How 1:1 Virtual Behavioral Health Revolutionizes Patient Outcomes, ft. Brad Kittredge

Speaker 1 (00:03):
Consumer demands, disruptive technologies and AI are shaping healthcare for years to come. On Hello Healthcare, we dive deep on these issues with leaders who are driving change. We hope that these stories will inspire you to create and demand a better future in healthcare. Please welcome your host, Alan Tam, Chief Marketing Officer at Actium Health.

Alan Tam (00:26):
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(00:47):
Hello Healthcare. As I prepped for our interview today, I couldn’t help but reflect on the transformation that the healthcare industry has experienced in the past few years, especially since the arrival of COVID-19. Well, a lot of progress has been made by providers, especially in the areas of digital health and healthcare consumerism. One area that continues to be overlooked and seems to be lagging behind is behavioral health.
(01:09):
In fact, did you know that our healthcare system wasn’t designed to deliver the kind of care that people with anxiety and depression need? In fact, here’s a dim reality. Millions of us, more than 75% of those with anxiety and depression, were not able to get the care that we need.
(01:25):
Today, I have the pleasure of being joined by Brad Kittredge, CEO and founder of Brightside Health. Brad has spent over a decade pioneering evidence-based and healthcare solutions to ensure that everyone has access to life-changing mental healthcare with measurably better outcomes. Brad, thank you so much for taking the time to join us today.

Brad Kittredge (01:44):
Alan, it’s great to be with you. I appreciate it.

Alan Tam (01:46):
Let’s start off with a quick self intro of who you are and why you started Brightside Health.

Brad Kittredge (01:51):
Of course. Yeah. I’m Brad Kittredge. I co-founded Brightside Health with Jeremy Barth and Dr. Mimi Winsberg back in 2017, and our focus and real mission is delivering measurably better outcomes at scale and behavioral health. We talk a lot about telemedicine being a great tool to expand access to healthcare, but our insight that caused us to pursue this current path was that we have a lot of systemic quality issues in mental healthcare, and if we just take that care and move it online, we’re going to help more people get access to subpar care. But instead, this transition offers us the opportunity to use a new set of tools and resources to try to establish a new standard of care that can deliver better care to more and more people.
(02:34):
Ultimately, the insight behind that that really gave us conviction here is feeling that our clinical conventions around mental health and depression and anxiety in particular have been sort of oversimplified. We’ve treated this as one condition or one group of conditions, and that everybody in those buckets may have very similar needs; when the reality that we see and that we believe is that it’s a highly heterogeneous condition with varied patient needs based on subpopulations that would fall under those diagnostic buckets. So we’re taking people with lots of different needs and giving them the same treatment and not accounting for their uniqueness, and that ultimately that’s the motivator and the opportunity where we think we can do better.

Alan Tam (03:14):
Absolutely. I think personalization is definitely a key theme that healthcare has been talking about for many years, and I think that it applies here more so than anywhere else. I’m interested to learn more about how do you figure that piece out, in terms of delivering the right message to the right person at the right time? What’s kind of the secret sauce or best practice approach there?

Brad Kittredge (03:38):
Yeah, you’re right that there are a bunch of different ingredients, but it is really about the right intervention for the right person at the right time.
(03:44):
One of the huge challenges that has held back mental healthcare delivery for decades is the lack of outcome measurement. Prior to the last few years, most estimates I’d seen were that fewer than 10% of mental health practitioners were practicing what we call measurement-based care, meaning that we were spending tens of billions of dollars on mental healthcare with little idea whether it was working or not. So really starting by getting measurement and actually having data about how things work is a really key ingredient in part that’s that’s really enabled by a lot of newer digital health solutions.
(04:15):
But from there, it’s really important to use that data to actually deliver timely interventions. Our healthcare system and in mental health in particular is often operated off of sort of a calendar heuristic that gives every patient the same pathway – “Try this and come back and see me in six weeks and tell me how you’re doing.” – when we know that people have very different paths and that our ability to measure and monitor remotely also enables the opportunity to intervene in a more timely basis. If we see that someone gets off track or has a setback, we can notify their provider and do a chart review and an intervention before an issue becomes a real obstacle. And so that timeliness of interventions is really important.
(04:50):
And then, when there’s an intervention, informing the right intervention for what does this patient need. So we use clinical decision support, analyzing and aggregating data that we can evaluate relative to published research, clinical best practice, as well as the data we’ve seen in our own population and make a data driven prescribing recommendation to our provider to get the right medication for that individual’s unique subtype and needs.
(05:12):
And then lastly, getting the communication right, getting that patient experience right so that it’s an environment where they feel like they’re in the driver’s seat of their care. They have a great alliance with their provider and they have clarity and understanding on what they can do to drive out outcomes for themselves.

