AWS Healthcare Response Part 5: Collaborative Mental Health Support

Nothing accelerates innovation more than challenges that need to be overcome. Over the last few months, the global healthcare industry has stepped up to the occasion: health systems have been deploying innovative solutions to keep their staff safe and improve patient outcomes, startups have been launching or scaling life-saving technologies, and regulatory bodies such as the Food and Drug Administration (FDA) have been issuing emergency use authorizations to permit adoption of these technology solutions.

Responding to requests from multiple healthcare organizations around the world, we introduced a series of webinars featuring vetted enterprise-ready startup solutions built on top of AWS and focused on helping healthcare providers navigate the challenges surrounding COVID-19. Below is the last in a series of blog posts that shines a spotlight on featured innovative startups. Dive deeper into their solutions, catch up on their presentations via webinar recordings, and get in touch if your healthcare organization needs help. Bringing awareness to these ready-to-deploy technologies may help arm the global healthcare community with the right tools to withstand the challenge.

By Jelena Joffe, AWS Connections, Global Startup Business Development & Corporate Innovation

Did you know that 1 in 5 people in the US [1] and 1 in 10 worldwide [2] have a mental health condition? And that only an estimated one third of people affected by a mental health condition receive evidence-based care [3]?

According to WHO constitution, mental health is an integral and essential component of health – a state of complete physical, mental and social well-being – not merely an absence of a mental disorder [4]. Nearly 800 million people worldwide suffer from mental health disorders, the most prevalent conditions being anxiety disorder and depression[5] (both of which cost the global economy $1 trillion in lost productivity each year[6]). Depression is also a leading cause of disability worldwide and puts people at 40% higher risk of developing chronic conditions [7].

Talking about mental health, WHO advises, can both help decrease the stigma around it and improve access to care [9]. By raising awareness of the new technologies that offer easy access to and help providers deliver evidence-based mental health support, we hope everyone who needs care will be able to get it.

Quartet Health, NeuroFlow, and Eleos Health, AWS-based startup partners, share their collaborative technology solutions that all contribute to a vision of delivering personalized, effective, easy-to-access mental health support. This couldn’t be more relevant as people around the world grapple with anxiety, isolation and stress caused by the pandemic.

Quartet Health offers an integrated mental healthcare approach, bringing together patients, providers, and payers and leveraging analytics to identify the right patients to match them with the right care at the right time. NeuroFlow has developed a digital health technology and analytics platform that improves patient outcomes through effective monitoring, positive reinforcement and targeted guidance. Eleos Health has pioneered the use of AI-based voice analysis to seamlessly improve the clinical experience and help deliver personalized behavioral health at scale, empowering clinicians with actionable insights and improving access to evidence-based care.

NeuroFlow: Founded by a veteran, NeuroFlow is a health technology and analytics company that understands the importance of access to mental health in different populations and care settings. It enables patient engagement in own behavioral health resulting in improved patient outcomes, overall wellness, and cost of care. NeuroFlow has been also named the “Best Overall Mental Health Solution” in the 2019 MedTech Breakthrough Awards program.

Most organizations face common challenges in providing mental health support: low profits and high operating costs, provider and expertise shortage impacting access to care, and stigma limiting patient engagement and openness to seek help. NeuroFlow approaches these challenges by bringing their collaborative technology and ecosystem directly to clinics (primary care, mental health systems, hospitals, government and military partners) and care teams (physicians, behavioral health specialists, and care managers). Through the tools integrated into EHR systems (athenahealth, EPIC, Cerner, and others) and a patient-facing application that drives measurement and engagement, care teams are able to receive AI-driven insights on the patient’s mental well-being and act on them in a timely manner.

NeuroFlow helps remove barriers and friction in mental health delivery in 3 main ways: through measurement, management, and motivation. On measurement side, their solution enables collecting more data more frequently, remotely tracking performance and risk stratifying population using validated assessments, and as a result adding more measurement-based care to behavioral health.

“It’s hard to attack the problem if we don’t know how big or pervasive it is.” – Julia Kastner, VP of Product at NeuroFlow.

On the management side, providing workflow tools to care teams ensures they can adjust treatment plans with integrated care and insights (incl. via EHR), manage patients more effectively and receive evidence-based personalized tools and resources automatically.

Finally, to motivate the patients to be more engaged in their behavioral health and overcome the stigma of a mental disease, NeuroFlow uses educational approach and behavioral “nudges”. NeuroFlow has leveraged marketing principles and behavioral economics to create a gamification engine that drives people into the application and allows providers to engage with patients in a more efficient way. Patients receive reward incentives and automated prompts to do assessments, quantitative tracking allows both patients and care teams to monitor progress, and content libraries feature personalized educational information and evidence-based activities. Higher engagement means better outcomes and NeuroFlow reports 79% of their users seeing a reduction in depression symptoms with an overall 72% user engagement rate.

