using the system.
Response
A panic button is only as effective as the response it triggers. Your policy should clearly define who will respond to alerts, what actions they should take when they arrive, and when to escalate the situation, such as involving law enforcement. Additionally, it should cover how responders are trained to stay safe in potentially volatile situations. ROAR’s system helps by providing precise location data for responders, reducing the time it takes for help to arrive and ensuring that staff are supported in high-risk scenarios.
Recovery and Follow-Up
After an incident where a panic button has been activated, follow-up is crucial for the well-being of the staff involved. Too often, employees receive little support after a traumatic event. Your policy should include provisions for immediate follow-up, offering safety planning and psychological support if needed. Documentation of the incident is equally important, not only for accountability but also for future training. At ROAR, we stress the importance of post-incident care and provide solutions that allow management to easily document and review alarms, helping ensure continuous improvement in safety practices.
Conclusion
In my experience, the intersection of proper technique, advanced technology, and comprehensive training is the ideal foundation for improving staff safety in behavioral health settings. This is something we recognize as a company committed to improving the lives of millions of workers, and our experience tells us that empowering staff with the tools and training they need not only protects them physically but also boosts morale, leading to better patient care.
Ultimately, by addressing unacceptable patient behavior proactively, integrating reliable panic button systems, and ensuring that all staff are properly trained, we can create a safer and more supportive environment for healthcare professionals. As we continue to work with behavioral health centers like BeWell in Philadelphia, our goal remains the same—to make healthcare workplaces safer for everyone involved.
About the Author: Yasmine Mustafa
Yasmine Mustafa believes ROAR found her, not the other way around. A former refugee and undocumented immigrant, she draws upon her unique life experiences to lead ROAR in its mission to empower and protect workers across all industries. Her journey is a testament to resilience and unwavering commitment. With over 15 years of leadership in the tech industry, including the successful sale of her first company, 123LinkIt, to a firm in Silicon Valley in 2009, Yasmine is a driving force for positive change, balancing profits with purpose. Yasmine’s workplace safety advocacy and leadership have earned recognition from the BBC, CNBC’s Upstart 100 and the City of Philadelphia. Yasmine is a highly sought-after conference speaker. A two-time TEDx speaker, Yasmine has also presented at the prestigious SXSW and CES conferences, sharing her deep passion for harnessing technology for positive change. Beyond her professional life, Yasmine enjoys time spent with friends and family, exploring the outdoors, biking, and hiking. She also dedicates her time to the boards of Coded by Kids, Leadership Philadelphia, and the Philadelphia Alliance for Capital and Technologies.
Can you define toxic productivity?
Toxic productivity happens when three things converge: (1) using productivity to cope with uncomfortable emotions, like shame or guilt, (2) productivity at the cost of wellbeing (3) a strong connection between how you value yourself and how much you achieve/produce. Together, these three mental states create a set of habits that lead to toxic productivity.
What values drive healthy productivity?
Balance / boundaries, intention, and authenticity
Why is addressing the emotional foundation one of the most important parts of healing and fulfillment?
Emotions are often the root cause of our behaviors, including unhealthy habits and coping mechanisms. By addressing the emotional foundation, we can uncover the underlying causes of issues like anxiety, stress, or burnout, leading to more effective and lasting change. Emotions can drive repetitive, unhelpful patterns such as perfectionism, overworking, or avoidance. By addressing these emotions, we can break these cycles and cultivate healthier habits and mindsets. When we understand and work through our emotional responses, we gain a greater sense of control and empowerment. This emotional clarity gives us the agency to make choices that align with our values and goals.
What are some of the most common myths that perpetuate toxic productivity?
What are the dangers of operating in autopilot mode?
How can we challenge the instinct to trust the negative beliefs we hold for ourselves (i.e childhood experiences, cultural myths, emotional responses from past occurrences, fear of rejection, avoiding painful emotions, etc.)?
It's essential to recognize when these beliefs arise and how they show up in our daily lives. Practices like journaling, meditation, or mindfulness can help us identify these recurring thoughts, their triggers, and the emotional responses they provoke. By tracing these beliefs back to their origins we can start to see them not as inherent truths, but as learned patterns that can be unlearned.
Challenging negative self-beliefs is a gradual and ongoing process that requires patience and consistency. By questioning these beliefs, reframing them, and building new, healthier thought patterns, we can move towards a more compassionate, empowered self-perception.
You mention how toxic productivity can show up under many disguises. Can you share some personal stories where you have experienced it firsthand?
Oftentimes, being busy and being productive are confused as one. Why is it important to reframe this misconception?
Being busy often involves filling our schedules with tasks, whether they are meaningful or not. Productivity focuses on the quality and impact of what we accomplish.
Productivity is tied to having a clear sense of purpose and direction. It involves focusing on tasks that move us closer to our goals. When we equate busyness with productivity, we risk losing sight of our purpose, becoming caught up in activities that don't contribute to our long-term vision.
When we conflate busyness with productivity, we might feel pressured to keep moving without taking breaks, resulting in physical and mental exhaustion. Understanding that productivity isn't about how much we do but how effectively we do it helps us to set healthier boundaries and incorporate rest into our routines.
Toxic Productivity: Reclaim Your Time and Emotional Energy in a World That Always Demands More is available now.
For many organizations, mental health has emerged as a critical area demanding more attention and resources. According to a report by Mental Health America, about 50 million U.S. adults are experiencing a mental illness, but over half (54.7%) don’t receive any treatment. Health plans are uniquely positioned to expand covered and affordable mental healthcare access to millions of people, and in doing so, bring down healthcare costs overall.
As demand for mental healthcare increases, the traditional approach of expanding access to networks won’t solve this challenge. Instead, partnering with solutions like Headspace can help health plans transform and improve their mental health offering. Over 45 health plans are already partnered with Headspace, and we’re highlighting three reasons why integrating behavioral health solutions into your health plan is today’s path forward.
1. Addressing the provider shortage with a layered approach to care
According to recent data, 47% of Americans live in areas with a shortage of mental health workers. For every 10 people entering the mental healthcare field, 13 are leaving. This shortage makes it difficult for health plans to expand their networks sufficiently to meet the growing demand for mental health services.
“Growing your network isn’t going to solve the access challenge. There’s simply not enough providers or clinicians. We need to add layers and other interventions to support the system” - Jason Richmond, VP of Sales Solutions, Headspace
Choosing a mental health solution with a layered approach is an opportunity to give more members access to the appropriate resources and care for their needs. Not everyone in need of mental health support requires the services of a therapist or a psychiatrist. Individuals can benefit from support that fosters everyday well-being, such as mindfulness exercises, mental health coaching, and self-guided care. A layered approach — one that offers multiple modalities within a single care platform — ensures that everyone gets the right level of care, at the right time, and in a continuous way that addresses their evolving needs.
2. Mitigating the impacts of other costly chronic conditions
Mental health is inextricably linked to physical health. People with depression have a 40% higher risk of developing cardiovascular and metabolic diseases. Conditions like depression, anxiety, and stress can exacerbate chronic diseases like diabetes, heart disease, and hypertension, leading to higher healthcare costs and poorer patient outcomes. By supporting mental health needs, health plans can safeguard against costly healthcare expenses associated with comorbidities and improve overall health outcomes for their members.
“Payers are seeing that if we address behavioral health, it’s going to impact all of these other costly chronic diseases.” - Solome Tibebu CEO & Founder, Behavioral Health Tech
The Headspace approach provides access to a spectrum of care including guided meditations, mental health coaching, and psychiatry — so everyone gets the right care at the right time. By offering a comprehensive range of mental health services, Headspace helps people manage their overall mental health, which, in turn, positively impacts their physical health. In fact, a recent study conducted by Headspace showed a 15% savings for members who meaningfully engaged in both coaching and clinical services, and consistently lower spend across treatments for cancer, maternity, musculoskeletal, and metabolic health compared to benchmark.
3. Expanding access, reducing stigma, and driving engagement
One of the largest barriers to mental healthcare is the stigma associated with seeking help. Many individuals avoid mental health services due to fear of judgment or discrimination. Health plans can play an active role in combating this stigma, normalizing mental health, and encouraging members to seek the care they need.
“Unlocking access to a coach and mindfulness content proves highly effective for most members. We’ve found that 75% of those engaging in care services like therapy or coaching can have their needs fully met through coaching alone.” - Karan Singh, COO & CPO, Headspace
Health plans have the opportunity to expand access to mental health services in a way that’s convenient and discreet. Digital care platforms offer anonymity and flexibility, allowing members to access care from wherever they choose — particularly important for those who may feel uncomfortable seeking help in traditional settings.
In addition, digital care platforms help members navigate care options to get support when they need it, unlike traditional providers, where the wait time is often much longer. Headspace provides access to a mental health coach in less than two minutes and an average wait time of just 3 days for the first therapy appointment, significantly reducing the barriers to accessing timely care.
Building a better future together
Partnering with a mental health solution like Headspace is a transformative step towards building a healthier future for all. By recognizing the interconnectedness of mental and physical health, addressing provider shortages, and reducing stigma, health plans can provide comprehensive, effective care that expands access and meets the diverse needs of their members.
As we move towards a measurement-based approach to healthcare, the importance of mental health can't be overstated. Health plans that embrace mental health solutions not only improve outcomes for their members, but also demonstrate a commitment to holistic, person-centered care.
Many health plans have members in institutional settings with co-morbid physical and behavioral health conditions. With the right support, health plans know that many of those members could achieve better health, better quality of life, and more independence – at lower overall cost. But providing that support effectively is not easy because those members’ health needs and life circumstances vary so widely. Food-as-medicine programs can play a powerful role in helping members manage and sustain their transition to less restrictive or fully independent living situations. Not only can such programs improve the health of members with chronic illness but they can also help members stay connected to their health plan while growing their self-confidence, developing independence, improving mood and outlook, and reducing stress. Together, these interventions can meaningfully impact mental health as well as physical health and reduce barriers to independence and overall health and wellness. North-Carolina-based Alliance Health Plan recently engaged with NourishedRx to lead a food-as-medicine program with a complex member population it wants to help transition to less restrictive living situations. Alliance Health specifically works with Medicaid beneficiaries who have mental health illnesses, substance use disorders, and intellectual and developmental difficulties.
In the Spring of 2024, NourishedRx began its program by providing 6 weeks of prepared nutritious meal deliveries to Alliance Health members, followed by 10 weeks of healthy groceries. These members were diagnosed with a behavioral health disorder and are also smokers, many with some form of chronic disease. The goal of the program is to foster their independence and keep them housed.This population requires care management from interdisciplinary teams, so Alliance Health wanted to find interventions that offered holistic support and resources. Our data on the broader benefits of food-as-medicine programs demonstrated the kinds of outcomes they sought. Success will be measured by the number of people who maintain their housing and independence, but the impact is already being felt.
As Lori Caviness, Director of Community Health Strategy and Social Impact, Community Health and Well-Being, Alliance Health Plan, puts it: “We are so encouraged by the early results of this program to improve food and nutrition security for people enrolled in ourTransitions to Community Living (TCL) Program. Members have shared that the program has helped boost their energy levels and has made it easier for them to stay in housing and live independently.” In initial surveys, program participants talk about feeling happier and more energetic and report losing weight because of their dietary changes.In our work with food insecure and chronically ill populations, we’ve observed a robust relationship between healthier diet and improved mental health. 81% of our members reported improvement in how diet impacts their health and well-being, and 57% reported a decrease in the number of their unhealthy mental days (in the past 30 days). 59% reported an increase in social interactions with family and friends.The following are some areas where food-as-medicine provides holistic support to not only affect physical health but also enhances mental health and fosters personal agency and independence
1. Reducing the impact of ultra-processed, junk and fast foods
People who are food insecure may not lack access to food so much as they lack access to healthy food. This is a problem for many who are chronically ill, lacking transportation or support, and struggling to afford quality food. Fast food, junk food, and ultra-processed food may be the easiest, cheapest food available to them in nearby convenience stores, gas stations, drug stores and fast-food restaurants.Eating this food affects physical and mental health. The link between healthy diet and better health outcomes for people with chronic illnesses like obesity, diabetes, cardiovascular disease and kidney disease is well established. According to a recent Harvard study published in JAMA, ultra-processed foods are also linked to an increased risk of depression. Indeed, people who eat9 or more servings daily are 50% more likely than those who have fewer than 4 servings to develop depression. Other studies have shown that diets high in added sugar, artificial sweeteners, refined carbohydrates, trans fat and high sodium food are also associated with increased risk of mood swings and depression.A balanced, healthy, consistent diet is powerful medicine for reducing that risk of depression. It creates a foundation for better health.
2. Reducing the stress of food insecurity
People whose cupboards and refrigerators are empty, who do not know where their next meal will come from, who struggle on a daily basis to afford or obtain the food they need for themselves and their families are under tremendous stress which leads to a higher risk of anxiety (257%) and depression (253%). Food insecure people are more likely to use mental health services and to seek care in emergency departments. Some people also experience shame and a sense of helplessness that exacerbates feelings of depression, loneliness, and anxiety. Food insecurity makes it harder to manage mental health problems which can exacerbate a negative health cycle. For some, it can become harder to take positive steps by seeking help, changing circumstances or behaviors, or finding resources or employment.Providing healthy nutritious food, educating people on healthy alternatives, and instilling new habits and behaviors can have a tremendous impact on health, quality of life and mental wellbeing. In our programs, 53% of our members reported reduced risk of food insecurity and 61%reported reduced risk of nutrition insecurity. And reducing that mental health load helps members better manage their physical health, too. For our diabetes patients, specifically, 66%of our members reported feeling less overwhelmed by the demands of living with their disease, and 68% reported improvement in complying with their diabetes therapy regimen.
3. Supporting seniors, mothers, and children
Food insecurity can affect anyone’s mental health but it can be particularly challenging for mothers, children, and seniors.Food insecure mothers are over twice as likely to have depression and trauma. In children, hunger relates to increased risk of depression and suicidal ideation through early adulthood. Food insecurity leads to challenges in school, in social situations, and with disorders like ADHD. It can also impact development and lifelong health.Food insecurity in seniors is often masked due to isolation, changes in eating habits, and the need to adopt new diets to address chronic illness. Lack of access to healthy food can increase stress and anxiety, intensify isolation, disrupt medication management, increase cognitive decline, and lead to health problems that further exacerbate depression. For the senior moving from a skilled nursing facility to the home, accessing food, knowing what to eat to help with physical conditions like diabetes, and even feeling motivated to cook are barriers that food-as-medicine programs help overcome. Similarly, for mothers with newborns that face economic difficulties, challenges getting and cooking food, combined with any postpartum fatigue, overwhelm and depression and any pregnancy related health challenges, improving access to healthy food and nutrition can help entire families thrive.
Improving Resilience and IndependenceAcross our food-as-medicine programs, 97% of members report that their experience with the program improved their knowledge and confidence in eating healthy foods, while 98%reported their experience with the program will positively affect their ongoing food choices.55% of members have reported reduced concern about stable housing.This level of holistic impact is hard for traditional healthcare interventions to achieve. Food-as-medicine programs may be uniquely positioned to do so. Not only is food and food security fundamental to physical and mental health but the programs themselves offer care and support that goes beyond food deliveries. Our program, for example, also serves as a de facto screening mechanism to identify physical and mental health issues that the health plan should know about so that they can address the social health barriers that may be impeding overall health and wellness.When participants exit such a program, they have received the education, guidance, and motivational support to sustain new eating, shopping, and cooking behaviors that further bolster health and well-being. Food as medicine programs help members feel less isolated, more cared for, and more supported in adopting healthier lifestyles and behaviors. This canlead to more resilience, self-confidence, hope, and optimism, which are fundamental to independence and drive meaningful and sustained change.
These days, mental health in the workplace is a big buzzword.
Maybe you’ve seen companies who say they support their employees’ mental health. But you haven’t seen much evidence besides some yoga mats shoved in a dusty corner. Or a one-off session from a life coach. Or a free mindfulness app for everyone.
Is that really doing anybody any good?
Sure, it lets executives get that one off their conscience and get back to work. But does it actually address this much deeper, systemic issue — helping the 84% of people whose workplace conditions have contributed to at least one mental health condition?
All signs point to no. Unfortunately, these examples are just Bandaids on a much bigger issue.
We mined the latest research and spoke with someone who’s on the front lines of this problem to see what employees really need right now and how you can actually give it to them. Here, you’ll see examples of effective mental health support programs and HR benefit packages for employees. Take a look at this overview of how you can start changing the mental health of your workplace.
Common Mental Health Struggles in the Workplace in 2024
It’s no secret that the last few years have been difficult for everyone. According to recent research conducted by LIMRA, U.S. workers (particularly Gen Z employees) struggle with mental health concerns, including:
These issues have been growing worse over time and should not be taken lightly. But with the increasing severity in mental health issues comes something else, too — something that may be a surprise. Mental health struggles are more visible. People are more aware of the importance of mental health — both in others, and in themselves. And, slowly, they’re feeling safer asking for help when they need it.
“In the last few years we’ve seen a growing recognition of the importance of mental health and a significant rise in awareness and openness concerning mental health issues,” says Aimee George Leary, Executive Vice President and Chief People Officer at Booz Allen Hamilton (BAH). “I do think that is because of the pandemic for sure, and people being alone and isolated. And I also just think that people are more comfortable in coming forward because we’ve been working on it for such a long time in the world, too.”
Example Mental Health Support Programs for Employees
Booz Allen Hamilton has several programs to support its employees’ mental health. If you’re setting up wellness programs for your own workers, this example framework might be a helpful place to start as you begin to model something similar.
Leary includes tips for smaller companies who might not have as many resources as BAH. But really, each program is based on the same thing: people who care. If you’ve got that, you’re golden.
#1. Wellness Champions
BAH’s first program is called Wellness Champions — an intentional way to set up peer-to-peer relationships that encourage good health all around.
“We create ‘wellness champions’ across the enterprise. These are employees who take on the responsibility of promoting overall wellbeing, including the physical, mental, emotional health within the organization,” Leary explains. “So they try to push communications and things around people adopting healthier lifestyles through participating in some of our wellness programs.”
She adds that each “champion” is trained in the company’s benefits. They might promote opportunities to engage in company-wide wellness challenges, or to attend workshops on stress management that BAH has set up.
#2. Mental Health Allies
Mental Health Allies is a new program for Booz Allen Hamilton. The company just introduced it this year.
“It’s a little bit different from the Wellness Champions in that we begin training employees in what we call ‘mental health first aid,’” Leary says. “This is a commercial, vendor-based product that we partnered with to create a mental health ally network across the company.”
Like the Wellness Champions, Mental Health Allies can promote mental health awareness within the organization. But they can also show their fellow employees the resources that are available to them. The idea is that employees are more likely to talk to their peers than they are to call HR or someone else — so when they do, BAH makes sure those peers are prepared.
“[The allies] help them feel more comfortable with bringing forward some of their challenges and getting the help that they need.”
#3. Manager Training
It’s not only employees who receive mental health training at BAH. Managers do, too. Leary says the company pushes its managers to understand the signs of emotional suffering.
“We partnered with another organization who helped us train on the five signs and symptoms of emotional suffering that we provided to our managers. They oftentimes too are the first point of contact for our employees. So… knowing if they’re in distress, how to get them help.”
The idea is to create comfort for people who need support, giving them multiple avenues of connection.
#4. Employee Care Center
Finally, Booz Allen Hamilton recognizes that in times of crisis — such as suicide calls or disaster relief — peer support is not enough. There comes a point where people need trained mental health professionals. So that’s what BAH provides.
“We also have an employee care center. We put this in place around the time of Covid — different than the help desk, different than calling HR. This is a phone line and an email line that’s staffed by HR experts who really are deeper in helping people understand the resources. It’s support for wellbeing, medical emergencies, employees loss of life.”
This line connects employees with certified doctors, counselors, legal or financial support, or whatever else they need. When recent hurricanes affected a number of BAH employees, the company also brought in trained professionals who organized special listening sessions and did outreach to the affected communities, getting them the resources they needed.
“We got a tremendous amount of positive feedback on that care center through these recent crises [and] disasters… to help people navigate what they need.”
Where Can You Start?
Implementing these kinds of corporate programs might seem like a massive amount of work. But if your company is on the smaller side, your mental health initiatives don’t have to be to this scale to still be effective. Leary’s advice? Start with your managers.
“Some of this training is available open source. But getting [your] managers to know what to recognize and then knowing where [you] can point people to help in the outside world, I don’t think that would cost you a lot of money,” she says. “That’s where I would start. Get the leaders, get people aware, embedded into the culture for people to feel comfortable in bringing these things forward.”
Curate mental health resources from nonprofits or other organizations. For a low-cost solution, create a one-pager of resources you can point people to. Leary also points toward an Employee Assistance Program or a resilience fund.
“Our resilience fund is money that we put aside. So when people are going through hardship, they can apply… It’s kind of like a grant. They don’t have to pay it back. That can help them get out of whatever’s going on in their life.”
Mental Health HR Benefits: What to Know
Internal programs that support employee wellbeing are one thing. Mental health HR benefits are another. What kind of coverage should you offer your employees? Is telehealth counseling enough? What other items count as mental health benefits? What do your employees even want in their package… and how can you communicate what’s available? Let’s take a look at some of these questions.
Example Mental Health Benefits
First of all: In case this was in question, yes, you should offer mental health coverage! SHRM data from 2023 shows that 89% of organizations offered mental health coverage, but 59% of U.S. workers said their employer didn’t offer enough resources to support their mental health. You should certainly offer mental health care options to your employees.
When it comes to mental health-related benefits, there are a wide range of choices you could offer. Popular ideas include:
According to Leary, Booz Allen Hamilton covers its diverse workforce by sourcing benefits that support a broad range of potential needs. “Some of the things that are popular are these Employee Assistance Programs. So we, for example, offer upwards of 12 sessions per year for employees and the people in their home. That’s coaching for wellbeing, burnout, nutrition, it could be anything. And those counseling sessions are taken advantage of and seem to provide some really great support for people.”
BAH also provides mental health support for members of its health plan through another provider.
Which Benefits Should You Offer?
With so many choices available, how do you mix and match the best ones for your organization? This question doesn’t have a one-size-fits-all answer. It’s very individualized for each company.
Consider the demographic information of your employees to get a handle on what mental health benefits might be most helpful. Or ask them directly, running focus groups and surveys with questions like:
“The parents that we’re seeing are really struggling with their kids,” Leary says about Booz Allen Hamilton. “So we just pulled forward an organization that really focuses on digital resources for parental support because that’s been such a loud cry from our workforce on how to help them help their children because they can’t focus if their kids are struggling.
“I think you have to look at the makeup of your workforce. You have to understand, do you have a demographic that might be focused on one thing or another, or more prone to one thing or another? Look at what has the most impact for your audience.”
Communicating the Benefits You Offer
Once you’ve decided on the benefits you want to offer, make sure your employees know about them. Statistics from NAMI’s 2024 Workplace Mental Health Poll indicate that one in four employees say they don’t know if their employer offers mental health care coverage. What’s more, over half of entry-level employees who may have coverage are not confident in their ability to access those benefits.
One way Booz Allen Hamilton tackled this issue was through an internal “empowerment fair.” The company went on the road to 12 locations and set up booths for all of the services it offers.
“There are people that have been with the company for 20-some years and they’re like, ‘I didn’t know we offered that!’” Leary says. “You need to grab their attention to say, ‘Did you know that you have access to ___?’ And people just don’t, because again, there’s just too much coming at us.”
Leary also emphasizes the importance of continuous education about benefits (whether during open enrollment, or at other times of the year). People need to be reeducated about what’s available on an ongoing basis. And since they’re taking their information from their managers or from their peers, equipping those groups to know and share their benefits is key as well.
The Benefits of Good Benefits
Obviously, comprehensive mental health coverage supports your employees by helping them to each individually be as healthy as possible. But good benefits also have a cumulative ripple effect across your entire organization. By offering relevant mental health-related benefits, you’re likely to see a positive difference in areas like your:
“We have anywhere from 80,000 to 100,000 applicants a month,” Leary says about Booz Allen Hamilton’s candidate attraction. “And our attrition is at an all-time low. Our experience scores are really, really favorable. So we watch those things to see, are we delivering on what our employees want and what they need to be successful.”
If you don’t have a caring culture where people feel supported, she points out, they’re not going to stay — and then your company’s work is not going to get done. Good benefits are good for everyone.
Empowering People to Change the World
No matter how big or small your company might be, people are your most important resource. Invest into your team’s mental health. See them as people first, employees second. When you support their health all around, your company can’t help but grow.
“Our culture at Booz Allen is one of caring. And you can’t care about your employees if you don’t care about their overall health and wellbeing,” Leary says. “So we feel it’s really important to support our employees at their core.”
For the past 10 years, Booz Allen Hamilton has been especially focused on mental wellbeing through comprehensive HR benefits and smart, people-led internal programs. BAH knows that the best way to deliver good work to its clients and communities is for its employees to be well — including mentally. The company wants to empower people. And as a natural result, what happens next?
“Our purpose statement is, we empower people to change the world.”
And so can you.
Race. Gender. Age. Sexuality. Ability. Profession. What do these things have in common? These are all examples of areas where people might hold implicit biases — and where those biases could have negative effects on the mental health care that people in need receive.
“Implicit bias describes unconscious attitudes we hold towards different groups that can affect our perceptions and actions,” says Guiying (Angel) Zhong, Youth Scholar-Activist. “For example, microaggressions are one way implicit bias can show up in behavior.”
Even when we aren’t aware of it, the biases we have can control how we act. And when you apply this concept to health care providers working with mental health patients — where providers might be making life-altering decisions — things can get serious fast.
Here, Angel and Seika share their insight and their personal experiences on how implicit bias affects mental health care. They also outline actionable steps providers can take to acknowledge their own biases and work toward better health outcomes.
Implicit bias (or unconscious bias) refers to the unconscious association of negative stereotypes and beliefs about different groups of people. This bias operates beneath our awareness, but it influences our perceptions, attitudes, and actions.
“Implicit bias is not inherently ‘your fault,’” says Seika Brown, advocate and global mental health researcher and the founder of YLG Research. “It is the result of historical systems and inequities that have conditioned and taught certain biases. While holding an implicit bias doesn’t make you a bad person, what matters is your willingness to unlearn these harmful associations, both individually and at an organizational level.”
While implicit bias is unconscious, explicit bias is direct. It’s out in the open — something you fully intend to do.
“For example, asking for a male doctor because you believe men are better than women would be an explicit bias,” Seika explains.
When you exercise explicit bias, you consciously endorse negative stereotypes or make discriminatory decisions. And usually, people with explicit biases don’t feel any shame or regret about expressing those beliefs.
We can become more self-aware by reflecting on questions such as this one: Who do you feel comfortable approaching, and who do you avoid? For instance, imagine you’re lost on the street and need directions. Would you feel equally comfortable asking a Black man for help as you would asking a White man, an Asian man, or a woman? Implicit bias might influence your decision, even if you’re not fully aware of it.
“In situations where harm has been done due to implicit bias, the principle of ‘impact over intent’ is crucial,” says Guiying (Angel) Zhong, Youth Scholar-Activist. “Taking accountability for the implicit biases we all hold with self-awareness rather than self-judgment is the first step to mitigating their impact.”
However, Seika also points out that implicit bias does not define your character. “Everyone has implicit biases, but what is essential is the commitment to unlearn them and take action to reduce their impact on others.”
You can also take implicit bias tests online.
“Health care is one of the most common spaces where implicit bias has significant consequences,” Seika says. “Research shows a clear link between providers’ unconscious beliefs about race, gender, or socioeconomic status and the quality of care provided.”
When it comes to mental health care specifically, implicit bias can be tied to disparities in diagnosis; quality of care; and stigma. BIPOC communities, for example, have historically been harmed by bias-driven misdiagnosis and underdiagnosis of mental health conditions.
“Black patients are more likely to be diagnosed with schizophrenia compared to white patients who present with similar symptoms [and] ADHD is underdiagnosed among Asian American children,” Angel explains.
A provider might unconsciously underestimate the mental health concerns of certain patients because of societal norms or limiting views, making incorrect assumptions that hinder care. Another example of implicit bias is that in some cultures, mental health issues are seen as a “Western disease,” leading to the misconception that certain populations are immune to such struggles.
Seika has even experienced the consequences of implicit bias because of her profession: “I sought therapy and was dismissed because I worked in mental health, with the assumption that I should be ‘okay.’ This biased response discouraged me from seeking therapeutic help for years.”
At the end of the day, implicit bias can have a profound effect on who seeks care and how that care is provided. And when implicit biases go unaddressed, they erode trust in health care systems and services, driving people to stop pursuing care and resulting in poorer health outcomes overall.
How can providers move forward in addressing implicit bias — both individually and structurally — to provide better mental health care for everyone? Tackling implicit bias is a long road that needs continual work and attention. But these three steps, suggested by Angel and Seika, are a great start.
Angel knows it can be uncomfortable for people when they’re first learning about implicit bias. They automatically assume it makes them a bad person — and then they get defensive, which isn’t conducive to learning.
“Shifting the conversation from ‘you, as an individual, have this bad trait that must be addressed’ to ‘we, as a community, have a responsibility to mitigate harm by learning about where certain unconscious assumptions we hold come from’ is imperative to facilitating meaningful growth that advances equity,” she says.
Seika adds the following tips for mental health providers who want to work on unlearning implicit bias:
Don’t overlook the community around you. Even if you don’t work directly with patients, taking the initiative to engage with your neighbors, coworkers, or clients can help break down implicit biases by exposing you to diverse perspectives and experiences.
“Develop partnerships with community leaders and community-based organizations to better understand and address the needs of diverse populations,” Angel suggests.
Individual self-awareness is an important and necessary start. But systemic bias is very real, too. “Systemic change is needed to root out deeply ingrained biases that affect care on a larger scale,” Seika says.
Health care institutions might consider creating equity action plans that include:
“Dominant cultural narratives that uphold discriminatory stereotypes can influence how we see and treat marginalized groups without us knowing,” Angel says. “We internalize features of our environment: If that environment has long-standing structural inequality, we will internalize that inequality, resulting in unintended differential treatment and inequitable outcomes.”
Implicit biases are something we all have. But as Angel points out, that means we also all have the power to address them — both individually and collectively. And that’s encouraging news for health care patients and providers across America.
We just have to be willing.
This article is part of our Young Leaders in Behavioral Health series, where we’re highlighting the six impressive young people chosen as our Youth Advisors for the 2024 Behavioral Health Tech Conference. In this article, we spoke with Alex Muir, MBA candidate at Kellogg School of Management, and Zoe Tait, Strategy and Business Operations Specialist at Jimini Health/Chief Research Assistant at the Stanford Computational Psychology & Well-Being Lab, about how artificial intelligence could help treat mental health disorders.
When you think of artificial intelligence, what image first comes into your mind? Many people wince at the idea of driverless passenger vehicles or roll their eyes at the thought of college students turning in papers written by ChatGPT. We don’t necessarily think of artificial intelligence as something that could have positive applications in a mental health care setting. But what if it did?
When it comes to artificial intelligence and mental health disorders, Zoe Tait is well-versed: Her undergraduate honors thesis, “The Naturalistic Uses of Large Language Models (LLMs) for Mental Health Purposes,” studied how individuals use LLMs for mental health support.
“The ongoing mental health crisis and loneliness epidemic has decreased many individuals’ quality of life and ability to find quality mental health care,” she says. “The recent technological innovation and the recent rise in AI applications create the perfect opportunity for increased innovation in the digital mental health space. It is critical that we continue to ramp up the investigation of how to best integrate AI into settings where mental health care is a key focus.”
Zoe and Alex shared their insight on whether AI can help treat mental health disorders, and how to appropriately deploy AI solutions.
Can Artificial Intelligence Diagnose or Treat Mental Health Disorders?
Alex Muir, MBA candidate at Kellogg School of Management, believes that artificial intelligence can do both.
“Fundamentally, AI is fantastic at organizing and learning from large swaths of data to produce an output,” she says. Our job, she explains, is to provide AI models with high-fidelity data of prior diagnoses or what treatments work. From there, “the learnings could be applied to more effectively diagnose and treat mental health disorders.”
Zoe Tait, Strategy and Business Operations Specialist at Jimini Health/Chief Research Assistant at the Stanford Computational Psychology & Well-Being Lab, agrees. Artificial intelligence has potential for both diagnosis and treatment of mental health disorders. But that doesn’t mean the human element can be taken out of the picture.
“I believe that for AI to be successfully integrated into the current care landscape, there must be a collaboration between mental health practitioners and those developing AI-based tools.”
AI and Diagnostics
Mental health disorders are typically diagnosed through a psychological evaluation, lab tests, and a physical exam to rule out physical problems. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) helps clinicians and providers correctly diagnose a specific mental illness. How could artificial intelligence step in to make these diagnostic processes more accurate and efficient?
“Recent work has shown that individuals with higher levels of depression will show significantly greater use of first-person singular pronouns (e.g., ‘I,’ ‘me,’ ‘my’) (Nook et al., 2022),” says Zoe. “Understanding how AI and LLMs can be integrated into the assessment or diagnosis of mental health disorders by identifying language patterns is critical.”
Alex also cites an additional study published in 2017 that used deep learning to search for biomarkers of psychiatric and neurologic disease. “This study used a deep learning model to accurately classify patients diagnosed with schizophrenia based on their brain scans. Traditionally, the mental health field has struggled to have biological markers of mental illness/disorders. If we can truly find a way to develop models to classify appropriately mental disorders, this could be a huge leap forward in our ability to catch and treat mental illness.”
AI and Treatment
Some experts think that artificial intelligence should step in before symptoms get severe, offering cognitive behavioral therapy (CBT) to people who are dealing with mild anxiety, depression, or burnout. Zoe agrees that while AI may not be able to completely replace therapy, it has the potential to increase “support, access, and overall accuracy in information-gathering, leading to a potentially significant improvement in patient outcomes.”
And the benefits of AI aren’t just about the patients — they apply to clinicians, too. LLMs can augment clinical training, assist clinicians with their tasks, and lift the cognitive burden that often comes hand-in-hand with delivering care.
Next Steps to Implementing AI in Mental Health Care Settings
“Just like how humans are not perfect, AI is also not perfect,” Alex warns. “We should be wary of becoming overly dependent on a model, especially when we are not confident the underlying data is of a sufficient quality.”
Alex and Zoe discuss some of the considerations and risks around using artificial intelligence in the mental health field, and the next steps and advice they would propose.
Collaborate With Stakeholders
“When implementing AI in the clinical setting, it’s critical to collaborate with stakeholders across multiple areas to ensure patients receive the best care possible,” Zoe says.
This includes people who play a key role in clinical or technological oversight, such as:
Maintain the Human Connection
A crucial part of mental health care hinges on human connection. There’s even a term for this — the “therapeutic alliance,” which refers to the collaborative alignment and bond between a clinician and patient.
“This alliance allows the patient to feel supported throughout their care journey,” Zoe explains. “Understanding if it is possible for an individual to form a similar therapeutic relationship with an AI agent will provide insight into how to best integrate patient-facing AI into care.”
AI can remember more than a human can. But humans carry certain qualities of empathy and validation that can’t quite be replicated in a bot. Researchers are still learning how to build AI that retains its memory capacity, yet also knows how to best support a human. Patient trust is too precious to lose — and the human element that fosters that trust may be irreplaceable.
Utilize Frameworks
To successfully and safely integrate AI into a confidential care setting, use a framework for the deployment process. For example, the READI framework proposes a framework for readiness by outlining six important criteria:
“Realistically, we need to start collecting, organizing, and cleaning the appropriate data so that we can deploy the proper AI models,” Alex says, adding, “Additionally, all AI deployments should be used in tandem with a licensed provider.”
Where Else Can AI Help?
The areas where AI can help with mental health aren’t limited to diagnostics and treatment. AI-based solutions could also help people by:
AI in Mental Health Care: A Timely Solution
Our society is at the cusp of a major opportunity. Technology and innovation are at the forefront of the news cycle. Gen Z uses tools like ChatGPT sometimes every day. Finding ways to integrate this new familiarity with AI into mental health care settings is a smart way to ensure more people receive the care they need. And young leaders like Alex Muir and Zoe Tait are poised to help make this happen.
“AI has the potential to assist in ensuring increased access to quality mental health care around the world, therefore making mental health care more equitable across communities,” Zoe says. She adds: “I believe that we are further along than we think in terms of making valuable tools and technologies available to clinicians and patients to improve the current care landscape.”
HOW DO YOU FEEL? begins with you hitting what you describe as a “breaking point.” How did you get there? What did the lead-up to that moment look like?
Sometimes you don’t know you’re off until you’re REALLY off. Like so many of my patients, I blow past early warning signs (for me, extreme anger at my inbox, for example), and attribute them to work or, really, medicine just being hard. I think “I’m fine” and just “a little tired,” and push through nearly falling asleep, and ignore my emotions, and just keep going. I learned to do that in medical school, because we’re always needed, and not supposed to come first, and all of those thoughts were only compounded in the pandemic. I felt pulled and needed so much as a psychiatrist who saw healthcare workers and an administrator in charge of our staff and faculty support during such a challenging time, but I also felt guilty because I was not an “actual frontline worker” and that only made me want to do more and more. What feels like a sudden break is never really sudden, but is often just bad enough for you to finally recognize yourself in the equation.
This book discusses not only the challenges healthcare workers face but also the complexities of caring for others in general. What implications do your findings have for readers who are outside of the medical field but are nonetheless struggling with the difficulties of care work in their personal lives?
Not everyone is in healthcare, but healthcare is just one example of putting others before yourself. Take motherhood, instead: I hear over and over from women that they care for their kids, and sometimes also their parents, and after that, there is no time for them. The truth is, we are all better caregivers when we recognize and take care of our own needs. I think seeing me and the patients in the book struggle with this balance is not only validating but enlightening. I hope people who struggle with the same universal themes (overwork, perfectionism, empathy, burnout) feel less alone, but also learn some tips and tricks to try in their own lives. It isn’t a self-help book, but readers will see me suggest interventions to my patients and my therapist do the same to me, and can decide if they want to incorporate any of those ideas into their lives. Plus, if a healthcare worker who studies mental health topics like burnout (or, in the case of me, specializes in it!) can fail to notice symptoms in themselves, or better yet, stigmatizes mental health conditions, of course everyone else does. It puts into perspective just how challenging it is to prioritize our mental health, and that itself is a worthwhile conversation to have out loud.
HOW DO YOU FEEL? recounts sessions with four of your healthcare worker patients. How did working with these patients affect your understanding of the issues in which you specialize—and even your understanding of what you were experiencing on a personal level?
I fell in love with psychiatry because of patients’ stories. I loved how I could hear a hundred stories of people with depression, and maybe their medication treatment would be similar, but the reasons for their depression were always different. Every day I learn something from the privilege of sitting with patients and being the first (and often only) person they tell some of their hardest life challenges. Sometimes my understanding grows just because of how they describe their subjective experience, or the culture of healthcare in their fears and opinions, and that informs how I help them and other patients like them in the future. But, also, their stories
can trigger something in me—a memory, or a similar feeling or thought—and that often means something deeper. I might journal or ruminate on it, or, better yet, bring it with me to therapy and that reflection, of my feelings because of a patient, can help me learn more about myself as a result.
Some readers may be surprised to learn that healthcare workers like you navigate many of the same issues they do when it comes to seeking care and connecting with a therapist. You mention that those trained in mental health, like most people, sometimes lie to their therapists. What’s behind this? Why do so many of us struggle with total honesty even in this ostensible safe space?
Being a psychiatrist in therapy is just like everyone else being in therapy, except I have training in it. That adds a sort of meta layer to our relationship where I can sometimes notice communication techniques and my own resistance, and perhaps that makes me a little more annoying as a client (and not everyone would choose me as one!). Still, noticing I’m doing something doesn’t necessarily mean I don’t do it. Case in point—I’ve lied to my
therapist (not the one in the book, though, she’s special). We lie because we aren’t ready to have those conversations yet, or we’re afraid of being judged (even if it is a safe space), because others have judged us before or we’ve seen someone else be judged for something similar. In truth, though, we have to get through the scary stuff out loud to fully process it. Sometimes it feels safer to leave it in a box on a shelf and avoid it, but the box always gets heavy and breaks eventually.
Many readers will see themselves in your discussion of perfectionism. What are the two types of perfectionism? How does understanding perfectionism help you better treat your patients, and how might readers apply this knowledge to their own lives?
Perfectionism is much more than just a drive to do well, as the type of perfectionism you have affects your emotions and self-concept. Normal (or adaptive) perfectionists try to be perfect, but along the way do not compromise their self-esteem. In fact, all they’re doing actually makes them feel better about themselves because they are trying to reach their goals. They can also manage making mistakes. On the other hand, maladaptive (or neurotic) perfectionists have goals that are often unrealistic, but don’t recognize that, and feel dissatisfied and not “good enough” when they don’t reach them. Failure, for them, is not seen as an option, and when it happens, as is inevitable because we are human, the impact is greater. A reader might see themselves in either type, and just identifying that is the first step in understanding themselves and their reactions better, and eventually learning to cope more effectively with it.
Of course, you might want a perfectionist doctor to be responsible for your care, thinking they will be more meticulous in their learnings and skills (which they often are!), but the maladaptive ones are more likely to feel inadequate and experience depression, anxiety, and burnout. Besides affecting themselves, these symptoms can affect the care you receive as a patient, and, even if the doctor is still working and available to provide the care to you in the first place. As a provider, understanding perfectionism helps me conceptualize the reason a mistake might affect a doctor’s self-esteem so severely, and I can use that to help me work with them to identify their behaviors, thoughts, and experiences. The goal is often to create more balanced thoughts, so they can be more adaptive about it all, which will, in turn, help their mental health outcomes. This would be the hope for any reader struggling, as well.
HOW DO YOU FEEL? pulls back the curtain on many less-discussed aspects of providing mental health treatment, including by detailing the complex emotions you’re navigating during your sessions with patients. These reflections are often vulnerable—you reveal that therapists sometimes struggle to maintain detachment, experience self-protective impulses, find themselves heading into a session in a state of agitation, and worry about avoiding secondary trauma. Why was it important to you to reveal the more tangly aspects of the practitioner’s experience?
Psychiatrists don’t often have the best reputation to the public. Maybe because of Freud our silence comes off as uncaring, and maybe because of people’s bad experiences with one doctor or another, we now have a reputation for just being drug pushers, and not curious about patients’ stories. But, in my experience, all of that couldn’t be further from the truth. By pulling back the curtain, quite literally into my own head, I wanted not just to show people what we do but also to emphasize our humanity. The latter is important for both patients and mental health practitioners to recognize. Too often we pretend our jobs don’t affect us, and that to truly do our jobs well, they can’t. But that is a myth. I often think about a quote by Rachel Ramen: “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” I think it’s about time we talk about the water, and what it feels like to be constantly rained on. Silence isn’t helping anyone.
Throughout the book, you talk about self-disclosure, both as it pertains to your therapy itself and to overall medical care. Can you share more on that subject?
Self-disclosure is an interesting topic because it’s an area that even mental health professionals discourage. You are supposed to be a blank slate so that a patient can’t come in with beliefs about you because of your story. But I have a public presence (through writing and social media) that has grown to include more of my own experiences over time. It wasn’t easy, say, to write about being on medication and stigmatizing myself for it, but I decided it was necessary, and that if it helped one person who read it, it was worth it. That doesn’t mean no one in my academic life has ever judged me for it, or that I didn’t worry about the consequences. But I’ve decided self-disclosure is not just important for a patient; it’s necessary for culture to change around mental health in general.
Part of the reason it has become easier for me to be so vulnerable is work in my personal therapy. I’ve talked about writing and what parts of my story I owe others (hint: none), and I’ve also seen my therapist use self disclosure beautifully to make me see things I wouldn’t otherwise (like telling me she is on meds to emphasize it didn’t change my opinion of her). It is no wonder that data suggests clients who have therapists who practice self-disclosure had lower levels of distress and liked their therapists more. Our lived experiences also make us more empathetic to the experiences of patients, and I personally think I’m a better doctor for all of it.
You’ve become an authoritative voice in the media on burnout, an issue you also address with patients in your clinical practice. How did you come to develop that niche?
I didn’t wake up one day and decide to be a burnout expert, but it more or less found me. When I was in college, I started to observe that people in pre-med who were kind, not cutthroat, and would have made awesome doctors, regularly dropped out. I became so curious about why, that I studied pre-med as a culture
for my Master's thesis in Anthropology. After that, once my eyes were open to some of these challenges and disparities, they were constantly aware. I studied med student mental health and access to care in medical school, and started (and helped lead) support groups for medical students as a resident. Aware that burnout was a major issue I was hearing about in all levels of training even before the pandemic, in March 2020, I had the background to jump in quickly and help. I was clinically seeing healthcare workers, students, faculty, and staff, and also working on outreach and education. At the same time, noticing the same issues across the country, I was talking about it in writing (e.g. I wrote a STAT piece on it in April 2020 long before it was covered elsewhere) and on social media. COVID didn’t create the mental health crisis in healthcare, so it doesn’t stop just because COVID did. It is my job to remind people of that.
You disclose that you experienced burnout yourself. What pushes healthcare workers towards burnout? What are some of the warning signs? What coping mechanism did you employ to handle burnout? What advice would you give to others experiencing burnout?
Burnout is a workplace associated condition, meaning that the systems and circumstances where you work, caused you to feel the symptoms you experience. In healthcare, the reasons for burnout are vast and include everything from documentation and electronic medical records, to insurance companies and safety in the workplace, to a general lack of support. It is no wonder that doctors are burned out at rates as high as 50%, and more than other fields. Burnout is not simply “being tired from work”, but is defined as 3 different overall symptoms: 1) Emotional exhaustion: This looks a lot like physical exhaustion but you just feel “done” at the end of a workday 2) Depersonalization (or Cynicism depending who you ask): Feeling disconnected or more angry/frustrated, and 3) A reduced sense of personal accomplishment, which is more self-explanatory. In my practice, and personal experience, the first 2 symptoms are often blown past and ignored as predictable outcomes of work, especially in medicine where the baseline is basically to not sleep, not eat, and be burned out, but once someone feels they are doing less, or someone else might think they are doing less, they start to take notice.
This means, though, that the more subtle symptoms, like overwhelm, a change in your schedule, or procrastination, are often ignored and it is more severe by the time you pay attention and try to take action, which happened to me (and so many of my patients!). By that time, time off is really all that can help and allow you a break and reset, as something like yoga will feel useless, and even detrimental as a suggestion, at that time. Once I reset, though, it was important that I didn’t just go back to the same ways of coping with a bad system that I did initially. One of the things that helps now is paying more attention and asking myself how I am feeling regularly, and not just when things are bad. Not only does it remind me I am part of the equation and might have reactions, it lets me notice changes earlier, with more options for interventions to help. I tell this to anyone who asks, as a good place to start: So, how do you feel?
What systemic changes would you like to see to help prevent burnout? How can supervisors identify and better assist someone who might be struggling?
Across the board in studies the things that help with burnout are meaning, purpose, and supportive supervisors. Meaning and purpose can feel intangible and philosophical even, but what it really means is when we spend more of our time mentoring or seeing patients (what we signed up to do, and derive meaning from)
instead of paperwork and charting and yelling at insurance companies, we feel less burned out. To do this, systems need to look at what is in place to support their healthcare workers- other staff, time off, changes to the electronic medical records-and invest in helping their teams spend more time on their purpose. The concept of a “supportive supervisor” is vague, in some sense, but has to do with communication, transparency, and the culture in the workplace. Supervisors need to be trained to recognize burnout and talk about burnout with their teams, but also in how to create supportive work environments. The good ones should be rewarded, often, and others should be given education and skills to help their behaviors. Policies, like leave and remote work, come into play here as well-as a more flexible workplace that supports work/life balance will lead to less burnout. Ultimately, every area of the system interacts with burnout in some way, which is why jobs like mine, as a Chief Wellness Officer, even exist. We can be the ones to work across the silos, and remind people of the humanity of the workforce every chance we get.
How do you feel?
Anxious and even a little afraid, but also proud and excited—like any good expression of vulnerability.
Solome Tibebu, Founder & CEO of Behavioral Health Tech, recently sat down with Vice President of Health & Performance at Canyon Ranch, Dr. Mark Kovacs, to discuss what trends he is seeing, how provider burnout can be addressed, and how Canyon Ranch (and their new program, Longevity!) can help.
Poor maternal mental health is a critical and growing public health issue. Over recent years, we have seen the rise of postpartum depression and anxiety. When a mother is struggling, the impact extends to her partner, her children, and even her community. As these challenges grow, so too does the need for effective solutions. Mental health challenges during pregnancy or postpartum can have lasting consequences, but with the right support, we can change the trajectory of families’ lives.
As Malekeh Amini, CEO of Trayt Health, points out, the statistics tell a sobering story. "Postpartum depression has been increasing for years, with an analysis by the CDC showing that it was seven times higher in 2015 than in 2000. Now, the Dobbs decision has created an entirely new level of anxiety, depression, and fear surrounding the inability to get medical care for life-threatening conditions."
The reality is that legal and societal shifts, like the Dobbs decision, have added new layers of stress for pregnant women. This raises an important question: how can we step up to ensure that mental health care reaches these women when they need it most? Luckily, organizations like Trayt Health and CareSource are using technology to expand access, especially in rural and underserved communities.
The Changing Needs of Pregnant and Postpartum Women
The mental health needs of pregnant women have evolved quickly. Two decades ago, postpartum depression was not a commonly discussed topic. Nowadays, it is a well-known and growing issue. According to Amini, postpartum depression rates were already soaring years ago, and they have recently been compounded by social and legal changes.
