Tag: telehealth

Online CBT Improves Depression Symptoms

Posted on by Jason Barry

Amid a recent flurry of reports calling into question the effectiveness of virtual cognitive behavioral therapy, a new study published in JAMA Network Open found that computer-assisted CBT (CCBT) does in fact improve depressive symptoms in primary care patients.

  • Methodology – The study included 175 adult primary care patients at the University of Louisville who had scored 10 or higher on the Patient Health Questionnaire-9 (27 point scale), indicating at least a moderate case of clinical depression. Nearly 62% of participants made less than $30k/year, while 74% did not graduate from college.
  • Interventions – Participants were randomly assigned to CCBT or treatment-as-usual groups (TAU) for 12 weeks of active treatment, as well as 3- and 6-month follow ups. CCBT included 9 online CBT lessons and weekly 20-minute teletherapy visits, in addition to TAU, which included in-office treatment at the primary care practices. 
  • Results – CCBT led to significantly greater improvement in PHQ-9 scores than TAU (mean difference: -2.5), with the positive results maintained at 3-month (-2.3) and 6-month follow-ups (-3.2). CCBT remission rates were more than double TAU at all time points.

Conclusions and Relevance

This study was particularly interesting because of the treatment’s sustained results and because its participants largely came from groups that are often underrepresented in CCBT research. Although the study had some limitations (treatment-as-usual as a control can’t compare CCBT to regular CBT), the results suggest that CCBT has the potential to be particularly valuable for patients in diverse primary care settings.

Amazon Expands Telehealth Services Nationwide

Posted on by Jason Barry

It’s never great to hear that a competitor with deep pockets and an army of engineers is pushing into your market, and this week Amazon gave companies in the employer telehealth space a lot to be nervous about.

After launching as an internal service in 2019, Amazon is now expanding its Amazon Care health offering to employers across the US amid “growing demand” for hybrid care.

Amazon Care’s hybrid model consists of two main elements:

  • Telehealth-based primary care delivered by a dedicated Care Medical doctor
  • Nurse practitioners dispatched to patient homes when medical needs can’t be resolved over video

Virtual services are now available nationwide to meet the needs of Amazon Care’s growing roster of employer clients, which now includes TrueBlue and Whole Foods Market (a fairly self-congratulatory announcement considering Amazon acquired the grocer in 2017).

In-person services are also expanding beyond the 8 existing locations (Seattle, Baltimore, Boston, Dallas, Austin, Los Angeles, Washington, DC, and Arlington), with Amazon planning to bring its nurse practitioner network to 20 additional cities by the end of the year, including San Francisco, Miami, Chicago, and New York City.

Industry Impact

The telehealth landscape is crowded with companies promising to improve outcomes with video visits, but Amazon Care’s in-person component could prove to be its biggest differentiator.

The hybrid model allows Amazon to keep patients within its ecosystem when in-person care is needed, building off the logistical expertise of its retail business to coordinate at-home and virtual care. Amazon is aiming to make ordering healthcare as seamless as ordering any other product off of Amazon.com, a patient experience that the company could be uniquely positioned to pull off.

New HHS Data Highlights Telehealth Disparities

Posted on by Jason Barry

A new report from the HHS’ Office of the Assistant Secretary for Planning and Evaluation found that although telehealth use remains drastically elevated from pre-pandemic levels, access challenges are equally persistent.

The analysis stems from the Census Bureau’s Household Pulse Survey, which had a total of 808k US adult respondents between April and October 2021.

Overall, 23.1% of respondents reported using telehealth over the past month, with use levels similar among most demographic subgroups.

  • The lowest telehealth use was among those who were uninsured (9.4%) and young adults between the age of 18 and 24 (17.6%).
  • The highest telehealth use was among those with Medicaid (29.3%), Black patients (26.8%), and those earning less than $25k (26.7%).

The most significant disparities began to emerge when examining the modality used by different subgroups.

  • The share of telehealth visits by video was highest (meaning the share by audio was lowest) among those between the ages of 18 and 24 (72.5%), college graduates (67.4%), beneficiaries of private health plans (65.9%), and white respondents (61.9%).
  • The share of telehealth visits by video was lowest among those without a high school diploma (38.1%), adults ages 65 and older (43.5%), and Latinos (50.7%).

The Takeaway

Although reports on telehealth disparities are unfortunately quite common, the HHS survey’s modality analysis highlights the need for new strategies to ensure equitable access to video visits.

Audio visits lack several advantages of video visits, including the ability for providers to pick up on nonverbal communication or check on a patient’s home environment. As a result, the authors emphasize a need to keep barriers such as device ownership, broadband access, and digital literacy at the forefront of future regulatory conversations.

Calm Acquires Ripple, Appoints New CEO

Posted on by Jason Barry

Wellness company Calm announced the acquisition of Ripple Health Group as it becomes the latest meditation app developer to set its sights on the healthcare market.

While the terms of the acquisition were not disclosed, Ripple’s CEO David Ko will now serve as Calm’s co-CEO alongside Calm co-founder Michael Smith.

