Improving the mental healthcare experience can be done through the use of technology.
In this episode of Bite the Orange, we are joined by Jonathan Knights, Head Of Applied Science at Mindstrong, an end-to-end digital healthcare provider focused on upgrading mental healthcare with technology and a twist: using a human-centric approach. Mindstrong improves patients’ access to care by using digital tools and technology to enhance therapy sessions and make information available. This way, clinicians and members can manage their mental healthcare seamlessly. Jonathan explains how Mindstrong uses a measurement-based care system to personalize which particular service someone needs to achieve a symptom reduction goal. He discusses what he calls active-passive data collecting and the importance of integrating research into care in real time.
Tune in to learn more about Mindstrong and the way they use technology for digital mental healthcare!
FULL EPISODE
BTO_Jonathan Knights: Audio automatically transcribed by Sonix
BTO_Jonathan Knights: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen, and welcome to another episode of Bite the Orange, where we bring innovative folks that have interested minds and interesting stories to share with us. And the point of this discussion is not necessarily just to listen for the sake of it, but we want you to listen and be an advocate for this and be able to bite that orange or the bitter pill and support all these interesting innovators that we're bringing on today to join us in this beautiful and amazing story and journey. So today we have a very, very special guest, someone I've followed for quite a while as well, and I don't take that lightly. You know, we all on LinkedIn, we see people's postings back and forth, but I bet certain people that post and you find it very interesting and I'm looking forward to actually having this conversation today with Jonathan Knights, who is currently director at Mindstrong. So welcome, Jonathan, to the show.
Jonathan Knights:
Thanks, man. It's a pleasure to be here.
Emmanuel Fombu:
Thank you. Thanks, Jonathan. So to start off with that, some listeners might, may know you and some listeners may not have known you, but today they all know you. And so tell us something about yourself, your background.
Jonathan Knights:
Yeah, so I'm a computer and pharmaceutical scientist by training, joined the industry in 2013, actually to start working on the first digital medicine program in pharma history. I sort of thought that I had peaked too early in my career, when I started coming out, I thought, Man, a computer and a pharmaceutical science project all in one right after graduate school. This is too good to be true. But the good news is I found more interesting or continue to find interesting things to work on, and I come to the space with a very personal connection to mental healthcare and mental illness. It's something that's been prominent in my family growing up, something that I've seen the inefficiencies in the healthcare system, the impact of those firsthand. And for one way or another, I just sort of gravitated and kept getting pulled back into mental healthcare to apply my craft. So, yeah, it's been a good ride so far, but a lot more to do.
Emmanuel Fombu:
It's very interesting that they talk about this. I think in today's world, actually, today we're in 2022, I hope we're in 2022. I think people are being more open about the concept of mental health, right? My background piece of my family or different Cameroon, for example, is a place that people don't talk about mental health, right? It's, even growing up, and when I went to medical school and I'll tell you, I've been working in cardiovascular medicine, mental health in medical school was something that we just mentioned briefly in the class about DSM four, and they check the box and then you move on, right, and we look at grief and the different aspects of it. So it was, mental health, you would think, in schizophrenia or something like that, but there are many aspects of this, right? And so to you personally, as someone that has experienced this, of my personal experience, and someone that's worked in that particular space, how would you define mental health to the community?
Jonathan Knights:
Yeah, well, so my experience to date has actually been more on the serious mental illness side. So working with schizophrenia, major depression, and bipolar as primary therapeutic areas that I've focused on. But within that space, since I have moved out of exclusively focusing in pharma, more on the clinical care delivery side. So at Mindstrong we're an end-to-end digital healthcare provider, and you know, the concept of mental healthcare has certainly broadened from my perspective. And, whereas in my clinical development days we were focusing on improving PAN scores and Majerus and Weimer for the different serious mental illnesses, I've really embraced and adopted a much more holistic view of mental wellness and wellbeing, and treating all aspects of behavioral medicine in addition to mental illness and pharmacotherapy. So we're definitely doubling down on how do we measure mental healthcare and mental wellness as a starting point.
Emmanuel Fombu:
So how would you define, just to make a clear piece, if someone has a mental health condition is like severe or serious mental health condition, which you've defined is likely some of those conditions, but I'm sure there's a lot of them across the spectrum, because we have a severe condition, there are different ways of treating this, correct? So you have a therapy where you can give like a traditional pharmaceutical kind of drug and then a behavioral aspect of it, we can leverage technology, which in some terms is known like digital therapeutics in different ways. So where does like it, does my Mindstrong fit in this, in this whole spectrum?