But what has changed? It’s not just the mental health struggles women face—it’s how those struggles are being recognized and addressed. We now understand that mental health is not an isolated issue. It touches every aspect of life, from a mother’s relationship with her partner to her ability to care for her children. And importantly, it is not just about depression. Anxiety, stress, and feelings of isolation are becoming increasingly common, particularly in areas where access to mental health services is limited.
Many of these women live in rural areas, far from the resources they need. And while they may be dealing with severe mental health challenges, the stigma around seeking help often prevents them from reaching out. This is where technology is stepping in, helping healthcare providers to connect with and support these women in ways that were not possible before.
The Power of Technology in Detecting Maternal Mental Health Conditions Early
We know that early intervention is key when it comes to maternal mental health, but how do we make that happen? One word: technology. Platforms like Trayt Health are bridging the gap between primary care and mental health specialists, enabling early detection and intervention for postpartum conditions like depression and anxiety.
Amini explains: "The primary care setting is the first line of defense and our best opportunity for early detection and intervention for maternal mental health conditions. The Trayt platform not only facilitates the screening process but also provides powerful data analytics to measure results and improve clinical decision-making."
This means OB/GYNs, pediatricians, and primary care providers can now work hand-in-hand with psychiatry specialists. By using Trayt’s Psychiatry Access Programs, healthcare providers can get the support they need to manage mental health issues within their own clinics. This is a valuable tool, especially in rural or underserved communities where psychiatrists are in short supply.
One of the best things about this technology? Universal screening. No one is left behind. Every woman has the opportunity to be assessed for mental health conditions, and doctors have the data they need to make informed decisions. It’s a game-changer for families, ensuring mothers can receive the mental health care they need before things get worse.
Overcoming Barriers to Maternal Mental Health Care
Of course, technology alone will not fix everything. We still need to tackle the stigma that surrounds maternal mental health, particularly when it comes to substance use disorders (SUD). Many women are afraid that seeking help will result in them being labeled as an unfit parent or reported for neglect. This fear can prevent them from accessing the care they so desperately need.
Sandra Berg, Senior Director of Behavioral Health at CareSource, highlights this challenge: "The stigma of mental health and substance use is a deterrent for pregnant women to seek care. Postpartum women also are fearful of disclosing a mental health or SUD challenge because someone may report them for neglect."
The reality is that these women need compassionate, non-judgmental support. And that is exactly what CareSource is offering through partnerships with telehealth providers like Brave Health and Luna Joy. By providing access to mental health care virtually, CareSource is helping women overcome the stigma and practical barriers that often prevent them from getting help.
For many women, especially those in rural areas, telehealth is a lifeline. Imagine living hours away from the nearest mental health specialist and having to choose between getting help or taking care of your newborn. For these mothers, telehealth offers the flexibility to connect with specialists from the comfort of their home, reducing both the time and stress involved in seeking care.
As Amini puts it: "By supporting statewide Psychiatry Access Programs, Trayt is bridging mental health deserts and expanding the reach of scarce mental health resources."
Looking Ahead: The Future of Maternal Mental Health
There is no question that technology will continue to play a vital role in maternal mental health. Healthcare providers like CareSource are committed to using these tools in innovative ways. Berg explains: "We continuously seek clinically sound collaboration with outcome-driven organizations to support our maternal mental health. We do this while maintaining close contact with our members to listen to what services they need."
Beyond telehealth, platforms like Manatee are taking a family-focused approach to maternal mental health. Dama Dipayana, Co-founder and CEO of Manatee, shares: "Meeting moms and families where they are with their virtual sessions is incredibly impactful. Additionally, building the metaphorical 'village' is vital to supporting new parents."
By offering services like virtual therapy and care coordination, Manatee helps families create sustainable, long-term mental health strategies. This holistic approach is key to addressing not only the needs of the mother but also the entire family unit.
As Dipayana notes, digital care will likely become the standard for maternal and family health. Virtual platforms enable faster intervention, reducing the time families spend waiting for care—a critical issue in underserved areas.
Conclusion
Maternal mental health is an issue that affects every corner of society, from the mothers themselves to their children, partners, and communities. While there is no one-size-fits-all solution, technology is opening new doors for early detection, intervention, and support. Platforms like Trayt Health, CareSource, and Manatee are proving that with the right tools and partnerships, we can break down barriers and provide the care that mothers need.
By combining human compassion with cutting-edge technology, we can create a brighter, healthier future for mothers and their families. For those interested in diving deeper into these topics, the Maternal Mental Health panels at the Behavioral Health Tech conference from November 5-7 in Phoenix, Arizona, will provide valuable insights and discussions on the future of maternal care.
References
[1] Amini M., Trayt Health. (2024). Supporting Maternal Mental Health Across Texas: A Case Study. Retrieved from Trayt Health Case Study.
[2] Centers for Disease Control and Prevention. (2021). Postpartum Depression Facts.
[3] Berg S., CareSource. (2024). Interview with Sandra Berg, Sr. Director of Behavioral Health and Programs, CareSource.
[4] Amini M., Trayt Health. (2024). Interview with Malekeh Amini, Founder and CEO of Trayt Health.
[5] Dipayana D., Manatee. (2024). Interview with Dama Dipayana, Co-founder and CEO of Manatee.
Three numbers can save a life.
That’s the concept behind the new (or, by now, not-so-new) 988 suicide hotline that covers the United States and Canada. In October 2020, the National Suicide Hotline Designation Act of 2020 was signed into law, designating 988 as the nationwide dialing code (including both calls and texts) to connect people in crisis with suicide prevention and mental health crisis counselors. The new hotline number officially launched in July 2022.
Before that, people who were dealing with a mental health crisis would call 1-800-273-8255. While this number is still available (calls are automatically rerouted to 988), the shorter, three-digit code is much simpler for someone whose mental capacity is very low in a moment of crisis. It’s similar to 911, making it easy to remember. But connecting with call centers staffed with trained mental health professionals (including ones who speak Spanish, who are LGBTQI+ affirming, or who speak ASL over video call) is much more beneficial than calling 911 for a first responder to show up at your door unneeded.
988 quickly caught on and became particularly popular during the pandemic. In May 2024, 988 received over a million monthly contacts. And in a world where depression and suicide rates are increasing, this is incredibly valuable work. Yet still, call centers are only meeting the bare minimum.
“They answer the phone. If needed, they send you to the hospital. Maybe they refer you to some type of community support. But that’s about it,” says Dr. Sahar Dawi, PhD, MBA, Behavioral Health Subject Matter Advisor Accenture.
What happens to patients after they call? Do they receive the mental health care and support they need? Or do they slip through the cracks?
Call centers are stretched thin trying to meet the need. 988 is a crucial service. But it can’t become stagnant. This is a major opportunity for tech companies to step in, helping innovate and evolve as they seek to follow up with each and every caller.
Why Are 988 Caller Follow-Ups A Challenge?
Following up with 988 callers isn’t impossible — but it certainly poses a challenge. Take a look at these primary obstacles that make patient follow-ups difficult.
Capacity and Workforce Shortages
As the demand for mental health services continues to grow, call centers are becoming overwhelmed. Many centers lack sufficient trained staff to handle the volume of calls they’re receiving. And those they do have are emotionally exhausted: In a 2024 survey from Accenture, 42% of behavioral health workers reported burnout.
Funding and Resources
“While the [988] program is a national initiative, funding varies by state,” Dawi explains. This leads to inconsistencies in service delivery; struggles with limited staffing and technology; and difficulty meeting demand.
Technological Integration
In some cases, a patient in crisis may need support in the form of a specialized mobile unit from another emergency service. Seamless coordination between 988 and other existing emergency services, such as 911, is an important part of the overall crisis continuum. However, it’s also complex to integrate and deploy.
Data Interoperability Challenges
Crisis center data needs to be shared with the national 988 coordinator on a state-by-state level to provide a comprehensive view of the current state of 988 across the U.S. This can be tricky because of the different data challenges that affect different call centers.
Continuity of Care
988 serves as an initial intervention. But the big challenge, according to Dawi, is ensuring callers receive appropriate follow-up care or referrals.
“This includes linking people with long-term mental health services, which may not be readily available due to broader shortages in mental healthcare or may not be an option for the call centers as they do not have the capacity to make those referrals.”
This issue is particularly apparent in rural areas, which often have fewer mental health services, making it even harder to connect individuals in crisis with appropriate care.
Space to Innovate
You can’t keep doing the same thing over and over and expecting different results. And in this case, the data is clear: It’s time for a change, to benefit behavioral health workers and patients alike.
Faced with the list of challenges outlined above, tech companies might be disinclined to help 988 callers get access to follow-up care.
“It’s all heavily regulated,” Dawi notes. “Especially with smaller startups, it’s hard for them to get in. This is a system-wide problem.”
The opportunity for innovation is broad. And the incentive is there: Besides the obvious benefit of helping open up access to mental healthcare and save human lives, this is a well-funded market. For tech companies, a solid state contract could be financially lucrative.
What does this follow-up actually look like? How does it work? The sky’s the limit. Different tech companies might plug different gaps depending on their specialties, working to create a plan for 988/911 interoperability or introducing an automated system with data warehousing and mechanisms for statewide data sharing among centers.
Maybe three numbers can save somebody’s life. But it’s the follow-up — someone remembering them and getting access to the mental healthcare they need — that will keep them alive. And when it comes to 988, that follow-up can easily be powered by the innovation of tech startups across the continent.
It’s up to you.
How people seek and access mental health care was forever changed by the pandemic. In a market flooded with new care delivery methods – it is worth considering what capabilities are required for durability and longevity. We spoke with leadership from Grow Therapy, a national behavioral health provider group and technology company, about reaching an inflection point in mental health where quality and value-orientation need to be prioritized, in addition to improving access.
1. Equitable, affordable access to high-quality behavioral health care is the goal. What tangible steps is Grow taking to make this vision a reality?
Manoj: At Grow, we are rooted in the belief that everyone should be able to afford behavioral health care. Grow assembled an expert team and designed highly effective revenue cycle management. This enables us to bill private and government health plans, making therapy and psychiatry more affordable than self-pay. It also provides the means to invest in our providers. Grow clinicians have access to world-class quality improvement programs, marketing support to grow their practices and tooling that gives routine and actionable feedback about their clients’ engagement and treatment progress.
Cynthia: This provider-centric approach to innovation pays off, with more than 90% of clinicians preferring Grow over other behavioral telehealth systems. Grow’s provider Net Promoter Score (NPS) is 88, which is considered “excellent” on a scale of -100 to 100. Our provider retention rate is 90%. When we take care of providers, they’re able to do a better job taking care of their clients. Our client NPS is 85 and more than 80% return for multiple visits.
2. How is Grow Therapy integrating measurement informed care (MIC) into its clinical practices and what does that mean for your client, provider and health plan stakeholders?
Cynthia: Grow’s MIC infrastructure uses evidence-based measures to gauge symptoms and treatment progress. We provide a level of clarity that is standard in physical health care but has been historically lacking in behavioral health. For example, keeping track and bringing visibility to improvements in depression and anxiety can motivate clients, so we collect and analyze PHQ-9 and GAD-7 responses throughout their therapy or psychiatry journey and share those findings with clients and their providers.
Manoj: We can only manage what we can measure, and there is still immense progress to be made in behavioral health. 75% of Americans believe behavioral health issues are identified and treated less effectively than physical health, according to a West Health and Gallup survey from February 2024. Better measurement will help us understand root causes, making them inherently more solvable. It also allows us to align outcomes with payment, incentivizing providers to close care gaps.
3. Changing the payment paradigm has been tough across the board, but progress has been particularly slow in behavioral health. How is Grow going to change that dynamic?
Manoj: There are two essential ingredients for innovative reimbursement models. One is demonstrable outcomes measured through data and analytic capabilities. The other is payor and provider alignment on how those outcomes impact payment. The former is a strength of Grow’s and the latter is an active collaboration underway with many of our payor partners. When we enter into value-based agreements, we incentivize quality care and clinical outcomes to achieve enhanced rates. Additionally, we prioritize delivering value to health plans, whether through improving HEDIS measures, client experience, or consistent measurement.
4. Imagine a future where every American can afford behavioral health care. What comes next for Grow?
Manoj: The rapidly evolving behavioral health landscape necessitates not only keeping up with the current environment, but also proactively envisioning and executing what behavioral health will need in the future. Ultimately, this means doubling down on Grow’s value orientation to reimagine a more equitable, integrated, and higher-quality behavioral health care system, while also being mindful of health plans’ need for cost control.
Cynthia: In addition to stepping up to lead in value creation and quality improvement, we need to bolster the workforce pipeline to make the recent gains we have seen sustainable. Behavioral health should be a viable and attractive career option long term. Grow minimizes many of the stressors that might deter potential providers from accepting insurance and has support available to help prevent burnout and compassion fatigue. We want to inspire the next generation of top talent in behavioral health.
In a world where one in five adults experiences a behavioral health condition, our payment models lack incentives for high value care and therefore our system is failing patients, providers, and payers. It's time for that to change.
When tailored to the unique challenges of behavioral health care, value-based reimbursement models can transform outcomes, improve costs, and increase access to high quality treatment for millions of people.
The fee-for-service (FFS) model has long been the dominant paradigm in health care reimbursement, including behavioral health. Under this model, providers are paid for each service rendered, regardless of the necessity of the service or the outcome. While straightforward, this approach has significant limitations.
The challenges of the FFS model are multifaceted and include:
These limitations have real consequences. People living with serious mental illness die 10-25 years earlier than the general population, mainly due to treatable medical conditions[1]. Moreover, the economic burden of mental illness in the United States is staggering, estimated at $225 billion annually[2].
Let’s also consider the case of untreated serious mental illness (SMI) and substance use disorders (SUD). Approximately half of adults living with SMI report an unmet need for mental health treatment [3]. These gaps in care lead to increased emergency department visits, hospitalizations, and incarceration rates, all of which drive up costs without improving outcomes. Value-based contracting (VBC) in behavioral health aims to align payment with patient outcomes, quality of care, and cost efficiency.
The potential benefits of VBC in behavioral health are significant. For patients it promises improved outcomes, better care coordination, and enhanced overall experience. For providers, it means aligned incentives that reward quality care and reduce administrative burden. And for payers, it yields better cost management and predictability.
Early success stories for physical health VBC models provide a glimpse of the potential. For instance, the Medicare Shared Savings Program generated $1.66 billion in savings for Medicare in 2021 alone while improving quality metrics [4].
While most of us agree on the importance of driving toward value-based payment in behavioral health, the key challenges that often arise are related to quality measurement and outcome tracking, and provider and payer readiness.
Quality Measurement and Outcome Tracking
Person reported health outcome measures (PROMs) are our most robust tools as they are clinically validated, and are true health outcome measures as opposed to process measures, which focus on steps that should be followed to provide good care [5]. They also help define symptom burden and measure change over time during the course of treatment.
Three concerns that are frequently cited for PROMs are as follows:
Process and structural measures are important, but they only measure actions delivered within evidence-based treatment, as opposed to true health outcomes that matter for patients and families [6]. For behavioral health, the process measures with the most robust evidence for impacting health outcomes and costs are related to medication adherence.
Patients living with schizophrenia who are adherent to antipsychotic medications - and patients with opioid use disorders who are adherent to medications to treat addiction - are more likely to enter remission from their behavioral health conditions and remain stable in the community, outside of hospitals, facilities, and other high cost locations of care. When implementing process measures, we should take the greatest care to choose those with the most robust evidence for driving improvement in total health and costs.
Provider Readiness for VBC
Behavioral health providers are an eclectic group. They range from solo practices to large multi-disciplinary health systems. Providers may specialize for a subset of behavioral health conditions, such as eating disorders or substance use. Providers also often focus on specific patient populations defined by age or payer type. They may offer one modality of treatment, such as therapy, medications or procedures like ECT. Finding one value-based payment model that addresses all of these factors is challenging.
Behavioral health providers also vary in their ability to manage financial risk, with many providers being part of small practices that are operating with smaller margins and not able to accept financial accountability for patient outcomes. Additionally, many behavioral health providers were left out of HITECH and other incentive programs for EHR adoption; therefore, providers’ ability to measure and report on quality is limited [7].
Fortunately, value-based payment models exist on a continuum, with increasing accountability for population health outcomes and costs. The spectrum is defined by the Health Care Payment Learning & Action Network (HCP-LAN) and is summarized as follows [8]:
When offered this full spectrum of value-based payment options, then providers can enter at any stage depending on their readiness. Additionally, over time, payers can offer financial incentives and support for providers to build the infrastructure to move to greater accountability for population outcomes. Drawing on experience from the rest of health care - we will achieve the highest value from our behavioral health system when we move providers and payers toward alignment for population health and costs. We should orient our investments to helping providers along this spectrum as quickly and robustly as possible.
Payer Readiness for VBC
Value-based payment for services outside of health systems and primary care is relatively new, and payers have multiple issues to consider as follows:
Instead of counting services, the future of behavioral health care is about making every service count. By embracing value-based care, we will create a behavioral health system that truly serves the needs of patients, providers, and society.
The journey is challenging and requires investment and alignment across the multiple sectors that impact patients and families. We cannot wait because the consequences are severe and are happening now - with hospital crowding due to lack of access to care in the community, rising suicide rates especially for youth and elderly individuals, and an inadequate provider workforce requiring us to use our limited resources as efficiently as possible.
The opportunities are huge – particularly for optimizing health care resources and improving lives - and they are clear and within reach. Let’s join together and make it happen.
I look forward to discussing this topic in more detail at this year’s Behavioral Health Tech conference. I hope to see you there!
References
Behavioral healthcare has undergone significant change that began when the COVID-19 pandemic demanded the industry to shift to providing care via telehealth. As the world went virtual, the healthcare industry followed to maintain continuity of care, with virtual appointments rapidly changing from being a supplemental option to becoming a mainstream, essential component of the healthcare system.
This transition has created a more focused approach to behavioral healthcare. In particular, virtual care has proven to be invaluable for treating eating disorders, as it enables specialized care to be delivered directly to clients' homes. Virtual care also allows for therapies that addresses co-occurring disorders, like Cognitive Processing Therapy (CPT) for post-traumatic stress disorder (PTSD), to be delivered simultaneously, resulting in a better treatment experience and likelihood of long-term recovery.
Meeting People Where They Are
One of the greatest strengths of virtual behavioral healthcare is its ability to meet clients wherever they are – both literally and figuratively. For those balancing work, school, family responsibilities or lack of transportation, virtual care offers an adaptable, flexible option that fits into their lives. Furthermore, it provides an alternative to not seeking treatment at all.
This accessibility is especially significant in "treatment deserts," where resources are unavailable or hard to find. It’s also particularly important for eating disorders, because early intervention is vital and can increase the chances of recovery.
We also know clients who consistently engage in treatment tend to experience better outcomes, getting better faster and staying well longer. For clients who may feel ambivalent about recovery, a common feature of eating disorders, virtual care provides an approachable entry point. Clients who are medically stable but not ready to commit to 24-hour care in a residential setting often start with virtual treatment, later becoming more open to exploring higher or lower levels of care depending on their individualized needs and severity of symptoms.
The Unique Challenges of ARFID and Binge Eating Disorder Treatment
Eating disorders such as Avoidant/Restrictive Food Intake Disorder (ARFID) and binge eating disorder (BED) have emerged as critical areas of behavioral health that require specialized treatment. ARFID, though less well-known than anorexia or bulimia, can have a profound impact, particularly on children and adolescents. It’s characterized by extreme “picky eating” with an aversion to certain foods, which can lead to nutritional deficiencies. BED, the most common eating disorder, involves cycles of binge eating followed by feelings of shame or guilt, which can be difficult to break without the right support. This eating disorder is often missed by medical providers, and individuals are instead recommended medical interventions such as bariatric surgery or GLP-1s, which do not treat BED, have significant side effects and perpetuate the “thin ideal” that can reinforce eating disorders.
Both ARFID and BED require nuanced, specialized treatment. Virtual care has proven to be an important solution for these disorders, as it allows clients to receive care among peers with the same problem in a format that fits into their daily lives without entering a clinical environment. In Monte Nido’s specialty virtual ARFID Intensive Outpatient Program (IOP), more than half of the 140 clients have shown significant progress in expanding their food variety. Additionally, 92% of these clients achieved adequate nutritional intake levels by the end of their treatment. For individuals with BED, the average length of time they had the condition prior to treatment was 20 years, with 14 years before any intervention at all. These statistics illustrate the immense need for accessible, effective treatment options that reach individuals earlier in their journey.
Monte Nido’s programs are individualized for clients and their families, because we know family support leads to better long-term outcomes. In virtual IOPs, clients engage in treatment personalized to their needs, such as group therapy or family-inclusive care for conditions like ARFID, where family involvement is critical for helping a loved one continue on their path to recovery.
Virtual care also allows clients to connect with peers who share similar challenges in specialized group therapy, creating a sense of community through shared experiences. For instance, one Monte Nido past client stated, “I am so glad I found Monte Nido’s binge eating disorder program. I would not have had the same experience in a program based on the universal treatment model.” Similarly, parents of children with ARFID can find a sense of belonging in virtual groups.
Balancing Virtual and In-Person Care
While virtual care has become a powerful tool, it’s important to recognize that it’s not a one-size-fits-all solution. Just as certain medical procedures can only be performed in clinical settings, some aspects of behavioral healthcare require face-to-face interaction and daily medical or psychiatric monitoring. Individuals with severe or complex conditions often need in-person treatment because virtual is not a suitable or even safe substitution. Monte Nido carefully balances these needs by offering both virtual and in-person care, ensuring each client receives a treatment plan tailored to their unique needs. The flexible approach bridges the gap between intensive treatment and sustained wellness, offering virtual services for Partial Hospitalization Programs and IOPs through secure, HIPAA-compliant platforms.
Driving Positive Outcomes
Recent Monte Nido outcomes have shown there are improvements across in-person and virtual programming using gold-standard assessments that measure the severity of eating disorder symptoms, as well as depression and anxiety. Clients improve on all measures in both in-person and virtual programs, with the EDEQ Global Score, which measures eating disorder symptoms, improving and the PHQ-9 score, which measures depressive symptoms, decreasing. These improvements highlight the effectiveness of less intensive, yet highly structured, treatment programs in facilitating meaningful recovery for all eating disorders.
Not only are these programs effective, but 88% of Monte Nido clients discharging from virtual treatment described their experience as good to excellent, and clients rated their experience with program staff – including clinical directors, primary therapists, dieticians, recovery coaches and their psychiatric and medical providers – as "excellent" on average, underscoring the high-quality care provided through these platforms.
Additionally, virtual programs may offer a more cost-effective solution for clients. For example, Monte Nido’s virtual BED program can be a less expensive alternative to interventions like bariatric surgery or long-term GLP-1 treatments, while more importantly addressing underlying mental health issues that contribute to weight cycling. Similarly, the ARFID program helps prevent hospital readmissions, reducing healthcare costs for families who might otherwise face repeated hospitalizations.
The Future of Behavioral Healthcare
No longer just about offering basic mental health services, the future of behavioral healthcare is about innovation, accessibility and improving outcomes through highly individualized care. By leveraging both virtual and in-person treatment options, we can ensure behavioral healthcare is more effective and accessible than ever before, meeting clients where they are – both physically and emotionally.
With a focus on evidence-based outcomes and a commitment to delivering high-quality individualized care, Monte Nido strives to help clients and their families find the support they need to achieve lasting recovery. We’ve seen positive outcomes throughout our virtual and in-person programs, especially with our BED clients who have improved on all measures and at all levels of care, emphasizing that the right treatment works, and people do not have to suffer in silence. We believe recovery is possible for everybody with the right treatment and support.
Welcome to this week’s installment of the Behavioral Health Career Launchpad. In case you missed it, over the last eight weeks we have covered a number of topics including what roles are available in behavioral health tech, how to evaluate company culture, and how to crush your interviews.
This week we are going to be discussing the rewards and challenges of working in behavioral health tech, and making the case for why the pros outweigh the cons.
Challenges of a Career in Behavioral Health Technology
We are going to start with some of the challenges that you may face while working in the behavioral health technology sector. Now, this section is not meant to scare you! But as we mentioned last week in our interview with Dr. Clare Purvis, entering the behavioral health technology sphere requires a level of pragmatism on what can be changed quickly and what may take a bit more time.
There are a number of challenges you may face while working in behavioral health technology:
Rewards of a Career in Behavioral Health Technology
So now that you are aware of some of the challenges, we want to focus on just a few of the many rewards of a career in the behavioral health technology space.
The list is long, but here are some of the rewards that we wanted to highlight:
Conclusion
If you are passionate about mental health, we cannot recommend a career in behavioral health technology enough! Despite the challenges of working in the space, there are many rewards that greatly outweigh the challenges. We will continually encourage the best and the brightest to seek a career in behavioral health technology as we need lots of minds coming together to solve the biggest problems.
This article is part of our Young Leaders in Behavioral Health series, where we’re highlighting the six impressive young people chosen as our Youth Advisors for the 2024 Behavioral Health Tech Conference. In this article, we spoke with Anika Nayak, Youth Advisor for BHT, and Mitchell Kabenda, behavioral health counselor and computer engineering student, about digital health equity.
Can technology play a role in addressing health disparities? For Anika Nayak and Mitchell Kabenda, who both have impressive education and real-world experience in the crossover between public health and technology, the answer is simple: absolutely. Identify health equity gaps. Solve problems with solutions grounded in technology. And help everyone reach their best possible health.
But in the real world, digital health equity isn’t quite that easy.
“It’s not just about launching new technology,” says Mitchell Kabenda, behavioral health counselor and computer engineering student. “It’s about making sure these tools are affordable, easy to use, and built to serve the unique needs of marginalized communities.”
Data privacy, ethical development, and clinical validation are just a few of the considerations around digital solutions that could help bridge health equity gaps. Below, Mitchell and Anika share their expertise and opinions on technology’s role in health equity advancements and where we go from here.
Anika Nayak, Youth Advisor for BHT, defines health equity as meeting people where they are to make sure they reach their greatest health potential.
“Health equity involves removing any barriers that prevent people from living their healthiest lives,” she explains. Inadequate access to healthcare can have major consequences for patients, per McKinsey — but when everyone has an equal opportunity to achieve their best possible health, individuals and populations can flourish.
“From my experience in the Global Health program at the University of Iowa (‘21), I’ve learned that [health equity] involves tackling the root causes of health disparities, like socioeconomic challenges,” says Mitchell. “For example, lower-income individuals often face barriers to accessing vital resources such as healthcare, nutritious food, and stable housing, which leads to poorer health outcomes. These systemic issues prevent people from maintaining good health, ultimately impacting their quality of life. Health equity aims to address and correct these imbalances.”
There are numerous factors that influence a person’s health. In Mitchell’s work as an inpatient behavioral health counselor, she sees firsthand how healthcare is something that begins long before an individual ever steps foot inside a hospital.
“Issues like food deserts, limited mental health services, and a lack of culturally sensitive communication all play a role in whether someone can live a healthy life.”
Equitable access helps prevent avoidable health issues and improve health and quality of life for everyone.
Digital health equity ensures tech-based health solutions are accessible to everyone, regardless of socioeconomic status. Both technology and innovation come into play to meet the unique care needs of diverse communities. Since many marginalized communities lack internet access or digital literacy, digital health products must be accessible and affordable so underserved communities can benefit.
An article published in Public Health Reports® defines health disparities as a particular type of health difference that is closely linked with economic, social, or environmental disadvantage — in other words, gaps in our progress toward health equity. Mitchell and Anika discuss the following examples of disparities:
It’s also important to note the additional, unseen barriers that exist. According to Anika, stigma remains one of the greatest obstacles to mental health care today “due to the different cultural perceptions about mental illness and wellbeing that exist.” And Mitchell points out other systemic barriers that limit upward mobility.
“Lack of education and job opportunities often result in fewer financial resources. As a result, communities facing these challenges struggle more to access proper healthcare.”
Digital solutions and technologies can play a key role in closing healthcare gaps — especially by improving access to care for underserved communities.
“Digital solutions and technologies can be uniquely tailored to meet the diverse needs of marginalized communities, so they should be encouraged when it comes to mental health care,” says Anika.
What could this look like? “Research shows that telemedicine has been very effective in improving healthcare access for underserved groups, including rural and marginalized communities, especially for mental health services,” Mitchell explains. According to the American Telemedicine Association, places like schools, prisons, and rural hospitals often face barriers to traditional healthcare. Telehealth services can reach where physician practices cannot.
Another example of addressing health disparities with digital solutions could be through mobile apps.
“We can create mental health apps that provide promising interventions 24/7 to youth struggling with their mental health, in a way that is accessible and easy to understand,” Anika suggests.
She also points out that closing the gap in digital access creates enormous potential in advancing economic progress, creating jobs and other opportunities in local communities.
As digital health technologies continue to expand and evolve, the potential for digital health equity solutions grows broader and more exciting. But in Mitchell’s words, all that glitters isn’t gold.
“As someone gaining a deeper understanding of digital health, its opportunities, and its constraints, I believe the most important focus should be developing solutions with long-term sustainability in mind. Yes, technology is attractive, and it’s revolutionizing industries — including healthcare. But without focusing on sustainability, these innovations may not have the lasting impact they’re intended to.”
Anika and Mitchell provide the following pieces of advice to organizations and individuals who are seeking to develop sustainable, effective digital health equity solutions.
Data privacy is a significant concern when it comes to digital health products, services, and solutions. Protecting personal and health information is key to maintaining user trust. Without strong, effective security measures that are clearly communicated, people will be hesitant to use digital health tools.
In this area, creating products for profit isn’t enough. Those products or services must address real healthcare needs. Digital health tools should be created with ethics in mind, ensuring they genuinely help patients without exploiting vulnerable populations.
The best way to make certain you’re meeting patient needs, Anika says, is by simply talking to those patients. “Bring historically disenfranchised voices to the forefront. Make sure you ask people what solutions they want before implementing it into their communities.”
She also encourages companies to prioritize the voices of young people. As the next generation of leaders, Gen Z deserves a seat at the table.
“Many digital health products still lack clinical validation, which raises concerns,” Mitchell says. “It’s essential that these tools are supported by strong research to prove their effectiveness and safety before they’re widely adopted.”
Finally, digital health tools need to be reliable and functional over time — “especially in areas with poor infrastructure, like limited internet or inconsistent electricity,” says Mitchell. If they can’t work in these conditions, they won’t have a lasting impact where needed most.
Digital health holds major potential to help close health equity gaps, especially as it gives more people access to healthcare resources that were once out of reach. This progress is exciting! But leaders like Mitchell and Anika also recognize the importance of solutions that are sustainable, ethical, and backed by research that proves their effectiveness.
“Moving forward, it’s important to consider not just the ethical side, but also the overall impact and effectiveness of these innovations, making sure they truly help the people who need them most,” Mitchell says.
Digital health equity is a marathon, not a sprint. And Mitchell Kabenda and Anika Nayak are at the starting line with their shoes laced up, ready to contribute their valuable knowledge, skills, and expertise to broaden health access for all.
Behavioral health innovation and care is finally having the moment it deserves. Stemming from COVID-Era Momentum, where millions of Americans realized the need for more mental health care, the treatment and management of mental health conditions is on the rise. Yet, we are still in the early innings of what behavioral health access and care delivery can and should look like.
In order to build on this momentum in a post-Covid era, we need to address the key drivers that increase adoption of mental health services for patients and providers alike. This comes from (1) building technology designed specifically for mental health clinicians and (2) embracing strong ecosystem partnerships.
Clinician Burnout is still a real problem
Study after study shows us that behavioral health clinicians continue to cite burnout as the top reason for job dissatisfaction in the field. In the past three years, >50% of mental health clinicians reported a feeling of burnout. Time spent charting and EHR complexity is the top reason driving burnout, as existing technology that wasn’t designed for behavioral healthcare is forcing clinicians to spend too much “pajama time” on their computers. In fact, 75% of clinicians indicating burnout cite their EHR as one of the main sources of that feeling.
Access to behavioral healthcare in the US has increased, but there’s still much more room to grow
Depression rates nearly tripled between 2019 and 2023, jumping from 11% to 32% according to Forbes. Luckily, patient access has improved to partially meet this demand, but there is still a need to improve access. Almost half of patients that need mental health services are receiving them in some capacity, but we need that number to be 100%. We need to continue pressing the case forward for personalized, preventative, and longitudinal care that is tailored to the specific needs of patients, which includes preferred modality of access (e.g., in person vs remote vs a combination thereof).
(source: Kaiser Family Foundation)
Behavioral Health clinicians require their own set of solutions to best service patients
Funding for mental health startups boomed in recent years and potentially reached a hold-steady point of ~$500M/year, per Crunchbase. It’s important that the healthcare ecosystem matches that funding energy with a focus on providing clinicians the tools they need to succeed. Behavioral Health clinicians need specific tools for longitudinal, collaborative, virtual-first care. That includes last-mile solutions specifically designed for them - for example the ability to chart, chat, access patient records and collaborate with team members all on a secure mobile app.
Healthie stands out as one of the few specialized tools for behavioral health clinicians, delivering virtual-first longitudinal care – making it the preferred infrastructure platform amongst digital health innovators including Two Chairs, Brightline, Marker, Brave, Cartwheel, and Plume.
Brightline delivers virtual-first pediatric behavioral health services to children, teens, and families in all 50 states. After outgrowing their original EHR, Brightline leveraged Healthie’s platform and API to build a long-term, scalable solution. Read the full case study.
Healthie emphasizes continuity and consistency in patient management through its virtual-first approach. It provides an integrated suite of tools that support long-term patient engagement and tracking, allowing clinicians to deliver more effective, personalized care. Just a few examples of this include:
On top of that, Healthie is designed with the patient in mind. More than 50% of Healthie’s 6M+ active patients use our mobile app as their primary mode of interaction.
Patients deserve easy access to mental health services through technology. That means keeping design simple and ensuring they can conduct the essential actions with minimal effort. Here are some examples of what that means at Healthie:
Mental health as an industry needs to meet patients where they are. Additionally, reliability and scalability are paramount for care delivery orgs. Healthie recently reached a milestone of securing its 10 millionth appointment booked across our customer base.
In an era when you can order a cab, groceries and book trips on your phone, healthcare is slowly inching towards modernization. But frankly, the tooling has not fully kept up with modern needs - 53% of mental health patients say they want access to online tools, and 40% say they want asynchronous care available 24/7. Healthie is proud to be a bulletproof solution for critical mental health care needs across many specialty areas including ABA Therapy, Families and Children, SMI and more. The mental health industry deserves not just triple-9 uptime, but scalable solutions that are flexible to meet clinician and patient needs.
A single company can’t do it alone. Ultimately, empowering clinicians and patients through technology means embracing a growing ecosystem of partners building for behavioral health organizations.
We are no longer in the age of one company doing it all. As Shopify, Stripe and many other world-class tech companies have shown us, building a partner ecosystem allows care delivery companies to focus on their core competencies and deliver on customer needs. Healthie’s “Harbor” has pre-integrated applications for behavioral health clinicians that enables last-mile personalization of care, picked by clinicians based on how they want to build patient experience. Enabling a seamless experience for patients is part of what drives long-term adherence and ultimate outcomes.
Just some of our behavioral health partners include:
While the promise of AI in healthcare is exciting, the promise of AI in healthcare will materialize in hundreds of ‘micro-applications’ across the EHR environment and into the patient experience. Each one chips away at various clinician and patient experiences to ultimately increase efficiency, predict best practices, and reduce feelings of burnout. At Healthie, we are both building and partnering with incredible companies building AI-driven solutions for clinicians. We firmly believe that the clinician <> patient relationship is here to stay, and AI will certainly help foster the time that providers can spend actually delivering care to patients, and that solutions need to be tailored for the specifics of behavioral healthcare
Our industry is headed towards a supply and demand mismatch in mental health. Stronger technology, bespoke to our vertical, will play a key role here.
While just 4-10% of NP and Mental Health Therapist jobs are fully remote, there’s significant demand for more remote opportunities. Additionally we know there’s a clinician shortage in mental health that’s only going to get worse. For both of these issues, technology is set to play a key role in bridging the gaps and ensuring the industry has what it needs to continue to boom.
About Erica Jain
Erica Jain (LinkedIn) is the Chief Executive Officer & Co-Founder of Healthie, where she builds healthcare infrastructure to power virtual-first healthcare delivery. Healthie is an API-first platform offering EHR, Scheduling, and Patient Engagement solutions for next generation digital health companies. Reach out to us here: info@gethealthie.com
As the behavioral health sector grapples with a workforce crisis, the dire shortage of qualified professionals continues to increase workloads and burnout among existing staff. This shortage not only impacts the quality of care but also exacerbates financial strains as claims denials skyrocket.
At the intersection of workforce and revenue cycle management exists a critical point at which these two areas can work synergistically to address today’s challenges in the behavioral and mental health space.
During a recent live webinar, “Happy Staff, Happy Patients: How to Drive Satisfaction Through Revenue Cycle and Workforce Management,” senior executives discussed the top priorities of healthcare leaders in these areas, how leaders can work cross-functionally to achieve shared goals, and the pivotal role technology plays in empowering patient-centric care experiences and building a more resilient behavioral health system. Here are the key takeaways.
Top priorities for healthcare leaders
The behavioral health sector is facing unprecedented challenges that impact both workforce and financial sustainability. At the heart of these challenges lies a growing demand for services coupled with a shrinking workforce, creating a perfect storm for providers.
Workforce management (WFM) challenges
Revenue cycle management (RCM) challenges
In response to these challenges, Chief Nursing Officers (CNOs) and Chief Financial Officers (CFOs) are aligning their priorities to create more resilient and efficient operations.
Top priorities for CNOs
"I've learned how critical it is to have the right tools in place in order to ensure that you have the right staff in place to take care of your patients. So, any type of tool that can provide visibility, transparency into what's going on is a top priority of mine." – Dr. Michelle Spurlock, System Chief Nursing Officer, Acadia Healthcare
Top priorities for CFOs
"Retention for us is huge because we’re at a point now where we cannot lose people. We need to be pulling people in, not having people walk out the door." – Gordon Dixon, Chief Financial Officer, Smokey Point Behavioral Hospital
Collaborating cross-functionally to achieve shared goals
Cross-functional collaboration is essential to achieving leadership priorities. While WFM and RCM are distinct functions, they are interconnected and can significantly enhance the overall effectiveness of healthcare delivery when aligned properly.
The integration of WFM and RCM is crucial in addressing the challenges faced by behavioral health providers today. By aligning these two areas, organizations can enhance patient-centered care, ensuring that the right staff are available to meet patient needs while managing financial sustainability.
WFM focuses on optimizing staff allocation and ensuring that skilled professionals are scheduled appropriately to handle varying patient acuity levels. Strategic staffing not only improves patient outcomes but also fosters staff satisfaction. Conversely, RCM addresses the financial aspects, streamlining billing processes and reducing claims denials, which are often exacerbated by a lack of or inaccurate data in the revenue cycle process.
Working cross-functionally enables CNOs to collaborate with CFOs to ensure adequate staffing levels and manage labor costs, while CFOs focus on maximizing reimbursements and minimizing denials. This partnership enhances communication across clinical, nursing, and billing teams, ultimately leading to improved operational efficiency and better patient care.
Looking ahead to a resilient future
Healthcare leaders should be optimistic about the future. Leveraging technology to boost efficiency, enhance patient care, and gain more visibility with data-driven insights paves the way for a more resilient and effective behavioral health system. CNOs and CFOs have the opportunity to work together to optimize staffing and resource allocation while maximizing reimbursements and streamlining scheduling and financial processes across their organizations.
Cross-functional collaboration powered by the right tools can build strong teams through transparency, accountability, and genuine appreciation. Leaders can better understand staff needs, balance schedules effectively, and foster a supportive work environment while engaging both staff and patients. The integration of workforce management and revenue cycle management tools can make this happen.
By embracing innovative solutions and prioritizing staff satisfaction alongside financial sustainability, healthcare providers can better meet the growing demand for behavioral health services while delivering high-quality, patient-centered care.
Join us at Empower, Inovalon’s annual data-driven healthcare summit, this October for an in-depth discussion about how strategically leveraging data enhances patient outcomes, streamlines operations, and fosters equitable practices in healthcare.
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For the past 15 years, I’ve seen healthcare professionals discuss how to solve the growing behavioral health crisis. While many have advocated for better quality care to free up access, the prevailing solution has been hiring more behavioral health providers. Increasing access is important, but it was also the go-to and often only solution many health plans pursued during the COVID-19 pandemic, whether that was investing in digital solutions to enable self-care and teletherapy or expanding their behavioral health provider network. Today, we’re reaching a pivotal moment: With all the access health plans have invested in, what’s actually working? Is the access connecting individuals to quality care? How can healthcare leaders create standardized mechanisms to measure behavioral health and answer these questions?
Behavioral health care faces two glaring problems, which contribute to systemic barriers to access and quality care: it remains incredibly siloed from physical health, and as a result, it has not been held to the same standard of data collection and measurement-based care. Unsurprisingly, health plans don’t have the necessary insights to understand who needs behavioral health support and whether the programs and benefits they provide are making a positive impact.
And it’s mission critical that the healthcare industry tackles this data problem because healthcare costs continue to rise. In fact, a recent survey from Business Group on Health predicts costs will reach a 15-year high in 2025. A significant contributor to those costs is untreated behavioral health conditions.
Given rising costs, risk-bearing healthcare organizations (and the employers that pay for their services) want to understand, “How are the programs I’m paying for making a positive impact on my population’s health?” Without behavioral health data, many organizations won’t be able to answer this question. And staffing alone won’t solve the problem. The question health plans must answer is: How can we collect the right population insights to understand risk and whether that risk is being appropriately managed? Healthcare will always face constraints; there simply aren’t unlimited resources to meet demand for services. Having better insight into behavioral health can help plans use those limited resources more effectively and make better decisions. This will unlock greater efficiency, setting up health plans to tackle the access problem and check out-of-control costs.
To right these systemic wrongs, health plans must incentivize universal behavioral health screening across care settings – behavioral and physical. Screening of behavioral health needs population-wide allows organizations to understand who needs support, and it takes the onus off patients to ask for help. Relying on a patient to navigate a complex healthcare system and find the right program allows too many individuals to fall through the cracks. Their symptoms remain untreated until they escalate to a high-cost care setting, like the emergency department.
Critically, patients must receive screenings regularly. Annual depression screenings capture symptoms one day out of the year for a condition that can change significantly across those other 364 days. And these screenings need to actually go somewhere – not on a paper filed away, but integrated into healthcare infrastructure so that providers and payors can act on this behavioral health data appropriately.
Previously, it wasn’t possible to achieve these aims at scale, but technology is empowering healthcare organizations to deliver screenings regularly, remotely, and digitally so that providers or care managers can track individuals’ wellbeing over time and understand how to best support them. Integrating this data into existing care platforms unlocks insights that can help providers intervene early when a patient is showing signs of decline. Instead of utilizing high-cost care, that person can be enrolled in an appropriate program and get the help they need.
Once health plans establish rich data collection, both in physical and behavioral health care, they can begin to invest their resources more effectively to drive the greatest impact. This is particularly critical for health plans who historically haven’t had insight into behavioral health care and its impact on their members. Considering that individuals with behavioral health conditions drive 6X higher medical costs than those who don’t have these conditions, it’s incredibly important that health plans understand which programs are making a meaningful difference on outcomes and lowering costs as a result.
Measurement-based care, delivered at scale, can finally shed light on behavioral health program performance, and arm health plans with the tools they need to appropriately incentivize their provider networks. We’ve seen the transformative power of a tech-driven, measurement-based care approach firsthand with our partner Colorado Access.
Colorado Access is a non-profit health plan serving primarily Medicaid members. It has a robust network of behavioral health providers, but wanted to understand how effective these programs were in driving positive clinical outcomes and ultimately lowering care costs. The health plan provided NeuroFlow’s measurement-based care solution Owl to its behavioral health providers. The solution makes it easy to regularly measure patient symptoms and track progress over time both within and outside of the clinic. If patients' symptoms don’t improve, providers can adjust the treatment plan, or if patients scores indicate remission, they can receive stepped-down care.
Having this data allowed Colorado Access to see that the behavioral health programs that utilized measurement-based care reduced patient symptoms. These providers drove 56% faster time to remission for their patients compared to those who did not engage in measurement-based care. That led to a 30% increase in access because these patients were eligible for discharge or stepped-down care.
As a result of helping patients recover more effectively and efficiently, Colorado Access saw a 63% reduction in ED visits and a 75% reduction in psychiatric admissions. That decrease in utilization translated into a 28% reduction in PMPM costs. With these insights, Colorado Access can more effectively incentivize its provider network to utilize this technology and deliver high-quality and cost-effective care.
We’re entering a new phase of healthcare. After adding significant behavioral health access in the wake of the pandemic, it’s time for health plans to implement standardized ways to measure these programs’ success. Employers are demanding this level of insight. According to that same Business Group on Health survey, one third of employers are planning to renegotiate their contracts in 2025, given rising healthcare costs. Employers said that when they evaluate health plan partnerships, both claims data and data measurement and transparency are top priorities.
We can’t solve for what we can’t see, which is why now is the time to invest in actionable behavioral health data, whether that is in the therapist’s office or in ambulatory care. By incentivizing measurement-based care across their networks, health plans can provide the transparency employers are looking for and leverage these insights to invest their resources more effectively. That will significantly lower costs, which Colorado Access has demonstrated and continues to demonstrate today.
Health plans who fail to adapt to this new phase of behavioral health care risk falling behind their peers and lacking the critical tools they need to justify their programs and make better decisions. Access is important, but access without data and evidence of impact is simply added costs, which the market is no longer willing to bear.
Robert Capobianco has extensive strategic and operational experience with tech startups and large corporate organizations. He has a proven history of developing innovative strategies that drive revenue growth and market leadership resulting in multiple exits through strategic acquisitions - collectively exceeding $200M in acquisition value. Robert has over 25 years of experience in the healthcare technology industry, helping health plans access and activate robust population analytics to build more comprehensive alternative payment solutions that reduce costs and improve outcomes. In his current role, Robert is the Chief Commercial Officer at NeuroFlow. He is responsible for defining and executing NeuroFlow’s long term commercialization and business development strategy.
As you look to pivot into the behavioral health field, assessing the culture of the company you want to join will be essential to your eventual success and wellbeing at work. Every company has a culture, whether or not they have been intentional with its creation. As you recruit within the field of behavioral health, you will need to decide what company culture is the right fit for you.
This blog post will provide you with practical tips to evaluate the workplace culture at your future employer.
What is company culture?
So, what is company culture? Simply put, company culture refers to the behaviors and practices that dictate the experience of working within an organization. Company culture influences how decisions are made, how a company approaches challenges, and how the employees interact with one another. The culture of a company will permeate their day-to-day operations, therefore affecting your day-to-day life.
How do I evaluate company culture?
First, you must decide what really matters to you. This self-reflection should ideally happen before you start recruiting, but it is never too late to define what really matters to you. During this self-reflection, write down the values you want to see in your next company and example traits you can look for. Some examples of these traits could be a collaborative environment, a company that gives you a lot of responsibility, or a solid long-term vision for the company. Remember, no company is going to have it all. You cannot get hung up on searching for a unicorn (unless it is the > $1B in revenue kind). Thoughtfully decide what is most important to you.
Second, pay attention to the details during your interview(s). Interviews are a fantastic way to learn about the culture of the company. Along with the formal dialogue happening during the interview, observe how the interviewer interacts with you. Are they an active listener? Do they respect your time as a candidate? Are they curious about your background? Additionally, most interviewers will leave time at the end to ask questions. Instead of asking: “How would you describe the company culture?” ask something specific. Karshima Sharma Desai, Recruiting Manager at Grow Therapy, suggested: “The best questions are based on research. It is a good sign when candidates are curious and ask astute questions after perusing Grow’s website and social channels or reading our press releases.” Compile a list of company specific questions that probe at the qualities that matter the most to you.
Third, talk to other employees not in your interview panel. Depending on the structure of your interview panel, it may be helpful to talk to someone outside of the team you will be joining. By speaking to someone outside of the immediate interview panel, you can discuss how different teams approach their day-to-day work, or how different teams work together. Please be sure to be respectful of everyone’s time, and understand that some folks may not have the time to speak with you.
On the other side: How do I promote a positive culture?
Whether you are an individual contributor, middle-level manager, or executive at a behavioral health tech company, we all have a role to play in promoting a positive workplace culture. Here are just a couple of ways that you can promote a culture that everyone will want to be a part of:
Conclusion
Evaluating cultural fit at a potential employer is just as important as ensuring that the job description matches your skills. As you look at behavioral tech companies that have noble goals, make sure to take some time to reflect on what the right fit for you will be!
What are some of the most effective digital tools currently available for supporting peer recovery, and how do they compare to traditional methods?
First, thank you for the opportunity to weigh in on this topic! As you’re aware, September is National Recovery Month, and this is a wonderful opportunity to consider how we can enhance the unique and powerful connections forged through shared lived and living experiences of mental health and substance use disorders.
Digital support tools can be a powerful complement to traditional peer recovery methods and can provide enhanced accessibility, personalization, and continuous support, while traditional methods of peer recovery support focus primarily on human connection and face-to-face interactions that remain invaluable for many. In other words, they should augment, not replace, in-person services and pro-social activities.
The most effective approach often involves a combination of both digital and traditional methods tailored to the individual's needs. Over the past 4-5 years, digital tools for supporting peer recovery have become increasingly effective, offering several advantages and augmenting traditional peer recovery connections. These tools include mobile apps, telehealth, video capabilities, online support groups, wearable technology, text-based support, “gamification” and virtual reality. These digital support approaches include real-time and asynchronous support, community forums, mood tracking, and crisis management. Some provide GPS-based sober social networks and instant access to peer support.
