On November 3, 2018, I had the great pleasure of attending the experiMental Conference, put on by Pronoy Saha’s Healthcare Technology Forum at UCSF Mission Bay. As expected it was a great gathering of digital mental health entrepreneurs, researchers, practitioners, investors, and interesteds. I am always so inspired and motivated by what I perceive to be a growing cohort of participants interested in this space.

The one day event contained a series of sector overviews, application cases and pitches by firms in this space. I was honored to be one of the speakers and will write about this in a future post. This post I want to focus on my favorite insights from the conference. Four insights from this talk really resonated with me.

1. Payor/Provider Integration eases Innovation: A challenge of executing digital mental health initiatives in a pure payor or pure provider organization is the conflicting incentive of savings in the former and care delivery in the latter. Developing a solution with a payor and selling it to a provider for delivery, or developing in a provider and convincing a payor to reimburse is vexing. The Kaiser Permanente presenters (Estee Neuwirth, PhD, Sr. Director of Innovation & Design, Kaiser Permanente, Trina Histon, PhD, Senior Principal Consultant, Prevention, Wellness & Digital Health, Care Management Institute, Kaiser Permanente, and Chris Browning, Experience Design Strategist, The Design Consultancy, Kaiser Permanente) alluded to the integrated payor/provider nature of their organization as a factor that allowed them to better align payor/provider incentives under a common organizational culture, infrastructure, and leadership. It was not easy, just relatively so. This fact points to the need to continue to look to these organizations as first achievers of digital mental health adoption & scale. It was encouraging to see this work and put me on notice to track these type project more closely forward going.

2. Skills before Pills: We all can attest to how psychopharmacy is a dominant, perhaps too dominant, approach to addressing mental health challenges in our current mental healthcare environment. Digital delivery of mental health therapy has potential to popularize and scale other mental health therapies that have not been used as much. It further has potential to shift us more towards a prevention approach in lieu of treatment. The speakers from Kaiser-Permanente used this mantra “skills before pills” in the roll out of their Project Chemai, and I love it! “Skills before pills” captures this idea that we need to be working on developing a mental health (versus sickness) system which works on helping us practice the skills of good mental health early and consistently throughout our lives. This development of skill will not eliminate pills but has promise to reprioritize first-line therapy. I have to also believe that this reprioritization will result in better quality, cost and access outcomes. I carry this mantra with me now daily. Let us work on developing our mental health skill before we need pills.

3. Engagement ≠ continuous use: During the conference, this topic of user solution engagement came up. One of the speakers challenged the idea that good engagement is the continuous use of a solution. The speaker asked us to contemplate that good engagement may necessarily include several user segments that: a) engage, get a result and never return, b) engage, get a result, and return at some time later in response to a relapse of some sort and c) engage regularly and continuously over time. For me this was a good reminder of the subtle range of behaviors we can expect to see as digital mental health solutions are adopted. I am afraid that in my own research I had thought too narrowly about what good engagement is. I suppose that best engagement is (a) if this denotes a healed user. One could also surmise that a segment (c) user may have sub-optimal engagement because the engagement is not getting a productive result. This is a topic for research and product development which hold potential for the creation of more subtlety in customer experiences better catering to differential engagement segments.

The Veteran’s Administration (VA) Critical Success Factors in DMH: I have been following the work of Julia Hoffman at the VA for many years now, starting with the release of PTSD Coach, which has evolved into a therapeutic & care app store for veterans. At times when I talk with colleagues who talk about how the government cannot do anything right, I will bring up the innovation work that the VA has been doing a evidence to the contrary. Shannon McCaslin, PhD presented for the Veteran Administration’s National Center for PTSD at the conference and took a question from the audience whose answer confirmed for me what it takes to get successful adoption of tech in organizations and networks over time. She cited the critical success factors of:

1. Champions in the organization who sponsor and protect the vision and work,
2. Practitioner Networks, in this case, the VA’s Innovation Network, which collaborate, perform, critique, evidence and advance the work
3. Virtual Education, which leverage the very technology being adopted to make the case for its adoption, and
4. Communication, communication, communication, which is often underutilized as we tend to grow tired of our change communications before it has broken through and had an effect on the audience.

Again, these insights were a good confirmation and reminder of factors:
a) payor/provider integration,
b) skills focus,
c) engagement segmentation and
d) champions, networks, education and communications
that are so critical the work we are doing to gain traction for digital mental health solutions and practices in our current systems.

This post has grown overly long so I will stop here for today and tackle points from a talk I gave in my next post. Be well.

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