The Gap Nobody Talks About: Getting Digital Mental Health Tools to the People Who Need Them

What does it actually take to move a digital mental health solution from pilot into standard care inside a health system? 

In this episode, Jim Murray is joined by Dr. Angela Skrzynski, clinical and operational leader in digital health at UA Health, Screen Well, and Tandem Health, and Trina Histon, PhD, Managing Director at Percolating Health and board member of the Society for Digital Mental Health. Together, the three draw on decades of real-world implementation experience to unpack why so many promising tools stall before they scale, how to build clinical workflows that reduce burden rather than add to it, and what it will take to make behavioral health technology work for the communities that need it most. 

From crawl-walk-run deployment frameworks to the evolving role of AI, this conversation covers the honest realities behind digital health's most important promises.

About Moodr Health

Moodr Health is an enterprise engagement platform purpose-built for Medicaid plans, rural health systems, and safety-net providers managing high-risk populations. Moodr helps care teams reach the right members at the right time through a HIPAA-compliant platform built on a healthcare CRM that integrates seamlessly with existing care delivery systems and workflows. From reducing avoidable readmissions and administrative burden to improving care plan enrollment and supporting value-based reimbursement, Moodr turns real-time insights into measurable outcomes at scale.

Learn more at www.moodrhealth.com

Transcript

SPEAKER_02 0:11

Introducing the Mooter Health Early Innovators Campaign. Innovation in healthcare doesn't just happen in boardrooms. It happens on the front lines, where organizations are doing more with less and pushing boundaries to better serve their communities. That's why MooterHealth is proud to launch the Early Innovators Campaign, a series spotlighting forward-leaning organizations and individuals who are shaping the future of behavioral health and care delivery. Over the coming weeks, we'll be featuring podcasts and conversations with leaders who are redefining what's possible. Stories from innovators in health systems, higher education, and recovery support. And insights on how new models of care are being built for equity and impact. Our early innovators are proving every day that change is possible. And we're excited to share their stories with you. So stay tuned, follow along, and meet the leaders building what's next. Welcome to Meter Health's Early Innovators Podcast, where we highlight today's leaders and stories shaping the future of behavioral health. The perspective of today's guests will be incredibly valuable to share, and today I'll be joined by Dr. Angela Skrozinski, who is a clinical and operational leader in digital health, with deep experience implementing innovative care models inside healthcare systems. She's been at the forefront of bringing digital tools into real clinical workflows, especially in behavioral health, helping translate promising technology into solutions that actually work for patients and care teams. Currently, working at Virtual Health as well as serving as the medical director at Screenwell and also clinical product lead at Tandem. Angela, love for you to briefly tell us about the mission of these organizations and your roles there.

SPEAKER_01 2:03

Yeah, sure. So Virtual Health, of course, I've been with them for nine years now. I've spent several years since the pandemic really in the transformation office there. And of course, their mission is to keep the community healthy. Screenwell is an early stage startup that is invested in population health and improving that by helping employers to increase access to and completion of evidence-based screening, cancer screening in particular for their employees, with the goal, of course, of driving earlier detection, improving clinical outcomes, and maintaining a happier and healthier workforce. So I'm super excited to be working with them and see what amazing things they're able to accomplish. And Tandem Health is similarly an early stage startup. And their mission is mental health based. So their goal is to transform mental health care really by equipping the frontline clinicians, traditionally like PCPs, with AI-driven tools to increase access to high-quality mental health care within that routine clinical setting. So taking away the barrier of a six-month wait to a therapist and offering a bridge or solution. And so super excited about what both of these companies have to offer in the future. And thank you for having me today.

SPEAKER_02 3:27

Glad that you're here. Glad that we continue to have our paths cross over the years. I'm also joined by Trina Histon. Trina, having earned a PhD in health psychology and a BA in applied psychology from University College Cork, is also an industry recognizable digital health leader who spent over two decades at Kaiser Permanente driving innovation at scale and later helped bring cutting-edge solutions to market at Wobot Health. You can find Trina on stage internationally to share best practices, and they're widely respected for their work, bridging product, clinical care, and system level transformation, particularly in expanding access to behavioral health through digital solutions. So Trina now helps startups deploy digital health solutions from pilot to scale with impact, and currently on the board of directors of Society for Digital Mental Health, as well as Managing Director at Percolating Health. Trina, welcome. Please briefly tell us about the mission of these organizations.