This allows care teams to get a continuous holistic picture of a patient with a lot less effort and offers an ability to surface people who need the most care through automatic triggers and act accordingly.

In response to COVID-19, NeuroFlow’s clinical team was able to leverage their measurement and engagement methodologies to build a risk assessment and an anxiety screener, collect best practices on handling stress, social-distancing and isolation, and make them available via their app and a public-facing website.

Beyond general patient population, NeuroFlow have been also engaging with healthcare workers and first responders and providing resources to help address healthcare provider burnout. These resources were designed to provide education, build resilience and help frontline workers with symptom management to get through these challenging times.

NeuroFlow is already supporting US Air Force, Department of Veterans Affairs, Jefferson Health and 100+ other organizations. While mental health is important for everybody, according to one of NeuroFlow’s customers (Commissioner of the Philadelphia Fire Department, Adam Thiel): “There is still a gap in getting people to raise their hand, because sometimes the tendency is just ‘this comes with the job’.” According to the CDC, frontline workers (healthcare providers and first responders) may respond more strongly to stress in a crisis [10] and even before the pandemic data has shown burnout among health care providers to be higher than in other fields [11], with over one-half of physicians and one-third of nurses experiencing the symptoms [12]. Given the sudden increase in stress placed on frontline workers, encouraging them to engage in own mental health can’t be more relevant.

Use case: measurement, management, and motivation platform for mental health.

Eleos Health: Built by a team of veterans and supported by key strategic deployment partners, Eleos Health delivers personalized behavioral health therapy at scale while improving outcomes and access to care using voice analysis.

Eleos Health rightly notes that a mental health pandemic is on the heels of COVID-19. With a widespread stress, staggering unemployment rates, and major costs to health systems (60% of overall medical expenditures are driven by the 23% of members who have mental or substance use disorders), how does one improve patient outcomes within these constraints?

While today only 50% of clinicians are following evidence-based treatment approach [13], it represents one of the major ways to impact patient outcomes. Data shows that when clinicians follow evidence-based treatment plans, they see 50% increase in outcomes at 2x faster improvement rates. Current solutions, however, are manual, outdated, and fragmented, making it very difficult for a clinician to understand what exactly needs to be changed in the treatment plan to drive better outcomes. This is where AI-based voice analysis comes in to help.

According to Eleos Health, 45% of clinical improvement is associated with voice-related data and biomarkers. Eleos Health’s voice analysis looks at the proxy indicators associated with the two main areas that impact behavioral health outcomes – relationship (therapeutic alliance with the patient) and model or technique (evidence-based treatment). While clinicians conduct a tele-therapy or a face-to-face session, AI-based technology performs encrypted voice analysis, detects and identifies key metrics associated with the relationship and the model, and highlights actionable insights to the clinicians.

The system helps to improve outcomes through voice analysis and automated self-reported outcome collection, save time by auto-generating reports and treatment notes, reduce burnout of clinicians through automation and workflow integration, and accelerate clinical learning and supervision with time-stamped feedback (insights can be shared with integrated care teams and supervisors).

Eleos Health also offers a HIPAA compliant one-click tele-therapy platform with a dial-in solution for patient population struggling with technology, unlimited high resolution sessions, and a customized virtual “front door” for patient walk-ins. All data collection on the platform is done passively, which means clinicians can continue to provide care as they used to. Based on organizational needs, it can be used it as a stand-alone platform or be integrated into EMRs (electronic medical records).

Delivery of evidence-based care is augmented by integration into the key parts of a clinician’s work: from data intake, through intervention, to session prep and recovery planning. During the intake step, the system creates a baseline for future improvement and saves time on note-taking and administrative tasks. During the intervention, it provides nuanced real-time information to assist in clinician’s decision-making, show the outcomes, and correlate them to how care is provided. This allows clinicians to better prepare for the next session, view patients’ progress, and build personalized recovery plans.

Eleos Health has been actively engaged in providing response to COVID-19 related psychopathology. In one of their recent use cases, they’ve been working with UHS, an inpatient behavioral health hospital, to understand the type of therapeutic intervention that drives better outcomes with COVID-19-related stressors, create adjusted treatment plans, and demonstrate clinical improvement.

Eleos technology capability allows healthcare organizations to triage and prevent deterioration in at-risk patients as well as share best practices across the network on most effective personalized treatment plans. For clinicians, this solution acts as a personal feedback system, allowing to keep control over shared information and both receive and provide remote supervision. Most importantly, for patients the platform offers high-quality personalized care, accessed remotely in a secure way, with engagement in between the sessions.

To support COVID-19 frontline workers, Eleos Health launched Project Parachute, an open marketplace that connects clinicians who are willing to provide pro bono tele-therapy hours and frontline workers who are seeking help. The project has seen tremendous response in the community, with over 650+ clinicians already signed up across 40 states and over 400 successful matches made between clinicians and frontline workers – remotely, at no cost. If you know any healthcare providers or frontline workers who might benefit from this service, please help spread the word.