Jonathan Knights:
Yeah, so Mindstrong, specifically, is a provider of mental health services that, we are sort of empowered with technologies and measurement-based care as well. We layer passive sensing through mobile devices to infer behavioral modalities on top of or in between clinical sessions. We use technology to meet people where they are and to improve access to that care. But as you mentioned, Manny, so in the pharma days, we talk about digital medicine and that was a specific digitized medication or some kind of supercharged pharmacotherapy, and the space of digital therapeutics has definitely emerged within digital medicine, both as adjunctive treatment and in some cases primary treatment for some mental health conditions, which I think is really exciting. I don't think in the future there wouldn't be anything barring a company like Mindstrong or a team like my team from incorporating those into our care models along with our clinical care scientists. But at the moment, we are, we're focusing on improving therapy, what we call care partners, or more similar to case management, but coaching and removing social determinants of health barriers, etc., connecting to resources and then medication management and psychiatry. So we focus on improving the mental healthcare experience with technology, but with a human-centric approach and definitely a psychotherapy focus.
Emmanuel Fombu:
So basically, what you and your team, or the company in general, Mindstrong, it's a reimagined healthcare delivery, right? So it's beyond this concept of you just see a doctor near you go home, but you actually have care teams that take care of that patient in a continuous manner so they don't drop that ball, right, and by doing that, correct, by doing that, you probably have improved adherence with therapy, right, someone has someone to talk to, which is very interesting, correct?
Jonathan Knights:
Yeah, so we, so I was really keen when I got to, when I got to Mindstrong. So we embedded our applied scientists or data scientists, applied scientists into our clinical teams. So we do rounds with the clinicians. We've stood up some workstreams that we call micro labs and Mindstrong labs, which are opportunities for members and clinicians to partner on experimental or emerging technologies. The focus is always, though, how do we use these technologies within the context of improving a therapy session or within the context of improving a decision or the information that's available to a member or our clinicians to make it better, to make a better decision. We also, one exciting thing, we recently filed a provisional patent for using our measurement-based care system and building a modeling framework around that to personalize how much of any particular mental healthcare service someone may need to achieve a symptom reduction goal. So for instance, if you were going to therapy once a month, is that enough? If you were seeing a psychiatrist every 60 days, is that enough? Would the evidence suggest that going to more frequent therapy sessions or adding coaching sessions into your care plan, would we expect that to help you from a symptom reduction standpoint? So we're actually really excited about this framework and we're going to be launching it within the next quarter or so, which is really exciting and something that when we think about some of the challenges that we are looking at, at Mindstrong, optimizing the time that mental healthcare professionals spend with our members, and we call them members because to us that indicates more of a collaborative experience and an ownership on the members side rather than referring to them as patients, but so just for, just as an anchor, a member from my vocabulary as a Mindstrong patient, just derailed myself a little bit.
Emmanuel Fombu:
... at that point because you mentioned something important that I also find very interesting is, if you talk to payers or insurance companies in general, they call, everyone in your cohort members, our members, right? So you kind of feel like you belong in that membership club. It's like you're a member of something, right? But you're not that patient that they don't have the short or long term. And you've been, like myself, you know, been working for pharma, like on the pharma side of it, where we have patients who don't necessarily, because of regulations necessarily we have direct contact with patients, right? Being on the other side now, on a tech side, where you have direct interaction with those patients and they call, the members, so the question becomes, as you see the future of our industry and where we are going as an industry, how do you see things evolving? Because I would rather be a member than a patient.
Jonathan Knights:
Sure, I, so what I hope happens and what we are, what we've been building up is this idea of, remember when the Toms shoes became big and this idea of having a social impact through investing your resources was something that everyone realized, oh, this is a no brainer. If someone's going to be putting in their time, money, or resources into something, they want to see something on the other side of it, or they want to know that something's coming out of it. And so a lot of the programs that we're standing up to increase the frequency and the speed that we start putting technology or algorithms or decision-making tools in front of our members or clinicians on more of an experimental basis and creating a research environment alongside our production clinical environment to really drive a community feeling around, hey, I, if I'm looking for mental healthcare and I'm choosing between a brick and mortar or a digital mental healthcare company, if I can also participate in and learn from other people's experience and research in real-time, we think that's a little bit of a differentiator in a sense of, I don't want to say that crowdsourcing mental health research, but doing research on the front lines and integrating that into care in real-time is something that I hope people embrace and something that I think will really help the technology companies and the clinicians start to deliver better care. I don't know that, I answered your question in terms of where do we see the.