SPEAKER_00 4:29

Sure. Thanks, Jim. Great to be here and great to be back with Angela again, too. The Society for Digital Mental Health is a US-based but globally reaching society that really is about creating accessibility for digital technologies to be placed in patients' hands and be that via direct consumer andor also through health systems or through behavioral health providers, and it's really bringing high-quality tools into patients' hands. So actually, the SDMH annual meeting is in June. It'll be virtual. Check out SDMH's website for that. And then at Percolating Health, as you mentioned, Jim, my goal there is to really support startups and health systems deploying digital mental health tools. It's always a fun place to be, and I know it's the topic of our conversation today. In addition to those roles, I'm also co-lead for the digital adoption work stream of the mental health goals program in the UK. So not dissimilar to the US, all of the challenges we face in deploying digital mental health tools just change the accent and maybe some of the care settings and the same kind of constraints exist. So lots of good people really trying to figure out how to get good tools in the hands of users to help solve for some of the access issues we see in mental health care, but also ensure that person at two in the morning has a support to manage through that moment.

SPEAKER_02 5:49

Thank you. And thank you for joining today.

unknown 5:52

Of course.

SPEAKER_02 5:52

Angela, Trina, and I all actually work together on implementing Wobot at Virtua Health, a real-world example of what it takes to take a digital mental health solution from concept to deployment inside a health system. My name's Jim Murray. I'll host today's podcast, and I've spent a career in and around the adoption and scale of consumer technologies, currently leading commercial growth at MooterHealth in provider and payer communities, engaging high-need patient member populations through proactive SMS outreach. MooterHealth's HIPAA compliant platform, built on the backbone of a healthcare CRM, integrates seamlessly with existing care delivery systems and workflows to enable care teams to deliver scalable, data-driven engagement across patient populations, turning real-time insights into measurable outcomes. And what we're hearing across the industry is that accelerated achievement of downstream quality, reimbursement, health equity initiatives, they're all interconnected and all required. And at Motor Health, we've found meaningful ways to help health systems increase revenue via value-based care incentives while simultaneously reducing financial penalties surrounding avoidable readmits. But for today's episode of this podcast, we're going to talk about health system implementation of technology solutions, digital mental health, and why scaling these to benefit underserved populations matters. So I'm going to start things off, Trina. I'm going to hand the first question to you. But please, Angela, Trina, jump in at any point if you've got something that you'd like to add to any of these questions. Trina, let's start here. When health systems adopt digital health solutions, especially in behavioral health, where does implementation most often break down in your perspective, in ways that maybe aren't obvious at the leadership level?

SPEAKER_00 7:42

Yeah, great question to start with. I would say how I think about this is along three dimensions. I think about people, process, and technology. And there are potential barriers or failure points along those dimensions. So from the people side, you may have signed off from senior leadership, but if you haven't taken that all the way to the frontline teams and understand their day-to-day context, their practice context, and you haven't solved for a pain point that they're feeling, because often the metrics the leader will track are not the same to the ones the primary care clinician tracks. So ensuring that you've really thought through the problem you're solving all the way through. So that's one of the people elements. I think the other that I've seen time and time again is involving all the right stakeholders in the right time and cadence of the conversation. So you can get all the clinician buy-in, but if you haven't necessarily also talked to IT leadership and legal and procurement, things can take a long time in a protracted contract, for example. And so some of the people. Some of the process, I think really deeply understanding the clinical workflow, so you're not adding more clicks in the EMR or more minutes that a doctor and a patient don't have in a visit to talk about your solution. So really thinking about how do you make it easy to do the right thing, if you will, and make that referral. That's one example of the process. And then the technology itself, you can have the best solution. But if it isn't sitting in the right integration layer in the EMR or it isn't easy to make that referral from the frontline teams, you're not going to get across the finish line of even a pilot phase. So there's some of the early things that if you haven't had that conversation and shone a light into all those corners, if you will, and have a plan, then I think that's where those failure points live. And it's often then obviously the tool itself will have gone through vetting with clinicians, so it's got an evidence base that it is solving for a clinical need, and that that it's something that patients will want and use as well. So it's all of those things in my experience.

SPEAKER_02 9:41

I saw Angela nodding her head there. I don't think that anybody's looking for workflow in a interruption, right? Integration is different than interruption.

SPEAKER_01 9:50

Not at all. No, it's interesting, Trina. You hit so many important points, and you're an expert in this area. And one of the other things I find is even if you achieve all of that, which is quite a big ask, then there's still the issue of clinicians keeping the solution top of mind. Because they're juggling so much that no matter how well the solution works, no matter how easy you've made it for the clinician to use it, they still have to remember to use it. They can be fully bought in in the course of the day and the 30 patients and the gosh, 200 complaints, right? How do they really remember that the solution exists and how to deploy it? And so I think that's another layer I've encountered of difficulty too.

SPEAKER_02 10:40

I think that as I go into market and try and sell these solutions, I'm often reminded or remind myself, the clinician isn't bringing the checkbook to the table. So I can make a great pitch and the administrator can love a solution. And that may be the last that it ever sees the light of day, because there is a gap between solving for the pain point of the administration as opposed to the pain point of the clinician. So I have multiple customers when I'm trying to move a new solution into market. Angela, I'd love to ask you thinking about your experience implementing, and you could use Wobot. I'm sure there's other solutions that you've implemented at point of care. If you could redesign one part of how health systems deploy digital health solutions from scratch, what would it be?

