Reimbursement coverage for behavioral health services hit a milestone in 2008 when Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) which required insurers to equalize coverage for behavioral health and medical health benefits in terms of co-pays, deductibles, lifetime caps and access to providers. Fast forward to present day when demand for behavioral health services outpaces the availability of treatment and the COVID-19 pandemic ushers in unprecedented levels of anxiety and isolation. A panel of behavioral and mental health executives dig into how the care model has shifted during the pandemic, what changes are still essential to deliver quality behavioral health care, the unique role technology can play in behavioral health care, and how both payers and providers are currently defining value for their patients.   

“A lot has happened in healthcare in the past two years,” Lucienne Ide, Founder and CEO of Rimidi, says. “We went from a miniscule adoption of telemedicine—much less remote monitoring—to now everybody’s looking at the future and saying, ‘This is here to stay. How are we going to do it in a scalable and sustainable way?’” Rimidi has the plan. Ide’s focus is patients with chronic diseases. Episodic care is not working for them, she says, and a once-a-year or once-a-quarter trip to the doctor feels more like being called to the principal’s office than a health-focused partnership. At Rimidi, Ide and her team are building sustainable progress by pushing healthcare past just digitizing data into true decision support for both patients and providers, innovating in care delivery and doing the “dirty work” of truly setting patients up for success. Ide and host, Steve Krupa, talk about the pain points in shifting to a value-based models; how EHRs, patients, and providers are responding to Rimidi’s decision-support tools; and her best advice for healthcare entrepreneurs.Lucienne Marie Ide, MD, PhD, is the Founder and Chief Executive Officer of Rimidi, a cloud- based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.

Doctors making house calls might seem like a relic of the past, but the act of caring for patients in their own home is experiencing a revival. Only this time, it’s highly dependent on technology. This special episode features a panel discussion from a Digital Healthcare Innovation Summit (DHIS) Spotlight Episode earlier this year. Moderated by Ellen Herlacher, Principal, LRVHealth, this panel offers insights from entrepreneurs who founded some of the most innovative tech startups that are bringing change and disruption to the home health field. Hear how they’ve approached this dynamic and fast-moving market, learn about the challenges they’ve faced and their strategies for overcoming them, and leave with an understanding for where they see the biggest opportunities ahead.

Like many healthtech leaders, Walter Jin didn’t start his career in this industry. He began as an investment banker and then joined what was a much smaller Carlyle Group based in Washington DC in the 90’s. The firm had originally focused on aerospace defense but wanted to diversify, and since Walter happened to be doing healthcare deals for them, he was then asked to start their healthcare group. In 2008, he retired from Carlyle and started his own investment firm Three Fields Capital, but after a few years, he decided to take a step back from the finance world when his parents got sick. Walter continued some investing on the side via a family office and was eventually approached by Oscar Salazar (Uber co-founder) about Pager. Originally the “Uber for Doctors and Nurses,” Pager had promise but was plagued by challenges with affordability, supply chain, and access. Walter saw potential though, so he invested in the company, served as Chairman for about 3 years, helped it pivot to a platform focused on access and steerage, and then became CEO, the role he has had for about 3.5 years. Tune into this episode to learn more about Pager’s origins, its new focus and business model, how the company has been able to white-label its platform to embed within many provider/payer stacks, and healthcare’s response to this rapidly growing company, plus Walter’s thoughts on the future of the health system and digital care.

John Kao is a seasoned entrepreneur and executive. After beginning his career at FHP International, he then started four other companies in succession: Secure Horizons USA, PacifiCare Health Systems, The TriZetto Group, and CareMore Medical Enterprises, before then being compelled to found Alignment Healthcare. Alignment’s origin is a bit more personal to John though, as the business idea arose from his and his mother’s experiences as she had a heart attack. After experiencing a lack of consistency around clinical information, particularly post-discharge home healthcare; poor communication post-discharge about cardiac rehab; and medication mismatches pre- vs. post-hospitalization, John felt he couldn't be the only one going through this, so he started Alignment Healthcare. He felt there was a huge need for proactive care at the home and/or virtually for the 20% of seniors who are frail or have polychronic conditions, and that the cost savings arising from providing better care for this population could be reinvested in the other 80%. Tune into this episode to learn more about Alignment Healthcare’s origins, its unique business model, its strong values, and the healthcare market’s response to the now-public company, plus a candid conversation about some of the most valuable lessons John has learned transitioning from an entrepreneur to a CEO.John Kao is Founder and CEO of Alignment Healthcare, a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Mr. Kao has had a long career committed to the healthcare industry and has served in executive roles at CareMore Medical Enterprises, The TriZetto Group, PacifiCare Health Systems, Secure Horizons USA, and FHP International. Mr. Kao believes strongly in the tenets of servant leadership and serves on various boards of non-profit organizations. He received his bachelor’s degree from Santa Clara University and his MBA from UCLA Anderson Graduate School of Management.

Mark Frank has what he calls “professional ADD.” He naturally likes trying different things and building new skills, which is ultimately what led him to become an entrepreneur. Even while serving in the Army after college, Mark still found entrepreneurial aspects as a platoon leader; after all, he was responsible for everything his unit either did or didn’t do. He used to think of himself as an operator or executive, which was his role at his first startup, but now he looks for ideas/opportunities, makes note of them, and eventually either whittles them down into business opportunities or sets them aside. After a challenging and frustrating experience finding a therapist (balancing location, schedules, insurance, and fit is a real nuisance), Mark realized the huge opportunity to help both patients and therapists connect more easily. Hence, SonderMind was born. Tune into this episode to learn more about SonderMind’s origins, its unique business model, how it has tackled some of the big problems in the therapy space, including access to care and providing valuable business support to therapists, plus a conversation about the current challenges and opportunities with many mental health benefits.

