I recently spoke to Barnaby Perks who is the Founder of IESO digital health, who provide digitally-enhanced mental health services to health providers, private individuals, and businesses.
After hearing Barnaby speak at the TechTour in Helsinki, I asked him to share some of his time to tell the story of IESO digital health.
The Early Days
The core concept for IESO digital health was conceived by two psychologists in the late 90's. The NHS were not able to treat all the patients that were seeking or recommended for therapy because of therapist availability and the patients’ ability to access clinics. They had a thought - wouldn't it be easier to deliver CBT over the internet, so patients could be treated from their home? Fast forward to 2007 and they persuaded the Bupa foundation to fund a clinical trial in London, comparing online delivered CBT with standard care. The results, published in the Lancet in 2009, were similar to what you would expect to see when comparing face to face CBT with standard care.
Introducing Barnaby Perks
Based on the results of this study, investors started paying attention. With that Barnaby Perks was approached in 2011 to lead the company as its founding CEO. Barnaby and the rest of the team identified the IAPT (Improving Access to Psychological Therapy) program as their initial opportunity to work with the NHS. The premise behind this program is basically an economic one; if you treat people with mental health conditions you will get more people into employment, they will have fewer sick days and will be more productive. Of course from a clinical perspective you would also see a reduction in costs in the health system due to untreated mental health disorders, which often lead to physical health issues resulting in a significant financial strain on the health system.
After running a number of pilots under the IAPT programme, IESO were approached in 2012 to treat 100 patients in Surrey who had been on a waiting list for two years. They treated those patients throughout 2012 and achieved fantastic initial outcomes with 45% recovery on what was a very difficult cohort of patients.
First Big Break
In 2013 the groups that commission the IAPT services in Surrey joined forces and allowed multiple contractors to bid to provide therapy services to the population of Surrey. IESO was successful in that bid because of their success with the first 100 patients. Initially, under this agreement, patients needed to come through GP referrals, but after a year the commission expanded the contract to self referrals, allowing IESO to market to a larger audience for the first time. This led to massive growth in the number of individuals availing of their CBT program.
How it Works
IESO are directly commissioned by the NHS, and are in all cases accessing self-referrals as well as referrals from the GP. Once the self-referral information is analysed, they assign a therapist who will schedule the first session with the patient. During that first session they will cover a lot of the self-assessment data, they will go over the diagnosis and create a treatment plan. Sessions then follow on a weekly basis until the completion of the treatment. Between appointments, patients use the site to access their transcripts between sessions, do the homework assigned by the therapist and track their goals until the next session. The therapist uses the site to send asynchronous messages to the patient between sessions as well as remind them of various parts of their treatment and even assign new tasks. All of the IAPT’s strict outcome measurement questionnaires are also carried out through the site. In order to be reimbursed, IESO bill the CCGs (clinical commissioning groups) on a monthly basis for the patients that have completed therapy that month. For the most part, this billing has two components based on activities (episodes of care) and recovery (desired outcome).
In 2013 1,500 patients were treated on IESO’s system. In 2016 this rose to 10,000 patients, and in the first three months of 2017, 4,000 patients have already received treatment using their system. Therapy completion and recovery rates are now averaging at approximately 55% with IESO’s solution, while the rates for face to face therapy reside in the upper 40s%. IESO’s system is recording higher completion rates than face to face and for those who complete, they have a higher recovery rate.
The Future for IESO
IESO are creating a vast amount of insightful longitudinal data on the clinical care pathway, and are now using this data to augment therapists (making therapists better therapists) by applying natural language processing and machine learning. They are doing this by helping therapists with diagnosis, assign protocols and to make sure those protocols are actually used in therapy. In order to take advantage of this opportunity at scale, IESO have developed a beachhead into the US market. They have secured a partnership with Beacon Health, the largest mental health payer in the US, and are now operating in Colorado treating Medicaid patients. 100 patients have completed the program in the US to date, with results comparable to those seen when deploying the service in the NHS. A credit to Barnaby and his team for developing a fantastic outcome-driven solution to a gargantuan global problem.
IESO digital health are HealthXL Verified