Alan Tam (05:27):
That’s super fascinating, Brad. What are some of the key findings for you in this segment of the market? Any surprises in terms of what you’ve learned, in terms of what works and what doesn’t work?

Brad Kittredge (05:39):
Well, as we know, this is a market of a lot of surprises, so I think we’re all finding new things every day. But one of the things that I have been very pleasantly surprised at is sort of a validation of one of our initial hypotheses, and that was in many cases, as people have looked at telemedicine, they have assumed an implicit trade-off where you might have more convenient or timely care with telemedicine, but there may be a trade-off with quality and that you’re sort of accepting that if you choose to go with telemedicine. And from our point of view, we didn’t like that implication or that assumption, and actually thought that by delivering care this way we can deliver better care.
(06:17):
And so, one of the things we’ve learned is we took our data and we wanted to compare it to the best practice of the standard of care. So we found a health system in the Midwest that’s consistently considered one of the best of the health systems in the US and we compared our outcome data against theirs, and the pleasant surprise that we had was that it validated our belief that we can deliver better care. We showed that we had 50% higher treatment response and remission rates than one of these leading health systems.
(06:45):
And so, I think the surprise here is not only that people have adopted telemedicine rapidly through COVID and that it’s staying and not really going away, but that it offers us a new set of tools to actually question a lot of our clinical approaches and standards of care and an opportunity to deliver not just more convenient care, but better care in many cases.

Alan Tam (07:05):
From that perspective, looking at telehealth, what are some of the things that are working really well for behavioral health?

Brad Kittredge (07:14):
If you look at the data, it’s been really interesting to see in telemedicine use so far in the last few years that behavioral health has really been the leading use case. It’s been probably about half of telemedicine related claims have been for behavioral health encounters. So it’s a really kind of leading use case to figure out what’s working and not working and what can be applied to other domains.
(07:36):
One, I think it’s important, especially in if we’re looking at chronic conditions, that having a one-to-one patient provider relationship rather than a pool of providers I think is really important for continuity and longitudinal care and effective therapeutic alliance and decision making. That’s been really vital. The other thing that’s working is of course, just the patient-facing part of things that people value and remote care, not just because they don’t have to drive to the doctor’s office, but because they can have more frequent touchpoints, they can feel like their care is in their pocket and their provider is there with them at all times. And so, we see that those trends have really continued to play out even as some of the pandemic restrictions have faded.
(08:20):
On the provider side as well, there are really powerful levers where providers when practicing in a remote care environment have more control over the way that they practice. They have more direct relationships and ongoing care relationships with their patients. And on our side, we’ve really invested in the tools that our providers use so that it minimizes any time they have to spend on administrative or billing work, and allows them to focus the vast majority of their time on clinical care, which they really value, of course.

Alan Tam (08:48):
That makes a ton of sense, and especially the fact that our mobile devices are constantly with us 24/7. I think it’s definitely sounds like a clear win here for behavioral health.
(09:00):
What are some things that are important from your perspective on the provider side to get right?

