Health and technology are intersecting in interesting ways lately. Coping mechanisms like group therapy are more socially acceptable. Now is the time for Black tech developers to carve space in the health field to ensure diversity & inclusion remain a top priority. Solome Tibebu is a
#DigitalHealth Investor for @AffinitiVC and founder of @AnxietyInTeens 501c3. Sis is also the co-author of @ReThinkBHI behavioral IT Innovation. She shares some behavioral health start up tips for emerging entrepreneurs.
How Behavioral Health Startups and Payers Can Partner Successfully
Over the last five years, a plethora of mental health and substance abuse startups has skyrocketed. And rightly so. Many of these solutions are finding ways to reduce the cost of care delivery, improve quality of care, reduce inappropriate healthcare service utilization. [They also] increase PCP usage, and increase staff capacity in an area where qualified professionals are few and far between.
Many payers still aren’t very sophisticated about implementing digital behavioral health tools yet. Innovators must be prepared to offer considerable education for payers to adopt such offerings. Payers are complex organizations to navigate, and launching a new solution of any kind isn’t easy. This post is intended to equip both innovators and incumbents to partner in addressing our society’s most pressing behavioral health issues.
Now, payers have moved from “it matters” to “now what do we do?!” with many still struggling with the best course of action. Payers are recognizing the value that frontier technologies and startups with new care delivery models can make on their businesses, such as:
- The ability to improve patient outcomes via tech-enabled delivery of evidence-based practices
- Access to local and regional mental health care professionals and delivery networks employed by the behavioral health startups
- Reduced cost of care delivery through AI, machine learning, chatbots and other automation tools
- The right solutions to continue adding value to members at any acuity or stage of care
- Enhanced data, analytics and care coordination from their existing health IT tools
- Overall more consumer-friendly experiences
Too much of what payers are adopting today are made up of one-size-fits-all models.
When it comes to behavioral health, payers need to offer condition-specific solutions and provider networks for a wide variety of mental health and substance use issues. Today, you can find a huge list of professionals listed on their provider network portals, most of whom appear as experts in many or all behavioral health conditions. Adding more specialty areas to their profiles will get them more referrals, after all. But this comes with several issues:
- Of course, not all behavioral health professionals are experts in each and every behavioral health condition. Behavioral health is an umbrella term for many specific conditions, each with their own evidence-based treatment modalities. Providers with such experience in certain specialty areas may be few and far between in many parts of the country
- Payers have very little ability to actually determine who’s really good at treating what types of members
- Payers cannot verify whether or not these providers are using evidence-based practices
Historically, these networks have been built to meet employer/Medicaid geography and credentialing requirements. As a result, [they are] stuck in the old ways of doing things.
Don’t treat behavioral health as one homogenous disease state. Payers need the tools to support the many diverse subsets of behavioral health. There is an opportunity for payers to adopt new tools which more accurately look at behavioral health as the wide umbrella that it is, offering condition-specific solutions that match up with condition-specific provider networks.
Tech startups can enable a future where payer networks can transform from local, multi-specialty providers to national, tech-enabled providers with the ability to deploy local, high-touch clinicians within their own specialized delivery systems. With better technology and analytics, payers will also be in a position to operate their own provider clinics. The opportunity is further supported by new payment models offered through CMS, including new Remote Patient Monitoring (RPM) codes and proposed expansion on current substance use telehealth coverage.
To capitalize on these opportunities, it is critical for internal and external stakeholders to navigate complex payer organizations, especially as it relates to partnering with startups.
Clearly, both parties want to go to the dance, but will they ever connect?! Below, I’ll outline three key areas to keep in mind when partnering with an integrated health system: the Prep, the Pitch and the Plan, and accompanying tips for each.
How does one start a conversation with a payer? Early-stage entrepreneurs can get a head start navigating their prospective payer partners through these steps:
Where to look:
When it comes to partnering with certain departments within a payer organization, you may be tempted to focus on the Innovation department exclusively. Innovation departments are important partners for startups, oftentimes greatly helping the startup navigate to the correct department internally. But beware, they don’t typically have their own P&L, so you may find yourself in Free Pilot Land indefinitely. If they’re a tech-enabled provider, plan to approach clinical and provider network leadership. Expect to contract with behavioral health specialty companies, or the behavioral health specialty business units within the integrated payer systems. Sometimes a connection through non-traditional paths will get you to the right department, e.g. sales team members who are sympathetic to your cause. But sooner than later, identify the right person who can make decisions and write checks.
Understand your market, solution and impact better than anyone else.
This includes the ability to communicate each of these clearly and succinctly to the person in leadership who actually has your pain point. What motivation does this specific payer department leader have to pick up the phone? Just because you are saving dollars in the overall healthcare system doesn’t necessarily mean it hits this individual’s bottom line.
Consider smaller organizations first.
These smaller payers want to offer competitive offerings and may not already have a solution in place. The smaller organizations with smaller executive teams may be far more nimble than an organization like Kaiser or Mt Sinai. Consider starting with one of these first and get your proof of concept up and running there initially.
Consider getting outside support.
Remember, payers are complex organizations. There are a number of healthcare accelerators who have existing relationships with many healthcare organizations. These organizations can provide seed funding, coaching and connections to health systems to shorten the sales cycle. While advisors, board members, and other entrepreneurs can make a huge difference, someone like a dedicated, vetted consultant with a strong track record can help save startups months if not years by making outside connections very quickly.
Identify the key person who will drive your startup forward internally.
It is best practice to identify an internal champion at your payer prospect. [This will] help move your startup forward within their organization. If your champion isn’t willing to give you what you need to be successful (e.g. certain claims data, information for integration, etc), then they aren’t your champion. How do you find a champion? Leverage advisors, board members and other digital health entrepreneurs in your network to introduce you to payers of interest.
Know how decisions get made.
Ask your champion what their typical process is for working with organizations like yours. Sometimes the smallest hiccup can kill an entire deal, so be sure to stay close to the process all throughout.
Engage decision makers and influential non-decision makers alike through the entire process.
Make sure there is alignment among executive, clinical, or any other type of leadership critical to the implementation and adoption of your solution throughout the procurement and implementation process.
Once various preparations have been made about your specific solution, it’s time to dig into how you’ll position your offering with the payer and where your each parties’ assets and gaps are in the partnership.
Save tons of time and resources down the road. Here is a high-level list for what startups should review before charging forth with a partnership with a payer organization:
- Know what specialty offerings the payer already offers their member base.
- Understand where behavioral health sits in the payer’s ecosystem.
- Think through your approach to data.
- Evaluate your strengths vs what the payer can bring for the most fruitful partnership.
- Know your outcomes, now and in the future.
- Be realistic about what your capabilities truly are, especially with the most complex patients.
Now it’s time to start exploring an actual partnership. While there are many ways structure a partnership, we will cover some common themes.
- Business models should align with incentives.
- Thoughtfulness required for integration: technically, operationally, and clinically.
- Implementation as a process.
In conclusion, all of the simple, low-hanging fruit tools and technologies have been tried. Payers desire novel, evidence-based solutions. With the right people at the table and a laser-focus on the clinical and financial impacts the partnership will make, there is a lot of promise for novel behavioral health solutions to transform care delivery and patient outcomes in the near future.
Solome Tibebu is a healthcare investor and former mental health tech startup founder.
Her work as an investor, entrepreneur and health and human service technology expert has been featured in The Huffington Post, Forbes, TEDx, Inc Magazine, Upworthy, Psychology Today and more.