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Recapping the news on policy that affects behavioral healthcare.
Editor's Note: At BHT, our goal is to bring together various viewpoints and create discussion that advances the improvement of mental health for all from the perspectives of the individuals working on-the-ground on these topics. A recent sponsored post on the topic of parity generated a lot of interest and prompted a lot of discussion. Part of the discussion resulted in an article with a viewpoint from a different perspective which we are delighted to share today.
Article written and sponsored by: Inseparable, American Foundation for Suicide Prevention, American Psychological Association, American Psychiatric Association, Children’s Hospital Association, Eating Disorders Coalition, The Kennedy Forum, Mental Health America, the National Alliance on Mental Illness (NAMI), the National Association for Behavioral Healthcare, and the National Council for Mental Wellbeing
America continues to experience overwhelming mental health and addiction challenges, impacting children, adults, and entire families. Though the need for mental health treatment has increased, health insurance plans continue to restrict access to lifesaving care. This is despite the fact that 15 years ago, Congress passed the bipartisan Mental Health Parity and Addiction Equity Act (Federal Parity Act) to stop insurers from discriminating against policyholders in need of mental health care. Through overlapping strategies, including low reimbursement rates, failure to contract with available providers, grossly inaccurate provider directories, financially burdensome practices that drive providers out-of-network, and delays and denials of medically necessary care, plans limit access to behavioral health care at enormous cost to American families and communities.
Plans’ violations of the Federal Parity Act are now well-documented, with recent reports to Congress from the U.S. Departments of Labor, Health and Human Services, and Treasury (the “tri-agencies”) finding violations of the law’s requirements outrageously commonplace. These violations result in individuals, including children and their families, not being able to find urgently needed care and, if they do find care, often not having medically necessary services covered. These barriers result in delays to care that drive up preventable costs, in families taking on huge debts to pay for care themselves, and many people simply going without the care they need. To address this crisis, the tri-agencies proposed revised parity rules last summer to better hold plans accountable to follow the law.
These proposed rules tie back to the original purpose of the Federal Parity Act – ensuring equitable access to behavioral health care. Under the proposed rules, plans would be required to collect and analyze data on how their practices (such as reimbursement rates, credentialing procedures, medical necessity determinations, and network composition) impact access. When plans’ practices have the effect of restricting access to behavioral health care in an inequitable way as compared to physical health, plans would have to take steps to address these disparities.
Importantly, utilization review would still be allowed, and inappropriate care could still be denied.
Perhaps not surprisingly, while professing to support parity, plans have strongly objected to the proposed rules. In buttressing their opposition, plans have pointed to “many” comments opposing the rule, but failed to mention that the overwhelming majority of comments (well over 95% of the more than 9,500 comments) strongly support these needed rules. And, the main national coalition of mental health and addiction organizations, the Mental Health Liaison Group, urges finalization of the proposed rules to provide long-overdue, and urgently needed, accountability for plans.
Plans have also made unsupported claims about the effect of the rules on behavioral health technology and innovation. We know that innovation is critical to improving our nation’s mental health and that technological solutions, including app-based telemedicine and diagnostic and treatment tools, must be part of the solution to our ongoing crisis.
In fact, the failure of plans to scale up investments – and pay appropriate reimbursement rates – for groundbreaking solutions is a significant barrier to innovation. By requiring plans to collect and analyze data on how their practices artificially limit access to care and then take “reasonable steps” to address inequitable access, the rules will increase investments in behavioral health treatment. Given the widely recognized shortage of network providers (though, again, below-market reimbursement rates and onerous paperwork push providers out of network), two of the reasonable steps that plans will likely take to increase access are to invest in 1) tech-enabled telehealth care and 2) behavioral health technologies.
Currently, commercial plan expenditures for behavioral health care are in the neighborhood of 5-8% of their total health care expenditures. While pandemic-related increases in demand have boosted spending in recent years, McKinsey nonetheless estimates that the total disease burden associated with behavioral health conditions is 15%, or approximately double the percentage plans currently spend on behavioral health care. Thus, to address the true burden of these conditions, insurers must Increase investments in behavioral health. A significant portion of these investments will directly benefit telehealth and other behavioral health technologies.
In addition to spurring new investments to increase access to behavioral health care, the proposed parity rules will improve health outcomes and reduce other medical costs. But don’t just take our word for it. Research firms, like Milliman and Moody’s Investors Service, concur. Milliman’s research has found that individuals with behavioral health conditions have, depending on their diagnosis, between 2.8 and 6.2 times higher physical health care costs than individuals without those conditions. Moody’s found that individuals with behavioral health needs had very high annual health care costs ($12,272) that were driven by comorbid physical health conditions. Yet only 7.9% of the services these individuals received was for behavioral health treatment (under $1,000 annually). To drive down overall health care costs and increase profitability, Moody’s recommends that insurers increase investments in behavioral health.
Unfortunately, despite this robust evidence, plans continue to oppose change because limiting increases in behavioral health reimbursement boosts short-term profitability. In addition, many insurers still artificially separate their physical and behavioral health lines of business, making it very difficult for plans to realize cost savings from behavioral health investments (or to ensure parity compliance).
While health plans are wedded to the status quo, the American people are clamoring for change. Sixty-four percent of voters said that health insurance companies denying needed mental health services is a major problem contributing to the mental health crisis. This is not surprising given the ongoing behavioral health crisis, and the fact that 18 percent of insured adults reported that their private health plan had denied care in the past year.
Improving Americans’ health and well-being requires insurers to do their part in improving access to behavioral health treatment. It’s time that insurance companies stop resisting parity and start investing in behavioral health and equitable access to care.
Article written and sponsored by: Inseparable, American Foundation for Suicide Prevention, American Psychological Association, American Psychiatric Association, Children’s Hospital Association, Eating Disorders Coalition, The Kennedy Forum, Mental Health America, the National Alliance on Mental Illness (NAMI), the National Association for Behavioral Healthcare, and the National Council for Mental Wellbeing.
The mental health crisis is widespread and deeply entrenched in this country.
Health plans and employers fully support parity between Mental Health and Substance Use Disorder (MH/SUD) and Medical and Surgical (M/S) benefits (i.e., physical health) and have been working over the past 15 years to implement parity for behavioral health services.
Despite these efforts, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (DOT) – collectively, “the Tri-Departments” – are proposing changes to the federal parity law that will undermine health plan and employer efforts to continue to achieve parity and offer robust, affordable access to and coverage of MH/SUD care.
If finalized, the Tri-Departments’ proposed rule will significantly impact patient access to virtual behavioral health providers, particularly through new start-up companies with providers trained to treat eating disorders, obsessive-compulsive disorder (OCD), and SUD.
The Mental Health Parity and Addiction Equity Act (MHPAEA) celebrated its 15th anniversary in 2023. It applies to certain commercial and employer plans, such as self-funded Employee Retirement Income Security Act (ERISA) plans and Medicaid Managed Care Organizations (Medicaid MCOs).
The MHPAEA requires parity between MH/SUD and M/S for treatment limits and financial requirements. The parity standards for financial requirements are known as quantitative treatment limits (QTLs), and examples include copays and deductibles. Health plan procedures that impact the scope or duration of MH/SUD benefits are known as nonquantitative treatment limitations (NQTLs).
An NQTL is defined as a limitation on the scope or duration of benefits that is not quantitative. Common examples include:
On August 3, 2023, the Tri-Departments issued a proposed rule that applies to certain commercial and employer plans and would significantly modify MHPAEA. If finalized, it would take effect for plan years beginning on or after January 1, 2025. Over 9,500 comments on the proposed rule have been filed, many expressing concerns with the proposal. The new proposed rule could impact health outcomes, patient service quality, cost of care, affordability, and, ultimately, the availability of coverage.
The MHPAEA proposed regulation will substantially limit, if not eliminate, the ability of health plans to use utilization management tools such as prior authorization and concurrent review, thus hindering a health plan’s ability to inform a provider or a consumer that alternative or virtual treatments are covered and available under their plan. This will mean fewer referrals to virtual behavioral health companies since health plans may not be conversing with the provider or patient before the patient receives inpatient or outpatient care. It may also result in unnecessarily high levels of care for many patients who would be best served by the less acute options virtual health companies can provide.
For example, suppose the treating provider doesn’t interact with the health plan because there’s no utilization management. In that case, the provider may not know about the virtual behavioral health treatment options available through the patient’s plan. A provider may also have financial incentives not to use these new virtual or digital solutions. A consumer with an eating disorder may be placed in a residential treatment setting when a virtual family-based treatment would be equally effective because the treating provider had an existing relationship with the treatment center and was unaware that the patient’s health plan also covered virtual eating disorder treatment.
For the above reasons, the proposed rule could also slow the utilization of new home-based therapies for SUD. Without purposeful shaping of care for consumers at the beginning of their treatment, new alternatives to inpatient treatment and the opportunity to be treated at home will occur less frequently. Furthermore, new virtual school-based services, intensive outpatient programs, OCD treatments, and suicide prevention offerings will likely all see a decline in usage under the proposed rule.
The proposed rule does not count tele-behavioral technologies as part of a health plan’s provider network. Telehealth has proven vital for behavioral health treatment over the last several years. Health plans and other payors have significantly increased access to MH/SUD services during and after the pandemic, in part through these services. In addition, telehealth utilization for MH/SUD services industry-wide increased by 1,019% during the acute phase of the pandemic compared to the pre-pandemic era.4 By the post-acute pandemic period, telehealth utilization had risen by 1,068% compared to the pre-pandemic era, while in-person visits increased by 2.2%.”5
The proposed rule would evaluate health plan behavioral health provider networks and compare them to the health plan’s M/S provider networks. If access to a health plan’s behavioral health network is determined to be “materially different” than access to the plan’s medical/surgical network, the health plan would be out of compliance with the parity law. The proposed rule provides no credit for tele-behavioral health in assessing a network's adequacy. If the rule is finalized in its current form, and health plans don’t get credit for including telehealth and virtual services in their networks, the growth of telehealth and virtual behavioral health companies could stagnate.
AHIP, The Association for Behavioral Health and Wellness (ABHW), Blue Cross Blue Shield Association (BCBSA), and The ERISA Industry Committee (ERIC) are dedicated to ensuring equitable coverage of MH and SUD treatment. In the past 15 years, our respective members have worked tirelessly to implement parity for behavioral health services, innovating new approaches and benefits, working to combat provider shortages and lack of access, and driving quality to improve patient outcomes.
We are asking virtual behavioral health vendors to make their concerns known to the parity regulators by signing a letter sharing the abovementioned concerns. To learn more about the issue and help change the provisions in the proposed rule, please contact Kathryn Cohen, Senior Director of Regulatory Affairs, ABHW, at cohen@abhw.org.
Article written by and sponsored by: AHIP, Association for Behavioral Health and Wellness (ABHW), Blue Cross Blue Shield Association (BCBSA), The ERISA Industry Committee (ERIC)
1https://www.nimh.nih.gov/health/statistics/mental-illness.
2https://www.kff.org/mental-health/press-release/latest-federal-data-show-that-young-people-are-more-likely-than-older-adults-to-be-experiencing-symptoms-of-anxiety-or-depression/.
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1199525/.
4Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022,” August 25, 2023, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2808748?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=082523. See also https://ahiporg-production.s3.amazonaws.com/documents/AHIP-Analysis-of-Behavioral-Health-Spending-2013-2021.pdf.
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In my two decades of working in mental health policy, I have never been more hopeful than I am today.
Mental health is truly the “bipartisan issue of our time.”
Indeed, there has never been a more opportune moment for transformative actions to advance quality mental health solutions. The stigma around mental health is receding, more people in need are asking for help, and more organizations are raising their hands to be part of the solution, as evidenced by recent record-setting investments from the public and private sectors.
One of the solutions my colleagues at the Meadows Mental Health Policy Institute and I are most excited about is the integration of specialty behavioral health care into primary care and pediatric settings.
The Collaborative Care Model, considered the “gold-standard” of integrated care, provides for the routine screening and early detection of mental illnesses (just like other conditions such as high blood pressure), and enables intervention when conditions are easier to treat.
Over 90 randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses such as anxiety and depression.
I am especially enthusiastic about Collaborative Care’s potential to alleviate the country’s youth mental health crisis, as my colleague Melissa Rowan and I recently wrote in a joint blog post with Rachel Nuzum of The Commonwealth Fund.
To capitalize on this positive momentum, however, we must address our antiquated behavioral health technology infrastructure, a theme I heard echoed throughout November’s Going Digital: Behavioral Health Tech Conference.
With the passage of the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act, in 2009, the federal government mandated the creation of electronic medical record systems throughout health care facilities.
This modernization of our technology infrastructure catalyzed health systems’ ability to support busy clinicians in assessing risk, prescribing medications, and monitoring care protocols and outcomes, by allowing doctors to instantly access and review patient history and leverage care supports and prompts, such as automated reminders for screening and risk factors. It also facilitated population-level understanding and advancements in what was more likely to be working—and not working—in health systems across America. Patients now experience direct benefits as their medical histories and records can now follow them more easily between different clinical settings. Moreover, individuals have seen notable improvements in outcomes for major illnesses such as heart disease and cancer over the past decade.
