The venture capital world has largely ignored innovation for serious mental illness (SMI) care until recently.
But with more payers moving away from behavioral health carve-outs and some of the highest costs in health care, SMI could be a ripe segment for investment.
“If you get outside of a major city, there are very few [options for SMI care]. So, serious mental illness has been a big area of focus for us. There’s a lot of room for innovation,” Dr. Ben Robbins, a trained psychiatrist and general partner at GV, said at Behavioral Health Business INVEST. “Serious mental illness is different from other parts of the healthcare ecosystem because it changes people’s life trajectory so dramatically. We do a lot of work around peers trying to layer in novel approaches to how you engage somebody with SMI. And we’ve had a lot of success.”
GV, previously called Google Ventures, was founded in 2009 and has over $8 billion in assets under management. Its portfolio includes 400 companies.The venture firm has deployed over $1.2 billion into health care and life sciences companies since 2020.
Its previous mental health investments include firsthand, Headway, Brightline and Quartet Health.
Historically, reimbursement rates for SMI care have been low, and much of that work is done in the Medicaid space. Additionally, payers carved out behavioral health benefits, making them less of a focus. But this could be changing.
“What’s not intuitive about SMI is that the costs for the most complex patients are driven almost entirely by medical costs,” Robbins said. “And so the trend towards carve-in and trying to combine medical and behavioral- I think it’s particularly focused on SMI, because the medical costs are astronomical in that population.”
While serious mental illness care could be prime for value-based arrangements, Robbins noted that for that to work, it has to be integrated into physical health care.
In a value-based arrangement, the cost of behavioral health services for patients with SMI may increase.
“When I think of value-based care, I usually think you’re taking some financial risk, so you get a payment based on what you anticipate some of these costs are going to be and then you’ll get rewarded if you basically decrease that cost. In behavioral health, I find that to be a little problematic,” Robbins said. “If you have somebody who has undertreated schizophrenia and you start delivering care, it’s feasible that person is going to gain insight and they’re going to gain motivation to seek care and costs can go up.”
Alternative models of care
Still, there is a lot of white space in value-based care and lowering the costs for behavioral health because there is an overutilization of services. Robbins noted that some folks come into the emergency department because it’s cold and rainy outside and they have nowhere else to go.
These patients may have behavioral health conditions but may not leave the inpatient level of care. However, clinicians are often risk-averse and refer to a higher level of care.
This is where inpatient alternatives come into play. Robbins noted that ‘middle acuity’ care, such as partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs), could be an option for patients who don’t need inpatient care but do need more than traditional outpatient programs.
Many patient demographics could benefit from these services beyond just the SMI population.
“PHPs and IOPs are largely group-based. We’ve seen a couple of venture-backed companies doing virtual groups, and the sense of connectedness, the rate of engagement, the sustained engagement, it’s really high, especially among teens,” Robbins said. “It makes sense. It’s an area I always think of as having a particularly high stigma around mental health care. But I think it’s a pretty effective way to get around that stigma.”
Robbins noted that seniors could be another demographic that could be prime for more group-based interventions.
Because they are done in a group setting, these types of programs could also help solve the workforce shortage problem in behavioral health.
“It [could be beneficial] if you have the ability to refer into group settings or alternative settings where it’s not necessarily one-on-one, or if it’s an MD who has peers as part of the clinic, and that peer is doing a lot of the in-between visit work, making sure things are going well, making sure the meds are picked up, and helping somebody feel connected and engaged,” Robbins said.
Investing in the peer support space is another way to alleviate the workforce challenges and help individuals with SMI and other behavioral health needs stay engaged. Robbins noted that peers can come from the patient’s community and potentially relate to patients on a deeper level.
“I’ve seen a small group of people and companies start to deploy peers using this lower-cost model,” he said. “The thing that’s shocking to me is that the engagement rate with peers is just so much better, especially with complex populations than the engagement rate with clinicians.”
In early 2023, GV invested $28.1 million in a firsthand SMI startup. The company is focused on using peers to build trust with patients with SMI to help boost patient engagement and connect patients to the health care system and community resources.
