More Americans continue to demand mental health services, but often issues of access can compound efforts to receive care. For many low income-individuals who fall within the Medicaid population, various barriers like cost, stigma and accessibility have especially been problematic over time.
In 2017, Anna Lindow set out to improve access to mental health services for Medicaid recipients, doing so well before the pandemic normalized the use of telehealth. Thus, Brave Health was born.
Headquartered in Miami, Brave Health contracts with 113 plans in 10 states to facilitate mental health services to over 65 million individuals. Licensed physicians, nurse practitioners, therapists and counselors provide services to individuals through the Brave Health platform, with most of its wellness team employed full-time by the company.
Although the platform accepts Medicare and a number of commercial insurances, Brave Health specifically targets the nearly 76 million Americans covered by Medicaid, which is the nation’s largest payer of behavioral health services.
Initially starting out as a provider of treatment for substance use disorder (SUD), Brave Health would eventually branch out to offering a wide variety of behavioral health assistance. Today, its range of outpatient services include therapy, psychiatry, case management and medication-assisted treatment (MAT) for SUD. Currently, Brave Health is available in Florida, New York, Texas, Illinois, Michigan, Ohio, Kentucky, Alabama, Georgia and North Carolina.
Recently, Brave Health raised $10 million in a Series B financing round led by City Light Capital, Union Square Ventures and Able Partners. The funding brought the amount raised to date by the company to $20.75 million, which it intends to use to expand its platform and double the number of states it looks to be in by 2022.
Leading Brave Health is its co-founder and CEO Lindow, whose own journey to mental wellness began when she was 15, after seeking assistance following the death of her mother. A former vice president with the business education organization General Assembly, Lindow would go on to help create Brave Health as a way to provide more access to individuals needing behavioral health assistance, but — who unlike her — may have encountered previous roadblocks with access.
Lindow recently talked with Behavioral Health Business, where she discussed Brave Health’s focus on the Medicaid population, how the company has won over investors with its business model, its latest funding round and more. Portions of the interview have been edited for length and clarity.
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BHB: You started Brave Health with the goal of providing services for the Medicaid population. Were there any particular gaps with mental health access that you initially identified with this population, which informed the creation of the company?
Lindow: Initially, in the very early days, we were primarily focused on medication assisted treatment for opioid use disorder. And we still do that in some of our markets. But what was fascinating was that as soon as we started offering those services, we started hearing from our payer partners that patients were interested in getting additional behavioral health services from us, and payers were interested in us delivering those.
With Medicaid, we have the general behavioral health access care gaps that exist in our country, plus even more limited access because fewer private practice providers accept Medicaid than commercial insurance or Medicare. We very quickly became aware of the dramatic gap in access to all behavioral health services — not just in medication assisted treatment — which is why we expanded our offering.
At what time after Brave Health was founded did you decide that the company was going to start focusing on behavioral health services, in general?
We started seeing patients in our mini-clinic in 2018. Within the first year, we started to get a lot of feedback from our health plans, but it wasn’t overnight. We learned more from our patients, and by 2019, we had that full offering in place.
Did you always intend for Brave Health, at some point, to offer a fuller range of behavioral health services? If so, did it happen sooner than you expected?
I think so. As an entrepreneur, you learn so much so quickly once you start to work in the marketplace. We were fortunate to get a lot of great indirect feedback from our payer partners and our patients, and were able to act on that feedback quickly.
There are many in the Medicaid population who have long struggled with access to virtual platforms of various kinds. Was that a concern of yours when you established the company?
Early on, we did have that concern. What’s really interesting is that between 2016 and 2018, the percentage of Medicaid beneficiaries who have a smartphone accelerated to be in line with the national average of adults with smartphones. It was pretty dramatic when we first started working on Brave to when we became a fully virtual provider in 2019.
That availability of technology within the population we were serving changed significantly. As we made that shift, there was a societal shift happening. I would assume it is only higher now in 2021 than it was in 2018. Technology adoption has changed and grown as Brave’s changed and grown.
Many Medicaid recipients come from communities where, in some quarters, cultural stigmas regarding mental health have long existed. How has Brave Health attempted to tackle this?
Another shift we’ve seen since I’ve started working on Brave is, broadly speaking, reduced stigma around seeking behavioral health care, which is wonderful. It’s a trend I hope to continue to see.
I was watching a football game the other day. I can’t imagine in 2016 having seen the NFL do an advertisement around reducing stigma for CTE or seeking mental health services. There’s been a big change in our country not just during COVID, but before as well.
When I started working on Brave, people were like, “Oh, that’s that sounds interesting.” Now, I think that how we create access to mental health services in our country is a number one topic of interest and discussion. We’ve worked hard with any prospective patient to reduce fear, frustration, confusion and stigma around starting the process of behavioral health services, because it is scary and can be frustrating. I do think the trends, broadly speaking, around awareness and reduction in stigma are happening in parallel.
When the company began raising money, were there potential investors who might have been skeptical that tailoring telehealth services to the Medicaid population could work as a business model?
Union Square Ventures, who did our initial seed round, has been incredibly supportive since the beginning. Investors who’ve come in later are organizations that have theses or positions on the importance of access not only to mental health and behavioral health services broadly, but within the Medicaid population.
City Light, who was also on our last round, has a mandate around impact investing. We’ve been fortunate to work with wonderful investors since the beginning. I would say that in the past six to nine months, I have heard so much more interest in the possibility of investing in businesses that support Medicaid populations. It wasn’t something that I was hearing as a focus or interest a year ago. And now people are saying, “What are we doing to invest in organizations that serve one in four Americans?” That is a significant change that I have no reason to believe will do anything other than continue.
Can you provide some insight on how the company plans to apply the $10 million raised from its most recent funding round?
We have a model and a wonderful team that has been doing amazing work with patients. At this point, we’ve really established that what we’re doing is needed across geographical regions. This is not as if a corner of one state needs behavioral health services, but everywhere else, we’re fine. This is a situation where, tragically, I think every single part of our country is experiencing some sort of lack of access. And so our goal is really to be that engine for creating high quality, affordable, fast and convenient access for those who need it most.
Does Brave Health have a target on how many states it would like to be in by a certain — say, for example, six months from now or the end of 2022?
I would say we’re planning to be in about 10 more by the end of next year.
For the states that Brave Health is looking to enter into, would it be contingent on them to increase their portion of Medicaid spending?
We’ve seen such a sea change in how states think about telehealth reimbursement for Medicaid. I think we’ll continue to see states looking at ways to innovate, and looking at ways to bring more telebehavioral health services to their beneficiaries.
We’re in a good place as a country. All 50 states reimburse for some kind of telebehavioral health, even as there are still some regulatory barriers in some states. We’ve seen a lot of change, even in the past 18 months, and we’ll continue to see things going in that direction.
In the long run, what are some of Brave Health’s goals?
When I think about what I want to accomplish in five years for example, it’s really around what we can do for patients. I want people using Medicaid to know that there are options available. I want them to know that if they need or are considering behavioral health services, that they can get access quickly and easily, and in a way that gives them the care that they need and helps them improve their health. It’s as simple as that. We’re here to improve health outcomes.
Companies featured in this article:
Able Partners, Brave Health, City Light Capital, Union Square Ventures
