Scott Breitinger and Akshay Venkitasubramanian
Mental healthcare practice in the US today has a systemic problem with gravitating to the “worried well” and neglecting the 60% of adults with a diagnosable mental illness who did not receive any mental healthcare within the previous year. Misaligned financial incentives along with stigma has fostered this problem. However, new innovators are entering the mental healthcare domain with specific solutions for specific problems: problems faced by the consumer in accessing care, providers in referring patients for care, and payers in managing cost of care. Here are key areas in mental healthcare where vibrant innovators are gravitating today and where we see the most traction for transformation.
Software-based Therapy Platforms: lowering the cost of quality psychotherapy through standardization and automation
Evidence-Based Psychotherapy Techniques (EBPTs) are an integral part to adequately treating many major mental health issues. Thomas Insel, the former Director of the National Institutes of Mental Health noted the undervalued importance of EBPTs that, “while psychosocial interventions have received much less marketing attention than pharmacological treatments, the results are arguably more encouraging.”
EBPTs — including Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and mindfulness training — are effective treatments for common psychiatric conditions, but they remain inaccessible and costly for many. Taking the example of CBT, while therapist-facilitated learning is often the most resource intensive aspect of a patient’s development of new skills, new software platforms accessed through smartphones and other mobile devices have the ability to provide structured learning and supplement practice with less expert oversight. Companies like Joyable, which focuses on CBT, and Headspace, which focuses on mindfulness training, use structured software programs to help individuals navigate their psychological challenges in a personalized manner that drastically reduces the costs of care, increase treatment access and delivery of therapy. Joyable, for example, combines the use of a personal health coach and software-based therapy together to ensure accountability and increase the rate of completion of their full CBT course.
Matching patients with the right providers: creating more efficient access to care through better patient matching systems
Individuals who are seeking a mental healthcare provider today need to be able to self-navigate through confusing provider titles, diverse offerings of treatment modalities, unclear costs of care, and opaque or limited information on provider quality. Psychology Today has been the web-based platform used across the globe to help patients search for mental health providers and for providers to advertise their services in the open marketplace. This is the first generation matching platform that patients and providers have turned to in an attempt to navigate the disorienting jungle of mental healthcare. With this platform, however, there is no incentive for providers to tailor their profile to specific areas of expertise. This results in a listing system where providers can check off capabilities and qualifications in a shotgun approach to showing up on any and every patient search query. If the Psychology Today listings are to be taken at face value, extraordinary breadth of expertise is the norm for most providers on the platform. Of course, in practice, this isn’t true. And, as a patient looking for care, there’s no easy way to differentiate quality providers. However, the design of this system is being iterated upon by a newer generation of companies who seek the same goal of making it simple to find the right provider based on a few pertinent search inputs.
Companies like SonderMind and ZenCare are beginning to curate their approach to listing and matching providers with patients. Clinical providers apply to be listed on these platforms and undergo some proprietary vetting by the platform company. Both of these platforms work to better ensure that automated provider matches are cogently informed by what the client is looking for with their care inquiry. As a value added for therapists, SonderMind attempts to capacitate providers with streamlined practice tools to manage billing, insurance-claims, and maintain electronic medical records. ZenCare has also focused on making the process of finding a therapist feel more humanistic by developing curated provider profiles with brief video interviews and professional headshots so that prospective patients can get a better feel for who that therapist is as an individual.
Turning Primary Care into Integrated Behavioral Care: building capacity to manage mental health where most patients seek health care
In the setting of a very finite number of mental health professionals, leveraging the location where most individuals seek healthcare — i.e., primary care practices — has much greater potential to create access than simply advocating for more mental healthcare specialists. Primary care providers (PCPs) are intuitively aware of psychiatric issues impacting a patient’s wellbeing, but often lack the time and resources to treat mental illness fully, making them ideal collaboration partners for mental health providers.
Integrated behavioral care allows PCPs to screen more patients, implement straightforward first-line treatments, and maintain consultation and referral options to embedded psychiatric specialists. Fundamentally, integrated care’s major innovation is in organizational structure, in which a primary care physician can be closely supported by a “care manager” specializing in the administration of psychiatric treatment. For challenging or complicated cases, an embedded psychiatrist provides dedicated oversight for a given caseload. While basic medication management is implemented by the primary care physician, care managers are the team members who have the most intensive engagement with the patient, with responsibilities to assess patient engagement, treatment response, record treatment data, and promote patient adherence and commitment to treatment.