But unfortunately, that landmark legislation did not include behavioral health care providers. As a result, today, more than a decade after the passage of the HITECH Act, many behavioral health providers still use recordkeeping systems that rely on rudimentary technology such as paper and fax machines and cannot be integrated with other health care records. The past decade has also seen dramatic declines in behavioral health.
In partnership with Going Digital: Behavioral Health Tech, and with funding from The Commonwealth Fund, the Meadows Institute produced a white paper last May recommending that the Office of the National Coordinator for Health Information Technology (ONC) develop security, interoperability and privacy standards to address this gap.
During one of the policy track sessions I moderated at November’s conference, I was encouraged to hear ONC announce a partnership with SAMHSA to invest $22 million into behavioral health tech integration. While this is an exciting development, a significantly larger investment will be critical.
That is why my organization is proud to be leading an effort to unite a diverse coalition of partners from across the health care spectrum, including Going Digital: Behavioral Health Tech, Hopelab, and GreyMatter Capital, behind a plan to generate a legislative solution to this challenge.
To that end, we sent a joint letter last month to the United States Senate Committee on Health, Education, Labor and Pensions urging it to include provisions to support behavioral health providers’ adoption and use of electronic health records as part of the SUPPORT for Patients and Communities Reauthorization Act.
We are grateful that the HELP Committee passed the SUPPORT Act, which included language to require the ONC to convene an expert roundtable to “examine how the expanded use of electronic health records among mental health and substance use providers can improve outcomes for patients in mental health and substance use settings and how best to increase electronic health record adoption among such providers.”
This language is a positive step toward modernizing information systems for behavioral health providers and integrating behavioral health with primary care. But we must not stop here.
We cannot ensure proper care for people with behavioral health needs when providers are not able to use advanced technology to coordinate patient health records.
With the help of our partners, we look forward to pushing for the full passage of the BHIT Coordination Act, S.2688/H.R. 5116, which supports behavioral health providers’ efforts to adopt health information technology systems.
I invite more behavioral health technology companies to join our coalition. Together, we can achieve a transformative solution for this challenge and grasp the unprecedented opportunities that lie within reach for the behavioral health system.
Kacie Kelly is the chief innovation officer at the Meadows Mental Health Policy Institute. @KacieAKelly
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.
Brad Kittredge, founder and CEO of Brightside Health discussed how to meet patients where they are to better deliver life-saving mental health care with Dr. Douglas Nemecek, Chief Medical Officer of Behavioral Health at Evernorth Behavioral Health. Read highlights from their conversation below. The following has been edited for length and clarity.
Most of us don't know how to easily access health care—specifically, the right type of health care. We need to do a better job of helping people find more appropriate care, especially regarding mental and behavioral health. Limited time for appointments, a lack of patient self-advocacy, and a provider shortage are also barriers to behavioral health care. However, leveraging technology is working to help expand access and make it more convenient for people.
The data is definitely encouraging, showing us digital solutions are improving access to care for individuals. Before, people would go through three to five different providers before sticking with one and getting the care they need. This takes too much time, and people likely won't re-engage. Now, we're seeing people engaging sooner and quicker and not having to try as many different providers or clinicians before they connect with somebody who is truly engaged. The more we can simplify this journey for people, the sooner they'll receive care, and we'll start seeing better outcomes.
One of the things that we need to acknowledge is that there isn't just one front door that will work for everybody. We've gotten better with our ability to personalize care journeys for individuals so that we can address their specific needs and use cases. But to do that, we have to have multiple front doors to engage people where they are and when they're ready to commit to care. That's where digital solutions come into play – creating new front doors via the web and apps to expand access, making it easier to connect, and adding more variety and opportunity to personalize care.
To deliver coordinated, impactful care, we need to start measuring outcomes. As a specialty, we haven't done much from a measurement perspective over the last 30 years, but that's where we see the future heading – measuring who's getting better and how they are getting better. It's about keeping the patient at the center of what we do so we can further personalize care and optimize outcomes so each individual can better function at work, at home, and in their community.
So many investments and innovations focus on how we deliver behavioral health care today. But as a psychiatrist, I know we must find better ways to deliver care at scale to people needing help. That requires strong partnerships with providers that enable us to take something to market in a way that improves access and outcomes. They need to prioritize measurement, help improve the therapeutic alliance, and demonstrate that they can make that initial match with a patient in a way that really works for the patient. And they need to help us increase our diversity so we can make sure we can make meaningful connections with each patient. It’s really about having all the right pieces so that we can optimize the care journey and optimize the care outcomes. These are some of the things we're focused on at Evernorth to drive outcomes in a scalable, sustainable way.
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!
As of March 2023, 160 million Americans live in areas with mental health professional shortages, with over 8,000 more professionals needed to ensure an adequate supply. In order to address this shortage, long-term legislative opportunities are necessary but will not provide immediate relief to the millions of Americans in need of care. Digital tools overcome many of the barriers to traditional mental health care; however, they present their own challenges concerning federal regulation and public and private insurance coverage. In order to start implementing near-term solutions, The Commonwealth Fund and the Meadows Institute have begun focusing on existing authorities that have not yet been applied to the behavioral health sphere.
The Commonwealth Fund is a private U.S. foundation dedicated to promoting a high-performing healthcare system that can provide society's most vulnerable, including low-income people, the uninsured, and people of color, with better access to care. In 2021, The Commonwealth Fund launched their focus on behavioral health and dedicated efforts towards helping policymakers on federal and state levels. The fund was able to track trends in mental health care demand and compared state to state and the US to other countries to isolate which populations are most underserved and why. They found that youth populations of color were most at risk for mental health professional shortages and began analyzing how they could target this population. One of the main factors that prevent patients from connecting with service providers, in addition to the workforce shortage, is that Medicaid is not accepted by many care providers, which only further isolates disadvantaged populations.
The Meadows Institute works to utilize public and private partnerships to advance innovative funding models for mental health care and services. As digital mental health technology is not FDA regulated, both clinicians and consumers struggle to determine which tools are safe and effective. Additionally, unregulated providers have no incentive to protect the privacy of their patients, and their data security is unmonitored. Once a consumer has identified a digital mental health tool (DMHT) they would like to use, there are a myriad of complications with insurance. As DMHTs are both a service and a device, which are usually disparate categories for insurance purposes, it is difficult to quickly and easily reimburse consumers. Additionally, DMHTs are constantly updated, but the research that reviews these technologies is much slower and struggles to effectively ensure that all information is accurate for insurance claims. These difficulties are particularly complicated for Medicaid at the state and federal levels. All of these barriers discourage providers from exploring options with tools and technologies that may never get approved; meanwhile, the population of Americans without mental health care only grows.
However, there are many opportunities for near-term solutions. The creation of clear definitions and standards can go a long way in ensuring that consumers have safe and effective care that does not put their privacy or data at risk. With regard to reimbursement, clinicians and staff should be paid for their time spent using an online resource and the time taken to educate patients on it. Providers can explore enhanced payment possibilities, such as increasing the rate for the same service, as DMHTs are part of supplies and should be factored into the calculation of cost. Underlying all of these solutions is the need to target vulnerable populations when crafting policies to ensure these solutions are aiding all people seeking care.
Medicaid programs can encourage the adoption of DMHTs and universal screenings, as well as focus on youth mental health, by making it a part of the request for proposal process with managed care organizations (MCOs). Looking towards exemplary states, such as Louisiana and Washington, to model evidence coverage determination processes can aid Medicaid providers in the process. Medicaid MCOs could also incorporate DMHTs into their own request for proposal processes by offering it under “value-added services.” There are many short-term proposals that can help mitigate the effects of the mental health professional shortage while longer-term legislative processes work towards fixing the core issues that resulted in this crisis.
Just because digital mental health tools are new and ever-changing does not mean we should not incorporate them into our notions of what constitutes behavioral health care. These tools can streamline the lives of many providers and patients as they overcome many of the traditional barriers to providing care and can address the need for 8,000 additional mental health professionals.
To download the full report, please visit Meadows Mental Health Policy Institute’s website here.
Chris Donovan, a healthcare transaction lawyer, is a partner at Foley and Lardner in Boston. He spoke with Laura Veroneau, a partner at Optum Ventures, on the investment opportunities within the behavioral health field, as well as the possible changes to the field in the coming years. The field of behavioral health has blossomed over the last five years, thanks partly to the pandemic. It shed light on a field that was generally underserved and overlooked as a part of meaningful healthcare solutions. Many new companies have developed business models, technologies, and innovations within the field that have placed behavioral health at the forefront of healthcare advancements. Companies and technology are only part of the puzzle to success within the field. Investors make up a huge component of the success and advancement in the future of the field.
Innovation in the behavioral space has increased greatly thanks to the heightened focus on the concerns of mental health. The new popularity and success of the field have brought to light some of the faults and the overall lack of access to behavioral health providers, medications, care, and research. With the thriving of the field, now more companies than ever are interested in making history with breakthrough innovations that help further the success of these patients and with the idea of an overall health-focused model versus separate mental and physical health models. With the many opportunities for growth in the field and many areas for investment options, there has never been a better time for the field to expand and receive the attention it so desperately requires. The industry was simply not meeting the same set of needs on the behavioral health side as it was hitting the physical health side. Thankfully, that has all changed.
In 2017, Optum Ventures saw an opening and an acceleration in behavioral health, mostly in part due to the recognition of the importance of behavioral health in conjunction with the overall ecosystem of healthcare. The advancements in the field have created an entirely new sector of behavioral health. There are now more specialties within the field itself as well, including the new focus on pediatric’s behavioral health, substance abuse, eating disorders, OCD, as well as others, that have immense opportunities for investments across the board. Since there is no one-size-fits-all for investments, there are many different options for investors to get involved and help shape the future of the field. In conjunction with the numerous investors, a necessary saturation of the field has developed. As one company finds success and starts to do well, then more competitors appear. This gives the investors more variety in their selections, as well as a chance to create partnerships that will have a vital impact on the advancements and capability of the companies to continue to evolve and provide continuous solutions.
The culmination of these different options and solutions suggests the opportunity for growth between different companies in the form of financial sponsors, bringing together broad solutions to create a comprehensive platform. There is so much potential for investments to flourish in the involvement of the investors and companies. This idea of investors and sponsorship in the behavioral health field can contribute to the consolidation of this field. Many strides are taking place to aid in viewing this specific field as a massive part of the healthcare system going forward.
Access continues to be a large struggle and to have a clear mismatch of need versus the ability to obtain care. Expanding access in all areas for people to receive behavioral health care is a critically important aspect of these investments. Since there is no one way to address the needs of these companies, it is crucial to be able to access the field as a whole, as well as evaluate the company's ability to thrive in the field.
Investors have many different aspects of these companies that they need to evaluate and analyze. Assessing the quality and outcomes of the services that the different companies can provide is a large part of the research that goes on behind the scenes for investors. The focus on quality and outcomes is one of the biggest challenges, not just for investments, but for the companies themselves in order to be successful, which in turn, directly impacts the investors.
A large factor in the success of these companies is the potential for acquisitions by higher-level tier insurance like Humana and United. There is a lot of focus on the behavioral space, as well as the lack of access and the increased need and support of the behavioral health field in general. Innovation within the field has opened a clear path for the success of behavioral health care in the future. The pandemic certainly created a push for the acceptance of this sector of care. With this newfound level of acceptance, there is more value that can be attributed to the level of service of the companies and the collaborative care model. Partnerships and bonds between investors and companies help to drive the sector of care to succeed.
With the increased attention to the field of behavioral health, the influx of innovations by a variety of groundbreaking companies, and the overall availability of investment in such a growing field, there has never been a better time to build a network of collaborative ideas that will help shape the future of a field for the better good. Investments help to make dreams a reality and allow innovation to drive the advancement of such an important field.
We spoke with several panelists regarding their companies and how they are using technology to better reach underserved populations. These companies are making great strides and are succeeding in closing the gap in behavioral health care.
Digital tech is helping provide care and assistance to populations often left behind the curve. There are many opportunities for increased access to healthcare for the people in these populations, and these companies are the ones to do it.
Dr. Lauren Powell, the Vice President for US Health Equity and Community Wellness for Takeda, helps systems and leaders move from embracing health equity in theory to health equity in action by noticing and intervening on how racism and other oppressive forces operate within themselves and their systems.
Ashlee Wisdom, the Co-Founder & CEO of Health in Her Hue, is a public health innovator committed to dismantling racist systems. Ashlee builds equitable solutions to overcome anti-Black racism and injustice in healthcare.
Gaurang Choksi is the founder & CEO of Violet. Violet is a platform dedicated to helping the healthcare industry connect underserved communities to culturally competent care by building a new standard for identifying cultural competencies within providers.
Kinda Serafi is a partner with Manatt Health. Kinda advises on the legal, policy, and operational challenges of the Affordable Care Act, Medicaid, the Children's Health Insurance Program, Marketplaces, and payment and delivery reform. She has significant experience implementing and analyzing federal healthcare programs for an array of clients, including state governments, foundations, providers, nonprofit agencies, and IT vendors. In particular, she frequently leads complex multi-stakeholder engagement efforts.
