Why online mental health tech needs Medicare

As it approaches profitability, digital health darling Talkspace is just the latest mental health company to set its sights on Medicare — competitors like Brightside Health have been doing it for years, co-founder and chief medical officer Mimi Winsberg told me at the media lounge at ViVE. (My colleague Mario Aguilar explored Talkspace's motivations for targeting the tricky market, earlier this week, sprinkled with a little of my reporting.)

Winsberg said Brightside Health's internal research finds that virtual care patients above 60 progress just as much as younger patients. Though keeping providers credentialed — and staying up to date on federal and state regulations — can be tough, Medicare is a growing market for mental health providers, with an estimated quarter of seniors facing mental health issues, Winsberg said.

Among tidbits that didn't make it into Mario's story: I spoke earlier with Included Health president Robin Glass, who said the company's also been treating Medicare patients for years, but that they make up a relatively small chunk of overall users. (None of the mental health companies I spoke to that catered to Medicare patients would share how many there were, nor how much business they brought in.)

Reaching seniors comes with challenges: Advertising through fliers and direct-mail ads is more expensive than paying for digital ads targeting younger users, Glass said. "The cost of attracting a new member is high relative to the service," she said.

hot takes

More on General Catalyst's cultural hurdles

I spoke with Oracle Health chairman David Feinberg at ViVE, where other staff was demonstrating the company's clinical digital assistant nearby. I was surprised to learn that top health execs like Feinberg — who's run prominent health systems like Geisinger and UCLA Health — finds conferences like ViVE useful for stacking meetings with other influential health leaders. (I'll have more on my conversation with Feinberg about Oracle-Cerner later this week.) I asked Feinberg about venture firm General Catalyst's bold attempt to take over and operate an Akron-area nonprofit hospital system, Summa Health. Success, he explained, will depend on HATCo CEO Marc Harrison's ability to influence the organization's culture. (My colleague Tara Bannow has reported on General Catalyst's need for clinician buy-in here.)

"We'll see if that infusion of tech is able to fundamentally change the culture," Feinberg said. It's not just about espousing values, he said; the top-down mission must also translate into concrete quality metrics, like ER wait times, he said. "Do we treat [employees] as if you're a member of our family, or do we just yell your name and say get in line?"

Washington

Federal regulators team up with industry on AI

Last week I described startups' mounting anxiety about evolving regulations; even at ViVE, lobbying groups and regulators appealed to founders to get in touch. Office of the National Coordinator for Health IT senior advisor Stephen Konya, for instance, introduced himself to conference participants as a liaison between entrepreneurs and the federal government. Still, founders told me it's still not clear exactly who's doing the regulating — agencies including ONC and the Food and Drug Administration are looking into health-related AI — and that industry organizations like the Coalition for Health AI are likely to influence upcoming standards.

As my colleague Casey Ross reported earlier this week, CHAI's moving quickly — the nonprofit has unveiled its board of directors, which include leaders from the FDA as well as ONC leaders.

"We are very much developing a consensus," Brian Anderson, Mitre Corp's chief digital health physician, who will lead the organization, told Casey. "Because the science is nascent and immature, it's really a process of shared discovery."

Still, CHAI isn't without critics: Some have argued that its plan to establish AI assurance labs at well-resourced academic health centers across the country could exacerbate health disparities instead of closing them, for instance.

Artificial intelligence

Q&A with Microsoft's Peter Lee

Also on AI, my colleague Nicholas St. Fleur sat down with Peter Lee, the computer scientist who heads Microsoft Research and co-author of 2023 book "The AI Revolution in Medicine: GPT-4 and Beyond." Lee — one of 50 members of this year's STATUS List — offered his take on the technology's promises and pitfalls.

Asked what to do about privacy risks and bias, for instance, Lee says he "would not trust an AI system on its own to make decisions on whether my health insurance claim should get reimbursed or not," but that generative AI could serve as a " second set of eyes to check whether that human being that's deciding my insurance is being biased against me or not, because I think the AI system can be really good at that." Read more of their wide-ranging conversation here.

Cybersecurity

Why the Change Healthcare attack is so significant

STAT's business desk has been doggedly reporting on the near-catastrophic cyber attack that disrupted crucial payment processing systems across the health care industry. As Brittany Trang scooped late last week, the Change Healthcare outage that began Feb. 21 could last for weeks, disrupting payments between providers and insurers. Optum (part of UnitedHealth, the largest health insurer) acquired Change in 2022.

Since then, Wired has reported that the hackers behind the attack received a $22 million payment, according to a Bitcoin blockchain transaction.

Health-related data breaches are by far the most expensive across industries, according to IBM data from 2023 cited in an Health and Human Services Department threat report on Russian state actors targeting health and public health organizations.

Also earlier, this week, my colleague Bob Herman spoke with Ben Handel, a Berkeley health economist at the University of California, Berkeley on what the Change attack means for doctors, pharmacies and patients. Read it here.

lizzy's device digest

Medical device lobby is tired of waiting on Medicare

Industry lobby AdvaMed tells my colleague Lizzy Lawrence that it's done waiting for the Centers for Medicare and Medicaid Services to make reimbursement for breakthrough devices easier. In a letter to CMS and shared with STAT, the lobbying group urged the agency to act faster to cement a reimbursement pathway — something the agency has been working on since 2021.

"I myself have begun to wonder if they're really serious about doing this, or if they're just saying they're serious about doing it for political reasons or otherwise," Advamed CEO Scott Whitaker tells Lizzy.

The Transitional Coverage for Emerging Technologies pathway would help "breakthrough devices" — qualified by the FFDA — to get expedited Medicare coverage, Lizzy reports. Read more.

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Thanks for reading! More on Thursday - Mohana

Mohana Ravindranath is a Bay Area correspondent covering health tech at STAT and has made it her mission to separate out hype from reality in health care.