Behind Kaiser Permanente's Big Moves on Mental Health Technology

Kaiser Permanente has become a role model for providing better, cheaper healthcare in America. Their futuristic visions, such as self-driving triage cars, interactive patient room screens, and a modernized waiting room experience, continue to push medicine forward. Now, Kaiser Permanente appears to be working on a model to expand the delivery of mental health services. With $203.6 billion spent nationally on mental health in 2017 alone in the US and strong ties to other health outcomes, it's a smart place for Kaiser Permanente to focus next.

In June, I visited to DocuSign headquarters for an event presented by Rock Health and Kaiser Permanente Ventures to discuss these plans. Dr. Don Mordecai, a psychiatrist and Kaiser Permanente’s National Leader for Mental Health and Wellness (MHW), led the discussion of their expanding mental health focus and how they are inviting digital health innovators to help. The event highlighted Kaiser Permanente’s current and future MHW priorities and needs, novel technologies and approaches to MHW, and factors for positive engagement. And it gave a preview to mental health startups of how to partner with the healthcare giant in the future. Here are the four big takeaways:

1 - There are many ways to get mental health services wrong

It makes sense that Kaiser Permanente wants to focus on mental health: 30% of patients coming in for primary care appointments have mental health concerns, according to Dr. Mordecai. Additionally, Kaiser Permanente facilitates more than four million mental health visits a year. To give patients the help they need, the organization wants to bring digital health support to these patients. However, there are big questions that must be addressed before making this a reality. Here are the challenges Dr. Mordecai is considering:

• Replicate vs. facilitate — Should mental health apps be trying to replace key features of human interaction or facilitate interactions between people?
• Predictive vs. reactive — Digital health services for mental health patients should be able to identify people who are at the start of a mental health crisis so they can avoid something more serious. When predictive analytics are used, providers can reach out to people who may be at a high risk for depression or another mental health condition.
• BIG BROTHER vs. big brother — With the ability to predict who is at risk for mental health conditions comes the potential for going too far and invading people’s privacy. One important tension point for Kaiser Permanente is striking the delicate balance between not being too intrusive (creepy) but being able to answer subtle cries for help with action (supportive).

2 - Mental health apps struggle with engagement

Dr. Mordecai pointed out that mental health apps need “uptake, engagement, and outcomes” to be seen as truly impactful. One of the biggest struggles that app creators face is getting people to start using and continue using their application. Without uptake and engagement by large numbers of people in the real world, the outcomes demonstrated in small pilot samples are limited in value. Dr. Mordecai was very clear to the room of innovators that they need to hit all three points in this trifecta to be considered for partnership. But it is possible, Kaiser Permanente reports that use of an eating disorder app is helping boost patient appointment compliance, confirming that digital health can and does help improve outcomes at scale.

3 - Machine learning can inform proactive outreach to the right patients

Pilots in machine learning are helping Kaiser Permanente predict which patients are at highest risk for self-harm, and sparking proactive, effective interventions. At the event, Dr. Mordecai shared data on suicide attempts within 90 days of a mental health outpatient visit. At first glance, it appeared that there was a 1 in 150 chance across the population in question, which makes it hard to take meaningful clinical action.

With closer analysis of the data, Kaiser Permanente found that risk for most patients is actually 1 in 350, far less than originally identified. However, also found within the population are much smaller segments of people who had a 1 in 10, 1 in 25, or 1 in 50 chance of attempting suicide after a mental health visit. These are the people who need more follow-up, supportive technologies and more consistent treatment. This is real and it is important. Suicide is the No. 1 cause of death among girls 15-19 in this country, a heartbreaking point made in another one of Dr. Mordecai's slides.

4 - Kaiser Permanente wants your app - but only when it's fully baked

If you have a mental health technology that has proven uptake, engagement, and outcomes and that you’re ready to scale, Kaiser Permanente is inviting you to get involved in their mental health app platform through KP Ventures starting now. That means you, Ginger.io, Joyable, Neuroflow, and Headspace (and soon, Lisa Health, Brightside). Their program is rigorous and can be very slow, but as the organization continues to expand its mental health focus, the opportunity could be invaluable to both digital health startups and the more than 12 million patients in their network who could benefit from digital mental health services.

PS: Thanks to Christina Vanvuren for help with this article!