Behavioral health dominating services across new digital health platforms - Panel 3

Chief Medical Officers at Hims/Hers; Amwell, Doctor On Demand, Neuroflow CEO @ May 19 event

Utility and efficacy From a clinical perspective, what is actually working? Moderators: Dr. Archana Dubey (Global Medical Director, HP), Bambi Francisco Roizen (Founder and CEO, Vator) Speakers: Dr. Peter Antall (Chief Medical Officer, Amwell); Dr. Ian Tong (Chief Medical Officer, Doctor On Demand); Dr. Patrick Carroll (Chief Medical Officer, hims & hers), Chris Molaro (CEO, NeuroFlow)

The group talks about how behavioral health is becoming a dominant service. For Doctor On Demand, it's 30-40%. For Amwell, it's 40% of volume. Watch the video and listen to them talk about the importance of behavioral health. 

Here's the takeaways [highly edited for clarity]

What's your differentiator and what are outcomes?

HIMS/HERS' Carroll: We've expanded the scope of care from hair loss and sexual dysfunction. Eight months ago (fall of 2020), we got into behavioral health. Our demographic is millennials. 30% of that population struggles with anxiety. Anxiety and depression treatment. We have a price point lower than the average insurance deductible.  For mental and behavioral health and other chronic disease management, our members come on and we offer synchronous connections for behavioral. They get medications delivered to the home.

Doctor On Demand's Tong: We focus a lot on delivering care at a reasonable cost. And we focus on how to incorporate value-based care. We've been able to meet this as telemedicine has been great to deliver access; quality is easier to control. Also, 43% of our clinicians are black and indigenous people of color. We built a practice that's inclusive. Over 70% are women. 20% LGBTQ. 5% of doctors are black in the country, yet at Doctor on Demand's,  20% of our doctors are black. With our diversity, we're able to connect patients with someone culturally concordant. 

Amwell's Peter: We prioritize quality of care; Our differentiator is that we're a software as a service company more than a delivery of care company. It wasn't as obvious pre-COVID. But with the explosion of telehealth, it's had a dramatic impact. 80% of all of our activities has happened off our network. We've seen this across Cleveland Clinic, Intermountaint, etc. We are also all about synchronous-based interaction especially, which is important in medical interventions. We have employed W2 and a mix of full-time, part-time and number of structures and policies in place to function as a coherent group for all the medical providers we work with. For outcomes, we work with health plans to get claims-based reports. That is the source of trust that exists. These aren't direct outcome measures but process measures. So we focus on how many visits it took to complete an episode of care. We also use PHQ8 or PHQ-9, GAD, PHQ-2 scores. But we mainly use those for sales and marketing efforts.  

Doctor On Demand's Ian: We also use PHQ-2 for screening level in primary care and urgent care. If you trigger that, then this triggers behavioral health practices. Then you may have to take a PHQ-9 and GAD-7. Because we have the integrated practice of primary/behavioral in one shop, we look at chronic disease or disease-specific outcomes related to blood pressure, cholesterol and diabetes and start to ask what is happening when someone is coming for behavioral health and treated for other conditions. Are we seeing correlation or causation with improved PHQ-9 and GAD-7 with physical condition. We launched coaching and it's a sub-clinical offering. We want to have primary care practice around the whole person.

Neuroflow's Chris: We work with these organizations; Neuroflow helps measure outcomes in between appointments. Getting navigation and measuring outcomes in between the appointments. If I see Ian (that lasts for a finite period of time); it'd be great to stay connected to him in between my appointments. We've developed that connection to happen to have that provider feedback loop to deliver all these screenings/assessments in between appointments. We believe the way we win and bridge physical and mental health is amplifying the people involved; augmenting the care; so when Peter is with a patient, he can risk-stratify the patient and stay connected with patients during the non-synchronous times. Getting the feedback loop right. We've integrated with EHRs.

Our clinical advisors and MDs closely advise us on what would create more work, then what would connect that patient to the right care in the organization. We do this with 400k patients under contract with patients today. We different from messenger tools because those tools are typically for  administrative purposes. Epic has MyChart; Athena Help has their own portals (checking bills, making sure appointments are set); we're able to deliver those screening tools - we're helping to redefine the way they're delivered and if I'm a patient on Amwell, and I score a 10 (moderately depressed), then what happens then? That screening goes to the provider and there's branching logic that suggests what to do next: coaching or motivational interviewing, or other exercises or activities. Automating the delivery of self-service tools and providing feedback so the higher-risk folks can be triaged more collectively. 

Are we moving away from Pharma science to behavioral science? 

Peter: It's an oversimplification to say we're moving from one model to another model. We're seeing an acceleration to the usage of digital tools - more self-help, mindfulness. I see an acceleration of tools that aren't pharmacologic.  

Ian: Let's all acknowledge, we went through the hardest year we've been through in our life, we all have the biggest excuse ever. They're not in competition with one another. We need the whole spectrum. We're finally fighting multiple battles. We have a lot of work to do. It's natural for us, that for the more severely ill, we can do some things with them. Are we overmedicating them? Are we reaching for that too easily? Clinical-minded people like myself shouldn't dismiss the impact of social determinants of health and coaching. 

Chris: This comes down to measurement-based care. Who needs to be on therapeutics and /or who needs to be on therapeutics plus coaching. All this new data can help inform the direction of treatment.

Patrick: Talk therapy can only go so far and medications have played a very valuable role. We've decided we'll offer a holistic care. Talk therapy is not going to get it done for some patients. We've had group sessions and individual psychotherapy and then access to a prescriber. Behavioral health issues even just focused on anxiety and depression - it's not a one-size-fits all. For many patients it's combination of medications and psychotherapy. For our demographic, it seems most effective. 

Peter: Been around healthcare long enough to see how trends come and go. There was certainly a period when SSRIs were new. Everyone went on Prozac for minor blips in their lfie. Recongize that when something is trending, there's value there and so let's not forget the tried and true methods of CBT, talk therapy. Often the treatment associated with long-term remissions is CBT. 

Future of Mental and Behavioral Health is brought to you by Vator and UCSF Health Hub. Thanks to our sponsors: Advsr, Scrubbed, Stratpoint. As well as BetterHelp, go to  BetterHelp.com/Vator for 10% off BetterHelp. This podcast is also brought by Octave, your partner for mental health and emotional well-being. Learn more at FindOctave.com. Also thanks to NeuroFlow which is working with hundreds of healthcare organizations to provide best-in-class technology and services for the effective integration of behavioral health. Learn more at neuroflow.com). You may still register for our June 9 and July 14 events, which are part of the Future of Mental and Behavioral Health series.