There are millions of people worldwide who suffer from some form of mental illness but have no access to effective care in a timely manner. The pandemic has accelerated the need for on demand evidence-based self-help mental health DTx and behavioural health programs to improve population’s wellbeing. What is the reality check in this rapidly growing billion-dollar digital mental health market? With Hannes Klöpper, CEO of HelloBetter, a global pioneer in the field of e-mental health, we dive deeper into the thriving digital mental health space, the company’s business model and their unique value proposition, the effectiveness of e-mental health options when compared with traditional face-to-face therapy, as well as how digital therapeutics revamp the standard of care in mental health.
Today, there is a growing mental health crisis with millions of people suffering from mental disorders. “It is Ok not to be Ok” has kindly entered our lives with our own awareness and acceptance of our moods and emotional issues. Advancement in technology and AI have laid the foundation for innovative, effective, and affordable guided digital self-help treatments designed by psychologists / psychotherapists to support and improve people’s mental health at scale. DTx for mental health disorders are transforming the standard of care in mental health and potentially closing the gap in prevention and treatment. According to the World Health Organization, two of the most common mental health conditions, depression and anxiety, cost the global economy US$ 1 trillion each year. In the past few years, the investment landscape boomed by the increasing importance of digital mental health solutions for population health.
The pandemic has also accelerated the demand for access to high-quality e-mental health care when needed in the privacy of one’s home. Worldwide, rules and regulations have been relaxed to allow a shift to socially distanced digital health and mental health care. One of the countries that has been viewed as a trailblazer in digital e-health is Germany. The Digital Healthcare Act, passed in 2019, allows approved digital health apps to be prescribed by doctors to their patients as part of a treatment plan at no cost. (To learn more about the German digital health market and how to successfully enter it, download “DiGA in Germany” whitepaper here) No surprise that a lot of health applications that can be reimbursed by statutory health insurance in Germany focus on mental health solutions. The adoption of digital mental health solutions by people who otherwise will not seek help and the earlier detection and treatment of mental health illness saves lives and reduces healthcare costs and economic burden.
How to improve access to DTx for mental health? How to reach people who fear being stigmatized and would like to have more independent, yet as effective treatment? Can e-mental health solutions meet the challenges posed by mental health care? Is online psychotherapy the future of mental health care?
In a candid conversation with Hannes Klöpper, CEO of HelloBetter (formerly GET.ON), the world leader in the research and development of online mental health courses for 12 years, we explore the digital mental health market, the trends in the space and what is ahead of HelloBetter!
Enjoy the interview!
Research2Guidance: Can you please introduce to us HelloBetter and what footprint would you like to leave within the mental health space?
Hannes Klöpper: HelloBetter was founded in 2015 by internationally recognised experts in the field of digital mental health. We build digital therapeutics for the prevention and treatment of mental health disorders such as depression, insomnia, anxiety, panic, stress, etc.
What sets us apart is the range of different indications that we cover as well as a very strong evidence-base for our psychological online courses with personal support.
There is at least one and sometimes several up to half a dozen different clinical studies for each of our courses / products that show their effectiveness compared with traditional face-to-face therapy, which is typically seen as the gold standard.
Our team fundamentally believes that we need to broaden the range of solutions available to patients. Right now, you are either “in treatment” or you are “on your own”! The treatment is typically one session a week with a therapist, reflecting on your situation, making plans, and agreeing on next steps. But there are of course very different patients with different needs. Solutions like ours can do a better job of accompanying the patients in their everyday lives and we can take them by the hand and support them wherever and whenever they need it.
Research2Guidance: A lot of companies with great solutions have failed because they have not figured out who will pay for their product/service. What is your business model?
Hannes Klöpper: Our business model is B2B2C. From the very beginning we fundamentally believed that our products should be free to clients, with either payors or employers footing the bill. In Germany we partner with half a dozen health insurance companies so their members can access our products and over 100 companies offer our courses free of charge to their employees.
At present, we are working on fully integrating a range of different products into the standard of care. We plan to have several of our products in the DiGA directory by next year, making our e-mental health solutions eligible for prescription by doctors and therapists and thus available to people all over Germany free of charge.
But we also look beyond Germany. We are open to conversations with health insurance companies from other countries that partner with providers of digital health solutions. Moreover, we look at other markets that may well emulate the regulatory pathway that Germany has pioneered.
And last but not least, we provide our technical infrastructure, as well as the scientifically validated content to other mental health service providers – both telemedicine as well as brick and mortar providers. This enables them to offer a fully digital solution, where they handle the patient management piece on top of our solution. This is what we call TaaS – therapeutics-as-a-service.
Research2Guidance: Interesting. Can you elaborate a bit on the product that you offer?
Hannes Klöpper: Our products are scientifically validated psychological online courses that empower people to change their lives. It is cognitive behavioural therapy translated into a digital solution. In a nutshell, our product is a standalone self-service solution, but there also is a coaching component where a qualified human psychologist or psychotherapist interacts with the client on a weekly basis. They support them, answer questions about the course, and help them in whatever way they can to maintain and improve their mental well-being.
