How Array is Connecting Behavioral Health Experiences Across the Continuum

Shannon Werb: There’s the fear that if I invest in the mental health service of a patient, let’s just call it psychotherapy early on, low acuity, that may look like I’m spending more investing more on that patient. But we know what that means is on the physical health side. That patient actually is going to do better or be have better outcomes on the physical health side, which is going to directly connects to preventative care. How do we help these patients not actually experience the high cost physical health conditions that they might experience long term?

Jared Johnson (Host): Welcome back to the leading podcast about consumer centered health. This is more than a show. This is a mission, y’all. As billers and operators, we’re here to share with you the latest consumer- centered ways that healthcare is being designed, marketed, and delivered. And as consumers yourselves, we want you to understand how these options work and why they might be right for you and your loved ones. Here’s what’s going down today. First up, we have the flavor of the week about Aura and ResMed’s new partnership. How are they creating a wearables to care strategy? And how can health become more preventive as more consumer devices become entry points to care? I’ll talk about that. Then Shannon Werb, CEO of Array Behavioral Care, describes what the digital entry points for mental health look like today, the downsides of investing in digital access, and what it will take to make virtual mental health actually feel personalized and trustworthy for patients. I’m Jared Johnson. Let’s get it.

Jared Johnson: Flavor of the week. ResMed and Aura are looking to establish wearables to care for consumers as they expand access to sleep care and health education. The two companies announced the partnership on May 19th, stating that Aura members can take action on changes in sleep or breathing patterns through educational resources from ResMed and pathways for accessing care. Aura members in the US with Gen 3 or Ring 4 plus an active membership can be directed from nighttime breathing disturbance patterns to ResMed sleep education, a sleep assessment, a discussion guide for their clinician, and an option to connect with an independent provider. There’s plenty of demand here. According to a press release, early signs of poor sleep are often dismissed, creating a gap between what people experience and what they seek support or clinical care for. Insights from wearable devices such as Aura Ring can help people better understand their sleep patterns and encourage them to have informed conversations with their healthcare providers so they can learn more about potential sleep disorders, including obstructive sleep apnea. Close quote. Industry reactions have largely been positive with many believing this is another sign that consumer devices have the potential to become the entry point to health care. As always, there’s curiosity about checking all the regulatory and clinical boxes, but I don’t see anything yet that indicates much to worry about on that front. Granted, we’re still in the early aftermath of the Whoop FDA warning letter from last year, so the broader wearable health conversation might still be unclear about how to avoid confusing wellness alerts with medical guidance. What’s the consumer lens? It’s essential to consider the consumer point of view. As medtec companies turn consumer data into care funnels, ResMed’s getting a front door, in this case, to consumers who may not know they have a sleep problem. While Aura makes its sleep insights feel more actionable and clinically oriented, they’re positioning it as a way to move from sleep insight to next action, especially around possible sleep apnea. In other words, medtech companies aren’t waiting anymore for patients to show up in clinical channels. They’re partnering with consumer platforms that already own that daily attention. For those wondering how significant this is, let’s remember that not everyone is checking their health data regularly. But that segment is growing significantly with more people every day wanting health to be preventive more than reactive. So maybe that’s why this move feels smart and even inevitable. And I for one will be keeping an eye on what comes next as consumer devices become another important entry point to care. Let’s take the wearables to care strategy seriously as we consider how effectively it can bring preventive health literally to consumers fingertips. That’s another way that we’ll build to the healthcare of tomorrow. And that’s the flavor of the week.

Jared Johnson: All right, let’s get into the flow. Please join me in welcoming my guest this week. I’m here with Shannon Werb. Shannon’s the CEO of Array Behavioral Care. behavioral care is always in the middle of my radar screen. So, I’m looking forward to  to hearing from him. Shannon, welcome to the show.

Shannon Werb: Great Jared. Thank you. Really excited to be here.

Jared Johnson: Give us a little bit more about who you are and what you do from your background. What would you like our listeners to know?