Judy Mohr Peterson is the Medicaid Director for the Hawaii State Dept. of Human Services. She is a nationally recognized leader in healthcare delivery system reform and Medicaid. They are focusing on the volume and population in need of all forms of behavioral health care.
Anna Fagin is a Principal with Town Hall Ventures. She is working to address healthcare inequities in underserved populations. She is responsible for investing in high-growth, technology-enabled consumer and healthcare businesses.
Dr. Juliette McClendon is the Director of Medical Affairs. Dr. McClendons is a clinical psychologist with expertise in researching and treating mood, anxiety, and personality disorders. She is a nationally-known expert on racial and ethnic health disparities and has worked extensively to address the impact of stress and trauma on the mental and physical health of people of color.
Dr. Travis Gayles is the Chief Health Officer for Hazel Health. Dr. Gayles previously served as the Health Officer and Chief of Public Health Services for Montgomery County, Maryland, where he oversaw the county health system, including the county's school-based health program, and was integral in leading the COVID-19 pandemic response. Dr. Gayles brings significant pediatric clinical experience and has been a published researcher on topics such as the impact of exposure to bullying and interpersonal violence on adolescent risk-taking behavior.
If providers agree that integrating physical and behavioral health delivers better outcomes, why isn’t every health plan doing so? One of the main reasons is: Their resources are stretched too thin. Suppose care managers had the resources to screen at-risk members and improve care coordination. In that case, they could more effectively guide members to appropriate resources, help identify co-morbid conditions sooner, and preempt emergency room visits.
Fortunately, technology can help with this. Technology can scale to offer care managers support for a larger member population and provide the insights Medicare Advantage plans need to identify risks and prevent behavioral health crises. Dr. Tom Zaubler, MD, MPH, Chief Medical Officer at NeuroFlow, shares more about the challenges faced by Medicare Advantage plans and how technology can help integrate behavioral and physical care management.
Many Medicare Advantage plans fail to deliver on improved outcomes due to their outdated and siloed approach to care. Providers agree that integrated care, assessing and treating physical and behavioral health together, delivers better outcomes, but many plans are still managing their members’ health needs separately. Many members with chronic conditions have underlying behavioral health needs that can prevent or hinder recovery. In fact, over one-third of individuals with chronic conditions also struggle with behavioral health conditions. Managing these health needs separately is not only inefficient; it’s ineffective.
Care management is also reactive. Many Medicare Advantage plans provide care management to their members based primarily on claims data. That means members have already submitted a claim for an emergency room visit, for example, before they receive support from their Medicare Advantage plan. A preventative approach can lower utilization, helping plans meet their cost savings goals and improve clinical outcomes. Preventative measures like regular behavioral health screening and providing access to relevant behavioral health resources are critical components of this effort.
Medicare Advantage plans have another unique challenge that calls for urgent preventative measures. Older populations are at a higher risk for suicide than many age groups. In fact, men over 65 years old face the highest overall rate of suicide. It’s especially important in these instances to manage physical and behavioral health needs together and proactively screen populations to mitigate behavioral health crises.
Delivering improved outcomes and lowered costs isn’t achievable if physical and behavioral health aren’t managed in tandem. For example, someone with diabetes is two to three times more likely to have depression than someone without diabetes, according to the CDC. Depression can lead to unhealthy habits like not checking blood sugar or skipping critical doctor’s appointments. It’s clear that overlooking the underlying behavioral health needs of a diabetes patient prevents physical recovery.
If care managers can integrate the physical and behavioral health data of their members into a single view, they can more effectively guide those members to appropriate benefits and resources that can support their recovery. Screening Medicare Advantage populations more regularly can also help identify co-morbid conditions sooner and preempt an emergency room visit or suicide attempt.
One of the main reasons care managers aren’t proactively screening at-risk members or improving coordination across physical and behavioral health care management is that their resources are stretched thin. Calling large volumes of Medicare Advantage members simply isn’t feasible, and many care management platforms don’t connect physical and behavioral health data. Technology can offer the scale care managers need to support a larger member population, prioritize outreach to their highest-risk members, and unify physical and behavioral health data.
For example, NeuroFlow screens members enrolled on its platform at a regular, monthly cadence. The digital engagement platform delivers clinically-validated assessments to screen for depression, anxiety, substance use disorder, and more. AI technology analyzes these assessments, along with other user signals, to inform a proprietary Severity Score. Depending on the severity of an individual’s behavioral health needs, NeuroFlow will either direct that person to relevant self-care resources or flag the member as at-risk to their care manager, prompting further outreach. Connecting members to self-care resources or care management can have major upstream impacts on clinical outcomes and costs of care.
Technology infrastructure can streamline integration by making it easier to identify and manage co-occuring conditions and enhance efficiency. To make a meaningful impact on clinical and business outcomes, care managers need a comprehensive and proactive approach to member wellness. Rather than waiting for worsening symptoms or for members to seek help, technology can provide the insight Medicare Advantage plans need to identify risk and prevent behavioral health crises.
To learn more about how technology can improve and scale integrated care management, visit NeuroFlow.
Dr. Tom Zaubler MD, MPH is the Chief Medical Officer at NeuroFlow, the leading SaaS solution for integrated behavioral health. He is also the Founder & Medical Director, Pegasus Psychiatry Associates. Prior to joining NeuroFlow, he was the Chair and Medical Director of the Department of Psychiatry at Morristown Medical Center for 21 years.
As we all know, our country is facing a significant youth mental health crisis. However, it is crucial to acknowledge that black youth–in particular–are facing their own crisis of struggling with suicide. This demographic is often overlooked when discussing the mental health crisis in America. And with the increased stigma the black community faces, it can be especially challenging for many black youth to talk about. In honor of Black History Month, we are bringing mental health to the forefront of discussions concerning the black community. We can better understand the pitfalls in the healthcare system and acknowledge the structural challenges that make accessing care more difficult for black youth.
There has been an increase in black youth suicide, specifically in the age range of 5 to 12 years old. The rate of suicide has doubled in the last 13 years. This came tied to a decrease in suicide among white youth. Black youth have the highest rate of suicide attempts across all demographics, except for American Indians and Alaskan natives. The rate of attempts among black youth has only increased in the last ten years. There is widespread concern for the increase in these attempts and suicidal ideations within the black community.
Unexpected life events seem to be at the base of these increases. While this demographic can be hit with many triggering events, the pandemic certainly propelled a surge in attempts and ideations. The pandemic has drastically caused an increase in unprecedented change, the adaption to an ever-evolving society, as well as grief and loss in the nation. This prompted an increase in mental health stressors for all, while this demographic fell behind with the least amount of access to help and support the youth in the communities. As the effects of the pandemic continue, even after the passage of the initial wave, this demographic needs to have more support and greater access to suicide prevention measures.
In 2020, GDBHT2022 speaker Brandon Johnson served as Substance Abuse and Mental Health Service Administration's representative on the Health and Human Services Report to Congress on African-American Youth Suicide. The report came from information included in the Appropriations bill in 2019. Congress then challenged the Department of Health and Human services to assess the situation and provide information regarding what was happening, what is already known about this issue, and what programs are in place right now to support African-American young people and those who are in their lives. This prompted a push for many agencies to start looking into the risk factors and the protective factors for the prevention of these issues. It also encouraged the mental health field to focus more on what it should be doing to address these issues. Using information from the national violent death reporting system data, under which suicide is reported from each state, the CDC can evaluate the situations leading up to the event. These situations could induce financial issues, relationship issues, previous signs of mental health issues, mental health diagnosis if the person was seeing a mental health professional, school-based issues, and any traumatic life events or crises in the two weeks leading up to the suicide, etc. This reporting system was combed for information regarding youth, and they found that traumatic events, family and relationship problems, significant arguments or conflicts, or any predetermined mental health concerns were all prominent factors in these deaths. From this information, it was determined that family needs to be involved in the mental health and wellness of young people–as youth do not have the ability to handle everything for themselves. They need the family unit to tackle everyday concerns.
Another part of this demographic is understanding that there is not just one aspect to the black youth community. There is the LGBTQ portion, those in foster care, those experiencing homelessness, and many other risk factors on top of the black youth community, that are influencing the youth. There simply are not many intervention strategies to help handle these issues.
There are many companies and organizations out there that want to help and be a part of the solution. So, how can organizations help? Community engagement. In order to understand the fundamental needs of communities of color, understanding the individual needs and lack of access to care available to the youth must be acknowledged. Unfortunately, the challenges to accessing care are abundant–no health insurance, socioeconomic status, increased stigma, provider bias, and more. Engaging with the black community and being open to helping the youth in these communities is an important step in preventing the loss of life in the community.
As we address the pitfalls of the mental healthcare system for black youth, we can also celebrate the positive efforts in improving mental healthcare for black communities during Black History Month.
This article gathered insights from Brandon Johnson's presentation at our 2022 conference. You can watch his entire session here by searching "Brandon Johnson."
Our kids are in crisis. It's so dire that the U.S. Surgeon General Vivek Murthy issued a rare public health advisory about our national youth mental health crisis. A 2021 General Advisory report found that one in three high school students and half of female students reported persistent feelings of sadness or hopelessness – an overall increase of 40% from 2009.
Pediatricians, parents and educators—the people who are closest to youth—are also sounding the alarm. Representing more than 77,000 physicians and 200 children’s hospitals, the American Academy of Pediatrics issued an urgent warning declaring the mental health crisis among children so dire that it has become a national emergency. Parents and educators report that they are equally alarmed. 91% of parents are worried about their childrens’ mental health. And, both parents and educators ranked “Mental and Emotional Health” as the biggest challenge facing middle and high school-aged kids today2. The majority of educators ranked it #1—higher than school safety, cyber-bullying, physical health and wellbeing, social media addiction3. The Pew Research Center just published an article illustrating that four-in-ten U.S. parents with children younger than 18 are extremely or very worried that their children might struggle with anxiety or depression at some point.
Clearly both experts and families are concerned. But, access to mental health services is very limited. There’s a shortage of mental health professionals and, even if a family can find a provider, the cost of care prevents many of them from getting the help they so desperately need. Our system has failed our kids. How can we help?
Mental health care is a tough business - not only emotionally but financially. A typical therapy session runs between 45-minutes to an hour. While there are large variances based on location and speciality, the reimbursement rate for a therapy session is often the same, if not lower, than a 20-minute office visit with an Advanced Practice Provider.
While it can be enticing to double down on higher reimbursement channels such as cash-pay only models or contracting directly with employers, this creates even more inequities in care. At Daybreak Health, we are committed to providing affordable and accessible care to all children which requires close partnership with insurance —commercial and Medicaid. This means negotiating our fee-for-service rates with commercial plans while also pursuing programmatic partnerships. It means being smart about contract prioritization of Medicaid Managed Care Organizations to maximize our impact based on population coverage. It means building out revenue cycle management tools while simultaneously fostering a pipeline of in-network insurance patients to justify the cost. And, it means staying firmly committed to our mission of creating equal access to youth mental health care.
School districts are also prioritizing mental health as a top investment area and using innovative funding sources to cost-effectively launch and sustain these programs. Billions of dollars of funding on a state and federal level have been allocated for youth mental health services, including ESSER and Medicaid. Oftentimes, district leaders are launching programs with temporary funds and then transitioning to general funds to ensure the long-term viability of the program. When asked which funds were being used, school districts responded that State grants and Medicaid top the list (51%) followed closely by Federal grants and general funds (50%)4.
Looking ahead, there are some interesting trends in where school districts are planning to invest most heavily in student mental health services:
With cost being one of the largest barriers to accessing youth mental health care, it is going to require systemic collaboration to help solve this massive issue facing our kids. Families, educators, pediatricians, insurers, government, and employers must act now and work together to put a youth mental health infrastructure in place to serve more kids in an equitable and affordable way. Together, we can solve the most defining problem of an entire generation.
Learn how Daybreak has partnered with 850 schools, representing over 30 districts, to reach ~650K students with school-based mental health services.
Article written by: Amanda Weaver, VP Clinical & Health Plan Operations, Daybreak Health
1 The State of Youth Mental Health & Our Schools Report, Daybreak Health, 2022
2 Ibid.
3 Ibid.
4Ibid.
It likely comes as no surprise—we’re in the midst of a behavioral health crisis.
Rising behavioral health costs, surge in demand for services, increasing staff turnover, and a lack of evidence-based treatments have intensified the need for change. In fact, at $225 billion, behavioral health accounts for nearly 5.5% of all healthcare spending.
As behavioral health leaders grapple with these issues and prepare for the future, it’s important to consider how payers and providers can better partner to deliver high-quality, cost-effective care which reduces symptoms, improves health outcomes, and delights patients.
Patient outcomes data from evidence-based practice is the foundation of strong partnerships between payers and providers. After all, you can’t manage what you can’t measure. Yet, behavioral health still lags in objectively measuring patient outcomes.
In this article, we’ll explore how providers and payers can partner to truly define what quality means in behavioral health (hint: It’s not just HEDIS measures), adopt measurement-based care to create evidence-based standards, and invest in data-sharing technology infrastructure.
