Startup, with Horizon as an investor, is making behavioral health inroads in N.J. and beyond

Behavioral health is increasingly a line of care that many providers are looking to grow, but one provider is focused on working with companies to focus on the mental health of their employees.Behavioral health is increasingly a line of care that many providers are looking to grow, but one provider is focused on working with companies to focus on the mental health of their employees.

Beyond the opioid epidemic, there is more awareness about mental health and its effect on everyday life.

In fact, some health care providers have even started screening their new patients for mental health issues.

Where do these patients then go?

For some, it’s a nearby provider. For others, telehealth becomes an option.

AbleTo, formerly AbilTo, a New York-based startup, says its largest book of business since launching in 2010 is in New Jersey.

Of the 10,000 patients it has served, 1,500 have been in the Garden State.

That may be in part due to the fact that Horizon Blue Cross Blue Shield of New Jersey invested in it, and is part owner, according to Senior Vice President of Strategy Jonathan Stout.

The organization has raised $21 million in venture capital funding, including a direct investment from Horizon.

Stout would know about Horizon, since he worked there for 12 years, including as chief of staff to CEO Robert Marino, before leaving last July to join AbleTo.

But AbleTo isn’t exclusive to Horizon. It is in-network with almost all commercial insurers in the state, including Horizon and Aetna — including through the largest purchaser, the State Health Benefits Plan — and works with United Healthcare’s Optum, Stout said.

“We’re solving a real access problem for people,” he said.

But it hasn’t yet reached the population most in need: Medicaid members.

“One of the things we have on our roadmap is to find that Medicaid partner … and develop a plan specific to that population,” Stout said. “We know we will have to tweak our model to serve that population.”

The strategy is targeting large-volume customers in order to be able to financially support Medicaid customers, since the reimbursement for treating them is so low, Stout said.

And the plan to eventually target the Medicaid population, amid proposals to cut Medicaid by hundreds of billions of dollars, is not easy.

“It’s a scary proposition,” Stout said. Which is why the organization wants to begin by “dipping our toes in with select partners rather than dedicating the full business model to Medicaid.

“Coming from Horizon, who has a huge Medicaid book of business, where the population is most in need of care, we have not yet entered the Medicaid market due to reimbursement challenges.”

So the strategy is to target blues plans across the country, since they typically have the largest market share in their states, as well as large companies who focus on offering health and wellness programs through their human resources departments.

The pitch? It’s like the flu shot.

“When it was first introduced, you knew it would drive up expenses, but knowing it would drive down future spend,” Stout said.

The same applies to AbleTo.

“We’ve sliced country up into a handful of Blue Cross plans that we want to go after,” Stout said. “They have to have key characteristics, which are scale, so they have to be a market leader in their geography who has the numbers, the volume of patients, for us to have the (return on investment) of targeting that geography. They have to really be a believer of the linkage between behavioral and medical health, because we will increase their spend on behavioral health.

“It might sound obvious, but only within last year or two, the market is starting to understand the link between behavioral and medical health.”

AbleTo offers remote services, which breaks through the stigma of mental health treatment.

“Sitting on a couch or not knowing who will see you in the patient room … we can overcome that stigma and that last barrier to treatment for people,” Stout said.

In addition, it creates targeted treatment plans that take into account the person’s whole health. So if there is a patient who has cardiovascular problems along with depression, their treatment plan is different from a person who is suffering from depression and substance abuse and who has diabetes.

The company markets itself as a plug-and-play solution for providers, especially larger systems that are looking to scale up their services in-house as part of their strategies to become clinically integrated systems.

Surprisingly, AbleTo doesn’t appear to be stepping on the toes of existing providers.

“Not for New Jersey, because we are already serving the market, but when we go into new markets, we go onto the provider directories for health plans to make appointments (as a customer seeking care). We were just doing it for a large blue plan in another state; of the 75 therapists called … we scheduled with only two in the next week,” Stout said.

The company touts a next-day guarantee and offers services in English and Spanish.

It is doing this through a network of 300 licensed therapists around the country, and a staff of almost 100 — which is expanding to more than 180 soon — in New York City.

The timing of AbleTo’s growth and the interest in the market is not coincidental.

“Behavioral health is front and center down in Trenton and elsewhere,” Stout said.