• Tell us a little bit about Tridiuum.

Tridiuum is a digital behavioral health company that powers interactions between patients and providers in the outpatient setting, particularly for integrated models and primary care. Our platform improves overall outcomes by supporting those interactions, managing the episodes of care, and scoring that care throughout the treatment journey. As importantly, we improve access to those provider/patient interactions by accelerating time to first visit as well as the quality of the patient/provider match through sophisticated deep learning algorithms. Across our entire product platform, we principally address mental health and substance use disorders, which are prevalent today, especially as comorbidities among chronic care populations.

 

  • We define the Smart Health Market as one that is consumer-centric and value-based. It advocates a pivot in focus from “sick care” to “health status.” Given that framework, please share how Tridiuum is contributing to the Smart Health Market movement.

Our platform has traditionally been used in the treatment of behavioral health issues that have been self-identified by the patient or identified by a provider, who then directs the patient to specialty services. But a lot of progress lately has centered on moving upstream into primary care and population health.

We can identify where depression, anxiety, and other issues are starting to bubble up – the behavioral health concerns that are almost latent – so patients might be treated earlier on more of a therapeutic basis. If we can keep acuity and severity low or move more upstream, we’re going to reduce the total cost of care by addressing those issues earlier. We’ll also reduce the impact mental health conditions may have on other chronic diseases.

For example, a diabetes regimen might cost $3,000 to $4,000 a year just in routine services to keep the condition in check. If you add anxiety or depression related to the patient’s challenges in managing diabetes every day, the numbers will be closer to $7,500 to $16,000. Those are very real economics when it comes to diabetes.

As another example, patients who are in end-stage renal disease might need dialysis two or three days a week for three or four hours each time. The basic regimen of dialysis care will run $75,000 to $100,000 on an annualized basis, and those numbers can triple or quadruple if you add multipliers of care related to behavioral health. If the patient is too anxious or depressed to follow the dialysis treatment plan, now we’re dealing with potentially life-threatening implications. It can lead to not just an emergency room visit, but a very expensive inpatient admission. As many as 40% of patients on dialysis have moderate to high depression rates, and as many as 15% exhibit suicide ideation.

 

  • In a survey Canton & Company did earlier this year, respondents said the industry would achieve Smart Health Market status in the next 10 years. Do you agree or disagree and why?

I think it will happen in the next 10 years, but I don’t think it will account for much more than 50% of the market. Ultimately, people will gravitate to better quality care, like what Amazon, JPMorgan and Berkshire [Hathaway] are designing with Haven. You have to believe Google and some of the other disrupters are going to do it, too. And costs will not go up with this type of model. In fact, they may be less.

When I think about the Smart Health shift, I always talk about eliminating the waiting room. People aren’t waiting in line to get treated for their colds. They’re much more activated and engaged in their care because so much more of it is digitally enabled now. They’re engaging from home or the office or even their car. There are so many vectors that will continue to drive that digital environment, particularly the payment mechanisms. The payer-provider-regulatory intersection must get to a point where they’re incentivizing wellness, prevention, and engagement with tech-enabled platforms. It meets the needs of the consumers and helps reduce costs.

 

  • What barriers does your company face as you advocate for Smart Health transformation?

The biggest challenge we face is the transition from fee-for-service to value-based care. And the adoption of value-based care is seeing varying degrees of success. It’s still the minority of care delivery – just 10% to 15%.

Meanwhile, so many providers are imprisoned by fee-for-service structures, even though those economics are being depressed all the time. The switch to take on risk is going to cause a lot of short-term pain for them.

Providers talk about wanting to improve outcomes and deliver better care, but you have to read through that. Often, they describe providing minimally viable clinical measurement and then reporting to their payer partners and integrated primary care teams. Those incremental actions are just a mask. They’re just checking the box. That’s not getting patients better.

Until fee-for-service swings substantially, we’re going to be pushing water uphill.

 

  • In your opinion, what are the top three things that will accelerate the market change needed to achieve Smart Health status?

First, for health systems to move to a Smart Health Market orientation, they should view their EHRs as a hub rather than a care delivery platform. They won’t be successful at innovating care and improving outcomes if they view the EHR as the ultimate tool to bring digital health to the forefront. That’s just not what they’re for, yet people have been bamboozled with that idea. It’s a joke to think that investing more in an EHR is going to be the principle strategy moving forward. That thinking needs to evolve.

Next, innovators must create highly usable, consumable products that lean into how people realistically function on a daily basis – not what they hope people will do. Most people are not tech savvy, so the products have to really resonate at a visceral level. I think 80% of what’s out there now is just horrifying because it’s so difficult to interact with.

Third, remember this is a marathon, not a sprint. Deals take time. You need to be well capitalized to advance into the Smart Health Market. You’re not going to be able to raise a Series A with $2 million and launch into the healthcare stratosphere. It’s an expensive market to buy your way into.

 

  • What advice do you have for other companies with a Smart Health Market orientation?

Technology has to become part of the fabric of how care is delivered both inside and outside of the four walls of the health system. Digital health tools have to be highly user-friendly and easy to integrate into a person’s day.

“There’s an app for that,” has lost its value. No one is going to use the hundreds of discrete apps that are out there. They have to be more integrated so people are moving naturally from things like journaling to improve their mental well-being to the idea of the quantified self – in other words, tools for self-knowledge gained through self-tracking. All of that has to feel like part of an ecosystem that is as natural and routine as brushing their teeth.

 

Learn more about Tridiuum at www.tridiuum.com.