Jhe three years since the launch of Cerebral have been a whirlwind. With a promise to expand access to mental health care and medication online, the company landed an impressive $462 million in funding by the end of 2021. But in the summer of 2022, the company was under intense pressure as its prescribing and business practices came under federal scrutiny. agencies and prosecutors.
As Cerebral navigates the fallout from these investigations and a rapidly changing telehealth landscape, its CEO emphasized that Cerebral is working to improve the quality of mental health care.
“I’m really confident about the clinical side of what we’ve done and we’re moving forward,” David Mou, a doctor who took over as head of the struggling company in May, said at the summit on Wednesday. STAT.
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When Cerebral launched in 2020, the San Francisco-based startup attracted customers with a subscription-based approach to mental health care, targeting conditions such as anxiety, depression, and brain deficit hyperactivity disorder. ‘Warning. But in May, it was reported that the company was being investigated by the Drug Enforcement Administration and had been subpoenaed for potential violations of the Controlled Substances Act. Pharmacies including Walmart and CVS stopped filling prescriptions for Cerebral’s controlled substances, and the following month the Wall Street Journal reported that the Federal Trade Commission was investigating whether the company had engaged in misleading or unfair.
Around the same time, Cerebral suspended prescribing controlled substances like Adderall and Ritalin online, citing that the drugs had “become a distraction from our goal of democratizing access to health care services.” mental”. But Mou instead framed the change as a clinical decision, pointing to the impending return of pre-pandemic regulations that would limit telehealth prescribing only of controlled substances.
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“We heard that in the coming months, Ryan Haight will be coming back,” Mou said, referring to the 2008 law that requires an in-person consultation in most cases before a controlled substance is prescribed. “We didn’t want to play around and…have a month to cut all of our patients, hundreds of thousands of patients, off of these drugs.”
Mou also pushed back against the idea that Cerebral’s business model might make doctors feel pressured to prescribe drugs, as reports about his clinical practices have suggested. “We encourage people to follow clinical guidelines,” said Mou, who added that providers are not given quotas on diagnoses, drugs, drug types or dosages. “And that’s been true since day one since I’ve been there,” said Mou, who joined Cerebral as chief medical officer in February 2021, replacing co-founder Ho Anh.
“I think there’s such an intersection between what’s good for the business and what’s good for the patient,” he added.
Cerebral’s challenges have raised questions about how to safely provide behavioral health care in a virtual setting, and what care is best delivered in person. But Mou resisted drawing a hard line between the two. “I don’t think it’s telehealth versus brick and mortar,” he said. “I think it’s about evidence-based care versus non-evidence-based care, high-quality care versus low-quality care. In fact, I see the future as both brick and mortar and telehealth, and this patient can move seamlessly between the different continuums.
Mou has repeatedly invoked the idea that existing in-person care is not enough for patients — and not just because of the difficulty patients have in accessing psychiatric care and therapy, a common refrain from health advocates. telehealth. Instead, he pointed to a lack of standardization in existing behavioral health practices, both in prescribing and tracking results.
“It’s a big problem in mental health, but we don’t have a benchmark metric,” Mou said. “It’s not like diabetes where we have hemoglobin A1C and all clinicians can agree that’s the norm.” With platforms like Cerebral, he said, more standardization is possible.
“Telehealth can be very, very beneficial for measuring clinical outcomes and process outcomes that are important,” Mou said. As an example, he pointed to Cerebral’s efforts to track metrics such as suicidality, emergency room admissions and hospitalizations.
But when asked if its internal metrics were established measures of clinical quality, MOU acknowledged that it was a work in progress. “You have to start somewhere,” Mou said. “In short, we need to agree as a field on what it is. But in the meantime, we’ll measure everything we can.
Mou also described new tools at Cerebral that could identify patients in need of additional support. “We have one of the most proactive suicide prevention programs,” he said, drawing inspiration from text messages patients send to providers. “Some of them say, I want to kill myself. I don’t want to go on anymore and I don’t want to wake up anymore. We use machine learning to identify them immediately.” He also described a program being developed to identify similarly domestic violence signals in text messages.
Mou said the data-driven approach is key to scaling the business of Cerebral, which faces economic headwinds: In late October, the company announced its second round of layoffs this year, cutting an additional 20% of its staff in operations, support and clinical care teams. He described how the company uses a number of criteria to identify high-risk patients, pairing those selected users with a complex case manager. “Because we have this data, we can focus on the patients who really need it and give them this high level of support,” Mou said. “It comes down to data science, really knowing our patients and deploying our resources in ways that optimize clinical outcomes.”
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