It's been three years since the global turning point of the COVID-19 pandemic, an unprecedented time that exposed and exacerbated a growing mental health crisis.
In the first year of the pandemic, the global prevalence of anxiety and depression increased by a massive 25%, according to data from the World Health Organization. Therapists already were in short supply before 2020, and this has only become worse with an ongoing need for mental health support for adults as well as adolescents and kids.
Grappling with mental health needs remains top of mind for employers and their workforces in 2023.
Seven-year-old company Spring Health has scaled up its solution to meet this demand for mental health support and business has been propelled by 270% revenue growth in 2022, Adam Chekroud, Ph.D., co-founder and president of Spring Health, told Fierce Healthcare in an exclusive interview.
The employer-focused mental health provider has grown its reach to more than 6 million covered lives, he said. Spring Health works with health plans and more than 800 companies, from startups to multinational Fortune 500 corporations including General Mills, Bain and Instacart.
As the company builds out its mental health solution to serve employees' entire families, it has tapped a new chief medical officer to lead measurement-based care and clinical quality efforts.
Mill Brown, M.D. has taken on the role after joining Spring Health as senior vice president for medical affairs in July 2020 as the pandemic reached crisis levels nationwide.
"As Spring Health achieves this level of scale, we really need to ensure that everything that we build and we bring to our members has the highest clinical quality to it and that we're actually building out new quality systems based on data," Brown said in an exclusive interview about his new role. "We're really trying to transform how mental health care is delivered but make sure we do it in a clinically safe and smart way. So having that single person whose only job is really around clinical quality and truly around making sure everything is safe and appropriate to care delivery helps to really balance out all those other pressures that a lot of startup companies have as they achieve scale."
He added, "There are a lot of growth imperatives, but we want to make sure there's a lot of clinical quality and safety imperatives that are well matched there."
The digital mental health space was growing rapidly even before the COVID-19 pandemic, but stress and anxiety brought on by the health crisis have accelerated demand for virtual behavioral health services. Digital mental health startups, often backed by venture capital firms, have helped rapidly open up access to mental wellness for millions of people. But, as the online commercial therapy industry has quickly grown, traditional mental health professionals have raised concerns about aggressive advertising for online services and the quality and safety of care.
Founded in 2016, Spring Health offers what it calls "precision mental healthcare" that matches each employee to the most effective care for them. The solution includes mindfulness and meditation, care navigation, coaching, therapy and medication management.
Spring Health focuses on tracking care outcomes, an approach that is generally lacking among most mental health providers, according to Brown. The company's data reveal that its workplace mental heath program delivers clinical and financial outcomes, according to a peer-reviewed study published last year in JAMA Network Open.
The three-year study found nearly 70% of participants showed improved mental health, fewer missed workdays, increased productivity and less likelihood of leaving their job. Spring Health members can see a provider in one to two days on average. The company's members achieve anxiety and depression score improvement rates of 74% and 72%, respectively, in an average of only five sessions, which is twice as fast as many clinical trials and other solutions, according to the study.
Board-certified in adult and child psychiatry and medical informatics, Brown previously served 21 years in the U.S. Army, where he achieved full colonel rank. In the Army, Brown led in several key roles, including chief of the behavioral health department, and built out a new integrated system of care.
With his medical informatics background, Brown says he is keenly interested in doubling down on Spring Health's approach to using data and machine learning to eliminate trial and error in mental health care, match people to the right care from the beginning and measure clinical outcomes as a routine part of care. He also sees opportunities to leverage data to determine treatment effectiveness.
Using machine learning models, Spring Health's solution assesses an individual's needs, and care navigators guide the individual to the right care, whether it's coaching, meditation, therapy or medication.
Brown joined Spring Health three years ago as he found he was "philosophically aligned" with Chekroud and April Koh, company co-founder and CEO.
"We believe in the importance of measuring outcomes and measuring data from the beginning to create more accurate diagnoses. If we're collecting outcome data throughout the course of care, we can figure out who's doing better and who's not and then we can intervene sooner and change treatment plans to get someone back on track faster. Even today, data is still relatively underutilized within mental health care, and very little technology has been built around it."
Chekroud credits Brown's clinical and medical informatics expertise as a key part of Spring Health's growth as it now reaches more than 6 million covered lives.
