Why Virtual-First Mental Healthcare is Exactly What We Need

Written by: Eric Simpson

Virtual mental healthcare is one of the fastest-growing areas in health technology. The industry can be broken down into two broad areas: app-based mHealth startups with everyday utility but limited or nonexistent clinical backing and innovations in delivering genuine professional mental healthcare. The first category has more to do with self-help than medicine, covering tools like habit trackers, meditation guides, daily affirmations, and hundreds of thousands of relatively lightweight competitors. 

That’s why the second category is the one that’s of genuine interest to biotech and medtech investors. Startups that provide counseling, individual and group therapy, coaching, medication support, and other behavioral health services have drawn substantial attention. Earlier this year, Brightline completed a $105 million Series C funding round; last year, Workit Health brought in $118 million. There are dozens of similar examples, with some virtual mental health companies now valued in the billions. 

These firms draw on a combination of established treatment techniques and multi-channel care provision to create novel modalities in behavioral health, from 24/7 remote monitoring to on-demand therapist support and new ways of leveraging data to guide medical decision-making. 

The most valuable of them leverage the strengths of mobile technology—efficiency, low cost, and at-home access—to meet needs that are beyond the means of traditional approaches. And from my perspective, the best way to illustrate that is by looking at addiction services.

Addiction and Telemedicine: The Opioid Epidemic

Two decades ago, there was no solid evidence that telemedicine worked. Observed efficacy, cost reductions, patient satisfaction, and clinician approval varied dramatically from study to study. That left many patients turning to detox and rehab programs, a field where it was (and where it remains) notoriously difficult to separate reliable facilities from non-evidence-based scams. The cost was also a problem: the average cost of residential treatment was often over $1,000 per week in 2022 dollars, and efficacy was decidedly mixed. Many people struggling with addiction simply could not access professional help through the rehab industry.

Although the situation has been slow to change, we have seen improvements, specifically through the growth of telemedicine. Technology was increasingly integrated into addiction treatment services over the course of the 2000s and 2010s. The increasing ubiquity of home computers and mobile phones, alongside reliable internet access, removed one major set of barriers. In parallel, acceptance of mobile technology gradually increased, and new applications offered HIPAA-compliant means of sending sensitive clinical information and communicating with patients. The costs of implementing telehealth systems went down at the same time that patient and provider interest in them went up. 

But the true driving force behind telemedicine and its accompanying technologies was crisis-driven consumer demand. First came the opioid epidemic, accelerating through the late 2010s and hitting rural communities hardest. By the time it was declared a public health emergency in 2017, simple geographic distance had emerged as one of the top barriers to care. In response, substance abuse treatment centers rushed to develop remote health options, from online screenings and assessments to phone and video therapy. 

The key service was medication-assisted treatment (MAT), which combined therapeutic care with methadone, buprenorphine, or naltrexone. There were—and are—substantial regulatory barriers to prescribing these drugs remotely, but virtual-first MAT is effective. Online and phone treatment for opioid addiction has roughly the same 3-month retention rate as traditional in-person treatments (roughly 57%-60%) while being much cheaper and potentially reaching far more patients. 

Disruption and Innovation: Responding to COVID-19 

The COVID-19 pandemic then transformed emerging models for virtual care. In early 2020, almost all non-acute medical treatment was immediately transitioned to Zoom or Microsoft Teams. The initial result was widespread confusion and frustration. But patients, providers, insurers, and regulators all adjusted quickly: session lengths were adjusted, and clinics and agencies partnered with outside groups to quickly implement new technologies and rapidly train staff on new platforms. The benefits are familiar—greater access, efficiency of both time and cost, flexibility, and comfort. (Therapy at home!) The downsides were increased dependence on technology and reduced information relative to in-person visits. Only 42% of clinicians feel they are equally effective in virtual settings as they are face-to-face. 

In many ways, the startups rushing into this space are answers to those challenges. They represent new models of care and ways to organize the personnel and technological resources required to deliver it effectively. Where telemedicine in 2019 was primarily a matter of brick-and-mortar facilities expanding service offerings, these newer operating models are distributed and decentralized, and their digital tools have been built with virtual service as their core function. Websites from companies like Eleanor Health and Lucid Lane are simple and user-focused, with easy-to-navigate processes for enrolling in treatment and abundant, accessible information sources.  

The result is a more streamlined and patient-focused set of apps and websites backed by clinicians who are—by now—familiar with working under these new conditions. We do not yet have detailed evidence of the outcomes of this new wave of services. But given the reliability of the previous generation of telehealth services and the substantial across-the-board improvements offered by leading startups, well, let’s just say that I’m optimistic about the future of mental health treatment. 

To discuss this topic further, we invite you to contact Eric Simpson.