What are the main challenges or barriers to implementing digital support solutions in peer recovery programs, and how can they be overcome?
One of the primary challenges for digital support solutions is directly tied to access. Unlike traditional peer support groups, digital support tools, particularly mobile apps, provide 24/7 access and allow individuals to connect with others outside their immediate geographic area. They can also complement in-person meetings by providing ongoing support between sessions. However, for these services to be beneficial, it requires that the person you are trying to support have access to the necessary digital tools and be able to easily use them.
Tracking recovery progress has also historically been challenging. Traditional methods for tracking recovery progress often rely on self-reporting, which can be less accurate than obtaining objective “passive” data. Wearable technologies, for instance, provide objective data that can help individuals monitor their physical and mental health more effectively. Engagement in recovery services, whether these services are provided in a professional treatment context or peer recovery support context has also been challenging. Traditional approaches can sometimes feel repetitive or lack meaningful engagement. Gamification and virtual reality experiences can make recovery more interactive and carry potential appeal to younger demographics. To overcome access challenges, we also need payment models that support the distribution of digital tools, internet connectivity, and community education.
How can companies offering digital support solutions ensure they are accessible and equitable for all individuals in recovery, including those with limited technology access or digital literacy?
Ensuring that digital support solutions are accessible and equitable for all individuals in recovery, including those with limited technology access or digital literacy, requires a multifaceted approach. For instance, providing digital literacy training, including in-app tutorials, can be helpful. This can include the inclusion of step-by-step tutorials within the app that guide users through the key features, helping them become more comfortable with the technology. Offering text message-based support services that do not require smartphones or internet access can also be helpful. SMS texting can be used for reminders, crisis support, and motivational messages. Providing support via voice-activated phone calls for those who may not be comfortable with or have access to text-based or online services. This can include both automated check-ins and human-operated helplines. Simplified app and website designs that are intuitive and easy to navigate and ensuring platforms support screen readers, voice commands, and other accessibility tools to accommodate users with disabilities can help. Providing content and support in multiple languages to cater to diverse populations can include offering translations for the app interface, support materials, and customer service. Along with this, developing culturally sensitive content that resonates with different communities, recognizing that recovery experiences and challenges may vary across cultures. With respect to technological access, companies can collaborate with nonprofits and other tech companies to provide smartphones, tablets, or computers to individuals in recovery who lack access to these devices. Under certain circumstances, offering a mix of digital and in-person services to ensure those who are less comfortable with technology can still receive the support they need. This can include in-person meetings, telephone support, and paper-based resources. Addressing barriers tied to affordability and mistrust with respect to data privacy and security is also important.
Looking ahead, what emerging trends or innovations in digital support do you anticipate will have the greatest impact on peer recovery strategies?
Looking into the future, digital support innovations in the peer recovery space will need to be conscientious of many of the key points previously mentioned, including how these digital support tools improve access to quality and evidence-based interventions that improve overall engagement in recovery. A digital support tool's ability to measure and track progress, along with improved interoperability with provider practice management systems, will also be paramount. Also, AI will continue to evolve along with digital support tools in this space, with the potential for enhancing these solutions in ways that weren’t possible even 3-4 years ago. AI can certainly enhance a digital support tool’s ability to interact with end users in ways that provide a predictive and tailored experience tied to individualized goals. That said, it will be very important to continue monitoring and researching how AI promotes information to the end user in ways that not only provide tailored content but assurance that this content is both accurate and appropriate to the end user's recovery journey. With all of this in mind, patient adoption and utilization of digital tools tend to be most successful when recommended directly by a provider or peer support specialist. Going forward, to complement the evolution of digital support tool innovation, consideration for how these tools will be incorporated into the cost of care will be very important. From that perspective, it will be very important for digital support tools to demonstrate their value, such as improving access and engagement.
As it relates to expanding access to peer support, is there anything on the policy front you're taking note of?
Third Horizon Strategies (THS) has been working diligently to keep on top of policies surrounding how digital support tools maintain data security integrity and how they fit into the behavioral health service array, which includes peer recovery support interventions. For instance, in this reel, our CEO, David Smith, shared a few insights related specifically to new reimbursement codes for the FDA-cleared digital mental health tools in the CY2025 Physician Fee Schedule (PFS). Whether or not policies like this improve the adoption and utilization of digital support tools remains to be seen. Though not directly related to a specific policy, in the context of peer recovery support, there are circumstances in which these tools can be a powerful tool to enhance the peer recovery support service experience. That said, digital support tools will never replace the valuable human connections that are made through meaningful and deep relationships forged from shared experience.
As one of the earliest pioneers in the field, Talkspace revolutionized the way individuals access therapy by offering convenient and affordable virtual counseling services. With Talkspace’s core therapy offerings, members are matched with one of thousands of licensed therapists within days and can engage in live video, audio, or chat sessions, and/or unlimited asynchronous text messaging sessions. Founded upon a mission to provide quality mental health services for all, the company quickly emerged as a leader in leveraging technology to bridge gaps in how mental healthcare is delivered. The impact has been significant as more than 150 million Americans have access to Talkspace through their health insurance plans, employee assistance programs, or as a free benefit through their employer, school, or government agency.
Despite establishing a strong position in the market, Talkspace was facing an increase in competition due rising demand for mental health services and more and more companies attempting to address the growing crisis through technology. Amidst an expanding diversity of clinical solutions, Talkspace was seeking new ways to break through a crowded market, communicate its unique value proposition effectively with key decision makers, and find ways to shorten notoriously long sales cycles in healthcare.
Continuous Thought Leadership & Brand Awareness
Recognizing the need for strategic collaboration to help unlock growth, Talkspace forged an early partnership with Behavioral Health Tech (BHT), the leading community solely committed to expanding access to mental health, substance use, and intellectual/developmental disability (IDD) services through technology, health equity and innovation. The best problem solvers in behavioral health need to be talking to each other, and BHT makes that happen by convening stakeholders across the healthcare ecosystem to facilitate the connections necessary for innovating culturally-sensitive, high-quality behavioral health for all. This partnership with BHT proved instrumental in Talkspace's brand awareness and growth efforts, providing access to a plethora of opportunities to amplify its brand presence and engage with key stakeholders.
BHT's year-round media and branding opportunities combined with their engaged, executive, and rapidly growing audience provided Talkspace with a powerful mechanism for sustaining brand visibility and engagement. “For example, their newsletter is very well thought out,” noted Erin Boyd, Chief Growth Officer at Talkspace. “I look forward to it every week and it helps us stay on top of everything newsworthy in our space.” By sponsoring one of BHT’s monthly webinars, getting mentions in its weekly newsletter, and participating in their various thought leadership engagements, Talkspace ensured that its clinical leaders and brand remained top-of-mind for healthcare decision-makers year-round.
Additionally, BHT's flagship annual conference emerged as a cornerstone of Talkspace's marketing strategy. Renowned for its excellence in content and boundless networking opportunities, the Behavioral Health Tech conference provided an unparalleled opportunity for Talkspace to showcase its offerings and connect in person with both existing customers and leadership at key prospects. “It’s by far one of the best behavioral industry events that I've been to when you combine the wealth of content with the quality of attendees,” said Erin Boyd. “Our presence at the conference allowed us to connect with C-suite and clinical leadership from major insurers, who were all there. We had incredibly helpful conversations with the CEO of a major health plan and with one of the biggest employers in the country. Those meetings wouldn’t have happened elsewhere.” With multiple executive leaders in attendance and speaking at the conference about the company’s strategic plans and roadmap, Talkspace was also able to generate earned media coverage from industry news outlets.
BHT & Talkspace partnership at a glance:
From Relationship Building to Business Growth
The partnership between Talkspace and BHT has evolved into a trusted alliance built on mutual respect and shared goals. Erin Delaney, Associate Director of Events at Talkspace, emphasized the depth of the relationship, stating, "In the few years we've worked with BHT, we have just built such a trusting relationship. It’s just amazing the brand and network they’ve established; they sit at the intersection of so many parts of behavioral healthcare, so working with them helps us be part of that ongoing conversation.”
The mission aligned collaboration between Talkspace and BHT yielded tangible business results, including the generation of lucrative contracts and expanded coverage for millions of lives that now have access to Talkspace’s tools and services. Additionally, the partnership and the connection to other organizations in the BHT network facilitated the launch of Talkspace's groundbreaking Behavioral Health Consortium - an innovative initiative aimed at expanding in-network offerings and enhancing access to specialized care and treatment programs. By sharing helpful industry insights, research, and best practices throughout the year with the BHT community, Talkspace effectively differentiates itself from competitors and solidifies its reputation as an industry leader.
With the rise of telemedicine and increased adoption of electronic health records (EHR) in behavioral healthcare, accurately measuring network adequacy and improving overall access to high-quality care has become crucial for payers. However, there are no established standards for what constitutes a "good" network size. The COVID-19 pandemic accelerated the adoption of telemedicine and a 2022 Alma survey found that 70% of providers wanted to maintain an entirely virtual practice. Traditionally, payers have relied on provider-to-patient ratios and travel distance metrics to gauge specialty provider availability. However, with the shift away from in-person care as the primary option, these metrics may no longer be as useful.
At the same time, the options for EHR tools have significantly increased and many platforms now offer tools like online scheduling that make it easier for clients to schedule sessions with providers in real-time. This scheduling data provides granular insight into the number of clients who can access the care they need, offering more detailed information than ever before. Considering these changes in recent years, there is an opportunity to redefine how the industry assesses network adequacy in a way that accurately reflects modern behavioral healthcare delivery. This data is critical because it drives strategic decisions for network growth, helps ensure client needs are met, and confirms compliance with regulatory requirements for access.
Keeping the industry shifts we’ve seen in mind, Alma sees an opportunity to adopt a new framework for evaluating network adequacy that could help payers improve client access to behavioral health care. This framework involves three key pillars for measuring client outcomes:
Behavioral health care is highly personalized and there is no one-size-fits-all approach. A large part of high-quality mental health care delivery is supporting clients in finding the right provider at the right time.
By measuring metrics such as days to care, provider availability, and appointments per covered life, this proposed framework ensures that clients have timely access to the care they need, reducing wait times and improving appointment availability. Advanced search tools and data on provider-patient fit help match clients with providers trained to offer the specific type of care they’re seeking, enhancing the effectiveness of care and client satisfaction. Additionally, incorporating data on clinical outcomes, such as improvements in PHQ-9 and GAD-7 scores, allows for continuous assessment of care quality and progress, ensuring that client needs are addressed.
With a renewed focus on mental health parity, the framework promotes equal access to care by shifting the focus from geographic location to appointment availability, ensuring all clients have access to necessary mental health services regardless of location. The emphasis on personalized provider matching and outcome-based measurements ensures that mental health services are delivered in a manner that meets the same standards of quality and accountability as other types of healthcare. By providing detailed data on client needs, preferences, and outcomes, the framework supports informed strategic decisions for network growth and ensures compliance with mental health parity laws, fostering a more equitable and efficient mental health care system.
I would suggest that payers utilize the data they already have access to and collaborate with their provider partners to leverage that data for building and informing future networks.
Payers have thousands of clients who visit their directories and other digital experiences searching for care. This is an important part of the process and, when combined with the data that technology-enabled providers have and their clinical expertise, payers will be able to assess the true demands for care across different markets. They will also be able to demonstrate where they’re adequately addressing the needs of the market, and more efficiently close gaps in their networks, improving the experience of accessing care for clients.
Behavioral healthcare is having a supply crisis. As of 2023, more than half of the U.S. population resides in a Mental Health Professional Shortage Area. The scarcity of qualified professionals severely undermines patients’ ability to receive treatment when needed because of longer wait times and reduced access to care, potentially worsening mental health outcomes. Rural areas are more likely to lack psychiatric mental health nurse practitioners, psychologists, social workers, and counselors, intensifying the problems with access to behavioral health services.
For healthcare organizations, the healthcare staffing shortage has led to increased workloads, provider burnout, and challenges in meeting the demand for mental health services. With the need for behavioral healthcare rising, addressing the workforce shortage has become an urgent priority for healthcare systems nationwide.
While the healthcare workforce shortage has been a longstanding issue, the COVID-19 pandemic significantly exacerbated the problem, resulting in an ever-widening gap between the supply of providers and the growing demand for mental health services.
From 2019 to 2023, the number of Americans living in areas designated as Mental Health Professional Shortage Areas skyrocketed from about 118 million to 169 million. During the same time, mental health claims rose 83%. And a 2023 survey of psychologists revealed some concerning trends:
The scarcity of services and increasing demand negatively impact both providers and patients. For healthcare organizations, increased workloads are straining an already stretched workforce, leading to increased burnout and attrition among behavioral health providers. This situation further exacerbates the dilemma in meeting growing demand. The shortage has placed additional pressure on primary care providers, who increasingly find themselves on the front lines of mental healthcare delivery despite often lacking specialized training in this area. An increased reliance on emergency departments and law enforcement for mental health crises places additional strain on these systems and often results in suboptimal care for individuals in need of specialized mental health support.
For patients, the provider shortage means reduced access to care and longer wait times, particularly in rural and underserved areas. Many healthcare providers have had to extend wait times for behavioral health services, with the average wait for a new patient reaching three months or more in 2023. The inability to receive timely and appropriate mental healthcare may lead to the escalation of mild symptoms into more severe mental illnesses, potentially resulting in poorer outcomes.
With the prolonged shortage only expected to get worse – the Health Resources and Services Administration (HRSA) estimates that by 2036, there will be significant shortfalls across various behavioral health professions – healthcare organizations must take an empowerment approach to healthcare staffing. This means that the most effective way for provider organizations to bridge the gap now and into the future is to support behavioral health professionals through a staffing initiative that empowers them to deliver patient-centric care and prevents burnout. This technology-driven approach should allow for open communication and inclusive decision-making by incorporating the following three elements:
Healthcare staffing is notorious for its complexity, but it doesn't need to be. A modern, mobile-friendly staff scheduling tool can centralize all workforce management data, providing real-time visibility into staff schedules across the organization. This streamlined approach ensures everyone is on the same page and reduces open shifts, miscommunication, and scheduling conflicts. With an advanced analytics solution that offers data insights into staffing patterns, utilization rates, and patient-to-staff ratios, management can make informed decisions to optimize labor resources, ensuring that patient care is not compromised and staff is not overburdened.
The freedom to choose preferred shifts leads to higher job satisfaction and engagement, which can greatly reduce burnout among healthcare staff. For healthcare organizations, flexible scheduling is a powerful staff retention tool that can also lead to cost savings, improved patient care, and increased productivity. Cloud-based workforce solutions enable management and staff to enjoy mobile app access, manage shifts collaboratively, communicate instantly about open shifts, and further streamline scheduling with predictive analytics.
A sense of ownership is core to effective healthcare staffing because it fosters trust among staff members and management and helps build stronger teams. Healthcare scheduling technology enhances oversight by allowing managers to monitor overtime, track credentials, and ensure that staff meet work commitments. For example, an advanced workforce analytics solution can provide a comprehensive dashboard of shifts and hours worked, making it easy to hold staff accountable for their attendance and punctuality and determine the right level and mix of staff while minimizing overtime.
Healthcare scheduling tools are vital for achieving appropriate staffing of behavioral health providers, especially in the face of worker shortages and increasing demand. By providing transparency, flexibility, and accountability, these tools help healthcare organizations optimize staffing, fill open shifts, reduce burnout, and improve retention. This empowerment approach will ultimately lead to happy staff and happy patients – a feasible goal for every organization.
Inovalon helps providers achieve equity in staff scheduling to strengthen engagement, retention, and satisfaction. The Inovalon ONE® Platform powers SaaS solutions that prevent burnout and turnover, providing financial benefit, and improving the patient experience.
For more information on solutions that can help your organization meet its staffing challenges more effectively, contact us today or visit our website.
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We created NOCD because we deeply understand the struggles and needs of the obsessive-compulsive disorder (OCD) community. Being a team of people living with OCD, advocating for the OCD community, or professionally treating OCD, we experienced firsthand the frustration of trying to navigate a broken healthcare system and decided to do something about it. NOCD Therapy was born as a result.
Our team’s passion fuels our large, continuous investment in delivering a world-class OCD treatment experience. Instead of taking an increasingly hands-off approach to growing and managing our OCD-specialty therapist network as we’ve scaled—like many virtual therapy companies do—we’ve done the opposite. We’ve invested more in training each NOCD Therapist, building the technology needed to support them and the members they serve, and establishing nuanced processes to hold our team accountable to a “VIP-only” treatment experience. It’s the recipe that powers NOCD Therapy to drive significant reductions in OCD symptoms and dramatically improve quality of life.
In our pursuit of greater transparency within the healthcare system, we’d like to offer complete visibility into our intentional processes for training NOCD Therapists, developing state-of-the-art technology, and holding ourselves accountable. And to go one step further, we’d also like to disclose our ongoing efforts to make the NOCD Therapy experience even better in the future.
All therapists must go through graduate-level training to practice; however, to effectively treat people with a chronic, severe condition that requires a specialized approach, like OCD, significant additional training is necessary. This training can be delivered in a variety of settings, but shockingly, many therapists who claim specialization in OCD have no formal training outside of what they’ve learned in graduate school or during a weekend workshop.
In fact, only a select number of therapists receive comprehensive training to treat OCD, and even fewer receive it from globally-recognized OCD experts. This is due to the expense—it can cost tens of thousands of dollars per therapist to receive comprehensive OCD-specialty training, as it requires therapists to dedicate weeks to learning exposure and response prevention (ERP), the gold-standard therapy for OCD, and employing top OCD experts to teach professional clinicians. Without specialty reimbursement for OCD-specific therapy services, many providers historically haven’t found the incentive to invest in such training, causing a mass shortage of quality OCD specialists over the years.
NOCD has stepped up to fill this void, since many people—1 in 40 globally—need it to be done, including many on our own team. We heavily invested in developing an elite program that would train each of our therapists, rather than require them to find and fund less extensive external programs, and have deeply trained thousands of therapists to specialize in OCD over the years to help people globally. The quality of our training model, led by Patrick McGrath, Ph.D., has become noteworthy, and it entails 4 phases: interviewing, training, evaluation, and continuous training for skill mastery. Here’s a deeper look:
To be hired by NOCD and begin training to join the NOCD Network, therapists are required to pass a stringent interview process, conducted by both a NOCD hiring manager and NOCD clinical interviewer. Their qualifications, along with alignment with NOCD Therapist attributes—being empathetic to help people feel understood during challenging times, actively listening to provide the most personalized experience, and devoting our full attention to maintaining the satisfaction of our members—serve as the foundation on which we build our therapists’ expertise in OCD. During each interview, one of our leading clinicians will evaluate whether a therapist is qualified to become a NOCD Therapist and will assess their ability to provide specialty care to people with OCD. If they appear to hold any biases against the OCD population, specific intrusive thoughts, or ERP treatment, we will respectfully part ways.
Further, after a clinical interview is conducted and before an offer is extended, a clinical leader at NOCD, assisted by artificial intelligence (AI), will retrospectively evaluate the interview as a “peer auditor.” This is done to ensure that only the top therapists are joining the NOCD Network. Only after the therapist passes the audits will NOCD extend an offer to the therapist.
Shortly after accepting an offer to join NOCD, the budding NOCD Therapist will begin onboarding by embarking on a 3-month intensive training journey to learn how to properly treat people with OCD. It starts with two weeks of small-group lectures. The training curriculum for NOCD Therapists is extensive, and it was meticulously created by NOCD’s clinical leadership team.
Here’s a breakdown of the lecture curriculum:
NOCD has set a new standard for how clinics should begin training therapists in OCD before seeing people with the condition.
After completing the initial training, to officially start treating NOCD’s community of members with OCD and related conditions, each NOCD Therapist must demonstrate retention of the recently learned material and pass multiple exams through the Clinical Advising Meetings (CAMs) process. This is to ensure that therapists are well-prepared to deliver high-quality care to individuals with OCD and related conditions.
As part of the CAMs preparation process, NOCD Therapists can work with fellow staff in practice, conduct one-on-one mock sessions, and watch guest lectures from OCD experts about specific OCD treatment topics. Therapists also can observe and learn from other experienced therapists from our network, asking questions to them directly within NOCD’s therapist community.
When it’s time to take their CAMs, prospective NOCD Therapists will do mock sessions with NOCD’s clinical leadership team and be asked specific questions that cover a variety of topics, from treating OCD to managing the virtual therapy process. If they pass our CAMs, therapists will be able to work with members from NOCD’s community, assuming they pass our due diligence–a NOCD process accredited by the National Committee for Quality Assurance (NCQA). If not, therapists will be asked to either exit the process or start it over.
The CAMS process takes our therapists months to complete, and it’s because our bar for offering quality care is incredibly high at NOCD. Those who suffer the most need the best treatment.
By the time our therapists pass the CAMs and begin seeing NOCD community members, they’ve spent hundreds of hours learning to treat OCD across a 3-month timeframe, in addition to the training they’ve received to earn their clinical degree. This robust OCD training is, in fact, just the beginning of their learning process at NOCD. As therapists progress through work at NOCD, they continue to engage in professional development activities designed to deepen their clinical excellence.
Here’s how NOCD Therapists are supported in maintaining their clinical skills and developing professionally:
Our goal is for therapists to advance and have a long-term career at NOCD, and we strive to make each year full of growth and meaningful impact.
The same passion that fuels NOCD to train therapists drives our team to create world-class technology that better connects them to our community members. From our team’s personal experiences with ERP therapy, we realized that we saw a therapist for one session per week but spent the rest of our time alone, often suffering. It became increasingly clear that a standard, face–to–face therapy model doesn’t fit a chronic condition like OCD, since a therapist likely isn’t available when OCD strikes unexpectedly.
Therefore, a better clinical model was needed, and it became abundantly clear that it needed to be tech-enabled. The NOCD platform was born from this inspiration. The platform combines the NOCD App for members with the NOTO Portal for therapists, and they’re integrated into one backend system: the NOTO Engine.
The NOCD App was the first product rolled out from NOCD in 2016. It was originally built to help OCD-specialist therapists support people with OCD between therapy sessions, giving their patients access to self-help tools, progress reports, and peer communities. But, since most people with OCD weren’t able to access a licensed therapist with specialty training in OCD, as time progressed, NOCD built the NOCD Network and gave community members the functionality to do therapy with a provider within the app. The creation was coined NOCD Therapy, and it created a “one-stop shop” for OCD treatment: live, face-to-face virtual therapy sessions with a therapist from NOCD’s Network who specializes in ERP, as well as support between sessions from the app’s self-help tools, peer community, and progress-reporting functionality.
As NOCD Therapy scaled due to its effectiveness, the NOCD App’s capabilities only grew to support the treatment process. For instance, custom therapy exercises were developed, sub-communities were created in the feed, messaging functionality was offered to asynchronously connect with therapists, spaces were developed to join live support groups, journaling functionality was created to help members reflect, and more. Before NOCD Therapy, these key components of the treatment process used to exist on paper or in formats that were often otherwise inaccessible outside of therapy sessions.
NOCD Therapy’s growth on the NOCD App spotlighted that our therapists needed support between therapy sessions, too—but unlike members who needed care for OCD, our therapists needed clear operational processes and the removal of administrative burden. Treating OCD with ERP therapy often takes more time, energy, and creativity than general therapy, so having the technology to streamline operational processes and reduce administrative overhead is a must. We made this realization after trying off-the-shelf Electronic Medical Record (EMR) systems for our network that didn’t work, and the NOTO Portal for therapists was born shortly after.
The NOTO Portal is a web and mobile app that exclusively supports NOCD Therapists in offering care to NOCD Therapy members. Inside the NOTO portal, NOCD Therapists can do face-to-face sessions with our network, concurrently take notes, administer assessments, message members and their families between sessions, view data to help understand treatment progress, and more. In addition, it helps our therapists communicate with our clinical leadership team, who can support them in ensuring quality treatment.
The name NOTO originates from the Latin word meaning “to know,” and when it’s split in two, the phrase “No To” appears. For reference, NOCD’s name originates from the dual-meaning concept “say no to the compulsive disorder” and “know about OCD.”
The NOTO Portal for therapists stands out for its ease of use and adaptability to therapists’ needs, qualities made possible by the expertise of the team that developed it: people who’ve scaled some of the leading electronic medical record companies, designed some of the most friendly interfaces in healthcare IT, and built some of the top enterprise platforms.
Our product team can foster a connected experience for both therapists and members because of the backend system that NOCD built to bridge the two platforms together, called the NOTO Engine. The name originates from the Latin word meaning “to know,” and when it’s split in two, visually the phrase “No To” appears. For reference, NOCD’s name originates from the dual-meaning concept “say no to the compulsive disorder” and “know about OCD.”
The NOTO Engine supports NOCD in a similar way a tree’s trunk supports its branches. A tree trunk is responsible for not only holding the tree sturdily upright, but also for transporting vital nutrients to each part of it. The NOTO Engine works the same way: It supports each platform NOCD offers externally to members and therapists, as well as internally to specific NOCD teams, by ensuring that information gets effectively transported to them. Without the NOTO Engine, the NOCD Therapy experience wouldn’t exist today, and NOCD would likely not have had the ability to scale to this point.
The NOTO Engine is powering the future of NOCD Therapy. It’s giving our team a unique ability to use advancements in data science to better support our therapists—offering improved ways to bill insurance companies and message members—and better care for our members, allowing them to receive guidance in the moment of an OCD episode, delivering content to effectively answer the OCD community’s most pressing questions, and connecting them with specific therapists who are an ideal match. By using technology to invest in serving the OCD community in more scalable and personalized ways, NOCD will be able to expend more resources on serving those in vulnerable and underserved populations, ensuring we can help more people suffering from OCD without financial barriers preventing them from accessing much-needed care.
The NOTO Engine was developed at our inception as a response to the frustration stemming from disjointed collaboration, where we felt the “right hand was not talking to the left.” This often resulted in us providing our members with only a “good” or “satisfactory”—but not “elite”—experience. We refused to accept this, as we hold ourselves to a higher standard. We’re still not perfect today, but we’ve been able to make substantial improvements in our operational proficiency and enhance the member experience while scaling—a rare feat, thanks in part to our strategic investments in our NOTO Engine.
The impetus for these investments stems from our team’s cultural values, particularly our commitment to accountability, defined by our core value of “extreme ownership.” We care deeply about the OCD treatment experience because of our personal experiences and backgrounds, which started with my own experience. I confronted many of the same challenges commonly faced by individuals with OCD when seeking an accurate diagnosis and effective OCD treatment. My experience of grappling with misdiagnosis, experiencing worsened symptoms from unspecialized treatment approaches, struggling to access a qualified and trained OCD specialist, and maintaining progress once I got better fueled the creation of NOCD. Several other members of the NOCD team share similar backgrounds, with many having undergone NOCD Therapy or providing support to those who have.
Based on these firsthand experiences, we know how important it is for the OCD community to feel confident in truly knowing what they can expect from therapy. Additionally, they must trust that their treatment progress will consistently meet the highest standards. By allowing the OCD community to openly hold NOCD accountable, we can continually learn and refine our approach to deliver an experience that both NOCD Members genuinely love, not just like.
Here are several ways we’ve adopted radical transparency to live by our value of “extreme ownership”:
Members can post unfiltered feedback on the NOCD website and in the NOCD App
Every member has multiple opportunities to share their honest review of their NOCD Therapy experience, and all reviews are posted directly on our website exactly as we receive them, unedited and unfiltered. We chose this standard of transparency because we see it as our responsibility to the OCD community—we earn the privilege to serve people with OCD and related conditions by ensuring they receive the utmost quality of care. Additionally, this transparency is for future members, who can confidently rely on the unaltered stories of their peers to gauge the quality of our services.
This commitment is not limited to a single point in time. We ask our members to provide feedback through quick rating prompts after each session with their therapist so we can catch any issues as soon as possible. While we can’t guarantee perfection, we can guarantee that we’ll strive to catch issues quickly and work to solve them immediately. Constantly auditing our process for opportunities to improve is an essential part of our commitment to providing the OCD community with world-class care.
We invested in building a Member Advocate team to problem-solve and advocate on behalf of our Members
Our goal is not just to gather feedback, but also to promptly address it—particularly when it concerns the active and ongoing therapy experience. Recognizing the need for personalized support and a champion for our members’ care, we built the Member Advocate team as part of our treatment service to troubleshoot any emerging issues.
Our Member Advocates are peers in the OCD community who are trained to deliver support to NOCD Therapy members, due to their profound understanding of OCD and related conditions—with many drawing from personal experience with OCD—as well as their familiarity with the NOCD Therapy journey. Member Advocates are to NOCD Therapy members as agents are to professional athletes or artists.
Member Advocates establish rapport with our members and maintain regular check-ins throughout their treatment. They play a crucial role in providing ongoing support, resolving challenges, and enhancing the overall treatment journey. Their approach is tailored to meet each individual’s needs, demonstrating a sense of urgency to ensure swift and effective resolution when issues do arise.
Additionally, following each therapy session, members are encouraged to share their honest thoughts in a survey. Upon receiving this feedback, our team of Member Advocates steps in to promptly address any concerns. In the event that a member is not completely satisfied with their NOCD Therapist, our Member Advocates can proactively assist members in finding a better match, ensuring their treatment journey gets back on track. Even once the member has the right therapist match, we continue to encourage honest feedback after each subsequent therapy session.
This VIP level of service coupled with the personalized support approach we provide and state-of-the-art technology ensures a smooth treatment experience and demonstrates our dedication to delivering exceptional care for every NOCD Therapy Member.
Therapists are encouraged to post their thoughts about working at NOCD
Our commitment to accountability extends beyond member feedback; we greatly value therapist perspectives as well. That’s why we also prioritize cultivating an open and collaborative feedback culture among our therapists. We actively encourage our therapists to provide honest feedback through various channels, whether publicly, privately, or anonymously, in the following ways:
Through these initiatives with our therapists, we aim to cultivate an environment where feedback is not only welcomed but actively sought after, contributing to our ongoing growth and improvement.
We take on risk-based contracts with health plans
Our commitment to accountability is also evident through our engagement in risk-based contracts with some health plans. Unlike the traditional model where providers are paid per session, this approach is centered on the value of the care we provide. Our primary goal is to help our members reclaim their lives as quickly as possible, and in situations where this objective is not met, we willingly bear the associated costs—meaning the highest standard of care is imperative for us to be able to exist to help others. We are so confident that we can deliver better care for our members that we are eager to work with health plans through risk-based models to get people the treatment that they need.
In other words, NOCD Therapy prioritizes meaningful outcomes, so we are focused on helping members achieve life-changing results. The emphasis we place on value over volume ultimately means members get better as quickly as possible and stay better for as long as possible.
We submit our data for peer review, so other providers can confirm NOCD Therapy’s clinical efficacy
Our dedication to further delivering clinical excellence is fueled by the impact we’ve seen so far. People with OCD who enroll in NOCD Therapy not only experience significant reductions in OCD severity, but they also experience substantial reductions in the severity of comorbidities—conditions that often result from OCD going untreated. These outcomes are seen across all OCD subtypes.
We submit our outcomes-papers for peer-review, though, to ensure they’re independently and anonymously validated by providers without connection to NOCD. For example, one of our peer-reviewed studies, the largest OCD treatment study to date, showcased NOCD Therapy’s clinical efficacy across thousands of people with OCD. We have more studies coming soon.
The data speaks for itself, but perhaps the evidence that we still value most is the thousands of heartfelt therapy reviews written by our members every day. Seeing that we’ve been able to provide the OCD community with the experience they’ve been asking for—one of comfort, trust, and deep understanding—is profoundly meaningful to us.
As we look back at the work we’ve done over the past decade, we see evidence that we are making progress. Unlike how things were before we started NOCD, someone seeking OCD treatment today can easily read articles to learn about commonly misunderstood OCD symptoms they might be experiencing, book a free call on our website, speak with an empathetic, informed team member who can answer their questions and match them with a specialty-trained OCD therapist who accepts their insurance, schedule a first therapy session, and begin working with a NOCD Therapist to help them begin conquering OCD—usually within a week.
Someone tentatively seeking care can scroll through the thousands of reviews that NOCD Therapy members have shared on our website, engage in the NOCD App’s peer feed or self-help tools, read peer-reviewed studies documenting NOCD’s clinical outcomes, and browse the personal profiles of hundreds of NOCD Therapists. They can watch videos of our therapists, read about them as people, and learn about what inspired them to dedicate their work to the OCD community. Most of our therapists come to us with a passion for ERP therapy and treatment for OCD-related conditions, while even some have shared a personal experience with OCD. We respect their personal commitment to excellence and to helping members build the skills it takes to manage OCD as a chronic condition long-term.
All of this exists today because we focused on rebuilding the entire treatment experience for people with OCD. We are still focused because more can be done.
Here’s how our team is using the foundation we’ve laid over the past decade as a springboard to accelerate progress even more in the future:
We have ambitious plans ahead. Our vision to end global suffering caused by OCD is not far from reality. Frankly, I’d bet it’ll happen in the next decade or so. There is only reason for hope! If you or a loved one has OCD or needs help, please don’t hesitate to book a free 15-minute call with our team. You are also welcome to contact me directly at stephen@nocdhelp.com. We’re always here for you, and it is our goal and our privilege to help you in any way we can.
If you are interested in working as a therapist at NOCD, our team would love to hear from you, too. Candidates can visit our website to learn more about joining us to make an impact. We are also always open to coordinating care with like-minded organizations who would like to collaborate with us on the full spectrum of care for members. We have created tools and resources that we are happy to provide free of charge to support screening in any provider’s office. To learn more, please reach out to our Chief Clinical Officer, Dr. Patrick McGrath, at drmcgrath@nocdhelp.com.
Maternal mental health is a critical but often overlooked aspect of reproductive healthcare. The journey to motherhood is beautiful, transformative, and sometimes overwhelming. While many mothers experience joy and fulfillment, others grapple with the challenges of mental health issues such as postpartum depression, anxiety, and mood disorders. In recent years, the spotlight has shifted towards addressing these issues, but the demand for maternal mental health support far outweighs the available resources.
Traditional approaches to mental healthcare rely heavily on face-to-face interactions with mental health professionals. However, the time and resources required to develop and expand this workforce to meet the growing demand for maternal mental health support are considerable. Unfortunately, these traditional methods are simply too slow to address the immediate needs of mothers in distress. Thankfully, there's a beacon of hope on the horizon: innovation in digital health.
At a critical time when maternal mental health outcomes are lagging and gaps in care loom large for underserved communities, a plethora of maternal mental health startups are springing to life.
“40% of Seven Starling patients haven’t had therapy before receiving mental health services through Seven Starling,” states Tina Keshani, Founder and CEO of maternal mental health startup Seven Starling. “Our tech-enabled and specialized approach allows us to break down existing barriers to care and drive access to the 85% who are diagnosed but never get treated.”
The intersection of technology and healthcare presents an incredible opportunity to revolutionize maternal mental health support. Digital health solutions, including teletherapy platforms, mobile applications, and remote monitoring tools, have the potential to bridge the gap between supply and demand. These innovative solutions offer convenience, accessibility, and privacy, allowing mothers to access support whenever and wherever they need it.
One of the most significant advantages of digital health in maternal mental health is its scalability. Unlike traditional face-to-face therapy, digital solutions can reach a broader audience and provide support to mothers in remote or underserved areas. This scalability is essential for addressing the vast unmet need for maternal mental health support.
Canopie is taking a population-based approach to maternal mental health, working with health plans and integrated delivery networks to engage expectant mothers in their 2nd trimester, regardless of risk level or diagnosis. "The support we offer through our digital platform and virtual services are designed to be delivered to entire perinatal populations preventatively. To date, we have served over 15,000 expecting and new mothers through our platform, and in collaboration with our health plan partners, connected at-risk mothers to additional services - including behavioral health support and case management. We have found our platform reaches - and impacts - mothers with increased social determinants of health risk factors" states Anne Wanlund, Co-Founder and CEO of Canopie.
Furthermore, digital health technologies can empower mothers to take an active role in managing their mental health. Mobile applications that offer self-help resources, mood tracking features, and peer support networks can complement traditional therapy and provide ongoing support between sessions. By equipping mothers with the tools they need to navigate their mental health journey, digital health can promote autonomy and resilience.
However, innovation in maternal mental health extends beyond technology alone. The power of collaborative care models cannot be overstated. Collaborative care brings together a multidisciplinary team of healthcare professionals, including obstetricians, pediatricians, nurses, social workers, and mental health specialists, to provide comprehensive and coordinated care to mothers and their families.
Just last week, maternal mental health startup FamilyWell Health raised $4.3M from .406 Ventures, GreyMatter Capital, Mother Ventures and others. Jessica Gaulton, MD, MPH, Founder and CEO of FamilyWell Health, explained how the company is training coaches to expand the workforce: "At FamilyWell, our perinatal collaborative care model is coach-driven, and we are finding that many of our clients are achieving remission from perinatal depression and anxiety in as few as 4-6 sessions with a certified perinatal behavioral health coach."
In the context of maternal mental health, collaborative care models promote early identification, intervention, and ongoing support for mothers at risk of or experiencing mental health challenges. By integrating mental health services into routine prenatal and postpartum care, collaborative care models can reduce stigma, increase access to care, and improve outcomes for mothers and their children.
In conclusion, the opportunity for innovation and digital health in maternal mental health is vast and promising. As we strive to meet the immediate needs of mothers in distress, we must embrace technology and collaborative care models as critical components of comprehensive maternal mental health support. By harnessing the power of innovation, we can ensure that every mother receives the support and care she deserves on her journey to motherhood.
Join us for 2024 Maternal Mental Health FORUM virtually on Tuesday, Mar 19, 2024 1:00pm-1:40pm PT with Solome Tibebu of Behavioral Health Tech, Tina Keshani of Seven Starling, Jessica Gaulton, MD, MPH of FamilyWell Health and Anne Wanlund of Canopie as we dive deeper into this discussion!
Article written by Joy Burkhard, Executive Director & CEO of Policy Center for Maternal Mental Health, and Solome Tibebu, Founder & CEO of Behavioral Health Tech.
I don’t think many realize that, often, the people caring for older adults are older adults themselves. In fact, 19% of caregivers in the U.S. are over the age of 65. And that demographic will only continue to grow as our older population rises, lifespans increase, and more and more people choose to age at home.
Many of these individuals – 15.7 million adult family caregivers in total – care for an individual with dementia or Alzheimer’s Disease. People like Dale, who, at the age of 82, is his wife, Joan’s, primary caregiver. Since Joan developed dementia around five years ago, Dale has barely left her side. He wouldn’t want to be anywhere else, but at the same time, he admits it can be burdensome to be a 24/7 caregiver without much freedom.
Unpaid family caregivers in general face increased risk of physical and mental health problems, as well as a higher risk for mortality. And while caregivers aged 66-96 who experience caregiving-related stress have a 63% higher mortality rate than their peers who are not caregivers, dementia caregivers were even more likely than caregivers of other older people to say that caregiving made their health worse.
It’s a no-brainer that Medicare Advantage health plans have a greater incentive to provide solutions and resources that can help their members – those who receive unpaid family care and those who provide it – to live fuller, healthier lives.
Well the issue got a push in April 2023 when the Biden Administration issued an Executive Order calling for increased support for family caregivers. In particular, the order called on the Department of Health & Human Services (HHS) to consider a new dementia care model that would include respite for family caregivers and make it easier to access Medicare beneficiary information. A few months later, CMS announced a new nationwide model to do just that – the Guiding an Improved Dementia Experience (GUIDE) Model, which will launch this July and include provisions for caregiving training, support, and respite services.
Recognizing that the challenges associated with caregiving are not just tied to age, but also race, economic status, and other social factors, the model incorporates policies to enhance health equity by ensuring that underserved communities have equal access to support. This includes a focus on low-income older adults, who are dually eligible for both Medicare and Medicaid.
At Papa, we’ve witnessed the higher need for support among dual-eligible members as well as those living in communities of color. In fact, we see two times higher utilization among those dually eligible compared to traditional Medicare Advantage members, while participants living in communities of color use Papa resources 25% more than those not residing in communities of color.
We applaud CMS for its continued push to advance health equity via this measure and the many others outlined in its Framework for Health Equity, as well as the agency’s efforts to expand support for caregivers and their loved ones.
The idea for Papa actually came, in part, from a need to provide respite to our founder’s grandmother, as she cared for Andrew’s grandfather, “Papa,” who was in the early stages of dementia. Andrew founded Papa because the support he and his family needed didn’t seem to exist. His grandfather didn’t need help with bathing nor toileting – what he needed was a Pal – someone to spend time with him, drive him to appointments, and provide relief for his wife and other family members.
So Papa was founded to fill this gap. A Pal to your front door when and how you need it most. Health care that doesn’t feel like health care – it feels like family.
Caregiving takes so many forms and it can look a little different everyday. Some days a caregiver may want help picking up and preparing a meal, other days they may need someone to take their loved one to an appointment and stop at the pharmacy on the way home, and another day it may be most helpful to just have someone they trust stay at home with their family member so they can go out on their own for a bit.
That’s why we believe flexible, trusted, human help at home is needed to support caregivers in the ways they want and need to be supported.
Take Dale, who I mentioned earlier. Papa Pal Yvonne comes over every Thursday morning, putting a big grin on Joan’s face – and Dale’s, too. Dale gets to feel like he’s not “dumping [Joan] off on someone” and uses the opportunity to go grocery shopping, run errands, and enjoy some much-needed independence.
Yvonne told us she can see the tiredness in Dale’s face sometimes. Some nights, Joan doesn’t sleep, which means Dale doesn’t sleep either. Getting that brief time alone on Thursday mornings helps him recuperate and recharge. And when he gets back, he and Yvonne take a little time to chat, too.
Yvonne has become a critical member of this caregiving team. “She’ll notice there’s something that needs to be done—small things, like the floors need to be swept—and she just does it,” Dale says. “I really appreciate that.” They make a good team, supporting each other as they support Joan.
Papa Pals like Yvonne have completed more than 2.2 million visits across over 7,300 cities since Papa’s founding. This personalized, trusted support is a coveted benefit for members like Dale and Joan and their families. And the ability to provide it at scale, thousands of times per day, is a game changer for Medicare Advantage plans looking to provide an extra layer of support for their members.
If we are ever to achieve our vision of a world where no one has to go it alone, we cannot leave family caregivers behind. It will take continued leadership from agencies like CMS and action from forward-thinking health plans to help get us there.
Article written by: Kelsey McNamara, MPH, Head of Research and Impact, Papa
When was the last time you sat down, quietly, both feet planted, eyes closed, to get in touch with who you are, your soul, your inner-being or a higher power? Most of you would probably say, “I wish I had made the time to do it,” and some of you probably have planned on it but life got in the way. This is likely because of the way we operate in today’s world. There are so many external demands that are constantly vying for our attention.
Now imagine being born into the internet “explosion”; a world in which you don’t understand what “logging off” means - if you were born between 1988-2012, this is likely you. We call you a GenZennial- you are Gen Z or a young Millennial – between the ages of 18-35. GenZennials live their lives on the internet and mobile apps; they use the internet and apps for everything from financial banking, to ordering groceries, connecting with family, getting a degree, and socializing. In fact, 98% of GenZennials own a smartphone and use the internet, 79% report that they can’t live without their phones, and GenZennials spend approximately 4 hours per day on social media; that is half of a work day.
Think about how you feel about the hustle and bustle of your own life, then add the pressures of being overwhelmed with external, digital influences, how these generations have learned to determine their self-worth by how many friends they have based on likes and follows. There is overwhelm with our external way of being and the need to be connected to a device to live our lives. All of this has contributed to a mental health epidemic.
We need to be doing a better job related to the mental health crisis in GenZennials. Almost half of GenZennials report being so stressed that they can’t function, one third have been diagnosed with a behavioral or mental health problem, and 42% have left a job due to stress and anxiety. In the past we have treated mental health like a faux pas; don’t ask, don’t tell, it's weird, it's uncomfortable, no one wants to talk about it, it's the elephant in the room. However, GenZennials are comfortable talking about their mental health. In fact, 63% of GenZennials report being comfortable talking about their mental health to others, 30% have seen a therapist at least once in the last three years, and 25% of GenZennials claim that mental health is the most important aspect of their health. So the question now becomes, “What are we going to do to change the mental health epidemic in GenZennials?”
Spirituality may be an untapped resource for GenZennial mental health. When you hear the word spirituality, it could mean many things. Some people associate it with religion, or think it is religion. Others would say it’s a component of. At the end of the day, spirituality encompasses many layers. It’s cross-cultural and inclusive of faiths. Spirituality is a broader concept in which individuals seek connection to self, to others, to nature, and to the sacred or higher being.
But this is not the spirituality we knew as kids - what we once knew when our grandparents were practicing religion and spirituality. For many of this generation, this isn’t driving to Temple on Saturday or church on Sunday with your family. This isn’t attending Bible study on Tuesday nights. This is gumbo. This is faith unbundled. This is autonomous. This is owning thoughts and ideals of the world and using it to build a relationship with ourselves and a higher being. Spirituality is not new, but spiritual self-care is.
Spiritual self-care includes practices or actions that nourishes our inner being, taking care of matters of the heart. For many years, individuals have used spirituality or religion when faced with a major life event such as death, loss of a job, or divorce. For GenZennials, it's more about spiritual self-care; they are obsessed with self-care. GenZennials are actively tuning into their emotional, mental and physical health. Self-care is the way they have chosen to feel more grounded and alleviate the pressures of overstimulating technology and societal expectations. They are using spirituality to connect with the world around them. This is their “chicken soup for the soul” and this is where the future needs to go. This is the comeback of spirituality, but with a different lens.
As a fractional Chief Science Officer in the digital mental health industry, I am often asked by companies to lead science strategy and use science to help inform product and content and generally business growth. I have been doing this for the Skylight app. Skylight is a FREE spiritual self-care app that offers practices to help users tune into themselves and/or a higher power and is tailored for GenZennials. Because it's free it's accessible to many individuals across age, education, economic status, race and religion.
What is unique about Skylight is that they are one of the only apps that is using spirituality and spiritual self-care to improve mental health, specifically in GenZennials. This is different from what I have seen in the mental health industry. We typically see meditation apps or sleep apps or apps that offer therapy or coaching. None of these have really worked and the market is completely saturated with digital mental health companies going out of business. We as a society need to do better, meeting GenZennials where they are and offering/providing digital ways to connect with themselves or a higher power so they can care for their physical, emotional, and mental well-being.
We recently looked into the literature to see what had been done using digital spiritual self-care for mental health in GenZennials. We searched 8 databases and 243 articles, and only 3 papers have mentioned spirituality, mental health and GenZennials but none were intervention studies. We also conducted a cross-sectional survey to learn more about GenZennial Skylight users, help inform product and content, and determine which mental health problems Skylight is impacting most. We learned that over half of those who completed the survey (N=255) come to the app for spiritual well-being and overall health. We also learned that those who use the app more frequently (at least 3x/week) report lower anxiety than those who use it less frequently. We also sat down and interviewed our users. Although we are still analyzing this data we have learned that GenZennials desire spirituality. To GenZennials, spirituality is “hip” and “on trend” and “inclusive”. GenZennials are trying to connect to something deeper and/or greater than themselves to tend to their emotional, mental, and physical health. Even in GenZennials that don’t identify with spirituality or religion, spirituality is a gentle, non-invasive way for them to explore things like their meaning and purpose in life. In these interviews we also learned that spirituality and spiritual self-care are moldable; that it doesn’t matter the background of the person or their beliefs, or their stage of life, anyone can participate. GenZennials are taking the information they learn from the internet, social media, and their friends and family to evaluate how spirituality can be applied to their life. Finally, our preliminary qualitative analysis suggests that spirituality is versatile. Spiritual self-care practices that our users most engaged with were affirmations, meditations, and prayer. Interestingly, all of these practices have shown to help individuals have increased happiness, gratitude, and self-worth. And all of these practices can be additive to other rituals or practices that are already being used to connect to the soul or a higher power.
Skylight’s mission is to promote spiritual and mental health by making spirituality accessible for people of all backgrounds, helping individuals center themselves and connect to their community, environment, and a transcendent being. In the future Skylight will inform their AI with insights from the literature, data analytics and science so that GenZennials are provided an opportunity to practice spiritual self-care that is personalized and evidence-based. GenZennials want to “drive their own ship” as it relates to their spirituality. There is a need for industry, research, and media to allow GenZennials to lead the way in solving the mental health epidemic. This is a call to action to provide GenZennials with digital tools for spiritual self-care; practices that nourish their inner-being allowing them to connect to themselves and a higher power. Let’s see what this does for the mental health epidemic in our future.
The areas that have been the most impacted by the opioid overdose crisis are also the ones with the least access to life-saving care. Groups Recover Together, a leading outpatient provider of opioid use disorder (OUD) treatment, offers care where needs are greatest: in rural counties with high Medicaid enrollment.
We recently connected with Groups’ Chief Outcomes and Medical Officer, Dr. Jacob “Gus” Crothers, to discuss their mission of expanding access to high-quality OUD treatment, the importance of leveraging hybrid care models, the benefits of value-based contracts, and the opportunities that arise when treatment providers are transparent about outcomes.
Many barriers come to mind. First, many state regulations are restrictive and out of touch with the evidence. The addiction field is evolving quickly, and state regulations, although well-intentioned, are out of date the minute they are codified. I’m unaware of any other field of medicine (aside from reproductive health) where lawmakers feel so strongly about legislating how medical and clinical professionals should practice. Most treatment providers I know wish regulators and legislators would leave the practice guidelines to the various professional societies (ASAM, National Quality Forum, etc).
