Democratizing Behavioral Health
Installment 7 of the AI in Healthcare Series with Michael Ferro
Written by Robin Farmanfarmaian
While Behavioral Health innovations, new business models and the shift to virtual care were already booming before the covid pandemic, they have gained center stage in 2020 and 2021. The reason is clear — the pandemic itself has been stressful for everyone. From Baby Boomers to Generation Z, each life stage comes with their own unique set of stressors during a global crisis — no one is immune. While one in 5 Americans already have some type of mental health condition, the pandemic has given most a reason to seek some type of professional help to learn coping strategies for the anxiety caused by global uncertainty.
While there are small differences between the terms “Behavioral Health” and “Mental Health”, some of the large private payers are using the term “Behavioral Health” as the umbrella term between the two to encompass everything from chatbots to chat-apps to therapists to psychiatry.
The new world of behavioral health apps and virtual care has the ability to reach people that haven’t had easy access to therapy or coaching due to location, time or cost … until now. Previously, the only way to access mental health professionals was the one-size-fits-all $100-$400+ for an in-person therapy or psychiatry appointment — which may or may not have been covered by insurance. That’s a business model that hasn’t changed in decades.
Since the pandemic, more people are asking themselves “why spend the time traveling to and from an in-person appointment for a healthcare professional that doesn’t need to do a physical exam when video is sufficient?”. Most of us are used to communicating and expressing ourselves through typing or video, so an in-person therapy appointment can feel antiquated.
Companies are now recognizing this and some have been offering chat and text functions instead of, or in addition to video or phone calls.
The best innovations fit into the patient’s workflow, not just the provider’s workflow. The most successful behavioral healthcare is the healthcare that actually gets done.
The decades-old business model has shifted, and while the $100-$400+ in-person therapy visit still exists, many companies and employers realize offering virtual video visits, phone appts, chat-app therapy, coaching and even AI-powered solutions fit into people’s lives better, and not just during a pandemic.
The new business models hitting behavioral health include one or more of these features:
- Monthly subscription fee
- Unlimited texting
- Pay per video or phone session, discounted compared to in-person
- Free as an employee benefit (employer pays)
- Hybrid texting and video: monthly subscription fee plus pay per session
Some of the behavioral health innovations including Pear Therapeutics, Calm and Headspace were covered in the installment on Digital Therapeutics: DTx. These are apps that are available by prescription only, work in conjunction with medication and/or the healthcare professional, and use techniques like Cognitive Behavior Therapy (CBT).
CBT is the most widely used, evidence-based and broadly applicable technique in behavioral health. It is based on the belief that emotions, reactions, physical sensations (i.e. pain), and actions are all connected. Teaching the patient or user different, more positive ways to think or behave can help counteract the negative issue in need of treatment (ie insomnia or depression). CBT can be an effective treatment for many behavioral health issues including depression, anxiety, addiction, interpersonal relationships (i.e. marital problems) and even some forms of severe mental illness.
Startups Tackling Behavioral Health in New Ways
Both employers and investors are recognizing this trend, with investors pouring money into digital health offerings that address behavior and mental health. Lyra Health tops the list of highest funded behavioral health startups with a total of $650M of funding.
Like many of the behavioral health solutions, Lyra works directly with employers as an employee benefit, and is not available for individuals outside of employment benefits. Lyra screens, treats and coordinates the full spectrum of needs for employees in behavioral care. Live video coaching, therapy, medication, guided self-help programs created by a coach, and digital health tools like meditation apps. The tools are determined by Lyra Health’s AI-based algorithms that help create the best plan for the individual: AI-enabled personalized behavioral health when, when and how it fits best into the individual’s life. This helps democratize behavioral health through employers in 2 ways: Easier access to personalized treatments by leveraging connectivity and AI; and making behavioral health more mainstream, breaking down the stigma barrier.
Ginger.io is a Unicorn startup in the behavioral health space with $220.7M in funding and a $1.1B valuation. Ginger.io has treated over 10M people in 40 countries with their data-driven virtual care solution.
Using the United States as an example: approximately 111M people live in areas of the US that don’t have access to behavioral or mental health. Ginger.io uses a combination of AI and humans (coaches, therapists and psychiatrists) to deliver the right care to the right patient at the right time — while also making it easier and more affordable than traditional care. Access is always through a smartphone, either by video, audio, or chat app.
One way Ginger.io is leveraging AI is by using NLP- natural language programming- to understand then analyze the conversations between the “Member” (what Ginger.io calls their patients or users) and their coach, therapist or psychiatrist. Their risk-detection algorithms identify the Members who might need help quickly because they are at risk for self-harm or suicide. Ginger.io flags that Member so the live human coach, therapist or psychiatrist can intervene and help, potentially saving the Member’s life.
Subscription Model + Chat and Video
Talkspace was one of the earliest behavioral health startups tapping into both the chat therapy function in addition to a revolutionary business model — unlimited texting with your assigned therapist for a flat monthly subscription fee. Founded back in 2012, Talkspace has raised a total of $106.7M and recently acquired another startup called Lasting to expand their footprint in relationship coaching like marriage counseling. While they initially launched as a chat-app, Talkspace quickly expanded into other offerings like video visits with your assigned therapist. Talkspace is reimbursed by insurance, in some cases insurance will take care of 100% of the monthly subscription.