Physical health has well-established, clear outcomes data that both providers and health plans agree indicate quality of care. Physicians systematically measure blood pressure to monitor hypertension and A1C levels to monitor diabetes, for example. Unfortunately, measurement and definitions of quality care in behavioral health aren’t status quo.
In behavioral health, the only consistent data that health plans gather are duration and type of treatment through claims data. Some health plans try to measure quality with HEDIS measures–which may include readmission rates, utilization, follow-up, and screening measures. While HEDIS measures are useful for measuring processes, they don’t measure patient outcomes, nor do they measure how a patient is responding to and progressing through care.
Similarly, most behavioral health providers aren’t systematically evaluating patient outcomes using measurement-based care (MBC) despite its proven ability to increase response rates to treatment, reduce required sessions, and lead to more patients in remission.
Research supports, and leaders in behavioral health advocate for, the use of MBC to measure behavioral health outcomes to indicate quality of care. With greater alignment on behavioral health quality and how to measure it, plans and providers can help members improve their overall health, increase efficiencies in care, and reduce total cost of care. (Learn more about how to use MBC to maximize the value of your behavioral health network from Companion Benefit Alternatives, the leading behavioral health plan in South Carolina.)
Research consistently shows that the practice of MBC improves clinical outcomes across all treatment approaches, populations, and settings. MBC enhances clinical decision-making and quality of care, enriches communications between patient and provider, and objectively documents the value of treatment to health plans.
Clinical studies have shown that patients who receive measurement-based care are 2.5 times more likely to reach remission, and treatment response time is reduced by half. Real-world data support these clinical findings. In fact, patients using Owl see a 56% faster time to remission and a 30% increase in capacity with existing resources (learn more here).
Unfortunately, MBC is still not the standard of care in practice. A 2019 MBC literature analysis revealed that less than 20% of behavioral health practitioners are integrating it into their practice.
Let that sink in–despite the proven and documented value of MBC, less than 20% of behavioral health providers are using an evidence-based approach to care. We wouldn’t find this acceptable for physical health. We argue it no longer makes sense for behavioral health.
Common barriers to using MBC in practice include the potential impact on clinical workflows, lack of technology to implement assessments, and the perception that capturing patient measures are time-consuming, cumbersome, and/or complicated. Yet innovative technology, like Owl’s measurement-based care platform, removes all of these barriers.
When providers adopt a consistent practice of MBC, they’ll have the data to demonstrate they are providing quality care to their health plans. This data empowers providers to hold meaningful discussions with their payers regarding how they are providing higher-value care and, therefore, should be reimbursed at higher rates (hint: payers want to incentivize better value for their members).
While there’s been a lot of buzz in behavioral health about the promises of value-based reimbursement for years, we’ve seen limited success. When providers and payers are working together with the same, mutually agreed upon outcomes data, everyone wins, including (and most importantly) patients.
Currently, many providers don’t have the technology to systematically measure if their patients are getting better. In turn, payers are unable to objectively assess their behavioral health network. With no true transparency or understanding of care quality, health plans don’t have the necessary data to have meaningful reimbursement conversations–leaving many providers feeling dissatisfied with payment rates.
With the availability of easy-to-use measurement-based care solutions like Owl, it’s time for payers and providers to collaborate on deploying the software infrastructure that supports gathering and sharing outcomes, data, and insights to measure and improve quality of care.
When health plans invest in MBC solutions, they can assess their network in areas of care quality, therapeutic alliance, and outcomes-driven treatment length benchmarks, which will incentivize and attract providers to deliver high-quality, cost-effective care for their members–a win-win for both providers and payers.
“We’re working on moving our behavioral health network to value-based reimbursement and away from fee-for-service models. We didn’t have a great way to choose quality metrics that make sense in behavioral health. Now, Owl gives us the evidence-based outcomes metrics we need and a platform that reduces burden for providers and easily integrates into their workflows. Owl also allows us to share data in a way that isn’t a burden on the providers.”
- April Richardson, M.D., Medical Director, Companion Benefit Alternatives
While payers and providers will continue to be challenged by the behavioral health crisis for years to come, the opportunity is now to better align on improving health through a well-thought-out partnership that redefines quality and elevates outcomes measurement and transparency.
There is an incredible need for behavioral health integration (BHI) in our healthcare systems. Many companies are working to achieve this through the use of digital care. Manatt and the American Medical Associate are working closely together in order to create a better system to serve the needs of behavioral health care. They have their own ideas and perspectives, but by working cohesively, they can supply a positive push for BHI through digitally enabled care.
Manatt is an integrated health services firm composed of a diverse team of more than 160 healthcare professionals, including lawyers, MBAs, financial experts, and consultants. It combines the rigor of legal thinking with strategic and project management disciplines.
Manatt works with a wide array of healthcare industry organizations to help them to achieve their strategic goals at the intersection of health and technology. They work with different kinds of clients and health systems on digital and telehealth strategic planning. They also work with various states on telehealth policy design and implementation.
The American Medical Association leads the charge to prevent chronic disease and confront public health crises. They work to remove obstacles that interfere with patient care. They drive the future of medicine by tackling the biggest challenges in health care and training the leaders of tomorrow. AMA has investigated the challenges of incorporating virtual care or telehealth to accelerate the adoption of behavioral health integration.
COVID-19 has brought attention to the dire need to expand and adopt behavioral health integration (BHI). This BHI is essential to solving the nation's growing behavioral health crises. There are digital tools, such as telehealth, that can be integrated to accelerate the BHI adoption process and help remove barriers to timely access to care.
By working with all their stakeholders, they can identify opportunities and practical solutions to advancing the adoption and overall effectiveness of digitally-enabled BHI.
The AMA has noted that many barriers are preventing the BHI's forward movement. Widespread adoption by physicians and practices seems to be the exception, rather than the standard, across our country, due to several barriers facing physicians' practices. These barriers include high startup costs, as well as low reimbursement levels, complicated billing requirements, and limited workforce availability. There are also some difficulties estimating behavioral health integration's net effects, particularly around their financing. Estimating the return on investment with behavioral health integration is also very difficult.
Manatt has noted another significant barrier: the obvious shortage of behavioral health providers and primary care specialists. There is also a need for adequate payment to providers to cover the costs associated with adopting, implementing, and delivering BHI. Another significant barrier is the regulations, both federal and state, that prevent or limit providers from sharing information across team members or between behavioral health providers and non-behavioral health providers. Other limiting factors, like prior authorizations required by health insurance, can impact the BHI. This can result in administrative burdens that make it more challenging to adopt this model.
Technology can identify key opportunities and limitations along the BHI patient journey. Screenings, intake, and clinical decision support tools and telehealth delivery are all possibilities. When appropriately applied, these tools can enhance the patient's engagement and treatment. Also, supporting integration while limiting fragmentation of care or whole-person care ultimately generates value for the patients and physician practices that support them.
AMA notes that technology should augment, but not replace, the longitudinal patient relationship. This will only partially replace the need for in-person interactions or the patient assessment that can be needed. It should be noted that the use of BHI is only clinically appropriate for some available people, and it will only work for some. Some patients and providers have preferences regarding the use of technology and can even lack digital literacy or broadband access, in addition to other factors as well. There is also a lack of robust clinical or economic evidence regarding the impact specifically technology solutions have within BHI models that can impact coverage decisions.
Manatt states that there is the capability to increase behavioral health diagnosis and treatment rates by incorporating evidence-based digital health solutions and enabling technologies into standard workflows. There is also an opportunity to implement technologies that facilitate better connections and care coordination across care team members, enabling highly collaborative care. There is an added chance to increase BHI training for primary care specialists and behavioral health providers by incorporating digitally-enabled BHI into standard curricula at universities, schools of medicine, and others. There is an opportunity to raise the provisions of evidence-based treatment into best practice standards by adopting and integrating standard measurement tools into provider and patient-facing technologies by promoting data-driven continuous quality improvement.
Health payors have a tremendous role to play in the adoption of BMI. By ensuring sufficient payment for BHI, they can support practices to our seeking to adopt the integration. They can also help to reduce the financial barriers that patients experience. These payors can help by expanding coverage and fair payments for all stakeholders utilizing the collaborative care model and other BHI models that facilitate care management and transitions of care for patients with behavioral health conditions. Another benefit that these payors can add is to allow equal payment for in-person and telehealth behavioral health services that are delivered via audio or video telehealth technologies. They also can make telehealth care more affordable by deciding how and when to apply cost sharing. There is an outstanding opportunity to offer technical support provider training and regional sharing of resources. Lastly, they can extend provider networks and improve access to BHI by minimizing and/or eliminating prior authorization or other utilization management practices for BHI services that can cause administrative burdens.
Employers can also play a role in BHI by ensuring that their employees have access to comprehensive primary care services, including behavioral health. They can enhance coordination among themselves, their employees, primary care specialists, and behavioral health providers. Allowing employees access to proper care will significantly and positively impact the BHI.
There are many parts to the BHI expansion and adoption throughout the country. From patients to providers, stakeholders, and payors, the list of the moving parts that will impact the adoption of BHI is endless. There is a clear need for BHI, and only by working together can we create a better system for behavioral healthcare in the future.
You can watch our full panel and hear more of these conversations 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.
Bill Smith started Inseparable two years ago, at the beginning of the pandemic. Inseparable aims to empower Americans from every town, city, and home to better care for one another by demanding and winning policy that cares for us all. Bill says, “the health of our minds can’t be separated from the health of our bodies.” Inseparable fights for a future where mental health policy, no longer an afterthought, helps our country thrive. Bill’s experience of losing his brother to mental illness encouraged him to create a movement to change the broken approach to mental health in the United States.
Inseparable’s mission is to focus on three core areas to improve people’s mental health:
The Treatment Gap
Bill explains how access to treatment is difficult for several reasons. First, there is a shortage of workers to meet the demands for mental healthcare. “Having a culturally competent and diverse workforce is really important so that you have people who understand your life experience,” Bill says.
Telehealth is a solution that addresses unequal access to healthcare services. Bill says, “we think technology and the role that it can play in addressing the workforce is a really important one to focus on.”
Integrating mental healthcare in different areas of one’s life is another pivotal solution to reducing the mental health treatment access gap. Bill explains, “integration is about making sure we talk about mental health everywhere they show up in life. Whether it is school, or work, or places of worship.”
The last part of the treatment gap Bill mentions is mental health parity. Bill describes this as “a fancy word for making sure that mental health issues are reimbursed and paid for the same way other health issues are. We know that people either individually or through their employers or where they go to school have access to health insurance that doesn’t always cover mental health services.” Inseparable aims to ensure people get the treatment they paid for and access to services they paid for through their health insurance.
Early Interventions
Bill discusses the urgency to address youth mental health early. He explains how reaching children through schools is the best approach. “One of the things we focus on specifically is the use of comprehensive School mental health systems. It’s a model that was put out by the National Center for school middle help, and it’s a series of things that you need to do so that a school is not just a safe place for people experiencing mental health challenges, but it’s a place where kids can thrive.”
Inseparable started the Hopeful Futures Campaign to implement comprehensive mental health in American schools. This Campaign equips activists with a series of tools to change mental health and school policies state by state. Bill says, “one thing we want to do is normalize that conversation about mental health from a very early age so that we are sending people out into the world who are OK to talk about their mental help when they need to and who will help people access care.”
Stopping the Criminalization of Mental Illness
The third issue that Inseparable aims to eliminate in mental health care is the criminalization of mental health. Bill explains the three-legged stool for mental health crisis response as “someone to take a call or message in a crisis, someone to show up if need be, and somewhere to go.” He says, “the real issue with our crisis response system is after that what happens if someone needs to show up and who are we sending and are they trained in crisis response and helping someone get access to the care they need and the.
Inseparable is currently focused on producing a report to show where states are on all three legs of the crisis stool. Bill states, “we are looking at specific legislation right now that would define price response services and make sure that they’re covered by Insurance in the same way that if you had a physical health crisis.”
Policy Changes
Inseparable is moving bills forward and proactively changing the policies to fix the mental health crisis in the U.S. Just a few of the recent bills that Inseparable has helped to pass include:
You can listen to Bill Smith’s whole conversation here and read more of our insights here.
It seems like every time we look at a calendar, we see another national or world holiday. There are some silly ones, like National Talk Like A Pirate Day and National Lipstick Day. But there are also some that do more than provide a reason to act out or go shopping. Any day that brings our health and safety to attention can make an impact. World Mental Health Day falls into that exact category. Can you think of a better day to take some time and focus on your mental health?
World Mental Health Day falls on October 10th each year and takes place immediately after Mental Illness Awareness Week. This week is dedicated to focusing on mental health and well-being. In 1990, Congress officially decided to make the first week in October Mental Illness Awareness Week. This was a major step forward in the care and treatment of mental health. Mental health affects everyone, and it was time to make it known.