SPEAKER_01 11:24

This is an important question, I think, for health systems to think about. And a lot of them are. There's so much that health systems do right. I think one of those things is that they're quite risk averse, and rightly so because their decisions literally impact life and death in their own backyards and their communities. And they touch so many lives over the course of a day, much less a year, right? So it's it's what they're doing is they're being very cautious. And I'm grateful for that. On the other hand, that comes with a risk of losing speed. And so I think there is the ability to meet in the middle and marry the two. There's always been this sense in traditional healthcare systems that, you know, a product or a service line needs to be near perfection when it launches. And I think therein lies a really big problem because what it really does is it keeps solutions away from patients for longer periods of time. And it also doesn't allow the solution to get in front of the patient for feedback ultimate iteration. And so I think that's really the place that a lot of health systems, you know, can can make some change and make some serious gains. And a lot of folks are doing this now too, but every health system has a different culture. And so some people do this better than others. But it's really about, I think, starting with a minimally viable product. As long as you're starting from a place of safety, you know, it's okay to go live if the patient experience isn't perfect, if it's not yet scalable, even if it's not yet creating the success that you're looking for, whatever the metrics are, as long as it's safe and it's not worsening patient safety, you know, you're not going to go terribly wrong. There's always the ability to iterate there. So I think that's probably what I would say is the number one thing that comes to mind for me.

unknown 13:24

Yeah.

SPEAKER_02 13:25

I'm curious, in that window, how long is a reasonable period of time where you see signal and you say, this is the real deal. Let's move.

SPEAKER_01 13:34

Yeah, I think it depends very much on what we're talking about, right? Because patterns emerge in different lengths of time for different issues, right? If you're talking about colon cancer, right? Like you're waiting years maybe to see the impact of your solution, but and there are other things that move much faster. So I think I can't give an exact timeline, but I think there's some wisdom to maybe not being always the first to market and not being last, not being even close to last, right? But being third, fourth, because then you have the benefit of learning from the first and second and third person's missteps, but you're also not so late to the game that you're missing out on adding value for patients. So I think that's probably where I always recommend the sweet spot to be, and what that timeline is exactly depends on what we're talking about.

SPEAKER_02 14:30

Fair enough. Thank you. Trina, I'm curious. When we think about from pilot to scale, a lot of digital health solutions succeed as pilots, but never scale. What's the difference between something that gets stuck in pilot mode and something that becomes part of standard care?

SPEAKER_00 14:48

Yeah, great question. And number of dimensions to this one too. Yeah, I think we've seen a lot of great tools get stuck in what I call pilotitis. Nobody wants that. I think in my experience, what's important is you actually begin with scale in mind. And I think one of the underlying issues there is what level of maturity are you at if you're a digital solution? Are you early in your journey and you just really want to get a proof of concept and early partnership? Maybe a pilot is actually really a good space for you to be in. So you can learn more about your product and how it behaves in the real world with clinicians and with patients. But if you're a mature solution, then you really want to think about what would that scaling look like and think about that end state. And then the model that I've learned and leveraged in Caius Permanente was called accelerating learning and spread. And it was really a blend between performance improvement and human-centered design. And the beauty of that model that worked really well as we were building and scaling the digital mental health ecosystem. And I was there, is you really had it designed into phases. So I think of it now as I've evolved it with Wobot and with clients as kind of crawl walk run. And so in that crawl phase, you're really thinking about how many clinical sites are you going to go live in, how many clinicians, what would be an expected referral rate, an expected clinician engagement rate, and then expected patient engagement rate. And then once you've figured out maybe where the friction points are and you've smoothed those over, then you have a decision gate. Okay, we've completed this first phase, we've hit all the metrics we've defined. Now we're ready to scale to this next level and you spread to the next swath of clinics. So that's really been a pathway to getting to scale. But I would say the other S after scale that we don't talk about enough is also sustainment. I think that's back to Angela's point of how do these tools remain top of mind for the clinicians. So they think, oh, yeah, this person has anxiety or depression or ADHD or whatever, whatever clinical area the solution's in. And how do I get that top of mind next visit, next patient? So those are the kinds of things that I think about. Very practically, though, a lot of where these early pilots live might be in innovation budgets. So there's also thinking about who has the budget authority and how do you actually get this built in either to a per member per month or some kind of license cost, and what does that look like at scale? And I know the models for are moving beyond a kind of a per license cost to maybe more of a software as a service type model. So really thinking about all those dimensions about how the funding stream will stay as well, and what value is coming back to the health system and where the ROI might lie and how you're building that evidence base. It's a lot of things to hold, but I think not having those conversations early enough or not evolving the metrics that matter in these different phases enough really then ends up being natural endpoints. So I think health systems have so much that they need to manage toward, whether that's the patients that they're seeing, the regulatory environment they're operating in, the business environment, the patient population, and the the sort of main disease states, if you will, that live within population health metrics, they're always trying to solve for those and manage toward those. And so you have to evolve with that too. So how are you evolving, how your solutions meeting more of the needs over time for that health system as well? So it's a dynamic system, it's not a set it and forget it. And I think in that spirit, it is a living ecosystem that you're building, and you have to plan for that and show up in that way accordingly.