"The promotion [to chief medical officer] is both a reflection of the impact that he has had in building medical infrastructure that has been really sound and compliant and has avoided a lot of the drama that other competitors have faced by making inappropriate clinical decisions. He's shown consistently good judgment and making safe decisions that are really philosophically strong for our members," Chekroud said.
Tapping Brown to lead the company's ongoing focus on care outcomes and clinical quality also solidifies Spring Health's commitment to the efficacy and value of its mental health services, he noted.
"We're in a strong position where we are careful, thoughtful and credible around clinical quality. Having one of the best child, adolescent and adult psychiatrists in the world in our C-suite in every meeting helps to ensure that we're thinking through all of the clinical consequences of every decision that we make. It ensures there's the right voice in the room to maintain that position," he said.
Digital mental health companies, many of which grew rapidly during the pandemic, are now drawing media and regulatory scrutiny, particularly for their prescribing practices for controlled substances. During the public health emergency, the federal government waived provisions that required doctors to see a patient in person before prescribing controlled drugs like Adderall.
Telehealth company Cerebral is mired in a federal investigation into its prescribing practices and "possible violations" of the Controlled Substances Act. Telehealth startup Done, which prescribes ADHD medication like Adderall, is under investigation by the Drug Enforcement Administration (DEA), according to media reports.
The DEA recently signaled that it plans to pull back COVID-era remote prescribing flexibilities.
When the DEA relaxed regulations around remote prescribing of controlled substances, Spring Health management took a more cautious approach, Brown said.
"We've held back on the controlled substance piece, but that's not to say we won't look at it in the future. We've been waiting for the post-pandemic regulations to come out and we're starting to look at that to see where it makes sense to incorporate it and do it in a clinically safe way," he said.
Chekroud acknowledged that there's been "a lot of drama" in the virtual mental health care space, particularly around companies that have made "poor quality decisions."
"It's inappropriate to prescribe addictive substances via video with a five-minute slot with an NP (nurse practitioner)," Chekroud said. "I think you've seen these kinds of pill mill models, there's a small handful of them, who have been appropriately penalized for that business model because it's basically 'anti-quality' measures. I think there are a lot of companies in the middle who kind of have drifted where they are not doing anything unsafe, but they're not leading the way in terms of delivering high-quality care at scale and delivering the results that employers want.
"What we're trying to do is really lead the way in publishing both clinical outcomes, with the JAMA paper that came out last year, and we had an independent actuarial firm that validated our ROI [return-on-investment]," he noted.
While the direct-to-consumer mental health care model has been challenged, Chekroud believes that business-to-business-to-consumer models that have a strong track record around ROI for employers will continue to thrive as organizations double down on supporting workplace mental health.
In September 2021, Spring Health scored a $190 million funding round to fuel its growth with plans to take the company global and expand its solution to serve employees' entire families. That round propelled the company's valuation to $2 billion, according to executives. The company has raised $300 million to date.
Traditional workplace mental health programs suffer from low sign-ups, poor access to care and a lack of care outcome tracking. Spring Health is focused on disrupting this model, Chekroud noted, and Brown will play a key role in these efforts going forward.
As the world enters the fourth year since the start of the pandemic, Brown anticipates mental health providers will see ripples of new behavioral health issues emerging that will need to be addressed.
"During my time in the military, you would see the first wave of support that's needed as people come back from war or deployments. Then we would see that next wave, whether it was six months to a year to five years later, among those who tried to 'tough it out' and never really addressed those issues," he noted. "I think we might be seeing those other waves and ripples post-COVID among those people who thought they were doing OK and then realize they are struggling to make that transition back into everyday life."
Since the start of the COVID-19 pandemic, there's been an uptick in mental health challenges among children and teens as well, Brown noted. Spring Health has been building out family programs to provide mental health resources and support for parents and adolescents.
"In 2023, we're going to be focused on really building out and training our many thousands of providers in measurement-based care and building ways to have sustained engagement with all of our members," Brown said. "I think we have the team and the scale now to show that we can do this well. What excites me about Spring Health is if we build that out correctly, we can truly show not just value to employers, but to health plans and others that allow us to really transform how they think about mental health in the context of all medicine."