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Pithiatism Redux

BY MARTIN SAMUELS

Those of us in medicine have all seen the famous painting of the Tuesday afternoon lessons at the Salpȇtrière in Paris in the 19th century. In Pierre Aristide André Brouillet’s painting, one can clearly see the great professor, Jean-Martin Charcot, holding forth while the patient, Blanche Whitman, is being supported by a tall young man, Joseph Jules Francois Felix Babinski, the Chef de Clinique (the chief resident) and allegedly the favorite to succeed Charcot. He never did as he was failed repeatedly on the exam necessary to become a faculty member at the university by a jealous, xenophobic, anti-immigrant rival, Charles Bouchard. Babinski was born in France and served in the army twice, but his name was Polish as his parents had emigrated to France to escape bias in Poland (sound familiar?).  Ironically almost no one remembers Bouchard (his only contribution being the Charcot-Bouchard aneurysm which may be the cause of some intracerebral hemorrhages), but there is no doctor on earth who does not know Babinski’s name. This is one of many reasons why Babinski is my neurological hero.  

A Clinical Lesson at the Salpêtrière, Pierre Aristide Andé Brouillet
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Big Health’s Softbank Money, FDA Board Member Send Strong Signals About Digital Therapeutics Market

By JESSICA DaMASSA, WTF HEALTH

With a $75 million investment from Softbank last week, and the addition of former FDA Deputy Commissioner Dr. Anand Shah to its Board of Directors this week, Big Health has sure kicked 2022 off with some noise! But, this is more than just big news for Big Health as CEO Peter Hames is here to tell us. This is a story about the market potential for an all-tech approach to mental health care, AND an important endorsement for digital therapeutics – specifically, those that do NOT require a prescription.

Big Health sits at the intersection of two of the hottest health-tech markets: digital mental health care and digital therapeutics. Its approach, via apps Daylight (for anxiety) and Sleepio (for insomnia), has been flagged as unique because 1) unlike other leading digital mental health companies like Headspace Health or Lyra Health, Big Health’s approach to care is tech-driven and does not depend on coach or clinician intervention, and 2) unlike its digital therapeutics rivals, Pear Therapeutics or Click Therapeutics, Big Health’s business model isn’t relying on prescriptions to get paid.

Big Health is, in other words, proving the market potential for a different “breed” of tech-first, PBM-backed digital therapeutics, and I ask Peter about it head-on as we discuss Softbank’s investment. The mega-fund has placed bets on all sides now, having invested in Cerebral, which delivers clinician-first mental health care and prescription medication, and prescription DTx company Pear, which went public in December 2021. So, what should the market make of the fact that Softbank sees room for Big Health alongside Cerebral and Pear? How have high-profile deals with CVS Health and the NHS in Scotland proven out the model? And, what does the addition of Anand Shah (and his insider perspective on the FDA’s sentiment toward digital therapeutics) indicate about what’s ahead when it comes to the regulatory environment for DTx in the future? So many market dynamics at play, so much to talk about!

The Intersection of 911 and 988: Decriminalizing Mental Health Crises

By BEN WHEATLEY

Effective July 2022, a new three-digit telephone number (988) will become the number to call in the case of mental health emergencies. Currently, 911 serves as the default number for people to call, placing the acutely mentally ill on a direct track toward police involvement. The new system is meant to ensure that every person experiencing a mental health crisis will receive a mental health response instead—help, not handcuffs.

In November 2021, 15 prominent organizations including NAMI (the National Alliance on Mental Illness) and Well Being Trust joined together to reimagine what a crisis response system might look like. Their Consensus Approach included the response to mental health crises, cases of suicidal behavior, and instances of substance use disorder. They argued that “Without a systems approach to transformation, simply implementing a new number to call will have little impact on those who are in need.” 

The Consensus Approach detailed seven critical pillars upon which a new crisis response system could be based, including Equity and Inclusion, Integration and Partnership, and Standards for Care. Pillar #4 stated that “Law enforcement should take a secondary role in crisis response.” This, they said, would be “a paradigm shift” that recognizes mental health conditions as “matters of health care, not criminal justice.” 