This year's World Mental Health Day will focus on making mental health and well-being for all a global priority. This focus comes off the back of the pandemic, as many mental health illnesses, such as anxiety and depression, have seen a rise of over 25% during the first year of the pandemic. Unfortunately, while mental health crises rose, access to mental health services fell fast. The mental health field took a massive hit with providers leaving, offices shutting down, and treatment programs being halted. Access for treatment of new mental health concerns was pushed back due to scheduling problems and a severe lack of mental health providers. New mental health patients had to wait upwards of six or more months in some places due to scheduling issues. While treatments were delayed and more triggering issues arose, mental health became a hot topic worldwide.
The World Health Organization hosts World Mental Health Day and works with many different partners to launch the campaign with the theme of the year. This day boosts awareness and gives the world a chance to focus on policy change, creating better conditions for people with mental health, allowing the opportunity to recognize progress in the field, and researching what else can be done.
Over the last two years, the mental health field has been hit with a massive blow. However, the future of mental health is bright. As we are rounding the last portion of the third year of the pandemic, we can see a beacon of hope on the horizon: technology is that beacon.
Technology is at the forefront of the advancement in access to mental health. While COVID-19 did some irreversible damage, it also presented the mental health community with a unique opportunity. With a large portion of the world quarantined in their homes, a need arose to access mental health services virtually. This was not something that generally existed before the pandemic.
The lockdowns opened the door for technology to be created in order to connect people with their providers without ever entering a medical facility. Innovations in the field have created not only digital platforms for pre-existing companies but also have allowed virtual pioneers to develop digital platforms for companies to exist in a fully digital environment. There has been an increase in mental health apps available for phones and tablets, bringing the care we need directly into the hands of those who need it. It is now possible to have comprehensive mental health care, treatments, programs, and medications monitored and maintained entirely online. You can receive mental health care almost immediately in an emergency and know your needs will be met.
This leap into the digital world has positively impacted the mental health field and the needs of so many individuals. In addition to the ease of access, this virtual care has also allowed the opportunity to seek treatment for those who otherwise would not or could not get the help they need. The elderly and teens have been especially vulnerable to the increase in mental health challenges, and they now can receive care and treatment in a manner that fits their unique circumstances. The elderly do not have to worry about transportation needs with virtual care. Youth and teens can now receive care without worrying about the stigma around seeking treatment. Another benefit of virtual care is that people with irregular schedules or crises that fall after regular business hours can now receive care in a 24/7 manner. College students can especially benefit from this, as they often deal with mental health concerns while being bogged down with school and work and usually would not have time to seek health.
We have so much to be thankful for this World Mental Health Day in the mental health field. Advancements in technology are making some significant strides toward access for all. There is still more we can do. This day allows us to take a step back and evaluate how far we have come and how far we still need to go. So this World Mental Health Day, let's ask ourselves, what is our next step to make mental health and well-being for all a global priority?
Ryan Hampton is the organizing director of the Recovery Advocacy Project and founder of the Voices Project. He is the author of Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis and American Fix: Inside the Opioid Addiction Crisis - and How to End It. In our conversation with Ryan, we discussed his journey in recovery and his work advocating for people with drug addictions, others in recovery, and family members of those impacted by addiction.
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.
Veterans' mental health always seems to be a hot topic. For such a large population – a population with its own designated health care system – we should not see any gaps in the care of their behavioral health. There are many Veterans who struggle with their behavioral health. Some may have started to have issues while they were on active duty, while others do not start to have issues until after they have separated from service. What are some of the causes for this specific group of people to struggle so much? Is there any way we can fix the system?
The Veteran community is notorious for having high rates of anxiety, depression, addiction, and suicide. Unfortunately, even with better access to care, these issues seem to plague the community constantly. It seems like every day, we hear of another Veteran who committed suicide. In addition to the diagnosable mental health problems Veterans experience, many outside influences can exacerbate these issues. Unemployment, physical handicaps, and homelessness are common issues within the Veteran community that can worsen mental health.
Unemployment is a fairly common problem in the Veteran community. There are many reasons for this. One of the biggest reasons is that military skills do not always transfer fairly to the civilian world. One example of this barrier is a hospital corpsman who, while active, performed many duties that would typically be done by a nurse or other licensed medical provider. Once this hospital corpsman leaves active duty, they are no longer qualified to perform these same tasks without receiving a college degree. For some, this means 5 to 10 years of experience is no longer valid and cannot be performed until the Veteran attends and graduates from college. This can be very disheartening and extremely depressing, especially when they love their job. This can set the Veteran back several years from obtaining a comparable salary to what they made in the service. The skills don't transfer over, and that is a huge problem. It may also be hard to obtain or hold down a job for many Veterans because of their former work environment behaviors. The service truly has a different lifestyle than the civilian world, and the two worlds do not always match up perfectly.
Physical handicaps are also a huge problem for the Veteran community. Many former service members receive a disability rating from the VA. While this is not a big deal for some, depending on the physical health problems they have been diagnosed with during or after active duty, this can severely impact their life. Active duty can take a toll on a Veteran's body. Deployments and years of active-duty service can often leave members with chronic health problems. Bone and joint conditions, especially in the back, knees, and shoulders, are common, along with respiratory and neurological problems. Generally, those who enter active-duty service are in good physical condition. Those who leave usually have some permanent physical and mental reminders of their service. Being diagnosed with a physical handicap can cause or increase depression. Some Veterans are even deemed totally and permanently disabled and labeled as unable to work. This, again, can cause major depression and homelessness. Even if a Veteran only has a few disabilities following their service, there is a high chance this will cause issues for them in the future.
Homelessness is another significant concern for Veterans. Unemployment and physical handicaps can increase the chance of a Veteran becoming homeless. Mental health also plays a prominent role in this. Poor mental health and untreated conditions can keep a Veteran from obtaining and maintaining a home or living space. Paired with unemployment, this is a bad combination. Once a Veteran is homeless, receiving proper health and behavioral health care becomes much more difficult. This will cause their issues to worsen, and the cycle of homelessness will continue. Mental health would likely significantly decline once a Veteran becomes homeless. These issues increase the likelihood of depression and suicide risks in the community.
There is a statistic floating around social media that 22 Veterans a day commit suicide. This has prompted several rounds of the 22-a-day challenge. This "challenge" involves doing some sort of physical workout, usually pushups, and filming it to post on social media. The idea behind this is to bring attention to the dramatic rate of suicide in the population. According to the 2021 National Veteran Suicide Prevention Annual Report, the actual rate is closer to 17.2 Veterans a day committing suicide. While this number is lower than the 22-a-day from social media, this number is not something that should be brushed off. The annual rate has been increasing since 2001, even though access to crisis care has expanded.
There are some higher-profile Veteran suicides, as well as ones that have gained national attention. In several instances, Veterans have committed suicide on VA campuses, some even in the parking lot of those campuses. While the VA explains that these individuals were very disturbed, many blamed the VA for the suicides. Many voice concerns that the VA does not do enough to support behavioral health care and suicide prevention.
Veterans have many outlets for help in a crisis. For starters, there is the Veteran's Crisis Line, which as of July 16, 2022, is even part of the prompt for the new (988) national mental health crisis line. There is also a prompt for the Veteran's Crisis Line whenever you call any VA official phone number. This option is always given at the beginning of a voice option, usually option 1. The VA has a special call center for the Veteran's Crisis Line, and the people working the line are trained to handle the sensitive issues Veterans struggle with. There are also screenings that take place at every VA doctor's appointment. They will always be asked if they feel safe or have any thoughts of suicide, homicide, or attempts of suicide. There is also a depression screening typically done. These can help get Veterans the care they need. The problem from here is keeping up with the need for mental health care.
Once a Veteran is diagnosed with a behavioral health concern, there needs to be a firm or set care plan. This could include therapy, medications, rehabilitation programs, etc. A VA care coordinator is often provided to Veterans with several issues or a care plan with many parts. The care coordinator usually helps with scheduling appointments, testing, and general advice based on the next steps in the care plan. These care coordinators are very helpful if they are used properly or if they are available.
The most significant problem in the VA care community is access to care. The VA system is bogged down. It can take months to get appointments. If one needs to be canceled or is missed, it can be just as long until the Veteran is rescheduled. If they are in a crisis or having a flare-up of mental health concerns, it is impossible to wait such a long time. Even once they are in a care system, say for therapy, the appointments can be spread very far apart. This is counterproductive in the treatment of behavioral health. When a Veteran is in crisis, they can feel helpless. If they go to a VA facility in a crisis, they often have to wait based on the volume of patients already being seen. There never seems to be enough providers. Veterans in crisis are a frequent occurrence at a VA facility.
Another significant problem with the VA is understanding. Many Veterans feel that their providers do not care or believe what they are saying. This heavily comes into play when they are being evaluated for their disabilities. Each disability is assessed and must be justified. If the Veteran cannot prove that a health problem impacts their life to the evaluator's level, then they may not receive a disability rating for those issues. This can mean that it will not be treated or taken seriously. The VA has a set of standards that each disability must meet in order to have it rated. Many evaluators are callous and can try to underplay the disability so that the VA does not have to compensate the Veteran for it. This seriously impacts the mental health of a Veteran. Being told that a chronic health issue they have been dealing with does not meet their criteria for being a covered disability can drive anyone to have depression and feel that their needs are not being met. As for female Veterans, there is often a feeling of not having their needs met or being told that their concerns are not valid. Being told that a situation that happened while active shouldn't give you PTSD or should have just been ignored are some of the most common responses female Veterans hear when discussing their active-duty service. Many female Veterans face a divide when they are talking about the trauma and can end up feeling rejected by the system that is supposed to support them. All of these concerns combine to increase poor mental health in Veterans.
Mental health will always be a concern for the Veteran community. While the VA is making strides to increase care for those in crisis, upkeep of care, lack of providers, and other barriers will always create dividing lines for those that need help the most. Changes to mental health care treatment should be at the forefront of the VA community.
You can learn more about the Annual Reports for the National Veteran Suicide Prevention here.
To learn more about the new (988) Lifeline, click here.
Project 2025 is the American Foundation for Suicide Prevention’s initiative to reduce the annual rate of suicide by 20% by the year 2025. This project focuses on four targeted critical areas: healthcare systems, emergency rooms, corrections, and firearms. The strategy will be to impact change at each system level, at the community level, as well as the national level, inspiring and creating change. They see the role as catalysts for implementing change by working with their 73 partner organizations and implementing life-saving work.
Mental health has always been an issue in our country. But, COVID-19 created the opportunity for change by highlighting and exacerbating the problem. There are disparities in how care is delivered and where it is delivered. Depression and anxiety have increased since the pandemic’s beginning and disproportionately impact minority communities. While suicide rates have not increased over the pandemic, at least through 2021, there is concern about mental health data. At the same time, more attention is focused on mental health than at any other time in our history. There is a chance to leverage that into systematic change.
This is a unique time for mental health. During the pandemic, mental health was at the forefront of conversation, both on its own terms and with the link between physical and mental health. The two are intricately linked. The more that can be done to create systems and structures where both needs are met and ultimately cared for, the more lives can be saved. Recent data from the Harris poll, paired with the AFSP, show that 81% of Americans believe it is more critical to make suicide prevention a priority due to the pandemic. In addition, 93% of people surveyed indicated that they believe suicide can be prevented. Additionally, 69% of people indicated barriers to discussing suicide with others, including a lack of comfort and knowledge. That is a critical gap that the AFSP aims to fill with Project 2025.
Project 2025 aims to reduce the annual suicide rate by 20% by the year 2025. The initiative is led by AFSP and supported by the CDC, the National Institute of Mental Health, the National Action Alliance for Suicide Prevention, and many others. The strategy is to intervene in systems where we lose the most people to suicide. The losses are most significant in these four main settings: healthcare, emergency departments, corrections facilities, and firearms. By focusing on these settings, a large portion of lives can be saved. Together with local chapters, and national and local partners, the AFSP is implementing evidence-based and research-informed programs and initiatives to save lives.
Suicide is a complex public health issue and requires complex solutions. Those solutions require that we address multiple levels in multiple fields. There is a focus on increasing the infrastructure to support those in crisis. AFSP is the most prominent researcher of suicide. There is an AFSP policy team that works in federal, state, and local communities, ensuring proper training for educators, healthcare workers, faith leaders, community leaders, firearm owners, as well as the general public on how to recognize the warning signs of suicide. They also offer support for attempted-suicide survivors and family members of those lost to suicide, with support groups and more.
Health equity guides all of the work that Project 2025 does, from choosing its partners to scaling initiatives. Mental health affects diverse populations, including people of color, indigenous communities, LGBTQ+ individuals, and those who are socio-economically disadvantaged. It also impacts those at the intersection of each of those identities. The current systems were designed in a way that puts these individuals at a disadvantage. But, these systems can be redefined to help those in need. The AFSP’s equitable partnerships are vital leaders and can lead to change in support and give permission to others to step in. Project 2025 focuses on minority communities and tries to elevate the members of those impacted by suicide. We are committed to meeting people where they are and where they need help.