Shannon Werb: Oh, great Jared. First of all, I think behavioral care, behavioral health is a very broad topic. When you think about Array Behavioral Care, we’re really focused in the mental health space and we are also focused and exclusively deliver all of our services virtually. So think about clinicians who are actually in their home practicing on behalf of Array delivering care to patients in multiple settings. And so all completely virtually delivered very similar to how you and I are talking today. And so early on I worked in private practice radiology eventually working for and responsible for the largest teleradiology service provider. Worked for startups building software for healthcare services businesses. I did some work in homebased acute care settings and ultimately was invited to join Array as CEO and help it along its journey to really the next phase of how we’re scaling um Array behavioral care. It’s a business that operates in all 50 states. So we’re national in scale. We deliver services to patients in crisis that are in the ER all the way down to patients that might need services in a lower acuity  setting like their home as an example. So, a broad set of capabilities, but I really felt like it had this great opportunity for me to practice a lot of the things I’ve learned along the way and capabilities I think I can bring to help scale an organization like Array.

Jared Johnson: Yeah, thank you. Maybe it’s a good point to share like what other areas or verticals are typically included when we talk about behavioral care or behavioral health services and kind of like where are things today like what’s being offered or just what trends are you seeing?

Shannon Werb: Yeah, I think if you take a look at behavioral health broadly speaking, you will find services like substance use disorder or autism services or capabilities that are directly focused on patients that need intensive outpatient therapy. Those sorts of services often times very in person as well. in the virtual mental health space to your point there are a set of capabilities that many companies are building  around psychiatric services. So we are likely the largest provider of telepsychiatry services in a high acuity setting meaning a patient shows up into the ER in crisis and needs care right now. And then you have other settings. For example, we have an outpatient business where we will virtually staff clinicians into community health clinics, tribal communities, correctional facilities, and sometimes simply the outpatient facility that is connected to a hospital where we might be treating patients in the ED as well. And then finally, another example would be um you know patients that are in their home and they maybe they have anxiety or depression. they have an they’re in network with, you know, behavioral health providers like us through their insurance carrier and they might simply seek care online. And so we provide those kinds of services as well. You can simply go to our website and book an appointment with us. Typically within a couple of days, one of our clinicians will be able to perform an intake, assess your needs, and then make sure we set you up with the right kind of care long term. So it’s a very broad industry. And I think when you when you think about Array, if you focus on any one of those three areas, homebased care or outpatient facility based care or high acuity care and an ED, there are companies that do one or two of those things, but there aren’t companies trying to approach the journey of a patient across all three of those areas. And that’s something that Array is really trying to tackle in our capabilities.

Jared Johnson: Nice. So what is the typical entry point because it would clearly be different depending on how somebody’s encountering the need for the service, right? So I mean are is there a direct to consumer component here or you mentioned you it’s sometimes through your insurance provider  how does somebody typically begin engaging?

Shannon Werb: Well, Jared, I think that’s one of the unfortunate areas of our industry is that it’s very fragmented. And so, it is unfortunately not uncommon that we might see a patient that enters our homebased service by connecting through one of our partners that refers them to us. That patient could also enter the hospital who then refers that patient to us. And that care, that journey is not well connected. That’s something we’re really trying to work towards is making sure that we’re however the patient enters their journey, that journey can be coordinated across all of the providers that patient might actually see. Um, and so I think unfortunately for patients today, they’re often navigating those entry points on their own. there aren’t a lot of great resources for that which unfortunately is also why patients that show up in the ED typically recur to the ED because when they leave they don’t really know how to best connect to the resources they need to stay well along their journey and so these are some of the things we think we can help work towards provide a better solution for patients by really connecting those entry points together so that sort of front door for a patient really doesn’t matter how they enter their care is coordinated along that journey.

Jared Johnson: We do get focused so much on the digital front door aspect that I I’ve seen this before where we don’t think enough about what happens yeah once you step through the door or it’s time to come back through the door you know keep the analogy going right the ability to be able to understand what happens after that the patient experience in any case doesn’t stop there and I still hear us talking about it that way is if just get them to the front door and yeah everything after that matters if not as much more for somebody to actually you know get the value of that service.