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Rcube Health’s ‘Resony App’ Catches Bayer Support for Mental Health DTx for Resonance Breathing

By JESSICA DaMASSA, WTF HEALTH

Digital mental health startups are leaning into the fact that mental health care is not “one-size-fits all” and, as a result, we’re seeing new offerings hit the market that seek to combine typical therapies and their human-plus-machine delivery in novel ways in order to better meet different patient needs. In this interview, we hear about Resony, a digital therapeutic that’s tackling anxiety and stress through a completely autonomous, AI-driven program that brings together resonance breathing and physical relaxation exercises with cognitive behavioral therapy. In other words… working on the physical side of that mind-body connection for the overall benefit of mental well-being.

Resony is just the first DTx coming out of Rcube Health, one of four early-stage startups that have gained the backing of Bayer G4A as part of their Digital Health Partnerships Program Growth Track. CEO and co-founder Ravi Janapureddy introduces us to the business that he’s building on the thesis that true scalability for digital therapeutics in mental health care relies on full automation – no clinical intervention. In a crowded space, how will Resony stand-out as a stand-alone business, instead of a ‘feature’ for a larger, full-service virtual-first mental health care provider? Is this where Bayer might see the opportunity for an “around the pill” or “alongside the pill” approach? Another digital mental health use case to explore!

988: A New Lifeline for Mental Health Emergencies

By BEN WHEATLEY

Miles Hall, a 23-year-old Black man experiencing a psychotic episode, was shot and killed by police after 911 received calls of a disturbance in his Walnut Creek, California neighborhood. His mother Taun Hall had taken steps to warn the local police that her son had been diagnosed with schizoaffective disorder and that he might be prone to mental health crises. She believed she had done enough to ensure that, in the event of a crisis, her son would be treated with care. But when the crisis came, authorities viewed Miles’ behavior through the lens of public safety, not through the lens of mental health, and it cost him his life. 

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Rumor Check with Vida Health’s CEO: Buyer Sentiment on Virtual Care, At-Risk Models, Mental Health

By JESSICA DaMASSA, WTF Health

To hear Vida Health’s CEO Stephanie Tilenius talk about what she’s hearing from payers, providers, and employers about at-risk value-based models, the shift to virtual care, and the growing importance of mental health services as a culture-builder for businesses forced into a part-virtual-part-in-office world, you get a sense of how her past work leading the various payments and commerce businesses of Google, eBay, and PayPal probably comes in handy. For example, the shift to virtual care, she says, is, “like the Internet in 1999…It’s happening.”

We get an update on exactly how Vida Health is making it happen themselves, and how they expect their newly expanded at-risk model will help. Vida’s always been fees-at-risk on physical outcomes related to diabetes management, hypertension, etc. BUT the mental health side of their offering (which experienced 6000% growth year-over-year during the pandemic) is now at-risk on outcomes too. With so much happening across the industry to move to value-based models, we deep-dive with Stephanie to hear what she’s hearing from her clients, including client-and-investor Centene and hear about growth in the employer market where she sees a major shift in how employers are thinking about healthcare as the new sexy job perk. “Instead of snacks or transportation or other benefits,” says Stephanie. “It’s all about healthcare.”

It takes a pandemic: Mental Health parity may finally have its day!

By EMILY EVANS

Emily Evans is the health policy guru at equity research company HedgeEye. She sends out these reports in emails to her clients regularly but (since I asked nicely) she allowed me to publish this one from late last week on THCB. You can catch Emily in person on the “How Much Are These Companies Really Worth? The IPO & SPAC Panel” at Policies|Techies|VCs–What’s Next for Health Care, the conference Jess Damassa & I are chairing on September 7-8-9-10 — Matthew Holt

Politics. President Biden is going to have more important things to do this week than worry about the mask/vaccine wars. At some point though, probably soon, Biden will need a scapegoat at the CDC. Several reversals on guidance around masks for the vaccinated and the unvaccinated have left local governments confused and people, most notably, parents of school age children, angry. The spread of the Delta variant isn’t helping matters.