Second, different arms of state and federal government have contradictory positions and priorities. There are tons of examples: At the federal level, SAMHSA and the CDC push for low-barrier approaches to treatment while the DEA simultaneously introduces safeguards that run counter to those low-barrier approaches. Each department is just doing its job, but there is no unified order of priorities. At the state level, public health departments and health plans want increased access to care but then make it extremely laborious to obtain licensure and credentialing and navigate the bureaucratic requirements required to expand access.
Third, fee schedules incentivize non-impactful services over impactful ones. Your typical fee schedule reimburses 3x more for a 10-second urine drug screen than for an hour of counseling, peer support, or care coordination. There is a role for toxicology testing, of course, but it won’t give anyone the skills to find or stay in recovery.
The best weapon against stigma is hope. When people feel that addiction is a death sentence or an incurable situation, then stigma spreads. When people feel hope for recovery and know that effective treatment is available and accessible, stigma naturally fades. The HIV epidemic can teach us a lot here. Although there is still stigma, the emergence of effective antivirals went a long way to reduce the fear and stigma of the diagnosis. In the addiction world, we also have effective medications and great outcomes for those who stick to their treatment, but most of what you hear about in the press is bad news about overdose and death. We need to share more stories of recovery to inspire hope and change the public’s perception of the effectiveness of treatments like MOUD combined with therapy and peer support.
Reducing stigma is critical because the stigma is often as impactful as the condition itself.
At Groups, we did a great deal of education around the 2023 Medicaid redetermination process. We alerted our patients, whom we call members, in each state before the deadlines for signing up for Medicaid in group sessions and through email and SMS. We held webinars to educate members about the process and their health insurance options more broadly.
We also facilitate partnerships with local health departments, criminal justice departments, and departments of corrections so folks transitioning out of ER or jail/prison systems can access treatment immediately.
Finally, our hybrid online or in-person treatment offerings and flexible group times allow members to access recovery in whatever way suits them best.
Local community partnerships are necessary to help people access treatment in their moments of need. We also need more education for general practitioners to recognize and treat early symptoms of addiction.
On the policy level, we need to accept that many (possibly most) individuals self-medicate with “street buprenorphine” or “street methadone.” We also need to understand that this behavior can be an important (albeit imperfect) step on the pathway to recovery. If we criminalize this behavior and overemphasize diversion prevention measures through strict regulations that limit access to medication, we may exacerbate this situation by making formal treatment even harder to access. If state and federal regulatory agencies adopted the philosophy that self-medication decreases the use of higher-risk opioids and introduces more people to the benefits of treatment, they would be able to provide aligned, streamlined policies that balance the inherent tension between access to MOUD and diversion prevention of MOUD. Given the size of the OUD treatment gap, it’s my opinion that access to treatment should be the clear priority for the foreseeable future.
Addiction treatment providers can contribute to better outcomes and experiences by being transparent with outcomes data and sharing findings about what’s working. As addiction becomes increasingly complex to address, our field needs to work together to share processes and outcomes so we can all get better results for the individuals and communities we care for.
Dr. Jacob “Gus” Crothers, MD
Chief Outcomes and Medical Officer, Groups Recover Together
Dr. Crothers completed medical school and residency at Tufts University. While there, he designed and implemented a resident-led group visit model for the treatment of opioid use disorder (OUD). The program continues to serve as a national model for integrating addiction medicine education into residency training. Dr. Crothers pursued his addiction medicine board certification at the Yale-affiliated APT Foundation, where many of the original studies of buprenorphine were completed. While continuing to practice part-time, Dr. Crothers served as Medical Director of Grand Rounds and scaled their clinical reach to over 5 million individuals in his five years of tenure. Dr. Crothers has served as the Chief Outcomes and Medical Officer at Groups since 2019.
Dr. Gentile: Underserved children with attentional challenges often face barriers to access to comprehensive interventions. Attentional challenges can significantly impact people lives and the lives of their loved ones. When not properly addressed, they can result in poorer physical health, decreased school and work performance, increased involvement with forensic services, and increased co-morbid mental health conditions such as anxiety and depression. Here are some of the contributing factors to the disparities in access to high quality interventions for attentional challenges.
Access to Diagnosis and Treatment:
Underserved children often encounter barriers to accessing timely and accurate attentional disorder diagnoses and care.
Limited Access to Multimodal Interventions:
Comprehensive management of attentional challenges often involves multimodal interventions, including behavioral therapy, educational support, digital health support, and, in some cases, medication which are in short supply in underserved communities.
School-Based Interventions:
Schools play a crucial role in supporting children with attentional challenges. However, underserved schools may face challenges in providing the necessary resources and accommodations.
Telehealth and Technology-Based Interventions:
The COVID-19 pandemic has highlighted the importance of telehealth and technology-based interventions. While these approaches can improve access to care, challenges related to technology access and digital literacy may impact their effectiveness in underserved populations.
As you can see, the state of interventions for underserved children with attentional challenges involves a recognition of existing challenges and ongoing efforts to address disparities. Multifaceted approaches that include both traditional methods delivered clinically and those delivered via technology are key to improving access to effective interventions.
Dr. Gentile: At Thynk, Inc, we are developing a suite of technology to improve cognitive function starting with Skylar’s Run, an EEG guided cognitive skills training video game designed to improve access for all that need or want it. Skylar’s Run is backed by eight studies, six peer-reviewed articles validated with hundreds of children from a variety of populations. At Thynk, Inc, we make cognitive training technologies easily accessible, effective, and fun. Just by playing our video game, we can train children on 13 core cognitive functions essential for learning and engaging in daily activities. The ability to focus and take in information is essential to personal, social, and academic growth and development.
Core to our mission is to ensure that we are engaging both majority and traditionally underserved communities in our research and development efforts as well as with commercialization. More to come with our first two commercial pilots kicking off at the beginning of the new year!
Dr. Gentile: Skylar's Run stands out because of its innovative design and robust scientific foundation. Our proprietary EEG headset and brain training technology form the backbone of Skylar's Run. It is the player’s attentional state as measured by the EEG that moves Skylar forward. The game is comprised of 15 different adventure “missions”. Each mission has specific validated game elements that teach 3-4 cognitive skills so that after finishing the missions over 6-8 weeks for about an hour a week, children have developed and practiced a new set of key cognitive skills.
Dr. Gentile: Skylar's Run stands out in improving lives of all children:
Player’s Brain Controls Skylar: The EEG headset monitors a child’s attention level in real time, measuring it every 1/10th a second. This data guides Skylar, the main character, through thrilling adventures. The more a child pays attention, the more success and rewards they experience in the game.
Transfer Effects and Real-Life Application: Many products can show in-game improvements, but Skylar's Run goes beyond that. Each mission includes a learning module where the player is exposed to specific cognitive skills. This is followed by a transfer module where the player can apply the newly learned skill in a new environment-think of this like doing homework at night. The cognitive skills acquired through the game are transferable to real-life settings, such as paying attention in class, focusing on homework, or managing impulse control in social interactions. One example of this skill transfer was the remarkable 6 to 8-month advancement in both math fluency and reading comprehension seen over just 6 to 8 weeks of gameplay. Another example of real-life skill transfer is the 80% improvement in parent reported problems with homework observed in our clinical trials.
Personalized Attention Assessment: Based on 10 years of R&D our product utilizes proprietary and validated analytical methods to reliably distinguish the brain EEG signals that are specific for states of attention and inattention. This allows for the development of personalized attention signatures for each user, tailored to their specific needs and mental abilities.
Cognitive Training Curriculum: We have devised a curriculum of 13 cognitive skills targeted in our video game training. Over the 15 missions a child learns and is tested on the different skills critical for success in home, school, and social settings. By integrating cognitive training with attention assessment, we provide a comprehensive approach to skill development.
Adaptive Gameplay: Our video game incorporates adaptivity, dynamically adjusting to the player's current ability levels. This adaptive feature preserves engagement and keeps the player in a "zone" of optimal learning and improvement.
Feed Forward Technology: EEG-based Feed Forward technology adds another layer of sophistication to our approach. This type of Brain Cognitive Interface has been shown to not only restore lost or impaired functions but also enhance cognitive capabilities by providing real-time feedback of brain activity. With that real time feedback, the participant gains immediate insight into desired behaviors and cognitive activities taught within the game which reinforces skills.
Learning Through Play: Video games are a powerful medium of learning because children naturally learn through play. Skylar’s Run is fun and intrinsically motivates the child to excel and master new skills without external pressure or external rewards. Video games decrease the likelihood of frustration seen in more traditional learning environments.
Interviewer: Why did you decide to go the direct-to-consumer route instead of the FDA route?
Dr. Gentile: Thynk, Inc. has chosen a direct-to-consumer approach for several strategic reasons:
In summary, Thynk’s Skylar's Run represents a cutting-edge approach to improving attention, impulse control, and self-regulation. Grounded in solid scientific research, the technology offers a unique combination of personalized attention assessment, a comprehensive cognitive training curriculum, adaptive gameplay, and real-life transfer benefits.
Medicaid recipients struggling with Serious Mental Illness (SMI) face countless systemic barriers that prevent them from accessing the care and support they need to get and remain well in their communities. Gaps in the healthcare system and inadequate funding have often broken their trust in traditional community providers. As a result, these individuals frequently utilize hospital emergency departments for care, which have traditionally failed to address their true needs, causing repeat visits and inpatient stays that drives up the cost for managed Medicaid organizations (MCOs) without any improved outcomes for the individual.
These gaps in care and exorbitant costs have, for decades, required an innovative solution that has remained elusive. At firsthand, we have taken on the challenge of finding a meaningful, scalable and lasting solution to this long-standing behavioral healthcare problem. We are addressing the unique challenges and needs of this population through a peer-led approach. Certified Peer Recovery Specialists (CPRS) are at the front lines, building relationships with individuals directly in their communities. They are able to tap into the power of empathy and lived experience to rebuild trust and dramatically improve care outcomes for individuals living with SMI.
Our peer Guides use their lived experience of SMI to support individuals in obtaining socio-economic assistance and in developing and maintaining successful primary care and behavioral health relationships. In addition, firsthand care teams employ social workers (Community Resources Guides), medical assistants (Health Guide Associates), and clinicians (Health Guides) to ensure comprehensive assessments and provision of care. Behind the scenes, our support teams in operations, clinical, engineering, and IT work to enable the frontline teams to build high-quality human-to-human connections through our custom internal software. Support like this creates millions of dollars in savings for taxpayers by decreasing inappropriate healthcare utilization by Medicaid members.
firsthand teams operate in large and medium size cities such as Nashville and Memphis, Tennessee and Youngstown and Cleveland, Ohio. While the firsthand peer-led model immediately proved successful at engaging high-cost users of hospital care in their homes, transportation emerged as a prominent challenge to accessing community-based clinics and resources. Insufficient public transportation systems meant that low-income individuals with complex medical needs could not attend specialist care appointments, exacerbating their reliance on emergency care.
While Uber Health and other ride sharing services appeared as an alternative, they were not devoid of drawbacks - high cost and a lack of wheelchair accessible vehicles. Beyond transportation, many of the individuals firsthand serves lack traditional support systems who they can depend on for rides, and often experience cognitive difficulties which make it particularly challenging to plan the steps necessary in remembering and attending an appointment outside the home.
Confronting these challenges brought us to a realization that technology could play a role in bridging the transportation gap. However, our experience had also informed us that many of our individuals either lacked access to technology or were not proficient in using telehealth tools, requiring assistance in both aspects. We saw that our CPRS team members could stand at the forefront of this necessity, serving as both technology and relationship conduits. Technology and fostering tech literacy are crucial to the individuals we serve, not only in managing their mental health, but in achieving a greater sense of independence as they advance in their recovery.
In search of a solution, we ran a pilot integrating technology with the empathetic touch of peer support guides to facilitate healthcare access. We began in the city of Nashville with Adam, a clinician, and Michelle, a peer supporter. Michelle engages individuals who have traditionally been high-cost users of hospital systems. As she works to support them with their social needs, she connects them to Adam for an in-depth health assessment within 90 days of enrollment. She and Adam coordinate visits and determine those in need of telehealth visits due to transportation issues. They then allocate one day a week solely for these visits.
On this day, Michelle goes to the home of her first individual, sets up the telehealth visit and connects the individual to Adam. Once the individual is comfortable, she moves to the next home and gets that individual set up while Adam is conducting the first assessment. We found that this method not only maximized the time of our care team, but also drastically reduced no-shows rates.
Previously, our internal data was showing a 50% no-show rate in the population we serve. However, when guided by peers, we found that appointment attendance skyrockets, with no-show rates diminishing to below 35%. It is not rare for Michelle to show up at an individual’s home at the time of an appointment to find them asleep, and she is able to wake them and prepare them for a productive assessment. Although technology has opened new gateways to healthcare, it wouldn't be complete without the human touch. This is particularly true for those grappling with social or technological barriers, or those requiring additional support.
Beyond ensuring appointment consistency, peer support guides like Michelle can also bridge critical gaps in healthcare. As the peer relationship forms, individuals develop a deep level of trust and comfort and often share concerns with their peer that they don't share with their clinician, such as the side effects of medication or changes in health (new cough, rash etc.). With this knowledge, the peer can inform the clinician, who can then set up a wellness visit and do a deeper dive. As telehealth becomes an integral part of our daily lives, the firsthand model has been able to successfully implement a blend of technology and face-to-face peer support. The strategy highlights the power of human-technology partnerships in creating more inclusive and effective healthcare services. By focusing on technology adoption in the homes of our individuals, we have improved our reach and efficiency.
This approach not only boosted our service delivery, but has also elevated the status of our peers to stakeholders in the clinical relationship, imparting them with a greater sense of purpose and meaning. Our approach has led to a significant reduction in ED use, with an annualized rate of 565 ED avoidances per 1,000 engaged individuals. This is a substantial stride towards better, more efficient community mental healthcare.
As a value-based healthcare company, we understand the need to be agile, both in perspective and action. We regularly scrutinize and update our practices based on feedback from our peers and the entire care team. The direct experiences they share with us not only guide our present, but also shape our future strategies. We discard what isn’t working and amplify what does into best practices, such as the peer-assisted telehealth strategy that Adam and Michelle piloted.
Our goal is to provide the best patient care, while also delivering cost savings to Medicaid programs and taxpayers. Our peers, care team and the individuals we support are critical partners in this. With their feedback, we refresh our strategies, ensuring they remain effective, compassionate and empowering. With every shared idea, every piece of advice, every experience, we have an opportunity to enhance our care, and improve healthcare outcomes.
Article written by: Mark Graham, VP of Operations at firsthand.
In almost every state in the U.S, there is almost total network inadequacy for evidence-based care if your loved one suffers from Stimulant Use Disorder (StUD), which is increasing at an alarming rate. While there are no FDA approved medications for the treatment of StUD, like there are for other substances, the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry have recently issued treatment guidelines for StUD which state that Contingency Management and Community Reinforcement Approach should be standard of care for StUD.
However, there is a stark disparity between what is recommended as standard of care, and what is currently reimbursed for through insurance.
"Contingency management (CM) has demonstrated the best effectiveness in the treatment of StUDs compared to any other intervention studied and represents the current standard of care. CM can be combined with other psychosocial interventions and behavioral therapies, such as community reinforcement approach (CRA) and cognitive behavioral therapy (CBT)." Contingency Management (CM) should be a primary component of the treatment plan in conjunction with other psychosocial treatments for StUD.”. ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. American Society of Addiction Medicine, Inc. 2023.
Contingency Management is a behavioral technique wherein the systematic delivery of positive reinforcement is provided for objective target behaviors that reflect progress in reducing/eliminating drug use (Higgins et al., 2007; Stitzer & Petry, 2006). Contingency Management is a protocol-driven intervention and includes a preset schedule of vouchers, gift cards, prizes, or other incentives that increase in value as participants demonstrate extended periods of stimulant abstinence (Higgins et al., 2007). Best practices in Contingency Management include higher value rewards (e.g. $599), objectively verifiable behaviors, and rapid delivery of rewards after desired behaviors have been performed.
The research evidence supporting the use of CM for the treatment of individuals with cocaine and methamphetamine use disorder is extensive (for reviews, see AshaRani et al., 2020; Bentzley et al., 2021; Bolivar et al., 2021; Brown & DeFulio, 2020; De Crescenzo et al., 2018). Contingency management has a uniquely robust impact on in-treatment abstinence and treatment retention, as well as sustained impacts on abstinence for up to 1 year after treatment (Ginley et al., 2021). No other behavioral intervention for the treatment of StUD has as strong an evidence base. Although CM is recommended as an evidence-based treatment in US government documents (eg, SAMHSA Tip 33), only within the US Veterans Administration Health System (VA) is CM used in routine clinical practice (DePhilippis et al., 2018; Petry et al., 2014).
Contingency Management traditionally has entailed intensive and ongoing staff training and education in order to ensure fidelity to a clinically efficacious Contingency Management model. Typically this model has involved rudimentary fish bowl voucher prizes, or other manual methods of reward delivery, which entail manual record keeping and are subject to variability in how closely a clinical protocol is followed.
There have also been questions about what is allowable under federal regulations for disbursement of incentives, and how to comply with the rigorous reporting requirements under federal guidelines. However, DynamiCare has received an advisory opinion from the Health and Human Services Office of the Inspector General which states it, “would not impose sanctions under the Beneficiary Inducements CMP”. This provides legal clarity which enables systems to implement Contingency Management in a fashion that is compliant with federal guidelines.
Overall CM can be implemented manually or using technology, however, the manual system tracked by treatment centers (using pen and paper) are not consistently reliable or scalable. Furthermore, the old manual system creates a staff burden and is subject to human error for the necessary CM tracking requirements needed.
Tech-based CM is the most practical and effective approach for payors and treatment programs, and also offers the most advantages for patients as well. In fact, the Office of National Drug Control Policy encouraged the use of technology-enabled CM in its drug control strategy:
These incentives are an integral part of protocol-driven and evidenced-based contingency management programs and can be offered through smartphone applications and smart debit card technology designed to provide comprehensive and personalized treatment for SUD (including, for opioid, stimulant, alcohol, and nicotine use disorders). These programs include tools that enable, for example, automated appointment reminders and attendance verification, automated medication reminders, drug, alcohol, and tobacco/nicotine testing, self-guided cognitive behavioral therapy, and recovery coaching.
The results from the first in the nation Medicaid funded CM pilot in West Virginia have been announced, and many other state systems are following suit. With the advancement of technology, payors and treatment programs can now consider offering evidence-based behavioral interventions delivered via digital health or web-based platforms as add-on components to treatment for StUD.
Specifically, DynamiCare Health offers a 12 month model to digitally implement CM through smartphone–smartcard platform, where a smartphone application allows for remote salivary and breathalyzer drug testing at individualized random schedules. The application tracks the individual’s history of drug tests and treatment attendance and provides appointment reminders. Incentives are delivered via a debit card that cannot be used to withdraw cash and has additional purchasing protections. Approximately half way through the treatment protocol, the DynamiCare system transitions from delivering external rewards of CM to focusing on the internal rewards such as education, jobs, relationships common in the Community Reinforcement Approach (CRA). Finally, DynamiCare Health offers weekly recovery coaching, CBT self-study library, and the evidence-based CRAFT family support system to complete its comprehensive behavioral health treatment offering.
Yes, in fact, the Washington State Institute for Public Policy, an independent think-tank with the most comprehensive review of cost-benefit analyses in addiction treatment, has ranked Contingency Management for SUD as one of the most cost-effective interventions for addiction that they have studied. Their analysis concluded that CM yields $38.29 in overall benefit for every dollar invested. Looking at healthcare costs alone, they calculated $1,833 in benefits for every $548 spent (3.3x cost-benefit ratio) (WSIPP 2018). For comparison, they estimate that buprenorphine maintenance, a gold standard treatment for opioid use disorder, yields only $1.81 in benefits to society per dollar spent, and the cost-benefit ratio for healthcare costs is 0.3x (WSIPP 2018).
With over 46 million people suffering from a substance use disorder (SUD), finding a SUD program to suit individual needs can be difficult.
Despite improvements in SUD treatment and a better understanding of the epidemic’s genesis, progress remains encumbered. SUD treatments are failing. A one-size-fits-all approach that is unaccommodating to individualized needs simply doesn’t work.
One of the many reasons America’s SUD treatment ecosystem has failed is due to a disconnected decision-making process that is designed solely to “systemize” and increase efficiency. SUD programs are expensive and inaccessible while some provide subpar treatment for a short amount of time due to insurance constraints. Research shows that the longer the treatment, the better the patient outcome.
Another barrier to patients seeking treatment is stigma, which often forestalls access and utilization to the addiction treatment care system. Examples include when people purchase Naloxone, asking a family member for a ride to treatment, or even when talking about addiction struggles with a friend. People suffering from substance use disorders lack personalized care that centers on their clinical and social needs. Wading through the myriad of rules, bureaucratic layers, and excessive processes surrounding healthcare is inexplicable especially in the context of the clinical and social barriers created from substance use disorders.
Without a holistic, patient-centric SUD program that’s well integrated with primary care, people will fall through the cracks. SUD treatment programs should be tailored specifically to the patient and the surrounding access needs. While mental health and primary care may be a core need, it presumes adequate transportation to and from treatment or picking up medications that help people through the recovery process. As a result, this gap needs to be addressed as part of the overall treatment plan. In the same regard, pairing a patient with an advocate, peer mentor, or personal quarterback is essential to finding the right resources, care, and access points that support persistent recovery rather than operating as a perfunctory checkpoint on a path to relapse.
Nomi Health is beginning to see the benefits of this approach through its Success Care program, a new and first-of-its-kind substance use disorder program that coordinates all services — health and non-health — into a single program providing comprehensive and integrated care. Dedicated peer specialists have been key to the program’s achievements. Individuals with shared and lived experiences who have overcome addiction can help patients in their unique SUD recovery journey.
Since Nomi Health’s Success Care program’s inception, it has experienced over 450% growth in patient visits. More importantly: 82% of patients have indicated that they have a high trust in the care they receive through the program, 80% of patients on medication assisted treatment are satisfied with their recovery progress, and 100% of peer support patients would recommend the service to others.
Nomi Health has learned that failing to look forward, acting proactively and aggressively, creates a ripple effect with a catastrophic impact on lives, deaths, and communities. Playing catchup doesn’t work. In fact, protraction is more costly than proactive action. If we want to solve this crisis in America, patient-centric care is that way to do it.
Learn more about the integrated and collaborative approach to substance use disorder treatment through Nomi Health’s Success Care program and see how a holistic and patient- focused approach can impact countless lives.
Article written by Sara Ratner, President of Complex Care at Nomi Health.
There are more mental health and substance use point solutions than ever, so how are health plans, employers, and, most importantly, patients to know which solution they should use to forge a path to meaningful behavioral health outcomes? We brought together health plans, providers, investors, and more at HLTH 2023 to learn how the healthcare ecosystem can better bridge the supply-demand conundrum in behavioral health while prioritizing affordability, access, and seamless patient experiences.
Andrew Cylkowski, Chief Commercial Officer at Lucet discussed breakthroughs in technology and AI, revamped care delivery models, and innovative digital interventions that are paving the way to better mental health care accessibility with Susan Solinsky, Co-Founder and Chief Growth Officer at Ellipsis Health, Dr. John Langlow, MD, MBA, Medical Director at Lucet, and Dr. Bipin Mistry, MD, MBA, Chief Medical Officer at Alight Solutions. Read highlights from their conversation below. The following has been edited for length and clarity.
Dr. Bipin Mistry: I look at things from an employer perspective, and it's been hard. Organizations are trying to tackle this problem to retain their workforce, and it starts with recognizing stress at the employee level. I've seen some organizations focus on training managers to identify stress in their direct reports, and others are trying to redesign benefits to account for work-life balance or are looking into point solutions. We’re trying to help employers understand their ecosystem.
Dr. John Langlow: Several tasks need to happen when a person sees a therapist, psychiatrist, or psychologist—but the first one is getting matched up with the right person. This is getting harder as there are so many different flavors of people who are dealing with special disorders like autism, eating disorders, substance abuse, and more. We have to be able to figure out a way to assess the member with measurement-based care, too, as putting someone with a provider is just not enough to keep people coming back. We need to figure out how to use providers’ unique skills in a better way.
Susan Solinksy: If an employee has a heart attack or breast cancer, we're immediately going to rally behind them. But if they have a mental health issue, we think there's something personally wrong with them. There's so much stigma and misconception around mental health, and I think employers have a big opportunity to use their voices and support all ages using social media. I think we all know that social media has exacerbated some of the problems that we’re seeing with depression and anxiety. But the question is, how are we going to use it to support people in need of help? We're starting to see a lot of influential people use their voices and raise their hands, and we’ll continue to see more of that.
Dr. John Langlow: There's a lot of work to be done in making telemedicine even more accessible. A lot of providers simply don’t know how to apply these solutions, while others got out of business because they have this idea that virtual care is dehumanizing, which isn’t true. These tools can help us do a better job and see people faster. Some tools help us quickly learn about patients’ disorders, and others help us develop treatment plans. There are all sorts of things that can be done with AI, too, like helping collect a detailed history or even doing a mental status exam. We have a long way to go with measurement-based care as well. A lot of providers are asking if there’s a way they can get out of it because they don’t have time, but we need to figure out how to do it and do it right.
Susan Solinksy: We did a big project last year that would be considered an integrated behavioral health delivery system. The doctors used cell phones with their patients, who would report to them in between visits and share when they felt depressed or anxious. It’s incredibly exciting because we reduced suicidal ideation and hospitalizations, and when you have a result like that – one that's tangible – the doctors are excited to keep using the technology.
Dr. Bipin Mistry: What I see ahead is technology really connecting the dots on mental health journeys. Things like VR and AI and how people are starting to interact with these technologies make this a really fascinating space. I also think we’ll start seeing people pay more and more attention to the way technologies are designed and packaged so they’re more intuitive. There's a lot of opportunities.
The Behavioral Health Tech Conference in November will continue to shine a light on ideas and solutions that improve access to mental and behavioral health care, pulling in perspectives from health plans, employers, behavioral health providers, digital health companies, investors, policymakers, and more so that we can continue making progress for people in need of care.
We’re looking forward to more discussions like this one, and we hope you’ll join us either in person or online. Register today!
In an era where adolescents are grappling with a rising tide of mental health conditions, the delay in seeking help is all too common. The struggle to conform to social and cultural norms often forces young individuals into a silence that amplifies their suffering. However, there exists a beacon of hope in the realm of technology that transcends mere entertainment—Virtual Reality (VR). This innovative technology may be a key to addressing the stigma surrounding adolescent mental health while offering truly effective treatment options.
As the landscape of mental health care evolves, VR emerges as a powerful tool to combat the growing crisis affecting our youth. VR, previously synonymous with entertainment and video games, is now poised to revolutionize the way we approach mental health treatment. A question that often arises is: What is VR? In essence, it involves putting on a headset that transports individuals into a meticulously crafted virtual world, complete with visual and auditory stimuli. The impact on one's psychological well-being can be profound.
Consider the example of an individual grappling with a fear of heights. With VR, they can immerse themselves in a simulation where they are precariously perched on a cliff's edge or hurtling down a towering rollercoaster. Similarly, those with social anxiety can practice public speaking in front of a virtual audience, gradually building confidence and reducing their fears. However, the applications extend beyond exposure therapy.
VR seamlessly complements traditional therapeutic methods like dance and music therapy, both enjoyed by youth. It allows individuals to engage in immersive environments where they can "play" musical instruments, offering a therapeutic avenue for reducing anxiety and stress. In essence, VR leverages the passions and interests of adolescents to provide them with a unique, engaging, and effective form of mental health therapy.
Understanding the importance of addressing adolescent mental health is paramount. Their mental well-being significantly impacts their intellectual, emotional, and social development, which, in turn, shapes their future as adults. Poor mental health can hinder the development of autonomy, problem-solving skills, and the ability to thrive in social settings. Recognizing that adolescents often struggle to relate to conventional mental health treatments, VR emerges as a bridge that allows mental health providers to connect with their younger patients effectively.
As the prevalence of mental health conditions among adolescents continues to rise and VR therapy gains traction, it is imperative for the behavioral health community to take proactive steps. The first crucial action is to increase awareness among youth that VR treatment is a viable option. Educating adolescents about the availability of VR as a resource for both entertainment and mental health support is essential.
Furthermore, integrating VR into mental health education within schools presents an exciting opportunity. Given that school-related stressors are a common trigger for adolescent mental health conditions, traditional one-on-one counseling often falls short. By incorporating VR into school mental health education, we can offer more effective results, equipping young individuals with valuable tools for managing their mental well-being.
Finally, as VR technology matures in clinical settings, the next logical step is to provide adolescents with the means to access it in their own environments. This approach offers increased privacy and fosters consistent use of the treatment, ultimately empowering young individuals to take control of their mental health journey.
The convergence of a growing mental health crisis among adolescents and the emerging potential of VR in treatment demands action. By leveraging the power of VR to engage and empower our youth, we can foster a brighter, more mentally resilient generation.
The U.S. mental health workforce lacks the number of psychiatrists and psychologists required to meet patient demand – and this is a growing problem. This situation has left health systems unable to effectively address the needs of patients with existing care delivery models and struggling to avoid provider burnout.
Dr. Katz, Inc., is addressing this challenge through a unified software platform and mobile app that enables health systems to easily adopt patient-centered and measurement-based care practices. The solution delivers both patient education and evidence-based measures, helping clinicians efficiently direct the course of care, monitor patients’ changes in anxiety, depression, and substance use risk symptoms, and tailor treatment plans.
Dr. Katz helps health systems meet the growing demand for mental health services amidst a widening crisis and challenging economic environment.
Americans depend on video – streaming, social media and broadcast — for news, entertainment, and communication. It’s time for video to be the primary medium for most healthcare. That’s the central purpose of Dr. Katz, Inc. Don’t write; show. Don’t read; watch. Of course, there’s always a place for the written word. But to learn, teach, and heal, video must take its proper place in healthcare.
Unfortunately, when it comes to learning about mental illness, communicating between visits with providers, and practicing at home the skills taught during sessions, most patients are stuck with paper, text and handwritten notes.
We are living in the age of YouTube, TikTok and Netflix: the average adult in the U.S.watches more than 3 hours of digital video each day! The more providers can use apps that harness video to bring healthcare and educational resources into our living rooms, the better care will be received.
Video is especially powerful from the standpoint of increasing accessibility. People sometimes think this means translating websites into non-English languages. Accessibility is more than that. Video is a medium that gives healthcare providers the ability to communicate broadly, demonstrate exercises, such as deep breathing and mindful meditation, in more visual, one: many formats that feel personal while increasing reach.
With the Dr. Katz app, our health system customers use video to give lots of people very easy, instant access to trusted information, clearly communicated in plain language by their top medical professionals. We facilitate that while providing closed captions, which help not only the hearing impaired, but all people. We are intentional about producing videos that use contrasting colors, large fonts for text on screen, and crisp audio – which helps not only the visually impaired, but all people.
I was recently speaking with a clinical psychologist at Massachusetts General who is a part of an early adopter group of clinicians using and providing feedback on the Dr. Katz app. “Sometimes hearing me explain it,” she said, referencing a video in the app that helps her patients practice managing compulsions, “while also visually seeing me doing the [stove checking] exposure, helps people learn the concept better.”
“Shorts” are concise educational videos in the Dr. Katz app. They improve people’s understanding of core psychoeducational concepts that clinicians discuss in treatment. Having Shorts in the app lets people stop, start, and rewatch videos at their own pace, which personalizes their learning journey.
During focus groups we conducted with patients who had sought support for mental illness in 2021, we learned that watching conversational videos, featuring clinical experts breaking down complex topics, would help people more effectively learn more about treatments, signs and symptoms to look out for, and generate questions. Video also helps people absorb information on how to have better discussions with loved ones, we learned.
Importantly, video has the potential to improve treatment for people of color. What we heard in our focus groups was that when experts featured in Shorts were diverse and representative, the patient’s healthcare experience felt more inclusive - this is a major opportunity for health systems interested in delivering more equitable, patient-centered experiences. There is an evidence-basis for this finding, as well. Research published by Stanford in 2018 demonstrated increased adherence to preventative health measures amongst black men that saw black physicians.
Finally, we have found that Shorts that offer a positive, hopeful message are received more favorably -- our takeaway here is that videos help serve another purpose: motivation. This is especially important when there might be long wait times to get into treatment, as well as weeks that pass between appointments.
Clinicians are obviously very busy. We have spent hundreds of hours researching patient education alongside Massachusetts General Hospital physicians and we know that adding complicated tasks adds time to routines and makes adoption of workflow changes less likely. So, we’ve come up with a couple convenient ways for providers to share Shorts.
First, providers connect Dr. Katz with their electronic health record system, which is how most manage their schedule of appointments and accept new patients into their practice. By automatically connecting to this flow of information, we save providers time and eliminate any need to manually create new patients in another system.
Next, providers are recommended Shorts that are relevant to them, based on their interests and practice. To date, we have published over 100 patient resources featuring 60 experts, from leading psychiatrists, psychologists, social workers and coaches. New resources are added every month. We make it easy for clinicians to search, explore a library and filter content by topic or speaker. Mental health is broad, so having a curated list of topics is something clinicians asked us for. From anywhere in the app, you can click on topics and view more content that matches. When providers find content based on its title, expert or description, they easily review it. Since videos are concise --typically 2-3 minutes -- it doesn’t take long for clinicians to watch. They favorite Shorts or add them to collections -- it’s just like Spotify. They access resources they want to use often and filter out the noise.
Third, providers tap once on Shorts to assign them to patients. If providers have built collections around a theme, such as “Medicating for Depression,” or “Well-Being Resources,” they can select everything in their collection and assign it. This saves more time and curates the patient experience, so they see what their providers have asked them to review before their next appointment. We have found that this back and forth improves the therapeutic relationship between patient and provider. “We’ll be speaking the same language,” Gene Beresin, Executive Director of the Clay Center for Young Healthy Minds, notes as one of the benefits of using Shorts.
We recently heard that it was difficult for clinicians practicing in medium-size clinics to share resources with each other. Sometimes, turnover amongst nurses, social workers, coaches, clinical administrative staff makes it hard to keep knowledge centralized, recommendations up-to-date and together in one place. A ton of extra time was being spent keeping individual lists and using email. This cluttered people’s inboxes. So, we’ve just delivered a way for clinicians and staff to share collections with each other -- now everyone can work off of the same, dynamic list. Getting rid of the burden felt by relying on “workarounds”is a big part of how we address clinician burnout.
We also think about ways to eliminate “barriers to entry,” or friction experienced by patients. Providers have told us that some patients do not wish to immediately download an app or create an account. “These patients should be able to access information, too. They should be able to share Shorts with their families because the information can be helpful for them,” a clinician explained to me.
So, we made it very easy for clinicians and clinical staff members to copy a link to Shorts and send them directly to patients, however they typically, securely communicate with them. Family members can also watch if they are involved, and the videos can act as guides to aid them in knowing how to best support patients.
We are always listening to and asking for feedback from clinicians. We ask them, “What types of Shorts would be helpful in your practice?” One idea we’ve heard is to add more videos that assist with reinforcing discussions around medications. People want to understand potential benefits, but also the expected time to see these results, risks, and side effects to look for and be sure to report.
Finally, as so much care has moved virtual, clinicians are looking to centralize the tools they use in their practice. We’ve been asked to help augment treatments by adding more types of resources to our library. We’ve already added measures, which are useful in capturing self-reported data on symptoms. We’ve been hearing that providers want to use video to explain how to practice protocol-based exercises and then offer an easy way, within the app, to allow patients to journal on how the experience felt - this is often referred to as“completing a worksheet,” and it’s something that traditionally has been done the old-fashioned way with paper and pencil. But this is what people are now getting used to doing online, through apps such as Headspace. Clinicians want to bring this into their own workflow using a HIPAA compliant, secure app that’s connected to the electronic medical record. We see this as yet another way to personalize the patient journey.
Burnout leads to turnover and the need to constantly re-skill. Learning is also empowering, inspiring, and community-building – so many clinicians that use the app tell us they enjoy hearing from their colleagues in video-form. Furthermore, in mental health especially, there are always so many new skills to develop — from new treatment modalities to insights around the impact of stigma and the life-saving benefits of gender-affirming care, and the potential of new drugs, such as amyloid agents to treat Alzheimer’s.
Healthcare systems use the Dr. Katz platform to get more value out of their investment in modern video technology, by administering online courses for providers and clinical staff, publishing skill-based programs, and distributing quick clinical tips. This gives providers an easy way to track completion, manage CME / CEU credits, and organize certificates in credential folders to save time with licensure renewals - this problem we heard referred to as a chaotic “last-minute scramble.”
To answer your question in another way: it’s important that clinicians are using the same app to bolster their own learning because this fosters a culture of continuous learning. In 2021, researchers from Vanderbilt University Medical Center who explored the concept of Learning Health Systems (LHS) posited: “One key step is often missing from workplace-based learning: the education of the clinical workforce at scale to transfer new knowledge into clinical practice.”
By unifying patient education and provider training in one cohesive app, we are taking a large step towards closing the longstanding gap between research and practice. Historically, we know it can take decades for best practices to get disseminated in healthcare. Video lets us share information instantly, effectively.
This comprehensive approach is unique. To make it possible, we designed for privacy, HIPAA compliance, as well as anonymity. We did this because continuing to do things the same old way, we knew, would only result in more provider and patient confusion, more friction, more time lost, more money spent supporting more apps, more of a gap between research innovation and clinical practice.
At Dr. Katz, we believe video learning deserves to be at the center of better care. And we are looking forward to seeing you at the 2023 Behavioral Health Tech conference this fall!
Anyone interested in learning more about Dr. Katz, Inc., can visit our website at www.drkatzinc.com or reach out to us at info@drkatzinc.com.
Article written by Nathaniel Hundt, founder and CEO of Dr. Katz, Inc.
There’s no doubt we’re in the midst of a mental health startup boom. With hundreds of new mental health companies having been created over the past few decades, we’ve now seen first generations of mental health unicorns that have built the infrastructure to accelerate this industry in years to come.
It’s impossible to read the news these days without encountering one (or several) headlines about AI. Seemingly every industry is exploring ways to leverage AI-powered tech, and these applications have the potential to transform the way we interact with the world and each other. This is understandable: AI capabilities are advancing at an exponential rate, and the possibilities feel endless. But it’s vital to recognize not only the possibilities, but also the limitations — and eating disorder treatment is one place where this comes vividly to life.
Most AI news has centered around highly advanced chatbots, most notably those that use GPT, or Generative Pre-training Transformers. GPT is, essentially, a large language model that uses natural language processing technology to understand user input and generate helpful, relevant responses. The technology pulls from a huge dataset of existing (human-created) language to learn about language, grammar, the meaning of words, and more, and informs how it both interprets and responds to human input.
It would be an understatement to say that both consumers and industry leaders are enthusiastic about the potential of AI. About three-quarters of internet users prefer using chatbots to people when looking for answers to simple questions, 65% of consumers feel comfortable handling an issue without a human agent, and 57% of executives say that chatbots bring in significant ROI with minimal effort. A striking 84% of companies believe that AI chatbots will become more important for communication between customers and businesses.
The healthcare industry isn’t exempt from these seismic shifts despite the more fragile nature of the industry’s work. Experts estimate that up to 73% of healthcare admin tasks could be automated by AI within the next year, and chatbots are starting to take over more “human” roles as well. A 2021 survey found that 22% of adults had used a mental health chatbot, and 47% were interested in using one. When asked why they sought out a chatbot over a human, most respondents cited affordability, ease of use, and ability to connect with a chatbot at any time.
At first glance, it makes sense that chatbots could serve as quick, low-cost alternatives to trained mental health professionals. After all, GPT technology is adept at responding to questions, synthesizing research, and having human-like conversations. But AI-powered chatbots also have points of failure, and in the realm of mental health — and eating disorders in particular — these can come at a serious, high cost.
Eating disorders are complex and highly nuanced mental illnesses; their signs and symptoms may be hidden or counterintuitive, and treatment needs to be highly individualized in order to be effective. What’s more, up to 90% of people with eating disorders have co-occurring illnesses, which makes their treatment even more complex. This murky landscape is not one in which chatbots thrive. Because the language models look for rules and patterns in their dataset, they’re likely to miss eating disorders that don’t fit a certain mold, or to misdiagnose someone whose symptoms correspond to more than one pattern.
There’s also the reality that while bots themselves don’t have biases, the data they learn from does. GPT chatbots are trained on massive sets of human-created language, and much human-created content around food, weight, bodies, and eating disorders is shaped by the powerful force of diet culture. This means that their interpretation of and response to questions may reflect weight bias, fatphobia, and the thin ideal. As Dr. Angela Celio Doyle, Equip’s VP of Behavioral Health, put it in a recent article: “Our society endorses many unhealthy attitudes toward weight and shape, pushing thinness over physical or mental health. This means AI will automatically pull information that’s directly unhelpful or harmful to someone struggling with an eating disorder.”
This potential risk was brought to life recently, when the National Association for Eating Disorders replaced its human helpline staff with a chatbot named Tessa. Within a week, it was reported that Tessa gave harmful advice that promoted dieting and weight loss behaviors to callers who struggled with an eating disorder, and the bot was shut down.
With chatbots, there’s also the risk of providing false information, which can be extremely detrimental in the case of eating disorder patients. While chatbots are designed to provide only information validated through their training data, they can be prone to what are called “hallucinations,” which is essentially when bots make things up and deliver them as facts. For a parent who is trying to assess their child for eating disorder risk, a patient researching treatment options, or a provider looking up the medical criteria to admit a patient to the hospital, this sort of false information can have dire consequences.
Lastly, chatbots simply can’t deliver the support that has been proven to help people recover from eating disorders. Though eating disorders are mental illnesses, the most important initial focus of treatment is behavioral modifications. This means helping patients normalize their eating habits, stop eating disorder behaviors (like restricting, binge eating, purging, or compulsive exercise), and restore their weight if necessary. While a chatbot might be able to advise someone to do all these things, they cannot supervise or support them in doing so; and without that accountability and wraparound support, someone in the throes of an eating disorder is unlikely to simply stop their disordered behaviors cold turkey.
Human connection is another vital part of eating disorder recovery. Research shows that the support of loved ones greatly increases a person’s likelihood of recovery, and clinical guidelines recommend that family members be involved in care. Mentorship — connecting with someone who has been through recovery themselves — has also been shown to increase a person’s likelihood of achieving full recovery. Chatbots, no matter how intelligent, simply can’t provide this sort of emotional, human element, and likely won’t be able to for a long time, if ever. Eating disorder care without empathy will always fall short.
This isn’t to say that AI has no place in the eating disorder treatment field. The technology is powerful and expansive, and we’re only just beginning to scratch the surface of what it might be able to do. And even in its current state, it’s easy to see use cases for it.
For instance, AI could be programmed to send “nudges” to people in treatment, using patterns and other input to sense when they may be in a high-risk situation (at a restaurant, for instance, or at the gym) and suggesting healthy coping techniques. AI could help direct patients and loved ones to the most relevant resources, giving people timely and tailored information. AI could be used to synthesize and summarize a patient’s different treatment options, comparing and contrasting them across an endless list of variables, like cost, efficacy, time-intensiveness, and more. Dietitians could leverage AI to put together individualized meal plans. Researchers could use AI to summarize large amounts of academic papers and determine new areas of research. Physicians could use AI-powered algorithms to generate highly individualized weight goals for patients. So on and on.
In the United States alone, some 30 million people will be affected by an eating disorder in their lifetime, and there’s a nationwide shortage of mental health professionals (not to mention mental health professionals who are also trained in treating eating disorders). This is to say: there’s a great deal of work to be done, and AI offers a promising way to lighten the load of both eating disorder treatment providers and the patients they serve.
AI isn’t bad. It is likely to be a powerful tool as companies like Equip and our colleagues in the field work to transform the eating disorder treatment landscape and deliver effective care to everyone who needs it. But in order to ensure we do more good than harm, it’s essential to always be aware of the limitations of GPT and similar technology innovations. We need to apply thoughtful scrutiny, to honestly acknowledge their mistakes and failures, and to adjust course accordingly.
At Equip, our treatment is data-driven and built on technology — we know that in order to tackle a problem as massive as the eating disorder crisis, we need technology — but it’s powered by humans. Learn more about what Equip’s evidence-based care looks like, and how we balance the human and the automated to deliver eating disorder care that works.
Alex Katz is the founder and CEO of Two Chairs. He started the company after watching family and friends struggle to find a therapist that worked for them. He realized that healthcare is not a commodity. There are dozens of mental health provider types and hundreds of different mental healthcare interventions, and only some are great matches for each person. The therapeutic relationship between a provider and a patient is everything. This problem was not unique to his own experience, but the reality is that it happens to many. He wanted to create an environment where there was less struggle to find the right provider type.
Two Chairs uses data to help match the right client to exactly the right provider in order to create the best possible outcome for treatment. Two Chairs aims to avoid the “Gold Standard of Care,” which he sees as the typical response from anyone seeking mental health care. People will end up testing several different therapists until they find the right one. This can end in worsening a situation with a patient who is seeking mental health care for the first time. They end up shopping around and have a bunch of “dates” with therapists where they're talking about things that they may have never talked about in their entire life before and then having to repeat that story over and over again. It's kind of no surprise to Katz that the modal outcome of the mental health system is people going to a therapist once and then never coming back. He has heard so many people say things like “Therapy is just not right for me.” This is heartbreaking from a provider's standpoint because therapy is right for everyone. It can literally help anyone, but people still end up with the wrong type of provider because of the level of diversity in the field.
Since shopping for a therapist is not like shopping for a typical consumer good, where you may know exactly what you want in advance, Two Chairs gathers a lot of information both virtually and with a licensed therapist who will evaluate the needs of a patient. The information is then put through an algorithm that considers hundreds of different data points and makes really precise matches for each patient that comes through their doors. 99% of their clientele stated they were matched with the right therapist. This removes the need for “other dates” and finding a new provider, which is extraordinary.
Tech plays a really critical role in how patients are matched with providers at Two Chairs. While there is a digital assessment used alongside an algorithm that evaluates numbers and data, in all reality, does not understand the element of therapy and the human intuition that comes from the initial evaluation sessions that are used to appropriately match the patients and providers. The secret to the matching at Two Chairs is an elegant blend of the best of expert human clinicians combined with the best of technology and data.
Data is used in many different ways to not only match the patient with a provider but also to evaluate the progress of the patients and outcomes. Data is collected from the patient before every single session. This information includes the alliance between the patient and provider, symptoms check-in, and checking in on their overall experience. The data collection is very critical. This helps to close the feedback loop with the matching process. Because humans are so unique, there is a lot that goes into providing better care based on the data collected. When we use the data collected to adapt and treat the patients better, the information is not just sitting in a database. It is actually being used to better the team and better treat each patient while driving outcomes.
Provider’s input is an important part of how Two Chairs works to fit patients and providers together. Providers’ preferences in patient groups or identities are often ignored or not talked about in the mental health field because there is this idea that any provider should be able to treat any patient. While this is true and this is how providers are trained, they do still have preferences that are an important part of the matching process.
When it comes to clinician experience, they want to focus on the long-term career of their providers. They want the providers to focus on working at Two Chairs not as a gig but as a whole career. They want their provider to be with them for years and years, not just part-time. Because of this goal of long-term career relationships is to invest time and effort in the providers and in the retention of their providers. Investing in professional development for providers is crucial in allowing providers to learn more in their trade, learning on how to work with different clients, and advance in the field. Also, tying clinicians to managers is just as important, as it allows there to be a ratio of providers to their care and investing in their growth and ensuring that they are taken care of. Ensuring the providers have everything they need, this extra level of focus helps to protect their providers and their goals.
There is a focus on a hybrid model for patient care. There are many patients, even in this post-COVID world, that would prefer to see a therapist in person. This has left a gap in patients who are sitting on the sidelines waiting for care to be in person. Since there is a major focus on tele-psychotherapy, it is important to offer both options for care in order to reach the most amount of patients. While other therapy options are moving away from brick-and-mortar options, Two Chairs remains a leader in their ability to meet its patients where they need to be met. Two Chairs is undeniably invested in patient-focused care in the mental health field.
Check out our interview with CEO Alex Katz of Two Chairs from GDBHT2022 here:
Maternal mental health is an often overlooked aspect of mental health. Now, mental health care is often addressed before or during an initial obstetrician appointment, or an appointment with a primary care provider. Following those initial appointments, new efforts are in place to address mental health in the prenatal, postpartum, and all other motherhood stages of our lives. These include routine questions and evaluations during each subsequent appointment, continuing on to even the wellness checks for babies, motherhood mental health is consistently a topic of conversation, and rightfully so.
Maternal mental health is no longer a closet topic, but it is now a crucial part of total body care for mothers. While no system is perfect for detecting the early signs of mental health concerns in mothers, the increased focus and consistency in the evaluation of their mental health are helping to detect and diagnose mental health concerns earlier, and with more support for the mothers.
There are many companies and programs out there that put women and maternal mental health concerns first. By utilizing these companies and technologies, we are able to dive into the underserved world of maternal women’s health. Digital advances are able to connect mothers with the care they need when they need it, and in a manner that fits their lifestyle. Maternal mental health is an aspect of mental health that has a lot of potential to make a big impact, by tailoring care of this specific demographic with unique challenges that care make seeking care hard. There are many different layers to maternal mental health, and the new shifted focus to addressed mothers’ care needs will ultimately aid in increasing the overall health and happiness, not just of the mothers, but of family units as a whole. The capability of these digital tech innovations is immensely powerful in their ability to reach those who need care the most.