SPEAKER_02 18:21

We could go down a rabbit hole just talking about ROI. But Angela, I'm curious when you think about underserved populations, what role could digital mental health tools realistically play? And where have you seen that they fall short?

SPEAKER_01 18:35

Yeah, this is, I think particularly around the time of the COVID pandemic, there was a lot of excitement about we were really seeing the height of the capability of digital health. And there were so many barriers at that time to accessing in-person care that it was really able to shine a light on what digital health can do in terms of increasing access. And then we started to understand too that while it breaks down certain barriers, it poses other ones. So I think that it's able to break down the barriers of illness exposure and time constraints and transportation insecurity, but it also then presents its own unique set of issues like digital literacy. And does the patient have internet access? Do they have a device that's capable of engaging in digital care? And this is so particularly important today when demands on patients are so numerous. People are struggling to find enough resources, time, money, energy, and there are so many different barriers to access. So I think the key really is to provide, meet patients where they are and provide multiple different access points to care. And I really feel like that means offering traditional analog options in addition to digital options, whether that be synchronous care, asynchronous care, there are different levels of digital engagement that you can offer for patients. And I think having sort of those tiered systems is going to become increasingly important if we really want to see digital health deliver on increasing access and equity. And then of course the other piece is improving on those barriers. So increasing in really investing in digital literacy and making sure that people know that these services are available. Because one of the things that we've traditionally found is that in some of our areas where SDOH needs are highest, they're utilizing digital care least. And part of that is the barriers I mentioned. And the other piece is that they just don't even know or think to use our telemedicine services because the friends aren't talking about it, or maybe we're not doing enough advertising in those areas. And that's another piece that I think we really need to work on as a digital health community.

SPEAKER_02 21:04

Angela, have you seen, and Trina, please jump in here too, in your experience? Have you seen community trust in these mechanisms of care called into question?

SPEAKER_01 21:15

For sure. I think there are folks who feel more comfortable. It's dependent too on the situation. What is the complaint? What are the circumstances for the person? Are they on a road trip? Are they at home and have ample time today? It's gonna vary per patient and also per circumstance. The same patient may feel very comfortable with accessing digital care for one issue and very uncomfortable in another area. I think it runs the gamut, but we're certainly seeing that there are certain patients and certain demographics who are more comfortable utilizing telemedicine, others that want options, and then others that really are always going to prefer the traditional in person.

SPEAKER_02 22:00

Trina, what do you think?

SPEAKER_00 22:01

Yeah, I I I might just add to that that I think all your points, Angela, are very well taken. And I think that I'm certainly seeing a rise of enhanced models of care, if I can frame it that way, where beyond the office visit, there is like bringing in community health workers, bringing in peers and near peers. So I think where success is being seen now is literally going into the communities and being in the communities and having people who are trusted community health workers who know the culture and the customs speak to how these tools can add value. And I think that's just so important because it's meeting people literally where they are, and then it's hearing about these tools from a trusted community member. And it's also then that community health workers a connection back to the health system. So the opportunity is growing now to have more of that broader footprint beyond the office visit, which I think is important. And the other thing that I've been intrigued by, and will actually get to see it live a little more in the UK work that I'm leading is this rise of the role of a digital navigator. So I think one of the challenges of just digital health writ large, whether it's mental health or physical health programming, is having a workforce that can take that referral from the clinician or the primary care doctor and then help that person get on board it. So it's beyond the traditional customer success role that you might have in a digital health company, but it's really being a navigator between the user, getting them onto the solution, and then also being a connection back to the care teams and the health system. So that role is something we're going to build out and learn more about in within the sort of UK model within the NHS. But there are some examples of it already that Reliant Medical have in Massachusetts and that Akron Children's Hospital have in Ohio, where they have that role in play, and it really does change the adoption curve for the tools. So I think there's uh workforce of the future slash jobs to be done role that's sitting out there for us to engage more deeply in that we haven't quite yet done to the degree we need to. So I'm excited to see where all that goes. But that is something that's on my mind.

SPEAKER_02 24:07

Have either of you seen at the clinical side of this equation the acceptance and the adoption for reaching underserved communities via these tools? Or is there some standoffishness? Have we reached that tipping point?