  • Calm’s app provides users with audio content that helps them reduce stress, improve sleep, or strengthen their overall mental fitness. Calm’s 100M downloads make it the most popular meditation app of all time.
  • Ripple is the developer of a pair of apps that aim to reduce the burden of caregiving. Care Memo allows patients to communicate with their care teams, while LikePaper helps users organize medical information and set reminders.
  • Following the acquisition, the Ripple team will focus on building Calm Health, an upcoming employer solution designed to support employee mental health that will replace Calm for Business after its launch later this year.
  • Calm Health will include “content, community, and coaching to drive outcomes across the full spectrum of mental healthcare,” building on the lessons learned from Calm for Business, which covers over 20M lives.

The Takeaway
Unlike Headspace and Ginger’s merger from late last year, which aimed to reach the meditation app’s large user base with additional teletherapy services, Calm’s acquisition of Ripple was geared more towards obtaining talent than existing products. The Ripple team and the appointment of Ko as CEO should help to accelerate Calm’s push into the mental health space, and Calm Health is now a core focus of the company’s product roadmap.

Talkiatry Raises $37M to Fuel Nationwide Expansion

Posted on by Jason Barry

Telepsychiatry startup Talkiatry recently announced the completion of its $37M Series A funding round, which it will use to scale its strategy of offering psychiatric care as an in-network benefit with payors.

  • Talkiatry’s platform guides patients through an online survey before matching them with a staffed psychiatrist based on the results, offering continuous virtual care from diagnosis to medication and ongoing support.
  • Many psychiatrists don’t participate in private health plans due to minimal reimbursement and paperwork headaches. Only 62% of them are willing to work with payors while just a third will accept new patients using Medicaid.
  • Talkiatry’s solution to this problem is to bring psychiatrists on board as W-2 employees as opposed to contractors, offering stability while streamlining administrative tasks. Since launching in April 2020, the company has hired 190 providers and conducted over 60k visits.
  • The funding will help Talkiatry expand beyond its home state of New York and continue to aggressively hire psychiatrists to meet the needs of its payor contracts that currently cover more than 200M lives.

The Takeaway

Nearly every startup in the behavioral health space is addressing a common issue: the supply-demand imbalance for providers. Many companies have turned to recruiting therapists in place of psychiatrists, despite the fact that only psychiatrists can prescribe medication.

By avoiding the contractor model, Talkiatry is finding success in attracting these highly sought after providers, and so far the approach appears to be scalable. Over 83% of the psychiatrists in the company’s pipeline have actively applied to join the team.

eConsult Company AristaMD Acquires Preferral

Posted on by Jason Barry

Lack of availability for specialist appointments is a growing problem that’s hard to tackle by just adding video calls or improving referral systems, but AristaMD believes that a combination of both solutions will move the needle in the right direction.

eConsult company AristaMD announced the acquisition of referral management startup Preferral to help address the 20% of referrals that it reports are misdirected and the 50% of referrals that “are often unfulfilled.”

  • AristaMD’s eConsult platform allows primary care physicians to submit a case to a contracted team of over 300 specialists, who then have 24 hours to review it. The patient’s clinical history, lab results, and images are provided to allow the specialist to return a treatment pathway during the one-day window.
  • The model is able to operate due to the fact that peer-to-peer asynchronous consultation is an informational consult, meaning that the specialist does not have to be licensed in the patient’s state. AristaMD works with health plans that offer eConsults as benefits, as well as health systems that use the platform to facilitate collaboration.
  • Preferral’s solution enables PCPs to easily send a referral to a specialist and confirm receipt with both the originating practice and the patient, eliminating avoidable complications that result from busy clinics using fax machines and follow-up calls to coordinate referrals.
  • Combining AristaMD’s eConsults with the Preferral platform will create a comprehensive physician-to-specialist referral solution, complete with reviews for prior authorization, scheduling, and interim care plan support.

The Takeaway

The acquisition of Preferral greatly improves the referral management component of AristaMD’s eConsults service, reshaping it as a comprehensive platform with the ability to improve access to specialists while expediting treatments.

Anchors Improve App-Guided Meditation

Posted on by Jason Barry

Although previous mental health research has shown numerous benefits to persistent app-guided meditation practices, few users consistently engage at a level necessary to attain the benefits.

A recent study published in JMIR investigated whether anchors help to establish a persistent app-guided meditation routine, allowing more users to realize the complete benefits.

Anchoring is the pairing of app-guided meditation with an existing daily routine to help develop the practice as an unconscious habit and improve consistency. Example anchors used in the study include “after I finish breakfast in the morning” or “after I finish my coffee in the afternoon.”

Methods – Researchers randomly assigned participants to one of three study groups, which each received reminders to meditate for at least 10 min/day using the Calm app and one of the following anchoring strategies:

  • personalized anchor group (PA, n=56) – could select from a list of possible anchors
  • fixed anchor group (FA, n=49) – was assigned a specific anchor
  • control group (n=62) – did not use any anchoring strategy

Results – During the 8-week intervention, the FA group had significantly higher odds of daily meditation than any other group (1.14 OR), and all participants experienced a linear decline in daily meditation (0.96 OR). Interestingly, the FA group also showed the smallest decline in daily meditation odds during an 8-week follow-up, suggesting that assigned anchors may improve meditation consistency more than self-selected ones. This chart highlights the results nicely.