With so many mothers suffering from undiagnosed mental health concerns, and with such a large number of women vulnerable, combined with the lack of focus on their mental health care, new innovations are necessary. In keeping with the focus on the startups making an impact in the care world of maternal mental health, connecting mothers with the right companies and resources for them will make all the difference. There is an abundance of potential for many companies to make a positive impact on the lives of mothers everywhere. New companies and new digital tech are making their way into the behavioral health world, in conjunction with the Department of Health and Human Services, as well as the Health Resources and Research Administration. Below are some resources and companies focused on helping mothers to regain control of their mental health.
LunaJoy
LunaJoy is a virtual mental health company designated to holistic women’s mental health therapy, counseling, and medication management, for every phase of life. They specialize in anxiety, depression, loss and grief, menopause, maternal and reproductive mental health, infertility, birth trauma, and many more. LunaJoy also offers gene testing in order to better match mental health medication to your genetics. This is beneficial as it may give the LunaJoy providers insight into how each patient might react to the medication. They offer therapy, psychiatry, mental health coaching, and a 24/7 care navigation team.
For more information on LunaJoy, please click here.
HITLab’s Women’s Health Technology Challenge
HITLab’s WHT is the intersection of women’s health and technology. The program was founded in 2018 with the goal of inspiring and boosting technology initiatives that help to alleviate unmet needs in women’s health. Through this challenge, we are able to learn of new digital tech that is changing the way women receive care and learn of new forms of care that are offered.
For more information on HITLab’s WHT, click here.
Mammha
Mammha is a digital mental health company that partners with physicians for a mother’s mental health. It is a digital tool that can be used to evaluate and flag mothers who have a screening that comes back positive for mental health concerns. It is used as a screening tool that connects mothers with resources, doctors, support groups, and more. Patients initiate the screenings on their phones, with instant results. In-depth results are passed to the care team providers. If the results come back positive, they are connected with a care coordinator who connects them with the support they need.
Mammha was a pre-seed category winner in HITLab’s Women in Health Technology Challenge, in December 2021.
To learn more about Mammha, please click here.
NCMHEP
The US Department of Health and Human Services, National Child & Maternal Health Education Program (NCMHEP), works with maternal and child healthcare provider associations and federal agencies to identify key challenges in child and maternal health, review relevant research, and initiate educational activities that advance the knowledge base of the field, and improve the health of women and children. They know that maternal mental health matters and that depression and anxiety can happen during pregnancy and after birth. They discuss many of the signs of these conditions and discuss how to find the help you need.
Find out more here.
National Maternal Mental Health Hotline
The Health Resources and Services Administration, Maternal and Child Health offer the National Maternal Mental Health Hotline. It is a 24/7, free, confidential hotline for pregnant and new moms with counselors who speak English and Spanish and an interpreter service in 60 different languages. They offer support before, during, and after pregnancy. The hotline offers phone or text access to professional counselors, real-time support and information, information on resources and referrals to local and telehealth providers and support groups, and culturally sensitive support.
For more information, please click here.
Dr. Shawn Hersevoort is the national medical director for Foresight Mental Health. He is aiding in the development of their psychiatry division, focusing on mental health innovation, education, and program design. Foresight is changing the way they deliver care. Currently, they focus on group therapy but are expanding their psychiatry and NP divisions. They employ hundreds of therapists, dozens of NPs and PAs, but only a couple of psychiatrists who mostly fill leadership positions. The group is based in California, and they work mostly with commercial insurance, but they are trying to grow towards working with Medicare.
Foresight has a board vision, they live by their values, which include cultivating positive mental health transformation and transparency. They also aim to be intentional, inclusive, and proud.
Mental health care in the United States has succeeded and failed us. There are many lacking points that have led us down this path of insufficient care. When calling to mind our failures as a system, Dr. Hersevoort discusses the book, “ Healing: Our Path from Mental Illness to Mental Health”, by Thomas Insel. The book states that there is often a failure to choose evidence-based medications and psychotherapies and health approaches. Dr. Hersevoort feels that, in the field, we don't do what we know works. There are also fostered stigmas, not just within the field, but among each other. Care is not collaborative and often does not include data or technology in a way that is meaningful. He also states that there are some points that are evident where there is lacking technology that can progress care.
Even though there are many excellent treatment options available, outcomes still seem to be poor. Outcomes are maintained at this level based on that followthrough with how the care is provided. Dr. Hersevoort discusses the lack of push to follow evidence-based care, as also stated in the book, and that until we can move to follow those care recommendations, the outcomes will remain constant.
Integrated care is discussed in a similar manner to these concerns. One specific form of integrated care is collaborative care. There is a drive to know whether collaborative care is breaking down barriers or not. Dr. Hersevoort notes a quote that he has used for over a decade, that collaborative care is simply rediscovering the neck, meaning connecting the head to the body for total body care. He feels that if you want to treat diabetes, focus on treating depression, If you want to treat pain, treat anxiety, and if you want to treat focus, treat sleep instead. These connections go on and should be a large focus in collaborative care. He feels that the beauty of the collaborative care system is that it meets the patients where they are, it empowers the front-line healthcare workers, primary care providers, the OB guides, the hospitalists, the pediatricians, etc., in order to have the tools to work with these patients at the front.
Dr. Hersevoort is responsible for the handbook of a training textbook book that is used to help train primary healthcare providers on basic psychiatry, in the state of California, based out of UC Irvine and UC Davis. Now, there is an app version of the healthcare decision-making handbook called Call Psych, that is available to help providers to make decisions on psychiatric care. The motto for the app is fast, safe, and evidence-based. You enter the app and input the information, it tells you what the medication is, and how and when to use it. It will be a part of the Foresight methodology. Tying back to Foresight, they are currently working on an Integrated Care Division. The group already functions with a very holistic mindset, and this will continue to progress.
Dr. Hersevoort notes that we still need to focus on the data, like the tests and the labs, along with assessment tools and rating scales to help us know how to move patients in the right direction. He says that by focusing on those SMART goals, specific, measurable, achievable, accountable, and time-bound, we can form a treatment plan backed up by vitals and labs to move us forward.
Dr. Hersevoort informed us that Foresight is aimed at addressing quality by reimaging its dynamic. They are moving towards multidisciplinary teams, multi complimentary service lines that cover the whole mind-body spectrum, to ensure that the patient's needs are addressed. He assured us that all members of this team approach are important and that all members are needed for the patient to improve.
He notes that there are five pieces that are needed to help complete this total body care impact: medication, therapy, health psychology, case management, and education are all crucial to this team plan for care. There is also a need for special teams, which they are currently building up. Those teams specialize in psychosis and bipolar, complex anxiety, complex treatment-resistant depression, substance abuse, kids including teens and ADHD, complex medical including geriatric and cognitive, as well as the personality disorders team. The idea is that each of these teams will be led by a university-level psychiatrist, and then be comprised of prescribers, MDs, NPs, PAs, students, therapists, health psychologists, and social workers.
Now is where access comes into play, which is always a concern. Foresight is going to be accessible to these patients in steps, starting from getting them to the hospital, to exiting the hospital and entering IOP programs. From the completion of the IOP programs, patients can go back to standard care providers, or be placed into the care of one of the specialty teams.
The goals of these programs are to increase overall total body health. The push for these specialty teams and programs will be used in order to treat the patients better, as well as be able to use data from the actual patients in order to help tailor care as the patient progresses, and as the team's programs. Data is at the base of the new programs and can show the trend for the treatment progress, and overall progress of the patients. Foresight really has its mind on the future of mental health care, and technology is right by its side. There are many opportunities that we can continue to look out for from Foresight.
For more information on Foresight, click here.
Since May is Mental Health Awareness Month, it is a wonderful time to evaluate our own mental health and how our mental health is impacting our total body health.
Our mental health is tied to the overall success of our bodies, and being aware of changes or concerns that can be addressed early, can make a difference in a lifelong condition or a condition that impacts our whole lives. We know that mental health is important and has, luckily, become more of a focused topic of conversation in the last few years. Keeping this in mind, there are important total body health concerns that should be just as important. Many other diseases and illnesses can be tied to overall body health, mental health, mental acuity, and conative function. Alzheimer’s disease, though not a mental health disorder, does impact our mental health, and it can be impacted by our mental health.
The National Institute on Aging defines Alzheimer’s disease as a form of brain disorder that is a form of dementia that slowly destroys memory and thinking skills and even the body’s ability to perform simple tasks. Symptoms generally appear later in life and are considered the seventh leading cause of death in the US, as well as the leading cause of dementia in older adults.
The National Institute also says that there there are complex changes involved with Alzheimer’s disease, which can begin even a decade before the symptoms appear. Genes and genetic mutations may be the cause, but there are many factors. Initial damages impact the hippocampus and the entorhinal cortex, killing neurons as the brain begins to shrink. Damage done is permanent and leaves the brain tissue significantly shrunk. This impacts the patient’s ability to communicate, think, and maintain normal cognitive function.
While there is no cure for Alzheimer’s disease and current treatment aim to delay or prevent further decline, there are links between physical and mental health and Alzheimer’s. The National Institute of Aging says that physical activity, diet, cognitive training, and a combination of these are used as non-drug interventions. Focusing on helping people maintain their mental health and mental functions are used in combination with treating the underlying disease progression, as well as managing behavioral symptoms.
The National Institute of Aging states that while dementia and Alzheimer’s disease are not mental illnesses, they can be associated with mental disorders and psychotic disorders. There are links with earlier development of the disease in individuals with prior existing mental disorder diagnoses.
It is important to evaluate our own mental health, and looking for signs of change can make a huge impact on the early detection of diseases and illnesses like Alzheimer’s disease. Taking care of our physical health with dieting and exercising, in addition to focusing positive efforts to better our own mental health, are excellent steps in helping to support total body health. As we go throughout the month of May, take some time to focus on ourselves and our physical and mental health.
For more information on Alzheimer’s disease, click here.
For more information on the Nation Institute of Aging, click here.
It is an understatement to say that the mental health landscape has dramatically changed in the last five years.
Multiple companies valued at over a billion dollars have sprung up, our workforce has seen a massive shift towards virtualization, and care is thankfully more accessible than ever. Our landscape is filled with companies growing rapidly, seemingly in a race to scale, and the road ahead appears to be one of consolidation and competition between increasingly large players. As mental health companies gain more scale, power, and resources, how can we avoid losing sight of the ultimate goal — to translate these advantages into a more effective mental health system?
Here we could learn a lesson from the NBA’s move to add the three-point line.
In 1979, the NBA was a Goliath’s game, dominated by people who were 7 feet tall. From 1960 to 1979, 10 of the scoring champions were 7-footers and the majority of championship teams were built around centers. After a game is played thousands of times, competition points it in a certain direction — in this case, rewarding the tallest players who can shoot without fear of being blocked. A Goliath’s game, in my opinion, is no fun to watch — just pass the ball to the 7-footer and watch them do their thing. We appreciate the skill, but it’s hard to love a game where the little guy has no chance.
The NBA apparently agreed because in 1979, to make the game more exciting, it made a small change to the basis of competition: It introduced the three-point line for shooting from a farther distance. At first, nothing changed. Less than 1% of total shots made were three-pointers in the 1980 season. But over the next 30 years, the addition of a three-point line accelerated innovations in the way the game was played, things like pick-and-rolls, off-ball screens, stepback jumpers, and quick release shot techniques.
As a result, it became possible for smaller, less bouncy players like Steph Curry to score in ways that were not initially thought possible. In 2022, 15% of shots made in the NBA were three-pointers. And the bottom line for the NBA? More exciting games and soaring popularity for the league.
A seemingly small change to the basis of competition, combined with time and the power of innovation, can change the whole game. Human ingenuity is the most powerful resource we have, if only we let it thrive — in basketball, in healthcare, and in any industry.
Octave has been a relatively small player in the mental health industry, but we’re working to make a real impact — not by growing to be the biggest, but by fundamentally rethinking what drives the industry and how to better align interests so we can all move forward. We have pioneered value-based care in mental health, measuring outcomes in relationships with large payers for the last four years and served tens of thousands of patients already.
As a former healthcare venture investor and then head of strategy at One Medical, I experienced firsthand the rollout of value-based care in the primary care sector. Ultimately, what I witnessed was too many misaligned incentives between payers and providers, a check-the-box mentality applied to value, and rewarding of questionable outcomes measurement. Today, the sector still has a long way to go in truly delivering effective primary care.
In doing this work then and at Octave, I’ve come to conclude that we will not be successful alone. In order for us to really achieve our mission of providing more effective mental health care to more people, we in this space need to start thinking collaboratively, to advocate for shared interests and build shared infrastructure. For example, we believe that advocating for technology interoperability, common standards in outcomes measurement, and policy change will take shared action, not just smart competition. We will be meeting with leaders across the mental health landscape to help work on these common agenda items.
The recognition and demand for care is there, but there are still too many barriers to getting that care to people in the right way, at the right time. I hope that if we collectively can make the systemic changes as small and palatable as possible, we just might be able to change the way the game is played.
Sandeep Acharya is the co-founder and CEO of Octave, a modern mental health practice that’s creating a new standard for care delivery that’s both high-quality and accessible. With in-person and virtual clinics, Octave provides personalized, evidence-based therapy while pioneering relationships with payers to make care more affordable through insurance.
A veteran in healthcare strategy and investing, Acharya previously led strategy at One Medical, responsible for launching and scaling several new services and overseeing the growth of its employer business to over 1,000 companies. Before One Medical, he was an investor, operator and consultant in the healthcare, retail, and technology sectors at Bain & Co, Bain Capital & Insight Venture Partners. Sandeep holds degrees in computer science and business from Wharton and Harvard Business School, where he was a Baker Scholar. In 2015, he was spotlighted on LinkedIn’s Next Wave of top professionals 35 and under.
As Chief Business Officer — and as a woman who is incredibly passionate about transforming the way we provide healthcare today — I have the privilege of working closely on our delivery model designed for specialty care and partnering with an incredible team to build a seamless patient experience.
We all know how challenging it can be to fit taking care of our health into our day to day life. As a woman, a parent, and a working professional, I know firsthand how this burden often becomes heavier overtime and understand how difficult it is to find and schedule doctor's appointments between time at work and time with my kids. It shouldn't be that way, and it doesn't have to be.
Our specialized approach to treating chronic conditions is designed to support the unique needs of the patients we serve, when they need us. Whether patients come to us to treat chronic migraine or rosacea, or come to us for a better understanding of their reproductive care options, each offering provides specialist-level telemedicine, personalized treatment, and ongoing condition management for exceptional care. Delivering this level of high-quality care requires an understanding of the overlap of the conditions we treat — and this is exactly where we see the importance and impact of mental health. We now have mental health services available today, and we are actively treating thousands of patients. Here’s how we got there, starting with pilot programs on Cove and Nurx, focused on helping more women meet their health needs more holistically, conveniently, and with high-quality care.
Cove has helped tens of thousands of patients see improvements in healthcare utilization and quality of life after only three months of patients using the service. With Cove, we reduce the amount of time to deliver care to patients by 28 days, reduce emergency department and urgent care utilization by 55% and 46%, respectively, and improve the healthcare experience with an NPS score of 73. Cove also provides more equitable access to care for BIPOC patients looking to treat their migraine. While we deliver on our commitment to democratizing access to migraine care, we always knew a strong link existed between migraine and mental health. Research from the American Migraine Foundation shows people with migraine are five times more likely to develop depression than those without.
Similarly with Nurx, we knew women needed access to more holistic care offerings, especially in the midst of a complicated reproductive care landscape. We saw proof of this complexity when we saw a 300% increase in requests for emergency contraception last year amidst bans on abortion in over 10 states across the country. On top of that, more than 1 in 5 women in the United States experienced a mental health condition in the past year. Mental health care was the third most common reason women cited for accessing telehealth/telemedicine services, with 17% saying it was the primary purpose of their most recent telemedicine visit. It was clear women needed more options.
In the midst of these challenges, we brought ourselves back to our mission: How can we expand access to mental health for migraine patients that results in better outcomes? How can we expand access to mental health for women that is better than what’s being delivered today? Working alongside our Chief Medical Officer, Neil Parikh, and our medical experts across migraine, women’s health, and mental health, we developed Thirty Madison’s first mental health program to support patients with the level of specialty care they deserved. In 2022, we piloted programs across Cove and Nurx to deliver care specific to each patient base.
For Cove, our migraine specialists believed patients would benefit most from two different options: Cognitive Behavioral Therapy (CBT) and Coaching. With CBT, patients access a self-guided program uniquely tailored to migraine patients. At the completion of the pilot phase, patients had a 1.3 day reduction in monthly headache frequency, a 1.1 point reduction on the pain scale, and a 13% reduction in Migraine Disability Assessment (MIDAS) score. For the coaching program, patients were matched with a certified National Board for Health and Wellness Coach (NBHWC-certified) who provides asynchronous health services. Patients participated for 8 weeks at a time and shared their feedback: fewer headaches and a higher quality of life.
On Nurx, the mental health offering for women addressed moderate anxiety, depression, Seasonal Affective Disorder (SAD), as well as Premenstrual Dysphoric Disorder (PMDD), Postpartum and Menopause Depression. Patients received ongoing follow-ups from their provider to make sure their treatment was working for them.
As we do with every Thirty Madison brand, we placed patients and their safety at the center to ensure care is being delivered at the highest clinical quality. Medical experts worked closely with the product team to build a check-in experience in line with the best-in-class clinical practices. Frequent check-ins are held at a cadence determined by the provider and tailored to the patient based on their unique clinical needs for regular provider communication with patients.
Positive feedback from patients and early proof of improved outcomes, all led by a thoughtful, empathetic approach from our medical team, helped us feel confident in moving forward the full implementation of our mental health service offerings for Cove and Nurx. We meet patients where they are on their mental health care journey, offering a variety of appropriate clinically-backed treatment options and educating them along the way. We bring clinical excellence to everything we do, accounting for their current condition to develop a cohesive treatment plan needed to improve their overall health. Consider this scenario: a patient who initially came to us for birth control mentions that they have some symptoms of depression. Their provider can now direct them to our mental health offering to fill out the comprehensive intake and learn if mental health treatment is right for them. The result: a better patient experience where they can manage all of their care in one place by communicating with an integrated care team. This quote from a patient demonstrates the kind of feedback we’ve received since offering mental health: "I am very happy with my health plan as it has dramatically improved my depression and anxiety.”
We always knew access to mental health would be pivotal to providing the best-in-class ongoing condition management across our therapeutic areas, and would drive our mission to improving outcomes for patients, especially for the women who need it most. Now, we deliver that care for patients every day. Our integrated care model continues to provide a seamless experience that nearly 1 million patients have grown to love — and we know it’s because every single step is developed just for their unique healthcare journey.
Caroline Hofmann serves as Chief Business Officer at Thirty Madison. Thirty Madison exists to deliver on healthcare's biggest opportunities: access and affordability; patient outcomes; and patient experience. Each of its specialized brands is focused on specific chronic condition areas, and thoughtfully designed to support the unique needs of its community with personalized treatments and care. With empathy at the heart of its innovation, its proprietary care model empowers hundreds of thousands of people with ongoing conditions with the accessible, effective treatments across a lifetime of care. Learn more at ThirtyMadison.com, and find out more about our mental health offerings here with Cove and here with Nurx.
This is a relatively new understanding, but we do know that it is possible to have medicine that does not work with your genetic makeup. Luckily there are companies out there that evaluate your DNA and genetic makeup to help you utilize the right medication for your DNA. The possibilities are endless when it comes to this revolutionary advancement in medicine. This kind of testing is called pharmacogenetic testing and is clinically proven and offers genetic-based testing to help you gain an understanding of what medication may work best for you.
Our genetic makeup has been scientifically proven to be linked to how medications work for us. Every year people are injured or stop taking medication altogether due to side effects or lack of response to medications. Millions of dollars are lost to this chronic cycle of medication loss and poor response. By utilizing Genomind’s Innovative and Precision Health technology, we are able to unlock our body’s ability to respond to medication so that we can receive personalized treatment. This allows us to improve quality of life, reduce costs, and increase the overall satisfaction of our care.
Every year there are an estimated 3.2 million hospital and ER visits due to adverse drug events. This is the fourth leading cause of death in the US. More than 50% of our patients are non-adherent to medications due to side effects or lack of response to a medication. Over 528 billion dollars annually are spent on the wrong drugs and missed doses, incorrect regimens, and adverse drug interactions. Over 52% of all patient adverse drug reactions are deemed preventable. Only by using our gene structure to evaluate our medication response will we be able to cut down on these numbers and make a change for the better in our lives
Genomind is used from the healthcare provider side of medicine and can be used to manage medications for individual patients or large populations. It can also track and assess each patient’s genetics to personalize and correct dosing and medication choices.
Genesight psychotropic is a pharmacogenetic test that analyzes how your genes may affect medication outcomes. The Genesight test analyzes clinically important genetic variations in your DNA. The results from these kinds of tests can inform and assist your provider in how you break down or respond to certain medications that are often used to treat depression, anxiety, depression, ADHD, and other psychiatric conditions. The Genesight test must be ordered by doctors or nurse practitioners. The test is a simple cheek swab that is taken in your healthcare provider’s office. There is also the availability to take this test in the convenience of your own home.
There are many benefits to using pharmacogenetic testing. Genesight, when used in conjunction with your mental health provider, can potentially give you the best outcome for your genetic makeup and the medications that may work best for you. Their testing may allow you to avoid unnecessary medication use and may stop you from spending unnecessary money on medications that will not work for you or are potentially harmful to you.
Clarity X offers two forms of genetic testing that can be used to answer questions as to how your body will respond to mental health medications. The response also will recommend the best medications based on your genetic makeup. They also offer testing that will assess your genetic response in other areas of medicine as well, aside from mental health. These breakthroughs in genetic testing can help to keep patients safer and healthier and can help avoid the risk the medication waste, provider time waste, as well as patient time waste. Matching you with the right medication is simply better for everyone.
Inagene is a digital health company that offers personal testing kits to help you assess your genetic response to medication. They offer several different kits, which are called personal Insight tests. They will evaluate your genetic makeup and predict your responses to different medications used for pain or mental health conditions. These tests help to ensure any medication that you are prescribed for different medical conditions will be safe and effective for you as an individual.
Inagene takes a unique perspective on pharmacogenetic testing and puts the testing in your control, and allows you to assess which medications will or will not work for you. This company allows you to track and follow your genetic response and predictive responses to different medications.
May is Mental Health Awareness Month. Our lives are impacted each and every day by our mental health. Being vigilant about our mental health can positively impact our lives and how our lives impact others.
In recent years, mental health overall has taken a significant hit. Many struggles became widely known, political issues triggered additional anguish and mental health breakdowns, and civil unrest completely altered how many Americans view our nation and the health that can come from our whole body health care. Here are some ways to help get your mental health back into the swing of things during this month of awareness.
According to Mental Health America’s 2022 data, 19.86% of adults are experiencing a mental health illness, which is equivalent to about 50 million Americans. Approximately 4.91% of those are experiencing a severe mental health illness. In 2022, 7.74% of adults in America reported having a substance use disorder in the past year, 2.97% of adults in America reported having an illicit drug use disorder in the past year, and 5.71% of adults in America reported having an alcohol use disorder in the past year.
Mental health concerns are on the rise. There are many ways to get help or provide resources for others in need. There is only so much that we can handle on our own. Use this May to address your own mental health needs.
Taking time to evaluate the stressors we have in our lives can change how we view our lives. If there is room for even slight adjustments, this month is the perfect time to address them.
Review your daily life and see what can be done to help eliminate any small challenges that can be easily adjusted in order to better your overall mental health. Taking time to meditate or reflect is often a great starting point in evaluating our needs for mental health.
It is more commonplace now to discuss mental health concerns openly in any setting. It seems like everywhere we turn, someone is discussing their concerns. This does not mean that we are required to divulge every piece of information about our own mental health and our mental health struggles. If you feel comfortable sharing, great! Don’t let others force you to share what you don’t want to.
When bringing attention to our mental health, the best thing to do is to bring it up with our healthcare professionals. Taking to our primary care providers can be the great first step in getting the help we need.
There are many great digital options available now that can connect you with mental health experts quickly and on your own terms. Remember that the help you need can be as easy as downloading an app.
The digital mental health boom is happening right now, and there are many options for accessible and affordable care at your fingertips. Feel free to review different options first in order to find the best fit for you. Mental health help is not always one size fits all, but there are plenty of great options out there.
Keep these mental health resources in mind during this month. Even if the information isn't necessary for us, just knowing the information can help others.
For more statistics and information on mental health in America, click here.
For information on the Substance Abuse and Mental Health Services Administration (SAMHSA), click here.
For information on the National Alliance on Mental Health, click here.
For information on the Trevor Project, click here.
For information on the 988 Suicide & Crisis Lifeline, click here.
For information on the Veterans Crisis Line, click here.
For information on the National Institute of Mental Health, click here.
April is Sexual Assault Awareness Month, which is also known as SAAM. The National Sexual Violence Resource Center announced that this year’s focus is “Drawing Connections: Prevention Demands Equity.” The idea behind the campaign is to call on ourselves to change the systems surrounding us in order to build racial equity and respect. Sexual assault is a national problem that can create lifelong mental and behavioral health issues. There are many ways to incorporate equity into awareness and find resources to support those impacted by sexual assault.
Sexual assault is a worldwide concern. Aside from the assault itself, a significant issue with the attacks is the lack of reporting by the survivors. While there are numerous reasons why the survivors chose not to report, stigmas, fear of retaliation from the assaulter, and shame on the part of the survivor can all play a large part in someone’s choice to report a sexual assault. Preventing assault is a major part of sexual assault awareness. There are different companies, programs, and groups that are devoted to this prevention that has impacted so many lives.
In order for prevention to be effective, there needs to be equity in all aspects of sexual assault prevention. Access needs to be available to prevention services and resources. All people who report assault should be met with the same level of respect, understanding, and care, regardless of race, background, culture, gender, or socioeconomic status. Many survivors reported that they chose not to report because they felt that they would not be believed about the assault or that their report would not be respected. Many also feel that, by reporting, they would be opening themselves up to others knowing of the assault.
Several companies out there are dedicated to helping the survivors. Many of these companies offer trauma care, healing services, and a community of understanding. There are many options available for virtual care to meet the survivor’s needs, when, where, and how they want.
Workplaces are taking steps to prevent sexual assaults. Many workplaces require some form of sexual assault and sexual harassment training to occur on a somewhat routine basis. This training can be offered in a handful of ways, ranging from individual courses on the internet or through work-based intranets to personal one on one training with managers or HR, in group settings, and even company-wide training.
Higher education systems are taking significant leaps toward prevention as well as survivor support. Many US colleges and universities participate in programs that can help them report assaults, prevent sexual violence, and provide information to survivors. These systems often work with different companies or programs to spread awareness, show survivor support, and allow others to learn about prevention techniques and reporting tactics.
Healthcare facilities often will have flyers in bathrooms, exam rooms, and waiting rooms with information about sexual assault awareness. These ads and flyers can be helpful for anyone who does not know where to start when it comes to reporting or is looking for information to support survivors. Healthcare facilities are also where they can report sexual assault and be evaluated.
Leda Health is a company that was built by survivors, for survivors. They work with a variety of survivors, largely working with student survivors. Their mission is to better help survivors, their loved ones, and the communities where they live. They work to change the landscape of sexual assault prevention, care, and healing. They want to be able to work with legislators to empower survivors with additional resources.
Leda views sexual health through the eyes of a survivor-focused lens. They have developed resources such as self-administered DNA collection and sexual health texting in order to meet each survivor’s needs.
For more information on Leda Health, click here.
Nema offers medical treatments for trauma survivors with PTSD. They have therapists focusing on women’s mental health, sexual trauma, gender-based violence, LGBTQ+-focused therapy, and PTSD. Their therapists meet with patients over a virtual care center that empowers them to experience the best therapy for PTSD from the comfort and privacy of their own homes.
For information on Nema Health, click here.
The Rape, Abuse & Incest National Network is the largest anti-sexual violence organization in the nation. They created and operate the national sexual assault hotline, 800-656-HOPE, in conjunction with sexual assault service providers across the county and operate the DoD Safe Helpline for the Department of Defense. They also offer many programs on prevention and survivor help and ensure perpetrators are brought to justice.
Many companies are stepping up, not only to help the survivors directly but also to make policy changes and legislation to help protect their rights and prevent equity inequality.
For more information on the National Sexual Violence Resource Center and National Sexual Assault Awareness Month, click here.
Behavioral health care is a rising concern, as is specific care for different behavioral health illnesses and disorders. Autism Spectrum Disorder is no different. There are many new startups on the horizon aimed at the diagnosis, treatment, and access to care for the disorder. See what these five companies have to offer in the ways of access to care and what they can do for those with autism.
Elemy focuses on helping to give the best support for children diagnosed with autism, as well as other behavioral health disorders. They do their part to connect families with care through technology. They offer access to therapists through proven treatments and AI-powered technologies.
They use a whole-child care model that helps children succeed. They use a multidisciplinary clinical team that specializes in the entirety of childhood behavioral health. They can help to evaluate, diagnose, and build a holistic care plan, which they personalize to each child’s need. They support them every step of the way. They also promote better interaction between the care support team, the child, and their families.
Akili focuses on determining the root cause of cognitive impairment. They are creating personalized digital therapeutics engineered to improve cognitive impairments directly. The medicines and treatments are powered through decades of neuroscience and built with proprietary technology developed to target and treat cognitive impairments at the course. Each treatment is specifically designed for each patient to meet their individual needs. This tech-driven company is changing how healthcare and treatment are delivered, which looks and feels like a videogame.
Axial connects the microbiome and neurology to improve lives. They are a leader in the biological role of the microbiome-gut-brain axis and its impact on neurological conditions. The company is uniquely positioned to advance a structurally differentiated therapeutic approach for the treatment of neurological diseases and disorders. Their programs are focused on the treatment of irritability in autism.
EarliTech uses clinically validated measures to create novel technologies that enable parents and providers to know where the child lies on the spectrum in order to tailor their treatment for the best personal outcome. They are working towards making early identification and the treatment of autism and related disorders more easily accessible to children everywhere.
Springtide is an integrated, evidence-based autism center that seeks to transform the way families receive care. They offer personalized treatment plans for children 2-18 years old with autism. Their interdisciplinary team of specialists coordinates daily to track and help each child succeed.
They focus on developing skills, maximizing the child’s learning potential, and integrative, team-based treatment. They also partner with families with parent support groups, parent coaching, care navigation, and extended hour to match families’ schedules.
The industry is in desperate need of support to meet the dramatic rise in people needing mental health care. We are grappling with a shortage of providers—Massachusetts ranks the best at 150 patients per clinician and Alabama most in need with a whopping 920 patients needing care for each active provider. These disparities are only growing. Thirty-three (33) percent of adults report symptoms of anxiety and depression, up from 11% pre-pandemic, according to a report by the Association of American Medical Colleges. Patients fortunate enough to access care then face a relatively inefficient, one-size-fits-all approach to mental healthcare where only approximately 50% of patients recover. This isn’t good enough.
We need to do more.
Dr. Jodi Prohofsky explains how ieso is learning from data and leveraging the latest technologies to eliminate guesswork and expedite recovery.
ieso has provided high-quality evidence-based outpatient mental healthcare to more than 100,000 patients in the UK. At each visit, patients and therapists communicate via typed conversation; patients also complete standard and diagnosis-specific mental health assessments.
Because we capture (with permission) the exchange between a therapist and couple it with session-by-session progress measures, ieso has a globally unique, de-identified dataset that we analyze to increase the quality and effectiveness of therapy. This enhances our understanding of what works for whom at a large scale - a huge leap forward from traditional psychology studies that often include a few hundred patients.
ieso is using natural language processing and data science techniques to analyze the dataset of over 600,000 treatment sessions and discover fundamental insights into the effectiveness of different elements of psychotherapy. For example, we can quantify the strength of the association between clinical content, such as a mood check or implementation of a change mechanism, and clinical outcomes. ieso has also learned how patient language and therapist variables are associated with clinical outcomes.
One of the many challenges therapists face is that every patient is different. How much easier would their jobs be if each person who came in had the same psychosocial stressors and lifestyle choices, experienced the same symptoms, and described those symptoms in the same language?
Consider this example: Two individuals come to a therapist with very different symptom profiles. One talks about how she cannot get out of bed, cannot complete her daily activities, has lost her appetite, and has unintentionally lost a significant amount of weight. The other is still going to work and continuing his day-to-day, but is irritable, has self-esteem issues and trouble concentrating, and his performance at work is suffering. They are both diagnosed with depression but to think that they should get the same treatment based on the same diagnosis just does not make sense.
People need personalized care.
Therapy for each patient can be personalized to their individual symptoms, if (in part) the specific subtypes of mental health conditions can be identified.
So, at ieso we set out to see if our dataset could be used to do this. This resulted in ground-breaking research, completed in partnership with the University of Sheffield, which identified five broad subtypes of depression, along with 14 depressive states characterized by distinct symptom profiles. Through mining and analyzing a combination of ieso and broader healthcare system data, the team was able to determine how each subtype responds to treatment.
This study was the first to demonstrate conclusive evidence of the existence of different dimensions and subtypes in depressive symptoms. This discovery has laid the foundations for changing the way we characterize and treat depression, significantly improving outcomes for patients, and driving efficiencies for service providers.
The era of one-size-fits-all therapy for depression is over.
Using data responsibly and effectively can help patients get better more quickly and can free capacity for more patients - an important step in improving access to mental healthcare as demand grows. At ieso, we’re committed to using our knowledge and research to create scalable, highly personalized, digital solutions that help prevent, treat, and manage mental health conditions so individuals can live fulfilled lives.
ieso is partnering with U.S. health plans, healthcare systems and payer partners to develop, deploy and deliver clinically validated, digital therapies for the treatment of a range of mental and behavioral health conditions. Learn more by meeting Jodi and the team at HIMSS ’23 this spring, AHIP 2023 this summer, or at the first in-person GD:BHT Annual Summit 2023 this fall. To arrange a meeting, email events@iesohealth.com.
Dr. Jodi Prohofsky is ieso’s US Chief Operating Officer and is responsible for helping forge new partnerships as they continue their expansion into the US. She is also tasked with ieso’s US clinical, operational and administrative functions. A qualified therapist and published academic, Jodi began her career with Cigna in 1992 as a line clinician before working her way up to SVP of their Clinical Operations. She has since held further senior leadership roles in the healthcare industry, notably at Bloom Health, Magellan Health, and Walmart, before joining ieso in 2022.
Valera Health is honored to announce accreditation in Credentialing and Recredentialing by the National Committee for Quality Assurance (NCQA). Valera Health is a leading behavioral healthcare practice that provides comprehensive, longitudinal care delivered through a team-based care model of coaches, therapists and physicians augmented by proprietary digital technology and analytics. From therapy to medication management, patients with mild depression to schizophrenia are treated with expert care.
Quality measurement in healthcare is critical in the management of clinical processes, outcomes, patient preferences, and implementation of systems changes. Quality experts, Federal agencies and consumers want effective, safe, efficient, patient-centered, equitable, and timely care. While physical medicine has clearly defined outcomes such as fasting glucose measurements and blood pressure, measurable outcomes in behavioral health have been more elusive.
As a former staff member who worked on the development of the Affordable Care Act on the Ways and Means Committee, I had a bird’s eye view as Accountable Care Organizations were launched by CMS to focus on well-defined metrics of quality. The stewards of quality measurement, like the National Quality Forum (NQF) and National Committee for Quality Assurance (NCQA), have made significant progress on improving the national inventory of mental health quality measures using EMR and claims datasets that can capture both process and patient-reported outcomes.
Valera Health’s foundation is built on this premise of measurable quality. The broader ecosystem, including health plans, quality experts, patients, providers and policymakers, needs to collaborate on redefining quality as it continues on the path of value-based models.
The next generation of mental health organizations will require three competencies to be well-positioned to drive high-quality care in this new paradigm:
Perceptions of healthcare quality vary widely by stakeholder. While patients may prioritize convenience and access, clinicians may focus more on ensuring the right care team for a given patient. Accrediting organizations like NCQA, on the other hand, may evaluate quality based on overall outcomes across a panel, while insurers may try to quantify process improvement. Given the complex interfaces between these stakeholders, thorough quality measurement includes not only outcomes but also the processes by which care is delivered.
This is especially true given the disproportionate impact the process of receiving care has on a patient’s experience. For example, following up with a patient after a positive screening or a discharge from an inpatient stay is an example of a process measure that is both within the control of a provider organization and associated with improved outcomes.
Process metrics tend to be most actionable on a day-to-day basis and should ideally provide leading indicators of at-risk patients. Moreover, choosing appropriate process metrics is critical for converting the enormous amounts of data generated by telemental health services into valuable insights that can drive the outcome that matters most to the patient: “am I feeling better?”
Valera Health’s hyper focus on high-quality requires capturing a mix of process and outcome measures.
It is the outcome measures, though, that ultimately are most important in providing an overall picture of patient health. For this picture to be clear requires communication across care settings, locations, and organizations.
Building these communication channels is a long-term journey that involves a constant stream of data being shared with and captured from the provider network, care managers, and anyone else on the care team. Valera Health utilizes a team approach in the delivery of care to high and moderate acuity individuals.
We facilitate a feedback loop by using one electronic medical record and one digital platform system that measures patient-reported outcomes at various intervals. Organizations with limited longitudinality of care will struggle to improve outcomes for individual patients as well as to improve their own care processes more generally.
At Valera Health, expanding access to care is a guiding principle; for an organization to continually improve its quality over time, it must expand the types of conditions it treats and patients it serves. In mental health, for example, while many organizations can manage care for a patient with mild anxiety, there are far fewer that are equipped to address serious mental illness in an evidence-based way at scale.
For these higher acuity patients, the use of clinically validated assessments over time provides critical insights to clinical effectiveness of treatment. For example, antipsychotic medications over time may increase weight gain for certain individuals; Can we identify this trend and intervene early?
Delivering truly high quality care requires having the capacity to collect data from providers and patients. It also requires actively staying up to date on the latest national standards and most recent research, and incorporating them into quality measurement and improvement efforts.
Behavioral health organizations best positioned to continue elevating the quality bar share three characteristics: an emphasis on process as well as outcomes measurement, ability to provide a feedback loop to their network providers, and incorporating new data, research and standards to elevate practice.
The National Quality Forum almost two decades ago had created a group of experts called the “Gretzy group” to develop a national strategy in creating measures that matter. My hope is that patients, health plans and providers along with organizations like NQF and NCQA can re-invigorate a collaborative effort to create robust measures that matter.
Article written by Dr. Thomas Tsang, MD, MPH, Co-Founder & CEO of Valera Health.
1 Muench J, Hamer AM. Adverse effects of antipsychotic medications. Am Fam Physician. 2010 Mar 1;81(5):617-22. PMID: 20187598
As we progress into an entirely virtual and digitally tech-driven society, some significant adjustments still need to be addressed. Crisis intervention is a critical interjection for a person who has an emergent mental health concern. While the reasoning behind these crises can vary, one thing remains constant.
As a nation, we are making great strides toward the future success of our citizens. Everything we could possibly want or need is available in some virtual or digital form, each having various levels and stages of interaction. Many things can be done now without having to set foot in an office setting or scheduling appointments months in advance. Waiting in lines has also seemed to become a thing of the past in many aspects of our lives with the capability of virtual ordering off of websites and with restaurants.
This change has also started to impact the way we provide our healthcare, with the new offerings of virtual healthcare appointments, prescriptions management, as well as some diagnostic testing and test result delivery. Mental health has had a significant leap toward the digital age with the increased offering of behavioral health care–right from our phones and computers. Numerous, and with a growing number, companies are starting to offer virtual platforms focused solely on behavioral health. There are so many different platforms that can help meet the needs we have for the care we want and deserve.
Recently, the Suicide Helpline has even changed its’ phone number in order to make it more accessible and easier to remember. This was a significant step forward as the new 988 crisis phone number is easier to remember and be directed to in an emergency. While this is a step in the right direction, some crisis still requires medical intervention. What if this is not possible for some people? Not everyone has the capability to get to a care center in an emergency. There is a growing need for a virtual crisis intervention to step in where the 988 number cannot. The need for a virtual crisis team would have doctors and crisis workers ready to step in when needed.
We continuously hear about how the Covid-19 pandemic changed everything and reverted so many years of progress. One major aspect of healthcare seemed to flourish: the behavioral health field. Through the power of digital technology, this field has received a much-needed boost, with advances in the field, diagnostic tools, treatment, and accessibility. It is now much more common to hear individuals and providers discussing behavioral health treatment.
Treatment accessibility continues to plague the healthcare field, especially when it comes to behavioral health and, subsequently, behavioral health crisis care. There is still a limited number of behavioral health providers that are available in person at local hospitals or in combination with health care facilities, which can make obtaining care in a crisis tricky. Rural areas continue to make the list of areas with inaccessible care, as well as care for those with mobility issues or other physical blockers. There need to be options for those who cannot seek the care they need when they are in the most need. Many patients have had issues with unnecessary emergency room visits that were not equipped to handle their care needs or waiting for beds for those who need immediate care when in a crisis. This is where the need for virtual crisis care can come into play. Many more people would be able to receive the care that they require if there were more options available for immediate behavioral or suicide crisis care.
With the growing need for virtual crisis care so prominent, many companies are stepping up. There are some companies that have recently announced their entrance into the virtual crisis field. These companies are already leaders in the virtual behavioral healthcare field and are taking a stand to help support their clients in the best ways that they can.
In December of 2022, Brightside announced Crisis Care, a national telehealth program for treating individuals with elevated suicide risk. Their focus is on helping to prevent avoidable and unnecessary ER visits, which can risk lives and increase healthcare costs. This option will be available nationwide once it rolls out.
Array Behavioral Care announced in January 2023, in collaboration with CVS Health, will allow them to expand their care to a more on-demand availability in order to help ease the burden of emergency rooms nationwide. On-demand care is a huge benefit for these types of mental health emergencies.
There are constantly new companies adding digital behavioral health and behavioral health tech innovations to the market. The influx of so many new ideas creates competition for these companies to be bigger and better than the ones before them. It also provides a platform for groundbreaking and innovative new technology to meet the growing needs of this once otherwise ignored field of medicine.
There is hope for the future of behavioral health care in the ever-changing and endlessly evolving digital technology. With many companies creating and adopting virtual care for behavioral health, it is only a matter of time before these companies begin to offer a wide range of virtual crisis care management.
The change in the 988 phone number was just the tip of the iceberg for immediate mental health crisis assistance. There is so much more that we can do and so much more to be done. We need more companies like Brightside and Array to step up and help to fill this crisis intervention care gap. With all the increased number of mental health providers, we have the opportunity to continue to make major positive impacts on those patients who need care the most. Are we up for the challenge?
For more on Brightside’s innovation, please click here.
For more on Array’s innovation, please click here.
Take time this February to focus on cancer prevention
We can choose to devote our time to many different things each day, week and month throughout the year. It never seems like we have enough time in our day even for the basics. However, our health deserves a tuneup, even when we know our plates are overloaded.
Cancer can have a major impact on our mental health while impacting the rest of the body. By staying prepared and working with ourselves and our healthcare teams, we can possibly prevent cancer and the mental health stressors associated with the illness. Tying our prevention efforts to our focus on our own mental health can have positive impacts on our overall health and wellness. By working to prevent illness, we can also benefit mentally. If our bodies are cared for physically, we can focus our efforts on our mental health needs.
We spoke with the professionals at Iris by OncoHealth about the emotional toll that cancer can have on us and a care platform that can support people with cancer.
Iris by OncoHealth is a digital care platform that provides supportive care via smartphone to people with cancer, including the ability to speak with oncology nurses 24/7 and to meet with oncology-trained mental health therapists.
“We created Iris because there are huge unmet needs among people with cancer, especially when it comes to mental health and finding a therapist with oncology expertise,” said Andrew Norden, MD, MPH, MBA, Chief Medical Officer, OncoHealth, and an accomplished board-certified neuro-oncologist.
“The emotional ‘side effects’ of cancer can be as difficult as the physical side effects. Biological, psychological, and social challenges contribute to cancer-related distress,” said Karen Fasciano, Psy.D., Mental Health Clinical Director, Iris by OncoHealth.
Other quotes from Karen Fasciano, Psy.D., Mental Health Clinical Director, Iris by OncoHealth:
Oncology mental health professionals can help patients to process and cope with emotions, adjust to illness, build resilience, and access effective treatments to address the emotional impact of cancer.
A cancer diagnosis can bring uncertainty and change and often requires building on existing strengths and developing new skills for managing emotions and relationships. Oncology mental health clinicians partner with individuals and families to help navigate these changes and build resiliency. Attending to the emotional side effects of cancer is crucial. Asking for support is a sign of strength.
The process of coping with changes and emotions related to cancer is dynamic. Coping is not a one-time event and rarely does a single attempt to cope work. Coping is ongoing and develops and unfolds during cancer treatment as new situations, information, or feelings arise.
Coping with cancer can feel like being on a boat at sea. Sailboats are built to navigate through the uncertainty of the weather, tides, land, and other obstacles. They’re resilient, adapting to forces outside their control. Sails can be pulled in or let out, and the rudder changes direction. You can shift your sails, invite others to join you, and change your direction using the rudder as you cope with unwanted illness.
Cancer Prevention
The Simplest Means
Here are a few things that you can do to be proactive about your health and prevent cancer.
One of the simplest ways to reduce our risk of cancer is to eat right. This may not always seem easy, especially when fast and convenient options are sometimes less expensive and can be ready on demand instead of having time to plan and prepare a meal. Ensuring we have a well-balanced diet filled with vitamins, minerals, and the proteins our body needs can significantly reduce our chances of certain cancers. Properly hydrating our bodies with water is a large part of eating right. Certain cancers can be triggered by the additives in the foods and drinks we consume. Keep in mind that eating right is better for our bodies in many ways.
Another important aspect of our overall health and cancer prevention is to give our health a checkup. By having routine visits with your family healthcare provider, you can alert them whenever there is a new concern for your health. Remember that healthcare providers are on your team in the fight against cancer.
If you have a new lump or bump or feel that something just doesn’t seem right, make time to see your healthcare provider. Monthly self-checks can help this measure, as the more you know about your own body, the more likely you are to catch on when something is amiss.
It is important to check yourself monthly for new or changing moles, lumps in breast tissue, armpits, and around the groin, and any abnormal bleeding, swelling, or tenderness. These issues would prompt a visit sooner than your normal annual visit.
Watching what we put into our bodies can greatly reduce the risk of certain forms of cancer. Reducing and stopping the use of cigarettes, tobacco, and nicotine products lowers the risk of oral cancers and lung cancers. Lowering your alcohol intake level also may reduce your risk of certain types of cancers.
Lowering sodium and sugar intake is another important part of cancer prevention. This goes along with eating smart, but they are major contributors to an overall unhealthy lifestyle that can increase your risk of cancer.
It is best to be physically active, if possible, in order to best reduce your risk of certain types of cancer. Being physically active can also help to keep you at a healthy weight, which in turn, also lowers your risk of cancer. Be sure that any physical activity is approved by your physician before trying something new or particularly challenging. Your healthcare provider will be able to recommend appropriate physical activity for you.
Being active can help us to maintain a healthier lifestyle and body weight. Lower body weight can help to reduce the risk of certain forms of cancer. Lowering your BMI and staying active is part of the recipe for cancer prevention.
Sunscreen is one of the easiest and most important parts of skin cancer prevention. Anyone and everyone should be wearing some form of sunscreen or skin barrier when exposed to the sun. Wide-brimmed hats and UV protective clothing are also recommended to help with skin cancer prevention, alongside the use of sunscreen. Babies and children are especially vulnerable to the sun’s damaging rays. Make sure to lather those kiddos up when they have sun exposure. Sunglasses are also important to help protect the eyes from sun damage.
For more information on the American Institute for Cancer Research’s recommendation for cancer prevention, please click here.
For more information Centers for Disease Control and Prevention’s recommendations for skin cancer prevention, please click here.
Our understanding of contributors to mental health—not just the symptoms but the emotional, physical, and environmental causes—has grown exponentially over the past 30 or so years, from the impact of diet and exercise to the myriad social determinants of health. The evolution of care delivery, however, hasn’t kept pace. This results in missed opportunities to help more people more effectively.
This isn’t to say treatment has remained stagnant. Modalities have evolved in recent decades—EMD, group therapy, telehealth, etc. But care is still centered on the 50-minute, face-to-face session and/or medications—a model that is prohibitively expensive for some and logistically challenging for most. This approach also leaves patients completely on their own for the days and weeks between sessions.
At the same time, demand for care has exploded since the start of the Covid pandemic and shows no signs of slowing. At the very least, there is a need and perhaps even obligation to figure out how to scale care to more people without diluting efficacy. But what if we could both scale care and improve outcomes for the vast majority of those in need of support?
We can. Here’s how.
Real life—and the friction of incorporating change—happens between scheduled sessions. Don’t leave people on their own here. Give them continuous access to therapists to speed up and lock in change.
At the same time, decouple support from the time-intensive model of weekly hour-long sessions. With asynchronous and chat-based models, therapists are able to deliver more frequent and more targeted support in far less time, which frees them up to help more patients.
This both improves outcomes and reduces costs. Traditionally, therapists are able to support between 20 and 50 patients at any given time. In the Meru Health model, which offers four traditional face-to-face video calls plus unlimited asynchronous text support, panel size is up to 150 patients. That’s an increase of 300% to 750%.
