Indu Subaiya Interviews Michael Laskoff, CEO, AbilTo

CEO of AbilTo, Michael Laskoff will join us on stage at the Health 2.0 Spring Fling Matchpoint Boston May 14th during the Fireside Chats. He will further discuss his partnership with Aetna and will be joined on stage by Aetna’s Michael Golinkoff and Meg McCabe.

Indu Subaiya: Today, I’m speaking to Michael Laskoff, CEO of AbilTo. Michael, welcome! You’ll be joining us at the Health 2.0 Boston Spring Fling for our Fireside Chat session on May 14th. As you know, Boston is going to focus a lot on partnerships in the Health 2.0 space and you have a very interesting story to share that we’ll get to in a bit. First, I want to talk about the online behavioral health space. We’ve observed your company for a few years, and there’s some really interesting work going on in this space. You are one of the leading innovators, so tell us about AbilTo and walk us through some of your programs today.

Michael Laskoff: Well, first of all, I should thank Health 2.0, which has been a great supporter of AbilTo over the past couple of years, and more specifically, helping us meet Aetna at one of your events. Actually, we were doing our very first demo ever on stage, which was at Health 2.0 in San Francisco, about a year and a half ago.

As you said, AbilTo is attempting to bring innovation into the behavioral health space, not only because behavioral health needs innovation, but because behavioral health is one of the very best ways to help combat rising healthcare costs in general, in critical categories like cardiac patients, diabetics and people who are suffering from chronic pain. If you actually add those three categories up, it accounts for some enormous portion of the amount of money that we spend as a country on the medical healthcare for individuals. But we have a fairly simple epiphany, if you can alleviate depression in individuals reliably, that you can in fact do quite a bit to help not only their mental health outlook but actually their total health outlook. So what’s good for individuals is good also for the people who are paying for their care.

Most people think of The Sopranos, sitting in an office, talking about their childhood to hopefully a very nice therapist. It’s a terrific thing for some people, but for people who have specific depression related issues that are triggered by things like heart attacks, we believe that there’s a far better approach. That approach is to help people change their behaviors in ways that are clinically proven by science to actually help people feel better.

What we do is we offer, in partnership with Aetna for example, a program called Cardiac Health Forum. With Cardiac Health Forum, we identify individuals together who have in fact, recently been hospitalized by a cardiac condition. When they come out of the hospital,Aetna helps us to contact them, with the permission of their member of course, and get them enrolled in a program. The entire program is completed remotely and this is where the technology part comes in. 100% of our services offered are via telephone, but most people actually are doing it via web-based video conference. The web-based program gives people the advantages of being face-to-face, that sense of intimacy and connectedness that we think of, but with convenience and lack of stigma, and doing it on your own time and place of choosing.

All materials are generated by us and we’re recording, in real time, quite a bit of empirical information that then allows us to actually substantiate the degree of improvement that someone is having. Almost 85% of all the people who start one of our programs actually finish. Now, that’s 16 sessions over 8 weeks, which is quite a lot. So, the fact that 85% finishes something we’re excited about. Also, the degree of depression that we’re helping to alleviate is in the neighborhood of anywhere from 75%, and in some cases upwards of 90%. In before and after, on an increasing number of individuals, we are able to track how they are actually doing by way of depression. Working with Aetna and with some of our partners we are now actually beginning to translate what those depression reductions mean in terms of cost savings and claim savings. So that was a long answer but that’s what we do in a very large nutshell.

Indu Subaiya: I recall from my medical school training that the ability to influence recurrence of an event after being discharged from the hospital is very high, just with things like support groups and mechanisms that address stress. I think you can see a real difference in outcomes. So, in that cohort are you focusing on just depression or is it kind of overall kind of lifestyle management issues?

Michael Laskoff: We would say that we are a complement to the kinds of disease management and coordinated care systems that large payers already put into place. By the way and thanks for bringing up the point about recurrence because that really is crucial. If someone has unfortunately had to be in the hospital for a cardiac situation what everyone wants to do is make sure that they don’t have to go back in.

What we do know is that about one in two patients who have been in the hospital for heart related events suffer depression, and it’s effectively one of the leading indicators of not only if they go back into the hospital, but when. One in four depressed individuals will be back in the hospital in six months versus one in four individuals who are not depressed. Their actual time to go back to the hospital is about 42 months, and there is a tremendous difference in terms of length of stay. If you are depressed, on an average, you will be in the hospital about 13 days and if you are not depressed, you will be in the hospital for about 4. It’s worth pointing out that being re-hospitalized doesn’t actually help anyone, doesn’t make people healthier, doesn’t add to their quality of life, per se. It just falls into the rubric of preventable conditions.

So, as I mentioned up to half of all cardiac patients suffer depression and 20% of all people who are diagnosed with Type 2 diabetes suffer depression when they find out that they are, in fact, diabetic. If you look at the number of people who are suffering chronic pain, who are collecting health benefits at this point, an enormous number of them are depressed. So, we are primarily focused on depression, on some anxiety but we don’t do any of the -– the sort of -– I call it almost like exotic things. People who require traditional in-patient care for example, should in fact continue to get that. People who need intensive community based services should in fact get that. This is kind of for the 80% that falls into the everybody else category.

