Categories

Tag: Trevor Van Mierlo

Mental Health’s Unfinished Digital Revolution

By TREVOR VAN MIERLO

In 2021, digital mental health and substance use startups attracted a record-breaking $5.1 billion in funding. Despite the surge, the promise of scalable, transformative digital health platforms remains unfulfilled.

Following the surge, investment plummeted. Unlike other industries that have been revolutionized by digital-first solutions, digital health struggles with models that fail to address cost, complexity, and access.

What we’re left with entering into 2025 are a smorgasbord of solutions clamoring to attach themselves to traditional enterprise incumbents (Health Insurance Providers, Electronic Health Records, Hospital Systems). These incumbents have achieved scale – but not the type of scale that digital health needs to flourish.

Investment in Digital Mental Health (2010-2023)
Digital Mental Health Investment (2010-2023)

Incumbents Build Deep, Startups Go Wide

Incumbent scale is infrastructure-heavy, slow, and linear, and focuses on deep integration within their established markets.

In contrast, startups aim for technology-driven, exponential, and global scale, leveraging digital platforms to serve millions of users quickly. While startups have the speed advantage, achieving scale similar to incumbents requires win-win partnerships and fundamental shifts away from established business models.

Incubent Scale vs. Startup Scale
Incumbent Scale vs. Startup Scale

The investment market does see the tremendous opportunity: a massive, growing global customer-base proactively demanding help as social stigma decreases. And as time passes, this customer-base grows exponentially with technology pervasiveness.

What investors see is unmet demand for mental health and substance use treatment, and a historic opportunity for digital health to step up and deliver solutions that are scalable, accessible, and affordable.

However, the delivery mechanism to these populations, though digital, is obfuscated through the blurred lens of incumbent purchasing power. We can’t get past incumbents’ size, their reach, and their connection to patients. In this common view, incumbents are the customer. This view is promoted by both industry and academia.

Continue reading…

Software Living in an Enterprise World: Why Digital Behavioral Health Can’t Gain Traction

By TREVOR VAN MIERLO

Let’s face it: for the past 25 years, digital behavioral health has struggled. Yet, we keep reinventing (and funding) the same models over and over again.

How It All Started

In the beginning (mid-1990s), a handful of developers, researchers, and investors envisioned high reach, lower-cost, highly tailored, anonymous interventions reaching millions of people with limited healthcare access.

The initial focus was never healthcare providers and insurers. These organizations were seen as too slow to adopt new technologies, and there was a general distrust of integrated care and insurers. Many digital health companies feared these organizations (and pharma) would leverage their power to learn from smaller companies, and then redevelop interventions internally.

Instead, the focus was on partnerships and B2C sales. Funding was easier to obtain from granting agencies, and there was ample development support flowing from sources like the tobacco Master Settlement Agreement (MSA). The primary concern was 1) whether the population could access these revolutionary tools and, 2) who would pay for them.

The Digital Divide

Back then, funders were often short-sightedly obsessed with the digital divide – the gap between people who had access to digital technology (mostly educated, higher-income earners in large cities) and everyone else. The argument was, “Why should we fund digital tools that will only benefit those who already have access to healthcare?”

Data was available, so academics armed themselves with ANOVA and relentlessly examined variables such as hardware costs, processing speed, age, gender, race, ethnicity, geography, income, and education. If you check Google Scholar, you can see the prevailing sentiment was that it would take decades for the digital divide to narrow, and new policy was desperately required to fix the problem (see: here, here, here, and here).

No More Excuses

Fast forward to 2024. According to a recent article in Forbes, there are 5.4 billion internet users worldwide (66% of the global population). In the U.S., 94.6% of Americans have internet access. Most US households have multiple devices, and according to Pew Research Center Research, 97% own a cellphone, of which 90% are smartphones.

As a Gen X’er who used a typewriter in college before upgrading to a Compaq Deskpro 286 from Future Shop (for about $400), my adult life has been a witness to the rapid progression of digital. Now, my 9-year-old daughter is teaching me how to play Fortnite (Epic Games), my 11-year-old is the only kid on his hockey team without a smartphone (this won’t last), and STARLINK allows me to chat face-to-face with my parents in rural Northern Ontario.

All aspects of technology are pervasive and accessible – but if you search Google or Bing for immediate, evidence-based behavioral help, you can’t get it. If you can find access it’s behind a paywall: through your employer (contact HR), health plan (call to see if you’re covered), or subscription ($19.99 per month).

That’s not meeting the original vision – and we have the technology. So, what’s the problem?

Continue reading…
assetto corsa mods