The courses are designed in a way that invites clients to share information about themselves, making it an interactive and engaging solution. This allows the coach to get a good overview of how they are doing and whether they are making progress over time.
Whether it is anxiety, depression, insomnia, or another mental disorder, each product first helps the client to reflect on their current situation, then there is a bit of psychoeducation where they learn about their specific disorder and how to break out of the vicious cycles, they are typically caught up in. The 3rd step is all about implementing change in one’s everyday routine. Scheduling activities and doing the kind of things that help one act and feel differently. Our clients are equipped with everything they need to feel empowered and in control of their mental health. Our coaches accompany them on this journey.
Research2Guidance: Quite compelling product that could be very valuable for those people with some mental health illness who fear of being stigmatized if they go to a psychologist / psychotherapist and who would like to get help and be guided in a more independent fashion. You have mentioned that all the courses are scientifically validated. What are the clinical trial challenges faced by healthcare companies and how can they be overcome?
Hannes Klöpper: Everything we do at HelloBetter comes out of 10 years of research and all our interventions have shown their efficacy in gold standard evaluation. For us, scientific validation is not only crucial from an ethical perspective towards our clients, but is also indispensable from a reimbursement point of view. Obviously, this requires a lot of expertise and comes at a high price point which is a challenge for many companies that needs to be considered early on. We are lucky enough to have a large international research network and the necessary expertise for this in-house. However, finding appropriate ways for researchers to evaluate an intervention in a fast-paced product development environment is complex and requires good communication and expectation management skills amongst researchers, psychologists, product managers and software engineers.
Research2Guidance: Covid has shed light on the importance of our mental health and the impact it has on our overall well-being. There is huge demand, a lot of players have entered this space, the investments keep rising, yet a shortage of human-therapists and a lack of real differentiation between a lot of the solutions is observed. How do you ensure your commercial success?
Hannes Klöpper: In Germany we are quite lucky that we have a clear pathway to reimbursement. Digital health applications or DiGA, as they are called here, become listed after a rigorous vetting process by the German regulatory agency for pharmaceuticals, ensuring not just market access, but full reimbursement by the German public healthcare system. This is a great way to achieve massive scale. Getting listed is of course only the first step. Afterwards you need to make sure you have a good working relationship with all stakeholders: insurers, doctors, therapists, journalists and the research community to effectively communicate the value proposition of digital therapeutics in general and your product in particular.
Research2Guidance: Partnerships are an important channel for innovation, and it is also a way to gain scale and expand reach. Within the mental health space, we see e.g., Ginger is partnering with insurers like Cigna, employers, and digital pharmacies, like Capsule. Happify Health’s is partnering with Sanofi and Almirall. You have mentioned several partnerships with health plans and employers. What have you learned from the partnerships you had so far and what makes a successful partnership?
Hannes Klöpper: Partnerships are indeed an important part of bringing innovation to market in the healthcare industry. In my opinion, for a partnership to be successful and to realize its full potential, a couple of things should be in place:
A partnership should be a strategic priority for both parties. It should not just be window dressing. Some companies look at it with the idea in mind: “Let’s do something digital, something fancy”, so they can send out a press release about it.
Taking transparency seriously and managing expectations is crucial to avoid disappointments and have a successful partnership. It is also important to have people on both sides that have experience with what is like to be on the other end. For example, people who are part of the startup and have worked before in the corporate world will better understand the decision-making processes and that things take time within an established company. It is similarly important for corporates to have people that come from start-ups. They will know that small teams can move mountains in an entrepreneurial environment, but also how crucially important it is to a small company that a project moves ahead as planned, because for an entrepreneur it is not just their bonus, but the company they have built for years that is on the line.
Timing is crucial. Often there are well-intentioned initiatives but when the timing is not right i.e. it is too early or too late, things do not work out. You have to find the window of opportunity and maybe adjust the speed of your collaboration. When the stars align, it is important for both parties to align because when you catch the momentum you can achieve great things together very quickly.
Research2Guidance: I think you have mentioned some good points when it comes to establishing a successful partnership. According to R2G’s Whitepaper “Partnerships in Digital Health – Breaking Points and Success Factors”, 80% of digital health partnerships are frequently destined to fail. How can a company deliver digital mental health support at scale with measurable business results?
Hannes Klöpper: First of all, it is crucial to align on the objectives. If the two partners pull in different directions, the partnership either will not be successful – at least not from both partners’ point of view. Measurable KPIs that both partners want to work towards help to create alignment. They also help to evaluate the success of a project. When you have a target, you know when you fell short, but also when you managed to outperform expectations. That’s very helpful particularly when it comes to adjusting your plans and mobilising additional resources. As Eisenhower said: plans are nothing, planning is everything.
