The Road Ahead for Brightline

by Naomi Allen, CEO and Co-Founder

It’s been a hard week for Brightline. We let go of some incredibly talented colleagues — people who have been in the company working hard building towards our mission to “transform the lives of kids, teens and families by delivering mental health care that works — powered by people and amplified by technology.” We made the decision over the last couple of weeks to restructure our national virtual-care employer-focused business to focus on a new go-to-market strategy that we believe will allow us to serve our mission in a more effective way.

Let me share a bit of how we got here

People who know me often know my family has had a journey in mental health for our own kids, dating back to 7 years ago with my oldest son, Matteo. We had been seeking services and support for him and had sat on wait lists for months, and had borne the burden of navigating his care without any real support from his school or insurance coverage. So when Annie Lamont and Billy Deitch at Oak HC/FT reached out to me in late Fall 2019 to see if I wanted to found a pediatric mental health company, it felt like a perfect match for my career journey and passion for pediatric mental health.

That market insight was prescient and timely. Mental health for kids was a crisis back then even before Covid back in 2019, with acute shortages of clinicians and challenges of affordable access. Unfortunately, it’s an even bigger crisis now. Post-Covid, the rates of youth mental health challenges have continued to increase, and more kids than ever are at higher risk. As a result, parents themselves are also in a mental health crisis, carrying an incredibly high burden of mental health stressors themselves, as cited recently by the Surgeon General. Parents have only become more desperate, and the current system isn’t building nearly fast enough to meet the exploding need. This crisis is also crippling hospital systems as higher and higher acuity kids and teens rely on emergency departments as their first point of care in a crisis.

So in late 2019, I gathered a small team of innovators and clinicians as our founding team. Together we spent hundreds of hours talking with families, clinicians, and youth as well as pouring over hours of evidence-based methodologies to create the original MVP idea of the company and care model in late 2019 and early 2020. The original concept was delivering high quality, tech-enabled, clinics providing affordable mental health services for kids, teens and families. We were planning to build clinics with a wrap-around virtual care offering — a solution now called “hybrid” care — where kids would be seen in person, and teens and parents could be seen in person and over an app. We were going to work with local insurance companies to get the services covered in-network to support affordability and access. We called the company “Emilio Health” after my early co-founder Giovanni Colella’s father, Emilio, who had struggled with mental health challenges his whole life.

In early 2020, when Emilio Health was just a few months old, we were working on opening our first tech-enabled hybrid clinic when Covid hit. We did what so many companies were doing and shifted our care to virtual only, putting our clinic buildouts on pause. We spent much of 2020 testing virtual care for kids and teens — nobody had ever demonstrated you could deliver safe, effective and evidence based care virtually to kids and teens. But we were doing it and learning and seeing great outcomes against a measurement-based model. We were humbled and excited to be providing these critically needed services at the exact months when families were starting to grapple with the profound impacts of Covid on their families and their kids, and the deep implications for child and youth mental health were becoming clear.

At the end of 2020, when it was clear Covid was here to stay for a while, and we’d be scaling care virtually for a while, we wanted to quickly move into additional states to support more families in our innovative evidence-backed virtual care model.

That’s when we started to get the phone calls — we heard from countless employers and health plans that needed our help. Employees were missing hours and days of work trying to navigate their children’s mental health challenges during and post Covid. They faced enormous hurdles in the form of long waitlists and high costs. We leaned in heavily into the employer-based mental health services model and grew from just 9 employer customers in 2021 to 43 in 2022 to an astonishing 430 by the end of 2023. We had excellent health plan partnerships and a broad set of leading employers. We couldn’t be prouder that they placed their faith in us. We were delivering virtual care nationally with a high quality team of therapists, psychiatrists and coaches. Along the way we built an incredible team, an innovative product. We raised several rounds of financing led by world-class investors.

So what isn’t working? Why the restructure?

Families that find out about Brightline through their employer have great clinical outcomes (more info here, here and here) and very strong NPS. But simply put, they are having too hard of a time finding us. Because we don’t sell directly to employers in our model, but rather through their health plans and partners, we aren’t top of mind enough for benefits leaders and therefore we don’t see enough of the types of marketing campaigns that really drive awareness amongst members.

Moreover, our own research was indicating that families actually were looking for mental health services for their kids through means other than their employer, namely through pediatricians, google searches, word of mouth, and hospital systems. Finally we started to see data indicating that — while many families love the convenience of virtual care for child and youth mental health services — many families would prefer in-person or believe in-person to be superior for their child (especially for higher acuity needs). It’s also very important to many parents that the care they receive is local to them, and that it’s covered by their insurance.

Approximately half of the individuals most involved in managing their child’s care — according to surveys we conducted — did not receive insurance coverage directly from their own employer. It was often via their spouse’s employer, which means they were often two steps further removed from our solution, i.e. us.

