The Big Picture
The impact of the COVID-19 pandemic on all aspects of our health cannot be understated. People continue to be infected at record rates and many others are grieving the loss of loved ones and dealing with financial distress––it’s all wearing us down, physically and emotionally. All of this while so many people can’t access their usual health-care services, including therapists, chronic disease specialists, and OB/GYNs. But with limitations come new innovations: The use of telehealth services has grown exponentially, and this new virtual-first approach will lead to care that is centered on the patient, not a health system.
“The pandemic really pushed us beyond what we thought was possible with telehealth capabilities, and pushed patients to become more comfortable connecting with health-care providers virtually,” says One Medical regional director and provider Natasha Bhuyan, MD. In 2019,11 percent of Americans used telehealth, according to data from McKinsey & Company. This year, 46 percent of U.S. patients have used telehealth to replace in-person appointments and 76 percent report they’re interested in using digital health services in the future.
Changes in regulation early in the pandemic were instrumental in allowing this rapid growth. Pre-pandemic, in order to adhere to the health privacy standards laid out in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), doctors had only a few video platforms to choose from for appointments. But in mid-March, the government eased HIPAA restrictions on telehealth services, allowing practitioners to use any kind of video platform for virtual visits. The federal government also increased funding for telehealth and added 144 new items to the list of telehealth services covered by Medicare and Medicaid. The list of actions being taken at the state and federal level to expand telehealth is long and complicated (and if we listed them all here, we’d be here all day), but the result is clear: More providers are able to offer their services digitally, enabling more people to access the care they need. And bills are currently working their way through Congress to make these changes permanent.
“The pandemic really pushed us beyond what we thought was possible with telehealth capabilities, and pushed patients to become more comfortable connecting with health-care providers virtually." Natasha Bhuyan, MD
Carolyn Witte, CEO and co-founder of Tia, believes that these telehealth expansions will help to make for a health-care system that better integrates virtual and non-virtual services (something she calls “virtual-first,” rather than “virtual-only,” care) long after the pandemic is over, which is good news for patients. “A virtual-first care approach allows Tia to fill local market care gaps quicker and more efficiently, allowing us to provide whole-person physical, mental, and emotional care sooner to communities who need it,” she says.
These communities include ones that are historically underserved. “Telehealth has the potential to increase access for certain populations, such as people in rural areas, who would not otherwise have access to doctors or specialists,” says Dr. Bhuyan. “It also allows us the ability to reach groups—like people who are transgender or adolescents seeking sexual health resources—who might not feel safe going into a physical office.” Plus, telehealth is often less expensive for patients. “Telehealth typically costs around $60 to $70 per visit, which is half that of an in-person office visit with a primary care doctor,” says Sachin Nagrani, MD, medical director of the telemedicine platform Heal.
Yet, while this time has sparked positive changes, the pandemic also showed just how systemic our health failings are, and how urgently governments and health-care leaders need to address said failings. Black and Latinx communities were hit the hardest by the pandemic, in large part because the social determinants of health (the conditions in which people live and work) have disproportionately affected queer, trans, Black, Indigenous, and people of color (QTBIPOC) for centuries. “There are many things in health care that need to be addressed in order to eliminate the health disparities that minorities face,” says Shakevia Johnson, MD. “Lack of trust is a major issue. Minorities do not feel safe. Minorities do not feel heard. This contributes to the stigma of seeking [and] participating in health care, especially mental health. We need to openly acknowledge that these issues exist and have open dialogues with Black and Latinx communities so we can work together to build safe, trusting relationships.”
All of these factors together will fuel the lobbying of the government (at all levels) for better access to doctors for all who need it. “The health-care system is amidst a tectonic shift from one-size-fits-all care to people-based care with different care models being built to serve the distinct needs of different populations…who each have unique clinical needs, but also sociocultural and financial needs that impact how different groups access or do not access health care,” says Witte. “With COVID-19 revealing such harrowing differences in outcomes across different populations, the need for people-based care has become even more paramount.”
