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Digital Health Black Sheep (Part 2)

Written by Andrew Le, MD

PublishedAugust 12, 2021

Welcome to the CEO Corner, where Buoy CEO and Cofounder Andrew Le, MD sits down with industry leaders to chat about the provocative topics of healthcare today. Andrew recently spoke with Karan Singh, the cofounder and chief operating officer of Ginger, an app that provides customers with access to unlimited self-guided care and 24/7 on-demand coaching, as well as video-based therapy and psychiatry support. In Part 1, they talk about being founders in digital health, mental health changes and challenges and what the next generation of founders should look out for.

In Part 2, Karan talks about light bulb moments – or lack thereof, the supply/demand imbalance that plagues all of healthcare, and diversity, equity, inclusion (DEI) strategies within companies and how to address DEI in underserved populations.

This interview has been edited and condensed for clarity.

Andrew Le, MD: I also have a quick follow-up question. You came into this with a very personal story, and then you mentioned you are helping so many people. How did it feel when you realized you had built a company and a product that solves a problem that inflicted your own family? Did you ever have that moment of realization? Or was there not that light bulb moment for you?

Karan Singh: I wouldn't call it a light bulb moment because it feels like it's a never-ending journey. Mental health is something that doesn't just go away. It's a constant learning process. It's not an eight-weeks-to-happiness plan. This is complicated and messy, and subjective, and nuanced. I'm proud of making steps in that direction. It starts with getting better data, starting to learn more about what interventions work for what kinds of people, when and how. But in the same spirit, you must enjoy the milestone markers along the way. We've discovered that we can impact a lot of people—meaningfully. Over this past year and a half as COVID has accelerated, so has the number of people with mental health challenges.

The recent statistics from the CDC indicate 40 to 40-plus percent of the US population has some sort of anxiety or depression. To step up and support a lot of people right now feels incredibly exciting. And, like any entrepreneur, it's a leg of this longer race. There's much more that we still need to do and so much more we still don't yet do well enough. I'm excited with what we’ve achieved but even more excited with what's ahead.

Andrew: I love that answer. In terms of what's ahead, you talk about going from the backroom to the boardroom and our current “new normal.” There's a lot of delayed care, and anxiety is at an all-time high. The need for access to personalize behavioral health has never been more important. What is Ginger's job in this crucial time?

Karan: We get a chance to reinvent how incredible mental healthcare is delivered, accessed, and received. Historically, there's been just a lack of education. Most people don't know what they need and try to navigate a broken system. There's a supply and demand imbalance. You don’t have enough providers to meet the need, which has grown exponentially through COVID. You have underserved populations that can't get access to any care. And then on the other side, you have folks who might actually be getting too much care. Additionally, you've got a lot of care providers—especially primary care providers—who just haven't been trained to deal with mental health. They are doing their best, but sometimes their only option is to prescribe medications.

We've built the Ginger system and experience around a couple of guiding principles. It's not just about taking an offline visit and putting it online, which is what most telehealth has historically been. It's really system design or redesign. It's delivering in-the-moment access to care—not later but right now. If you have the courage to actually seek support, you must be able to access it quickly. It’s prevention focused. Prevention is the bedrock of a lot of what we do. Most of the need in mental health is subclinical. And if we could catch it early enough, we could stem the tide. We can start to leverage a nontraditional workforce, like behavioral health clinicians who can manage 80% of the need that has historically not been a part of the equation. That frees up a lot of the more expensive and trained resources, like therapists or psychiatrists, to deliver that level of care.

Our care is team-based—not siloed. It's not unique individual situations, but rather a collection of people. It's measurement based, focused on data and objective measurements of success. And then finally—and maybe most importantly—it's value based. It’s not just about a fee-for-service environment; it’s about identifying ways to make mental healthcare access more affordable so that it can serve many people. We can’t do that without figuring out ways to pull costs out of the system.

Andrew: That's perfect. The way you answered the question is interesting because I had a follow-up question around the supply/demand imbalance that plagues all of healthcare. However, in behavioral health it is an acute issue. I love the multi-pronged provider care when it's needed—exactly at that moment. Bring in providers who traditionally couldn't help but now could in a larger proportion of situations. Move into value-based care. Make care easier to provide for those on the provider side, whether they're highly trained or more like the behavioral health clinicians you described. I love that. That's fantastic.

Can I ask you a question aimed at med students who are struggling, feeling alone, feeling like black sheep? You're talking to med students who are thinking about how they can make the biggest impact. They're curious about digital health what they could do. What advice would you give to the next group of clinicians or clinician trainees who see a broken system and want to fix it?

Karan: Where do I start? There's a lot of work to do. While there's been an incredible uptick in investment and innovation in the last few years, there's much more that's needed. At the end of the day, it is still about putting patients first. It's building an experience that people love, that makes them better, that focuses on their specific needs. Don’t try to be everything for everyone. We’ve all struggled with that at times, but it's really about determining the specific problem you want to solve. What are the incentives to solve that problem? And do you have countervailing forces that might slow down your ability to achieve it?

Finally, find an incredible team. I keep coming back to this because surrounding yourself with great people is so important. Take the leap. There's no doubt that we must innovate on a number of different dimensions, whether that's in mental health or in other parts of medicine like you all are doing. We're big fans. Much of this is opening the top of the funnel to make sure that people can actually step through, get quick access to a variety of different resources, and then ensure those resources are more targeted. It can be far more than what’s been done traditionally—a quick visit with a doc in a hospital or a set of medications. We can impact so much more of healthcare and medicine if we start to widen the aperture.

I'm excited about what's ahead and how so many innovations now focus on supporting communities that have historically been underappreciated, under focused, and under targeted because it never made sense economically. Now, there might be reasons for it as healthcare reform continues to evolve. Also, technology is beginning to remove costs from the system, allowing you to focus on groups and high-need populations that don't have a lot of great help. That's certainly true in mental health, but it's true in other parts of medicine as well.

Andrew: You brought up underserved communities. Obviously, as a country we’re currently looking at race relations, health equity, inclusion, diversity. What is the role of social determinants of health within behavioral health? And more specifically with Ginger, how are you all thinking about removing those barriers?

Karan: That’s so critical. Similarly, there is no health without mental health. Social determinants of health are bedrock or foundation. They must be a part of the equation. We think about it in a lot of different dimensions. One is that we're not an isolated resource. We need to integrate with the broader healthcare ecosystem. Whether that's getting referrals in or sharing data back, we must coordinate with other people and take a variety of things into account. We can't do all things for all people, but we can work with others who might have specialization there. That factors into how you recruit a workforce. We need diversity in the workforce, among providers, and on our team to represent the populations we serve.

That's certainly been a priority for me lately, but it's always been true. We can't serve people we don't understand. It's got to be built in. Then it's got to be built into the culture that we're creating—certainly in our company—but also more broadly as an ecosystem, as a space that's far more inclusive than it's historically been. For a long time in healthcare, you needed the secret passcode to go through the right doors and into the right rooms to crack the code. I'm hopeful that some of these things are going to make this far more democratic and accessible. But it’s fundamental that we pay attention to these things, that we invest in these resources, and that we change policy to encourage more innovation.

Andrew: Love that. Karan, this has been so fun.

About the participants:

Karan Singh is the COO and cofounder of Ginger.

Andrew Le, MD, is the CEO and cofounder of Buoy Health.