Vinaj: Tell us about your background. Why did you choose to work for Kaiser Permanente?

Estee: I’ve always been interested in social movements and change, and this led me to a PhD in Sociology. I grew interested in healthcare during my doctoral research in Silicon Valley where I observed the contingent workforce and low to mid-wage tech workers— many of whom did not have health insurance. I went on to complete my postdoc at UC Berkeley's School of Public Health. At that time, I decided not to go the traditional research route, but rather embed myself in an organization whose mission and values I believed in, where I could help transform healthcare. This was my entry into Kaiser Permanente 15 years ago. Kaiser Permanente is a great sandbox for innovation and making a difference; it serves over 12 million diverse members.

Vinaj: How does Kaiser Permanente’s integrated healthcare system and human-centered design affect its approach to mental healthcare?

Estee: A large percentage of the population has subclinical, non-acute mental healthcare needs. While traditional psychotherapy and medication are not always immediately appropriate for these individuals, their condition could escalate to an acute level if left unchecked. In light of this, we recently made commercial digital tools for Cognitive Behavioral Therapy, mindfulness and meditation available at no cost to our members. We realized we could augment traditional care with digital therapeutics to support their emotional health and wellness. These apps allow members to build skills and create daily habits integrating research-based, DIY techniques into everyday life. Because these digital tools are on our members’ phones and we’ve offered them at no cost, we’ve made radical self-care more accessible than ever. To our delight, the apps were downloaded above and beyond what we ever expected; in fact, within 72 hours we hit our target number of users for the year.

Vinaj: What is your digital tool selection process?

Estee: We considered developing our own app, but upon realizing the large number of great commercial apps that already existed, it became clear that our energy would be best leveraged by designing the infrastructure to integrate these existing tools into our healthcare system. We created referral processes and education for clinicians to make these tools available to members through email outreach campaigns and in-person clinic visits.

We started the process with a portfolio of existing tools and selected our first pool of candidates using the American Psychological Association App Advisor guidelines. We had a clinical team review the tools, then did rapid learning, ethnographic work and co-design sprints with members and clinicians. Subsequently, we performed testing in clinical settings with small groups of therapists, behavioral health specialists and primary care clinicians. We analyzed the data and looked at member engagement. Did patients download the tool, and if so, did they use it? We narrowed our scope to six apps that we now have in our clinical portfolio. Most of the tools treat a number of conditions, but we focus primarily on anxiety, low mood, depression and sleep issues.

Vinaj: What advice would you give startups developing digital tools for mental health?

Estee: Design for people, not organizations; think of an individual using your tool. Many of the apps we are testing are not as user friendly as we would like. Entrepreneurs and designers can really shine with tools that are user-centered and simple.

Once you have scaled to the point of working with a large organization like Kaiser Permanente, two areas to be aware of are security and data tracking. Many of the apps we considered did not have the HIPAA compliant privacy and security necessary to work with a healthcare system. Several of the apps also had poor data capture and sharing. Data is the bread and butter of healthcare systems— it tells us what impact we’re having and where to allocate resources— so that will be critical to include in the tool by the time you are hoping for it to be adopted by a larger organization.

Vinaj: How do you see digital tools impacting Kaiser Permanente’s approach to mental healthcare in the future?

Estee: We just hired our first Chief Digital Officer, Prat Vemana, who is a visionary and has big plans for Kaiser Permanente. I think having a CDO communicates that digital care is critical, it’s here to stay, and will be a part of everything we do. It ultimately signals to entrepreneurs and startups that this is a pivotal point in healthcare and the time for digital innovation is now.

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Estee Neuwirth, PhD, is the Senior Director of Innovation and Design at Kaiser Permanente’s Care Management Institute and leads an internal Design Consultancy inside the organization. She earned a PhD in Sociology from UC Davis, a BA in Sociology from Brandeis University, and served as a Postdoctoral Fellow at UC Berkeley's School of Public Health. Estee is a leader in Health Care with expertise and passion in focusing and empowering people and organizations to rapidly learn, improve, innovate, and excel. She currently leads a team with a diverse portfolio of R&D projects, leveraging data, ethnography, and design to transform care delivery and enhance the experiences of patients, families, and staff.

Telosity is a Vinaj fund focused on investing in Pre-seed and Seed-stage companies improving mental wellbeing for 10 to 24 years old. Learn more at Telosity.co.