During the Going Digital: Behavioral Health Tech Conference, we heard from startups, payers, providers, investors, and other visionaries in the behavioral health space. A conversation with Kristina Saffran, CEO and Co-Founder of Equip, and Dr. Martin Rosenzweig, Chief Medical Officer at Optum Behavioral Health, highlighted Equip’s work in eating disorder recovery and how they’ve partnered with Optum to reach patients across the United States.‍

Eating Disorder Statistics in the United States‍

Roughly 9% of Americans –about 30 million people– will have an eating disorder in their lifetime. Additionally, 95% of people with eating disorders are between 12 - 25 years old. The five main types of eating disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant restrictive food intake disorder, and other specified feeding or eating disorder. It’s estimated that 10,200 Americans die from eating disorders yearly, or one death every 52 minutes. 

As the world has dealt with COVID-19, cases of eating disorders have increased significantly. There has been a 25% increase in hospitalizations for adolescents with eating disorders since March 2020. Additionally, the proportion of ER visits for eating disorders doubled among adolescents. The National Eating Disorder Association also reported a 58% increase in calls, texts, and chats from March 2020 to October 2021. Experts say that isolation, loss of routine, anxiety, boredom, and food insecurity are all possible explanations for the rise in eating disorders. 

The Challenges Faced When Treating Eating Disorders‍

Kristina talks about her personal experience with Anorexia nervosa and seeing the complicated eating disorder care landscape as a patient. She explains that only “80% of 30 million Americans with eating disorders don’t get treatment and less than 1% have evidence-based treatment.” Kristina explains that an even more complex part of treating eating disorders is that “a core part of an eating disorder is not wanting to get better and not knowing how sick you are.” As such, families must be heavily involved in the healing process. Kristina elaborates, “eating disorder caregiver burden is arguably the highest of any condition because it takes so much work on the families part. We’re talking about families supervising every single meal, making sure their loved one is not over-exercising, [and] is not engaging in other compensatory behaviors.”

Dr. Rosenzweig also explains that for adolescents with eating disorders, “if they have a bad care experience out the gate, they’re less likely to engage and ask for help again.” Kristina continues that some “patients [are] blacklisted from treatment centers as ‘too sick to treat’…[But] patients don’t fail treatment, treatment fails patients.” Equip was built with the complex nuances of adolescent eating disorder care in mind.‍

Partnering With Payers to Tackle the Problem

Kristina and Dr. Rosenzweig agree that part of Equip’s success is tied to its work with payers to provide affordable coverage for patients and their families. Dr. Rosenzweig explains, “what we’re trying to do is really align around the Quadruple Aim, meaning that we want our members to get the right care at the right time, the right place, and obviously as cost-efficient as possible. And this is sort of a really the north star for us in terms of how we try and work with providers.” He continues that when he and Kristina first connected, he appreciated her “willingness to hear how to structure a program that would make this affordable to families.” They were able to work together to come up with a plan because Kristina wanted to do everything possible to make Equip affordable. 

Dr. Rosenzweig says that they “came up with a bundled payment. So, what that means is we would pay one CPT code, so there’s only one copay or deductible, but it covers a period of time and an array of services. So the family is getting the care in a way that’s really affordable in terms of their out-of-pocket costs.” ‍

Advice to Startups Looking to Partner With Payers‍

Kristina and Dr. Rosenzweig gave abundant advice to startups looking to make a difference in the digital behavioral health space. Kristina emphasizes that it’s “important that you do have [clinical] employees in this telehealth model because we invest tremendously in training folks in evidence-based treatment for eating disorders, but also for all the comorbidities that are the rule rather than the exception.” She continues that they pride themselves on investing in their clinicals to ensure the best quality, which they can do because of their employees. 

Dr. Rosenzweig explains the difficulty of scaling, saying, “healthcare is not united. It can be very regional…if you’re developing something. It may work well in Massachusetts, but it may not work in Louisiana… [You] have to think through, what are going to be the scalability challenges?” Companies must be cognizant of the hurdles they will face as they scale to new states, regions, and markets throughout the US. 

Dr. Rosenzweig also explains, “Don’t be afraid to be disruptive. We’re looking for startups that challenge the status quo. That don’t assume that the way that care got delivered is the way that it should be done.” Payers often want to think through problems in new and innovative ways.

Most importantly, Kristina clearly states, “nothing matters if your outcomes aren’t fantastic and if you aren’t moving the needle for patients and families.”

There are many valuable and actionable insights from our conversation with Kristina and Dr. Rosenzweig. You can access the Going Digital: Behavioral Health Tech talks to hear our full conversation.