Digital Therapeutics: How New Approaches to Behavioral Health Boosts Healthy Profits
Les C. Meyer, MBA
A CEO’s Perspective on Scaling Technology to Bolster Employees’ Resilience in the Workplace
As corporate America rethinks its approach to behavioral healthcare, disruptive technologies are spearheading a new breed of personalized care support that represents the best hope for optimizing employee experiences and sustained engagement — especially in the behavioral health area.
In kind, a broader value proposition has emerged in the corporate integrated behavioral health space. Instead of discussing return on investment in the context of healthcare costs, savvy C-suite executives are now focusing on their people – and their functional wellbeing – as the core mission of value-on-investment analysis that centers on resilience in the workplace and the business impact of organization health.
Simply put, if the mind is working at full capacity, then so will the body — and vice versa. “Behavioral health, a term inclusive of both mental health and substance use, is unfortunately considered by many to still be an ‘emerging’ topic,” says Bruce Sherman, MD, FCCP, FACOEM, Chief Medical Officer, National Alliance of Healthcare Purchaser Coalitions and Medical Director, Population Health Management, Conduent HR Services.
But research is showing that companies should change that perception. Focusing on the mind-body connection is good for business, and disruptive technology is emerging as a game-changer as more organizations embrace a total rewards approach to value-based benefit design plans to attract, motivate, engage and retain top talent.
“The pursuit for enterprise-wide strategic agility is centered on health promotion to improve the health and well-being of employees, their families and communities,” says Karen Moseley, Vice President, Education and Director of Operations, Health Enhancement Research Organization (HERO).
Finding a scalable solution for whole-person health
One of the problems has been that reaching the lofty goals endowed in system-wide health promotion has proven to be an uphill battle. The nation’s largest employers lose nearly $200 billion in productivity each year due to untreated mental illness while spending another $200 billion to treat anxiety and depression in the workplace.
While mental health services are largely accessible in big cities, they are beyond reach for most Americans. More than 30 million people in the U.S. who have treatable conditions cannot access affordable care, according to the National Institute of Mental Health (NIMH). But there are also other factors to consider. The stigma surrounding mental illness, for example, and the critical shortage of skilled psychotherapists, as reported by the U.S. Surgeon General.
About one-third of all chronic disease care expenses are directly attributable to co-occurring untreated mental illness, according to estimates from the Centers for Disease Control and Prevention.
“Improving behavioral health requires a solution that is individualized, scalable, patient-centered and science-based, and that empowers patients and practitioners to work together to address, broadly, the underlying biological systems that have to be balanced to remediate disease and promote optimal wellness,” says Cary Sennett, M.D., Ph.D., President of Medical Education and Research at the Institute for Functional Medicine. “Technology will be essential to that.”
Kimberlie Cerrone, founder and CEO of digital therapeutics firm Tiatros, Inc., was astonished to learn from the U.S. Surgeon General report that more than half of all U.S. counties do not have a single qualified psychiatrist, psychologist or licensed clinical social worker with the necessary training and experience. The San Francisco-based company creates and distributes evidence-based behavioral health and psychological resilience programs that combine the benefits of evidence-based therapeutic and online learning methods; advanced analytics and AI; and the power of peer communities to enable healing and healthier, more successful behaviors.
“This means to me that behavioral health is the horizontal play for all of chronic disease care,” Cerrone says. “If we can lower the rate of untreated mental illness by making the effective, empirically validated treatment universally available, then we would start to lower somatization rates, thereby lowering utilization rates and the cost of healthcare.”
Weaving integration into the solution
The only way to solve these problems is through a high-impact, technology-enabled solution, Cerrone insists – one that is scalable to reach millions of people. Such personalized care is available online to everyone, delivered with consistently expert quality, in the comfort of their own homes, on their own devices, when it works best for their schedules. The experience is social, engaging, and relatable, so many more people complete their programs and benefit from them.