SPEAKER_00 24:22

I would say I think the fact that the social determinants of health have grown in terms of the impact that somebody's life circumstance has and their ability to manage sort of whatever health conditions they are having. Like in the last decade, we've seen health systems create food markets, create food programs. We've seen health systems build housing, buy housing, provide housing. So I think the clinic is coming out of the walls of the clinic into the community because the need is so great. So I think the barriers have definitely come down because the healing can happen anywhere. And I think the recognition that new ways of reaching people need to be engaged in. And I think that's happening with the progressive health systems like the Virtues, like the Caesar Permanentes, and others. The other thing I will say is so many people have phones, of over 93% of people have a phone. And so I think there's been just a growing recognition that being able to deliver modalities and connection and services via either whether it's smartphone or via SMS, just the evidence base just keeps growing on the value of that. So we now it's hard to ignore the evidence base. And then there are groups like Find Help and others that are making those connection points to services. So it's not all clinical, but I think the patchwork quilt of what helps somebody move through their day and feel like they're connected to services that meet their needs. I think more and more health systems are taking on that connective role in addition to being the source of clinical care because they recognize if they don't have those partnerships, that patient's going to keep coming back into the ER, their condition's going to worsen. And I think clinicians are hungry for more tools in the toolbox that they can help amplify the care they're trying to deliver. At least that's my sense of what I see in Angela. You're delivering that care. Feel free to amend my statement. But I am seeing more acceptance for sure.

SPEAKER_01 26:13

Yeah, no, I completely agree with you, Trina. I think across the board we're seeing a lot more attention being given to closing SUH gaps. And I think that is hopefully increasing trust in the communities where maybe healthcare is most needed. And I'm seeing it done, like you mentioned, Trina by health systems, and also there's really an explosion of interest in this area from all sorts of sectors, right? Lots of private sector going into this area as well and interested in closing these gaps. So I think it's so important that really as a society, we've come to understand that we need to do better here. And I think that's a really important shift that we're seeing now.

SPEAKER_02 26:49

That probably then moves us into talk about engagement versus outcomes. Satrina, tools that I I don't know if I could adequately keep track of all the tools that you've moved into market in the varying roles that you've had, but with digital tools that that you've seen and been part of bringing into market, what have you learned about the gap between initial engagement and sustained use? You mentioned sustainability earlier. The gap between initial engagement and sustained use or clinical impact.

SPEAKER_00 27:24

Yeah, yeah. I think we're now in, I think, probably the third era of digital mental health, if I can frame it that way. And I think the early eras, and that's because we have AI everywhere, but I think the first era might have been characterized by engagement as a means and an end. And I think that the second era that I've lived through is you're really seeing that engagement having to translate into outcome. So it's not enough that somebody uses the tool, sessions, minutes, lessons, but I think there's just a growing body of evidence now that a certain amount of engagement will tip into seeing reductions in PHQ 9, reductions in GAD-7s, increases in well-being, increases in resilience, whatever the metric happens to be. And I think the metrics that you want to track at the beginning may look different to the metrics at the end. So some of those metrics you will have within the digital solutions. So if you're tracking PHQs, GATS, whatever, you can at a population level see how you're moving people from moderate down to mild again and look at that. That's one set of metrics. But I think you have to also begin to track outcomes in partnership with the health system. So I think about things like speed to support. So if a doctor is referring a patient to a digital tool, how quickly is somebody getting access to that tool and seeing some benefits? So it might not be a full moving from moderate depression to mild, but you are seeing some reduction in PHQ or an increase in well-being, etc. So I think what's been happening in the last couple of years has been, and rightly, a growing emphasis on outcomes and meeting both gold standard outcomes, but also looking beyond depression anxiety to also looking at things like functional status, is somebody in their life more? Are they enacting more, meeting their friends at the weekend that they were saying no to before because they just didn't feel good to go out? So I think there's a growing recognition on needing to look at metrics that matter to the end user, which is usually the patient, but also the metrics that have clinical utility. Because I think the biggest challenges for sustainment and ongoing value is does this state have clinical value and utility? And am I able to see that in on a patient population level in a panel, for example, if I've got lots of people using a digital tool? So I think that's an expectation now. It's not even engagement is enough. I think it's moved into threading the needle for where engagement quickly is followed by outcomes, but then it's also a growing number of metrics that are trackable either within the app itself andor in partnership with the health system. So you have the bookend of measures, and I know we had a nice partnership with Virtue to begin to do that because collectively then that actually informs what the next level of metrics need to be and how we need to move those together. So it's important by those phases I referenced you earlier, the crawl walk run, that you're able to define what the metrics that matter are in each of those phases. And the other thing is having the feedback loops to the clinical teams, to the end users. So you're continually learning from that data and refining your approaches because, again, it's not a set it and forget it. This is a dynamic system that's getting built. So you want to be able to nudge somebody, for example, if they haven't used the app in a while, and you want to see if they need any more support. Now it depends on what the app is for. So you might have an eight-week course, a 12-week course, or somebody's able to use it when they need to, which is often a preference for people in the digital mental health apps because feeling low or feeling depressed can come and go, right? Over time. It's not like you've now gone into the mild range in a PhQ and you're never going to go back to a higher score because you're human and life happens. I think it's important to think of the metrics from a leadership perspective. We talked about this earlier. Um, are we hitting those metrics, helping with NCQA, for example, depression response and remission measure, which can be a challenge? Or the frontline teams, they're seeing, oh, I had somebody used that tool, had actually had diabetes and depression. Now their depression's improved, their diabetes is improved as well. And then the end user in their life are they more in their life. We often maybe get single-tracked in looking at the measures, but I think if you're going to partner with the health system, having a point of view and how you're going to evolve that metrics palette over time will be important. And also from the health system perspective, that they are aware of how you'll need to have a sandbox for you both to play in from the metrics perspective and look at that data together because it's not done in isolation. There are visit codes, there are new prescriptions you want to look at, there are how somebody is doing in other dimensions of their health that can be valuable to help refine the deployment that you have. So they're all the kind of things I think about.

