3 Years In, Octave’s New Perspective on Making Mental Health Accessible

When Octave first opened its doors in New York’s Bryant Park in the fall of 2018, our mission was clear: make high-quality mental health care more accessible. We founded the company as veterans of the healthcare industry but outsiders to a mental health system that seemed to need a jolt to its status quo.

In my previous work at One Medical, I observed nearly a third of our primary care patients coming in with a mental health need – and that we had no way to reliably find them help. It’s not a surprise for anyone who’s sought mental health care before: chasing word-of-mouth referrals (if you even know whom to ask), wading through insurance directories, figuring out who takes what payment. We created Octave to answer a basic question: How can we remove those barriers to getting care?

Three years and a global pandemic later, our mission is more important than ever. But what we’ve learned, especially from the past year and a half, has really shifted and shaped how we approach that mission and what we need to do next.

Back in 2018, stigma seemed to be a major barrier, so we launched with a wide variety of services, offered in a warm environment, to serve as a welcoming home for emotional well-being. Quickly, however, we realized that the chief barrier to access was not stigma, but affordability.?

This only became more true as COVID-19 turned our world upside down, intensifying the demand for mental health care while forcing much-needed conversations about it. Suddenly, it was OK to talk about your mental health needs - but even more difficult to find help.

By then, our focus had shifted from wellness to clinical care, and from service innovation to easing the financial and operational burden on both patients and providers. Along the way, I’ve realized that the most concerning part of our mental health system is that it is two-tiered: those who can afford to pay out of pocket receive timely access to effective treatment, while no one else can expect the same. This tiered system is the larger problem we aim to tackle now – and our chief weapon in disrupting it is insurance participation.??

In the markets we serve today, only about 1 in 3 therapists is accepting insurance, and most accept no more than one type of insurance. Even if people can find a provider who accepts their insurance, success is not guaranteed: Industry data show that the most common scenario is patients having only one session with a mental health provider, suggesting that most give up if there isn’t a strong initial fit. Shifting these stats is more complex than it seems because it requires adjusting the way we deliver care, not just the manner in which it is paid for.

??? To really improve the care delivered in-network, providers have to be accountable for the quality of care being delivered. Therapists and their clients need to be supported? in the tricky process of navigating insurance payments. They have to be able to know when and how to graduate a client when the work is complete, and this is a nuanced and specific process for each client. Being able to evolve mental health practice requires consistency and scale, functioning collectively with insurance companies, medical providers and the mental health community – working as a complete collective, like a musical octave.?

Earlier this month, we were proud to announce our third major insurance partnership. Across our partnerships, more than 10 million people across California, New York, and several other markets will soon access our mental health services through their insurance co-pay. I’m excited to continue making advances in this area, broadening our insurance participation and working to improve the delivery of mental health services.

The next three years will certainly provide an opportunity for transformation, but across our industry, the question remains: Can we transform it in a manner that works for everyone??

• Will we use this window to shift the status quo towards greater equity in our mental health system, or will we only be creating more pathways for the affluent??
• Can we make our system sustainable for the clinicians whom it depends on, or will we race to the bottom with lower pay and, inevitably, lower quality??
• Can we have an informed perspective on the care we deliver, or will we be rushed into quick fixes??
• Can we thoughtfully incorporate technology without ignoring the fundamental role of human connection in making lasting impact???

We at Octave look forward to being part of the answer to these questions.