Despite the uncertainty over what the Republicans may or may not do with the Affordable Care Act, payers are warming up to digital health companies in the behavioral health management space. These businesses use technology to help identify and deliver care to those who would most benefit from services for moderate anxiety and depression. These technology companies are also providing a way to make the referral process smoother.

What intrigues payers and large employers with these companies is the prospect of reducing the cost of care and increasing productivity among employees.

New York City-based AbleTo has positioned itself as an end to end service for payers and increasingly self-insured employers. Its client base includes Aetna, United Healthcare, and blue cross blue shield plans. AbleTo also wants to work with benefit aggregators such as Castlight Health.

Rob Rebak, AbleTo CEO

In a phone interview, Rob Rebak, AbleTo CEO, said payers and large employers are increasingly baking AbleTo’s behavioral health services into their plans.

Rebak has been in this role since June last year. He took over from Michael Laskoff, the cofounder of the nine year-old business, previously known as AbilTo. Laskoff recently started another digital health business —this one targeting heavy drinkers — Annum Health.

One of the largest challenges facing digital health companies targeting behavioral health is the historic disconnect between behavioral health and physical health. AbleTo is interested in breaking down that barrier. The company sees a way to apply its behavioral health coaching program to improve how health plan members manage chronic conditions when they may be weighed down by depression, anxiety, stress or other comorbidities.

Another challenge is to identify plan members and employees of self-insured companies that need assistance managing moderate depression or anxiety that’s not severe enough to merit hospitalization but can affect job performance and overall health.

One obstacle to better integrating behavioral health services is that the vast majority of primary care physicians are not plugged into referral networks for psychiatrists and therapists so they don’t know where to send these patients. Also, a substantial number of high-quality psychiatrists are not accepting any plans at all and insist on cash payments, Rebak said.

AbleTo’s focus is on people who identify themselves as depressed or as coping with anxiety or stress. Plan members take a questionnaire to assess their level of need, if any. They are matched with a behavioral health coach and a therapist through a phone or video chat. Goals are set as part of an eight-week personalized program.

Rebak’s argument that AbleTo can boost work performance is underscored in a study with Aetna looking at members with cardiovascular disease with depression. For graduates of AbleTo’s program between October 2015 through May 2016, had a 61 percent drop in absenteeism and a 44 percent decline in people working while sick.

The company is also working on clinical research in other areas such as depression, anxiety and diabetes. It also has plans to explore how its technology platform can be applied to other areas, such as newly diagnosed patients and the range of emotions that diagnosis can produce.

“We are the most committed company in this space for publishing outcomes,” Rebak said. “These studies also help differentiate us from other startups [in this space].

One priority in the near future for AbleTo is adding telepsychiatry services to its platform. “We are finding that 20%-30% of our patients also have a need for some form of a telepsychiatry consult,” Rebak said. The idea is to better balance the services AleTo provides its customers.

“A large percentage of psychiatrists are medication first and a big percentage of therapists are therapy first,” Rebak added. Each of these professions seems to have their own religion. I think it would be great to get psychiatrists and therapists together and, in a very objective and unbiased way, look at the patient populations and see who really needs medicine-only, talk therapy only, or both.”

It’s not easy to stand out in the relatively young area of behavioral health tech. AbleTo faces lots of competition from companies such as Quartet, which this week expanded a partnership with western Pennsylvania-based Highmark Blue Cross Blue Shield. Others include Lantern, Lyra Health, Valera Health and Pacifica Labs, not to mention the raft of telemedicine companies that have added psychiatric services to their offerings.

It will be interesting to see how successful AbleTo is at playing the long game. It has experience on its side but the kind of partnerships the company forges and its expansion plans could make all the difference.

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