Shannon Werb: Yeah. And I think I think in behavioral health we’ve spent a number of years now, especially the last five years really driving access, you know, as unfortunately this really was exacerbated during  the COVID period where a it became okay to talk about mental health and many more people were comfortable doing so. But it also became clear as we talk about the you know mental health crisis that we have in this country. And I think it was it’s been great that we’ve all been working on creating access and availability for patients to get access to clinicians especially in network capabilities where it’s covered by their insurance. But I think I think the next stage of this is to start thinking about what happens next after access and that is we need to deliver good coordinated care so these patients actually get better and really start to think about outcomes and I think that’s really the journey that the behavioral health industry is on right now is moving from access to outcomes.

Jared Johnson: So what does it take here to make virtual mental health feel more personalized for the patient? because I can see I mean there’s still at the end of the day a virtual solution that’s being used but I would imagine there’s things we can do to make that that part of the experience feel more personalized for patients.

Shannon Werb: 100%. We have a concept that we talk to we call it delivering the right care at the right time in the right dose. And so that is our understanding at time of intake. We’ve developed capabilities to assess the patient and really understand what kind of care does that patient need? When do they need that care? Can it be scheduled for later or is it urgent and needs to happen right now? And then what’s the frequency of that care that we deliver? So to your point really personalizing the kind of care that that patient actually needs and I think that well you know obviously proud of Array we believe Array is well position because we have high acuity care that’s delivered now by a psychiatrist down to outpatient therapy delivered by um a therapist that might be scheduled for a couple days down the road when we need to follow up with that patient. But I also think that this is something that not just Array the industry in general’s embracing of telehealth enables that to happen even better. I often will talk about the fact that hospitals and health systems shouldn’t necessarily think about building all of this on their own or maybe it’s a  build versus buy. I think it’s a build and buy where you really try to figure out what parts of it are you able to invest in your own the health system and what parts of it should you partner and fortunately for us we are now proving that you can plug in virtual telehealth capabilities in many specialties especially in the behavioral health space to really augment the capabilities across the system and so we think that virtual health really helps enable the customization and personalization of care so we deliver the care to the patients in the way that they actually need it so they do start to get better.

Jared Johnson: I see. So, I’m probably not the most familiar with all the options that are out there. I’m familiar with options that are like marketplaces of therapists as opposed to what you’re describing, which is being treated by, you know, a true virtual behavioral health practice. From the patient perspective, what’s the difference there? Just so people can understand those options more.

Shannon Werb: Yeah, good question. F first of all, I should probably before I compare and contrast them, I should probably recognize everyone that’s investing time and resources into building capabilities to help patients get better. Regardless of the approach that that you’re choosing, we at Ray believe in the concepts of building a practice as an important differentiator to delivering quality care than those that are really building a network of clinicians. And if I dig into that a little bit, Jared, what I mean by that is a network of clinicians. There are these large very large organizations that are aggregating clinicians that are typically a set of independent contractors that are practicing on that network. Now, many times those clinicians practice on multiple networks as well. So they’re essentially making time from their schedule available on multiple networks to see patients. We feel like that solution is subpar to a practice model where a clinician comes to Array and they’re a W2 employee. They receive benefits. They’re typically full-time. Our average clinician shares more than 30 hours a week with us. And so when they practice with us, they typically practice with us as their career. We bring the best-in-class technology to the table. We really bring quality programs to the table and investment around really trying to help the clinicians deliver care and practice at the top of their license. That’s not to say clinicians don’t do a great job on a network-based environment. We believe it just looks very different in that that patient might experience a disconnect of clinicians that are moving between these networks very frequently or those appointments may not be as available as they look like they are versus a behavioral health practice where the clinicians are actually employed by the practice and part of this larger capability to deliver care in a clear and consistent fashion.

Jared Johnson: So, okay. So, you mentioned like connected or being disconnected. How should behavioral health systems do that? how do they create the continuity because you mentioned that’s what can keep patients from continuing to receive and even seek the care that they need, right? So, if they feel like they’re starting from scratch every time, I would guess that that leads them to feel frustrated and just ultimately not continue to seek care. So, yeah, how do you create continuity, I guess?

