Get-to-Market Health Founder Steve Shihadeh

Artificial Intelligence

AI Therapists in VR Help With Provider Shortage

New research in npj Digital Medicine suggests that virtual reality might be part of the answer to the nation’s mental health provider shortage, as long as patients don’t might if their therapist is an AI avatar.

The small study had 14 participants with moderate anxiety or depression undergo immersive therapy sessions led by a trained digital avatar developed by Cedars-Sinai.

Known as XAIA, or the eXtended-Reality Artificially Intelligent Ally, the program provides a way for patients to self-administer conversational therapy in relaxing virtual reality environments, such as a creek-side meadow or a sunny beach retreat.

• It’s unclear what the therapist avatar actually looks like, but we’re going to choose to believe it looks like this picture of XAIA in the diagram of the conversation logic.

Throughout the 30-minute therapy sessions, with topics ranging from loneliness and family problems to financial distress, XAIA successfully applied key psychotherapeutic techniques:

• Observations that reflect an understanding of the user’s issues; Ex. “Your worries about your health and your living situation are clearly causing you a lot of distress” 
• Normalizing feelings; Ex. “It’s understandable to feel like a failure when life gets rough”
• Showing empathy; Ex. “It must be a challenging time for you”
• Validation and praise where appropriate; Ex. “Your practice of not taking these relationships for granted is truly commendable”

Participants frequently responded to XAIA as if it were a human therapist, sharing raw emotions like, “I feel like I’m a failure. The only thing I have to look forward to – I know you’re going to laugh – is to go see Taylor Swift … I’m sorry I’m crying.”

• XAIA’s response: “Firstly, there’s no need to apologize for crying. These feelings are valid.”

Most participants described XAIA as approachable, empathetic, and intelligent, but it’s worth noting that a few mentioned they would still prefer a human therapist if given the choice.

The Takeaway

Although this wasn’t exactly the largest study we’ve ever covered, the results provide early evidence that a combination of VR and AI therapy could be part of the solution to balancing behavioral health’s supply and demand equation. Over half of people facing mental health disorders aren’t getting the treatment they need, and if XAIA isn’t already a clearly better alternative than no treatment at all, new advances will only make the AI+VR path more promising going forward.

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The Wire

• Neuralink’s Successful Human Implant: Elon Musk’s Neuralink has successfully implanted its first brain chip in a human, arriving less than a year after the device received FDA approval for trial. Musk turned to his own X platform to reveal that the patient is “recovering well,” adding that the “initial results show promising neuron spike detection.” The first use cases for Neuralink will center around allowing quadriplegics to control devices using human-brain interfaces, but the more Matrix-y goals are already on the roadmap.  

• Vytalize & WellSky Join Forces: VBC enabler Vytalize Health is joining forces with WellSky to optimize its value-based care outcomes using WellSky’s Next Generation Provider suite for sharing information across care settings and discharging patients to high performing post-acute facilities. WellSky will connect Vytalize physicians to its network of over 2,000 acute and 130,000 post-acute providers, helping ensure that hospital care teams are referring patients to best-fit providers at the point of discharge.

• First Alzheimer’s Transmission: Scientists documented the first-ever cases of transmitted Alzheimer’s, which was tied to a no-longer-used medical procedure but still raised important questions about the causes of the disease. The patients identified in the study had each received growth hormone from the brains of human cadavers before going on to develop early-onset Alzheimer’s, despite no genetic predisposition. The researchers emphasized that this doesn’t mean Alzheimer’s is contagious, but it provides the first evidence that the condition can be transmitted through medical care.

• Cognito Closes $25M: On a more positive note for Alzheimer’s-related research, medical device startup Cognito Therapeutics closed a $35M Series B extension to advance its headset for treating neurodegenerative disease. Cognito’s Spectris headset uses gamma frequency light and sound stimulation to combat cognitive decline, and it’s now hoping that its $128M in total funding will be enough to take the headset through the remainder of its active trial before submitting it for review before the end of 2025.

• ML Utilization Predictions: A study in Nature demonstrated that a machine learning approach can predict avoidable ED and hospital utilization for Medicaid patients with 90% accuracy. The Waymark Signal model included in the research looks at “patient risk trajectories,” social factors, and healthcare utilization to determine which patients are likely approaching a costly visit. When compared to CMS data from 2017-2019 across 26 states, Waymark Signal was 3x better at identifying at-risk patients and 10x better at predicting costs than conventional Medicaid risk models.

• FDA Elevates Digital Health Super Office: The FDA is reorganizing to keep up with the amount of health-tech innovation heading its way, including an expansion of the office that oversees digital health. The FDA is now calling the Office of Strategic Partnerships and Technology Innovation (OST) a “super office,” with new divisions focused specifically on digital health and medical device cybersecurity. The OST now covers digital health, supply chain resilience, technology and data, readiness and response, and health equity.

• Atrium Virtual Care: Atrium Health put out a whitepaper outlining the 30+ virtual care programs that it uses to treat patients and expand access to its services, providing a candid look at its successes and challenges. The North Carolina-based system’s virtual care initiatives span across virtual nursing, school-based clinics, behavioral healthcare, primary care, and hospital-at-home. Atrium’s hospital-at-home program is its “signature virtual care platform,” and has reportedly served over 8,400 acute care patients while avoiding over 30k bed days.

• Chatbots for Suicidal Ideation: New research in npj Mental Health found that over half of the 1,006 students suffering from loneliness and suicidal thoughts benefited from using a chatbot named Replika. The Replika generative AI model expanded a library of scripts written by clinical psychologists at UC Berkeley to address common therapeutic exchanges and investigate areas like emotional processing and perceived social support. Perhaps the most impressive finding was that Replika prevented 3% of the participants from acting on suicidal thoughts.

• No Surprises Act Delivers Surprises: A payor survey from AHIP and the BCBS Association estimates that the No Surprises Act blocked more than 10M unexpected medical charges through the first nine months of 2023. Although that pace is a surprise in and of itself, the survey also called out the “growing and troubling trend” of claims going through the independent dispute resolution process established by the No Surprises Act. Regulators estimated we’d see about 17k IDR cases annually, yet almost 670k cases were submitted to IDR between January and September of last year.

• Valendo Launches Out of Redesign: Virtual diabetes care startup Valendo Health is the latest company to spring out of Redesign Health, launching with $4M in seed funding and a pair of provider partnerships. Valendo is a value-based endocrinology enabler that equips providers with tools to increase clinical capacity and revenue through virtual care and practice management support. Its debut partners include Cecelia Health (national virtual specialty care provider for chronic care management) and Advanced Metabolic Care + Research (SoCal-based endocrinology center).

• Health Worker Exodus: COVID-19 had an obvious impact on the US healthcare workforce, but a new study revealed just how many of the US’ 18.8M healthcare workers left the profession during the pandemic. In JAMA Health Forum, researchers analyzed healthcare worker exit rates from 2018 to December 2021, finding that the Q1 2020 exit rate was well above 2018’s quarterly mean (8% vs. 5.9%), and the Q4 2021 exit rate was still far higher than the baseline 2018 period (7.7%).

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