Use case: voice analysis and personalized mental health therapy at scale.

Quartet Health: On a mission to ensure that every person with a mental health condition can get the help they need, Quartet Health has raised $150M over the last 6 years (company currently valued at $497M) to build technology that empowers patients, providers and payers.

Historically, physical and mental health have remained siloed and treated as separate conditions. However, looking at the patient holistically can produce a strong benefit to the member in terms of a better quality of life, improve provider workflows making it easier to integrate physical and mental health conditions, and reduce cost of care for payers (i.e. health plans) who bear the risk for the patients (i.e. members). Data shows that mental health condition can add 2-4x more cost to the physical health treatment (e.g. think about a patient with diabetes and undiagnosed underlying depression – solving for a mental health condition will help with the treatment compliance, which will in turn improve health outcomes and keep the patient away from the emergency room).

While academic models have proven that integrating mental and physical health (esp. in primary care setting) leads to better patient outcomes, executing on these models is costly and difficult to scale (one can’t put a social worker or a psychiatrist into every primary care office around the country). Quartet Health found a way to leverage these insights and a modern age technology to scale what has been proven while empowering both demand and supply side of mental health to connect the dots.

On the demand side, Quartet Health realized early on that they needed to support those who already had established trust with the members: beyond primary care providers, these were care plan managers (who interacted with members every day) and other organizations or providers where vulnerable populations would come to seek help.

Recognizing mental health to be a stigmatized condition, Quartet Health has figured out an efficient way to provide an “easy button” for those working directly with members to get them the care they need at the right time. Advanced data and analytics identifies patients with both diagnosed and undiagnosed mental health conditions while proprietary SmartMatch algorithm matches patients to the most appropriate care provider. Quartet’s platform hence serves as a digital “front door” for all referral channels and triages the members into the right care option for them (e.g. tele- or in-person therapy or psychiatry). This adds more accountability for providers to accept the referral and connect the member to care.

On the supply side, Quartet Health offers a host of vetted mental healthcare options and empowers local behavioral health providers (incl. social workers and psychiatrists) to support their patients (pre, during and post-COVID-19). With the growing demand for remote care during COVID-19, Quartet is now able to support those service providers that have never used telehealth before: Quartet’s software allows them to receive patients remotely and track their progress.

“Mental health – Wild West in terms of quality measurement.” – Jeff Soffen, VP Strategic Growth at Quartet Health.

Quartet extensively focuses on value-based behavioral care via quality measurement, noting that mental health is a bit of a Wild West in terms of how one defines quality (Is the patient actually getting better? How is the provider performing?). Yet, it’s exactly these relentless efforts to raise the bar on proactive high quality treatments that allow Quartet deliver better quality of life to members, tools and resources to providers, and cost savings to health plans.

Quartet’s strategy includes a local approach to scaling nationally and builds on an enterprise BTB sales model. Partnering with health plans (its partners in scaling) and deploying software into the local delivery system of providers and members (its community of users), Quartet looks to work with local providers on demand and supply side and take this to a national scale. Some of their featured partners are both local (e.g. Blue Cross Blue Shield plans, with high density in their markets) and national (e.g. Centene).

Quartet’s latest study with one of the Blue Cross plans has shown significant savings compared to a control population ($102 per member per month). This represents a win-win-win situation – members are getting better quality care as a result of having their underlying mental health conditions treated in the best possible way; providers on both supply and demand side are getting better support and tools at their disposal to provide care; and payers who are managing the members and trying to do what’s best for them are able to proactively match them with high quality treatments while delivering large savings to health plans.

In response to COVID-19, Quartet Health is growing quickly and is looking for ways for leverage their nimble technology and proven data models to support mental healthcare ecosystem across every market in every part of the country.

Use case: integrated mental health solution for patients, providers and care plans; smart care matching.

Let our AWS Healthcare Startup team know if we can help your organization in any way at hcls-startups@amazon.com.

Sources:

[1] National Alliance on Mental Illness: https://www.nami.org/mhstats

[2] https://ourworldindata.org/mental-health

[3] WHO mhGAP Community Toolkit: https://www.who.int/publications/i/item/the-mhgap-community-toolkit-field-test-version

[4] https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

[5] https://ourworldindata.org/mental-health

[6] National Alliance on Mental Illness: https://www.nami.org/mhstats

[7] National Alliance on Mental Illness: https://www.nami.org/mhstats

[8] National Alliance on Mental Illness: https://www.nami.org/mhstats

[9] WHO mhGAP Community Toolkit: https://www.who.int/publications/i/item/the-mhgap-community-toolkit-field-test-version

[10] https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fmanaging-stress-anxiety.html

[11] https://www.ama-assn.org/practice-management/physician-health/how-burnout-physicians-compares-other-professional-degrees

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367114/

[13] Waller, G., Stringer, H., & Meyer, C. (2012) https://psycnet.apa.org/record/2011-28275-001