Karan Singh, Ginger & Headspace Health, on solving the supply imbalance in mental healthcare

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In this episode, we sat down with Karan Singh, Co-Founder & COO of Ginger, now Headspace Health, through a merger with Headspace that was announced in August, 2021. Headspace Health is the world’s leading provider of mental health and wellbeing solutions. It’s members and enterprise partners’ employees have access to mindfulness and meditation tools, CBT, coaching, therapy, and psychiatry, ultimately helping them to be healthier and more productive.

Karan has over 15 years of experience in the healthcare industry, consulting with bio-pharma clients, commercializing data analytics, and establishing research partnerships with academic medical centers. He has served as a scholar at the Aspen Institute, delivered keynotes at the Public Health Institute and the National Institute of Mental Health, and was recognized as a rising star in healthcare by LinkedIn. Karan has a BA and BS in Economics and Business Administration from UC Berkeley and an MBA from MIT Sloan, with a fellowship in entrepreneurship from the MIT Legatum Center for Development. Karan also attended the Harvard Medical School / MIT Health, Science & Technology program.

We discussed:

• Ginger’s mission to address mental healthcare gaps by creating a comprehensive digital on-demand solution offering full stack mental health services at an affordable rate
• Potential reforms to make mental healthcare more accessible through reimbursement parity and interstate licensing
• The strategic rationale behind merging Ginger and Headspace into Headspace Health and what this means for users

Start to 14:11: Deep dive on Ginger

• On the genesis of Ginger: 13 years ago, Karan received a call from a loved one who had attempted suicide. This call shook Karan and highlighted the challenge many face in finding effective resources for mental healthcare. Beyond access issues, mental health was stigmatized, notably in the communities of color he grew up in, which often led to the suppression of mental health issues. Given this, Karan was motivated to develop a better solution for mental health that would integrate data analytics with clinical best practices and technology.
• On Ginger’s offerings: in the early days, Ginger partnered with provider groups from large academic medical centers to local community clinics to leverage data from patients to inform a proactive approach to treating mental health issues. Over time, Karan and the Ginger team realized the key gap in mental healthcare was upstream. Karan focused on making mental healthcare accessible by overcoming stigmas for seeking care and connecting patients to reliable providers who could provide effective evidence-based care. As a result, Ginger evolved to offer on-demand clinical services within the U.S. and in 50 countries abroad.

“What we’ve learned so far [from international expansion] has been that while the language people use might be different, the core stressors and issues — sleep, relationships, workplace stress, being a new mom or a new dad, grieving the loss of a loved one — were universal needs and universal issues.”

• Behind the name “Ginger”: “Ginger” comes from Karan’s childhood, when his mom would feed him ginger tea when she anticipated he might get sick. The name “ginger” underscores Ginger’s core mission to help users prevent major adverse episodes by enabling them to develop resilience through skill-building and proactively addressing issues before they become needs.

“We realized that we were sprinkled at the end of a broken system. In order to tackle this problem at scale, we actually had to start at the very beginning. Most people were waiting outside the front door, and access to care was a core issue.”

• On the differentiator: Ginger approaches mental healthcare by mitigating the friction patients experience when searching for a solution to their mental healthcare challenges. Ginger begins by making its mental health offerings on-demand and digitally native to improve patient access. Once patients start using Ginger’s platform, they have access to the full spectrum of clinical services from behavioral health coaching to licensed clinical therapy and psychiatry for medication management.
• On reinventing the system: Karan and the Ginger team realized that they needed to create a system to address diverse mental healthcare needs outside the broken status quo system. Unlike other features that simply take a traditional in-person appointment and put it online, Ginger offers a comprehensive solution that provides on-demand, evidence-based care that leverages data analytics to pinpoint the most appropriate type of treatment for the patient. Ginger focuses on making this solution affordable and scalable while emphasizing prevention to help users reinforce experiences and lifelong routines promoting mental health.
• On efficacy measures: Beyond using conventional metrics such as the PHQ-9 and GAD-7 to measure depression and anxiety, Ginger also utilizes natural language processing and other techniques to analyze patient conversations. This enables Ginger to implement additional checks to ensure the system is producing effective outcomes for patients at scale.

“Our take is that ultimately, [the gap in mental healthcare] has been a supply and demand imbalance issue, and that to solve this problem, we need supply side innovation.”