Brad Kittredge (09:07):
One of the very nuanced considerations when it comes to how do you build a system like this and how do you manage a network of providers delivering care this is to think about how to put up guardrails. One of the opportunities for using technology is around consistency and making sure that across a group of providers that you have consistent adherence to evidence-based care and clinical best practice. And so, technology can create really great guardrails there and give providers visibility and into the right way to practice, as well as enable new types of supervision.
(09:39):
So in traditional care supervision in some cases is people getting curbside consults or second opinions as well as random chart reviews. With digital care, one of the great things is that we can do quality assurance on every case. The system can constantly be looking at every chart for completeness or for med-med interactions or things like that, and we can actually trigger proactive supervision and get the right eyes on the right cases. And so, that’s worked really well in this environment and has been a really good thing for all of our providers to have a sort of proactive and supportive supervision environment.

Alan Tam (10:16):
What about from the payer side? What are the challenges and how can it be addressed?

Brad Kittredge (10:19):
I’m sure in asking that, that that’s a very big question. What I’ll lead with is we’ve had some really phenomenal partnerships with payers, and I’ve been very pleased with the way that payers have leaned into telemedicine adoption. Of course, on one level it was very necessary with COVID like it was for everybody, but I think the payers have smartly seen it as an opportunity and a way to improve care availability as well as data capture and reporting around care.
(10:45):
I see the convergence on the behavioral side with telemedicine adoption and the push towards value-based care .because finally again, we have data; we know whether care is actually working for an individual and across a population, which unblocks the main barrier to value-based payment in mental health care. And so, I think payers are leaning in. We’ve got really great relationships nationally with Cigna and United, as well as emerging relationships with a few others.
(11:11):
And I think it really is getting exciting in Medicare and Medicaid, where you’ve got incentives to more proactively managed care. So Brightside has really uniquely, and we’re proud to specialize at the high ends of severity and complexity, including our crisis care program for people who are elevated suicide risk. And what that allows us to do is team with health plans to do things like reduce admissions and readmissions to the ED and inpatient stays. Patient member population that are driving a disproportionate share of cost and risk. And so in those programs like Medicare Advantage or managed Medicaid, the payers are taking really proactive stances and really progressive approaches towards trying to do risk stratification and outreach and engagement of patients within the population who really need support and care.
(11:59):
While there’s a lot of work remaining to do, I would say that the payers have the right stance and the right approach. We as a startup would just like to move faster as always.

Alan Tam (12:08):
Absolutely.

Brad Kittredge (12:11):
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Alan Tam (12:34):
I do want to switch gears a little bit here and talk about what’s working in terms of engaging patients. Because it’s not easy; behavioral health is typically a little bit more challenging, but I’d like to understand what’s working here in terms of getting these patients to care? What’s engaging them and what’s driving them to the care that they need?

Brad Kittredge (12:55):
It’s really a timely and of course perpetual question that the job is never done here in engaging somebody in healthcare. If we look at the benchmark from traditional care, we know in mental health in particular, but this applies across a lot of treatment areas, that treatment adherence is really low. If you take med management for example, the proportion of people who go even fill their first script for an antidepressant is a small fraction of prescriptions, and then a lot of people experience side effects or fail to improve and have issues fall out quickly.
(13:26):
And so, it’s really important, particularly in the early progression of treatment to engage people and get them onboarded into their care. In part, getting their prescription is one of the things that we really believe is critical at Brightside. If you get someone on the right treatment and it’s working and they feel good, that’s going to be your strongest lever to keep people in treatment.
(13:44):
But beyond that, for us, it’s really about making people feel like they’re in the right place. We don’t call our members patients. I don’t think people really like the moniker or the label to be considered a patient, especially with a chronic condition that’s not going to go away after a visit or two. This is part of their lives and part of a thing they’re managing, and so we call them and treat them as members, like they’re part of this group and this organization and this program that is focused on helping them manage and live with and reduce the impact of mental health challenges on their lives.
(14:14):
It also, we’ve found it to be really powerful to put them in the driver’s seat. For so long, healthcare was opaque to the patient. The doctor had all the information and made these decisions in a silo. All the data we capture and all the information we have, we share to the patient so they can see it, they can see their progress, they understand when they have setbacks and they can be in informed conversations with their provider to make decisions together.
(14:35):
And then lastly, I would just highlight: For a long time our service was built on a web app so that people could access it through any browser. We found that as we launched our native app, we saw really good penetration, a lot of interest within our member base of downloading the app, and then really good engagement with that app. So every barrier you can take away around logins, around using push notifications to trigger actions from the consumer, when it’s the right time for them to do something in the app, it can be really valuable.
(15:00):
And then one other thing, let me throw out that that’s been really interesting and exciting, we’ve been investing a lot like of people in our data team. And so, we use predictive models of when somebody might be showing signs of becoming non-adherent with their care, and we can actually identify people who have a predictive behavioral footprint that might give us reason to want to intervene with them proactively and make sure they’ve got what they need in their care, they’ve got the right support from their provider and that we can keep them on track. And so, great use case for machine learning there.

