In a prior article we took a look at the Health 2.0 startup landscape, and saw how successful incubators help qualified founders with a Big Idea build meaningful relationships between investors, developers, business managers, and distribution networks. Now let’s explore a vibrant example of exactly such a digital health startup in the making, and how timely and relevant ventures such as this one help to bridge a significant gap within the healthcare system, benefiting professionals, institutions, and the ultimate end-user — the patient.
Measure for Measure
Meet Daniel Z. Lieberman, M.D. a professor and clinical director in the Department of Psychiatry and Behavioral Sciences at George Washington University, and no stranger to using technology to measurably improve care. Focused on addictions and mood disorders, he has developed web applications to study the effects of automated interventions that deliver evidence-based therapies to people who are unable to access standard treatment.1 Dr. Lieberman has also conducted a pilot study of an automated adaptation of social rhythm therapy for bipolar disorder, resulting in users experiencing increased stability of mood, decreased functional impairment, and improved quality of life.2
Recently taking things to the next level, Dr. Lieberman has teamed with digital health incubator Casual Corp to launch Good Measure, a startup company dedicated to developing mHealth solutions to help improve the quality of care for those suffering from depression and other mental illnesses. His first project: to provide an effective way to ensure that care for depression is evidence-based, measurement-optimized, and patient-centered, thereby getting patients the type and quality of care they need and deserve.
Inadequately treated depression has a high cost in terms of money and quality of life. A recent study that included 14,902 participants with diabetes mellitus, congestive heart failure, or both found that participants with depression had significantly higher total healthcare costs than those without ($20,046 vs. $11,956).3 The human cost is difficult to quantify but even more destructive, as undiagnosed or inadequately diagnosed depression remains a major cause of family, health, and workplace issues.
“A major cause of inadequate diagnoses in the US is that primary care physicians treat 70% of all cases of depression,4 because specialists are often too far away, and many patients best trust their PCP,” says Dr. Lieberman. “However, primary care physicians simply don’t have the time needed to perform a complete psychiatric evaluation. As a result, only 20% of these patients receive care that meets what has been described as minimally adequate standards.5 So I felt that creating a digital interface that guides patients through a validated, easy to use, point of care experience that measures the severity of their depression could improve diagnoses so they receive the treatment best suited for their condition.”
Good Measure’s customer-designed software provides best practice information based on the American Psychiatric Association Treatment Guidelines for Depression, and is presented in an intuitive, compelling way that encourages a collaborative relationship between the patient and the doctor, shown to be the key to patient satisfaction. And since depression interferes with and increases the costs for the treatment of diabetes, congestive heart failure, high cholesterol, hypertension, and other diseases, patients enjoy costs savings and better outcomes. At the same time, providers and payers will find government-mandated performance benchmarks easier to achieve.
“An important lesson learned in digital health is that no matter how effective the app or terrific the patient experience,” insists Dr. Lieberman, “adoption will plummet if physicians aren’t incentivized to use it. So the benefits for healthcare practitioners are equally vital to ensure uptake and compliance.” The good news: The US Preventative Task Force has identified screening for mental health problems as a priority,6 resulting in new codes paying physicians additional fees for these assessments.
As a result, using the annual depression and alcohol screening modules provided by the application, practices are able to increase visit charges by 30-50% over the usual patient encounter. Charting recommendations are integrated within the system, so the clinician can rapidly document and justify each charge. A menu of best practice treatment options derived from the authoritative guidelines is also embedded, providing clinicians with targeted, just-in-time informaton on optimal treatment based on the personalized screening and clinical status.
Benefits abound from the administrator’s point of view, too, in terms of increased revenue as described, and reduced pharmacy costs by discouraging the use of inappropriate or unnecessary medications. And by making patients active partners in their care and drivers of the app experience, physician training, commitment, and time are all greatly reduced as well.
Making it Real
“Digital health is where clinical knowledge, communications, and technology converge,” says Dr. Lieberman. “To be successful you need expertise in all three. That’s why my partnership with a best-in-class startup incubator like Casual Corp has been so important. They not only helped me build the application itself, but were instrumental in crafting the up front strategy, and established the down stream distribution and monetization approaches. I’m excited to see where we can take Good Measure!”
Daniel Z. Lieberman, M.D. is professor and clinical director in the Department of Psychiatry and Behavioral Sciences at George Washington University. He also serves as the Chairman of the George Washington University Office of Human Research Institutional Review Board. Dr. Lieberman is a fellow of the American Psychiatric Association and has spoken to audiences at the Department of Health and Human Services, the Department of Commerce, and the Office of Drug and Alcohol Policy. Learn more about Good Measure!
- Lieberman, D. Z. and S. W. Huang (2008). “A technological approach to reaching a hidden population of problem drinkers.” Psychiatric Services 59(3): 297-303.
- Lieberman DZ, Swayze S, Goodwin FK. Best practices for delivering bipolar-specific psychotherapy via an automated Internet application (2011). Psychiatric Services, 62(11):1267-1269.
- Unutzer J, Schoenbaum M, Katon WJ, Fan MY, Pincus HA, Hogan D, Taylor J: Healthcare costs associated with depression in medically Ill fee-for-service medicare participants. J Am Geriatr Soc 2009; 57(3):506-10
- Pratt LA, Brody DJ, Gu Q: Antidepressant Use in Persons Aged 12 and Over: United States, 2005-2008. NCHS Data Brief 2011; 76
- Horgan C, Merrick E, Stewart M, Scholle S, Shih S: Improving medication management of depression in health plans. Psychiatric Services 2008; 59(1):72-77
- U.S. Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009;151:784-792.