SPEAKER_02 31:58

Okay. I'm curious, and I loved your breakdown of year one, two, and three. What year is it where the intersection of the adoption of these technologies intersects perhaps with table stakes that value-based care is turning to these solutions? Do you see that intersecting at some point in the near future where not only did the patient get better, not only did the clinician's workflow get streamlined, but the system found that it defrayed cost or increased seven or twenty-five of the Oh, I think we're still early on systems being able to do that full life cycle, right?

SPEAKER_00 32:37

With help with apps and with digital mental health companies. But I would say there are several now at maturity in the marketplace, if I'm just scanning. And they might have started out in the mind plus meditation space and then they've grown their portfolio over time. Again, for that digital maturity piece, for those companies that have been around a decade or more, then they're absolutely in year five plus of those measures being able to show value because they won't win a repeat contract if they're not showing impact candidly. And usually those contracts are three-year contracts. So when the recontracting comes around, the metrics and the things that are tracked probably evolves and higher expectation is put on the shoulders of everybody. And I think that's appropriate for those solutions because they've been around a long time. But I would say we still have a ways to go if we think about value-based care and behavioral health. Um, it's still early days, because I think if you look at where health systems are, and this is where the NCQA HEDIS measures come into play, there I think systems are doing a lot better at screening for depression and screening for anxiety, and we've had those US Preventive Health Task Force recommendations for anxiety and depression for quite a while now, it feels. So we should at least be screening. Obviously, with I mentioned the depression response, remission measure DR for HETIS. Now there's an expectation that you've screened, you've actually followed up in a time window, and you've actually been able to demonstrate what percentage have responded or remitted within a four to eight month timeframe. So clearly the measurements are creeping more toward demonstrate that you've screened, you now know your population, now you're going to positively impact that population either via digital tools and or medications and other programs for those patients. So all of the things are moving toward sustainable demonstrated outcomes over time. I think DOR might be in its second or third year as a measure because it came out of the test window. So it depends on the measure in terms of how mature it is, but we're nowhere near the penetration of deployment of digital mental health tools to actually begin to hit some of those painful access points that patients face and clinicians see when they're somebody's on a wait list to go see a therapist. It it has to be all of those pieces moving together at the same speed, and that's just not been happening to the degree it needs to.

SPEAKER_02 34:54

That's probably the perfect segue then to talk about clinician workflow. So, Angela, this is really a two-part question here. As a clinician, how do you even know which patient needs what outreach today versus next week? It can't just be based on a calendar, like I told you to come back next week, and that's when your need will arise. And based on that prioritization, uh how do digital tools like chatbots even fit into those workflows in practice? Do they help? Do they reduce burden for the clinician, or is it just shifting the problem in a different way?

