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At 10 o’clock one morning this November, Rob Beal’s bosses summoned him and his co-workers onto a mysterious Zoom call. Beal had spent more than two years working as a coach for AbleTo, which provides mental-health services to people through apps, videochats, and calls, like Uber for anxiety. Beal, a 50-year-old former attorney, had devoted himself to his job coaching people through AbleTo’s anxiety and depression programs. Though he made $55,000 a year—not a cushy salary by San Francisco standards—he loved that he was helping people. About 10 times a day, for 30 minutes at a time, he would call one of AbleTo’s users and offer support or sometimes just a friendly ear. It wasn’t therapy, but it was close. “It’s exhilarating for me,” Beal says. “I invest a lot emotionally in my clients. I care about them.”
But now Beal’s feel-good job was coming to an abrupt end. The manager on the call said Beal and his six fellow coaches were being terminated. Their role no longer fit the company’s business model. They wouldn’t be calling to check in on their clients that day. Beal and his colleagues listened in stunned silence. Finally, one of the other fired coaches cried out, in a reflexive koan of pandemic anxiety, “But I’m essential!”
Two weeks later, AbleTo offered Beal his job back, but only part-time, and with no health benefits, sick leave, or paid time off. The pay would be 30 percent less than he was making—$18 an hour, or less than $38,000 a year if he was able to get 40 hours a week. He would become a health worker without health insurance in the middle of a pandemic. (The Atlantic obtained a copy of Beal’s separation agreement, as well as an email describing the part-time offer from AbleTo’s HR department. Another coach who was terminated alongside Beal asked to remain anonymous but confirmed his account.) In an emailed statement, the AbleTo spokesperson Stephanie Carroll said that as part of an integration with a similar service called Joyable, which AbleTo acquired in March , “seven of our non-clinical coaching positions in a specific product line were eliminated to better align with our business model. These coaches were offered severance pay and an opportunity to apply for other positions within our company.”
If Beal refused the part-time offer, he could collect six weeks’ pay as severance. Beal, who owns 170 shares of AbleTo stock, declined the money and the part-time offer in order to make his story public. Though start-ups like AbleTo have arguably broadened access to mental-health care, Beal and his colleagues’ experience serves as a cautionary tale about what can happen when tech companies control peoples’ psychological treatment. One reason so many people turn to apps such as AbleTo is that they can’t find a traditional therapist who takes their insurance. The Affordable Care Act required insurers to cover mental-health appointments, but it didn’t require doctors to participate in insurance networks. So today, many therapists don’t accept insurance, making traditional mental-health care all but unaffordable for many Americans. As a substitute, many companies offer virtual mental-health services such as AbleTo to their employees for free as a cost-effective way to keep them productive and healthy. The city of Reno, Nevada, for instance, is using federal funding to provide the Talkspace app, best known for its texting-based therapy, to all residents for free. Though these services may be affordable, they are that way for a reason. And workers like Beal, as well as their clients, may suffer when the companies shift from generating positive thoughts to generating profits. Long before working for AbleTo, Beal practiced civil litigation for 12 years and hated it. After he quit, he volunteered for a suicide-prevention hotline. Mental health intrigued him, but he wanted to work with people before they reached a point of crisis—who were just having a rough time, like so many Americans are these days. A few years ago, he heard about a company called Joyable, which was hiring coaches to guide clients through app-based exercises meant to help them get over depression and anxiety. I used Joyable’s social-anxiety program in 2018, had a good experience, and wrote about it in my book and for The Atlantic . In that program, users write down thoughts that are making them anxious and try to come up with new ways of thinking about the situation that are more accurate and less anxiety-inducing. The program’s low price appealed to Beal. For people whose employers don’t cover the service, Joyable costs $99 a month , compared with about $200 a session for psychotherapy in a big city. “The whole issue of paying for mental-health services is such an obstacle to getting help,” Beal told me recently. He applied, got hired, and was trained in Joyable’s cognitive-behavioral approach. In his calls with clients, Beal primarily used motivational interviewing, validating a client’s experience and affirming what they’ve achieved. He aimed to help people feel heard. For the most part, clients talked about their work and relationships. But “we would talk about anything; it would be wide open to talk about whatever they were dealing with,” Beal said. If someone complained about their boss yelling at them, for example, Beal would say things such as, “It sounds like you felt like your boss didn’t hear what you were saying and neglected your needs.” Then he might help the person come up with solutions themselves, by saying things such as, “Have there been any occasions where things went well, and this negative experience didn’t happen?”