Emmanuel Fombu:
No, no, no, no, you did. I think it did a great job answering that question, and it's something that you mentioned previously about passively collecting data, right, on a smartphone, which is, basically means you're actually embedding yourself within a member's workflow, right, or your data in a clinical site as a workflow, and which is, I think because they don't have to make that much effort to actually pass on data, which could be a barrier. So your background as a data scientist, for example, what are some of the unique kind of data sets that you collect right now, and useful, how they could be used, for example, to improve healthcare?
Jonathan Knights:
Yeah, so Mindstrong, initially, I think about Mindstrong sort of as, and again just kind of focusing in on the Mindstrong experience, I could chat a little bit about the data sets from the digital medicine products on the regulated side, but the data that's been of focus at Mindstrong has been around how members interact with their keyboard and how they interact with different types of applications and the time periods in which they use and don't use their phones. We also have a, one of the few companies that has a distribution license with sensor kit on the iOS platform, and so we're in the process of planning and standing up some research studies using that platform to bring a lot more value to our iOS members. But we've actually been extracting a lot of really interesting insights in terms of how people are, the time periods in which people use and don't use their phone, and starting to look at that as a surrogate for, we call it inferred rest. But this research is coming out in the near future, maybe by the time this podcast airs, the publication will be in review. But that's actually a really interesting data set, we are starting to turn on a lot more what we call active-passive data. So active-passive data being you're collecting it as part of a routine interaction with your phone, like, for instance, an audio journal. If you were going to be journaling anyways and you're doing that in your app, we're not asking you to go outside of your normal workflow or clinical workflow, we're just going to be able to integrate that data into your clinical workflow, so the analysis is more passive, but it's not like an assigned task, so to speak. So we're really excited about those data sets. And quite frankly, as a scientist, one of the barriers that I've always had on the regulated side, I know you'll be able to appreciate this is, the scientists who develop the products can't interact with the clinicians and the physicians who are using them on the other side, right? That's kind of by design on, you know, from a commercialization standpoint. And it was truly a barrier to building data science, seems a perceived barrier from my standpoint anyways. When you're trying to innovate and you're trying to assess the value or the cost of an algorithm relative to what it's going to take to run a clinical trial on it, and sometimes you can't answer those questions because the work hasn't been done yet. And the ability to have my team and our clinicians and our clinical scientists in the same room working on the same problems with the same technologies is something that is really beneficial. So just having the clinical workflow data in-house, we have a homegrown, essentially a homegrown EHR system where all of our clinicians enter in session notes and stuff like that. So just having access to that data as well as the member data and connecting that to see how we can improve the clinical workflows has also been a real gift from a scientific standpoint coming over from the regulated side where that just was never a possibility.
Emmanuel Fombu:
Which is very interesting and makes the idea of innovation healthcare from the tech side actually more fascinating and things that could get done much faster, right? I mean, of course, you're not putting anything into your body, so there should be less regulations so that the adverse events and what we compared that to what happens in pharma is completely different in terms of in front. So with that being said, what is your target client or customer? Do you guys sell directly to like a self-employed employer or payers? How do I get my hands on Mindstrong?
Jonathan Knights:
Yeah, well, I mean, I would like to think that from, anyone who needs or is in need of, wants or is in need of mental healthcare is an ideal customer of ours, so to speak. But from a distribution standpoint, yeah, we do engage in partnerships and collaboration agreements with large payer institutions, and so in that case, the model is healthcare companies refer members over to us. We are also getting into the Medicare and Medicaid fee-for-service space. We do also have a, the app is available direct-to-consumer on Apple and Android devices directly, and so that's something that is fairly new actually, within the last year or so, to open up the technology to the whole commercial space and going direct-to-consumer was a new feature that we pushed through about a year ago.
Emmanuel Fombu:
In a technical human space, I could just pay out of pocket, that's what it is.