Technology plays several different roles in aiding Project 2025. The pandemic has highlighted the need for telehealth for both physical and mental health. It has increased equitable access to care for those with barriers to accessing care for various reasons. At the same time, there needs to be funding and legislation to be put into play to allow this access to care. There are still areas in our country that may not have the infrastructure to support access, such as phones or the internet. There is a massive gap between people needing help and people getting help. Lack of coverage should not be the reason why someone does not seek support. There needs to be a legal way of supporting these changes, which needs to remain sustainable. In 2017, patients were five times more likely to receive out-of-network care for mental health services than traditional medical health care. Care for mental health needs to be more accessible. As a result, there has been an increase in mortality rate with mental health over a decrease in mortality rate tied to physical health. Data is crucial in helping to fulfill this goal.
While creating beneficial legislature and community programs can help the project, there is another key factor: Employers. Employers can offer training and be on the lookout for those who seem to be struggling with their mental health. They have the chance to make a positive impact. Raising awareness can help employers and employees be on the lookout for those in need. Talk Saves Live is another program employers can use to train their employees.
Many parts of this project will need to work together to accomplish the goal of the AFSP. This is a national, large-scale initiative that can help reach the most people—creating awareness and helping to create a beneficial change. Project 2025 is the voice of that change.
To watch our conversation with Renee Cruz, the Vice President for Project 2025, click here or search "Project 2025" in our video library.
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.
Who do you call when you have a mental health emergency? Do you want focused mental health care available for an immediate crisis? Mental health crises have been on the rise since the start of the COVID-19 pandemic. The world faced shutdowns, massive changes to employment levels, shortages, and an enormous shift in the availability of mental health assistance. Like all else, access to medical and crisis assistance took a hit, primarily due to staffing issues while combating an intensely rising rate of mental health emergencies.
If you live in the US, you have likely heard of the National Suicide Prevention Lifeline. This hotline has been very helpful in actively aiding those suffering from thoughts of suicide. That lifeline is now referred to as the 988 Lifeline, or the Lifeline or the National Suicide Prevention Lifeline. As of July 16, 2022, there is a new phone number to call in case of a mental health emergency. In an emergency, call or text 988 or chat on their website at 988lifeline.org. How simple is that? Help is at the tip of your fingers.
This change will take over as the primary contact phone number for the suicide help hotline, but the original ten-digit number will still exist. The Lifeline will not take the place of the Veterans’ crisis line. In fact, a Veteran or a family member can call 988 and press “1”, which will connect them immediately to the Veteran’s Crisis Line (VCL). The VCL is staffed with members of the Veteran’s Administration, trained specifically to assist Veterans and can connect them to the local VA medical center. Many positive changes are coming from this new number, but the necessary access to care is still a standard.
In addition to the change in the phone number, the hotline will now expand from just suicide prevention to include help with substance abuse and all other mental health emergencies. 988 will allow those in need to remain anonymous while still getting them the help they need. Calls will be directed to local call centers based on the area code of the callers only. As with all call centers, calls may be recorded for quality and training purposes. There may be an instance where the caller needs to be transferred to 911, who can track the caller based on their physical location if there is an imminent risk of harm to themselves. While they will be separate, 911 and 988 can work together if a caller needs to be transferred to the other emergency line. Another significant aspect is that someone can call on behalf of another person who may be experiencing an emergency but can not or does not want to call the line themselves.
One concerning factor with this change is that not all lifeline functions will be available in all areas. However, you can dial 988 anywhere in the country, and someone will answer the call. It just may not be in the area you live in. The phone number will still connect you to the national suicide prevention hotline. Overall, this lifeline does increase the range of help for those in a crisis.
A possible downside of this increase in nationwide care is that the lifeline will likely be understaffed. Community and local call centers can only manage calls based on how many team members they have. Volunteers will be needed to handle the increase in call volume. In addition to having enough people, the members need to be adequately trained to handle the delicate situations that can arise. Risk Assessment and Imminent Risk intervention training will be mandatory, but each local center may also require additional training. Because of the necessary training, it will take time before 988 is ready and able to handle all our country is going through.
With numerous mental health emergencies, suicides, and drug use and abuse on the rise, how is 988 going to be able to handle the call volume? As a nation, we can only hope that more people will step up to assist. When we call 911, we expect someone to be available. We should feel the same way about the 988 lines. We should always be able to have enough staffing to handle emergencies. Regardless of what type of emergency, be it mental, physical, or other, help should always be available. Now it can be.
To learn more about the new 988 Lifeline, click here.
If you or someone you know is having thoughts of suicide, is struggling with drug addiction, or having a mental health emergency, please call one of the following anytime, 24/7:
(988) 988 Lifeline
(1-800-273-8255) National Suicide Prevention
(988) then press “1” for the Veteran’s Crisis Line
https://wellbeingtrust.org/news/988-is-now-available-nationwide/
We hosted conversations with many innovative leaders during our Going Digital: Behavioral Health Tech Conference. One of these conversations focused on women’s mental health and was led by Anjlee Joshi, the Head of New Markets at Amae Health. The panel included Jessica Bell van der Wal, the Co-Founder and CEO of Frame Fertility, Layo George RN, MHSA Founder and Executive Director of Wolomi, and Crystal Adesanya, Founder and CEO at Kiira Health. All of these leaders gave us incredible insights into the world of women’s mental health.
This conversation happened before the Supreme Court’s ruling on Roe v Wade, but we must mention the ways in which this ruling has changed the landscape of women’s mental health in the United States. The United States has already been in a mental health crisis. The American Psychological Association (APA) confirms that this ruling will exacerbate the ongoing crisis, and increased structural barriers to abortion affect individuals’ psychological health. Additionally, this ruling will affect the healthcare system as a whole, telemedicine, and ethical dilemmas faced by providers. Women of color will feel the most significant impact.
This conversation discusses the pregnancy journey, women’s health, and how stakeholders can respond. Importantly, we address that women’s health is often seen as a “niche” or solely as reproductive health and is underfunded. Rock Health reported that as of 2021, companies focused on women’s health make up just 5% of digital health funding since they started recording in 2021, and companies focused on pregnancy, postpartum, and parenthood made up 37% of women’s health companies founded in the past five years. However, women make 80% of healthcare buying decisions, so there is a massive opportunity to cater to women and their healthcare needs.
Many aspects of women’s health in the United States need to be addressed. Crystal says she thinks about “how do you utilize technology to increase access, but also create services that are empathetic, one, and compassionate and culturally centered? I think that’s a big piece of what’s missing when you think about the healthcare experiences of women [in the US].”
Layo also emphasizes, “women of color, specifically, black women are three to four times [more] likely to die on their pregnancy journey, and it doesn’t matter if you’re educated if you have all the money in the world… There’s evidence that shows oftentimes we are more likely to not be listened to.” Black maternal mortality is at higher rates than in any other developed country.
Additionally, Jessica emphasizes that “there’s a lack of research and data around women’s health and fertility.” In fact, women weren’t required to be in clinical research until 1993.
Many women have shared their challenging pregnancy journeys to show other women that they are not alone. Even on this panel, Layo spoke of her experience with perinatal depression, and Jessica explained her experience with postpartum depression. Layo explained that they have mental health screening on the Wolomi app because “there is not a lot of [mental health] screening that happens during [the pregnancy] journey, prenatal and postnatal.”
Jessica reminds us of some harrowing statistics about family planning, “42% of people that go through fertility treatment report feeling suicidal and 94% of people report feeling depressed.”
Additionally, “four out of five women experience some level of anxiety when thinking about their ability to get pregnant, and more than a quarter [is] very or extremely anxious, and that anxiety starts at around 19 or 20.” Even before many women plan to start their families, women report being anxious about how their future fertility will unfold.
Crystal also reminds us that we also need to support and encourage women to take care of their mental health actively and continuously. She remarks, “because it’s not until they have very serious problems with their mental health, and then they’re like, maybe I should get it checked.” The high cost of therapy can be one reason people don’t access mental health earlier, but some digital solutions are trying to tackle those problems head-on.
One of the biggest misconceptions about women’s health is that it is not profitable. As Crystal explains, women’s health is a “very profitable industry. There are millions of women and billions of dollars that need to be made within the women’s health space, and I am positive that we are getting to that place where there is more and more of a recognition of the fact that this is an industry that has a lot of areas that needs to be touched on.”
Jessica agrees and continues, “I think there’s a temptation, for some reason or another, in women’s health, whether you’re an employer or investor, and wherever you are on the spectrum to say, ‘I’ve checked the box on women’s health, I must be done.’ And I think that means you assume that women’s health is kind of one piece of the puzzle. But I think if you flip that, the question I’d say is actually, ‘do you believe that health for women is different than health for men?’ And fundamentally, it is, and that’s why you see different vertical and deep plays in spaces of cardiovascular health for women, mental health for women, fertility health for women.” There are so many opportunities to innovate and reimagine care for women.
Crystal also emphasizes, “that’s something we need to remember in the investment communities. The fact that we can make a little go a long way does not mean that we do not need more resources.” Jessica ends with a call to action, saying, “I want to encourage employers and payers and investors to be curious enough to want to reach out to us and talk about these things.
But luckily, all of our panelists have hope for the future of women’s health. Layo explains that she has seen women “have a breakthrough or they have this beautiful birthing experience or [they] change their provider because of something they’ve learned, and they know how to advocate for themselves. And that gives me hope them the word getting out there.”
Jessica agrees, “we want to help women understand more about their bodies earlier, their hormones, their sexual health, their reproductive health. And we want to make sure these conversations with their providers are happening at least annually. And there’s interest, again, from all of these parties to want to participate. So that gives me hope.”
You can watch our full panel and hear more of these conversations here.
Every July, the United States (U.S.) observes the Bebe Moore Campbell National Minority Mental Health Awareness Month to bring awareness to the mental health challenges experienced by racial and ethnic minority groups in the U.S.
Bebe Moore Campbell (born February 18, 1950) was an author, advocate, national spokesperson, and co-founder of the National Alliance on Mental Illness Urban Los Angeles. Campbell was an advocate for mental health education and support among individuals of diverse communities and outlined the concept of National Minority Mental Health Awareness Month before losing her battle with cancer in November 2006. After her passing, in May of 2008, the U.S. House of Representatives announced July as Bebe Moore Campbell National Minority Mental Health Awareness Month to improve access to mental health treatment and services and promote public awareness of mental illness.
Approximately 18% of U.S. adults have a diagnosable mental disorder in a given year, and about 4% of adults have a serious mental illness. Most racial/ethnic minority groups overall have similar—or in some cases, fewer—mental disorders than whites. However, the consequences of mental illness in minorities may be long-lasting.
There are also disparities in mental health service use in the U.S. People from racial/ethnic minority groups are less likely to receive mental health care. For example, in 2015, 48% of white adults with any mental illness received mental health services, compared with 31% of blacks and Hispanics and 22% of Asians.
Reasons for these disparities in mental health care include the inability to access high-quality services, cultural stigma, discrimination, and overall lack of awareness about mental health. Under diagnosis and misdiagnosis of mental illness in people from racially and ethnically diverse populations stem from a lack of cultural understanding by health care providers.
During the Going Digital: Behavioral Health Tech Conference, we heard from startups, payers, providers, investors, and other visionaries in the behavioral health space. One conversation with Brandon Johnson, M.H.S, MCHES creator of The Black Mental Wellness Lounge, shed light on the mental health crisis experienced by Black people in the United States. The Black Mental Wellness Lounge is a YouTube page committed to promoting Black mental health and healing through the promotion of Black mental health tips, education, and resources for the community.
Brandon created the Black Mental Wellness Lounge to “have conversations about things that were impacting our communities specifically.” Brandon invites guests such as Black therapists and Black community members to give tips and resources for the community to utilize. One of the topics Brandon has covered includes the intersection between faith and mental health in the Black community. He says, “it is important for us as a faith community to really understand, how can we help people navigate this? How do we build the faith community in the Black church as a safe space to talk about these issues and challenges?” Brandon suggests that Black churches create mental health referral lists for churchgoers to make it easier for Black people to find a therapist and a safe space to discuss their mental health. Brandon highlights other organizations working to address Black mental health: The AAKOMA Project, Caleb’s Kids, and The Black Mental Health Alliance.
Brandon wants people to understand that although the topic of suicide and suicide prevention can be intimidating and can feel scary, but young people are already having these conversations. He states, “we want to be a safe place to land for our young people. To listen without judgment, to not minimize the things that they are experiencing.” He continues, “our young people have access to things that we didn't… so giving them the opportunity to talk about that in a safe environment would put them in a better position to be okay.” Brandon highlights the need for intervention strategies on the local, research, and startup level specifically for Black youth.
You can watch Brandon Johnson’s session here.
1. If you or someone you know needs mental health care, you are encouraged to seek help from professionals. The American Foundation for Suicide Prevention provides a great list of resources specific to minority communities and general, crisis, and mental health condition-specific resource lists.
2. Consider donating to the American Foundation for Suicide Prevention’s Project 2025 to achieve its goal of reducing the annual suicide rate by 20 percent by 2025.