The world is catching up to the physical inputs of mental health, from the established connections to diet and exercise to emerging science around simple breath. For example, a 2023 study in the journal Cell Reports Medicine, led by Stanford neuroscientists, found that cyclic breathing exercises are more effective than mindfulness practices at reducing stress.
In our research at Meru Health, we’ve found that our program-specific HRV biofeedback breathing practices increase the likelihood that participants will achieve clinically meaningful reductions in symptoms of depression and/or anxiety.
Mental health care providers have an opportunity, if not an obligation, to evolve treatment models along with the science to better address the entire ecosystem of mental health.
On the note of research, only about 3% of mental health apps are clinically validated. In simple terms, there’s a lot of digital junk out there peddling junk science. If you’re building new models of mental health care without establishing that they work and how they work, you’re doing a huge disservice to those who need care and those who want to provide it.
Since our founding, we’ve contributed to the published research on digital mental health, HRV biofeedback, and long-term outcomes of various behavioral health interventions. Our independent and peer-reviewed publications cover research we’ve done with independent institutions like Stanford and Harvard. And we’ve even taken the additional step of having our outcomes independently verified by the third-party Validation Institute.
Culture can be what defines us and helps shape our individual personalities, our family dynamics, and our ability to exist in our communities. Hurdle knows just how important culture is and makes sure to put it at the forefront of their care. They have dedicated therapists who are there to support you and have the ability to understand your needs through their culturally intentional care model. They are particularly aware that culturally intentional care is immensely important for often neglected communities like minoritized racial, ethnic, and cultural groups, as well as BIPOC and LGBTQIA+. Their care model meets the needs of diverse populations with attention to proper mental health care that has been historically neglected.
Hurdle utilizes a measure-based care model that allows for an evaluation of the patient’s symptoms before an encounter in order to inform of the behavioral health treatment. Although this form of care is heavily underutilized, measure-based care continues to demonstrate the ability to increase the outcome of the patient’s care. Their hope is to make a significant impact on those patients in culturally diverse communities who experience mental health concerns.
Hurdle has been working on a white paper outlining the importance of virtually intentional healthcare and the significant impact it has on the people seeking their mental health services. The white paper states, “Hurdle’s training model shifts the paradigm from the traditional therapeutic approach. We incorporate a multicultural framework that relies upon building new culturally-intentional skills to ensure that therapists are trained to exhibit cultural humility and engage in authentic discussions with members regarding their racial, ethnic, as well as cultural concerns”. It also states that they incorporate a multicultural framework that focuses on building new skills that are culturally intentional to ensure that their therapists are trained in cultural humanity and engage with members in conversations surrounding their racial, ethnic, and cultural concerns.
Hurdle claims that they have a higher retention rate of their patients and that their patients are more engaged and satisfied with their providers. Their data continues to show a positive change in their patients from their initial screening to their follow-up assessments. They have excellent rates of improvement with these patients who have mild anxiety or worse, as well as those with mild depression or worse. A significant number of these patients saw a significant clinical improvement in their symptoms.
Hurdle also incorporates a patient reporting tool that is used to evaluate the level of cultural intentionality of their providers. Again, a significant percentage of their patients state that their providers gave them the opportunity to explore how their race, ethnicity, and culture impact their lives. Their patients also agree that the provider’s willingness to discuss those impacts aided in building better relationships based on openness between patient and provider.
This care model is proving to provide a better connection with patients and their individual therapies, as well as their ability to cope and show positive progress in the reduction of their symptoms. The evidence from their data supports the idea that Hurdle’s culturally intentional care model positively impacts their patients’ lives and is continuously proving to provide a safe and reliable outlet for those patients of the often neglected communities of the racial, cultural, or LGBTQIA+ diverse. With such strong data supporting their work, the expansion of this care model is inevitable. Hurdle is pushing back against the boundaries that have negatively impacted these diversified communities.
For more information on Hurdle’s work and their white paper release, click here.
Here are five start-up companies focused on couples therapy.
With so many options available for individual and family psychotherapy, it can be hard to know where to start when you and your partner are looking for a provider specializing in couples therapy. These start-ups are a great place to look.
OURS was founded in 2020 and aimed to build better, stronger relationships for couples. With the assistance of technology, their approach combines the insight and human touch of a guide, with the delight and insights of technology, which helps to create a life-changing experience.
They use six pillars to aid the OURS experience: structure, expertise, education, time together, and community.
For more information on OURS, click here.
Ritual is a company aimed at navigating your relationship challenges individually so that you can grow together within your relationship. They want to help you build a better you so you can be your best self in the relationship.
They utilize weekly videos with tested knowledge and exercises focused on your specific needs and goals. There are also activities and journal prompts to help increase self-awareness.
For more information on Ritual, click here.
The Gottman Institute helps to build the foundation for a lifetime of love with research-based tools and resources. They have over 40 years of research with more than 3,000 couples. They offer therapy, webinars, private couples retreats, and much more. While they focus on couples, they also provide services for parents and single people.
For more information on The Gottman Institute, click here.
Pride Counseling is a great company for couples in LGBTQIA+ relationships. All of Pride Counseling’s professionals specialize in LGBTQIA+ concerns and are licensed therapists, psychologists, counselors, or social workers. Whether you are struggling with mental health issues, your identity, or just need someone to talk to, they believe help should be accessible to everyone.
For more information on Pride Counseling, click here.
Talkspace is a company that caters to everyone but has dedicated couples counselors and can be helpful for those with a busy schedule. Talkspace uses a personality assessment to effectively match you with a provider that best fits the needs our you and your relationship. They can help identify issues, rediscover strengths, work through dysfunctional dynamics, and restore trust, all with ongoing support.
For more information on Talkspace, click here.
Prentice Tom, CMO at Kintsugi - the AI-backed startup that can detect signs of depression and anxiety just by listening to short clips of speech
A new report by Mental Health America (MHA) states that over 50 million Americans are currently experiencing mental health conditions. These individuals span all walks of life, from young people dealing with climate anxiety or the adverse effects of social media to the impact of chronic disease and the loneliness epidemic’s toll on the elderly.
The worst part is that most of these people suffer in silence. Stigma and fear of judgment still sadly prevent many from seeking help. When patients don't speak up, it's difficult for their healthcare providers to know they are struggling. Primary care physicians correctly detect mental health conditions just 47% of the time and are likely to note them down only 33% of the time. As a result, mental illnesses are one of the most underdiagnosed conditions in medicine, and an estimated 60% of people who suffer from mental health conditions never receive treatment.
Screening for mental health conditions needs to be included as part of every primary care visit. In fact, the US preventive task force recently mandated that all patients under 65 should receive depression and anxiety screenings. In addition, hospitals routinely monitor physical conditions, like blood pressure, weight, and temperature, so why not a patient's mental health?
The reality is that mental health evaluation has traditionally been as much art as science. It is an area with few objective and quantitative tools available to the clinician to assess the presence of disease.
Existing screening processes are time-consuming, cumbersome, and rely on paper-based forms that can take up to 15 minutes per patient to complete. As a result, depression screenings take place in less than 5% of primary care interactions.
Mental health conditions also tend to lack measurable indicators of disease, known as biomarkers. For example, paper-based tests screen for depression and anxiety based on the patient's self-reported experience. However, true biomarkers are more objective and quantifiable. One of the best-known examples is a high blood glucose level, which helps clinicians detect diabetes and determine its severity.
Despite the very real symptoms that patients experience, the medical field tends to ignore health conditions that are difficult to measure, like long covid or chronic fatigue syndrome. As a result, it can take many people suffering from these conditions before they are officially recognized. For individuals, it can take years and numerous visits to healthcare professionals before they receive the correct diagnosis.
A mental health diagnostic tool that is objective and easy to use has been lacking until now; this is where voice biomarkers come in. Using voice biomarkers as a diagnostic tool is not a recent discovery. Scientific papers dating back to the 1970s describe the subtle vocal indicators of these health conditions, including reduced range of pitch and volume and more pauses in speech.
Advances in computational power and artificial intelligence have enabled us to turn this academic knowledge into a diagnostic tool that can seamlessly integrate into clinical workflows. For example, while seeing their doctor, patients can simply speak into their phone or recording device. Kintsugi’s voice biomarker technology can determine how depressed or anxious a patient is in real-time, helping clinicians ensure their patients receive the proper support in their moment of need.
In addition, voice biomarkers are extremely accurate at detecting the presence of disease – much more so than just talking to people. Even when people are trying to hide it, or it's buried in their emotional state at that time, we can still pull out the psychiatric pathology from certain voice characteristics.
The implications of this tech are huge: not only for healthcare systems, which can use it to gain a 360-degree view of a population's mental health but also for individuals, who can better assess their mental wellness and take action to promote it. In both cases, users are alerted about lapses in mental health no matter how “mild” they may seem. These early stages of mental distress are when we should be taking action.
Kintsugi is bringing diagnostic precision to mental health, helping to elevate it to the same status as our physical health. The result is a scalable, quantifiable, reproducible, and non-invasive tool that can screen every individual in the US for mental health conditions.
In addition to embedding into routine physical wellness exams, voice biomarker technology can assist in telehealth and call centers. Telehealth is increasingly becoming a vital healthcare touchpoint for the most vulnerable populations – such as people with disabilities or those living in rural areas – who cannot easily and regularly visit a primary care physician. Our platform runs seamlessly in the background with the caller's permission and can let providers know whether these patients might benefit from mental health services.
The COVID-19 pandemic has made virtual health visits more popular than ever. But it can be even more difficult for these practitioners to detect signs of mental illness. We need to ensure that patients get the same level of care as they would during traditional face-to-face visits. With Kintsugi, clinicians can screen patients for mental health conditions without interrupting the session. Our algorithm analyzes the patient's voice as they speak (not what they are saying, but how they say it) and provides a mental wellness score in real-time.
Imagine a patient arranges a virtual visit for ongoing migraines or back pain. It has been known for years that chronic pain has high comorbidity with depression, but it is not always easy for the physician to diagnose, especially in a virtual environment. Tools like Kintsugi can help clinicians identify that the patient’s pain might be impacting their mental health, ultimately painting a fuller picture of the patient for proper treatment.
Our API can be integrated into existing clinical workflows, EHRs, call-centers, telehealth platforms, and remote patient monitoring apps, supporting home care beyond the traditional healthcare setting. Facilitating screening, triage, and scheduling is one way to streamline and operationalize access to mental healthcare across the health system.
The Kintsugi tool has the potential to change how we view mental health. Traditionally, our society's approach has been physician-centered and tends to focus on disease. When we can assess everyone's mental health, we can broaden the scope of what's possible. Rather than just focusing on one end of the mental health spectrum – or, more specifically, the absence of health – we can stratify the population based on mental wellness.
We can also stratify care options. For example, many patients don't require pharmacologic therapy but could benefit from a meditation app, journaling, counseling or perhaps even an exercise regimen. In addition, if people can reliably assess their mental wellness regularly, they are more empowered to take action. Just like counting your steps provides quantitative feedback, using voice biomarker technology to measure your mental health and wellness can allow you to make minor adjustments to ensure that your health stays on track.
Finally, we all experience moments of feeling low. Tools to track mental health can help people better identify when "normal" sadness has transitioned into clinical disease. In addition, monitoring symptoms is significant for first-time sufferers, such as postpartum moms or those recently diagnosed with a chronic condition, who may believe that what they're experiencing and feeling is something all people go through. It's time to give these people a voice.
Over the past few years, the news, medical literature, government and healthcare industry has increasingly discussed addiction and called attention to the massive negative impacts it has on our country. Still, things do not seem to be improving, and our past efforts are not sufficient to meet the vast need. Addiction, a serious, chronic and treatable condition continues to be underdiagnosed and undertreated. This is unacceptable.
It is not possible to overstate the “entry to care” crisis for those living with substance use disorders (SUD). I took a spin through the recently released 2021 National Survey on Drug Use and Health (NSDUH) and the numbers remain devastating: 60 million people with past month binge alcohol use, 29.5 million people with an alcohol use disorder of which nearly 20 percent (1 in 5) had a severe use disorder, 8.7 million people who misused prescription pain medications in the past year and, remarkably, an estimated 1.8 million who initiated misuse of pain relievers in that time.
Against a backdrop of 43.7 million people – sons, daughters, spouses, parents, friends and colleagues – who needed substance use disorder treatment in the past year:
In the context of NSDUH, any treatment includes any intervention at any location such as life-saving care in an emergency department that may or may not involve follow-up treatment or participation in self-help support programs. Unlike any other serious and chronic illness, we seem to tolerate addressing the acute phase of this illness without sufficient early intervention or ongoing care.
Today, individuals in need and their families often determine their own level of care by accident and occasionally, it’s the right care. Lacking knowledge of treatment options and worried about sharing concerns with others, people may enter care following a legal or medical crisis or they may quietly search online without necessarily knowing what they need. It’s like spinning a wheel of fortune “weighted” in the wrong direction and getting lucky with the right care by chance.
If this was someone who had severe heart disease or suffered a heart attack, neither the lay nor the professional community would tolerate the risk of further harm from an unchecked health condition. In fact, with any other medical condition that has the morbidity and mortality of substance use disorder (SUD) this idea of uninformed, self-navigation would be unacceptable.
Admittedly, the factors associated with substance use conditions that contribute to the “entry to care” challenge include ambivalence and readiness for change. With conditions that require effort by the patient beyond taking a pill to get better, they need to initiate and maintain lifestyle changes. We see this behavioral component to treatment across a range of conditions, including obesity and its implications for diabetes or heart conditions. For a person with alcohol or other substance use disorder, the risk of serious harm can be imminent – accidental overdose or serious accidents due to impairment. Still, the desire for continuing to attend social events where friends are gathered but where there may also be significant use of alcohol or other substances can overshadow such concerns. For those who are ready for change, the efforts involved in finding and entering the right care are daunting – especially when they know that the therapeutic work may be difficult. Unfortunately, we often hear about the experience of “slogging” through the system: long wait times for appointments (4-8 weeks), higher than expected costs (“wasn’t in my network, I was stuck with a big bill”), time away from work or family (“I thought I had to go away for treatment’), and similar pain points. Sadly, many – despite the ongoing risk of harm – simply give up.
It is time to act.
We need to step in and render aid quickly – the reality is that SUDs are treatable and now we’re armed with a range of therapeutic goals and treatment options that did not exist a decade ago.
How can we help? We need to change and drastically improve the entry and access to care. Efforts to self-navigate online are painful. The system will serve up too much information, too many options – much of which is not applicable to the person needing services. It is hard to know what treatment to pursue when you are also working to understand your health condition, the associated treatment options (including both levels of care and types of care), and how insurance coverage for different services and levels of care works. When a decision is made to make a call, the problem of timely appointments becomes another hurdle.
Now is the time to support timely entry to care with attention to sustained engagement in treatment. We should continue to actively lean into whole person care because medical, behavioral, social, and environmental factors all play a role in health outcomes. Let’s approach SUD intervention and care with the urgency and duration that such a serious, high-risk, chronic and treatable condition warrants. Collaboration is a good word, but it requires understanding of the different and essential purposes, processes, and strengths that each stakeholder brings to the solution. Such informed collaboration is the pathway to improved outcomes driven by effective, simplified, and efficient care.
At Navigator, we know and understand the system of care and we build bridges. Working across the health system, we:
Facilitate collaboration within the health care system (among payers, medical and behavioral providers, and members/patients)
Address Social Determinants of Health, including:
Instill hope through human engagement by:
The need for early and effective entry to care for treatment of SUD is both well-documented and, unfortunately, experienced every day in every community. For that reason, Navigator’s door is open 24/7 providing simple, compassionate navigation and informed collaboration within the healthcare system.
Article written by: Deb Adler, CEO of Navigator Health, Inc.
We hosted conversations with many innovative leaders during our Going Digital: Behavioral Health Tech Conference. One of these conversations focused on the role of peer support in recovery and how RecoveryLink equips companies to provide advanced services for individuals in recovery. Dr. Robert Ashford, the founder of RecoveryLink, shared great insights about what peer support is, how RecoveryLink is making a difference in the healthcare industry, and what is in the future for peer support.
Dr. Ashford explains how peer support in recovery involves people with lived experiences, working one-on-one with individuals to develop a recovery plan with goals that are specific, measurable, attainable, relevant, and time-based (SMART). He says, “assuming that [participants in recovery are] the experts in their own lives, we can work with them to navigate what their long-term recovery plan looks like. It’s the lived-experience component along with the education that is really critical to this mix.”
Peer support is not intended to replace mental health providers, and Dr. Ashford clarifies some confusion the general public has about the role of peer support specialists. He says, “[medical providers have] their own domain, and we can all do more together rather than addressing those domains in isolation when we don’t have everybody on the coordinated care team that we need, including peers.” Peer support specialists do create clinical medical plans. They create recovery plans and collaborate with individuals for the long term.
RecoveryLink transforms how peer support services are delivered around the country. RecoveryLink offers both the software to enable organizations to operate peer recovery programs and also provides peer support services.
Dr. Ashford explains how RecoveryLink helps to “digitize their entire practice, engage with people and meet them where they’re at, and improve outcomes for those providers that already exist.” He also emphasizes how companies licensing and utilizing RecoveryLink to transform how they provide recovery support often did not use advanced technology to manage their workloads. He says, “So at the end of the day, who we’re licensing to and who’s using our software is any organization that employs peer support workers… We’re finding that traditional technology, traditional electronic health records, and case management solutions are not built for the recovery support process. They are built with the clinic and medical in mind, and that’s not what recovery support is.”
RecoveryLink also has its own peer support teams that assist those in need with navigating non-clinical needs such as housing, employment, education, and recovery planning. RecoveryLink partnered with the state of Texas through the University of Texas Health Science Center San Antonio to build a recovery hotline that leverages technology to assist people in need. This hotline is an omnichannel contact center staffed with peer specialists to help with crisis and digital support services.
RecoveryLink has engaged over a million people at the start of COVID, providing group-based recovery support. Dr. Ashford explains how group-based recovery can look like “recovery yoga, recovery CrossFit, recovery focus meditation, all recovery meetings, and group-based chats that can be available 24/7.” RecoveryLink started providing group-based recovery in March of 2019, leveraging technology to host over 60 recovery meetings with partners daily for family members, the LGBTQ+ community and individuals, and people who identify as women and men.
Technology has played a big part in the reach RecoveryLink has made over the past few years, especially among individuals who initiated their recovery during the COVID-19 pandemic. Dr. Ashford says, “If we can engage a million people in 2 years with free group-based recovery supports, that identifies the need and begins to validate the market. There’s a huge need for this – both for people who want to replace or augment or people who don’t have any other choices because they live in service deserts.”
In the next few years, Dr. Ashford sees growth in the future of peer support but explains the need for many more peer specialists to join the workforce. He expects we will see more adoption of low threshold and low barrier peer recovery support helping those early on in the substance use or mental health disorder cycle. Dr. Ashford believes more behavioral health providers will embed recovery support in their traditional service lines. They will augment their care, especially if they become reimbursable. Dr. Ashford also sees companies creating complete digital telehealth packages, including peer support for “true individualized digital care.”
Dr. Ashford explains the need for the peer support workforce to grow and develop a robust support and treatment network. He says, “right now, we estimate that there are about fifty thousand peer support workers in the United States. We need a million over the next ten years, which would have to come with some investments and companies providing well-paying living wage jobs and really articulating and seeing that this is a valuable part of the behavioral health continuum.”
You can watch our entire conversations with Dr. Ashford here.
Looking back on the Going Digital: Behavioral Health Tech Conference in June 2022, we highlight a few conversations we had throughout the event. We spoke with Jennifer Gentile, PsyD, the Senior Vice President of Clinical Innovation at Ieso; Trina Histon, Ph.D., a Senior Principal Consultant in Prevention, Wellness, and Digital Health at Kaiser Permanente; Reena Pande, MD, Chief Medical Officer at AbleTo; and Stephen Schueller, Ph.D., the Executive Director of One Mind Psyberguide, about responsible innovation in digital mental health. We explore what it means to build and deploy responsible digital products.
The FDA has created a Digital Health Center of Excellence to “empower stakeholders to advance health care by fostering responsible and high-quality digital health innovation.” Responsible innovation must include the importance of values such as trust, safety, and privacy, having checks and balances like oversight bodies, and processes of innovation and collaboration. Additionally, equal access and patient autonomy are critical pieces of responsible innovation. But what does responsible innovation in behavioral health look like today, and how can we improve in the future?
Because healthcare providers must abide by ethical principles to protect the rights and safety of their patients, digital health tools should abide by similar principles. Dr. Schueller echoed this idea when he explained, “I think responsible innovation really builds off a lot of the core ethical principles we have of medicine generally, do no harm and make sure that we bring value and benefits to patients.” He continues to explain that digital solutions should build upon the current standard of care to add value to the patient care experience.
Beyond the baseline of not harming patients, innovative digital behavioral health companies must deliver good clinical outcomes. As Dr. Gentile explains, “patients deserve high-quality mental health care, and more importantly, they deserve good clinical outcomes. Because we know as a society, everyone benefits if we have healthier, happier people.” An essential part of delivering good clinical outcomes is being able to perform research and measure patient outcomes using a specific digital health intervention. Dr. Scheuller comments, “if you want to be serious about outcomes…you need to measure it, and you need to measure it responsibly.”
Improving access to care has been an integral part of creating digital behavioral health technologies. However, Dr. Pande explains that “so much of the conversation these days feels like it’s around access, access, access, which is necessary, but not sufficient.” Dr. Schuller adds, “let’s get people connected to care, but what are we offering them when they get there?” A responsible digital health product can not only expand access to services but must also consider the quality of services they offer.
Discussing responsible innovation in digital behavioral health leads us to consider the role of digital health and when and why it should be used. One example is the ability to move beyond episodic data, typically seen in healthcare. Dr. Histon explains, “the value for me of adding a digital layer is you now have sort of continuous data that could and should deliver insights, even beyond, are we moving the clinical benchmark? So I’m excited by that.” Digital tools allow providers to connect with their patients more frequently and gather more information about how they’re doing on a day-to-day basis.
Additionally, digital health can be used to redistribute some of the administrative workloads off of clinicians so they can focus on helpful interventions. Dr. Gentile explains, “as a clinician, I don’t want to be in the business of taking clinician jobs, but rather, how do we help psychologists do what they’re really good at doing, versus having them spend time…scheduling appointments, or practicing breathing interventions.” Thoughtfully considering how digital interventions can be used in conjunction with mental health providers will create the best experience for both patients and providers.
An important part of responsible innovation in digital behavioral health is a genuine acknowledgment of what certain products can and cannot do. As Dr. Pande explains, “one thing that I’ve seen, which worries me, is the lack of humility and transparency about what your solution does well and what it doesn’t do. And part of being responsible is being very honest about when this intervention, digital tool, or therapeutic approach is right and when it’s not right.” Patients are best served when leaders are honest about when their product is a good fit for a specific population and are clear about its limitations.
Dr. Histon comments, “I feel that there is no one app to do everything…and people are complicated. And if you mismatch a solution…time one or time two, you’re reducing the likelihood someone sees the value later on.” There is always a danger that patients may start to feel hopeless if they are accessing an intervention that isn’t a good fit for their specific needs. The goal of digital behavioral health should be to help more people gain access to quality behavioral health services, not to turn them away.
As we think about responsible innovation, we wonder if responsible innovators can meet the needs of all stakeholders. Dr. Pande believes “you can do good and do well.” The key is ensuring all stakeholders have the same goals and mission. Dr. Pande continues, “I’ve been thinking a lot about a North Star, a True North. You have to be clear about what your True North is, and you have to stick to it, and you have to make sure that all stakeholders are aligned to that TrueNorth.”
Responsible innovation in behavioral health will take a conscious effort from all stakeholders to ensure that patient’s needs are the first priority, digital health is used as an informative and helpful tool, and there is transparency around where digital health is or is not appropriate.
These are just a few insights from our conversation with Dr. Gentile, Dr. Histon, Dr. Pande, and Dr. Schueller. To hear our full conversation, visit our video library.
Our youth are in trouble. As their mental health declines, adolescents are turning to resources like TikTok for help. However, licensed doctors analyzed 500 TikTok videos for a study related to ADHD, trauma, depression, bipolar disorder, and more; 83.7% were misleading, and almost half were inaccurate. Social media may be easily accessible for youth, but there are much better options for diagnosing and treating mental health conditions.
Specifically for youth, family-based treatment has been shown to be extremely effective in caring for youth by bringing in the entire family. One example being Bend Health. Bend Health increases access, improves quality, and reduces the cost of mental health care for families. We sat down with Co-Founder, President, and CMO Dr. Monika Roots to talk about the quality of their family-based, collaborative care and the accessibility to this care.
I’ve worked in virtual care for a long time, and no one has truly been able to take on kids and teens mental health in a really thoughtful and scalable way. Solutions tend to be focused on the child or parent, with no one really looking at the family constellation. So, we created Bend Health to support the entire family dynamic.
Kids and teens are highly affected by their surroundings, much of which is out of their control, so it’s essential to understand their environment and how it works. For example, say you teach a teen to pause and use deep breathing techniques in moments of frustration, but their parent shouts at the teen when they are frustrated, instead of using positive and calming communication. That teen is going to have a more difficult time implementing coping techniques because their environment continues to be an agitator.
The mental health of a child is much different than an adult. A child doesn’t have control over social determinant concerns, like food insecurity, within the home, but they will react to it. And it usually comes out in a myriad of presentations such as anxiety, introversion, or aggression. So, when we address the familial situation and dynamics, we can positively affect their behaviors and overall well-being.
Plus, having a child that is struggling with their mental health can have a huge impact on the other family members. Siblings need help understanding the situation, and how to talk about it, without taking it on themselves.
And parents often won’t reach out to others for emotional support because of the stigma, or because they think it’s their fault. We hear so often how isolating it can be. So, it’s important for us to make sure that they don’t feel alone, and to show them ways they can support themselves and their child.
We’ve designed our intake process to be efficient and comprehensive, allowing us to be there right when families need us the most. A wait time of 24 months for a child to be seen by a mental health professional is excruciating, so we’ve created a digital experience that reaches out to parents immediately to get them started, and to schedule an appointment.
Our thoughtful assessments allow us to quickly identify what may be going on, and to understand the severity of symptoms, along with a child or teen’s history. Additionally, we request a video that gives us an insight into what might be going on, in the family’s own words.
Then, we’re able to connect families with a care coordinator who can get them started with a customized care plan. Throughout this process, the administrative burden is taken off of the practitioner, so that they can come in at the right time and operate at the top of their license. We’re expanding their capacity because they have a team to support them along the way, and this allows our care model to be both impactful and scalable.
We believe that child psychiatry has complexities that adult psychiatry does not have, and that’s why we’ve enhanced the model. Our collaborative care model allows coaches, therapists, psychiatrists, and primary care physicians to be on the same page throughout the entire process.
Families need more than a curbside consult. And at Bend Health, families have quick access to a psychiatrist who actually sees children and teens on the frontend to make sure that the diagnosis and treatment plan is right.
For so many children and teens, the solution is a combination of coping skills, therapy, and parent involvement, instead of, or in combination with, medications. This model allows children and teens to have fast access to coaching and therapy to learn valuable skills, and offers medications only when necessary.
There is clearly a youth mental health crisis in our country, and our pediatricians are doing the best that they can, but they are overwhelmed. They typically aren’t equipped with the expertise needed to diagnose and treat the array of mental health conditions presenting today in their offices. And when they refer out to therapy, many of them can’t get appointments for their patients for months at a time. This results in many children and teens being prescribed medications because there are no other care options available. We aim to change that.
So, we’re always thinking about innovative ways that the mental health community can support primary care because right now they’re doing a superhuman effort. Through Bend Health, we’re able to partner with them and educate them. And then, together, we can really support the patient with all of the tools that they need to get better.
If you have been closely following the news and data, you know our nation’s emergency rooms need reinforcements.
Hospital emergency departments (EDs) across the country have reported a steady increase in patients presenting with behavioral health issues. Unfortunately, EDs are not designed or staffed to provide behavioral health patients with the care that they need. In fact, many EDs do not have access to an on-call psychiatrist for psychiatric emergencies. Research published by the Mayo Clinic in April 2022 found that of the more than 2,300 U.S. hospitals surveyed, 54% reported having no psychiatrist on staff or available for medical ED and inpatient consultation.
As a result, patients seeking behavioral health care in hospitals can languish for hours or days waiting for specialized care or bed placement. This leads to boarding, which is the practice of holding admitted patients in the ED when there are no inpatient beds available. Boarding is especially common among behavioral health patients due to the lack of psychiatric providers and inpatient services.
Boarding has become such a significant concern that nearly three dozen of the country’s leading provider groups recently urged the White House to address the issue. The nine-page letter depicted a bleak picture and declared the rise in boarding “its own public health emergency” for adults and children.
Compounding the problem, hospitals are facing unprecedented staffing shortages and clinician burnout in the wake of the COVID-19 pandemic. Hospital providers, staff and resources have been stretched to a breaking point as patients’ behavioral health needs continue to grow.
Easing ED gridlock with telepsychiatry and virtual collaborative care
The fact is that ED boarding is costly. A landmark 2012 Wake Forest University Health Sciences study found that psychiatric patients tend to wait 3.2 times longer in the ED than non-psychiatric patients, preventing 2.2-bed turnovers (or additional patients seen), which costs the ED $2,264 per patient when considering direct and opportunity losses. This, in turn, can lead to poor patient experiences, poor care, and poor outcomes for psychiatric and medical patients. Traditional care delivery models, operational workflows, and ways of thinking will not overcome these complex and multi-faceted challenges.
As an industry pioneer, employer of choice for behavioral health clinicians, and the nation’s leading virtual psychiatry and therapy practice, Array Behavioral Care is uniquely positioned to ease the boarding strain in our hospitals through telepsychiatry-based solutions. More than 20 years ago, our executive chief medical officer conducted one of the nation’s first involuntary commitments via telepsychiatry for a patient in need at a rural hospital. Since then, we’ve partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities.
Empowering clinicians
Array’s clinicians work with hospitals and health systems to implement innovative, physician-led programs grounded in evidence-based tools and protocols. It all starts with telepsychiatry which offers ready access to skilled, reliable, and experienced behavioral health clinicians ranging from adult and child and adolescent psychiatrists and psychiatric nurse practitioners (NPs) to licensed social workers and therapists. These behavioral health specialists provide guidance and support to onsite attending ED physicians with evaluation, disposition decisions and treatment for psychiatric patients.
Telepsychiatry can help reduce psychiatric boarding in the ED in 3 key ways:
With the virtual team approach, the treatment teams that are already commonly used in collaborative care programs in community-based settings across the country are paired with virtual licensed mental health specialists. This structure can be applied to acute psychiatric care in hospitals to increase access, quality and efficiency in behavioral health care, benefiting both ED providers and the patients they serve.
In practice, psychiatrists and psychiatric NPs function more as expert consultants, while therapists, social workers and other levels of behavioral health specialists can also be layered into the virtual behavioral health care team. Psychiatrists are available virtually to perform psychiatric assessments or mental status exams, serve as a consultant to the attending ED physicians or prescribe medication directly as appropriate depending on the needs and preferences of the hospital, and make risk determination, capacity to discharge and disposition recommendations. This expedites treatment and improves the quality of care for individuals with mental health concerns and frees up ED resources for more acute medical presentations.
Hospitals leveraging this model ensure the highest and best use of all clinicians’ time. Physicians and hospital staff onsite can rely on these virtual behavioral health care teams can help triage and assess individuals presenting with mental health concerns and make decisions regarding admission, discharge and referral for these patients.
The more behavioral health team members who are staffed virtually, the more significant the reduction in the operational, logistical and financial burdens that the onsite provision of those services would require. Virtual behavioral health care teams can also help support strained and overextended onsite staff in the ED and help curb clinician burnout, which costs the U.S. an estimated $4.6 billion annually.
Transformation across the continuum of care
Telepsychiatry is the lifeline our hospitals need to reduce ED gridlock. The boarding emergency is another troubling outcome of our country’s ongoing mental health crisis. Policy changes are still needed at the state and national levels to close access gaps, allow clinicians to be reimbursed for telehealth services at the same rates as in-person services and further enable widespread adoption of telehealth across the continuum of care.
At Array, we are intently aware that reliable patient access to behavioral health care extends far beyond our hospitals. Currently, behavioral health clinicians can only meet 28% of the behavioral health needs across the U.S. through in-person care. Virtual care has proven to be equal to or better than in-person visits during the pandemic. This care delivery model is integral to resolving the supply-demand imbalance our country is facing: the divide between patients who are seeking mental health help and licensed clinicians who are available to provide it.
Through our virtual behavioral care solutions in hospitals, outpatient health centers and at-home, Array is bridging divides in access and reducing mental health disparities across the continuum of care, one patient at a time.
Article written by: Geoffrey Boyce, CEO and Co-founder of Array Behavioral Care
Caregivers provide a solid and important aspect of healthcare. They provide the nurture behind the medicine, but above all else. Caregivers often deal with very sick patients. As a result, this patient care group can face some significant mental health struggles.
Here are some different companies doing what they can and providing resources to support caregivers while they support the care of others.
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Honor provides family care guides to help caregivers treat and assist those with chronic conditions. While the guides are aimed at the patients, they also allow caregivers to understand better the struggles the patients are undergoing while being able to help them manage their care.
ARCHANGELS is a national movement in a platform that reframes how caregivers are seen as honored and supported, using a combination of data and stories through public and private partnerships. They believe caregivers should feel honored and seen in the line of care. Their caregiver intensity index is designed to engage all caregivers, even those who do not see themselves in the role. Their platform provides each caregiver with a score that not only validates their experience but also allows them to reach resources that exist – but are often underutilized due to a lack of awareness.
The CaringBridge offers caregiver advice. This advice comes from those who have been caregivers, and it can be beneficial for caregivers to understand their role and better care for their patients. They offer tips on how to effectively care for others, how to deal with grief and loss, helpful information for long-distance caregivers, and many other beneficial pieces of advice. This advice is aimed at helping the caregiver be the best they can be. This sometimes means taking time to focus on themselves as the caregiver and their own mental health needs. There are many stressors in the role of a caregiver, and CaringBridge has many different options and advice to help.
Mental Health America offers free, anonymous, and confidential screenings for caregivers struggling with their mental health. They offer other mental health resources such as caregiving basics, coping with stress, crisis planning, parenting, and tools and resources. Caregivers need to take care of their own mental health. Supporting caregivers with information and resources can help them maintain their mental health and better serve loved ones.
Addressing access for the whole patient
It’s starting to sound cliche, but everyday it’s true. The numbers continue to climb and more people than ever are struggling with their mental health. As of 2020 in the U.S., 52.9 million people, or 1 in 5 adults, experienced mental illness. During the pandemic, 4 in 10 adults reported symptoms of anxiety or depressive disorder. Unfortunately, in our current paradigm that views mental and physical health separately, there’s a shortage of services that address mental health issues as part of a comprehensive care plan, which holds us back from making sustainable progress. More than one third of the U.S. population, about 130 million people, live in areas that have a dearth of mental health workers, and about 80% of rural counties lack access to a single psychiatrist.
We’ve swung the pendulum on stigma and people are raising their hand for care, but now what? Employers are still grappling with a sea of apps and the best path for integrating care delivery. While yes, society has embraced broader acceptance of digitally-enabled care models, are they really going to “solve” the mental health crisis? Particularly when they work in isolation?
More and more today the term “whole-person care” is used. While, yes, there is some debate about what that is, in mental health, it’s technology application that is supported with integrated care along a continuum; not an app in a silo. Certainly there are use cases for apps, but without an integrated primary care provider, there’s no single care partner to guide patients on their mental and physical wellness journey. Fragmented, siloed care actually restricts the visibility of caring providers and further contributes to the stigma associated with mental health challenges.
Providers who are on the front lines of care provision are speaking up about how the healthcare system can improve quality of care and expand access to services. Many solution providers (aka vendors) are talking about their ability to deliver new technology that achieves whole-person care, though some of that remains more promise than actuality.
The American Medical Association published a report earlier this year highlighting the severity of the mental health crisis and the vital need to reach people who require timely access to treatment. The organization asserts that the solution is found in behavioral health integration (BHI), which incorporates both mental and physical healthcare into delivery of services, in part, through digital enablement. In tandem with traditional interaction between providers and patients, technology that leverages digital tools for functions like screening and intake, telehealth services, and clinical decision support will help engage more people in mental health treatment and aid providers in its adoption and delivery. The report references ample evidence that BHI produces superior patient outcomes, improves patient experience and access, and can generate cost savings.
Further, the AMA and other leading medical associations established the BHI Collaborative, a group “dedicated to catalyzing effective and sustainable integration of behavioral and mental health care into physician practices.” The cohort’s objective is to empower physicians to expand access to mental health services through primary care settings and take a holistic, integrated approach that focuses on the well-being of the whole person.
The AMA has brought to light a very serious issue of which many employers and benefit designers are already aware: the current paradigm – which silos physical and mental health care – is not working. Companies are using employee assistance programs (EAPs) as a mental health front door, which has proven to be ineffective and simply not good enough to address the severity of these problems. Patients require care that incorporates visibility, collaboration, and integration among providers. So why do employers continue to settle for less? It’s about to change.
Turning the need and research into actionable care delivery
Member-centered primary health is a straightforward path for patients to see their primary care clinicians and mental health providers in a truly integrated fashion. More and more, employers are embracing an integrated model that engages patients and facilitates adoption by providers throughout the entire patient journey. It’s the journey from access to results. By incorporating technology to engage patients in mental health services such as screenings, diagnosis, and treatment, employers can see how proven integration models within primary care workflows are yielding positive results. Employers should both imagine and demand a world where success is being reported as improvement scores vs. visit volume.
Assuredly backed by data - supporting a new model of care
My experience-based assessment of the U.S. approach to mental health care does not stand alone; the numbers tell a troubling story about failings of mental health delivery and the impact of mental health disorders. The recent poll that found that two out of every five adults suffered from moderate to severe mental health issues during the pandemic also found adults reported difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%). Isolation, job loss, health concerns, and excessive worry during this unprecedented time has had a major impact on well-being. Further, according to the National Alliance on Mental Illness, one in six U.S. youth experience mental illness each year, and suicide is the second leading cause of death among people aged 10-34; half of all lifetime mental illness begins by age 14. A lack of treatment for mental health conditions costs the U.S. more than $100 billion annually. Yes, this is a major problem, one that disrupts lives, livelihoods, relationships, and our basic human desire to find joy.
When desiring help, patients often turn to primary care providers who report that 70% of all visits include a behavioral health component. In fact, nearly two thirds of people experiencing depression and other common mental health conditions are treated exclusively in primary care settings. While these clinicians provide the majority of mental health care for these patients, only about 3% of the encounters are coded for primary diagnoses of depression and anxiety. These providers may not be trained on optimal treatment methods, underscoring the need for collaboration with and among mental health clinicians.
From a whole-patient view, mental health conditions are associated with significant morbidity and mortality, and these individuals have a higher likelihood of developing cardiovascular and metabolic diseases. Those experiencing both physical and mental health conditions also incur higher health care costs and experience worse overall health outcomes. The whole patient and how we treat them really does matter. An integrated Primary Health team—in line with BHI strategies—enables partnered care toward holistic health, and the data shows it.
Crossover recently evaluated the effectiveness of its integrated approach in responding to the mental health crisis. When comparing the clinical outcomes of more than 3,000 Crossover members to patients in the community, study results showed Crossover to be significantly more effective than the community in improving overall mental health outcomes.
The data from our study and throughout this post reaffirms that an approach to interdisciplinary care works and the urgent call for inclusion of mental health within primary care models rings loudly. Mental wellness is a relational pursuit and cannot merely be managed by isolated transactions or singular care episodes. Instead, personalized care of each member, backed by healing relationships between doctors and patients, has the power to improve overall quality of life. Isn’t this the result every patient deserves?
Health care has its share of buzzwords, especially in the mental health realm. Measurement-based care (MBC) is one of them. People talk about its importance in enabling quality care. Research shows it produces strong outcomes and ensures that providers are delivering personalized, data-driven care to each patient. When you add on that more people than ever are experiencing problems with anxiety, depression, and substance misuse, effective mental health care is more important than ever.
MBC is intuitive and conceptually straightforward. But what does it mean to do it well for patients living with mental health issues? Some point out the challenge of measuring and quantifying mental experiences like thoughts and emotions, especially when compared to measuring physical outcomes like insulin levels or blood pressure. Providers can easily measure physical functions, monitor them, and connect patient progress to ongoing interventions.
The reality is we can do the same with mental health experiences. We have clinically validated assessments that capture the severity and nature of mental health symptoms. We can directly observe patient behaviors related to mental states. With the advent of mobile technology, we can even measure smartphone use and behavior and link it to the experience of mental symptoms. This measurement is not only possible, it is essential for providing effective treatment through an MBC approach.
It is one thing to collect data, it is another to leverage it in care delivery in a tailored, systematic way that produces strong patient outcomes. Technology is key to accomplishing this. Mindstrong is a virtual mental health platform that combines evidence-based care, data, and technology to empower people with mental health challenges. MBC is not only the foundation of our approach, it powers delivery of care every step of the way for each of our members and providers.
Data empowered care plans (DECPs) are a primary vehicle for delivery of MBC to Mindstrong members. First, members complete clinical assessments on their smartphone, wherever they are, at a time that is most convenient. These assessments identify and quantify symptoms and functioning. For example, for a member experiencing depression, these assessments measure whether symptoms relate to thoughts, behaviors, mood, or all 3 areas. The severity of each type of symptom is quantified. Second, the Mindstrong platform analyzes the data and surfaces the most relevant information to the patient's multidisciplinary care team. Members can also observe and track their data through the mobile app. Third, providers partner with members to review their data and create treatment goals based on reducing and resolving symptoms. Fourth, these goals are quantified and tracked over time, and treatment is adjusted to ensure progress and attainment of goals. In sum, DECPs hardwire MBC to care planning and delivery with each member.
Mindstrong’s DECPs also focus on areas outside of mental health. Many individuals with mental health challenges also experience problems with social determinants of health (SDoH). These include stability of housing, social support networks, and financial stability. Like mental health issues, these challenges place patients at risk if they are not resolved. Mindstrong uses DECPs to assess, understand, and provide support for SDoH in our members. We help them resolve these challenges as part of whole-person care.
Technology is essential for an efficient MBC approach. It facilitates data collection and makes it more seamless and engaging for the patient. It powers the analytics that make sense of the data and surface the most important information to providers and patients. It allows for streamlined tracking of patient progress and helps clinicians tailor treatment to maximize outcomes. Through Mindstrong’s virtual care model, these activities can be accomplished by patients and clinicians anytime, anywhere.
Two more things are critical to providing tech-enabled, measurement-based care. First, healthcare organizations need to study how their MBC approach is impacting patients. Treatment for mental health isn’t a one-size-fits-all approach. Certain patients with shared experiences and clinical profiles may respond differently than others to a particular intervention. At Mindstrong, we are agile in our MBC approach. We continually research which aspects of care work best for which types of members and why. We have the in-house clinical and applied science expertise to take this knowledge and continuously evolve our approach.
Second, MBC allows us to determine when members reach goals and can transition to another level of care. For example, when mental health goals are achieved, a member can transition from a therapist to a Mindstrong care partner and coach, who focuses on SDoH support and longer-term recovery goals. MBC is used to determine the right provider and level of support at the right time.
At its most fundamental level, MBC for mental health is about constantly collecting data about what is working for patients and having the willingness to change course to optimize engagement and outcomes. Not only is this approach possible, technology can power it in a way that is accessible and efficient for patients and clinicians. When this happens, people living with mental health issues begin their journey toward healthier, happier lives.
Article written by: Audrey A. Klein, PhD, Senior Director of Clinical Design and Operation, Mindstrong, Inc.
We’ve all been there, we get a little depressed or anxious and then, while in that mindset, we make choices like skipping our usual morning walk, having an extra handful (or two) of potato chips, and staying up late to scroll our phones or watch some mindless TV. The truth is, mental health conditions, no matter how minor, impact our ability to engage in self-care. For someone living with diabetes they don’t get too much time off from monitoring thier self-care. So even a short rut where they’re choosing foods that may not be the most nourishing, not sleeping well, or getting in enough physical activity can exacerbate factors related to healthy blood sugar management.
Effective treatment needs to start with an acknowledgement that the two are closely intertwined. You can’t treat one without the other and with the prevalence of depression in people with diabetes being 2-3x higher than in people without diabetes, it is clear that in order to move the needle on outcomes and improve quality of life for people who are suffering, a holistic approach needs to be taken. The fatigue of caring for a condition like depression or diabetes can be improved when patients learn important coping tools and skills that help them build resilience to manage the daily demands of both conditions.
For those with diabetes, subclinical and clinical mental health challenges often present itself as something called diabetes distress. Diabetes distress is basically when someone with diabetes has an emotional state where they’re overwhelmed by feelings of grief, shame, or mental exhaustion which impacts their ability to care for themselves and their disease. Certainly, more severe mental health conditions can impact a person’s ability to cope with the daily demand of managing a chronic condition like diabetes. But the whole spectrum of mental health conditions needs to be considered because even subclinical mental health challenges can have an impact on diabetes outcomes.
I work with a lot of people who Vida treats for both mental health conditions and cardiometabolic conditions — the biggest concern for me is usually that stigma will get in the way of someone receiving the mental health care they need. Untreated mental health conditions can lead to significantly poorer outcomes and greater risks of complications. When both untreated depression and diabetes coexist, health outcomes are worsened for both. This can mean lasting complications like damage to kidneys, eyes, nerves, and can sometimes lead to amputations and other costly complications. One of the biggest concerns to be aware of is that depression is frequently missed, undiagnosed, or when diagnosed, patients often don’t receive the care they need.
This article was written by Vida's Sr. Director, Cardiometabolic and Prescribing Gretchen Zimmermann. To learn more, visit vida.com or watch Vida’s session from the Going Digital: Behavioral Health Tech 2022 summit.
Event recap: Senior leaders from Alliance Signature Series Sponsors, representing organizations across the healthcare industry, discussed the opportunities and challenges of developing an evidence-based and innovative mental healthcare system. Panelists explored how their organizations propel change to accommodate person-centered needs and what the future holds for transformative mental healthcare.
Mental health diagnoses are treated far differently than physical health concerns. Mental health is treated like an episodic condition rather than a chronic disease. At this point in time, mental health needs are skyrocketing, and our healthcare system is falling behind. The lack of parity between mental and physical healthcare calls for new innovations in the healthcare system.
Unfortunately, there are many barriers to treating mental illnesses, as there is a growing shortage of specialized psychiatrists. It has become critical to prepare the primary care setting to be able to care for mental health patients. We know that 50% of mental health patients come to primary care settings. The first step to innovating the mental healthcare system is improving care accessibility. We can’t help people with mental health conditions if they aren’t able to access care, to begin with.
There is a significant lack of access to proper healthcare treatment and services, especially in underprivileged communities. The lack of equitable health care support significantly impacts how people perceive and obtain care. This contributes to mental health stigma. What we are doing is not working. Luckily, there are many opportunities for improvement.
Change and innovation are desperately needed. Trying to provide mental health services at scale can be challenging. Many new players and solutions are emerging in the behavioral health industry, but innovating an entire branch of the healthcare system involves a lot of trial and error. The history of psychology is deeply rooted in work that has gone on for over a hundred years. Much of the thinking is conservative. As the field grows, the thinking becomes locked in the thinking. Because of this, new solutions need to consider how to bring policy innovation that will support the clinical innovation that is taking place. Innovation is also rapidly changing with the help of digital tools. The challenge with that is ‘how are we going to integrate those advancements effectively going forward that can really maximize the capacity for people to take advantage of it in the best way and weave it together in a way that keeps people falling between the cracks?’ There is an enormous need for advancement, but without innovation, we will have a hard time getting there.
Innovation and technology are one way to fix some of the problems created over decades. Technology is a great way to help us find new modalities of care and help keep track of patient retention, engagement, and progression of care more efficiently. The only way we will improve the mental healthcare system is if we figure out how the field can move into the future as we have in every other field.
Equity in the space of behavioral health is an essential factor of innovation. We know that expanding the funding opportunities would help enhance equity in mental health providers’ training and credentialing. Another aspect of this equity issue is incorporating mental health access in schools. Providing more mental health services in schools can help pave the way for proper care for those who have not had access in the past. Offering the right kind of access for the people who need it can change how behavioral health helps heal everyone.
Innovation is how we progress into the future. There are many disparities in the mental health field, but there are many positive ways to make the right change to impact the most people. Innovation is not always about creating new things. It can also be taking an existing system and making it more effective by using data to our advantage and what we have available in the field of medicine. Innovation is the future; the future is better care for mental health.
You can watch our full panel here.
Social drivers of health (SDoH) impact upwards of 80% of health outcomes—and have been largely ignored by the health care system…until recently. Health plans and other industry players are increasingly recognizing the opportunity for non-traditional models of care to drive impact. One of those models is companion care, the new category of care created by Papa, which was designed to address individuals’ unique SDoH, including loneliness and social isolation.
Working through health plans and employers, Papa brings vital support and human connection right to a person’s front door when and how they need it, via our national network of vetted companions, called “Papa Pals.”
Papa Pals meet health plan members’ social needs that promote health, but are non-medical in nature, like transportation to a doctor’s appointment or grocery shopping, caregiving support, and of course, social interaction. As Papa Pals gain access to members’ homes and hearts, they’re able to build trust—the greatest asset we have in health care.
