Equip nabs additional investment to expand virtual eating disorder treatment services to adult patients

Digital health startup Equip is expanding its virtual eating disorder treatment services to adults as demand for care continues to grow.

Equip launched in 2019 to provide effective eating disorder treatments to adolescents. The company's online eating disorder therapy uses a family-based treatment model, a leading outpatient therapy for adolescents with eating disorders that’s been shown to reduce the chance of relapse by including parents in their child’s road to recovery.

The startup expanded to all 50 states in 2022 to keep pace with the rising demand for services, including the nine U.S. states that lack an in-person treatment center entirely.

Kristina Saffran, CEO and co-founder, told Fierce Healthcare back in June that Equip is now the largest eating disorder treatment provider in the country and has doubled down on working with health insurers. The company now works with more than 15 major health insurance plans, and its services are available to 115 million covered lives.

"We've always known that we wanted to treat adults. And we also know that quality is the most important thing," Erin Parks, Ph.D., chief clinical officer and co-founder of Equip, said during an interview. "Me coming from academia and Kristina coming from nonprofit, we are two very prudent people. We wanted to take this one step at a time. We are now a few years into treating children, adolescents and young adults and we have a couple of years of data under our belt, we have over a dozen peer-reviewed research articles and published outcomes reports and we're feeling really confident that we have figured out how to hire the right providers, train them and deliver outstanding care for children, adolescents and young adults. So we feel ready to treat adults well."

Nearly 30 million Americans will struggle with an eating disorder in their lifetime, according to data from the National Association of Anorexia Nervosa and Associated Disorders. But only a small fraction get care that results in lasting recovery.

Equip's expansion to offer online eating disorder therapy to adults dovetails with the demand the company is experiencing, Parks noted. "The number of calls we get from adults goes up and up and up month over month. A lot of people slip through the cracks," she said.

Health plans and providers also have been urging the company the expand its services to adults, Parks said. "They're like, 'Listen, the people that we're helping aren't just people up to age 24, we need you to start taking adult patients, too.' So as we went to renew our contracts with the payers, it was something that they were really excited about."

An estimated 5 million Americans develop eating disorders each year, and that number has risen since the start of the pandemic. But only about 20% of those people receive treatment, with even fewer gaining access to evidence-based therapies.

Eating disorders, impacting nearly 1 in 10 Americans, are mental health illnesses with serious physical health implications and have the second highest mortality rate of all mental health disorders, following opioid addiction.

Earlier this year, Equip published its first Annual Outcomes Report, which showed that patients saw their symptoms reduced by at least 50% in their first five months of treatment. Additionally, 94% of all Equip patients had their treatment covered by insurance as a result of strategic partnerships with many leading commercial insurance plans and Medicaid.

The company also announced an additional investment from General Catalyst, one of its early investors, which will fuel the company’s business expansion. Parks did not disclose the size of the investment. The San Diego-based company has raised $75 million to date, banking a $58 million series B round in February 2022.

Back in May, Equip tapped former Get Well executive Nikia Bergan as its first president.

These three developments all came together at the right time to shepherd the company through its next growth phase, Parks noted. "We have the money, we know who we're going to help serve with this next investment and then we have the leader that can help deploy that capital efficiently to make sure we're getting as many adults who want care the treatment that they deserve," she said.

Equip also wanted to give investor General Catalyst a "bigger seat around the table," she added. "They had owned a small percentage of the company and they had expressed interest, we wanted them around the table, so it's great to make them a formal board member," Parks said.

Equip provides patients with a five-person dedicated care team, including a medical physician (psychiatrist, primary care physician or pediatrician), a therapist and a dietitian. As the company was gearing up for its business expansion, it made investments in the past year to enhance its clinical and operations teams.

"We have been bringing in people who are experts, not only in adult eating disorders but also all the comorbidities. Eating disorders are often comorbid with depression, anxiety and PTSD [post-traumatic stress disorder]. And so over the past year, we've brought experts into our clinical programs team and we've been designing the training for our clinicians," Parks said. "As the demand grows, we'll be hiring more and more clinicians as we really pride ourselves in not having a waitlist."

Equip also has been investing in its electronic medical records system. "We want to make sure we have the tools to continue collaborating in a really cohesive way," she noted.

While Equip's therapy services for adolescents focused on a family-based treatment model, the company's adult therapy services are based on enhanced cognitive behavior therapy, one of the leading evidence-based treatments for eating disorders.

"Many randomized controlled trials show that it works well both via telehealth or in person for all the different types of eating disorders. There's seven different types of eating disorders and we treat all of them and their comorbidities," Parks said. "We are committed to evidence-based treatment with the understanding that not everything works for everyone. If CBT-E ends up not being a fit for them, we will pivot to other treatment modalities."

Equip's virtual services are filling a huge gap in the market as 25% of Equip patients live more than 20 miles from an eating disorder treatment facility, according to executives. Patients in rural areas struggle to find care, and the need for services goes across every demographic.

"Right out the gate, we've seen more demand from adult men than I think most research studies would suggest. That's because there were not safe places for men to go to get treatment. We also know that all races, ethnicities and education levels, all get eating disorders equally. Because of the stereotypes, really only people who met the stereotype were the ones seeking and receiving treatment. Now we're kind of seeing equal demands come everywhere," Parks said.