Shannon Werb: Yeah, it’s a really it’s a really good question. I think it’s even harder to try to execute against. And I wouldn’t say by any means do we have it perfect, but we believe in a couple of these philosophies that we’re trying to execute against that allow patients to experience more consistent care. Imagine if you seek an appointment with a practice or a network and  you schedule your first appointment, you begin getting to know that clinician and behavioral health is very much a relationship business. and then the next week or maybe a month later um that clinician is no longer available on that network. And unfortunately that’s one of the things you experience with these network organizations is these clinicians are moving around quite often and so you might have to move your care and then begin all over developing a relationship with another clinician. I think also when you when you’re establishing that relationship you might have a broader set of needs. Maybe you have psychiatric needs or medication management needs beyond psychotherapy needs. And does that network actually have those sets of capabilities available within its existing practice? That’s something we really work hard to do. So if a patient presents themselves to us and they have a higher acuity or higher need for services, we have multiple types of clinicians we can come in to do acute based psychotherapy or intensive psychotherapy. We have medication management. a psychiatrist that are all employed by our practice that can collaborate around the care of that patient without might what might feel as a disconnected set of options if all those capabilities aren’t available in one place. So really, it’s about trying to build something that is sustainable. So when the patient establishes a relationship, we have many patients that have been with us for years with the same clinician. They’re reliable, they’re there, and if the patients needs change over time, we can adapt to them and bring other clinical resources from our existing practice to help that patient.

Jared Johnson: So at the very least, fewer locations for the patient to have to coordinate themselves, fewer resources for them to have to connect into this experience.

Shannon Werb: You got it. Correct. Exactly right. Yep.

Jared Johnson: Nice. Yeah, we’ve referred to this concept more and more this last season on the show here as that constellation of care and for the most part right now current state it’s definitely a DIY effort. It is figure it out yourself connect that constellation yourself and that does include services and data from so many different sources that we usually don’t even have access to. So I feel like I mean that direction makes sense. the more you can curate even part of that ecosystem for a patient so that they’re not having to do that. I mean we talk about reducing friction from the virtual or digital side a lot but reducing friction from that experience side just reducing the amount of effort for somebody to have to overcome depending on how motivated they are to keep continuing to seek the care that they need. I mean those are constant questions for us to ask and try to make progress on. So love that direction.

Shannon Werb: If I if I could just add that real quick, Jared, I think you’re spot on. And if I back out of the clinical service delivery model or operational model a little bit and just think about the macro um you know view of this market, this behavioral health market in general, I think we benefited our industry benefited significantly from massive investment into our industry to really go pursue access and now as I mentioned moving towards outcomes. But one of the drawbacks unfortunately of lots of investment is you end up with a lot of companies that are pursuing oftentimes very point solutions or unique solutions to helping a patient. And I think what that turns into is a patient um you know having to navigate on their own to your point. And so I think one of the next stages from a macro perspective of our industry, we’re going to start to see these ideas come together in a way that allows us to deliver more complete care to an individual patient versus them having to navigate on their own. I think consolidation is something this industry will see and it will benefit patients.

Jared Johnson: I agree and that’s important to keep an eye on from that macro perspective of where the focus is. So to that point, I’m curious where Array is focused, where you’re focusing for like the next 6 to 12 months. What can you tell us about that?