Indu Subaiya: Those are staggering statistics about the role of depression and re-hospitalization after cardiac event. In terms of tracking these outcomes, will you be collecting data on a longitudinal basis or a pilot arrangement to track whether you can make these larger impacts?

Michael Laskoff: Absolutely. As I said, we have been providing program service to Aetna for coming up on about 7 months now. It’s a three months program and we are just getting to the point of being able to do the initial 90 days follow ups. What we know from the clinical literature that’s coming at us is in fact, there is a lot of contention about how one even does that lateral study. There is obviously great enthusiasm on the part of Aetna and some of the other health plans that we talking to at this point. Frankly, the alternatives aren’t very good and there is quite a bit of literature on the somewhat disappointing results of anti-depressants on mild and moderate depression cases. So that, giving them to people, who very frequently are taking many different medications already, doesn’t necessarily improve any kind of outcome and doesn’t really prevent cost. Of course, it’s easy for doctors to prescribe and therefore it becomes very prevalent.

We’re in the process of tracking and it’ll probably take us the better part to 6-9 months to begin to build a compelling, peer-reviewed quality set of figures on that. In the meantime I think what almost everyone is concluding is that what they’re doing currently isn’t coming anywhere near close enough to meeting their needs. So we’re meeting with a great deal of enthusiasm. This year in particular we’re actually trying to get these things implemented faster, particularly because anything anyone can do to cut their re-hospitalization rates prior to 2014 has become a pretty appealing.

Indu Subaiya: Absolutely! To how many people has the Aetna Cardiac Program been made available?

Michael Laskoff: I can’t give you the specifics but what I can tell you it’s a healthy three figure number and we’re increasing the number per week. Aetna is really to be commended, they are a big, complicated system. I think it’s probably rivals the US and the UN rolled into one happy equation. It’s been a lot of work to identify, get gears to mesh, to get these people identified and then deliver.

Aetna isn’t merely suggesting to these folks that they call us, they are actually really getting the permission of that individual, passing that information on to us and we are contacting those people. If Aetna does get a person to us, if we actually get permission to contact that individual, we are actually getting an initial meeting setup with almost half of them. Which when you look at it, the difficulty of just getting people to engage in things that are good for them, it’s pretty extraordinary that we’ve got into that level. We certainly did not start there.

Indu Subaiya: Congratulations on working at a partnership with a large organization like that. That’s a challenge for any young company. As we wind down here Michael, I’m curious because at Health 2.0, we are interested in the journey of young organizations . Tell us a bit about AbilTo in terms of the number of employees, your financing, where you guys at as a company right now?

Michael Laskoff: Of course! Again, I need to go back and say that actually an important part of everything that we’ve done in terms of fundraising and corporate financing and things of that nature, all of it was accelerated by being recognized by Health 2.0 as an innovator. So, again thank you for that. We now have six people full time, and we have over a 100 people — providers, coaches and therapists. The therapists are in 14 or 15 different states. All of whom we have recruited, trained and in fact when they work for us, only follow our methodology.

In terms of development work, we are proud of the fact that we are actually based on angel money only this quarter and management investments. We’ve reached the point where we are crossing into cash flow positive territory on our own, and as a result of that,  I’m pleased to say a number of strategic partners have expressed interest in investing. We’re probably looking at taking a small A Round hopefully in the next 90-120 days and we’ll be using that for what I say is the most challenging aspect of operating as a new company in this space, and that is the incredibly long sales cycle to get health plans on board. With Aetna, it was a very fast process, certainly by the standards of the industry. But we don’t thing that will be the case and we hear all kinds of stories of people reporting that it takes 10, 12, 14 months to close partnerships that everybody wants. We are hoping to go quite a bit faster than that but nevertheless, we’ve got to secure lot of resources to get those kind of efforts underway. Hopefully, we will be doing that and we will continue building the organization much faster through the remainder of this year.

Indu Subaiya: That’s really impressive, and one of the things we recognized from our vantage point is exactly what you said, that long runway leading to a deal with these larger players. It’s one of services that we provide, for example, with formats like Matchpoint; to help accelerate those conversations as well. Lastly, as CEO of a Health 2.0 start up, do you want to share one of your lessons learned as a CEO for other tech leaders out there?

Michael Laskoff: Yes, actually just one, which is be very skeptical of the people who tell you that something is impossible. Specifically with regard to the health space because it is very difficult to work with large partners to help them affect a change, but it is entirely possible. Generally it seems to be a factor of how badly you want it. We want it badly, and we are in one of those great situations where as our investors do better, we actually bring  more joy and alleviate suffering, on hopefully a very, very large scale. But it’s that sort of dogmatic belief that you can do things that other people have said is too hard, it doesn’t work. It’s the effort that really does seem to make the difference. I wish that we had known sooner how doggedly we had to pursue alignments with the existing payments channels. The fact that we are able to work within existing payment structures, for very large companies, does an immense amount to make our proposition easier. Many other people are out there trying to hack it out, trying to get people to invest in new things that require lot of work on the part of a big partner in order to engage.

Indu Subaiya: Michael thanks for both the inspiration and update on an amazing amount of progress!

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