3. Check out the National Minority Mental Health Awareness Month Facebook Page.
4. Tweet using #minoritymentalhealth to raise awareness.
During Going Digital: Behavioral Health Tech 2022, we were fortunate to host two incredible talks focused on Medicaid and behavioral health. The first talk was a Keynote by Chiquita Brooks-LaSure, the Administrator for the Centers for Medicare and Medicaid Services (CMS). We also had a panel discussion, hosted by Margaret Laws, the President and CEO of Hopelab, and featured panelists including Kinda Serafi, a Partner at Manatt, Judy Mohr Peterson, PhD, the Medicaid Director for Hawaii, Anna Fagin, a Principal at Town Hall Ventures, and Jeff Luce, Vice President at Optum, and the East Coast Medicaid Channel Lead.
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.
We are highlighting a few conversations from the Going Digital: Behavioral Health Tech Conference. We hosted a panel covering mental health policy featuring Pamela Greenberg, the President and CEO of the Association for Behavioral Health and Wellness, Charles “Chuck” Ingoglia, MSW, the President and CEO of the National Council for Mental Wellbeing, and Nathaniel Counts, the Senior Vice President of Behavioral Health Innovation at Mental Health America. We spoke about mental health policy in America and what they are excited about as we look beyond COVID-19.
Millions of Americans are affected by mental health each year. Provider shortages, long wait times, inadequate insurance coverage, and the trauma of the past few years have all accelerated a mental health crisis in this country. Unfortunately, 43% of Americans who needed mental health care and 43% of those who needed substance use care in the past year did not receive it, compared to 21% of those who needed primary care who did not receive it. Additionally, 61% of Americans think there are not enough providers trained to address issues related to race, ethnicity, sexual orientation, and socioeconomic status. There are many intertwined issues that make mental health policy in America complex.
Additionally, we are on the precipice of implementing 988 as the new number for suicide prevention and mental health crises, which people can call or text for immediate help. This number will route to the National Suicide Prevention Lifeline and goes live everywhere on July 16, 2022, one of the most significant mental health policy changes to take place in recent years.
Chuck mentions that the number one mental health concern he hears from people around the country is “the workforce shortage…the number one issue that organizations are confronting is a lack of available clinicians in order to deliver care, not just clinicians, but staff at all levels.” As leaders think about how to mitigate this provider shortage, many are thinking about how to maintain the expanded licensing rules in response to COVID-19 that have allowed mental health providers to treat patients across state lines through telehealth. As Chuck mentions, “How do we make it easier for individuals to practice in our area, so looking at regulatory and licensing barriers and burdens, getting rid of unnecessary paperwork or other administrative barriers that take people away from clinical care. And then how do we grow the pipeline?” Another way to expand access for people around the country is, as Pamela mentions, “we are advocating for coverage of licensed marriage and family therapists and clinical social workers and peers by Medicare.” Expanding coverage for therapists is a great tool to expand access.
In addition to expanding access to mental health services, it’s also important to meet people where they are and think about where people are trying to access care. One way of doing this is by expanding collaborative care, a model of combining primary care and behavioral health care. Nathaniel goes even further and says, “people mentioned collaborative care, and I think we’re also looking at access through schools and places, [trying to] meet people where they are.”
One of the main COVID-era policy changes that seem to have broad appeal is the expansion of telehealth access and the ability for providers to work across state lines. As Chuck explains, “there are many bills introduced in Congress around extending telehealth flexibility as there are members of Congress, and yet we seem to have had very little progress. Everybody wants to offer their support and… I think it’s gonna vary considerably also by payer type. Medicaid, Medicare, and private insurance all have different policies.” It’s promising that so many people are offering their support, but real action must be taken to solidify the expanded telehealth access.
Pamela continues, “the question is, for how long? An extension helps because it gives you a glide path if you need to make a change. But I think, Solome, you’re really trying to get at, are we going to keep these flexibilities?… A two-year extension is good, but we actually want them for longer than that.” The telehealth extension has been incredibly beneficial, but in order to make a real difference, it needs to be a permanent change.
Nathaniel mentions his excitement for new ways to engage different types of providers to create a community of support. He explains that he wants there to be a “broad array of providers, so peer support specialists, community health workers, a much deeper engagement of what this could look like. I think that will be critical both for improving access to care, but also engaging more people in the process of delivering care.” Engaging different types of behavioral health providers will expand access to care and could potentially create a more complete behavioral health system.
Pamela mentions that she’s excited to “see a future where we are paying for outcomes. Where we have some sort of alternative payment model [that] is much more common than a fee for service type model of payment.” Many speakers at the Going Digital: Behavioral Health Tech conference have mentioned the idea of having a different payment model that is outcome focused.
And finally, Chuck expresses excitement about the growing consensus around “strengthening the behavioral health safety net, ensuring there are standards, that there is a certain minimum level of expectation in terms of service delivery, care coordination capacity, partnership through certified behavioral health clinics… You should have access to effective evidence-based care no matter where you live.” We are seeing a growing call for effective, outcome-focused care across the nation.
To hear our full conversation with Pamela, Chuck, and Nathaniel, please visit our video library, which contains all the sessions from the Going Digital: Behavioral Health Tech 2022 conference.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
The current mental health care system unfortunately is not adequately addressing the roughly 50 million Americans who experience a mental illness. In fact, it takes on average 11 years from onset of mental illness symptoms to treatment. Additionally, 55% of US counties do not have a single practicing Psychiatrist and 148 million people live in a designated Mental Health Professional Shortage Area. With these statistics, the current US model for mental health treatment needs to find new ways to address the disconnect between the need for mental health services and the lack of available providers.
Integrated care, which is the partial or full blending of behavioral health services with general medical care, is one solution for addressing this problem. We recently hosted a webinar on “How Technology can Support your Journey Towards Integrated Care” with panelists Dr. Frank Webster, the Behavioral Health Chief Medical Officer at Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, Kacie Kelly, Senior Vice President for National Policy Implementation at the Meadows Mental Health Policy Institute, and Dr. Tom Zaubler, Chief Medical Officer at NeuroFlow. On the webinar, we discussed how integrated care overall could solve for several key challenges the behavioral health industry is facing. More specifically, we talked about the benefits of one model of integrated care called collaborative care.
Collaborative care is a specific type of integrated care using a team-based model of treating behavioral health in the primary care setting bringing primary care and behavioral health clinicians together to provide treatment. All patients in a primary care clinic are universally screened for psychiatric illness as part of their visit. Collaborative care has been studied in more than 80 randomized control trials and has been shown to improve patient outcomes, patient and provider satisfaction, and reduce healthcare costs.
Collaborative care in practice may have primary care physicians meeting with patients and prescribing medications, while Psychiatrists are often used as a caseload supervisors. Dr. Zaubler explains that “this allows Psychiatrists to manage a much larger caseload of patients than if they were seeing them individually.”
Offering behavioral health interventions in primary care settings is convenient, can reduce stigma, can deepen the patient-provider relationship, and can improve care for those with co-occurring mental and medical conditions. In our webinar, Dr. Zaubler noted that “95% of all mental health providers are practicing in siloed settings. And yet, when patients present with their psychiatric problems, roughly 80% either present in medical settings for their psychiatric care. There's a huge disconnect here in terms of where people are seeking care and where the care gets delivered.” Collaborative care attempts to bring together where people are already seeking care and the need for greater behavioral health care.
While the evidence supporting collaborative care continues to grow, uptick and adoption remains scant when it comes to implementing collaborative care across providers.
We have evidence that collaborative care is beneficial, but what challenges do health systems and providers face when trying to implement collaborative care? To start, some primary care physicians may have anxiety about a new way of doing things and disrupting current workflows. There is particular concern around prescribing psychiatric medications, which is why it's important to create an environment where primary care physicians feel supported by their behavioral health team and clinical decision support tools.
Additionally, creating a sustainable model of collaborative care requires an upfront investment. Health systems may be hesitant to adopt a new way of working that includes upfront costs. That’s where partners such as the Meadows Mental Health Policy Institute can be beneficial and Kacie Kelly remarked that, “we come in and oftentimes leveraged philanthropy to offset transition costs or startup costs and then help the practice with the operational workflow changes that need to happen, help them understand the changes with billing and reimbursement, and overall practice changes.” In fact, Kacie remarks that collaborative care “can be cost neutral around 6-9 months of utilization, and cost savings at the 9 month mark.” Collaborative care ultimately leads to cost savings through decreased medical utilization, emergency department visits, and inpatient stays.
An important component of collaborative care is measuring patient symptoms using validated measures such as the PHQ-9, a questionnaire screening for depression, and GAD-7, a questionnaire for anxiety. However, this can be time consuming and can create more paperwork for the front desk staff members.
Finally, there can be challenges for health plans reimbursing properly for behavioral health. Dr. Webster noted that “behavioral health typically makes up 3-5% of healthcare costs for commercial insurance. However, it's important for people to understand that 3-5% has a huge impact on medical costs.” Additionally, providers need to understand that they can bill and be reimbursed for these behavioral health assessments.
We’ve seen the reasons why collaborative care is so important and obstacles to pursuing it, but how can technology help us implement this strategy? Digital solutions can plug into various parts of an integrated care model, as shown in this diagram from Raney et al.
One digital solution, NeuroFlow, is a two-sided behavioral health platform that leverages technology to both remotely assess and identify patients appropriate for collaborative care as well as increase the efficiency of the care teams managing the patient panel. NeuroFlow’s engagement platform allows patients to quickly and easily complete assessments such as the PHQ-9 and GAD-7 in the comfort of their home and immediately engage with relevant clinical content based on their scores. At the same time, their providers and supporting BH care team collaborate on their treatment through a tech-powered registry that populates information directly into electronic medical records, allowing providers to track patient progress over time and be alerted to patients who are at risk. Their combined offering of technology and clinical services showcases the exciting road ahead for empowering care teams with technology to help scale proven models of care.
Another example is Valera Health, which acts as a practice extender and telepsychiatry option. Patients access Valera Health through a mobile app and are triaged by health connectors and then routed to therapists and/or psychiatrists as needed for telehealth visits. Patients then access appropriate self-guided programs and exercises to stay engaged.
Finally BCBS utilizes the Learn to Live program. Health plans have unique challenges because they use claims as healthcare information, but they cannot tell what is happening today, or predict future care. Additionally, health plans have billions of clinical data points but as Dr. Webster mentioned, “getting claims organized and sorted is really difficult.” To address some of these issues, BCBS utilizes the Learn to Live program, which is an online platform where individuals can take assessments and then receive web-based CBT lessons and live clinician coaching. Patients receive treatment and health plans can capture their assessment information as clinical data to help them get targeted resources to the people that need them.
1. Work with experts
Look for behavioral health providers who are well versed in collaborative care to help you with your founding team. Having technical expertise will make a huge difference in the success and longevity of your program.
2. Think creatively about startup costs
Ultimately, collaborative care leads to cost savings, but look into philanthropic options if you need help with startup costs.
3. Remember your CPT codes
Have your staff start getting used to billing CPT codes for all behavioral health assessments to ensure proper reimbursement.
4. When integrating technology, focus on measurement
As Kacie Kelly noted in our webinar, “I would encourage you, as you’re trying to figure out how to extend your workforce and how to get people tools between sessions, to really prioritize those tools that are measuring the outcomes and the impact” of your intervention.
To dive deeper, check out the full webinar, review a helpful collaborative care Q&A from NeuroFlow, and please join us for the Going Digital: Behavioral Health Tech conference on June 8-9, 2022. Registration to the conference is free, or consider making an optional donation to our 2022 non-profit partner, the American Foundation for Suicide Prevention.
Want a lot more digital mental health and substance use insights? Subscribe to our behavioral health tech newsletter here.
Innovation has the potential to address persistent challenges to health equity in Medicaid populations. The opportunity is especially ripe for technology and innovation to address the mental health and substance use care needs of Medicaid populations.
Unfortunately, there are many barriers for states and managed care organizations (MCOs) to adopt digital health and innovation. BUT! There’s good news: The Medicaid Innovation Collaborative (MIC) is a new initiative bringing together key stakeholders to deploy digital health and care delivery innovations to exactly these populations.
We talked with Karissa Godzik, Program Manager of the Medicaid Innovation Collaborative, about the states they are working with (Arizona, Hawaii and West Virginia) and their open RFPs for behavioral health startups to apply and partner with these states. (DEADLINE IS TUESDAY, APRIL 19TH - DON’T MISS OUT!).
Medicaid Innovation Collaborative, or MIC for short, aims to enable the Medicaid ecosystem to advance health equity through high-impact innovation. We believe that health startups can close critical gaps in care access, quality, and social determinants as well as boost the great work that’s already happening on the ground. Our program focuses on reducing the barriers to adoption and scale for these companies.
Our model provides a structured approach to deploying innovation. We built a framework to define a health equity challenge, supported by data and the perspectives of beneficiaries, to identify best practices and policies that enable innovation, and to find and implement solutions that can address these challenges. For this to be successful, all Medicaid stakeholders need to be involved, and we’re building a coalition of states, health plans, community representatives, and organizations committed to this work.
MIC was launched by three organizations committed to serving the U.S.’s low-income, most vulnerable and underserved communities: Acumen America, Adaptation Health, and The Center for Health Care Strategies. Our work also wouldn’t have been possible without the catalytic support of The MolinaCares Accord, CommonSpirit Health, and Hopelab.