Shannon Werb: Most patients in this country are very much connected to some sort of hospital or health system. And so that in these hospitals and health systems have been working hard for a long time to invest in technology to modernize care delivery meaningful use and investments in electronic health records. Unfortunately, those investments weren’t seen in the behavioral health industry. I feel like the BH industry is really trying to catch up. When we took a look at this and thought about, you know, the way that Array is trying to connect with and build this integrated model or this continuum of care for patients, we really thought about the fact that we wanted to make sure that what we could do is seamlessly connect with hospitals and health systems. And so, one of the things, one of the investments we decided on a couple years ago, which unfortunately takes a few years to execute, is to pull all of our services onto Epic, which is the leading electronic health record in this country. And so two thirds of the health systems out there actually deliver care on Epic, which we think allows us to uniquely deliver a more integrated solution to health systems. And so a big part of what we’ve been working on the last two years and as we move forward is all of our services are now stood up on Epic. They’re all available in an integrated fashion. So therefore, a health system doesn’t necessarily have the product from me. they can buy more of this continuum or this connected care experience where we can begin to fill in the gaps or help them in the areas that they’re not directly investing where we can bring virtual care. And so very much we’re spending time over the course of the next 6 to 12 months advancing the effort for our customer base largely hospitals and health systems to really connect to the broader set of care delivery we have available to them. If they only use us in the ED, maybe they want to also use us in the community. if they only use us in the ED and maybe their medical group wants to be able to discharge patients into our homebased model. Those are things we can now automatically enable. And so we’re trying to make sure those touch points are friction free, really easy for the consumer, really easy for our partners so these patients can seamlessly flow between environment.

Jared Johnson: What do you think needs to change for mental health to really be treated like other areas of preventive health? And I’ll footnote that with the thought of preventive health and the connection between that and health care has been the focus of our last couple of seasons here on the show as well. And talking about these areas of our health and wellness that traditionally have been addressed in one way by a provider, meaning I don’t really cover that, come to me when you’re sick or you need help versus you’re trying to prevent things in the first place. There’s this whole layer in between that we’re finding can be connected for a consumer well before they need to see a doctor of any kind or clinician at all. There’s a lot to learn and discover about where organizations and where individuals fall, where they I guess where they fit within that ecosystem and where they fit within that that supply chain of, you know, either offering a service or benefiting from or partnering with others in that space. There’s just a lot there. So we’ve been investigating that but we’ve been trying to understand it better from the standpoint of preventive health itself and say look traditionally prevention hasn’t been something that traditional health care has been really invested in bits and pieces yes programs here and there yes but virtual care has opened the doors to so many things here and other digital investments and emerging technologies and now generative AI tools have opened these doors to say you don’t have to treat health care and prevention in in different ways mostly because that’s not how a consumer thinks about it anyway. A consumer most of the time is going to think I don’t want to feel bad today. I want to feel healthy today and whatever it takes to get me there. That’s what I’m going to explore. Where does mental health fit in that ecosystem and what would need to change for mental health to feel like more of that ecosystem of preventive health?

Shannon Werb: Yeah, I think great question Jared. So I think the first way I would approach answering that is the industry broadly speaking health care really recognizing that there is a direct correlation between mental health and physical health. I think we’ve grappled with that for some time but we know that a patient who is feeling better on the mental health side is going to experience physical health in a very different way and vice versa. A patient that’s not feeling well on the physical health side is also going to experience mental health in a very different way. If we can really stop grappling with that as an industry, which often times gets connected to the payment mechanisms we have in place, behavioral health is still very much fee for service-based. And so therefore there’s the fear that if I invest in the mental health service of a patient, let’s just call it psychotherapy early on low acuity that may look like I’m spending more investing more on that patient. But we know what that means is on the physical health side that patient actually is going to do better or be have better outcomes on the physical health side which is going to directly connects to preventative care. How do we help these patients not actually experience the high cost physical health conditions that they might experience long term? And so we believe that this correlation is real. I think the industry itself understands that. I’m not sure payment mechanisms are all set up yet to recognize that. If you think about movement to things like value based care, value based care is typically appreciated on the physical health side and not necessarily is benefited on the mental health side. often times the use of mental health services for a patient is attributed back to the PCP and maybe it should be who made the initial referral into the mental health side. So I really think it’s the recognition of those two areas and the alignment of the reimbursement models to ensure we recognize the creation of value for a patient and that being proactive or preventative actually helps patients do better in the long run. Even though it might look like we’re spending a little bit more on the mental health side, we’re saving multiples more on the physical health side.

Jared Johnson: I love it. And that’s the state. Let’s keep driving towards that and then keep looking at how we can get there quicker. Shannon, thanks for everything you’re doing to make healthcare more consumer centered. Best of luck with everything you have going on and thanks for joining us today.

Shannon Werb: Thank you for the time and really appreciated the opportunity to chat with you.