Research2Guidance: In your opinion, can digital mental health solutions live up to the growing expectations? / What is the reality check?
Hannes Klöpper: I would argue that they have far exceeded expectations already. Like most people, when I first heard about the concept that something like an online course could be used to treat supposedly intractable disorders like depression, I was sceptical. But rigorous clinical research has shown that it can. To many it seems almost miraculous that when it comes to the level of symptom reduction, we can achieve effect sizes on par with face-to-face therapy! And these results hold not just in the controlled setting of a research study, but also in real-world implementation. So the reality check has already been conducted. Now it is all about communicating the great news regarding effectiveness and efficiency to all the relevant stakeholders such as patients, doctors, therapists and healthcare executives to speed up adoption.
Research2Guidance: There is a correlation between mental illnesses and chronic diseases. Are you considering branching into other sectors of digital health, like chronic illnesses?
Hannes Klöpper: Yes, we are looking to help people suffering from a broad range of chronic diseases. Because people with chronic diseases in general have much higher likelihood to suffer from depression and other mental health disorders. Life is tough for them, and that is why we want to support them with the mental health aspect of their struggle.
However, for us it has always been looking at the mental health implication. For example, our “chronic pain” course is not about treating the pain itself but improving the quality of life of people that suffer from chronic pain. Our “depression diabetes” course is primarily targeting the mood swings of people with diabetes and the mental health impact that diabetes often goes with. If people are not depressed, they are more likely to stick to their treatment plan for diabetes which helps a lot.
Research2Guidance: In May, we published a white paper on “DiGA in Germany” where we report that most of the health applications that can be reimbursed by statutory health insurance in Germany focus on mental health solutions. (Fact as of date of publishing it) According to you why is this the case? Is it because digital mental health solutions come with clinical trials and evidence-based data for the positive outcomes they bring or … ?
Hannes Klöpper: The research on the effectiveness of digital health interventions in the mental health care space has been around for 20 years. Digital mental health solutions are proven to be effective and naturally many of these solutions are seeking reimbursement. I think this is a very positive development for the sector. If there were none approved and listed, I would have been worried.
Research2Guidance: What trends do you see in this space?
Hannes Klöpper: I believe sooner rather than later digital mental health solutions will become a vital component of the standard of care. There are some use cases where the benefits are so obvious that soon we will wonder how we have ever lived without this digital component. This is true for behavioural health in general and mental health in particular. The standard treatment regimen of one hour per week of talk therapy will become a lot more flexible. The digitally enabled therapist will be able to become an always-on, just-in-time companion that provides the scaffolding needed for patients to succeed in breaking out of the vicious cycles that they are caught up in.
Digital mental health solutions will be an integral part of the care system and they will also reshape the care system to some extent. When it comes to mental health, we have a much broader menu of treatment options ranging from traditional medications, seeing a practitioner, and using digital medical devices. The new types of medical devices will integrate much more seamlessly with our everyday experience. Much like when you get a cast for a broken arm, it is with you 24/7 as long as you need to wear it to fully recover, and I think digital mental health solutions will be something similar for the behaviour health.
Research2Guidance: What is ahead of HelloBetter?
Hannes Klöpper: We are well established in Germany. HelloBetter is not just a provider of digital health applications, but a team of passionate, experienced researchers and patient-oriented psychotherapists. This year we are working on becoming listed as a DiGA. This will open the door to universal reimbursement in Germany. We are also keen on entering other European markets which will eventually follow this path and will establish similar reimbursement regimes for digital medical devices.
Of course, the US is another interesting market for us. In many ways it is the most advanced ecosystem for digital health but in others it is not. And that is what is fascinating. If you look at the payors and the adoption within the insurance space, digital health is still in its infancy. Most solutions are still built around the practitioner and insurance wants to use an existing billing code to pay for the time of a professional. The digital product enhances or helps to deliver the service of a traditional provider.
That is very different from what we see in Germany, where insurance companies are keen to pay for almost entirely digital solutions in order to reap material cost advantages. In the US there is a lot of venture capital and a lot of innovative companies but the system as a whole I would say when it comes to adopting truly innovative digital health solutions and creating structures to pay for them is kind of lagging behind where we are in Germany. That is why we feel like we are in just the right place at just the right time!
Research2Guidance: Hannes, it was a pleasure talking to you. Wishing you and your team at HelloBetter all the best and a lot of success!
HelloBetter (formerly GET.ON) is a global pioneer in the field of e-mental health, offering evidence-based digital therapeutics for a broad range of mental health disorders, such as depression, insomnia, chronic pain, anxiety and more. No other provider worldwide has conducted as many clinical studies on the effectiveness of its online mental health courses. With our unrivalled scientific expertise (30+ RCTs, published in peer-reviewed journals) and passion for supporting people with mental health problems, we have already helped tens of thousands of patients to lead better lives.
HelloBetter Insights shares our learnings and analysis with the broader mental healthcare ecosystem!