Here is the opening speech and the first panel at the Future of Mental and Behavioral Health event on May 19th. The first panel was hosted by CEOs of leading mental and behavioral health companies focusing on trainers and therapists. clinical vs subclinical and business models.
Panelists and moderators / hosts included: Bambi Francisco Roizen (Founder and CEO, Vator), Archana Dubey (Global Medical Director, HP), Mark Goldstein (Chairman, UCSF Health Hub); Speakers: Russell Glass (CEO, Ginger); Alon Matas (President of Teladocs BetterHelp); Alex Katz (CEO, two chairs); Sandeep Acharya (CEO & Co-Founder, Octave); Alexi Robichaux (CEO, BetterUp).
Russ Glass: Ginger is open 24/7. When you have a need in the middle of the night; if you have a panic attack; We are here for you. A flight attendant had a panic attack linked to a ginger trainer that brought her back to basic resilience. We all start at the behavioral coach level. About 80% of our members can use trainers, although we employ more therapists and psychologists as trainers. Our trainers can do more. We bring in therapists as needed. We also bring therapists and psychiatrists onto the care team so the experience is seamless. We will then try to withdraw from this higher level of care as soon as possible. Our coaching consists of 100% synchronous real-time maintenance. Everything is maintained via chat. There’s a ton of AI to monitor chats and extract key features like comorbidities and even tone of voice, combined with PHQ scores, and we create a personalized care pathway. We give the trainers measures and a predictive path for the patient. We are also looking for requirements that might be required in an acceleration. We also offer intelligent answers so that a coach only has to push a button.
Alex: Two Chairs is absolutely focused on therapeutic relationships. We want a clinical alliance between our patients and therapists. Our matching system is therefore the heart of our system. We take great care to collect tons of data from our customers and to schedule an initial 45 minute appointment. We use this data to create personalized matches. Because of this match, we see much higher alliance scores and an improvement in symptoms. Our matching system is based on building an exceptional clinical team. We also employ almost all of our therapists full time. We check people and train people of all different theoretical orientations. This strong team helps us achieve better therapeutic matches.
Sandeep: We’re all trying to improve access together. Octave Health is focused on results. We believe that providers trained in evidence-based modalities and focused on using measurements in their care will ultimately produce better outcomes. We are targeting a more acute population. Around half to two thirds of our customers have moderate to severe visual acuity.
Alon: BetterHelp only has licensed therapists. Our differentiator is that we don’t innovate because we put the proven therapy online and make it more affordable and accessible. The biggest problem is not that the therapy is not good, but that the vast majority of people who need therapy aren’t getting it. We have almost 20,000 therapists in our network, so with this critical mass we are very well positioned to enable quality adjustments. Nevertheless, matching is difficult because the therapy is so individual.
Alexi: For BetterUp we believe that 80% of people don’t need therapy because their needs can be addressed through coaching. We see ourselves as the top of the funnel. The reality is that most people don’t need therapy. We don’t find it productive to tell most people that they need therapy, nor do I find it realistic to believe that we can give therapy to people on a global scale. I also don’t think that should be desirable. If we were good at prevention, most people wouldn’t need therapy. If you think of therapy as secondary care, what is primary care? It’s coaching. It would be evidence based, informed by CBT, DBT and work by Frankl and Maslow and the Movement for Human Potential and Martin Seligman and positive psychology. We focus on self-actualization and resilience. We want to bring clinical accuracy to the non-clinical area.
How do customers perceive your services?
Alexi: We were pretty early in chronological terms. We started in 2013, we had the heroic idea that everyone would support the whole person. What we realized at the time was stigmatizing mental health for most people. We had to focus on what the frustrations of people who do not have acute mental illness are and how they feel about their mental health. Our cultural dialogue has done our users a disservice by focusing and branding us as mental health because people viewed this as eliminating mental illness. So we focused on coaching. However, what we actually did was mental health, resilience, and mild anxiety. However, by focusing on performance, leadership, promotion, and the results people want when they are healthy, we found that use and acceptance were off the charts. If rigor is the root of performance, then we said let’s do this about performance. For our population, we don’t want to burden them with concentrating on health as much as they expect their health to be. We want to focus on how we can get them to perform at their best. Now after COVID we’re getting a lot more on the clinical side.