Specialized Mental Health Services Spell Better Care for Underserved Communities
One-size-fits-all doesn’t work when it comes to mental health. The challenges that an individual faces need nuanced care and an approach that takes into account their background and lived experience. Access to this sort of culturally competent support is the missing piece of the mental health-care puzzle, says Sinikiwe Dhliwayo, founder of BIPOC-focused wellness communities Naaya and Black Folks Breathing. And in 2021, we’ll see more mental health apps, online platforms, and expert directories aimed at addressing the needs of specific communities—communities that have largely been marginalized, underserved, or completely left out of the mental health conversation—come to the forefront.
Funding for mental-health-focused startups is booming: Mental health startups, in general, have secured $1 billion in funding in the first half of 2020 alone, according to CB insights, with early-stage startups addressing specific mental health needs taking a large chunk of that cash in order to grow in the coming year. Real, for example, is a membership service that offers non-traditional mental health approaches for nonbinary and women patients that raised $6 million in July. And Hurdle, a teletherapy platform for people of color (rebranded in August 2020 from Henry Health), was selected as one of nine startups to receive funding from Morgan Stanley’s Multicultural Innovation Lab this year.
Exhale, which launched in August, is the first emotional well-being app designed by Black, Indigenous, and women of color (BIWOC) for BIWOC. “Exhale was ideated when I asked myself: How am I taking care of us?” says founder Katara McCarty. “By teaching BIWOC how to rid their nervous systems of trauma, I can do something about the [health] disparities. I can help them hit the pause button and heal our collective hurt.” McCarty hopes to launch a Spanish-language version of the app to reach even more BIWOC, and has plans to launch new apps in 2021 for other communities, including one focused on helping Black and brown children address their trauma.
Earlier in the COVID-19 pandemic, Sad Girls Club, a non-profit dedicated to creating community and diminishing stigma around mental health for women of color, launched “Soul Sessions,” where for every $100 raised up to 10 community members get the opportunity to heal in a safe space with an accredited wellness professional. And on December 12, founder Elyse Fox says Sad Girls Club will host a telethon with the goal of raising $250,000 to fund more new projects in 2021 and beyond.
Meanwhile, community-based care platforms and directories, like BEAM (which just expanded to include wellness practitioners beyond therapists), Therapy for Black Girls, She Matters (with an app coming in 2021), and Therapy for Latinx, offer resources for people to find therapists of similar backgrounds. (As it stands, 86 percent of therapists are white.) The app AYANA Therapy takes this one step further, working through employers to give employees access to therapy practitioners of diverse backgrounds.
McCarty knows how powerful being seen, included, and understood is for anyone looking for help with their mental health. “Another response that we've gotten from women: ‘[Exhale] has come at the right time. It's saying the right thing that I needed to hear that's encouraging and uplifting, and it makes me feel like I'm not alone.’ That's been really good,” she says. Essentially, when you try to speak to everyone, you speak to no one. And as we enter 2021 and mental health startup funding continues to boom, alongside the projected growth of mental health apps, we’ll see more tailored options for those looking for them, particularly for BIPOC.
Trend Photo: Getty / Alex Farfuri
You’ll Text With Your Therapist As Much As Your Friends
The stark rise in virtual therapy during the pandemic showed that Americans don’t need the comfort of a therapist’s couch to get the support they seek for mental health issues. “Demand for therapy seems to be rising and there is a special need to reach people in areas where services are limited or not available,” says Hara Estroff Marano, author and Psychology Today editor-at-large. Therefore, “I think there will continue to be an evolution in the way therapy is delivered.” The latest way we’ll be connecting with mental health support in the coming year: texting.
According to Dana Udall, PhD, the chief clinical officer for telehealth startup Ginger, the number of people using the platforms’ text-based behavioral coaching services grew 170 percent during the pandemic. (Ginger’s text coaching is done by a certified mental health coach; to speak with a psychiatrist or licensed therapist, you need to book a video session.) In November 2020, online therapy provider Calmerry launched with texting as a primary—and the most affordable, at $45 per week—option for connecting with a licensed therapist.And Neil Leibowitz, MD, the chief medical officer for virtual therapy provider Talkspace, where new users are up 150 percent since COVID-19 hit in March, says secure messaging with a therapist is the most popular form of support.