After losing his Holocaust-survivor dad as a result of three medical errors at a US academic hospital, Raphael Rakowski was driven to start Medically Home. Trained as an engineer who then successfully launched a few prior companies, Raphael was prepared to try to address the problem of high fixed cost burdens at medical facilities that he felt affected quality of care. He and his co-founders started Medically Home almost 13 years ago with the vision to provide high acuity, complex care, in a home setting. Thankfully, after some behind-the-scenes backing from Mayo Clinic, a momentous decision by CMS to provide a reimbursement code for their care model, and a boost in demand for out-of-hospital care during Covid, the company has recently really taken off. Tune into this episode to learn more about Medically Home’s technology and patient experience, as host Steve Krupa chats with Raphael about the company’s business model, tipping point, traction gained with both patients and providers, and future.Raphael Rakowski has devoted his career to transforming and transcending the ways in which companies provide essential services to the public, particularly in the healthcare industry. Raphael is a life-long entrepreneur, and his knowledge and expertise extends into sectors such as healthcare, consumer products, and renewable energy. In 2000, Raphael was the President of American Healthways, a Share care company, which focuses on using behavior change to track a person’s health. Following this, Raphael founded SAMI (Show All Medical Information) in 2010, a company designed to use modern healthcare technology to provide a simple search platform for families and their doctors. Raphael was also a co-partner at Intersection Partners, a group that helps launch and operate healthcare service companies. Raphael is now currently the co-founder and executive chairman of Medically Home, a company revolutionizing healthcare by providing hospital-level care for high-acuity patients in the comfort of their own homes. Through a combination of 24/7 virtual monitoring and in-person home visits, patients in Medically Home have higher rates of positive outcomes and lower readmission rates than traditional hospital patients.

As a former Partner at Deloitte, Rajeev Ronanki established and led Deloitte's Life Sciences and Healthcare Advanced Analytics, Artificial Intelligence, and Innovation practices. He then was offered a chance to join Anthem and lead their transformation to becoming a digital-first enterprise. Rajeev viewed this a great opportunity to help transform healthcare, so he accepted the position. How did he start to tackle this challenge and develop a vision for this insurance giant? First, by simply defining what “digital” meant within Anthem. Once aligned on that, he was able to start implementing automation of core business practices and developing an application to engage consumers in a more personalized manner. Then, the real value came. Leveraging over 10 million users on their digital platform, Anthem was able to improve their app based on user feedback collected on the platform (they tested an average of 180 user experiences per day!). More impactfully though, the group could start deriving real healthcare insights. Tune into this episode to learn more about Anthem’s new digital-first approach, as host Steve Krupa chats with Rajeev on the company’s digital revolution, its partnerships with startups and investors, the opportunity for more upfront diagnosis, and even Rajeev’s thoughts on blockchain’s utility in healthcare.Rajeev Ronanki serves as Chief Digital Officer at Anthem, Inc. He is leading the transformation of Anthem to become a digital/AI-first enterprise through driving the vision, strategy, and execution of Anthem’s Digital, Artificial Intelligence (AI), Exponential Technology, Service Experience, and Innovation portfolios. Through these efforts, Mr. Ronanki is enabling Anthem to harness the power of AI and data to better understand healthcare consumers and provide tailored, personalized care. His experience spans over 20 years of innovation-driven industry and social change across healthcare and technology.  

Having been both an operator and an investor in the healthcare industry, Fay Rotenberg knows the challenges and silos all too well. She was encouraged when she first met the co-founders of Firefly Health though. Initially, she had agreed to meet with them 1 day per week, then that grew to 2 days per week, then 3, and before she knew it, she joined the company as President and CEO about 3 years ago. Firefly is striving to shift healthcare from episodic to continuous care. They are a virtual-first clinical network consisting of primary care, behavioral health, and specialty care, all accessible via a world-class navigation platform. Think of Firefly as a mini and virtual Kaiser, as they are now also expanding into full benefit models for employers. By reducing costs and improving outcomes, they have begun to achieve concierge medicine at scale. Patients interact with their platform an average of 41 times per year and receive a response within 5 minutes, while doctors also love being part of their team-based care approach, as it allows them to focus on tasks that are most value added for them. Tune into this episode to learn more about Firefly Health, as host Steve Krupa chats with Fay on the company’s mission to provide half priced health care that is twice as good, its start with insurers as original customers (now somewhat competitors), its growth to over 50 employees, and its future including developing a health plan replacement for employers.

In his final rotation at Harvard Medical School, Andrew was baffled by how many patients were googling their symptoms to make decisions about whether to seek care. Things became personal though when his own father hesitated and waited too long to seek medical attention while experiencing a mini stroke (thankfully he survived). Andrew became convinced that there had to be a way to reduce the effort and hesitancy deterring potential patients from engaging with healthcare professionals. So, he took three years off from medical school and co-founded Buoy Health. The goal was to develop an AI chatbot that could help people answer the simple question: “When do I need to go to the doctor?” Built upon manual review of thousands of medical articles and incorporated user feedback, Buoy quickly became a truly machine-learned algorithm that could not only account for medical best practices but also user demographics. Today, buoy.com services over 30 million people, including being the official COVID-19 screening tool for both Massachusetts and Virginia. The company has also developed a “Back with Care” feature to help employees return to work and is about to release a vaccination module as well. Tune into this episode to learn more about Buoy Health, plus hear host Steve Krupa chat with Andrew on his transition from medical student to entrepreneur, what he wished he knew before starting the business, and Andrew’s vision for the company’s future.