HBHI is the host of 'Conversations on the Business of Health,' a series of one-hour webinars that engage leaders of business and academia about improving American health care. Here are highlights from the recent discussion about the business of digital behavioral health, featuring Steve Blumenfield, Head of Innovation & Acceleration at Willis Towers Watson; Adam Chekround, Co-founder of Spring Health; and Lisa Marsch, Director of the Dartmouth Center for Technology and Behavioral Health. This event was co-sponsored by the Center for Mental Health and Addiction Policy, a solution-oriented home for the diverse research and educational efforts at the Bloomberg School of Public Health.
The conversation was moderated by Matthew Eisenberg, Associate Professor and Associate Chair for Faculty at the Johns Hopkins Bloomberg School of Public Health, and Beth McGinty, Chief of the Division of Health Policy and Economics and Livingston Farrand Professor of Public Health at Weill Cornell Medicine. Eisenberg is a member of HBHI’s leadership team and McGinty is an HBHI affiliate scholar.
It’s clear that changes in telehealth policy, mobile technology development, and consumer demand have fundamentally reshaped mental health treatment and substance use care in the US and around the world. What does this mean for people’s outcomes, specifically behavioral health care access, quality, and cost?
“Having worked in this space for a long time, this feels like a really exciting moment in time,” said Marsch, who serves as Director of the Dartmouth Center for Technology and Behavioral Health. “There's a whole confluence of factors that are transforming the digital behavioral health industry, really positioning it to explode and drive impact globally.”
The need for behavioral health care is growing fast, both in the US and around the world, as mental health challenges have spiked considerably since the start of the COVID-19 pandemic. The supply of therapists or other behavioral health providers is simply no match for the number of individuals in need of care.
Spring Health Co-founder Chekround was determined to reimagine—and reinvent—behavioral health care for the employer-sponsored market. The reality of the status quo, in his own words: “An Employee Assistance Program has 100,000 providers in the registry; most of the information is outdated. Even if you call them, they won't take you on as a new patient. The rates will be extremely low, the utilization will be extremely low, and the employer will see no benefit.”
There are also other unique barriers to accessing behavioral health care—including stigma. But a digital care option might make people more comfortable seeking treatment.
“Most people struggling with substance use disorders, for instance, do not engage in our traditional systems of care. Sometimes it's access issues, often it's stigma issues,” said Marsch. “One key benefit of these digital tools is allowing us to enhance the scalability and widespread access to therapeutic tools that can really impact people's lives and their functioning and their outcomes.”
One key benefit of these digital tools is allowing us to enhance the scalability and widespread access to therapeutic tools that can really impact people's lives and their functioning and their outcomes.
Beyond dramatically expanding access, digital tools are proving to be as effective (if not more so) than traditional, in-person care. A 2020 study from the Veterans Administration showed that telepsychiatry by video was as effective as in office-based care for treating depression and post-traumatic stress disorder. The convenience and availability are positive.
“Having treatment 24/7 accessible, like a clinician in your pocket, means you can use telehealth more frequently,” said Marsch. “We've been seeing that the pace of clinical impact with a digital intervention is actually shorter than with some of our traditional models of care where you see a clinician in a sort of intermittent, episodic way.”
With promising impacts on access and quality, how do digital behavioral health solutions stack up on costs?
“We generally tell our employers not to expect savings, and this is still the hottest, most important benefit they put in place for their people—hard stop,” said Steve Blumenfield, head of Innovation and Acceleration at Willis Towers Watson. “Because the need is so vast, the access to care need is vast, but the good news is that there is a trajectory potentially to bring some costs down here.”
The key to putting the costs of digital behavioral health in context, Blumenfield explained, is a holistic understanding of its value. It can prevent disability and absenteeism while addressing population-level harms of depression, anxiety, and substance use. As it stands, the growing demand for behavioral health services has the potential to force changes to the fee-for-service model that has hindered innovation in traditional health care delivery.
“If we keep on having this conversation just about cost and not about outcomes and not about value, we'll continue to be in the same position we are today,” said Chekround.
Go deeper on this topic with HBHI’s 'Conversations on the Business of Health' webinar from Dec. 16. Watch it here.