Jonathan Knights:
I was going to say the, we are, we're now putting intentionality around benefits for the app natively, not increasing the value of the technology in the absence of sustained or consistent therapy or psychiatry. It should be, We're here when you need us, so to speak. And when you don't, there's a suite of tools and technologies available for you to help manage your own lifestyle and mental healthcare.
Emmanuel Fombu:
Which is quite fascinating, I think this is, just listening to you speak, I think people that doubt the amount of work and research that's behind a lot of companies in the digital health space, especially around digital therapeutics, or technology in healthcare delivery, or direct-to-consumer kind of process, I hope from listening to you speak today, realize how much research is behind this, right? You have experts behind this that are really studying this to make sure it's quite effective, and you got, you're filing patents behind this, right? And you get, so you actually studying this as a massive scientist behind this whole effort. It's not just a random company on the App Store.
Jonathan Knights:
Yes, I mean, I would be remiss if I didn't acknowledge that the digital healthcare space, as you know, is flooded with a whole spectrum of quality from an evidence base and teams behind the products. But, you know, speaking from my team specifically, we, coming from a very rigorous scientific background, that's what we apply at Mindstrong on a daily basis. We have IRBs for our secondary data analyses so that we can publish in journals. We do everything above board, and we try, we are as open as we can be. And I try to approach from an evidence generation side to bring the rigor of the regulated side and being very careful with what we say and what evidence we have. And we take it very seriously, it's not just me at Mindstrong. And so while I do, obviously, I miss my team and I take full responsibility for them, and I can speak to the quality and the effort and the work that we do, it is very true, and we see reports all the time of healthcare apps that are not going through research, that are not generating evidence. And so it's true that, I don't know, I actually don't know a way of, without going through on a consumer side and really doing due diligence and looking for the companies that are publishing and the companies that are out there talking about their evidence. It's sort of a manual process at the moment, I think, unless, Manny, you know, of any resources or anything of people collating evidence around apps or companies.
Emmanuel Fombu:
No, that's exactly the purpose of this, John. It's obvious conversation, so like to make everyone understand that, yes, because some quacks in the market, right, but just specific companies with experts behind them that actually have research behind them. And so the biggest need is to find a platform that could differentiate these companies to say this one is good and this one is not because this one has published papers and this one hasn't, right? And how, is it peer-reviewed papers, get that expertise and knowledge behind it, to make sure we actually are achieving what we are trying to achieve and to make decisions? So with that being said, I think it's a good time to wrap up here, but John, we would love to have you back. You know, as you get more studies coming out, you know, to share those stories with us and to understand, and to see and share with us are the impacts that's happening in this particular space. So thanks for your work and thanks for joining us today on another episode of Bite the Orange, John.
Jonathan Knights:
Yeah, I would love that. Thanks so much, Manny. Thanks so much for you and the team for having me.
Emmanuel Fombu:
All right, thank you.
Jonathan Knights:
All right.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com, or you can visit us at EmmanuelFombu.com or BitetheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Jonathan Knights:
Jonathan is a computer and pharmaceutical scientist by training and an experienced Director in Pharmaceutical and Data Sciences with a demonstrated history of working and developing talent for clinical development and regulatory filings in the pharmaceutical industry. He has expertise in applied computer science, statistical data analysis, network architecture, pharmacometrics, biotechnology, and the life sciences. Jonathan worked on the first digital medicine program in pharma history. He has a very personal connection to mental healthcare and mental illness and is currently Head Of Applied Science at Mindstrong, a company that combines mental healthcare, data, and technology to improve outcomes and reduce the total cost of care. He has a BA in Mathematics and Chemistry from Connecticut College and a Ph.D. in Pharmaceutical Sciences from the State University of New York at Buffalo.
Things You’ll Learn:
Digital therapeutics emerged within digital medicine, both adjunctive treatment and in some cases primary treatment, for some mental health conditions.
Mindstrong layers passive sensing through mobile devices to infer behavioral modalities on top of or in between clinical sessions.
Mindstrong refers to members, rather than patients because that indicates more of a collaborative experience.
Mindstrong allows members to participate in research and other people's experiences in real time.
Mindstrong is looking into how members interact with different types of applications and the periods in which they use or don't use their phones.
You can collect active-passive data as part of a routine phone interaction.
The Mindstrong app is available direct-to-consumer for Apple and Android devices.
Digital healthcare delivery usually involves a big amount of research to support it.
Unfortunately, many healthcare apps do not generate evidence to support themselves with research.