Quartet is a leading innovator of integrated behavioral care today. Recognizing the challenge with disseminating the Collaborative Care structure as originally developed at the University of Washington, which depends on a significant degree of institutional scale and expertise to implement at the organizational level, Quartet has built a virtual platform that connects primary care providers with a network of vetted behavioral health and psychiatric specialists in many geographies throughout the United States. This creates the potential for seamless and quick referrals. As Quartet continues to scale at a rapid rate, it will test the implicit hypothesis that ephemeral virtual links between primary care and mental health providers on a patient by patient basis can perform as well as physical integrated care clinics, where robust and durable team-based systems require greater investment to develop and sustain.
Value-added Therapy Services: increasing the effectiveness of therapy using tech-enabled resources
Mental health — like all other forms of healthcare — is most effective when the patient is able to comply with care guidance and meet their personal goals. In order to do so, mental health providers can add “surround services” like coaching services, tele-therapy, and support groups.
Coaching services are plenty, however, the programs designed by AbleTo and Ginger are built to support evidence-based mental health care. Both platforms offer a time-bound coaching program that lasts typically 12 weeks, a variety of coaching services supported by telepsychiatry to address varying needs of the patient and collect outcomes to measure effectiveness of care.
Support groups are also an effective way of engaging patients between therapy sessions by creating a community to rely on. Community or social support can often be essential when the patient is suffering from common behavioral and mental health concerns like postpartum depression, weight management, substance abuse and gender/sexual identity issues. Typically, support groups are organized by community organizations which may or may not have strong integration with patient’s therapist. Octave is a new provider of evidence based mental health services and uses support groups as one of their main offerings. All Octave support groups require a pre-consultation with therapist to assess their fit and goals.
Innovations in Employer Benefits: reducing the externalized cost to employers of unaddressed mental illness
The corrosive effect of mental illness on employee productivity is expansive yet insidious. In monetary terms, looking at the cost of untreated depression alone, the US bears $30–51 billion annually in lost productivity. Furthermore, the costs associated with ancillary complications of mental illness are difficult to aggregate accurately but are substantial. Economic research suggests that as much as 70% of the costs of major depression, for example, are indirect. EAPs provide employers with a set of structured benefits to maintain a healthy workforce by helping employees find affordable and high-quality resources to address personal and/or work-related problems as they arise. However, inadequate benefit design and haphazard assembly of resources by traditional EAP vendors often results in a “hyperlink farm” to assorted benefits without any clear organization or guidance and questionable return on investment for employers.
Modern Health, Lyra, and Spring Health are innovators in EAP space and are building their solutions to generate a strong return on investment by providing easy navigation to mental health care. These tailored benefits seek positive outcomes in three categories: increased employee retention, increased productivity, and lower downstream healthcare utilization. Each of these companies has done work to create their own vetted provider network of clinicians who use only evidence-based treatments. Using either matching algorithms, expert guidance, or a combination of the two, prospective patients are directed to a specific mental healthcare provider. These EAPs use various pricing models to bill the employer on a usage or capitation basis, thereby reducing or eliminating the direct cost to the employee. Underpinning all of these design choices, is the more rigorous use of data analytics embedded in the design of better service interfaces for enterprise clients, patient-users, and provider-users.
Where will innovation lead us from here?
The innovators described above all have the common theme of attacking the barriers to accessing care. New business models will be dependent on identifying the precise friction points and barriers in the system that may be either intractable or invisible to most insiders, but routine and obvious to an outsider with the right complementary expertise. Data scientists, software developers, product designers, and clinicians all have unique perspectives that can be leveraged to improve mental healthcare tomorrow, and creatives of all stripes are needed to step into the role of mental health entrepreneur and innovator. Entrepreneurship in mental health is just picking up steam and plenty of opportunities exist to target the challenges for the patients treated in the office today as much as the 60% of individuals with diagnosable mental illness who aren’t yet engaged with care.
Scott Breitinger, MD is a psychiatrist at Mayo Clinic in Rochester, MN. twitter: @sbreitingerMD
Akshay Venkitasubramanian is a senior associate at Mount Sinai Health Partners in New York City.
the authors have no financial interests in any of the companies discussed in this article