Yet most telemedicine-based solutions lack a critical function – the integrative medicine skill set that can solve the root problem for psychological services. “There simply are not enough people who are trained in psychotherapy to provide the service, even if it’s delivered by telemedicine,” Cerrone says.
Therein lies a real dilemma for corporate America, as the economic costs of mental illness continue to rise and are projected to outpace combined spending on cancer, diabetes and respiratory ailments, according to NIMH data.
“The largest and most difficult-to-quantify part of every corporate healthcare budgets is spent indirectly on mental illness, i.e., hundreds of billions of dollars of healthcare spending on chronic gastrointestinal illnesses, musculoskeletal illnesses, insomnia, pre-diabetic conditions, heart disease, substance abuse, migraine, and other chronic illnesses that are greatly exacerbated by untreated co-occurring mental illness,” Cerrone says.
More companies are offering a variety of behavioral health and resilience solutions to their employees that include mobile wellness apps and on-demand, telemedicine-style clinical services. While these programs work well for some employees, Cerrone cautions that they’re not designed to reach an entire workforce. A large technology company in Silicon Valley, for instance, told Cerrone they cannot meet the demand for behavioral health services on a one-to-one basis without economies of scale and meaningful program elements.
Her company’s cognitive behavioral therapy (CBT) approach is at the core of behavioral economics and behavior change. These elements “are necessary for making any meaningful inroads on controlling costs for employers while improving the well-being of their employees — there is no health without behavioral health,” says Fikry W. Isaac, MD, MPH, FACOEM, CEO, WellWorld Consulting, former Head of Global Health Services, and Chief Medical Officer, Health & Wellness Solutions, Johnson & Johnson.
Heeding a personal calling
For Cerrone, taking a leadership role in behavioral health is part of a personal mission. She developed a keen interest in raising the bar on treatment after both of her sons returned from military service struggling with post-traumatic stress disorder. One of the things she learned is that healing is a social activity, which led to group therapy emerging as a centerpiece of behavioral health treatment and her business model. The approach features eight, weekly sessions of 90 minutes and an aftercare component.
“It’s a scientific fact that patients who are alone and isolated do not do well,” Cerrone explains. “People want to share their stories with others who understand what they are experiencing.”
Tiatros employs a proprietary software-as-a-service platform to create a unique, private social network for each peer group of 12 to 16 participants who have the same health challenges and life goals. It is compliant with the Health Insurance Portability and Accountability Act (HIPAA).
“We put people who have common health challenges and health goals together into a unique private social network, and then we teach them cognitive behavioral therapy skills in a way that is really engaging and relatable,” Cerrone explains. She notes CBT is the best, scientifically proven treatment for common mental illnesses, with over 80% of people who complete a CBT therapy course having positive clinical outcomes and a sustained recovery.
These programs incorporate a variety of methods, including narrative therapy, storytelling, journaling and mindfulness meditation — with components tailored to resonate within each group. For example, some might be struggling with combat-related trauma; while others involve women who are dealing with postpartum depression.
Each peer group is monitored by a trained facilitator under the direction of an expert CBT therapist, and in some cases, a physician of record. Social media-style methods are used to encourage members to form a supportive and nurturing community that is itself therapeutic.
Focusing on people value – not costs
As technology becomes increasingly sophisticated, Cerrone is excited about using artificial intelligence tools and advanced analytics to overcome “the structural barriers to delivering effective mental health care to millions of people in the U.S. and around the world.” Tiatros, which has partnered with IBM to advance the delivery of scalable digital therapeutics for mental health, supports what she calls “the unfettered and untouched capture of structured and unstructured behavioral health data contained in psychiatric evaluations, patient narratives, and patient interactions.”
Cerrone says the trouble with this information, which clinicians use to make treatment decisions for in-person psychotherapy sessions, is that “it’s always been largely discarded because there’s no place to put it into institutional electronic medical records.”
Mindful of this systemic failure, Tiatros collects and manages the data so that it can be mined for clinical use in a HIPAA-secure database.
