GV, formerly Google Ventures, has been an active investor in behavioral health for the past decade. The firm now sees serious mental illness (SMI) and value-based care as its next frontier.
In 2021, digital mental health companies raised $5.5 billion in risk dollars, an unprecedented amount. Historically, however, most digital health investment has focused on wellness and mild mental health conditions.
As the industry matures, startups’ focus on mental health is shifting to more acute conditions, an area of interest for GV’s Dr. Ben Robbins, a trained psychiatrist who was recently promoted to general partner at GV.
“It seems like we’ve moved from what I think of as sort of consumer models of mental health care to low-acuity clinical models of depression and anxiety,” Robbins said. “Really, in the last year or so, we’ve seen a lot of activity in areas that I find really interesting, like psychiatry.”
A growing number of startups they focus on care for serious mental illness, Robbins says, a sector that is prime for innovation.
“The community of people who are willing to take the risk of starting a business is getting smarter,” he said. “Y [SMI] It is an area that is complicated. You can’t just have content or just a lightweight chatbot. I don’t think this is a space that is really conducive to the pure virtual. The combination of cognitive impairment, the social complexity, the clinical complexity: I think it more or less has to be a hybrid model, if not completely in person.”
GV invests in both digital and physical companies. GV’s previous mental health investments include Headway, Brightline and Quartet Health. The firm is now actively looking to invest in serious mental illness, according to a spokesperson.
Founded in 2008, GV has more than $8 billion in assets under management. Its portfolio includes 400 companies. The venture firm has invested more than $1.2 billion in healthcare and life sciences companies since 2020.
“I think there is a lot of work to be done on how to build a better health care system,” Robbins said. “I don’t think we’ve discovered behavioral health [as an industry], and there is much work to be done. We are very comfortable with physical investments. I love the idea of more hybrid care.”
There is also a business case for entering the SMI space, in particular. The estimated lifetime burden of SMI is $3 million per patient, according to research from the Substance Abuse and Mental Health Services Administration.
“As entrepreneurs have learned more and more about the way health care works, the needs, the economic models, there is a growing acceptance of these more complicated operating models that involve going out on the street and sending doctors who are willing to look for people. on the street,” Robbins said.
Federally funded community health centers are already providing high-quality care to SMI patients, Robbins said. Still, getting patients with SMI into care is a major challenge.
“These facilities are quite capable of handling patients who are already activated in some way to seek care for illnesses, especially in major cities,” Robbins said. “I think there is a lot of need around a more proactive approach.”
Mobile clinics that bring people to care could help fill this gap, Robbins said.
“Really, in the last year or so, we’ve seen a lot of activity in areas that I find really interesting, like psychiatry.”
– Dr. Ben Robbins of GV, a trained psychiatrist
The federal government has taken steps to promote community models. For example, him US Centers for Medicare & Medicaid Services (CMS) proposed a new ruling that, among other things, would bring medication-assisted opioid use disorder treatment to the community through mobile clinics.
Other companies, such as firsthand, are using peer support networks to help engage SMI patients and get them into care.
Values-Based Care
Value-based care, in the behavioral health space and beyond, is another important focus for GV.
“We spend most of our time on value-based care and the things that can enable value-based care,” Robbins said. “We are spending a ton of our time just stepping back and finding out what has really shown promise, because almost nothing seems to have shown the ability to deliver high-quality care and lower costs, despite huge investment and experiencing.”
The GV team is scanning the industry and looking for models that have shown promise in delivering care based on measurable value. There is great potential for models focused on reducing the hospitalization rate, both for behavioral health care and for physical health care.
Intensive outpatient treatment (IOT) programs and community care programs are two possible avenues to help patients access care outside of a hospital.
“I continue to be amazed that there isn’t more business activity around intensive outpatient programs, partial hospitalization programs (PHPs), which I believe are the lifeblood of freestanding psychiatric hospitals,” Robbins said. “IOPs and PHPs are super interesting just because of the tremendous need. You have outpatient providers who don’t have a way to escalate care without sending people to the ER. You have erectile dysfunction that has a wait of 7 to 10 days. People are literally in waiting rooms for weeks. So this idea that you can have a kind of middle ground at scale, where it’s not a closed inpatient unit, not just outpatient, you’re seeing someone all day, every day for a couple of weeks.”
The integration of physical health and mental health is another aspect of values-based care. SMI patients are more likely to have comorbidities such as diabetes and heart disease.
“I think value-based behavioral health can be done when you have patients with medical and psychiatric comorbidities when medical costs are high,” Robbins said. “You can provide value-based care that focuses on medical costs, but then mental health quality.”
Still, there are a number of challenges to integrating a values-based model into behavioral health care.
“I don’t think we’re very close to being able to measure the results,” he said. “I’m not even sure we’re using the right framework.”
Surveys originally designed for clinical research are now applied as metrics of quality, Robbins says, which may not be enough to measure value.
Measuring and delivering high-quality care is a top investor priority for the future.
“In the world of behavioral health, the team and I are very interested in finding out how we deliver great care and how we measure it,” said Robbins. “Delivering excellent care, I think is currently within the scope… of things that we can do. But the idea of measurement, I’m not sure we’re that close, so I’d love to find ways that we can measure high-quality care.”