• On addressing health inequity: Ginger recently expanded into the Medicaid space through its partnership with AmeriHealth Caritas D.C., offering 110,000 Medicaid enrollees free access to its on-demand mental healthcare services. Ginger has also begun to roll out services in Spanish, starting with select users this fall and reaching all users by early 2022.
• On diversity and inclusion: Ginger is concerned about promoting diversity and inclusion, both within its own operations and in providing culturally competent care for growing multicultural populations in the U.S. and abroad. To do this, Ginger strives to recruit and retain a diverse team both for its own business operations and for its provider network. Ginger recognizes the importance of curating clinical staff who can connect with the diverse backgrounds of users to overcome cultural stigmas and provide more effective care.

“The same core thesis, which was that measurement-based care and data could play a really critical role in delivering more effective and skilled mental healthcare, that sort of core concept persisted. What we then added to that was a set of people — incredible coaches and clinicians who could deliver that care.”

14:11 to 26:09: Industry trends and reflections

• On the evolution of mental healthcare adoption: When Karan first started Ginger, the healthcare landscape lacked innovative offerings and consumer adoption was limited. In the last 5 years, consumers, insurers and provider systems have grown to appreciate the importance of mental health and its role in influencing physical health. This has translated into more funding from investors into mental health initiatives, with the most dollars pouring into mental healthcare-related startups since 2018 relative to other health sectors.
• On the impact of COVID-19: Ginger has experienced a significant uptick in utilization rates throughout the COVID-19 epidemic. Research also shows that in particular, depression and anxiety rates within adolescent populations have risen. Ginger aims to continue addressing the need for mental health services around the world, and to do this in the right order and phasing as it continues to scale.

“Within the last five years … more and more payers, providers, and plans are recognizing that the mind is not separate from the body, that we actually need to treat the two together, and that this can be highly correlated and highly impactful.”

• On existing gaps: From a legislative perspective, the ACA and Mental Health Parity laws have enabled greater health equity for mental healthcare by expanding Medicaid and requiring large-group employer plans to cover mental health services at the same level as medical and surgical services. The ACA also required individual, fully-insured small group, and Medicaid expansion plans to cover mental health services and prescriptions. However, despite the legislative backing for mental health, the actual reimbursement of mental health services has not been adequate, resulting in continued access and quality issues.
• On improvements to the system: Karan is optimistic that COVID-19 has accelerated the recognition of the importance of mental healthcare, both for consumers as well as regulators and the broader healthcare industry. To create a system that works sustainably, systemic changes need be made around payment reform to support access expansion. The temporary authorizations for telehealth waivers eased the operational challenge of operating across state lines. More reforms such as reimbursement parity and relaxing state licensures will attract more talent into mental health, leading to more supply to meet growing demand.

“There’s a lot of systemic changes that need to be made, like payment reform and the overall shift to value based care to help reimburse mental health care more effectively.”

26:09–39:41: On the Headspace merger

• On the rationale behind the merger: Ginger and Headspace saw opportunities to unlock a better experience for users by merging. Headspace’s unique mindfulness and meditation content aligned with Ginger’s emphasis on preventive care. On the other hand, Headspace users sought additional mental health services that could address their more serious mental health needs. The merger has allowed the two organizations to share content and services to support the full continuum of care for users.
• On shared culture and values: A core reason Ginger and Headspace were able to merge is their mission, culture, and value alignment. This alignment was table stakes in evaluating whether a merger would make sense. The two companies realized they were both tackling the same challenge from different angles, and this shared goal created the foundation for the merger.
• On near-term priorities: Ginger and Headspace are targeting cross-selling their solutions across their respective books of business. The combined company seeks to educate current users on the array of services and content its counterpart offers in order to better address user needs.
• On creating a virtuous circle: The mental health industry has historically lacked a robust set of data to help improve treatments. To address this, Ginger aims to collect data and publish key findings to elevate the overall thought leadership in the mental health space. Ginger hopes that its findings will help others share and learn as well. In doing so, Ginger is fostering ongoing dialogue between stakeholders united in addressing mental healthcare disparities.

39:41 — End: On assembling a team and interacting with investors

• On the importance of the team: Karan stresses the importance of surrounding yourself with a team that is aligned with the company’s overall mission, values, and goals. For Karan, this entails team members who are optimistic, curious, and have a growth mindset.
• What to look for in investors: Karan learned to separate investors into types based on whether the investor is likely to invest and what additional information they are looking for. In deciding which investors are likely to invest, core value alignment is key. Investors who already signed on to invest in the company can also connect the management team with other suitable investors in their network and draw in other investors.
• Tip for working with investors: Keeping investors informed is key, especially when the company runs into challenges. To do this, Karan maintains a high degree of transparency on company operations with investors. As a result, investors can more easily share any relevant information or recommended strategies.