While health plans and other stakeholders have generally struggled to access and understand people’s barriers to health, the bonds Papa Pals form give them much deeper insight. With this insight, Papa and/or a member’s health plan are able to connect members to vital services that can advance their health and well-being, addressing issues like food insecurity, home safety, and medication adherence.
I think the best examples of how companion care addresses SDoH are the personal ones. Take Papa member Lacey, a young mother of four on Medicaid in Michigan. Her Papa Pal, Michelle, provides child care support, advocates for Lacey and Lacey’s family at the food bank, and helps provide transportation to doctor’s appointments. It took Lacey time to be comfortable accepting help from a Papa Pal, but now she says that because of Michelle, she has a better outlook on life. “It’s like we fill a hole in each other’s hearts,” she said. “I’m really thankful for this relationship and I feel like it’s something everybody needs.”
Addressing SDoH through Papa’s companion care model enhances members’ health and quality of life, improves health care utilization, and reduces overall health care costs.
We’ve seen a 64% increase in individuals reporting severe loneliness as part of our initial assessments from 2020-2022. Yet in the face of this loneliness epidemic, 60% of severely lonely individuals who actively participated in their health plan's Papa program experienced clinical improvements and moved to a lower category of loneliness, as determined by the three-item UCLA loneliness scale. We also reduced mentally unhealthy days by more than six days, per the CDC’s Healthy Days measure.
Knowing loneliness is linked to increased risk of heart disease, stroke, diabetes, depression, and dementia, and that unhealthy days are associated with multiple chronic conditions and predict both hospitalization and mortality, these improvements are significant—and they refurberate through the health care system.
In an analysis of Papa among Meridian’s Medicaid population aged 45+ with a high rate of emergency department (ED) utilization, active Papa participants experienced a 25% reduction in ED visits, 14% decrease in hospital readmissions, and a 33% reduction in overall health care costs. Preventive cervical cancer screenings, diabetic eye exams and HbA1C testing for Papa participants also rose by 50%, 46%, and 35% respectively. While Papa is known for its work with older adults in Medicare Advantage, these results released just last week demonstrate the power of personalized, human help for historically hard-to-reach populations.
We’ve seen similar results across Medicare Advantage and socially isolated patient populations as well (stay tuned for these claims-based study results over the next few weeks!). Through trusted relationships and proactively addressing SDoH, companion care helps close social and clinical care gaps, supporting members’ well-being and reducing health care costs.
With companion care, members receive truly personalized support—when, where, and how they need it most—improving health plan perception and satisfaction, as well as overall health care experience.
We recently found that members who are severely lonely are less likely to view their health plan favorably, compared to those who are not lonely. Lonely individuals also reported they find it more challenging to get needed care right away and rated ease of getting prescription drugs and tests/treatments lower. After participating in Papa, the average member’s rating of their health plan moved from a 4-Star ranking to above the 5-Star threshold for the “health plan rating” CAHPS measure. Not only does this change have significant financial implications for health plans, but it demonstrates the far-reaching effects of proactively addressing loneliness.
Companion care has also been shown to reduce the number of members who leave their health plans voluntarily, also known as member churn. It’s estimated that of the 28 million Medicare Advantage enrollees today, approximately 3.6 million will churn this year alone and, subsequently, $36 billion in revenue will be exchanged between health plans and/or traditional Medicare. Notably, in a study of a Florida-based health plan using Papa, Papa participants had a churn rate that was 15.8% lower than members who did not participate in Papa. Put differently, the study results indicate that Papa increased overall member retention by 2.8%.
Another component of improving member experience comes from Papa Pals’ ability to help members navigate their health plan benefits to resolve issues and enhance utilization, while removing complexity and confusion from their health care experience.
This example always stands out to me: One of our Papa Pals recently worked with a member to resolve a $10,000 medical bill. The Papa Pal learned of the issue during a visit and escalated it to our care navigators, who coordinated between the insurer’s claims department, the hospital, and billing company, ultimately resolving the issue and saving that member from an unimaginable amount of stress and anxiety.
Put simply, people need people. Personalized, proactive support delivered where health happens—in homes and communities—is key to reaching people across plans and geographies, and has a dramatic impact on member experience, health and wellbeing, all while reducing health care costs and improving health care utilization.
Article written by Papa's Vice President of Health and Social Impact, Ellen Rudy, PhD
The silver lining of the COVID-19 pandemic is that seeking mental health treatment became much less stigmatized, and mental health care access has expanded through more available tools. In fact, since the start of the pandemic, most people agree that society has become more comfortable using telemedicine for therapy (63%), using digital tools to improve mental health (58%), and engaging in mental health discussions (56%). October 10 was World Mental Health Day, which is an important moment to recognize this achievement, but also to highlight that we must do more to expand access to all communities in need.
For many, the pandemic introduced and magnified health anxieties, catalyzed major lifestyle shifts and increased isolation. A CVS Health and Morning Consult study found six-in-ten (59%) Americans have experienced concerns about either their own mental health or that of family and friends, a 9%-point increase since April 2020.
As the need for care increased, digital tools played a crucial role in closing access gaps – especially in mental health. For instance, among Aetna’s commercial members, 58% of outpatient mental health visits were done via telemedicine in 2021, up from 49% in 2020 and less than one percent in 2019. Year to date in 2022, the use of telemedicine remains strong at 55%. It is not surprising that this trend has continued as telemedicine has proven to be particularly effective for mental health care as it allows for greater convenience in connecting with a provider, and it can be a good option for those who may be apprehensive about receiving this kind of care in person.
However, while the pandemic sparked a dialogue about the importance of mental health, not every community has been able to obtain care equally. While use of mental health services among White adults (with any mental illness) was 46.3%, only 29.8% of Black and 27.3% of Hispanic adults with any mental illness used mental health services. This is a gap that we need to close. To help, CVS Health has launched several efforts to expand access to care, especially digitally.
For example, during the pandemic we launched a program called Here4U, which is a virtual peer support group, facilitated by a licensed clinician, that addresses the importance of mental wellbeing. These groups, which we’ve tailored toward specific communities such as Black women, LGBTQ+ youth and working moms, allow participants to discuss life challenges, changes at home, or other pressing issues and events. Following participation in a Here4U group, individuals have expressed that they felt heard and understood, and appreciated the ability to connect with their peers. Being able to discuss life’s challenges with others in similar situations can be extraordinarily helpful and encourages those in need to seek further care.
We’ve also continued to expand access to therapy within local communities across the country. Patients can get same-day depression screening appointments at all CVS MinuteClinic locations, as well as in-person and virtual mental health counseling services in select states. These professional mental health care providers can conduct an assessment and offer personalized treatment plans and counseling that address feelings of stress, anxiety, grief, depression and more. CVS Health also provides a wealth of publicly available mental health guides – with an emphasis on Black, indigenous and people of color (BIPOC) youth - screening tools to help anyone get a quick read on their emotional health and other resources on CVSHealth.com.
Americans are more open to accessing mental health resources, and technology makes them more accessible than ever before. Still, there is more work to be done in eliminating the stigma of mental health and expanding access to all populations. Members of the healthcare system, employers and other community leaders can help by initiating conversations about mental health, prioritizing treatment as they would for a physical ailment and using all available resources to ensure factors like income, location and mobility don’t impede access to critical care.
Article written by: Cara McNulty, President, Behavioral Health and Mental Well-being, CVS Health; and Taft Parsons III, MD, Vice President & Chief Psychiatric Officer, CVS Health.
Across the world, there is a mental health care treatment shortage; we are in a crisis. Mental health care has never been in such high demand. In fact, by 2025, shortages are projected to get worse for psychiatrists, clinicians, counselors, and psychologists. Today, in the US alone, thousands of people are sitting on waiting lists for evaluation, treatment, and just someone to talk to. Clinical depression is one of the most common mental health diagnoses in the US, with more than 21 million adults reporting a clinical episode in 20201. In 2022, 9 out of 10 therapists reported “the number of clients seeking care is on the rise”1. This demand is magnified in rural areas. A family therapist in Georgia reported “I live in a rural town, but I still get approximately seven to 10 inquiries a week that I have to turn away”1. This is one of many other examples that show the gap in the mental health care system is increasing every day.
It is important to remember this gap in supply and demand can not be solely addressed through increased accessibility, which has been the focus of most innovative solutions over the last few years. While this “Room to Zoom'' approach, widely adopted recently, would potentially provide access to care for someone living in rural areas, it would not guarantee care availability. Too often patients and clinicians are restrained by factors out of their control: time, money, and policies. Even when a patient can see a mental healthcare provider, their insurance coverage, time, and geographic location impact their path to treatment. These factors are more critical when social determinants are also considered, making marginalized groups at higher risk for long-term mental health concerns. The current health care system keeps patients, and clinicians, trapped in a circle of inaccessibility.
During the COVID-19 lockdowns, clinicians heavily relied on virtual communication to connect with their clients. While using these virtual communication tools made it easier for clients to access their clinicians, what limited their access was clinicians time, leading to longer wait times. In fact, in 2021, 75% of clinicians reported an increase in wait times for basic mental health services1. That is, the technological access innovation did not solve clinician availability. That is because our industry has not been optimized for scale.
The question then becomes, how can we make mental healthcare more scalable?
Furthermore, while there has been an increase in differentiation of roles for managing patient interactions, we need to reimagine these roles by equipping individual clinicians with the right tools to effectively manage the population waiting for care. For instance, there is only 1 psychiatrist for each 1,960 patients in need of mental healthcare. Given that a psychiatrist can only handle 200-400 patients per year, inappropriate referral of all patients to a psychiatrist would cause extensive backlogs. In fact, in the United States the average wait time to meet with a psychiatrist, for an initial evaluation, is 50 days1, almost two months. Research has shown that longer waiting time for treatment leads to poorer health outcomes1. This means that when patients are waiting for treatment, their mental health concern, no matter how minor, could become more severe and therefore more difficult and expensive to treat. Nevertheless, not all patients need to see a psychiatrist. According to a clinical trial we are performing at OPTT Health, ~85% of the patients could be handled by a combination of supervised online CBT plus weekly engagements by lower cost personnel like social workers and mental health coaches. The remaining 15%, which translates to 294 patients out of 1,960, would definitely benefit from psychiatrist intervention. This model of assigning different resources to different patients can perfectly work in the new collaborative care models1.
But how can we measure each individual patients’ needs for such optimized resource allocation?
There is not one solution to solve this macro problem, however many experts suggest that well developed and clinically validated digital care can be a key part of the solution set. There has been a shift towards virtual care, telehealth, and asynchronous digital care. Research shows that this trend has been expedited by the pressures of the COVID-19 pandemic. Digital care reduces patient and provider costs, allows care to reach those living far from resource centers, and connects patients to clinicians in a timely manner. Also machine learning and AI (ML/AI) algorithms have been developed to support clinicians in making efficient and effective decisions in their practice. The use of technology drives a better experience for both patients and clinicians, and in fact has been shown to improve professional engagement and job satisfaction for practitioners.
There are a few cautionary notes in using digital technology for care delivery though. First, is the question of clinical validation. It is important to remember that mental healthcare, like any other field of healthcare, needs to follow a rigorous validation process. Not every solution that works in person, works digitally, and not every solution actually helps. Any digital solution therefore should be clinically validated in proper clinical trials and meticulously adjusted to meet patients’ diverse needs. Second, is the challenge with care adherence. This means that, even if a solution has been shown to reduce symptoms in a clinical trial, patients should actually go through the process to see the outcomes. Many digital mental health solutions have +80% patient attrition past sessions 3-4 of their care plans. This means that most of the patients would not benefit from them, even though they have been validated.
On the analytical and ML/AI side, there is always the question of whether these algorithms can be trusted. Most of the ML/AI algorithms are black boxes, that crunch in an array of variables and spit out a decision. As such, it is not clear for a clinician what this decision was based on and how they can trust its outcome. This lack of transparency and accountability therefore can hinder their use in the clinical process. Furthermore, many clinicians consider such use of AI in decision making as a competing factor for their job security.
I firmly believe the answer to both these concerns is technology backed care delivery by clinicians. A hybrid model of care delivery in which digital technology is used to transfer the main time consuming parts of therapy to the patients and to save clinicians for short, personalized feedback, could both scale up the number of the patients each clinician can handle, and keep patients accountable and adherent to treatment. Additionally, ML/AI algorithms should become like any other medical tool, that while they might be technologically advanced, they provide intuitive information that are easily comprehended by clinicians (e.g. MRI imaging). Therefore, any ML/AI in mental health should also follow an explainable ML design so their functionality is transparent and trustable. For instance, algorithms could compile a big range of unstructured data (including patients’ use of language and speech, their activity and sleep patterns, etc.) to produce a few clinically relevant variables that help clinicians in their decision, rather than making the decision for them. At the end of the day, tools are not replacing clinicians, but empower them.
Dr. Mohsen Omrani is Co-Founder and CEO at OPTT Health. OPTT is a provider of comprehensive hybrid digital care plans augmented by AI for proactive triage and monitoring of patients to simplify the digital-first delivery of mental health services for care teams. Learn more at www.OPTT.Health
A chronic disease is one that lasts three months or longer, may get worse over time, and may not be curable. Some chronic diseases include cancer, diabetes, heart disease, stroke, arthritis, and many others. As of 2014, 60% of American adults had at least one chronic condition, and 42% had more than one. In fact, Americans with five or more chronic conditions make up 12% of the population but 41% of healthcare spending. Additionally, chronic diseases are America’s number one cause of death and disability.
People with chronic diseases are more likely to have or develop a mental health condition. In 2012, the CDC found that 51% of Parkinson’s patients, 42% of cancer patients, 27% of diabetes patients, 17% of cardiovascular patients, and 11% of Alzheimer’s patients also had depression. Additionally, people with diabetes are 2 to 3 times more likely to develop depression than those without diabetes.
Also, the COVID-19 pandemic has introduced a new set of patients with chronic disease, the COVID long haulers. A study from May 2021 reported that one-third of COVID patients had been diagnosed with neurological or psychological symptoms in the six months after infection. In fact, patients with long COVID rank cognitive function and mental health as their top concerns. COVID has increased the prevalence of chronic conditions and behavioral health conditions.
Not only are people with chronic conditions more likely to have mental health conditions, but people who have depression and another medical illness are more likely to have more severe symptoms of both illnesses. As Rick echoed in our session, when “people do not address the behavioral health condition, that exacerbates all the other conditions that they are carrying.”
Treating mental health and chronic conditions together can help people manage both conditions better and improve outcomes. As Rick mentions, “mental health is a critical component of whole-person care,” and it’s important to integrate mental health services when addressing chronic conditions.
There are many point solutions available for tackling chronic conditions, but to appropriately address chronic conditions and mental health simultaneously, integrated solutions are key.
Lyn Health is a digital clinic for those with two or more chronic conditions. Lyn Health utilizes a Care Circle, which is a team of physicians, clinicians, and social workers, to offer virtual primary care, care navigation, medication management, behavioral health services, and social support. A key part of the model is the Care Partner, who acts as a navigator and liaison, and Erica explains that a large part of that is about “meeting members where they are, understanding what is going to suit their unique needs, and being able to set ourselves up accordingly.”
Dario Health is a digital platform to address chronic conditions such as diabetes, hypertension, weight management, musculoskeletal health, and behavioral health. Dario offers connected devices such as glucose monitors, scales, and blood pressure cuffs in conjunction with a mobile app and live coaches to address chronic condition management. Data analytics allow patients to review their metrics over time, and a provider-facing online platform gives providers insight into their patient’s progress.
Vida Health is a mobile app with a modular platform designed to treat chronic conditions, such as diabetes and hypertension, and mental health conditions, such as anxiety, depression, and stress. The app can sync with scales, blood glucose meters, fitness trackers, and other smart devices. The app also offers asynchronous messaging, digital content, and video visits with a personalized coach and therapists as needed for a full care experience.
Please check out our video library to hear our entire conversation with Rick and Erica from Lyn Health.
Ryan Hampton is the organizing director of the Recovery Advocacy Project and founder of the Voices Project. He is the author of Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis and American Fix: Inside the Opioid Addiction Crisis - and How to End It. In our conversation with Ryan, we discussed his journey in recovery and his work advocating for people with drug addictions, others in recovery, and family members of those impacted by addiction.
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.”
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.
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.”
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.”
Ryan hopes that addiction treatment can become more mainstream in the future and reduce barriers to minimizing the treatment gap. 9/10 people who need treatment don’t get it. “It is my hope that through our advocacy and collective work with providers and scientists and policymakers that we can get to a place where it is streamlined right into the Primary Healthcare System.”
Mobilize Recovery is a free movement from September 29th- October 1st, 2022. It is an initiative of the Recovery Advocacy Project and the Voices Project, where attendees will learn innovative strategies & tactics for grassroots organizing & recovery solutions.
You can access our 2022 virtual sessions with employers, benefits consultants, telehealth leaders, health plans, and more within the Going Digital: Behavioral Health Tech free video library to hear more conversations like this.
Founded in 2017, Two Chairs is a mental health practice built for clients and therapists. We start with a research-backed matching process to ensure the ideal client-therapist fit, offer hybrid care to maximize choice and access, and employ a diverse, collaborative team of licensed clinicians across 90+ areas of expertise.
At Two Chairs, hybrid care is a flexible care model that allows for a seamless combination of virtual and in-person sessions. For clients and clinicians alike, hybrid care is about tailoring the experience of therapy to something that will work for each individual person.
Over the past couple years, virtual care has come to prominence out of necessity, but it has many benefits. For clients, it provides access to therapeutic support quickly and with little hassle. It can also lower barriers to care associated with physical spaces, eliminate the need to travel and associated costs, and save time to fit therapy into life more easily.
For clinicians, it can make work more convenient by eliminating a commute and allowing them to work on a more flexible schedule, as well as enabling them to reach patients they otherwise may not be able to.
On the other hand, many people still want the option of in-person care and find more benefit in doing therapy face-to-face—66% of clients want the option of seeing a clinician in-person for behavioral health purposes, according to Rock Health’s 2021 Consumer Adoption Report. With in-person therapy, clinicians can better read nonverbal cues that support verbal communication, and different therapeutic methods like art and music can bolster support. In-person therapy also provides a safe space away from everyday life for clients and allows clinicians to connect with their clients more directly and without technical glitches.
Hybrid care combines the best of both worlds, and it gives people the option to get care when and how they need it, whether it’s all in person, all virtual, or a little bit of both.
At Two Chairs, we believe in spaces as sanctuary. Whether our clients are virtual or in-person, we want them to feel safe and comfortable.
All of our therapy clinics across the Bay Area, Los Angeles, and Seattle are warm, welcoming, and open spaces, reflecting the core tenets of therapy itself. They incorporate trauma-informed design with simplicity, privacy, safety and a sense of peace, with natural elements weaved throughout to calm senses and have a positive impact on psychology.
Research shows that a strong client-therapist relationship is the key to successful therapy, so we’ve invested in perfecting the match.
Part of the matching appointment that every Two Chairs client goes through involves a discussion around how they want to receive care, whether that’s in-person, virtual, or both — and how important that factor is to them.
Whatever they decide, that is taken into consideration with hundreds of other data points covering symptoms, goals, preferences, demographics, and other factors to match them with a therapist who is just right for them.
We aim to center the client in everything we do, and that includes offering options for care delivery to provide quality and well-tailored care to a wide range of populations.
Offering virtual care gives access to folks who may live in more remote areas in the states we serve, or those who can’t easily get to a clinic on a regular basis. Alternatively, providing immediate and effective in-person care gives an option to people who want in-person therapy but are having a hard time finding the right therapist for them with availability. And a hybrid option gives people flexibility to receive care when and how they need it, allowing therapy to more easily fit into their lifestyle.
To us, providing hybrid care is one of the best ways to improve the mental health system. By giving both clients and clinicians the option of where and how they do therapy, we’re building a practice that enables a strong therapeutic alliance and improves access to exceptional mental health care for all.
The opioid crisis in America is at an all time high, with a tragic and record-breaking 100,000 deaths each year now attributed to drug overdose. In a 2021 report, the Substance Abuse and Mental Health Services Administration noted that 2.7 million people in the US struggled with an opioid use disorder (OUD). The burden of drug use and overdose is particularly high in rural communities. The good news is that safe and effective treatments exist and can be life-saving. But in rural America access to those treatments can be painfully difficult. For starters, rural communities lack providers. Over half of U.S. counties, most of them rural, have no DATA-waivered physicians to prescribe buprenorphine. That means 28 million Americans live more than 10 miles from the nearest buprenorphine provider. To make matters worse, the rates of naloxone use for opioid overdose are lower in rural communities than in urban and suburban communities. Rural areas also have high rates of poverty. Although some rural states have adopted Medicaid expansion, many addiction providers do not accept it. For example, a 2017 study found that 50% of the active buprenorphine prescribers in Ohio accepted only cash. The amount of suffering is staggering. The challenge is how to make evidence-based care for opioid use disorder both accessible and affordable.
Workit Health offers whole-person care for opioid and alcohol use disorders using a virtual first approach. Founded by two women in recovery, Robin McIntosh and Lisa McLaughlin, who grew tired of seeing friends fall through the cracks of traditional treatment systems, Workit Health offers video visits with a medical provider, counseling and psychosocial support, and an interactive curriculum of skills-based courses. Almost a quarter of Workit Health members live in rural areas, where this virtual program bridges the gap between what we know works for these serious health conditions and who actually receives it. Through Workit Health’s mobile and web applications, members have a frictionless experience attending video visits with dedicated clinicians and picking up their prescriptions, including buprenorphine, at their local pharmacies. People who once had to travel hours every day to receive medication are having their lives transformed by receiving the gold standard in opioid use disorder care from the comfort and privacy of their own home. This innovative approach to delivering care not only reduces stigma, it makes care more affordable, which is critical to serving rural communities. For instance, a core component of Workit Health’s mission is to serve the Medicaid population, and today roughly 60% of Workit members are covered by Medicaid.
Workit Health’s CEO’s Lisa and Robin have Michigan roots and witnessed the lack of access to care for substance use disorders impacting their communities. In response to this, they launched Workit Health and first began serving the residents of Michigan, well before the onset of the COVID-19 pandemic. At first, the majority of Workit members were from metropolitan Detroit and Ann Arbor. But a large portion of the state of Michigan is rural. In the Upper Peninsula, the northern-most landmass of the state, the average distance to a buprenorphine clinic is 63.3 miles, and Michigan counties lacking an emergency department are all located within the Upper Peninsula. Although the Upper Peninsula is adjacent to Northern Wisconsin, it has nearly double the prescribing rate for opioid pain medications as its Wisconsin neighbors. The Workit team turned these challenges into inspiration.
Since 2019, the number of members in the Upper Peninsula of Michigan who have attended an appointment for opioid use disorder with a Workit Health clinician has soared 300%. In rural zip codes across the Lower Peninsula of Michigan, the number of residents Workit Health is serving has increased by more than 200%. The members report that the change is life-altering. One member posted a public review of Workit that said, “[the] program has been a complete life changer! I used to have to drive 50 minutes to my clinic where I was overcharged and judged…they take my Medicaid so it's WAAY cheaper… and most importantly, these people treat you with dignity and respect!”
Encouragingly, Workit Health’s impact on rural areas is not confined to Michigan. Similar growth has taken place in rural areas of Ohio, Virginia, and California. As the opioid epidemic rages on, solutions like Workit Health are a testament to the power of innovation to achieve dramatic and sustained reductions in harm from opioids, particularly in some of the hardest hit areas of rural America.
Dr. Justin Coffey is a neuropsychiatrist and an innovative physician leader whose career efforts to improve behavioral health care have focused on the intersection of technology and improvement science. He leads Workit’s clinical and scientific teams, who combine patient-centered design with evidence-based practices to develop and deliver high-value, whole-person behavioral health and addiction care.
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.
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.”
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.”
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.”
These prolific investors also had advice for startups moving forward. One piece of advice was to stay mission-driven. As Deena explains, “you can move that fast and break things in tech, but when it comes to health care, if you move fast and break things, there are lives at risk. And ultimately, you’re misaligning investor-fueled growth at the expense of actually improving health outcomes.” Digital health companies have a different value proposition than other tech companies, and it’s imperative that they keep patient health and safety in mind as they manage their growth.
Alyssa chimes in, “we really are different than the rest of tech, and it takes a lot of smart people around the table in healthcare to build really powerful solutions. And there’s a reason we’re thoughtful and methodical because people’s lives are in the hands of these companies.” She also reflects how transformative and powerful it is to build something new in digital health during a global pandemic. Startups and investors must remember their mission and keep patient health and safety at the forefront.
Please browse our video library to hear our entire conversation with Aike, Chrissy, Deena, and Alyssa.
During the Going Digital: Behavioral Health Tech Conference, we heard from startups, payers, providers, investors, and other visionaries in the behavioral health space. One conversation with Britain Taylor, a Ph.D. Intelligence and Systems Engineering Candidate at the Indiana University Bloomington shed some light on artificial intelligence’s (AI) role in mental healthcare. She is the creator of ShuffleMe, an AI predictive software that detects current mood and helps social media users understand what content impacts their mood in real-time.
Studies have found that social media is responsible for aggravating mental health problems. Social media can create pressure to create stereotypes that others want to see. Social theories have found that social media use affects mental health by influencing how people view, maintain, and interact with their social networks.
According to research, since 2010, iGen adolescents have spent more time on new social media screen activities and less time on non-screen activities. This may account for the increase in depression and suicide. A Pew Research Center study found that of nearly 750 13- to 17-year-olds found that 45% are online almost constantly, and 97% use a social media platform, such as YouTube, Facebook, Instagram, or Snapchat. A cohort study found that greater social media use correlated to online harassment, poor sleep, low self-esteem, and poor body image; in turn, these related to higher depressive symptom scores.
Artificial intelligence (AI) refers to the simulation of human intelligence in machines that are programmed to think like humans and mimic their actions to perform tasks. Now more than ever, innovative technologies such as AI are being used in the healthcare industry to address mental health challenges. There has been an increase in funding in digital health, and with AI-powered mental health, record levels of venture capital money are flowing into the sector.
The three AI technologies transforming mental healthcare are,
Artificial Intelligence is a growing industry, and researchers constantly discover new and exciting ways to utilize AI technologies to improve health. Research has shown that AI can even be used to reduce symptoms of anxiety and depression. The study found that within the first two weeks, users of an AI therapy app, Youper, experienced anxiety and depression decreases by 24 percent and 19 percent, respectively. These levels remained low after using the app for four weeks. The approach to combining AI and telehealth capabilities encourages patient engagement, improving mental health.
ShuffleMe is an AI software that utilizes computer vision through a facial mood tracking camera that takes snapshots at key moments of mood indication. Britain explains how the ShuffleMe experience works. She says that a user would first download the ShuffleMe software, then give the software permission to access the camera on their device. “Then the software does all of the work in the background,” she says. The software functions by tracking facial expressions and eye pupil detection to track the placement of what a user is observing on their screen. Britain describes how “after you browse on Instagram, Facebook, or Tiktok, for example, you would go to the dashboard, and you could toggle mood incline or mood decline to see which social media content impacted your mood. So the software takes a screenshot of what that social media content was when you emoted a negative facial expression.”
The ShuffleMe software has also expanded to give users access to therapists or psychologists via an online chat. The data from the software can be sent to mental health professionals with certification and knowledge about tech addiction and digital health. ShuffleMe’s user experience is unique because users are given as much information and resources about their passive and active behaviors on social media. “[ShuffleMe] provides access to actually receive help on the platform,” Britain says.
Britain explains how the ShuffleMe software has changed how users interact with their social media. She says, “We’ve seen our users unfollow certain users… or even deleted one of their social media platforms because their data was showing that the time they were spending on social media and the content was impacting their daily life.” Britain explains her thoughts on optimizing mental wellness through technology: “I think it depends on the individual. Some tech really helps people feel connected, find relatability and increase their sense of community. Depending on the person, the tech doesn’t support the individual or their mental health.”
The ShuffleMe software is free to users and can be downloaded at ShuffleMe.app. “We are focused on getting our software in as many hands as possible because we are focused on saving lives and making an impact,” Britain says. The ShuffleMe software is currently partnering with the American Heart Association and connecting with university students to use the ShuffleMe software. You can follow ShuffleMe on Facebook, TikTok, Instagram, Linkedin, and Twitter at @ShuffleMeApp. You can access the Going Digital: Behavioral Health Tech talks to hear our entire conversation with Britain Taylor.
Integrated care is mentioned in many of our blogs and a focus for multiple Going Digital: Behavioral Health Tech partners. Addressing both physical and mental health conditions can be very beneficial to members if all of the providers are talking to each other. Communication is much more efficient when the providers are all in one app and one care team. Vida Health’s app not only provides this, but it has just launched a new prescription service. Vida Health’s Chief Medical Officer, Dr. Patrick Carroll, tells us more about the development of this service and what members can expect.
Yeah, thanks for having us Solome. We launched our prescribing capabilities this month and look forward to tracking the early results. Prescribing was something we had been considering adding to our capabilities for a long time, but we knew we wanted to be thoughtful about the offering and do it in-house, so we began building the process, clinical rigor, and team at the beginning of the year.
As a physician, over the years, I've seen that some patients do well with behavior change only, and others benefit from also using medications and related devices. At Vida, we know that treatment doesn't stop with a prescription — that’s why we always pair prescriptions with therapy or coaching. That human connection helps us make sure members have the resources and relationships they need to truly be successful. The addition of our prescribing capabilities will better support our members by enhancing the care interventions Vida providers can use to help members with higher-severity conditions see greater health improvements. Not only will it help our members see greater outcomes, it’ll help our business customers achieve greater value while offering their population access to broader levels of care.
Both physical and mental healthcare with Vida is always human-led – each member has a primary provider they can stay with for their entire program. That human connection, combined with our robust technology, allow Vida to deliver truly personalized care plans that put our members at the center of everything. As with all Vida services, our prescribing program follows a holistic, individualized approach — with some members starting new medications or receiving new devices, some focusing on adherence, and others reducing or removing medications and devices.
For example, a patient of ours who’s on existing diabetes meds and who has undiagnosed depression can come down on their insulin dose as the member works with us to improve their mental health, loses weight, and lowers their A1c. Now that they have one Vida care team with medical prescribing services, all that care can be done in one place, and the providers can talk to each other to create a personalized care plan.
One unique thing about Vida’s platform is that all of our mental health providers, like therapists and mental health coaches, are on the same platform as our physical health providers, like dietitians and certified diabetes educators. Instead of getting medications from one clinic and therapy or coaching at another, our members can receive required chronic care in the same place — using one app and one care team. That single environment for both physical and mental health lets us deliver the right level of care and helps the providers engage with each other and coordinate care effectively. That personalization also leads to better engagement and better outcomes, creating an improved experience for members and ultimately greater value for clients. Now, with the addition of prescribers to our clinical team, we’re able to offer truly integrated care where prescribers can work in tandem with our therapists and coaches.
Going back to how combined physical and mental care that’s coordinated in one platform can lead to better outcomes — we actually just had a new peer-reviewed research paper published that shows 3x greater weight loss among those who also reduced their depression compared to those who focused on weight loss alone. And then switching that around, patients who experienced improvements in their depression showed consistently better weight loss outcomes than those whose depression didn’t improve.
During Going Digital: Behavioral Health Tech 2022, we were fortunate to host two incredible talks focused on Medicaid and behavioral health. The first talk was a Keynote by Chiquita Brooks-LaSure, the Administrator for the Centers for Medicare and Medicaid Services (CMS). We also had a panel discussion, hosted by Margaret Laws, the President and CEO of Hopelab, and featured panelists including Kinda Serafi, a Partner at Manatt, Judy Mohr Peterson, PhD, the Medicaid Director for Hawaii, Anna Fagin, a Principal at Town Hall Ventures, and Jeff Luce, Vice President at Optum, and the East Coast Medicaid Channel Lead.
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?”
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.”
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.”
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.”
1. Focus on Quality Outcomes
Make sure your product provides a top-notch member experience, works well operationally, and delivers incredible clinical outcomes.
2. Work with Medicaid Plans on Bundled Payments
If you are offering services like coaching that fall out of the traditional ICD-10 code model, work with Medicaid plans to find a billing setup that works for both of you.
3. Crush Your First Contract
In order to successfully expand to additional states and markets, focus on excelling with your first contracts and having something positive to show your second market.
To hear both of these sessions, please visit our website.
Ria Health is a tech-enabled telehealth clinic that treats alcohol use disorder (AUD). Their team is singularly focused on helping people change their relationship with alcohol. As mentioned at this GDBHT2022 session, their evidence-based program combines science-backed methods alongside technology to improve accessibility and affordability. Ria Health has helped close to 5,000 people experience successful outcomes and is available in nearly all 50 states. We sat down with their team to get more specifics on their virtual alcohol use disorder solution.
About half of heavy drinkers concurrently suffer from anxiety and/or depression, a problem that alcohol makes worse. People often drink to self-medicate for these underlying anxiety or depression problems but are left with worse symptoms when they withdraw from alcohol. This pushes people to drink again, perhaps even more often or more per session, perpetuating the cycle.
Misusing alcohol can also result in real-life consequences that can negatively impact someone’s mental health. This includes relationships, work-life balance, and can even result in legal problems (such as DUIs). These stressors can impact social settings and experiences, driving people to isolation, worsening a person’s mental health, resulting in anxiety and depression.
Significantly reducing, or stopping, alcohol consumption leads to an overall better mood and an improvement in levels of anxiety. Some patients will also benefit from counseling and/or an evaluation for anti-anxiety or antidepressant medications.
Ria Health’s medical staff includes both physicians and nurse practitioners that conduct a thorough initial assessment to tailor an individualized program for each Ria Health member. Our program combines both counseling as well as medication-assisted treatment (MAT) which, evidence shows, results in the best outcomes for those struggling with AUD.
Our initial medication assessment takes into account an individual’s unique medical and psychiatric history as well as a member’s own goals. We’re not an abstinence-only program and understand that members may only want to reduce their drinking and overall consumption. We help align on a goal that is likely to result in a member sticking with the program and achieving the goal they want.
Depending on the individual’s pattern of drinking, our team members will prescribe one of several medications available for those struggling with AUD. Different medication is best suited depending on whether a member wants to abstain from alcohol or is looking to reduce consumption.
This includes medicine that can reduce cravings (Naltrexone, Topiraamate, Baclofen), treat symptoms related to withdrawal symptoms, anxiety issues, and lack of sleep (Gabapentin), as well as assist in maintaining abstinence (Acamprosate).
On the counseling side, patients are able to match with a coach of their choice who helps them develop goals as part of a collaborative approach to treatment. These coaches and counselors provide ongoing accessible care that’s tailored and suited for a patients’ schedule to maximize support and availability. Depending on the member, coaches will pull from a myriad of tools, techniques, and options such as 1-1 counseling, workbooks, and group therapy that is aligned with a member’s preferred treatment and learning style.
AUD isn’t just a personal problem — it’s a problem that can affect a person’s employment and work environment as well. Employers also experience negative consequences as a result of an employee with AUD issues. Productivity, work satisfaction, presenteeism, and absenteeism are all issues that can worsen over time without AUD treatment.
By helping employees become aware of their relationship with alcohol, an employee can begin the work towards addressing AUD which starts with an understanding of how alcohol can affect them across interpersonal relationships, home, and work life. When AUD is properly managed in the workplace, employers can save an average of $8,500 per employee per year.
Ria Health helps employers give a treatment program that empowers employees to manage their AUD, resulting in increased productivity and performance while decreasing healthcare costs, bringing savings to both the employer and employees.
By offering a focused AUD program, as opposed to a one-size fits all approach, employers can expect better engagement, adoption, and overall program success. We know that employees are specifically looking for specialty providers that offer more accessible options. Ria Health’s telehealth-based program is much less disruptive to employees' lives and doesn’t require a major uproot compared to a residential treatment facility or an IOP/PHP.
In many cases, the employee doesn’t even need to take time off of work to obtain treatment. The lack of disruption makes program adoption much easier and reduces the burden on the employer of having to cover for an employee who may be taking an extended period of time away.
Lastly, Ria Health is vastly more affordable compared to traditional inpatient programs — costing just a quarter as much. These savings are passed on to both the employers and employees.
Our last blog discussed insights from innovative serious mental illness startups. One of the featured companies was Mindstrong Health. Their CEO, Michelle Wagner, gave a hope-filled opening session at Going Digital: Behavioral Health Tech 2022 this year
We wanted to dive deeper into Mindstrong’s process, including how they are revolutionizing serious mental illness care, measuring outcomes, and partnering with payers. You can read our conversation below.
SMI populations are hard to treat, hard to engage, and as a result, are populations that are overlooked and underserved. Supporting this population requires not only outstanding clinical care, but also the creativity and nuance to meet members where they are on their mental health journey.
Mindstrong's blend of proven science, state-of-the-art technology, and dedicated care teams are the secret sauce behind our ability to help members feel better, do better, and stay better. We believe in mental health care for all and specialize in serious or complex challenges. It may take more work, and we’re committed to better outcomes for everyone.
The Mindstrong App & Care Platform includes measurement-based clinical care, customized interventions, case management and resources for SDoH needs; 24/7 support for all acuity levels, with a specialization in SMI gives our members the safety net they need to build confidence in their care. Our integrated care team includes Care Partners, Therapists, Psychiatric NPs, and MDs. Each Care team is a tailored blend of provider(s) based on members’ specific needs and preferences. Mindstrong is mental health care with the strength to tackle anything.
Care delivery at Mindstrong relies on data to inform our Measurement-Based Care (MBC) approach to enable progress tracking and aiding in clinical decision making.
Bringing together technology, data, and care, we measure member progress on an ongoing basis to ensure that member needs and changes are continually assessed and met.
Our proprietary platform sends intelligent, clinically-informed symptom surveys to members automatically, in between sessions.
We use clinically validated assessments including DSM-5 and Level 2 PROMIS. Providers use the Level 2 PROMIS Assessment information to better define the qualitative nature of the problems, determining a more accurate diagnosis, and developing measurable treatment goals.
We complement the clinical assessments with post-session assessments and ongoing Care Plan reviews, to ensure we’re constantly meeting the needs and evaluating progress of members in a truly personalized way.
In addition, we are constantly measuring through member surveys like mood surveys and therapeutic alliance.
All assessments are automated based on smart logic that is built into the backend. This reduces the burden for our providers to have to manually send or administer questionnaires to members.
MBC has been shown to outperform treatment as usual, where data is a powerful tool in amplifying care effectiveness.
MBC also empowers and engages the member in their care by giving them the ability to track their progress toward their health and wellness goals and openly discuss their progress with providers.
We partner with payers who are shaping and leading the way in value based care. Mindstrong specializes in payers’ high-cost and often overlooked members, including those with SMI conditions and older populations.
In our partnerships, we reduce TCOC for payers and improve clinical outcomes for members. We do this by focusing on outstanding clinical care, high-touch acquisition, whole-person care including SDoH and care coordination, predictive analytics based on passive data from members, and care teams that partner with members to eliminate roadblocks members experience in achieving their mental health goals.
Our start-of-the-tech, proven science, and dedicated care teams enable high member engagement, real-time crisis intervention, and ongoing monitoring.
The results are improved financial outcomes for partners and improved outcomes for members.
For those interested in learning more, please reach out to Ceili Cascarano at ceili.cascarano [ at ] mindstronghealth [dot] com.
During the 2022 Going Digital: Behavioral Health Tech Conference, the venture capital panel featured healthcare investors such as Chrissy Farr, a Principal and Healthtech Lead at OMERS Ventures. Farr remarked that startups focusing on anxiety and depression “will continue to be a tricky funding environment in the next couple of years. But more investors I'm talking to are thinking about severe mental illness…I think those companies will do quite well in the coming years because it's a space that has not been invested in in the same way.”
As investors and innovators in the mental health space start focusing their attention on serious mental illness (SMI) focused startups, they need to keep some critical concepts in mind if they hope to successfully engage and serve patients managing severe mental illness. Hear from leading SMI startups on their unique approaches to engagement and partnership in this week’s blog.
The National Institute of Mental Health (NIMH) defines SMI as “a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.” SMI can include conditions such as major depressive disorder, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder.
As of 2017, there were 11.2 million adults in the United States with an SMI. Because SMIs involve serious functional impairment, these impairments can lead to difficulty maintaining employment, poor social support, multiple psychiatric hospitalizations, homelessness, incarceration, and co-existing substance use disorders. In fact, about 1 in 4 adults with an SMI also have a substance use disorder. The SMI population also has a life expectancy that is 20-25 years lower than those without SMI. People with SMI also have worse medical outcomes, higher rates of suicide, and greater levels of stigma than those without SMI. Even further, there is a shortage of providers who treat SMI.
We spoke with Dr. Holly DuBois, the Chief Clinical Officer at Mindstrong, during our Going Digital: Behavioral Health Tech Conference and she emphasized, “We know that those social determinants [of health], for folks, especially with a serious mental illness, they're profound, and they have a huge impact on their ability to engage and then sustain any outcomes.” Watch her session here.
There are a growing number of startups focused on SMI care, such as Amae Health, aptihealth, firsthand, Mindstrong, and NOCD.
Amae Health utilizes psychiatry-led, integrated care providers for outpatient physical and behavioral health services delivered within in-person clinics. Amae Health focuses on caring for the highest need individuals who are experiencing unmanaged acute episodes or chronically unstable severe mental illness. Often these individuals are seeking care through Inpatient Psychiatry and ERs and unfortunately are met with months long waitlists to get any kind of specialty-related SMI care. For this population, piecemeal solutions or relying on the existing fragmented network has proven to be insufficient.
Amae Health’s solution is designed based on real world evidence and research from their CMO’s integrated care model at the VA, which demonstrated industry leading clinical and financial outcomes. Their tech-enabled integrated outpatient psychiatry-led behavioral and primary care services are delivered via our in-person clinics and community centers. Each patient has a dedicated care team who in addition to providing clinical care, focuses on basic needs, healthy living, social, and community components impacting the patient, helping them stabilize their lives, have community support, and rebuild purpose.
aptihealth matches members ages 12 and older with a collaborative care team including a licensed therapist and psychiatric prescriber, if needed, and focuses on those with mild symptoms to those with SMI.
aptihealth’s mission is to improve behavioral healthcare for underserved populations—one member at a time. To accomplish this, they operate fully within the healthcare system, partnering directly with health plans, health systems, physician practices and community-based organizations to intelligently integrate care. With domain expertise in patient engagement, behavioral and medical care, virtual-first care delivery and unprecedented data and insights; their care model reliably impacts the most important behavioral health drivers of outcomes and cost. Their technology guides care using workflow best practices and data insights to enable right care, right modality, right time. Their modern design creates an intuitive experience for members and robust capabilities for providers to optimize engagement. Insights from their treatment data drives breakthroughs in mental health understanding, treatments, and outcomes. All of this results in informed, organized, coordinated, collaborative and successful care, evidenced by unprecedented member experience, clinical outcomes and return on investment.
Mindstrong offers telehealth and virtual care using therapists and psychiatrists. Mindstrong also users AI-powered digital biomarkers, collected passively as members use the Mindstrong app, to monitor patients' mental health status.
Mindstrong's blend of proven science, state-of-the-art technology, and dedicated care teams are the secret sauce behind our ability to help members feel better, do better, and stay better. They believe in mental health care for all and specialize in serious or complex challenges. It may take more work, and they’re committed to better outcomes for everyone. The Mindstrong App & Care Platform includes measurement-based clinical care, customized interventions, case management and resources for SDoH needs; 24/7 support for all acuity levels, with a specialization in SMI gives our members the safety net they need to build confidence in their care. Their integrated care team includes Care Partners, Therapists, Psychiatric NPs, and MDs. Each Care team is a tailored blend of provider(s) based on members’ specific needs and preferences. Mindstrong is mental health care with the strength to tackle anything.
NOCD is a telehealth provider for the treatment of OCD, utilizing therapists who are trained in Exposure and Response Prevention (ERP) therapy, the gold standard for OCD treatment.
There are 179 million* people with Obsessive compulsive disorder (OCD) around the world. Never before has there been a dedicated platform to identify people who are suffering from OCD, bringing them to care, helping them navigate the healthcare industry, and providing in-between care support in order to make sure they maintain their care journey. This member-focused approach that was built from the consumer backward is truly groundbreaking in the behavioral healthcare space, arguably in the healthcare industry in general. People suffering from OCD no longer have to feel alone as they continue to reduce the social stigma surrounding OCD. Reducing this stigma & identifying people in need allows us to enroll patients into the largest telehealth network of OCD-specialized therapists.
NOCD has reinvented the front door to healthcare and revolutionized OCD treatment & patient experience. They have developed a discreet way of identifying a serious mental illness community through innovations such as finding those suffering where they are in their journey by engaging with consumers and helping them navigate the healthcare system in order to receive the right care.
As well as utilizing technology to create an experience from treatment seeking to receiving treatment through our telehealth platform and offering in-between session care & support through peer communities, direct access to experts and self-help tools.
NOCD’s telehealth platform enables patients to schedule live face-to-face therapy sessions with licensed clinical therapists specializing in ERP therapy. In between visits NOCD’s member tools empower them to better manage their OCD and practice therapeutic techniques. The combination of therapy, and care management support between sessions is an innovation in the behavioral healthcare industry. They have created an integrated platform between consumer engagement, healthcare treatment, and in between care, an integration that is unique in the behavioral healthcare space. NOCD has designed this entire experience from the consumer backward in order to meet a suffering and underserved demographic where they are in their care journey, bringing them to affordable, accessible and insurance-covered care, and working with them to maintain their journey in order to regain their lives.
*Based on a global population of 7.8 billion people and a recognized OCD lifetime prevalence of 2.3%
What do SMI startups steeped in care delivery want payers and providers to know? Here are some of their thoughts:
Amae Health: “[Payers and providers] know that consistent high quality SMI+SUD, medical, and social integrated care are deeply necessary to effectively help this population. However, being able to bring these pieces together in an equitable, measurement, evidence based and incentive-aligned manner has been the primary challenge. Amae Health seeks to do just that in order to provide integrated care.”
aptihealth: “When care is clinically integrated with health plans and systems across all points-of-care; patients can be engaged whenever and wherever they touch the system, with insights that create the opportunity to navigate the patient to the optimal course of care, reducing ED visits and admissions. That’s the challenge, and it’s our job to make sure payers and providers know that there’s a solution.”
firsthand: “Real support can only be financed if we truly integrate the medical and behavioral risk dollar. Without that integration, there is not enough savings to substantiate investment in appropriate whole-person clinical models at scale.”
Mindstrong: “These populations need more than an episodic fix; they need support that balances mental health care with whole person care, with a goal of building resilience and empowerment. With the right blend of data, technology, and care, SMI members can experience sustained outcomes and Payers can reduce [total cost of care].”
NOCD: Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. It is imperative that those suffering from OCD require specialized treatment: Exposure & Response Prevention (ERP). Lifetime prevalence of OCD is approximately 2.3%, affecting nearly 1 in 40 people (~8M Americans). OCD is debilitating; those suffering are 10X more likely to commit suicide, it is ranked by the WHO as 10th leading casue of disablity, and approximatly 1 in 4 people with OCD develop substance abuse. Despite the prevalence, OCD is widely misunderstood & misdiagnosed. This, combined with a lack of mental health resources, causes a 14-17 year patient journey to find appropriate care. Limited access to proper care at the appropriate time creates a burden on the healthcare system. Per 1M commercially insured, OCD generates $104M+ annually in behavioral health costs; of which, 96% is associated with inappropriate care.
To read more articles like this, read more of our Insights here.
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Ahead of the Going Digital: Behavioral Health Tech Conference, we will be sharing some insights that you can expect to learn more about during the conference. Dr. Quidest “Dr. Kiki” Sheriff, DO, MS is the founder and CEO of Doctors Under the Radar (Doc U R), a company focused on physician mental health that engages healthcare leaders, creates transformational workplace change with mental health and suicide prevention strategies, and design health-tech data driven solutions. Dr. Kiki sat down with our very own Solome Tibebu to discuss her experience with burnout and her decision to create Doctors Under the Radar.
As Dr. Kevin Hopkins recently explained for the American Medical Association, physician burnout is “a combination of physical and emotional exhaustion that can lead to reduced effectiveness-either real or perceived.” Doctors and all mental health professionals are experiencing extremely high rates of burnout, which has only been exacerbated by the COVID-19 pandemic. In fact, medical students are two to five times more likely to experience depression than their age matched peers.
In 2018, the American Psychological Association estimated that 21-61% of mental health practitioners were experiencing burnout, and a 2020 study found that 78% of Psychiatrists screened in the study were positive for signs of burnout. To combat the growing need for mental health treatment and due to an ongoing shortage of mental health providers, in November 2020 one third of Psychologists report seeing more patients since the start of the pandemic and 30% said they have not been able to keep up with demand for treatment.
Mantra Health, a digital mental health company, recently released a white paper on provider burnout in counseling centers. In their sample 91.4% of respondents reported burnout and 45% of clinicians agreed or strongly agreed that their workload compromises their ability to provide quality care.
Dr. Jessica Gold, a practicing Psychiatrist, so eloquently explained in a Forbes article last year, “therapists are a limited resource and cannot, no matter how much they try, make up for a broken mental health system with extra hours, night and weekend accommodations.” So in order to improve provider burnout, we have to think about how organizations and employers can make changes.
Clinician burnout has downstream effects on the entire healthcare system. Clinician burnout is costing the health care system about $4.6 billion a year. Additionally, studies show that if things continue the way they are, by 2025, 75% of healthcare workers may leave the profession.