About a year after Beal took the job, AbleTo acquired Joyable . But Beal’s job and that of the other coaches remained the same, he says. In all, Beal estimates that he coached over 800 people. Though people can pay monthly for the Joyable app and coaching services (I did), over time most of Beal’s clients were receiving the service as a fringe benefit paid for by insurers or by their employers, which included companies such as Northwell Health, Pandora, and Costco. A few months ago, Beal and his colleague say, AbleTo hired a team of part-time coaches based in Florida, who he says also did not receive health benefits, paid time off, or sick pay. “I spent a lot of time supporting those new folks, without realizing that those are the people coming in to take our jobs,” Beal’s colleague told me. Indeed, the part-time jobs that AbleTo offered Beal and the others were based in Florida. But this part-time arrangement isn’t fair, Beal and his colleague say. If they are helping so many American workers stay sane in a pandemic, surely they deserve health insurance themselves. “It’s like Starbucks telling their baristas, ‘You can serve the coffee, but you can’t drink any,’” Beal said. AbleTo isn’t the first company that has raised concerns that tech platforms sometimes put growth and returns ahead of patient care and therapists’ well-being. Some therapists who have worked for other virtual mental-health providers, such as BetterHelp and Talkspace, have complained of low pay and difficult working conditions. One therapist who offered services on Talkspace found that when she provided a client with links to therapy resources outside the app, a company representative contacted the therapist to say she “should seek to keep her clients inside the app,” according to a New York Times investigation from August. At one point, Talkspace reportedly introduced a button clients could press that required their therapist to respond within a certain time, or risk having their pay docked. (In an email, a spokesperson for Talkspace told me, “Any therapist that wants to refer a patient to a higher level of care, in or outside of the Talkspace platform is free and encouraged to do so ... The call button was introduced last year to ensure timely response and high quality care ... It’s been integrated into the client experience with no incident.”)
On the review site Wirecutter , also part of The New York Times, a reviewer who attempted to sign up for HealthSapiens, a telephone counseling service, was “informed by the exasperated therapist who picked up that while a licensed counselor is always available by phone, they are not available for 24/7 counseling. Rather, they can schedule a weekly 20- to 30-minute phone session—beyond that scheduled session, the phone service is available only for scheduling and emergencies. The therapist herself called HealthSapiens’s marketing false advertising.” (HealthSapiens did not respond to an emailed request for comment.) Derrick J. Hoard, a marriage and family therapist based in Seattle, signed up to offer therapy through BetterHelp, a virtual therapy program, about two years ago. He remembers a relentless schedule of back-to-back sessions, 24/7 texts from clients, limits on the number of words he could exchange with clients, and a rate that amounted to less than $30 a session, compared with the $200 he charges in his private practice currently. “The way they have it set up is so abusive,” Hoard told me. “It just sounds like someone in the tech industry just decided, I want to see what I can do.”
In an email, the BetterHelp co-founder Alon Matas responded that BetterHelp’s compensation structure has changed since Hoard stopped providing therapy through the platform. “There are no ‘24/7 texts’ from clients and there never were,” Matas wrote. “Clients can send a message to their therapists in their own time and the therapist would respond on their own time. As for ‘back-to-back sessions,’ just like in traditional counseling settings, it is entirely the therapist’s choice on how they want to set their workday, including how many sessions they would like to have on a given day.” He added that therapists are paid based on how much time they spend on both live sessions and messaging. A group of therapists called the Psychotherapy Action Network has spoken out against the rapid rise of these apps at the expense of traditional, long-term psychotherapy. Talkspace sued the group for defamation after its chairs wrote a letter to the American Psychological Association expressing concern that some health-insurance plans cover Talkspace. Janice Muhr, a co-chair of the group who has her own private practice in Chicago, told me she wasn’t surprised that some say BetterHelp, AbleTo, and others pay low rates. “It’s saddening that there’s a tremendous pressure on the field to do shorter-term work or less-expensive work,” she said. Regarding the Talkspace lawsuit, she said, “We were delighted that the case was dismissed efficiently and that we prevailed in the legal system.”