Alan Tam (15:28):
Absolutely. I really like that example and your approach to predicting and proactively communicating to this patients.
(15:37):
Now, typically behavioral health is a little bit more sensitive, the members are a little bit more sensitive, perhaps even a little bit more taboo in some demographics. How do you approach that from a proactive perspective of reaching out to a member and guiding them to care despite the fact that they either may not know or are perhaps resistant to receiving treatment because they don’t want to acknowledge it?

Brad Kittredge (16:03):
That’s been one of the things that’s been said about the mental health population for a long time, and certainly in pockets it’s true, but it hasn’t really been indicative of our experience. When people are struggling with mental health challenges, they know it. The truth is, everybody wants to feel better. It’s just been hard to approach care, and so I think in these cases it’s just about extending a hand and engaging people in a respectful way that gives them hope and opportunity and makes it simple.
(16:28):
In particular, with this condition, when people have depression, you’re cognitively not functioning at the level you’d want to, and your motivation is probably at an all-time low. And so, giving a little bit of hope, giving easy stepping stones and showing somebody the way I think is really critical without paternalism or hierarchy, but really with teaming and partnering with people so that they can get on their own path to feeling better has been very effective for us.

Alan Tam (16:52):
Who out there is doing it? Who do you see making inroads and making tremendous progress here?

Brad Kittredge (16:57):
Well, I think Brightside’s doing it right. So, very proud of the work that our team is doing in sort of really balancing the consumerism with real clinical rigor. I’d say more broadly in digital health, I would point to our friends at Virta Health. If you know anything about the keto diet and about the work that they’re doing to actually reverse type two diabetes, it is a very difficult intervention when someone has to be extremely committed to following that intervention and sticking with it to get those results. And so, the engagement threshold and hurdle that they have to get over to be able to deliver their care is very high, and they’ve shown a lot of success doing that. So I think they’ve built a phenomenal model with a really strong thesis on a new approach to care and seeing some really exciting results.

Alan Tam (17:39):
So going back to something we touched briefly upon earlier, how does one measure success here? Not only the finality of the outcomes and getting members on the right journeys, but also potential milestones on the progress towards success. How do you guys look at it?

Brad Kittredge (17:58):
Yeah, I think we’ll measure success differently depending on the audience that we’re talking about. So for Brightside success is always started and ended with clinical outcomes and our ability to measurably improve people’s lives. With behavioral health, of course, all of our outcome measures are self-reported. So the way that that’s done is looking at somebody’s scores on these standardized assessments at baseline, and then we measure regular intervals over time through their care.
(18:27):
And so, we can assess whether somebody is getting a benefit from their care in two ways. One is a clinically significant symptom reduction, which is a minimum number of points reduction from their baseline score; or achieving a score that would be consistent with considering that patient to be in remission, where their symptoms of come below what’s considered a clinical level. So we’re always looking at an individual and across populations at what portion of people and how quickly can we get people to those thresholds, and then how do we compare our performance against those thresholds to other care options that people would have that are considered the standard of care.
(18:59):
When it comes to a consumer, of course, I think priority number one is feeling better. If you don’t feel better from your care, that you’ve sort of failed. But beyond that, all of our providers get compassionate and culturally responsive care training, and so we want of course every patient to feel heard, valued, and supported throughout their care. We want them to feel like they’ve got a great provider who provides their care, and we measure NPS as well. So those are great. And then when we’re working with our payer partners, they of course really care about and value those clinical outcomes, but we also want to extend those to financial ROI, so that they can see the return on certain programs and continue to invest in those programs to have an impact for their customers who are sometimes employers as well as for their members.