The other revolutionary thing Talkspace did was use artificial intelligence to help match the user (patient) to a therapist based on their personality. That helps solve one of therapy’s biggest hurdles for success — the wrong therapist for the wrong patient. If a patient doesn’t like their therapist on the first visit, they may never return, and that might lead to dropping out of therapy completely. This type of failure isn’t a sign that therapy wouldn’t be successful for a specific patient, only that the care delivery method (that specific therapist) didn’t work for that patient. By using AI to help match the patient to the right therapist based on the patient’s personality the first time can be the difference between success and failure.
There are many other startups and large companies in this space —another good one to watch is BetterHelp, founded in 2013. Similar to TalkSpace, it is on a subscription model with a text chat function and optional phone calls or video visits.
Behavioral Health Coaching + Companion Wearable
Control Your Thoughts, Control Your Life
Feel is one of the virtual behavioral health companies that combines Remote Patient Monitoring (RPM) with coaching. Through a smart wristband with 5 sensors, Feel analyzes heart rate, heart rate variability, temperature and electrodermal response- also known as galvanic skin response. Electrodermal response is a measurement of the electrical changes in sweat glands. This has been shown to help categorize someone’s emotional state. By leveraging cutting-edge AI, Feel is able to learn about an individual’s normal daily patterns, and can identify the individual’s emotional changes. That in turn helps to identify triggers so Feel can provide personalized guidance to help that individual learn how to regulate their negative emotions. Personalized behavioral medicine where and when someone needs it the most.
Healthcare is at the early stages of collecting and analyzing vocal biomarkers. As covered in the installment on AI Voice Technology, AI-based vocal biomarkers metricize changes in a person’s voice including tone, pitch, annunciation and speed of speech. When taken together with other data points like vital signs, the combination can help lead to a diagnosis, measure a disease trajectory or quantify treatment plan efficacy.
The Amazon Alexa smart speaker is already HIPAA compliant and being used in healthcare in multiple ways, as covered in the AI Voice Technology installment. In 2020, Amazon launched their Halo Wearable, which also leverages AI voice technology. Halo is a fitness wearable that is worn on a patient’s (user’s) wrist and comes equipped with an accelerometer, temperature sensor, heart rate monitor, and 2 microphones. What Halo doesn’t have is a screen. Instead it uses Halo’s bluetooth in conjunction with a smartphone, and measures a patient’s voice to determine and categorize that person’s emotions. So Halo can tell the wearer about how their voice tone may come across to others, such as “hopeful”, “elated”, or “hesitant”. The Halo wearable also tracks sleep, activity, and body fat percentage (with a smartphone). While this wearable is not a medical device, and has not gone through clinical trials for FDA clearance for any type of medical condition, it is the beginning of collecting a giant database of categorized vocal biomarkers that can be used in healthcare. It’s still the early days of vocal biomarkers, but expect to see their use grow significantly over the next 5–7 years.
New healthcare delivery methods like Lyra, Ginger.io, BetterHelp and Talkspace help to democratize behavioral health to a point, but are still limited by two major barriers: First, the product — delivering therapy or counseling- needs to be delivered by a trained professional, a limited resource. Secondly, because that trained professional is human, they require payment in line with their expertise.
To democratize behavioral health to everyone, the human being will need to be an enhancement or optional component versus delivering the core product, the product being therapy, coaching or counseling. That is where the artificial intelligence enabled software programs can democratize some forms of behavioral health to people who would never have had access otherwise.
While a hardware device such as a smart tablet or phone and internet connectivity are required, companies including SpaceX, Facebook and Google are working on democratizing connectivity to the world to deliver not just healthcare, but other crucial components like education, jobs and financial opportunities.
Democratizing Behavioral Health with AI Chatbots: No Human Needed
The WoeBot mental health chatbot was originally created by Stanford psychologists and has now been used in over 120 countries. Similar to Digital Therapeutics like Pear Therapeutics, WoeBot uses the gold standard in therapy, Cognitive Behavior Therapy (CBT), to help the patient with everything from depression to anxiety and more.
Because WoeBot is AI-based, the software has the ability to learn about the individual over time, and alter the CBT approach based on that data. Unlike Pear, WoeBot has not gone through the FDA and does not require a prescription or healthcare professional to be used in conjunction with the CBT chatbot. Instead, WoeBot is free to use, and can reach people outside of the traditional healthcare system, on-demand when they need it the most. The best healthcare fits into the individual’s daily workflow, not just the healthcare professional’s daily workflow. This is the type of innovative solution that scales across the globe and democratizes CBT-based behavioral healthcare to anyone with a device and connectivity.
Check out the previous 6 installments on the AI in Healthcare Series with Michael W Ferro and Robin Farmanfarmaian:
Remote Patient Monitoring
AI in Healthcare Introduction
Digital Therapeutics: DTx
Who Pays for AI in Healthcare?
AI Voice Technology in Healthcare
Virtual Reality in Healthcare