While there may be political motivations for some of CDC Director, Dr. Rochelle Walensky’s guidance. A better approach, this last week anyway, would be never assign to cunning that which can be explained by incompetence.

Bringing a large, sprawling bureaucracy into line after a decade or more of being considered irrelevant is not a simple matter. It is made particularly difficult by the agency’s remote location in Atlanta to which Dr. Walensky commutes. 

For the time being eclipsed by a messy exit in Afghanistan, the CDC’s failures are still being noted by longstanding supporters of the agency like former Food and Drug Commissioner, Scott Gottlieb. As the Delta variant follows the same summer path as Alpha from south to north and break-through infections become identified as more common than previously thought (though mild for the vaccinated), the pressure to get the CDC reorganized will grow.

The good news, notwithstanding the vitriol over mask wearing and vaccine mandates, is the assumption underlying the CDC’s guidance on masks/vaccines is that children will be going to school and college students to class. It is, we can all hope, the first step in recognizing that there is no Zero-COVID; no magic bullet; just adaptation and adjustment, something at which humans excel.

Policy. Last week, the Department of Labor simultaneously filed and settled a lawsuit against UNH for violations under the Mental Health Parity and Addiction Equity Act of 2008. The dollar value of the settlement was immaterial but United HealthGroup (UNH) agreed to take corrective action which will be substantive.

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#Healthin2Point00, Episode 225 | Amwell acquires SilverCloud & Conversa – plus more deals

Today on Health in 2 Point 00, we have a deal so big it’s brought me out of vacation just for this episode! Amwell acquires not one, but TWO companies – DTx mental health company SilverCloud Health and chatbot company Conversa Health for a combined $320 million. In other news, mental health company Sondermind raises $150 million, bringing their total to $188 million, and femtech company Elvie raises $80 million, bringing their total to $133.9 million. —Matthew Holt

Ofer Leidner, Happify Health

by MATTHEW HOLT

Happify Health is a online mental health company that is focused almost exclusively on scaling care by offering self-service tech solutions across the patient journey. After R&D starting in 2012, they’ve been scaling since 2017 and now are working with large employers and big health plans. What they don’t do is have their own therapists or psychiatrists. This is an interesting approach and probably much more scalable than many of their competitors. Today they raised $73m more to build out their solutions. I talked to Happify Health’s President, Ofer Leidner about how far they can go with automated self-service. He thinks it’s a long way.

Modern Health’s CEO on Becoming Digital Mental Health’s Latest Unicorn

By JESSICA DaMASSA, WTF HEALTH

Digital mental health startup Modern Health just closed a $74M Series D, bringing their funding total to $170M, and earning the company a $1.17B valuation that makes it the FASTEST-EVER female-founded company to hit unicorn status. CEO Alyson Watson explains what sets Modern Health apart in the incredibly crowded, well-funded, and highly-competitive mental health tech space where the growing issue of skyrocketing demand for care is likely soon to become a shortage of care providers.

Modern Health is hoping to win here by becoming a one-stop-shop for a full-suite of mental health services. They’re bundling together all the different kinds of mental health point solutions currently out there – from tech-enabled self-service cognitive behavioral therapy programs and peer-to-peer group therapy all the way to one-on-one virtual visits with clinicians – and differentiating by designing a better way to intake patients, so care can be more accurately and cost-effectively matched to patient needs. Says Alyson, “If you’re just solving mental health through the old-school way of connecting someone to a therapist, and that’s your be-all-end-all and your only solution…well, eventually, that bubble will burst.”

Founded in 2017, the company has grown both its client-base (220 employers) and coffers quickly. They’ve already acquired Kip, another digital mental health biz, and are looking for more. Tune in to hear what Alyson’s got on deck for 2021 and what she expects to be driving further growth in the mental health virtual care market.