Trainer versus therapist
Russ: The majority of our providers are therapists / psychologists. We can just treat more people with coaches. Back to the crux of this panel, we see that someone with a mental illness costs the health system 2.5 times more. The more serious it gets, the higher the cost. The system is very costly and there is not enough maintenance. We are trying to change the model to optimize the cost of managing most of the employees.
Alon: You don’t have to be severely depressed or clinically diagnosed to see a therapist. Therapists help people in a wide range of situations. Coach vs. Therapy is a hazy line. Much back from coaching. From an inventory point of view, coaches are cheaper and less in demand. We shouldn’t be confused when someone needs a therapist. You should see a therapist, not a trainer.
Russ: The idea that it is a cloudy line is out of date. Maybe a decade ago. It’s heavily data-driven. In fact, our systems can predict when someone will need the interventions that a licensed therapist can offer. In order to scale care, we need to be more careful about ensuring that those therapists who can provide these interventions are deployed to people who need them. We’ve published peer-reviewed results that show trainers are just as effective as shutting down GAD and PHQ-9 and increasing resilience.
Sandeep: It’s not just a cost, it’s a function of access. At this event, we discovered that 50 to 100 million people have a need and we don’t have enough licensed providers. I guess 80% need coaching, none of them need coaching. It is our collective duty to make sure we get this right. We try to work with family doctors and doctors. Due to the fact that we take out insurance, we work with people with fewer options. We haven’t always accepted insurance.
Alex: We are directly with the consumer and also work with payers. Our model is chargeable, but we all want to receive value-based care. We work with the current systems.
Sandeep: We mainly get reimbursement from the payers. It is a service fee with a degree of risk as our fees are based on the achievement of results. We have considered episode-based payments, but this brings us into conflict with our customers as sometimes they need therapy for a clinical need and sometimes when there is no clinical need. Service fee in terms of quality at risk.
Russ: There are two main payment models. The company pays pe / pm (per employee / per month) for unrestricted access to coaching, content and there is a service fee for clinical needs that is billed to the health plan. We also have a new value-based model that combines coaching, therapy and psychiatry, and over half of our client acquisitions choose this option. We have also signed our first national payer, Cigna, who reimburses the coaching.
Alon: We’re a direct-to-consumer model for weekly sessions with therapists and unlimited messaging for $ 200 to $ 300 per month. traditional model of 45 minute sessions. We also work with employers and universities. However, our main business is directly with the consumer.
Alexi: We sell to companies even though we have a newer D2C. We have two areas. Talent-focused buyers are structured in a SaaS model. When we sell in terms of services, it is a price-per-participant model. We don’t want people to see healthcare as an entitlement, but as an investment. When we started in 2013, there really weren’t any dollars in wellness benefits. It was clinical or nothing. But they are more open now. In terms of performance and outcome metrics, we can map our services to sales performance, attrition, revenue, mindset, civic behavior, and creativity.
Adopting And Working Towards A Gym Membership Model?
Alexi: When we started out, we wanted to build a mental health gym (original space); it can work; people have been using coaching for years because it is not a clinical supply; We know how the series of numbers works. We know how far the negative goes. We don’t know how positive the number line will be for human prosperity. If you are striving for self-actualization, it can be a journey of several decades. Adoption is very high for talent – around 60-70% because it is ambitious. If we provide the benefits, it’s about 15-20%.
Russ: We’re in our mid-teens with entrepreneurship. We consider this all about behavior change. We try to change behaviors so that they ultimately have their own resilience. they learn how to eat well; In an ideal world, we would see everyone as long as they had to develop these habits. Then they would move on. It turns out that 20% is more than a year lengthways. Some are more episodic. Some just want a 3 month period and learn new skills.
At the end, listen to more discussions about how companies attract trainers / therapists and what they pay for them.