By the time he was a teenager, Patrick Kennedy was an addict. He loaded Poland Spring bottles with vodka, and camouflaged the painkiller OxyContin, known as the “hillbilly heroin,” in vials of
In his newly released book A Common Struggle, the 48-year-old former Rhode Island congressman also chronicles his parents’ addictions. His father, the late senator Edward Kennedy, and his mother Joan, struggled with alcohol. His family was not pleased with the disclosure.
Unlike cancer, diabetes, or dementia, which carried at one point a social stigma, mental illness remains something that is best hidden. Yet, the economic burden is significant with nearly $200 billion in lost earnings annually, according to a study published in 2008 in the American Journal of Psychiatry.
“The mental health space has been carved out as an appendage to the medical system,” says Kennedy.
The tide is shifting. Dozens of digital health startups are breaking down barriers and giving mental health the focus it deserves. The stakes are high. Last week, famed Venrock heath IT investors Bryan Roberts and Bob Kocher, an architect of the Affordable Care Act, announced they invested $35 million in Lyra Health, a startup that helps identify people with mental illness, but has yet to launch a product.
Earlier this month Kennedy joined the board of Quartet Health, a one-year-old New York-based startup that works with primary care doctors to facilitate care coordination for patients in need of mental health treatment with psychiatrists. It raised $7 million led by Oak HC/FT’s Annie Lamont, another top health technology investor, and others, including billionaire Nicolas Berggruen. Founder Arun Gupta, a former venture capitalist, teamed up with Steve Shulman, who headed Magellan Health Services, one of the biggest behavioral healthcare companies. “When you look at mental health in the right light, it’s the number one type of opportunity in improving care,” says Gupta.
Getting Kennedy on Quartet’s board is certainly a boost for Gupta, who met him this past summer thanks to Lamont. Kennedy too makes no bones about placing bets on a potential winner. “This is a terrific opportunity for me to learn the business of healthcare; to see how the rubber meets the road,” he says.
For years, Kennedy championed legislation to prevent discrimination against mental illness. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, a bill he authored, which dictates that health plans provide the same benefits to mental health disorders as other medical issues.
Kennedy says the mental health community has been left behind by the 2009 HITECH Act, which set aside incentives for the purchase of electronic health records and tied them to objectives, such as screening for smoking, chronic disease management and preventive care. He adds that less than 30% of behavioral healthcare providers, such as psychiatrists, have made the transition from paper to digital records. The government states that 54% of all office-based doctors use electronic health records according to its requirements.
No matter, a larger incentive looms for insurance companies and healthcare providers to view mental health as an integral part of medical care. The shift from fee for service to value-based payment, which rewards providers on patient outcomes, compels them to treat people more holistically.
Mental health cuts across several medical specialties. Nearly 70% of people with a mental disorder suffer from another medical condition. People who have diabetes, for example, are twice as likely to be diagnosed with depression. The challenge is to get specialists, such as cardiologists, oncologists, or gastroenterologists to screen for mental health. “It’s a complicated area that requires deep integration with the care of the patient overall,” says Lisa Suennen, a healthcare venture capitalist, and a former executive at Merit Behavioral—now part of Magellan.
Leading hospitals such as the University of Washington and Intermountain Healthcare have already adopted collaborative care programs that have shown to reduce costs. At Intermountain, for example, patients treated for depression by a team of mental health clinicians that includes their primary care doctor were 54% less likely to end up in an emergency room than those who were not.
Via an app, Quartet gives primary care physicians access to psychiatrists for consultation, a key challenge for a general practitioner. Through partnerships with insurers (Gupta will only say they’re “marquee” names) and healthcare systems, the startup says it mines millions of claims to flag patients with co-morbidities or who have not been treated for behavioral health issues; it then notifies the primary care doctor. Quartet follows up to make sure patients kept their appointments, checks clinical results, and calculates the cost of care.
Health plans pay per member, and compensation is often tied to quality of care and cost reduction. That and getting rid of the stigma will be the ultimate tests for Quartet and others.