SPEAKER_01 35:27

Yeah. So I think you can't understand when to intervene, when to escalate without surfacing some sort of data in between, like you mentioned, every three month or whatever visits. So this is where I think some of these tools do come in really handy. If you think about, for instance, a digital clinical care journey, right? That's one of those high frequency, uh kind of low lift touches that allows for a weekly PHQ 9 and a GAD seven or whatever. It takes the patient a moment, takes the clinician a moment to review it. In fact, I in an ideal scenario, it's only popping up to the clinician if it's flagged. I know Mooter, for instance, is a platform that's really good about doing this kind of thing, surfacing the really valuable data and flagging the out-of-range values. And then, okay, this person needs a little bit more attention, we're gonna escalate. So I think that when used correctly, tools like that can be really functional and can actually improve clinical outcomes without certainly without increasing the clinician burden and hopefully even reducing it. But as Katrina really started to speak to earlier, we're in a place right now where we're talking about clicks and seconds. When I use a tool when I'm in the middle of seeing patients that takes an AI tool that's taking 60 seconds to generate, that's hard. That's a significant impact on my workflow. You may say 60 seconds, what's the big deal? But it's 60 seconds for 25 patients. I just added 25 minutes to my day. And by the time you get to the last patient, you could be 25 minutes behind then, unless the tool also saves you more than one minute per patient. And I think it's really important that we're thinking about things that granularly. Like it really is a matter of three extra clicks and five extra seconds is going to change the usability and the adoption of a tool. And I think the one thing I will say is that clinicians really do the work for the good of the patient. So if I'm uh trying to get users to adopt a new solution, a mental health solution that's digital, if I can show them that the tool is safe and effective and has excellent clinical outcomes, they're willing to accept some friction to implement that feature. And I think that's one thing that is on our side when we're implementing these tools is really the fact that clinicians are really in it for the patients. And as long as the tool is safe and effective and you've really been able to demonstrate those outcomes, you can have an imperfect kind of experience, but it can't be too imperfect. We're really like if you have to go out to a different platform, if you really, if you really have to go outside of your typical workflow, it's just even the best intended clinicians are not going to be able to adopt it. And yeah, it's a debalancing act.

SPEAKER_02 38:28

Very good. I know that we've just got a little bit of time left together. So we've got a few follow-on questions here. Maybe this one will sting a little bit. Trina, what what's one assumption health systems still get wrong when they invest in digital health?

SPEAKER_00 38:44

Get wrong. It's a very punitive way to frame it, Jim. Huh.

SPEAKER_02 38:47

I think um be better. How's that?

SPEAKER_00 38:49

I think health systems have to do so much that it's really challenging to deliver care and be in a regulatory environment and be in a business environment that can often maybe feel a bit hostile. So I have a lot of empathy for the processes of care and the people delivering that care. What I will say though, uh a former colleague that that I did get to work with called Scott Heisler, and he would say necessity is the mother of innovation. And I think when health systems are in constrained times, which I think I feel like we've been in them for quite a while, innovation budgets and things like that actually get slashed. And that is the very time you need to innovate if you're having pain points within sort of access, for example, can be months, weeks to months for patients needing to see a therapist, but really not stepping into the innovation space to understand how might we do things differently because they're so constrained. So I would say not cutting innovation budgets and actually doubling down on them and assembling the right teams for that are innovation-minded clinicians and operations folks and assembling the right teams to face that innovation cycle so you can really learn. I was fortunate to be part of that apparatus while I was at Kaiser Permanente. So I've lived through when it's configured and worked and you get to partner with frontline teams and set it up correctly. But I think it's often not replicated in other systems or in times where there might be more financial constraints, but that is very much the time you need to think about that. I also think that engaging the right stakeholders in the right part of the conversation. So where I've seen contracts move quickly and getting to frontline teams and getting first patient in move quickly is where the clinical leadership has recognized they need to bring their IT peers, they need to bring their legal team, their procurement team, all in the room to hear the conversations and ask the questions at the same time. When you have that sort of model to get to deployment, you're going to be more successful because you've surfaced the issues early on. And that's really intentional leadership and intentional infrastructure. And that doesn't exist in many places. You're often grabbing folks who are very busy in their day-to-day, bringing them in for a meeting, they're maybe not entirely sure why they're there and they're listening and they're hearing, but they're not necessarily plugged in. I don't think it's it you have to design it to deliver it, and it won't happen by accident. So that intentionality and that space and funding for innovation, and then thinking about okay, if we're going to move from an innovation budget then to actually day-to-day business budget, how do we do that? So they're the things that I think aren't always figured out soup to nuts that could benefit from that. That's top of mind for me based on what I've learned.

SPEAKER_02 41:26

So in in your past, at those early stages of bringing in new technologies, do you consider at the table there where you're making the decision what the ROI is, whether there's a belief of functional utility towards improving outcomes or improving workflows, or is it let's roll the dice and see what it does? Does ROI play a part in that? Because that certainly matters when it comes to budget cutting.

SPEAKER_00 41:53

Yeah, so it will play a part to get to those later scale and sustainment phases. I think in the earlier phases where you're trying to learn together, I don't think healthcare wants to roll any dice, Jim, just to be clear. It's like first do no harm, right? We think about that. Yeah, we're not going to Vegas. But but I do think if there's a need and a digital mental health tool is very strong on the say cognitive therapy tools and techniques, and we know that they're they have an evidence base and that there's a sort of a need to get those tools and techniques into patients' hands between sessions or while they're waiting for an appointment. I think being intentional about where it sits and fits initially and then how you would grow that over time. I think there is appetite for that, and there needs to be a sandbox for it. But again, intentionally designed, you know, with with clinicians in the room, patients in the room, and then having the sort of the industry partner or the company hearing what the needs are and helping solve for those pain points. So everybody's rolling up their sleeves. It's not I'm just gonna throw this to you and then you're gonna you're gonna get it and we're gonna be great. I think it is a partnership and it is a dynamic ecosystem that's always moving. But but ROI will absolutely come into play for longer, deeper contracts and again building out those metrics that matter over time.

