Fostering successful pilots with health plans is critical for digital mental health startups.
These relationships can promise significant promise for providers and payers, but a negative outcome can mean wasted time and resources.
While risk is an inherent part of a trial run for a digital mental health provider, both health care companies and payers can take steps to create the best chance of a positive outcome.
“Going into a pilot with a payer is not for the faint of heart,” Damayanti Dipayana, CEO of virtual mental health startup Manatee, said at Behavioral Health Business’ INNOVATE event. “My whole thesis was, I want to first work with our health plans, who are great partners. We generate revenue by providing services. … And then in parallel, we work on some innovative ways [to address the] real big pain points that health plans want to solve.”
Alameda, California-based Manatee provides virtual mental health services for children and families in seven states. The provider has raised a total of $11.6 million, according to Crunchbase. Manatee’s most recent raise was $2.4 million in May 2024.
For Manatee, getting a pilot contract is a minimum-12 month process. Digging through paperwork alone can take weeks. First and foremost, mental health providers must be able to generate revenue before getting a successful pilot, Dipayana said. Having revenue not tied to a pilot assured her that Manatee “was not going to die.”
The vast majority of Evernorth’s pilots go “well to extremely well,” according to Andrew DiGiacomo, the organization’s director of provider partnerships for behavioral health.
Evernorth is Cigna’s (NYSE: CI) health service division.
One example of a failed pilot was a company that could not manage Evernorth’s volume of referrals.
“If we start presenting this to our account management teams, our marketing teams, our clients, they do not want to hear back, ‘Hey, we sent someone here for this pilot program, and they got rejected,'” DiGiacomo said. “That’s a complete and total disaster.”
It is crucial that both parties be on the same page from the get-go, DiGiacomo said. Payers must alert providers that they will invest time and resources with no guarantee at the end of the process.
Tracking success
Determining the right metrics is crucial for a pilot’s success. Clear communication about these metrics is also critical.
The right metrics for a pilot depend on several factors, Dipayana said. One key factor is duration.
“It’s all about building value, reducing costs and providing high-quality care,” she said. “Sometimes you don’t get to really evaluate that within 12 months.”
Historically, the behavioral health industry has focused on access, Dipayana said. Access is usually one of Manatee’s core metrics for pilots. But it’s also crucial to ensure access to the right level of care.
One of Manatee’s top priorities when beginning to work with Evernorth was its matching process. Less than 3% of families require a rematch with a different clinician, according to Dipayana.
“It’s very hard to get that first impression back,” she said. “It’s honing in on access to the right level of care so that you actually can get the engagement and the outcomes.”
Therapeutic alliance is one of the most crucial predictors of success, DiGiacomo said. Payers want patients seen quickly, and by the right provider. Matching a patient to a less ideal provider results in the “biggest complaints,” he said.
While metrics are crucial for determining success, it’s important to ensure that metrics are concise. Payers may ask providers to collect a slew of data, only to ignore some points when making decisions. Evernorth aims to keep its number of metrics to between two and four.
One factor matters above all else, Dipayana said.
“None of these things matter if you don’t have engagement,” she said. “This is something where we’ve been successful and unsuccessful in the past. We can get a pilot, but if you don’t have member engagement, none of it matters. It doesn’t matter how good your product is. If people aren’t using it, you’re never going to see the outcome.”