Impact – Meditation apps are among the most scalable treatments for a variety of disorders, and could have the potential to help level the supply-demand imbalance between mental health providers and patients. Despite their promise, high attrition among app users is a large barrier, but positive results such as these continue to help address the issue.

The State of Telemedicine Adoption

Posted on by Jason Barry

While we publish new telehealth trends virtually every week, Rock Health consistently adds more color to these stories with its deep dives into funding and consumer preferences. Its latest research in collaboration with the Stanford Center of Digital Health is no exception.

Rock Health’s annual Digital Health Consumer Adoption Survey of 8,000+ US adults sheds more light on self-reported digital health behaviors, exploring three core insights with plenty of charts included for the visual learners:

INSIGHT #1: Future care models will increasingly integrate asynchronous modalities. (Chart 1)

  • 51% of this year’s respondents have used live video telemedicine, making it the most used modality over audio-only or text-based care.
  • Rock Health predicts that asynchronous non-video modalities will gain popularity because they enhance clinician efficiency and enable proactive continuous care

INSIGHT #2: Telehealth satisfaction remains high but is trending downward. (Chart 2)

  • 43% reported greater satisfaction with live video calls compared to in-person care, down from 53% in last year’s survey.
  • The authors attribute the decline to the changing expectations around telemedicine as an alternative to care, rather than as a needed replacement.

INSIGHT #3: High telemedicine adoption skews towards the young and wealthy. (Chart 3)

  • Telemedicine adoption is highest among high income patients aged 18-44, underscoring gaps related to broadband access, device ownership, and digital literacy.
  • To address these gaps, Rock Health suggests that innovators understand the population they’re building for, and what factors drive that group’s adoption.

Telemedicine’s Path Forward

The survey suggests that telemedicine is beginning to focus on personalized treatments that address the nuanced needs of individuals, serving as a tool for care rather than a business model. Rock Health holds an optimistic view about the future of telemedicine, and with more scalable and equitable solutions hitting the market every day, that’s a safe stance to take.

Cerebral Raises $300M for Digital Mental Health

Posted on by Jason Barry

Online mental healthcare provider Cerebral announced the close of its $300M Series C round, raising the company’s valuation to $4.8B within two years of its launch.

  • Cerebral is a “one-stop shop” for comprehensive digital mental healthcare and wellness, offering support for depression, anxiety, and post-traumatic stress disorder among other illnesses.
  • Monthly subscription plans give members access to Cerebral’s team of over 2,000 clinicians, lowering barriers to care through its virtual platform combining therapy and medication management for full-service support in the home setting.
  • The funding will be invested in new services such as schizophrenia management expected to launch in 2022, as well as strategic partnerships and international expansion.
  • Advancing partnerships with employers and payors is another priority for the funds, with Cerebral’s new Chief Impact Officer, Simone Biles, enrolling to help on this front after withdrawing from the Tokyo Olympics to focus on her own mental health.

Industry Impact

In-person mental health facilities were heavily impacted by the pandemic, experiencing capacity constraints that frequently led to month-long wait times to see a provider. This created a window for digital providers to address the care gap, with Cerebral reporting that the wait times for its  “instant live” visits are now just over five minutes.

Large amounts of capital continue to be directed towards the mental health space, and more M&A announcements from its well-funded startups are likely to follow as companies like Cerebral aggressively compete for contracts with employers.

SWORD Raises $163M for Virtual MSK Platform

Posted on by Jason Barry

Digital musculoskeletal (MSK) care provider SWORD Health raised a $189m Series D round, making the startup the latest digital health “unicorn” by lifting its valuation to $1.8b.

Based on SWORD’s fundraising pace, it’s safe to say the pandemic has been a boom for virtual MSK solutions. The company closed a $25m Series B in January, followed by an $85m Series C in June, and the recent funding pushed its outside capital total to over $324m.

SWORD offers a suite of personalized MSK solutions that includes:

  • ASK a PT – 24/7 remote access to physical therapists for general questions
  • Digital Guardian – Applies wearables and video monitors to guide safe workouts
  • The Academy – Customized educational content

The virtual-first approach is designed to reduce preventable surgeries for patients while driving value for risk-taking customers such as payors, employers, and health systems.

SWORD CEO Virgilio Bento founded the company in 2015 after seeing first-hand the “challenges that families face when they have to recover a loved one.” The WHO estimates that close to 2 billion people suffer from MSK conditions globally, creating a lot of room for multiple companies to emerge as leaders.

Digital MSK startups have attracted significant investor attention in recent months, with Hinge Health securing $600m to expand its online MSK platform, and Kaia Health raising $75m for its no-hardware-needed rehabilitation programs.

The Takeaway

SWORD prides itself on being “the industry’s only end-to-end digital MSK solution” (but then again, so does Hinge), and it will need to demonstrate that its hybrid approach offers a superior return on investment than competing strategies. If it can accomplish this, then the new funding should give it strong positioning within an MSK market that is quickly establishing itself as one of the top telehealth use cases.

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