Alan Tam (19:43):
Absolutely. I think those are definitely some of the right metrics to measure there, and I think it also translates over to other types of applications in the non-behavioral space.
(19:53):
As I listen to you share and talk more about this, what are some things that can be learned and borrowed that can also be applied in other types of clinical care settings and treatments? What are some best practices that you see here that can be translated over?

Brad Kittredge (20:07):
Well, I think what’s interesting is when we started Brightside and when we were doing our early rounds of fundraising, we were really the first to market with a consumer medication management solution for mental health. A lot of people were unsure whether it could be done remotely; whether consumers would want to do it, whether it would be safe and effective clinically. And we had done a lot of analysis and really felt strongly that we could, and I think since then have shown that we can.
(20:33):
I think the same process is sort of ongoing in every chronic condition vertical and saying, “Can we really do this remotely?” Of course, mental health has an advantage where you don’t really need to do a physical exam on somebody, in most cases, to be able to appropriately assess and treat them remotely. And in some cases with other conditions, you do need those. But I think what we’re seeing are really thoughtful approaches to questioning all assumptions, and finding hybrid models or finding ways to send things to people’s houses or have them drop into clinics to be able to get all of the ingredients that care model might need that might really be driven by virtual first care.
(21:08):
So I would lay down some of the same considerations in behavioral for those conditions. It’s all got to start with data. Everything needs to be measured so that you can trigger interventions, measure outcomes, and of course, measure ROI. You’ve got to actually instrument your clinical protocols so that you manage variability and you make sure that across a dispersed provider network, you’re getting people actually adhering to the right care.
(21:33):
That’s one of the real advantages of these platforms that are sort of custom built around the unique needs of a patient vertical, is to be able to instrument in those clinical guidelines. Because telemedicine is so much more than just web visits. The opportunity here is using technology, using data, and using clinicians to deliver the right care for the right patients at the right time, driven by what evidence and data show to be most effective for them. I’m seeing great companies applying that across different verticals. You see a lot of cool stuff in cardiac health, in diabetes and more; where people are taking these lessons that I think, again, digital health has maybe had the luxury of being the first to go prove out some of these concepts, but that we’re going to see more and more applied to all of these other chronic condition areas.

Alan Tam (22:17):
Brad, thank you so much again for your time in sharing these insights. I think it’s extremely valuable what can be borrowed and what can be learned from a lot of the work that Brightside is doing in behavioral health. Definitely leading the forefront in terms of engaging folks and driving folks to care.
(22:36):
If folks want to continue the conversation with you, what’s the best way for anyone in the audience to get ahold of you and to reach you?

Brad Kittredge (22:46):
Yeah, well, you can always find us at brightside.com. You can reach me directly at brad@brightside.com. We’re always happy to have conversations with other stakeholders, partners, and collaborators in the ecosystem. I firmly believe that if you observed the last few years of the emergence of digital health, in many ways we’ve kind of emerged as a parallel healthcare system to traditional care; and the real opportunity in front of us now is to bring together solutions, whether they’re multiple digital health solutions or digital and traditional care, to find the best combinations of care options for solving real patient needs. So we’re very open and eager to lots of discussions around collaboration, and really excited to see all the great innovation, as well as high value services surrounding and emerging in this industry. So thank you, Alan, for the great work you’re doing and for an interesting conversation today.

Alan Tam (23:38):
Absolutely. So for those of you in the audience, much to learn here. Brad is a wealth of knowledge. Please do look him up at Brightside Health; and until next time, hello.

Speaker 1 (23:49):
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