In our discussion, Dr. Kiki stated that it's important for health systems to “create an atmosphere where it’s okay to state that you’re experiencing burnout and to ask health systems, what initiatives do you have in place to engage your clinicians?” Additionally, Dr. Kiki emphasizes that it's important to have an internal audit to “talk to your clinicians to understand what their problems are, and this will drive your solutions.”
Solutions that health systems and other organizations create must focus on three pillars that support intrinsic motivation and psychological well being: autonomy, competence, and relatedness. So solutions may involve reallocating resources so clinicians feel they have more control over their schedule, and are less burned by administrative tasks. Additionally, the Mantra Health white paper suggests creating solutions that focus on they key themes of togetherness, openness, boundaries, and increasing meaning.
Doctors Under the Radar strives to provide resources and support for all clinicians in the workplace through strategic consulting, health-tech innovation, and media. As part of their strategic consulting initiatvie, Doc U R partners with healthcare organizations to normalize mental health and suicide prevention in the workplace, including culture management, leadership engagement, and data-driven decision making tools.
Mantra Health is a digital mental health provider for university students that works with university counseling centers to support existing providers, expand capacity, and reduce administrative burdens for existing providers. Therapists employed by Mantra Health are also able to create their own schedules, for greater autonomy. Additionally, the Mantra-affiliated providers can collaborate with the on campus providers to give comprehensive care coordination to university students.
Burnout can lead to increased loss of empathy, impaired job performance, and increased medical mistakes. It can also lead to greater costs to the healthcare system, including clinicians leaving the workforce.
To reduce burnout, clinicians of all kinds need to feel that their time is valuable and they can have autonomy in their work.
As Dr. Kiki mentions, “and just one other thing that I would like to see is just that we change the face of medicine, in which doctors are seen as superheroes, and they constantly have to wear that cape, which dehumanizes them and makes it harder for them to be true to themselves.”
To watch the entire interview with Dr. Kiki and hear about her personal struggle with burnout, please join us for the Going Digital: Behavioral Health Tech conference on June 8-9, 2022. Registration to the conference is free, or consider making an optional donation to our 2022 non-profit partner, the American Foundation for Suicide Prevention.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
This week, we’re talking to a group that is focused on populations with complex comorbid physical and behavioral health conditions. As we’ve discussed quite a bit on the blog, we know that when mental health and substance use disorders go untreated, they can cause individuals much more difficulty dealing with their symptoms. If paired with a chronic illness, this burden only significantly increases. This combination leads many patients to seek emergency care at higher costs to health plans. These payers are eager for solutions that address untreated behavioral health conditions to reduce these costs.
When it comes to supporting patients dealing with multiple chronic conditions with underlying behavioral health issues, it is important to have a care team skilled in engaging patients with personalized plans and timely care. The team from Ontrak Health shared their approach with us.
One of the key healthcare challenges we are tackling at Ontrak Health is how to engage complex populations with unaddressed behavioral health (BH) conditions + chronic physical conditions into high-value care to meaningfully reduce medical expense.
When an individual is not receiving adequate treatment for a behavioral health issue - such as depression, anxiety, or substance use disorder – and they are not engaged with a primary care provider or proactively managing their other chronic physical conditions, their physical health will likely deteriorate until they require crisis care in an ER or hospital setting. It is well documented that preventable ER and inpatient stays are one of the main drivers of avoidable healthcare costs.
Unfortunately, in many cases the BH issue will continue to be unrecognized or undiagnosed in the urgent care setting. For example, take an individual with diabetes who has exacerbations that land them in the hospital twice. They are stabilized at the initial visits, but then a few months later are back in the hospital, and the diabetes is labeled as refractory (not responding to treatment). However, the underlying cause is actually undiagnosed alcohol use disorder that is destabilizing their blood sugar. Alternatively, it could be untreated depression or anxiety that is preventing them from participating in diabetes management or adhering to treatment plans.
It is this cycle of low value utilization that contributes significantly to inflated healthcare costs.
Our focus at Ontrak is helping individuals achieve lasting health improvements to reduce medical expenses. We do this by removing barriers to care, empowering sustainable behavior change, helping members develop self-efficacy, and connecting them with providers to address underlying behavioral health conditions. Through this proven approach, we are able to deliver a significant and durable reduction in ER and inpatient utilization and costs across our member base.
Ontrak recently announced an industry-first Advanced Engagement System that will enable us to deliver precision behavioral health by infusing AI into every step of the behavioral healthcare journey. Our AI-powered platform will optimize program eligibility, member identification and outreach, coaching interactions, provider visits, interoperability of data between Ontrak, providers, and health plans, and last but not least, outcomes.
Once enrolled into the Ontrak program, AI will match members with the best Ontrak Care Coach to help them work towards their health goals, and also recommend the best behavioral health provider match for treatment. Once matched with a member, our coaches take a person-centered approach to engagement, and connect in the ways that work best for the member, allowing the coach to become a trusted advocate and resource.
Our integrated platform will also facilitate collaboration between coaches and providers by offering unprecedented visibility to a member’s care journey, progress and health outcomes, and providing seamless exchange of session notes and other data.
Lastly, our AI-infused services will help coaches develop deeper engagements with members by enabling highly personalized, timely, and empathetic care, while maximizing the efficacy of treatment plans by providing, for example, real-time feedback on fidelity to evidence-based models.
Leveraging AI to optimize each step in the care journey alongside personalized, high-touch coaching means that we can deliver better outcomes that last.
As noted earlier, we deliver meaningful cost savings to our health plan partners by durably reducing avoidable inpatient and ER utilization. Across our Medicare, Medicaid, and commercial member base, we have reduced hospitalizations by 63% and ER visits by 42%, on average. A soon-to-be published analysis of the “treatment effect” of the Ontrak program demonstrated a $486 PMPM greater cost savings durable over 24 months for Ontrak graduates compared to a propensity-matched control group who did not enroll in Ontrak.
We are able to deliver superior outcomes by leveraging AI combined with deep human connection that allows us to identify, engage, guide to treatment, and activate previously unaddressed populations.
As the pandemic continues, substance use disorder (SUD) has been on the rise. Recent data shows over 93,000 reported drug overdoses during 2020, which is the highest on record and nearly a 30% increase from 2019. The shortage of providers in this industry has only worsened the crisis for many individuals, families, and communities. Peer support has been a widely used treatment plan for these conditions (e.g. AA programs), but even these programs are struggling to manage the high demand. An innovative company in the SUD space, Marigold Health, provides a virtual peer support network that has scaled to meet the needs of many individuals with SUD. Shrenik Jain, Founder & CEO, sat down with us to discuss the importance of the virtual aspect of peer support, Marigold’s success working in Medicaid, and what’s ahead for the company.
We face an acute shortage of behavioral health providers, and everyone is struggling with patient engagement. Millions of dollars have been invested to make proactive interventions such as counseling and medication-assisted treatment for substance use disorders more accessible, but still only a small minority of those in need receive services consistently.
Peer support, the use of trained individuals in recovery to support others on a similar journey, has been demonstrated to engage patients who may not be willing or able to utilize other services, and is reimbursed by Medicaid in over 40 states. However, the reach of peer support has been limited – grassroots groups such as 12 Steps aren’t integrated with the larger care team and existing phone-based peer coaching programs cannot serve enough individuals to impact the health of a population.
Marigold’s virtual peer support program combines intensive 1-1 supports with 24/7 access to anonymous group chats where patients support each other. When we enter a market, we build a local team of certified peers who embed in existing primary care and behavioral health providers to sign patients up for our app. Once in our online community, we have a set of technology tools that allow our peers to coordinate with others of the care team to respond to patient needs expressed in groups.
In short, we are a virtual provider focused on driving patient engagement and developing a new workforce of behavioral health providers.
We have seen a lot of success working in Medicaid: Medicaid MCOs often have strong relationships with local providers and government stakeholders that we can partner with then rapidly enroll a large member base. One of our biggest advantages is patient acceptability: 70-90% of patients we approach are willing to enroll and give our text groups a try.
In Delaware for example, Marigold partnered with a Medicaid plan to engage members with substance use disorder (SUD) and increase their utilization of proactive services such as MAT. Within 5 months, 2 DE-based peers had provided support to 900 plan members, almost 13k messages were sent in 15 themed support groups, and we signed referral partnerships with agencies collectively delivering ~80% of methadone care statewide. We structured a bundle (alternative payment model) with the plan that allowed us to rapidly expand eligibility to all members following an initial pilot.
The funding is all going into growth, primarily growing the team as we enter new states. Our goal is to build the most capable peer workforce in the country, whose recovery experience includes a full spectrum of mental health disorders and challenges beyond substance use alone.
In our other departments, we are currently searching for a Clinical Director to report directly to our Chief Medical Officer and further develop programming, as well as a Director of Growth, who will work directly with the CEO to build plan partnerships.
U.S. Surgeon General Dr. Vivek Murthy has again addressed the devastating effects of the pandemic on the mental health and well-being of young people.
According to the CDC, schools have direct contact with “56 million students for at least 6 hours a day during the most critical years of their social, physical, and intellectual development.” There’s plenty of data demonstrating that for a variety of cost, mobility, and time reasons, youth in underserved communities aren’t getting the access to high-quality health care they desperately need. However, school-based health centers can be a game-changing source of access to physical and mental health services for youth who need it most.
Hazel Health is already providing fast access to equitable physical and mental health care to millions of students nationwide. Students have access to their services regardless of their financial or insurance status. I was delighted to connect with the Hazel team and discuss how they are expanding healthcare access to children and teens across the country:
K-12 students are facing an unprecedented mental health crisis. Before the pandemic, approximately 17% (1 in 6) U.S. youth ages 6-17 were experiencing a mental health condition each year, but as many as 60% of students (ages 12-17) with depression did not receive any treatment. Of the adolescents who did get help, nearly two thirds did so only in school. During the pandemic, depression and anxiety symptoms in youth doubled compared to pre-pandemic levels.
Hazel Health believes that one way to make sure children and teens can access mental health services is to meet students where they spend their time - at school and at home. This removes so many of the barriers that students face when trying to seek mental health care, including months-long wait times to see a provider, transportation, and the difficulty of navigating the health care landscape to find appropriate, affordable, high quality mental health services.
At Hazel we have found that the line between physical and mental health isn’t black and white, particularly when working with children and teens. We partner closely with school nurses, who have always known that their students who visit them frequently, complaining of stomach aches or headaches, often have something else behind that - depression, bullying, and other issues outside their control at home or in their communities, such as food or housing insecurity. School nurses and counselors have always identified these issues - Hazel gives them a resource to connect them with to address both their physical and, when needed, mental health. Hazel therapists can see students immediately short term, and then work to connect them with a local therapist or other resources for longer term counseling.
We have focused on providing same-day service for physical health, and very short (1-2 week) wait times for mental health, to help close the gap for the 20 million children in the U.S. who lack access to high quality health care.
Hazel has a unique viewpoint - we work with school districts in both urban and rural communities. Transportation is a core challenge we solve, and that comes up in both rural and urban communities. In rural communities, the nearest clinic is often very far away. 23% of Americans in rural areas say access to good doctors and hospitals is a major problem in their community. However, in talking with parents and school staff, this issue is just as relevant in urban communities. In urban school districts, parents have shared with us that getting to a clinic that accepts their insurance is sometimes a 2 hour bus ride away, and costs $15. Compound that with hours of missed work to pick up their child from school, wait several days for a sick-visit appointment, travel to and from the clinic, and the cost for a family living on low wages becomes astronomical. For both urban and rural communities, entire family systems are helped when they can see a Hazel doctor or therapist right from school, and they are more likely to get care.
An additional benefit of making physical and mental health services more accessible, with less travel time or time waiting for an appointment, is that students miss much less school. In one study Hazel did with WestEd and the Department of Education, we found that nearly all telemedicine visits (94%) resulted in students safely returning to class by resolving immediate health concerns. Students who returned to class received, on average, three hours of instructional time remaining in the school day. This resulted in over 2,500 instructional hours saved over two years for this particular district.
At Hazel, addressing social determinants of health is a key component of our mission. Hazel was founded on the belief that great health care addresses not just a physical or mental ailment, but also the social and environmental context surrounding a person's health and well-being. For children across the country to experience improved health outcomes, we must consider the conditions in which they live and learn, and we must take steps to address challenges in their environment that contribute to poor health outcomes.
Economic stability is a key predictor of good health. Today, around 37 million people in the United States live in poverty and more than 16% of children under 18 years old live below the poverty line. Many people can’t afford healthy foods, health care and housing. Hazel serves all students, regardless of their financial or insurance status. This means that all children, those who have insurance, and those who don’t, can benefit from the service.
By providing access to physical and mental health care right from school, Hazel helps students remain in school, and parents at work (parents don’t have to take off work to take their child to the doctor, resulting in missed pay in many cases). Hazel’s Family Resource Managers help connect families to community resources such as food services and housing programs.
We recently developed a 1-page summary of Hazel’s impact across each of the 5 core social determinants of health for more of a deeper dive into this topic.
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To learn more about Hazel, request a demo, or view career opportunities visit us at www.hazel.co
Last week, I sat down with tech-savvy Dr. Carrie Singer, owner of Quince Orchard Psychotherapy based in Rockville, MD. Together we discussed what it's been like to be a mental health provider during the pandemic, what the typical patient journey toward finding the right care is today, how she built a successful therapist network, and where she sees the digital behavioral health industry going. You can watch our conversation on our YouTube channel, or you can read the transcribed conversation below:
Solome Tibebu (0:02): Hello everyone! Welcome back to Going Digital: Behavioral Health Tech. So excited to have our next guest here, Dr. Carrie Singer from Quince Orchard Psychotherapy. She has developed a successful practice from the ground up. And I'm super excited to talk with her today. So Dr. Singer, how about you introduce yourself real quick.
Dr. Carrie Singer (0:23): Hi, Solome. Thank you so much for having me. Hi, everyone. Like she said, I'm Dr. Carrie Singer. I own a group private practice in the Washington DC suburbs. In the last five years, we've gone from just me to 40 therapists and we still have 1400 clients on a waitlist, unfortunately. So I've just really gotten interested in the demand for mental health services and the tools and technologies that are coming out to meet that demand. I've gotten really interested in coaching and consulting in the space. So I'm glad to be here and try to lend a little bit of a clinical lens to the conversation.
Solome Tibebu (0:52): Fabulous. So how about to get started, can you tell our audience a little bit about what it's been like to be a mental health provider during the pandemic?
Dr. Carrie Singer (1:01): Sure, I don't want to speak on behalf of all mental health providers. But I think collectively we can say it's been a little rough. Because being a therapist is hard anyways, and you're carrying a lot of people's pain and suffering. There's some days where you sit and listen to people cry, or have suicidal thoughts for the majority of your day. It's hard to keep positive sometimes, especially during the pandemic, when we're all having our own collective traumas and issues, and grief and loss issues. It's just been compounded. Plus, not to mention, there's been so much more of a demand for services. Having to turn people away has been really hard. The people that are receiving the referrals tend to have more acute symptoms. So it's been a lot more time consuming to manage.
Solome Tibebu (1:40): Mm hmm. Definitely. In fact, let me ask you a little bit more from the patient perspective, what have you found the typical patient journey toward finding the right care?
Dr. Carrie Singer (1:53): Sure, I mean, the feedback that we hear is that there is a supply and demand imbalance. And that patients think it's going to be like finding a new primary care doctor. "I'll just look in my insurance directory, there'll be a lot of options. And I'll just call down the list until I find someone." And it's not really like that with finding a therapist. A lot of times the insurance directories might have incomplete information or be out of date, or they might look through therapists directories, but there's so many choices. They don't exactly know what type of treatment they need. And they start making the phone calls and emails just to realize that people don't have any openings, can't see them after school or on the weekends, don't treat the specialty condition they need help with, most significantly don't take their insurance, so the cost of care is going to be a lot more than they can afford. And so a lot of times people will just give up and not get the help they need until maybe they have a panic attack or crisis situation that leads them to the emergency room, which ends up being a real drag for the healthcare system. It's a lot more expensive than preventative care.
Solome Tibebu (2:48): Right. And yeah, clearly a lot of opportunity to evolve and augment access to care with different solutions. But I'll ask you about that next. So going back to your practice, as I mentioned earlier, you built this practice from the ground up. So many digital health companies right now are attempting to build large therapists networks. What have you found to be the secret sauce in terms of attracting and retaining talent?
Dr. Carrie Singer (3:20): Well, it's no secret, treat other people the way you want to be treated. It's nice if you can offer things like making people an employee and giving them benefits, like health care, or 401k, or especially paid time off. But above that, I think that therapists, almost as much as pay, value flexibility. They really like the ability to control somewhat: the patients they see, the hours they work, how many they see in a day. So for our therapists, that's been really critical. But I think sometimes these digital health companies too, they're sometimes led by non-clinical leadership. They don't have a long track record. People they're hiring don't know each other, don't know the management team, don't know what the company stands for. I think for us, having a personal connection with each employee has really helped us retain them and feel like part of a team and a culture where they can learn and grow professionally and personally.
Solome Tibebu (4:07): That's awesome. So bigger question, where do you see the industry heading?
Dr. Carrie Singer (4:14): Well, I think there's a lot of pockets of opportunity. But more specific to the type of work I do, we've seen a lot of consolidation of care through mergers and acquisitions, or through some big players coming into the space. And it's a little bit worrisome sometimes. You don't want there to be mental health monopolies. I think there's pros and cons. But I guess, if we want CVS and Walmart and Google and Amazon controlling our mental health care, I get a little bit worried about how that medical information is stored and used. But I think because of the access problem, if there's bigger people who can come in that have the funds to make it a streamlined process for patients to find the right care and aggregate providers to provide the care, I certainly don't have any problem with that. I think sometimes it's just the delivery of that that can be an issue. But I do I think there's also opportunities because there are so few clinicians to sometimes explore the use of non-clinicians to fulfill that need, so trained behavioral health coaches, and what does that certification process even look like? Or maybe blended care models where you're starting out, maybe offering patients some self help tools, mood tracking devices, and then maybe you're giving them some other supports, like digital CBT tools. And then you're blending that with therapy and psychiatry services that you're meeting patients where they're at and the continuum of care.
Solome Tibebu (5:29): Right. Yeah, I mean, talk about quickly changing times. I think in the last week, there was like three different mergers and acquisitions in the space and how many fundings just in the last couple of days. And so that is, of course, leading to new challenges as the industry evolves. So you started to touch on digital tools. Tell me a little bit about what are some of the ideas or tools in digital health that you're really excited about?
Dr. Carrie Singer (5:57): Sure. I mean, I really believe when it comes to like the Triple Aim philosophy of any tools that can make care affordable, accessible, and high quality are going to win. And usually you get two out of the three, but not all of them. So if there's anything that can make the care... Like us, we have care that it as affordable, we accept insurance. And I believe it's high quality, but it's not very accessible. We have a long waitlist. We see our patients for longer lengths of time. So if some of these bigger players started to get on health insurance panels and have in-network contracts, I'd be really excited about that. Because still, most of the time, they're going to be charging patients anywhere from $100 or more per month just for text-based chat therapy, whereas they could see somebody using their copay and pay nothing. So I'm also interested in like FinTech and AI solutions for making the treatment costs more apparent to the not only the patient, but also the provider at the time of care. So people go in with a better informed sense of what they're signing up for and what they can afford, so they don't drop out early. I'm also really interested in tools like remote patient monitoring tools or wearables that blend mental health and physical health data, because I believe we are moving toward a value-based behavioral healthcare paradigm in the near future. And if we can show, which research has proven, that if you treat your mental health, your physical health symptoms will improve. I think that could be some really exciting data.
Solome Tibebu (7:13): Right. I love so much that you address something interesting that helping consumers understand what it is they're actually signing up for. And now that there's just a plethora of everything from totally asynchronous text or self guided versus all the way to face to face and what kind of credential provider you're working with. I mean, I'm very excited about that aspect of continuing to teach consumers in general, what is it that they're actually getting into? So I'm glad you mentioned that. But as always, I wish we had more time to chat. Thank you so much, Dr. Singer for joining me today and your insights.
The demand for digital therapeutics has accelerated as technology has advanced, provider shortages persist, and more consumers are looking for solutions to their mental health concerns amid the pandemic. Digital therapeutics serve as non-drug alternatives to support mental wellbeing and they are also reducing barriers to care for underserved populations.
Big Health, a digital therapeutics company dedicated to helping millions back to good mental health, has pioneered and scaled the industry-leading reimbursement model for digital therapeutics via the pharmacy benefit manager. This week, the company announced its $75 million Series C funding round. I had the opportunity to talk to Celeste James, Vice President of Equity & Population Health, about the importance of digital therapeutics and Big Health’s goal for health equity, including their quest of ensuring 50% of their users come from medically underserved populations.
Sleepio and Daylight are Big Health’s first two digital therapeutics for insomnia and anxiety, respectively.
Sleepio is a multi-week sleep improvement program featuring cognitive behavioral therapy (CBT) to help people fall asleep faster, stay asleep through the night, and feel better during the day.
Daylight is a digital therapeutic intended for the treatment of Generalized Anxiety Disorder (GAD). The program takes automated CBT and other techniques, including tense & release and worry time, and fully automates to provide evidenced-based care without intervention from therapists or other medical professionals.
Both Sleepio and Daylight are proven to provide safe and effective non-drug alternatives for common mental health conditions and in separate controlled studies, helped 76% of patients achieve clinical improvement in insomnia, and helped 71% of patients achieve clinical improvement in anxiety.
We are at a unique moment of opportunity as the pandemic has led to increased prevalence of mental health conditions, making mental health care a top priority for payers, health systems, and patients. As a result, the shortcomings of traditional models of care have become clear: human-delivered therapy, even when enabled by technology, is insufficient to meet the ever-growing level of need, resulting in long wait times, provider shortages, and rising costs. For this and other reasons, mental health remains one of the most inequitable areas of health care.
Further, the reality today is the vast majority of patients with a mental health condition seek care within primary care, with more than 80% receiving medication. Separate clinical research has shown that these medications are often associated with moderately severe side effects and/or adverse events, and minimal long-term benefits.
Digital therapeutics, however, provide safe, effective non-drug alternatives and evidence-based care, including cognitive behavioral therapy, through a pure software solution without coaches or clinicians – reducing barriers to care. This care delivery model allows us to reach individuals who otherwise wouldn’t have access to care due to barriers such as transportation, insurance and out-of-pocket costs. When created and implemented thoughtfully, digital therapeutics provide a consistent and equitable experience for users, reducing stigma and avoiding biases that often occur in traditional mental health treatment, and thus, improving health outcomes at great scale.
In April 2021, Big Health shared a public commitment to mental health equity, which includes a long-term goal of ensuring 50% of our users come from medically underserved populations. As part of Big Health’s commitment to increasing mental health equity, the team developed three specific goals addressing our internal structures and external impact:
Today, 38% of Big Health’s leadership team consists of women or underrepresented minorities. Although we are still shy of our long-term ambition of having the diversity of our workforce reflect that of our user base, I am encouraged by the team’s progress to date. However, we must continue improving diversity and inclusion at Big Health to ensure that Black, Latinx and LGBTQ+ communities among others are better represented within our employee base.
Big Health aims to ensure that millions of people have access to evidence-based mental health care – the north star that drives all decision-making in the organization – and that we deliver equitable outcomes regardless of ZIP code, race, or economic status. In my role as Vice President of Equity & Population Health, I am supporting Big Health’s mental health equity goals by being integrally involved in our product development, go-to-market strategies, and business operations to ensure we bring an equity mindset to all that we do to scale access to good mental health.
Amid the Great Resignation, employers are striving to support their employees in various ways. Mental health concerns have risen during the pandemic, which has created a need for employers to support the mental health of their employees. These times have been especially difficult for parents in the workplace. These mental health concerns are not only affecting them but also their children. In an attempt to help the entire family and ease the burden on the working parents, employers are increasingly interested in behavioral health benefits that are family-focused. Brightline has been in the spotlight for providing behavioral health care that is specifically designed for children, and they have recently published a guide for supporting the mental health of employees with kids. We spoke with CEO Naomi Allen about the importance of family-focused behavioral health benefits.
Kids aren’t just small adults! When it comes to behavioral and mental health, you really can’t just replicate what’s been built for adults and have it work for kids and teens. What’s going to work for you as a parent at 35 or 50 years old just isn’t right for a 3 or 15 year old. It seems obvious, but to do it right takes a lot of factors and designing specifically to work for each age range. So even from the start, you need to consider that the way kids present with behavioral and mental health issues is different, and how to address that — for example, depression in kids can often show up as irritability. Kids and teens confront different issues, and respond to therapeutic interventions differently. Managing tantrums, developing organizational skills for school, coping with teen’s self-esteem or tough stuff with friends — you need to be able to really meet kids and teens at their level, and tailor interventions to work for where they’re at in that moment, emotionally and developmentally.
Here’s a good example of what that could look like: you may have a middle schooler who is feeling worried lately as schools are shutting down again, and is having trouble sleeping. At Brightline, we would assess where that child is, and if their anxiety meets a clinical level of need. If so, we can get them started with a therapist to work through those worries, build coping strategies, and address the impact on their sleep. But maybe their anxious thoughts don’t hit a clinical level of need — in that case, we can get them into our “Sleep Made Simple” coaching programs to build skills for tackling the anxiety and related sleep issues, alongside self-guided content with their parent or caregiver.
This is exactly why Brightline isn’t adapted for kids, it’s built for kids. Everything we do is flexible and designed specifically to work for children and families — meeting them where they are emotionally, developmentally, and literally bringing it to them with virtual care. By engaging parents and caregivers in their child’s care, giving them access to progress updates and regular check-ins, they are supported and know how their child is progressing forward. Our coaching programs, therapy, evaluation and medication support, speech therapy, and ongoing support and resources for parents and caregivers alongside their kids, and for teens, in our digital platform — we’ve designed it truly to work for them.
For working parents and caregivers, juggling the demands of a full-time job and the complexities of seeking care for their child can feel completely overwhelming. Rates of behavioral and mental health needs among youth are skyrocketing. Parents and caregivers themselves are suffering too: more than half (59%) say they’ve experienced their own behavioral health challenges due to the stress of managing their children’s behavioral health needs.
This isn’t going away — we expect that the pandemic will have lasting impacts on mental health, and we need to get out ahead of this and support families so they don’t have to make the difficult decision to leave the workforce. We can meaningfully support parents and caregivers by giving them access to comprehensive behavioral health care for their children, through virtual care, coaching, and self-guided content — so that they can access what they need, when they need it.
We’ve felt this in our own company. The majority of our executive leaders, and many others on our team, are also parents to children under the age of 18 — some of whom have significant behavioral health needs. For many of our kids, those needs have been exacerbated during COVID. The ongoing uncertainty and changes during the pandemic have made it incredibly difficult to balance this all — some of us have had to cut back, or in past lives before Brightline, had to quit jobs to care for our kids. This shouldn’t be a decision parents have to make, yet it’s happening every day. We can, and must, change this by getting working parents and caregivers care that actually works for their children, and supports them, too.
This is all taking a real toll on working families and their employers: in fact, our 2021 Pediatric Behavioral Health Needs Survey found that one in five (21%) of parents and caregivers have either already quit their jobs in the last year or plan to quit their jobs in the coming year to better care for their children’s behavioral needs. There’s an increasing gap with women feeling burned out and leaving the workforce at higher rates than men.
We’re approaching the third year of the pandemic, and it’s costing employers. According to Gallup, replacing an employee costs half to two times the employee’s annual salary. When employees are having to spend so much time managing their kids’ behavioral health needs with limited or so support, there’s a significant impact on productivity, too. Add to that medical costs associated with employees’ own heightened mental health needs, and this has a significant cost burden for employers.
It shouldn’t be either/or for parents and caregivers. By making behavioral and mental health care for children and families a covered benefit, health plans and employers can connect families to much-needed support so they don’t have to choose between their careers and supporting their kids. Families deserve better, and companies have the power to change this situation.
I think we’re really seeing a shift in adoption of family-focused benefits. At Brightline, we’ve driven significant momentum in this past year to meet the needs of families. In the past year, we expanded our digital platform, Connect, and coaching programs to all 50 states, the first time comprehensive behavioral health care for kids, teens, and families was made available nationwide. We’ve now had nearly 14,000 parents and caregivers using Connect, in all 50 states. We’ve expanded our clinical services to cover 89% of the U.S. population in terms of the states where we have licensed therapists at the ready to work with families. We’ve seen fast and significant adoption by leading health plans and national employers who recognize the great need and impact bringing these services to their members will have — we’re now covering 24 million health plan lives, partnering with 35 employers, and are rapidly forging new partnerships and expanding access from here.
Want to partner with Brightline? Reach out to partnerships@hellobrightline.com or visit hellobrightline.com to learn more.
We’ve been discussing the migration to precision medicine in several of our blog posts lately, outlining how some GDBHT mental health and substance use partners are meeting patients where they are. One exciting field that is equipping providers to offer individualized mental healthcare is pharmacogenetics.
Pharmacogenetics provide additional data on a patient's response to medications. Dr. Daniel VanDorn, PharmD, Sr. Medical Science Liaison and Lead Scientist for Product Development at Genomind, enlightened us on these topics and the innovative ways that Genomind is increasing prescribing confidence, reducing healthcare costs, and improving patient experiences.
Precision or personalized medicine is a care model designed to optimize efficiency and therapeutic benefit for patients. Precision medicine often involves genetic testing to reveal how a patient may metabolize certain medications or determine the potential impact medications can have on the body. However, it is not yet commonplace for health care providers to have access to genetic information, while other factors can be used that are more widely accessible.
In addition to genetic factors, drug-drug interactions (DDIs) are the most common, preventable cause of adverse drug events (ADEs). ADEs harm over 2 million people and cost the US healthcare industry $30B annually. Up to 22% of all patients taking medications are predicted to have DDIs, with estimates up to 31% in the elderly population. While there are tools available to health care providers that assess DDIs, they are infrequently and disparately utilized across our health care system.
Imagine if we could quickly identify, within a large data-base of health information, specific subpopulations of patients at greatest risk of drug-drug interactions, while also providing therapeutic alternatives to reduce this risk. Now imagine that we can also identify those patients at greatest risk of harm due to potential genetic factors, and thus stratify which patients are suitable candidates for genetic testing. This is exactly what Genomind’s precision technology was designed to do.
Mental illness impacts 20% of the U.S. population and that percentage is quickly growing across every age group. Individuals who are prescribed mental health medications often are subjected to a trial and error approach to treatment. For far too many patients, this results in months or years of struggling with unresolved symptoms with the added burden of ADEs. Real-world data suggests that 67% of people with depression do not achieve remission with their first medication trial, with the odds of remission declining after each subsequent trial. Depending on the condition, 30-80% of psychiatric patients have unresolved symptoms. Many abandon drug therapy altogether, usually due to adverse drug effects. There is an obvious need to embrace tools that limit trial-and-error, reduce risk of ADEs, and improve patient outcomes. Pharmacogenetics is one such tool.
Pharmacogenetics (PGx) refers to the study and application of how an individual’s genetics may influence their response to medications. This is far from a new concept. Other fields of medicine such as oncology and cardiology have applied PGx for years, which has since evolved into a standard of care in these fields.
Similarly, utilization of PGx in psychiatry has grown over the past few years due to its potential to decrease treatment by trial and error. A recent meta-analysis (study of studies) showed that depressed patients were 71% more likely to achieve remission when PGx was used to personalize their treatment, compared to those subjected to the standard approach. Similar studies suggest that PGx can reduce the rate of hospitalization by 50%.
PGx can provide additional data for healthcare providers to tailor treatment to the individual. The Food and Drug Administration (FDA) has identified over 270 medicines with genetic-based guidance on their manufacturing labels. Additionally, the Clinical Pharmacogenomics Implementation Consortium (CPIC) has reviewed more than 400 gene-drug pairs, and has produced peer reviewed PGx guidelines related to many mental health treatments. So how can we responsibly prescribe medication without having this information about our patients?
This more personalized and informed approach to treatment has been associated with higher remission rates, decreased healthcare costs and reduced hospitalizations. Our challenge now is to broaden awareness and increase the adoption of this practice, especially within mental health.
As the science of medicine evolves, Genomind feels a keen sense of obligation and responsibility to evolve with it. We maintain the latest medication guidance within our models and continually optimize our laboratory processes. We have also expanded our solutions to support not only individual patient care, but the management of large patient populations, which will continue to grow in importance and focus within the healthcare industry.
Genomind’s Population Health solution is driven by GenMed✓Pro, Genomind’s precision gene-drug-drug interaction software. The proprietary logic that drives GenMed✓Pro is now being applied to large healthcare databases to assess the full drug regimens of populations en masse. This allows payors and large health care institutions to identify individual patients at greatest risk of harm due to DDIs. The software then provides a list of alternative medications which may be less risky, as well as specific FDA or CPIC guidance where appropriate.
In addition to identifying known drug interaction risks and alternatives, we also apply a genetic prevalence algorithm that calculates the probability of gene-drug related risks. This further allows these institutions to stratify their population by probability of genetic risk and identify individual patients for whom PGx testing may be warranted. Our full platform can be seamlessly integrated into any workflow through our numerous EMR / EHR partnerships. We are making it easier and faster to personalize treatment in a way that hasn’t been done by the competition.
Genomind has served over 300,000 patients in providing personalized, psychotropic medication guidance. Our tools are accessible to over 100M covered lives including Medicare, Medicaid, and several Commercial insurers. We work with, or are actively engaged with, employer benefit brokers, telehealth/psych companies, PBMs, behavioral health carve-outs, care management solutions, and ACOs covering over 51M lives. We look forward to increased adoption in the future and plan to help lead this change.
Genomind’s value-proposition to the healthcare market includes:
This Thanksgiving, I want to recognize the caregivers who have stuck by so many of us throughout COVID-19 this year. The impact on caregivers’ mental health is a significant one, and I’m delighted to showcase two organizations doing important work to support caregivers everywhere.
I’m sure you will remember Alex Drane, CEO of ARCHANGELS, joining us with Marcus Osborne, Senior Vice President of Walmart Health, at last year’s Going Digital: Behavioral Health Tech conference (watch session free here). ARCHANGELS is a national movement and platform that is reframing how caregivers are seen, honored, and supported using a combination of data and stories, through public and private partnerships. ARCHANGELS provides communities (including states, employers, healthcare providers, and payers) with an omni-channel data-driven engagement approach that changes caregiver’s lives (as well as top and bottom lines) for the better. Check out her recent report with McKinsey about the health of American unpaid caregivers amid COVID-19 and her collab with BCBSA Health of America here (and watch BCBSA Health of American's GDBHT2021 session here, too).
I was elated to hear that Alex and her team have teamed up with CaringBridge, another organization I’m proud to support. CaringBridge is a nonprofit social network that offers simple tools for patients and their caregivers to share health updates and rally their community’s support. A health journey of any kind—diagnosis, injury, medical or behavioral health condition, pregnancy complications or other experiences—is difficult to endure alone. At a time when COVID-19 has impacted so many lives, I am pleased with how CaringBridge is leveraging technology to ensure that no one goes through a health journey alone. Tia and Alex both shared their perspectives with me on caregiving, mental health and tech:
Tia: While we’ve all read recent studies spotlighting the downside of social media and its correlation with increased isolation, technology can play a positive role in building community when going through difficult times. We’re in the beginning stages of investigating longitudinal research on how CaringBridge, a nonprofit digital social platform for people going through a health journey, specifically improves health outcomes. What we know right now is that people with social support have better health outcomes, less inflammation, and are more likely to adhere to treatment regimens. We also know that caregivers’ anxiety and depression decreases by up to 30% when using a digital tool like CaringBridge (as they know someone is in their corner offering support). And during the pandemic, we continue to work with healthcare institutions like Johns Hopkins to provide CaringBridge as a tool to manage patient communication with family and friends.
Ultimately, we believe in digital social technology like CaringBridge that enables simple and easy communication and support in one place. And with a singular focus on health journeys, we can provide a safe and private space to create community and support during a most stressful time.
Alex: The intensity of caregiving is real – full stop. We feel its impacts on every side – the good, and the not-so-good. Then there’s this: of the 43% of adults in the US serving as a caregiver right now, around half of us don’t even identify as caregivers in the first place. It’s kinda hard to be supported in something not acknowledged. And caregiving is an area where we could all use some support. We know from ARCHANGELS data recently published with the CDC that 70% of unpaid caregivers are experiencing at least one adverse mental health symptom – it’s 91% for High-Intensity caregivers (those ‘in the red’). But we also know there is indisputable power in ‘the knowing’… as in knowing respite services exist reduces stress by 70%. How we engage with caregivers matters – and finding and using language that ‘speaks’ to the close to the one in two of us caring for a loved one is a vital part of providing support.
This year, I was delighted to join the CaringBridge Board of Directors. The board will be matching donations made on November 30, Giving Tuesday, up to $100,000. Along with the matching gift, please join me for a virtual gathering open to all on Tuesday, November 30th from 7:00-7:30 PM CST. It will be a night of gratitude and story sharing, featuring co-hosts Tia Newcomer, CEO of CaringBridge and Emmy award- winning journalist Cathy Wurzer along with Alexandra Drane, CEO of ARCHANGELS.
Finally, thank you, to all of the caregivers pouring your compassion and energy into loved ones each day. It is of utmost importance that we as a society prioritize your mental health with additional resources and support.
Integrated care has been an ongoing goal in the healthcare industry, but Included Health is raising the standards. Included Health was formed after the merger of Doctor on Demand and Grand Rounds. The company’s integrated collaborative care model is creating a space for all healthcare needs, from behavioral health to chronic care and more. They also have a few initiatives that focus on meeting the unique needs of various populations including LGBTQ+ and Black communities. Dr. Nikole Benders-Hadi, Medical Director of Behavioral Health at Included Health, talks more about the new entity with me:
Included Health is the first virtual health company to include everything - behavioral health, primary care, chronic care, specialty care, LGBTQ+ care and more - all under one roof, for everyone. Our goal is to care for every individual, every community - no matter where they are on their care journey or what type of care they need, and ensure that their location no longer decides the type, or quality, of healthcare they receive. We’re proud to have a name that reflects that.
There is no one-size-fits-all in healthcare. When it comes to the Black community, we know that major health disparities exist, including that only 1 in 3 Black Americans in need of behavioral health treatment receive care and that Black women are 3-4x more likely to die from a pregnancy-related death. These types of healthcare disparities for Black and African American individuals are unacceptable and we want to do our part to help improve these types of inequities in the healthcare our members experience every day.
We already have an LGBTQ+ specific solution and we wanted to launch a hyper-tailored solution for the Black community as well, so we partnered with companies like Walmart, Genentech, State Farm, Target and more to create something specifically for this community. We're using insights from these companies' employee resource groups (ERGs) to build the first dedicated care concierge and healthcare navigation platform focused on improving the healthcare experience and advancing health equity for Black Americans.
Taking this hyper-tailored approach ensures that we are addressing the very unique challenges facing the Black community in a meaningful way.
We believe that mental health is health and, coming out of the pandemic, we're continuing to see increased numbers of people struggling with both chronic medical conditions as well as mental health issues. At Included Health, we've built a truly integrated practice. Our primary care doctors are specially trained to recognize behavioral health issues so they can seamlessly refer patients to our behavioral health team, and we provide a full suite of behavioral health offerings, inclusive of psychiatry, therapy, and coaching services. Our aim is to meet the member where they are, and provide the access to care they are most in need of at that moment so we help them live their fullest lives.
Included Health is taking huge strides towards an integrated healthcare system for all.
Sometimes, general teletherapy is not enough for individuals who are struggling with issues beyond mild and moderate anxiety and depression. It is time to move beyond one-size-fits-all solutions and move toward more personalization for different conditions. I met with Stephen Smith, Founder & CEO of NOCD, to discuss community-driven therapy and their unique approach to tackling issues like Obsessive Compulsive Disorder. This was particularly personal for me, as someone who has struggled with OCD since I was a teen. Read my interview with him on the blog and join us for a conversation on November 3rd here.
At NOCD we see that the one-size-fits-all strategy to solve behavioral health needs is not enough. Personalized approaches are imperative for conditions like Obsessive Compulsive Disorder (OCD) that are so highly stigmatized. The general approach fails to identify the unique symptoms of the individual and their specific needs. The need for specialized care is required to better serve these serious psychological conditions that are much more prevalent today.
Solutions that are more modern and innovative are meeting members where they are in their own care journeys, and NOCD works to identify those suffering from OCD where they are already searching for information - online. We then provide necessary, personalized and evidence-based care: Exposure and Response Prevention Therapy (ERP), the gold standard in OCD treatment. Delivering a more personalized treatment with a condition-specific therapeutic approach enables members to not only achieve better outcomes, but allows them to reach these outcomes efficiently. It is imperative for employer benefit strategies to adopt this specialized behavioral health care as their employees’ needs have changed.
Employees are recognizing this need for specialized services for mental health conditions as well as their physical health conditions. Furthermore, they are making career decisions based on whether or not an employer meets their needs and the needs of their families.
Community-driven therapy is a new behavioral health market category that leverages condition-specific peer communities to identify consumers in need of help, encourage them to begin treatment, and serve them in an ultra-personalized and evidence-based way. Also, providers in a community-driven therapy model are directed to deliver specific evidence-based treatment modalities based on the specific needs of the community they serve. The Community-Driven Therapy market is poised to successfully address many severe and costly needs within behavioral health, starting with OCD, given it’s so personalized in nature. Serious behavioral health conditions require a personalized setting, a level of convenience, and constant support between sessions. Crafting therapy around the patient allows them to receive therapy more efficiently and effectively, so by utilizing community-driven therapy, NOCD is able to focus on our first and foremost value which is Member-first. What that means is that everything we do at NOCD is for the members we serve and we optimize every step in our process for them. We’ve developed a new way to identify and manage people with OCD as a serious behavioral health condition.
Through the creation of the largest online OCD community, we developed a deep understanding of the wants and needs of people suffering with OCD. This understanding helps us bring people who have this serious condition to treatment much more easily and efficiently. Each member can continue their own personalized journey while seeing others in the community progress as well which allows our community members to see that they are not alone in their treatment journey.
By using a community-driven therapy approach we deliver improved outcomes, provide unique face-to-face sessions specifically designed for OCD treatment, foster deeper relationships with our patients through peer advisors and provide in-between session support with tools that patients actually want to use. All of these capabilities we have were purposely built through learning from our community and adding the personalized touch that is needed to treat a chronic and misunderstood condition like OCD. We take a deeper look at this in our upcoming State of the Behavioral Health Industry webinar with Solome on November 3rd at 12:00 PM CST, 1:00 PM EST, 10:00 AM PST.
There is often shame and stigma surrounding the OCD population due to the taboo nature of the intrusive thoughts, feelings and urges they experience. Those who are part of this severe and stigmatized population and who may not feel comfortable to share these thoughts end up going undiagnosed and left to suffer in silence. However, we’ve found these same people often search online for answers and this can oftentimes be the best place to intervene and meet them where they are, bring the proper treatment to them, and greet them with a community that understands their journey to regain their life.
This stigma occurs on a mass scale because most people think OCD is a personality quirk and don’t understand that it’s actually characterized by these recurring intrusive thoughts, images, and urges that can be debilitating. Our most recent partnership showcases NOCD’s commitment to breaking down this misconception and effort to destigmatize OCD. As part of our OCD Awareness Month programming, we’ve partnered with comedian Maria Bamford to educate more people about OCD and explain what it’s really like. Through her comedic art, she's helping others understand that OCD is not a personality quirk, but rather a debilitating condition that manifests in taboo ways and is still widely misunderstood. NOCD is on a mission to rebrand OCD through this and our continued efforts in raising awareness and providing education.
Link to Webinar Registration: https://hubs.la/H0ZN16m0
Link to OCD Awareness Month Programming: https://hubs.la/H0ZN80q0
Link to Maria Bamford Videos: https://hubs.la/H0ZNnf60
COVID-19 is driving more individuals to move from experiencing just mild to moderate anxiety to more severe mental health issues such as starting or increasing the use of substances and suicidal thoughts. The Kaiser Family Foundation outlined the impact of COVID on substance use and suicide increases in certain communities, including the fact that essential workers face greater increases of SUD than others, 42% over 30% for mental health issues and 25% over 11% for SUD. I sat down with Dr. Smita Das, MD, PhD, MPH, Psychiatry Medical Director at Lyra Health, to learn about their exciting new expansions to address these growing needs:
As a physician treating patients, I see firsthand the gaps in the current traditional health care system. People who are struggling with unhealthy alcohol use or strong suicidal thoughts—which number in the millions—often are considered too “complex” for traditional outpatient models. With the system not set up to support individuals with complex diagnoses, people unfortunately only get care when their symptoms progress to be more severe.
Even then, gaining access to relevant treatment through EAPs and health plans can be challenging, as existing care options don’t always address comorbidities that often present alongside alcohol use disorder, such as anxiety and depression. Stigma is also a factor when it comes to these areas, making it even harder for people to get the critical care they need.
With approximately 30% of Lyra’s members currently struggling with problematic drinking, and 16% having suicidal thoughts and behaviors, Lyra recognizes the critical need to address complex mental health issues, and is proud to offer outpatient care options that help employees and their families wherever they are on the mental health spectrum.
Lyra Health’s newest offerings address problematic alcohol use, suicidal thoughts and behaviors, and personalized support for children, adolescents, and adults who need help accessing specialized mental health support. Its new comprehensive alcohol program helps people reduce drinking or attain sobriety by combining virtual therapy, group sessions, ongoing symptom assessments, peer recovery support specialists to help members stay on track, digital lessons that teach coping skills, and medication to fight cravings. Because it is delivered through Lyra’s comprehensive Blended Care virtual platform, support can be accessed from the privacy of members’ homes, helping reduce the impact of stigma and help them develop coping skills relevant to their usual home/work environments.
Lyra’s Blended Care Dialectical Behavior Therapy (DBT) for Suicidality helps members decrease suicidal thoughts and behaviors. DBT is considered the gold standard for treatment for individuals with moderate to high suicidality. Lyra DBT combines one-on-one virtual therapy sessions with therapist-prescribed skill-building lessons through Lyra’s Blended Care platform to help individuals recover quickly and effectively. Members receive flexible, ongoing support through weekly group skills training and access to 24/7 crisis support from a DBT-trained support team.
Finding care for complex mental health needs can be among the most difficult experiences for people and families due to the exhaustive process to evaluate and manage higher levels of care. Lyra Concierge: Advanced Care Coordination provides personalized support for people who need care through intensive outpatient and rehabilitation facilities. Lyra additionally provides clinical leave evaluations should short-term leave for mental health be required.
Stigma is a very important topic and one that Lyra approaches thoughtfully when developing all of its comprehensive mental health offerings. For our 2.5 million members around the globe, Lyra is a trusted mental health partner. Our newest services will be as easy to access and flexible as our other offerings. These new care options are also offered virtually. The combination of trust, ease of access, and ability to get high quality care from the privacy of home all can help overcome stigma.
As a result, employees facing more challenging and complex issues will benefit earlier in the progression of their symptoms and more durably. The support they will get for themselves and their families will give them the opportunity to more meaningfully engage in life and work once they recover.
Can a trusted consumer brand reduce stigma and draw more people into the mental health care they need? Can technology and other emotional support modalities help meet the resulting demand? How much better could things be with a full suite of services that allow individuals to access a wide array of support levels, from self-guided meditation, to text-based coaching, to teletherapy and telepsychiatry?
These were the questions many of us were asking when the big, juicy news of Headspace Health was announced: Headspace, a global leader in mindfulness and meditation, and Ginger, a leader in on-demand mental healthcare, recently announced that they will be merging to form Headspace Health. I had a chance to connect with the Headspace Health leadership team about the merger. Here is our conversation below:
As Headspace Health, we are building the most accessible and comprehensive digital health and wellbeing platform. Together, we can manage the full spectrum of mental healthcare needs and go a long way in closing what is a huge gap in the world.
In the near-term, Headspace and Ginger members will not experience any changes to our products and services. After the transaction closes, Ginger coaches and the greater clinical team will begin leveraging Headspace’s popular meditation and mindfulness content as part of the care they deliver to Ginger members. Over time, we will be integrating the services to deliver a frictionless experience for our members, beginning with our enterprise business, then moving to our consumer business.
According to the World Health Organization, close to 1 billion people around the globe are living with a mental disorder, and more than 75% of people worldwide with mental, neurological and substance use disorders receive no treatment for their condition at all. Headspace and Ginger will bring their combined expertise in consumer brand, evidence-based interventions, and technology to improve resilience, reduce stress, and provide treatment to the millions of people experiencing mental health symptoms, from anxiety to depression to complex diagnoses. By coming together at a critical moment of global need, Headspace Health - the combined entity of Headspace and Ginger - will democratize mental health and wellbeing so people around the world can access a full spectrum of affordable and comprehensive support to meet their needs — regardless of their background, location or ability to pay.
Prevention is absolutely critical. We believe that by bringing these two companies together we can help more people get access to care sooner. There’s a huge need for people to address their mental health before it becomes acute. It is clear to us that Headspace is doing this in a very thoughtful, elegant way and its approach is proven. When you combine the range of high-quality, low-cost coaching and psychiatry options offered by Ginger with Headspace’s beloved mindfulness and meditation content, we now have the ability to dramatically improve the accessibility of mental healthcare to more people around the world. And together, we can reach them earlier in their journey, and provide higher acuity care when needed.
For example, Headspace already helps millions of individuals build successful routines and resilience that can then help when those inevitable stressful moments happen in their lives. In those moments, if they need additional support, Ginger is there to support them with text-based coaching, and video-based therapy and psychiatry. As their condition improves, they can step back down as needed and continue with their meditation and mindfulness practices.