“Tiatros-enabled services for employers eliminate confidentiality issues while providing a comfortable means for employees to relax into the program,” states Kim P. Norman, MD a practicing psychiatrist, researcher, and thought leader in scalable therapeutics, “The group therapy sessions are a way for employees to learn more positive reactions to life’s large and small challenges and to improve their overall resilience and wellbeing.”
Whereas patients in traditional, one-on-one psychotherapy see a clinician once a week for 45 minutes, most people using the Tiatros platform engage daily, with some engaging multiple times a day. This “creates a psychotherapeutic environment with much more frequent and active engagement,” Cerrone says, delivering a “remarkably high program completion rates and clinical outcomes that are as good, or at times even better than those found in traditional in-person psychotherapy,” she reports.
For example, participants in peer groups consistently reported a 70-75% program completion rate and showed fewer symptoms of post-traumatic stress and reductions in fear and sadness, coupled with significant spikes in joy, by the end of the eight-week program. (See Figure 1)
Employees also reported significantly reduced levels of physical ailments, such as headaches, body pain and gastrointestinal distress that are often seen in post-traumatic stress disorder. Some program participants also reduced their alcohol dependence.
In the end, the emphasis is on quantifiable value. “What we’re finding is we have so much more and better data than the fields of psychiatry and psychology have ever had before,” states Cerrone. “Our customers all anticipate that we will save them potentially a great deal of money,” she continues, “but no one has asked us to document cost savings. Rather, they’re interested in how the behavioral health and psychological resilience programs improve the health, productivity and psychological resilience of their entire workforce. We do this by using several validated productivity and clinical outcome measures, as well as innovative advanced analytic methods.”
In the next few years, Tiatros hopes to improve its approach and integrate bot technology so that it can scale up to meet growing demand across the U.S., and ultimately, around the world. A key objective is to increase personalization of the individual user experience for better clinical outcomes.
Tiatros’ behavioral health work-life resilience innovation lab plans to release to customers the nation’s first Behavioral Health Mind-Body Connection Index — Organization Health Resilience Wellbeing Dashboard — next year.
About the author
Les C. Meyer, MBA is CEO of HPI Advisors, LLC, and chairs the Informed Opinion Leadership Action Group. He is also a member, Roundtable on Population Health Improvement, National Academies of Sciences, Engineering, and Medicine (NASEM), Health Enhancement Research Organization (HERO) Employer-Community Collaboration Committee. For more information please contact: [email protected]
Kimberlie Cerrone, MS, MBA, JD, is the Founder and CEO of Tiatros, Inc.
Tiatros is a San Francisco–based Digital Therapeutics for Behavioral Health company that provides a portfolio of safe and engaging online psychotherapeutic and psychological resilience programs that uses scientifically-proven therapeutic and online learning methods; advanced analytics and AI; and the power of peer communities to enable healing and healthier, more successful behaviors.
Tiatros® Personal Growth and Psychological Resilience at Work and Home (Figure 1 – call-out box)
Empirical Validation – A top technology company in Silicon Valley:
Resilience Training in a Non-Clinical Employee Population
Participant Narratives And Interactions
Participants engaged actively in their programs and expressed gratitude for Tiatros as a new employee benefit
Participants were comfortable engaging openly and authentically with other company employees within their peer groups
GAD-7, PSS-10, PHQ-9 and PHQ-15 show meaningful reductions in anxiety, perceived stress, depression and somatic symptoms
Tiatros AI showed a greater than 3x increase in cheerfulness; 50% reduction in propensity to worry
Program Completion Rate: >75% Employee Conversion Rate: >20%
Note: Tiatros provides customers’ with customizable dashboards giving clinicians and case managers the real-time data and analytic tools they need to actively manage the behavioral health component of client employer-employee work-life resilience total wellbeing programs. Tiatros aftercare program proactively identifies employees who need additional targeted resilience skills training based on reported employee stress perception, employees anxiety, employees depression, and employees somatization including individual moods and/or personality traits outcomes reporting.