SPEAKER_02 43:07

Very good.

SPEAKER_00 43:08

Yeah.

SPEAKER_02 43:09

Angela, let's pretend we can fast forward five years from now. You will have been a tandem for long enough to impact product development. What does a well-designed, digitally enabled behavioral health system look like, especially for communities that may historically haven't had access?

SPEAKER_01 43:28

Building the dream mental health platform, I think it uh it's going to be, and I say it's going to be because I think we'll have it by then. So I think it's going to be AI enabled, it's going to be culturally competent, it's going to allow specificity to a variety of different conditions, different behavioral health issues, whether that be depression, whether it be anxiety, whether it be and then specific also to populations and ages and stages. So maybe it's first trimester, maybe it's The postpartum mother, maybe it's the aging individual who's struggling with all the changes that happen in our geriatric population. But on top of that, it has to be uh excellent at uh screening diagnosing, and then it needs to provide uh fast, uh easy, uh cost-effective access to a diverse range of treatment options. So synchronous will really if we're going up in the scales of asynchronous to synchronous to then escalation to in-person care as needed, right? Seamless, all in the digital platform and including acute episodic visits and longer-term digital clinical care journeys and longer-term touch points. I think the dream model has all of that well thought through, built in and built out.

SPEAKER_02 45:07

Trina, do you agree?

SPEAKER_00 45:09

I do. And I think AI enabled, you said at the top of your comments, Angela. I think we are absolutely in the era of AI and healthcare and AI and mental health. And I think in five years we have to have moved beyond. I think there are about 30 plus frameworks right now. We need to move from the framework to the operational realities of how we ensure these tools are safe and effective and that we recognize how dynamic they are, but that we're showing that outcomes that we are able to reach more patients and help more people either connect to care if that's appropriate for them, andor get support for the moment they're living through, that may or may not need care if that's appropriate for them, but that we know that and it's that we're measuring it and we're tracking it and we're not just falling for the hype cycle which we're in right now, because AI will be at every part of behavioral health, whether it's the ambient scribe in the background for the visit and/or the between session homework and/or the standalone mental health chatbot that may not require any clinical intervention, but is built on solid clinical principles and an evidence base. Because if we don't succeed at that, people are going to go to other spaces and places where AI is available that don't have any of the guardrails on it. And that will not be a future. That'll be pretty. We're already seeing some of those things play out already.

SPEAKER_02 46:24

We are at the top of the hour. I want to thank you both so much for sharing your expertise and perspectives today. As follow-up, where could our listeners find you if they've got more questions? Trina, the name of your organization again? They could find you on LinkedIn.

SPEAKER_00 46:39

Yeah, they can find me on LinkedIn. I think that's the cleanest place to do it. And I have a website for Park Leathering Health, but LinkedIn is great. I'm pretty active on there.

SPEAKER_02 46:46

And Angela, same?

SPEAKER_01 46:48

I would say the same. Yeah, LinkedIn. And if you can spell my name, good luck to you. That's how you find me.

SPEAKER_02 46:54

Oh, I lost audio there. I didn't hear a thing.

SPEAKER_01 46:56

Did you lose me? Oh, you're back.

SPEAKER_02 46:58

There you go. You're back.

SPEAKER_01 46:59

Oh, all right. Sorry about that. Yes, just like Trita, you can find me on LinkedIn if you can get the spelling my name correctly.

SPEAKER_02 47:06

Very good. What one last parting question? I get some great recommendations this way. I would love to know what the last book you each read, or if you're in the middle of one that you particularly love right now. What are you reading? What's keeping you busy after hours?

SPEAKER_00 47:21

I'm reading The Empire of AI. So all about the origins of OpenAI, Karen Howe's book.

SPEAKER_02 47:28

Okay. Thank you.

SPEAKER_01 47:29

I am actually reading right now a book, an autobiography by a friend in our community. It's actually one of my daughter's best friend's father, Devon Loeb, has written a book about his life growing up in our neighborhood, really, called The In Betweens. And it's great. It's a one-page tour. So yeah. Oh, awesome.

SPEAKER_02 47:49

Thank you so much again for sharing your expertise and perspectives today. Really glad that our paths crossed again and look forward to the next time we get together. Thank you.

SPEAKER_00 47:58

Thanks for hoping us. Always good to chat.

SPEAKER_02 48:01

See