Our mission for years has been to “transform the lives of kids, teens and families by delivering mental health care that works — powered by people and amplified by technology.” And our approach to this mission, reaching families on a national virtual-only employer solution isn’t working. We owe it to families to shift our approach in order to better serve our mission.

We’ve gotten convinced about what we need to do to serve the broadest version of our mission, and it’s largely getting back to our pre-Covid original vision.

We are shifting Brightline in four critical ways:

1. Moving back to hybrid care, and adding physical brick-and-mortar clinics in key markets. We will continue to offer virtual services in the markets we serve but will add in-person and hybrid offerings.
2. Narrowing our geographic focus (versus the 50 state offering) to go deeper in key markets by partnering with local providers, schools, and health systems, to drive awareness of Brightline’s offering. We will continue to have marketing to employers’ employees in those key markets where we’ll have brick-and-mortar and hybrid care, where Brightline will be an in-network provider. And we’ve engaged already in active conversations with a set of employers about creating referral pathways for them to send employees to Brightline clinics next year.
3. Continuing to deliver high-quality and evidence-based mental health care for kids, teens and their families, but adding in support for higher acuity needs in recognition for the growing crisis an urgency, and
4. Going deeper into partnering with insurance companies to drive more in-network coverage and affordable access for families by moving from self-insured employers into fully insured and Medicaid coverage in key markets.

Why hybrid?

As we move into our initial target markets — selected due to a combination of factors like the patient demand and our insurance coverage — we are planning to open physical clinics. The plan is to start with a handful in 2025 and expand in the years to come. For those who don’t live nearby a physical site or prefer virtual care, we will still have a telemedicine option available.

Virtual care is excellent for many families and can be very effective (especially for lower acuity and adult-focused care). And I truly believe that hybrid is the right modality for many patients, especially as families face more complex mental health challenges with their kids and teens than ever. Another benefit? I’ve found it to be an appealing option for clinicians who value both flexibility and community. Brick-and-mortar is so powerful because it means a physical space embedded within a community, where families walk by everyday. In a world of digital, we can sometimes forget about that, but it’s a strategy we’ve seen work for hybrid companies such as TwoChairs and One Medical. Trust is built by simply being there, day in and day out, serving as a visual reminder to patients that help is available.

Why higher acuity?

We will continue to serve families who have kids and teens with a broad set of needs. We are proud that we serve not “just” the typical care around anxiety and depression but also a broad set of clinical and care needs for kids, teens, and families including services for parents and caregivers (more critical than ever). To that end, we plan to cover a broad spectrum of clinical and care needs, including support for our higher acuity patients. That includes models that are designed for kids in the aftermath of an emergency room visit, as well as supporting those who are indicated for medication-supported behavioral therapy.

What now? Our most important first move: transitioning care with our member safety and experience as the North Star

We recognize that some of our members obtained coverage via their employer or payer. So we have been steadily reaching out to our employer customers — and if the health plan is amenable, we will retain these members and offer services in-network in our targeted geographies. Continuity of care is our focus. To that end, we’re providing ample time for our clinicians to wind down care by year end and providing retention bonuses for them to support members in active care. We will be stopping new intakes temporarily on 11/1/24 to support our current members, and will re-open intakes in January 2025 in the supported go-forward geographies.

For members we cannot support, we have a plan in place to transition them to providers that prioritizes safety and the member experience. We will be holding their hands throughout this process to ease the transition at every step.

This decision may feel sudden for those who have been following our progress at a distance. But we are making it very deliberately and thoughtfully, and we’re doing it in a position of strength, while we’re in a very strong cash position, with strong momentum in our financials, and with multiple years of runway.

Public sector is strong and growing for Brightline

While we’re restructuring our health plan and employer-focused business, we continue to remain very focused on public sector current clients and future opportunities. We see an ongoing and growing drumbeat of innovative state and local agencies seeking high quality services to help stem the youth mental health crisis. Brightline is proud of the work and impact we are having with millions of families in the State of California and we’re just getting starting in the public sector space. More to come on that in the upcoming months.

Grateful to all Brightline’s partners and champions

I’d like to sincerely thank my incredible team that got us here. You are hands down some of the most talented professionals I’ve ever encountered in my career, equal parts mission-driven, strategic and ambitious. I have a very heavy heart letting go of such talented people, and recognizing that we will be discontinuing services in many geographies where Brightline has had tremendous impact. With their permission, we’ve developed a list of the talented individuals at all levels from both our clinical and corporate enterprise teams who will be looking for their next roles and opportunities. If you are hiring, I would love nothing more than to make an introduction and provide a reference. Please let me know if you’d like to receive the list of available talent.

To my board, I thank you for your faith and your guidance. And to all of you reading this post, I appreciate that you took the time.

In the weeks and months ahead, I’m looking to speak with anyone who’s run a scaled hybrid business in health care, particularly if you’ve served higher acuity patients and/or Medicaid. My Inbox (and door) are always open: nallen@hellobrightline.com.

Warmly,

Naomi