From states, we’ve heard that it comes down to limitations in resources, time, and ability to track impact. Federal and state administrations can change quickly and frequently, so it can make it hard to plan long term, not to mention how long it can take to propose and launch new initiatives. And when states do want to drive towards certain outcomes, they may have to wait months or years to collect the appropriate baseline data and start to realize improvements, all while coordinating with multiple managed care plans to get the right metrics and reporting in place.
On the managed care side, first and foremost, they are working to meet their contractual obligations while trying to navigate varying state requirements. They typically find it more difficult to engage members, and plans don’t necessarily have the data they need to draw conclusions about the kinds of initiatives that would support their goals. Even when interested in adopting innovation, the time and effort to source, evaluate, and onboard vendor solutions is a real obstacle for many of these plans.
Our program aims to engage all Medicaid stakeholders, but the program is championed by state Medicaid agencies. Each cohort begins with state Medicaid agencies who commit to 1) a shared health equity priority and 2) rallying their managed care plans to achieve this goal. For our current cohort, we have Arizona, Hawaii, and West Virginia, who selected behavioral health as their priority, and all 15 of their health plans participating in the cohort.
Central to the MIC model, we also work to elevate the voice of Medicaid beneficiaries and other community advocates throughout key phases of the program. Beyond participating in in-depth interviews, we ask community representatives to join a Community Advisory Board, which guides the areas of focus and criteria for the request for information, vendor selection, and solution implementation.
For their participation, states receive technical assistance from the Center for Health Care Strategies as well as facilitated collaboration with their peers in other states. States and their health plans both get access to the primary research conducted with beneficiaries and the organizations and providers that care for them, providing deeper insight into the lived experience and real challenges faced by those they serve. All of the work culminates in an innovation showcase, which provides states and health plans access to vetted companies and their solutions, which are sourced through an MIC-led national request for information. Selected companies will have the opportunity to be considered for contracting and implementation.
The 2022 Cohort is looking to identify private-sector, tech-enabled solutions that address behavioral health challenges for adolescents in Arizona and West Virginia and pregnant and postpartum women in Hawaii.
For adolescent behavioral health, we’re looking for companies that provide: (1) navigation and coordination of care, resources, and services for adolescents and their families, and (2) alternative care models to address early intervention, crisis response, and ongoing follow-up services.
For maternal behavioral health, we’re looking for companies that can enable, navigate, and coordinate behavioral health care for expecting and new moms.
Selected organizations will present their solution to state and managed care leaders in May 2022, with the potential to engage health plans for future contracting opportunities.
The application closes next Tuesday, April 19th, and there is no fee to apply.
Application and additional information can be found here: medicaidcollaborative.org/apply
Last week, three youth health agencies, American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, and the Children’s Hospital Association, declared a state of national emergency in child and adolescent mental health. Several health tech companies and GDBHT partners came together to inspire a call to action.
The declaration addressed the upward trend of mental health concerns for youth. It alarmingly noted suicide as the 2nd leading cause of death for 18-24 year-olds in 2018. Given the effects of COVID-19 and racial injustice over the past two years, the mental health of our youth has only worsened--disproportionately affecting youth of color. The industry cannot keep up with the elevated demand for mental health services. Youth are waiting weeks, or even months, to access the care that they need. The children who may have waited to seek care until they absolutely needed it now have to wait even longer. This can be an incredibly frustrating process for families who are already suffering.
This state of national emergency is a call to action and advocacy for crucial changes to address these issues and provide solutions to our youth. We believe technology will support the ability to address youth mental health in a more scalable way, and we’re proud to have some amazing innovators in our network. Learn more about some of our newest and existing GDBHT partners tackling these issues below:
BeMe Health, a digital behavioral health platform built specifically for teens, today announced that it has secured $7M in seed financing and partnerships with leading commercial and Medicaid healthcare payors to transform behavioral health for teens. Backed by Polaris Partners and Flare Capital Partners, the funding will be used to help accelerate and scale operations around BeMe’s unique tech-enabled approach to teen mental health. Board members and advisors also include Alexandra Cantley, Partner of Polaris Partners; Bill Geary, Partner and Cofounder of Flare Capital; Carolyn Magill, CEO of Aetion, Inc. and me!
Bend Health is a new healthcare company launched to increase access and reduce the cost of expert mental health care for families. It is revolutionizing the treatment of mental health conditions for kids and teens through a novel data-driven technology platform and evidence-based care model that enables the first scalable and integrated care solution in mental health. They’re also one of the few mental health providers who enable access to high quality teen and child psychiatrists within 48-hours or less through a clinically-validated collaborative care model (CoCM).
Brightline is the first full-family behavioral health solution built specifically to care for kids, teens, and parents across a range of common family challenges. With multidisciplinary care teams, personalized family system care, evidence-based care delivery, and extraordinary technology, Brightline is able to support families with whatever challenges they’re facing and ultimately help them thrive long-term. They recently announced a new partnership with another GDBHT partner, Violet, as part of their ongoing commitment to continue delivering inclusive care for the many communities it serves.
Hazel Health is the largest telehealth provider for K-12 schools, partners with school nurses, counselors, parents, and local providers to bring high-quality whole child health care to every student. Nearly 2 million students use Hazel for fast access to equitable physical and mental health care. Recently, they announced the addition of Dr. Travis Gayles as Chief Health Officer, Andrew Post as Chief Innovation Officer, and the promotion of Jeannie Chen to Chief Clinical Operations Officer, furthering the company's commitment to transforming access to quality healthcare for all.
Headspace Health - Earlier this summer, on-demand mental health care startup Ginger (now Headspace Health) had announced their new offering for adolescents ages 13-17, “Ginger for Teens.” Teens who are dependents of Ginger-eligible employees can gain access to text-based coaching, self-care resources, and if needed, twelve video-based therapy and psychiatry sessions at no cost via smartphone.
Holmusk - a leading global data science and health technology company building the world’s largest Real-World Evidence (RWE) platform for behavioral health, announced its abstract was published as part of the Proceedings of the American Academy of Child & Adolescent Psychiatry (AACAP) 68th Annual Meeting. AACAP’s Annual Meeting is the world’s premier gathering of child and adolescent psychiatrists. They stated that their results generated new insights that can inform policies and guidelines around the practice of polypharmacy for individuals with ADHD.
Hopelab is building a road map to deliver hope for the next generation through targeted social impact investments, translational research, and advisory services that focus on advancing solutions for BIPOC and LGBTQ+ youth mental health. A few months ago, Hopelab announced an external investment initiative, Hopelab Ventures, a commitment to partner with innovators who advance the well-being of BIPOC and LGBTQ+ youth.
For people who have a child or loved one struggling with OCD or disorders related to OCD, like Hoarding, Tics, or Body-Focused Repetitive Behaviors, it can be difficult to navigate. NOCD offers specialized OCD treatment, for people ages 5 and up, through live face-to-face video therapy sessions with licensed therapists. All NOCD therapists are trained in Exposure and Response Prevention (ERP) therapy - the gold standard OCD treatment - and members receive support between sessions through the NOCD platform. In addition to our live face-to-face video therapy sessions, NOCD also offers educational resources and guidance through sessions designed for family members, caregivers, and friends of those with OCD and related conditions. These sessions help them support their loved ones in their progress and provide guidance on how to assist them through difficult situations.
Telosity by Vinaj Ventures invests in companies addressing gaps in care by developing affordable and scalable solutions to support youth mental well-being. They recently published some research revealing Gen Z is leading the charge to change society’s perception and approach to mental health challenges.
Log into our library to watch the entire Going Digital: Behavioral Health Tech youth track here for free.
120/80 MKTG has powered the communications of top behavioral health brands and leaders like Headspace Health, Brave Health, Big Health, Cityblock, Papa and more. And now they’re on a new mission: reducing disinformation in the vaccine wars. Many people are talking about the COVID-19 vaccine on social media platforms, but not everything that is posted is true. Not knowing what is true or what is disinformation can lead people to feel anxious about getting the vaccine. In an effort to debunk the myths and establish a trustworthy source, 120/80 MKTG has started a new campaign, “Just the Facts on Vax: Inoculating Against Disinformation.” I sat down with 120/80 MKTG’s spokesperson and writer and director of the campaign, Jon Reiner, and his team to learn more.
Six infectious disease doctors and nurses – including in-demand experts Dr. Carlos del Rio and Dr. Celine Gounder – are speaking up in a public health campaign, “Just the Facts on Vax: Inoculating Against Disinformation,” targeting the 14 states with the lowest vaccine rates in order to persuade people to get vaccinated. At this juncture in our two-month campaign, the results are encouraging with more than 1M impressions, 400,000 views and 2,500 visitor clicks to find out where to get a vaccine.
Overcoming COVID-19 vaccine disinformation requires going into the belly of the beast —Facebook, YouTube and other social channels. Launched on September 1st, “Just The Facts on Vax” is being streamed on Facebook, YouTube, Twitter, Instagram and LinkedIn as a short-form twenty-episode series, each of which addresses a specific vaccine-disinformation myth, such as “Getting the COVID-19 vaccine can harm my ability to get pregnant.” The campaign was born out of an urgency to win the information battle and help end the public health crisis by recruiting and providing a platform for medical experts whose knowledge and frontline experience would shift attention to where it belonged – on the facts.
Several of the United States’ top epidemiologists, infectious disease specialists, OBGYNs, nurse practitioners and public health officials have now presented “The Facts”:
Disinformation topics include:
“Just The Facts On Vax” was created and self-funded by 120/80 MKTG as a public health initiative to increase vaccinations, differentiated from other campaigns by its utilization of medical experts rather than celebrities and its reliance on science.
As health communications professionals, it was agonizing to witness COVID-19 vaccination rates stall because of public trust sabotaged by disinformation. Facebook and YouTube, in particular, had dithered, giving visibility to conspiracy theories undermining the science so essential to combating ignorance. For me, Facebook’s silence on harboring the ‘Disinformation Dozen’ was a galvanizing moment. Our public health crisis was losing an information battle, and it demanded a response that would go straight to the belly of the beast.
“Just The Facts On Vax” has a single objective — to get more people vaccinated. So far, the campaign’s challenge to the disinformation has moved more than 2000 people to search where they can get vaccinated. If even one person’s life is saved because they listened to the experts and got vaccinated, then that’s why we are doing this. We hope others will join us.
Just as disinformation can cause confusion and the anxiety it generates, fact-based information can have the opposite effect, giving people a sense of confidence to make a reasoned decision. To that end, the source matters. In the case of the #JustTheFactsOnVax campaign, we believed it was essential to have leading infectious disease doctors, epidemiologists, OB GYNs, and public health physicians be the sources of fact-based information, who would appeal to people’s reason. Episode #19, for instance, responds to fears that getting the COVID-19 vaccine is more painful than other vaccinations. That episode’s speaker, Dr. Carlos del Rio, addresses the issue in both scientific and experiential terms, stating that COVID-19 the vaccine does not hurt more than getting a seasonal flu shot.
Find out more and share the “Just the Facts on Vax: Inoculating Against Disinformation” campaign on social media: Facebook, YouTube, Twitter, Instagram and LinkedIn.
Blue Cross Blue Shield Association’s VP of Strategy & Analytics, Mark Talluto, spoke at the Going Digital: Behavioral Health Tech 2021 summit about their data-driven approach to address behavioral health conditions and the disparities that affect communities of color (watch his session with me here). BCBSA recognizes the importance of addressing the racial health disparities that exist for mental health diagnosis and treatment in this country.
Their studies show about one-third of millennials have a diagnosable behavioral health condition. Although, Black and Hispanic millennial communities have a lower prevalence, likely due to under-diagnosis. BCBSA’s National Health Equity Strategy strives to address racial health disparities by collecting data, scaling effective programs, working with providers and communities, and influencing policy decisions.
Next week, I will be joining fellow healthcare industry professionals at the BCBSA Health of America Forum on October 20-21 (learn more here), including Briana Duffy, Market President for the West Region of Beacon Health, and Shana Hoffman, President and CEO of New Directions Behavioral Health. I'll be asking them about how Beacon and New Directions are focusing on stigma, access and cultural understanding when it comes to behavioral health service delivery.
Communities of color are disproportionately impacted by many of the nation’s top health conditions, including mental health. Health disparities are a multi-dimensional problem that cannot be solved by one single solution. It requires action from policy makers, providers, communities and healthcare industry leaders to raise awareness about mental health conditions, including anxiety and depression, that affect various generations and marginalized communities. By speaking openly about mental health, and the importance for leaders – no matter the industry – to address these conditions, we can explore ways to reduce stigma associated with mental illness, promote help-seeking behaviors and emotional wellbeing practices.
The third annual Health of America Forum hosted by the Blue Cross Blue Shield Association will take a deep dive into the key issues driving the maternal and mental health crises in America, including how we can collectively address racial health disparities. Over two days, business decision-makers, community leaders, and HR and wellness officers will virtually come together to discuss what steps should be taken to reimagine a more equitable healthcare system. We will discuss the challenges we face in addressing mental health issues, particularly in black and brown communities, and as a result of COVID-19. Join us here.
