Introducing WV’s Investment in Brave: An impactful business poised for growth
Today, we are excited to announce our investment in Brave Health. Brave is a virtual mental health platform specializing in counselling, therapy, psychiatry and medication management. Brave was uniquely built to focus on the Medicaid population: everything from its back-end infrastructure to the types of providers it hires has been designed with the complex needs of this population in mind. We are joined by a fantastic slate of fellow investors in Brave, including Town Hall Ventures, Union Square Ventures, City Light and Able Partners.
We were incredibly impressed when we met Anna Lindow, Brave’s co-founder and CEO. Anna is an astute operator and startup veteran, having led key divisions and market expansion initiatives at General Assembly prior to its sale to Adecco in 2018. She is joined by Jake Schwartz, co-founder of Brave and former CEO and co-founder of General Assembly. Jake comes with family business experience in the opioid recovery clinic and mental health markets. Together, the two have a bold vision to transform behavioural healthcare for high needs individuals across the U.S. in a patient-centric and outcomes-focused manner. The latter is non-trivial, as most companies in the space today lack the infrastructure to enable this in a frictionless and operationally efficient way.
Setting the Stage: Mental Health Today
There are several areas of healthcare where COVID-19 has created a new paradigm, but perhaps none are as poignant as in mental health. Prior to the pandemic, mental health had some insurance coverage but patients were limited by their networks. Waits were long to get into a provider that was covered under your plan. Nearly 20% of Americans reported experiencing mental illness, with undoubtedly a significantly larger number undiagnosed and unreported. In short, things were already bad. Then the pandemic hit and a plethora of circumstances increased demand for services dramatically: acute anxiety and depression increased due to pandemic-driven circumstances and those already living with chronic mental illness lost their support systems and routines. The preexisting supply and demand imbalance in the industry became staggering.
The supply-demand imbalance in mental health is paramount: 60% of U.S. counties have no practicing psychiatrists, and the wait time for an in-network appointment with a provider averages 3–6 months. This leaves, as no surprise, one in three Americans diagnosed with a mental illness untreated. Talk therapy, even when available, doesn’t cut it for many today. A session costs $75-$150 on average, and 45% of untreated individuals cite cost as a barrier. Even for those with insurance, a behavioural health office visit is five times more likely to be out of network than a primary care appointment, leaving patients with significant co-pay expenses. This makes supportive mental healthcare effectively out of reach for high-needs populations such as the 80 million + Medicaid enrollees.
On the positive side, regulatory barriers to providing care were lowered during the pandemic: responsible use of Zoom, FaceTime, and other tech coupled with a loosening of geographic licensing restrictions made it easier for providers to reach patients. Importantly, there has also been more dialogue about mental health. Whether it’s employees disclosing it to employers to ask for benefits, leaders in organizations speaking openly about their struggles, or schools providing enhanced education and training. We believe this trend will continue, as younger generations, more cognizant of their mental health, grow into the workforce.
Source: Stress in America survey by American Psychological Association
WV’s Thesis in Mental Health
We see two main types of startups in the mental health space today: next-generation providers and the provider tools that enable them and industry incumbents:
Our thesis is that next-generation providers that will succeed will need to have a go-to-market edge through addressing a unique patient population and leveraging technology to enhance scalability. WV’s investment in Brave hits on both of these important pillars. For provider tools, WV believes that solutions that enable practitioners to scale their time, especially in a provider-supply constrained environment, will be highly successful. Given our investment in Brave and that next-gen providers make up the vast majority of players in the space, we’ll focus the rest of this piece on that angle.
Pillar 1: Unique Patient Populations
After canvassing the market of mental health startups, we concluded that offerings for the commercially insured or cash-pay populations are plentiful, and competition there is fierce. As a result, we shifted our focus to sub-populations (some examples are below) and other insurance sources, namely Medicaid and Medicare. Through this, we observed that Medicaid enrollees were particularly underserved, a problem exacerbated by the common social determinants of health challenges that patients in this population can face.
Examples of Unique Patient Populations and Digital Providers
Despite the large size of the Medicaid population, encompassing approximately one-third of the U.S. today, there are only a handful of digitally-focused mental health providers focused on this space. We chalk this up to the need for longitudinal outcomes with Medicaid patients to gain reimbursement from payors, higher complexity of Medicaid back-office workflows, and misconceptions about Medicaid patients’ ability and willingness to engage in digital solutions. In contrast, Brave has cut through all of these obstacles successfully, building a platform that is purpose-built for the needs of the Medicaid population and its payor base. It provides patients with timely support in an accessible way that has demonstrated outcomes. This has allowed the company to extend its services in 18 states with some of the U.S. largest MCOs.
Pillar 2: Compelling Technology
While care delivery platforms are at their core provider businesses, we believe that the most successful ones leverage technology thoughtfully to help super-charge the valuable time of their providers and streamline back-office workflows. Brave exemplifies this. Traditionally, servicing Medicaid patients requires providers to navigate tedious and complex billing, licensing and administrative processes. A lot of this is done manually, which partially drives the notoriously low margin profile of Medicaid contracts. In Brave’s case, the company leverages technology to help with everything from patient coordination and scheduling to payor reimbursement and provider credentialing. The result is an operationally efficient organization that can meaningfully scale its patient base in an economically viable and outcomes-effective way. We see this as being a compelling asset and one that differentiates leading platforms from their competitors.
Brave Health: A Winner in the Making
Through targeting a large, niche patient population paired with a thoughtful technology strategy, we believe Brave has set itself up for success and continued growth. The company has an ambitious vision to democratize mental healthcare to an underserved population and has built a strong team and platform that can deliver on it. We are thrilled to be partnering with Anna, Jake, and the full team at Brave and to be a small part of their journey.