Psychiatrist Shakevia Johnson, MD, says during the pandemic, she's seen a rise in people using text hotlines and expects text therapy to be the next wave of this in 2021. "Text hotlines work very well, so it doesn't surprise me that text therapy would emerge [next]," she says. "We have to meet people where they are and text lines would be an awesome way to engage people."
Because text therapy and coaching are so new, more studies are needed to prove their effectiveness—but early data is promising. A small study published in the journal Psychiatric Services in July 2020 found augmenting traditional treatment with text-based methods to be safe and beneficial for people experiencing depression or another serious mental illness. However, whether or not text therapy can stand in for traditional therapy or is best used to compliment it remains a topic to be explored, as signs point to a continued interest from patients.
The rising popularity is undeniable and for those who are looking for help between sessions or don’t have the time or resources to sign-up for full ones, it’s certainly a growing option. And more options for mental health help is definitely a positive.
Trend Photo: Stocksy / Liliya Rodnikova
Tracking Stress Is the New Tracking Steps
First, we counted steps. Then, sleep quality was the health-tech metric to watch. But in 2021, a growing number of wearables will be tracking stress and helping us do something about it—a development that couldn’t be more timely. Even before the COVID-19 pandemic, the majority of Americans reported experiencing stress during the day, and nearly half said they felt worried a lot. And now? A recent study in the journal Cardiology proved that the pandemic is only exacerbating those rampant stress levels, to the point that doctors are already seeing an increase in stress-related heart disease.
Some leaders in the health-tech space—including Garmin, Whoop, Samsung Health, and Oura—have previously tracked stress levels using heart rate data. But the newest wearables, coming to market in late 2020 and through next year, track stress in new ways. The latest Apple Watch Series 6 ($429) uses a built-in blood oxygen monitor to sense quick and shallow breathing, which can then be used to detect anxiety or panic attacks. Fitbit’s forthcoming release, the Fitbit Sense ($330) will be the first wearable to track stress through electrodermal activity, or how well skin conducts electricity. (Sensors on the rim pick up on moisture triggered by stress.)
Launching in mid-December 2020, Cove, a device that wraps around the back of the head, tracks stress via heart rate, silently vibrating behind the ears to soothe the wearer and promote better sleep. Cove’s vibrational frequency was designed to stimulate the nerve endings of the skin, activating the brain’s posterior insular cortex to temper stress.
“Launching Cove now seems more relevant than ever,” says Francois Kress, the CEO and co-founder of Feelmore Labs, Cove’s parent company. “In these challenging times, many of us are facing stress, uncertainty, fear, and doubt. These stressors can impact overall well-being, including sleep. Cove was created as a simple tool to incorporate into everyday life [that can help].”
While Cove focuses on reducing stress in the moment, Garmin, Fitbit, and Samsung devices give wearers a stress “score” and specific stress management tips tailored to lower that score over time. For example, Fitbit’s lead research scientist, Conor Heneghan, says if the wearable picks up on sweat-triggered stress markers, wearers may be prompted to do an audio-guided meditation through the FitBit app as a way to help the body relax. Similarly, Samsung Health has partnered with the Calm meditation app to help smartphone and Galaxy Watch3 ($340) users lower their stress scores. Garmin devices—namely, the $700 Fenix 5 and $650 Forerunner 935—prompt users to do a breathwork exercise when they detect high stress levels.
Heneghan believes that in 2021, stress tracking will fit right alongside markers of a healthy lifestyle like exercise, nutrition, and sleep. “Defining health is about so much more than being ‘exercise fit,’” he says. “As technology has evolved, we’re able to offer users more metrics and insights about their overall health.”
So next time someone asks how you’re doing, you might want to glance at your wrist before answering. Your wearable might just know better than you do.
Trend Photo: Stocksy / Gillian Vann
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