In Muhr’s view, insurance companies should reimburse therapists more, which would encourage more therapists to participate in insurance networks. After his firing, Beal felt a little depressed himself. He derives joy from connecting with people, but his tether to the beautiful chaos of other humans was unexpectedly cut. He wasn’t able to tell any of his clients—some of whom he had spoken with nearly 100 times—that he was leaving. By the time Beal was fired, Laura, a client of Beal’s who asked to go by her first name to protect her privacy, had been talking with him for a year and a half. Laura had signed up for Joyable to help her handle the stress of caring for her aging parents, but recently she had been mostly making use of the coaching sessions, not the app. Beal was supportive and affirming, she told me, making her feel less alone whenever she was overwhelmed. It’s almost like he became a friend, she said. When she first started talking with Beal, Laura mentioned that she was deeply religious. Weeks later, Beal gave her some feedback that involved her faith. “It showed that he was really, not just listening and paying attention, but … I felt cared for,” she said. For the first time in a long time, she wasn’t the one doing the caring. In November, Laura got a text message from a man saying he would be her new coach. “Where’s Rob?” she texted back. After some wheedling, the man responded that Beal was no longer with the company. (Carroll, the AbleTo spokesperson, said, “AbleTo participants were immediately transitioned to new coaches to ensure seamless continuity of coaching support.”)
Laura was crestfallen. Around this same time, Laura’s father had died. She broke up with her fiancé. She felt like she was losing all of the people in her life who had supported her. Now Rob, too? She didn’t want to explain her whole saga to a new person. When Laura told me this, I thought back to my own Joyable coach, and how much she helped me as I paced around my nasty one-bedroom apartment, the first draft of my book open on my computer and too many LaCroix cans open on my desk. How she strained to understand my convoluted journalism problems and offered tips that I still use today—or at least try to. How I had always been reluctant to stick with therapy because I thought it was too expensive and I didn’t deserve something so expensive, but Joyable was so cheap! Why not? If my coach had been fired in the middle of our time together, I would have been sent reeling, even more than I already was. Muhr says the ideal way to end a therapeutic relationship is mutually—when both the therapist and the client realize that they’ve accomplished all they can or want to accomplish. To abruptly fire a coach and replace them with someone new, she said, “is a really bad idea.” Similarly, according to the American Psychological Association’s code of ethics, psychologists should “make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted.”
But perhaps this is yet another convention the company felt it could disrupt. We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Mental-Health Apps Are Cheap for a Reason

03 Dec 2019
We gave Rochelle Sheldon a little longer than an elevator ride to pitch Joyable, an online platform which allows people to contribute as a group to bigger, more meaningful gifts or experiences, eliminating the unnecessary waste and spending that comes with present shopping. We’ve all been there before on Christmas or a birthday: what do you buy your significant other, Mum, Dad, best friend, brother or sister when you’re scraping the barrel for ideas and will probably just end up buying yet another expensive Glasshouse candle or a sweary self-help book to add to the collection? (I’m looking at you, The Subtle Art of Not Giving a Fuck). Or even worse, something that barely leaves an impression on the person it’s given to and will just be regifted or chucked out? Enter Joyable. The company allows people to pitch in together for meaning and memorable gifts or bucket list experiences for their loved ones. Think a crowdfunding website, but for presents. Co-founder Rochelle Sheldon says the idea for Joyable came from wanting to change up the traditional Christmas experience of buying everyone a present, which they may not even use. “Mid-last year after finding a box of my kids' Christmas presents gathering dust in my garage – unwrapped but unopened – I knew things had to change and I was the one to lead it,” Sheldon says. “My ah-ha moment came when last Christmas, we ditched presents altogether (we still had presents from Santa) and instead the whole family contributed to all of us going to Fiji together for a holiday. It was magical, and I thought, ‘Imagine if other families want to end the hideous cycle of buying presents that have no emotional connection and instead come together to buy something really special someone actually wants?’ And so the seed for Joyable was sown.”
Sheldon is no stranger to helping brands grow. She has previously been the 2IC for other women’s businesses, and was recently executive coaching CEO and director of influence at social media marketing company Socialites. Over her time in the digital space, she has facilitated over $4 million in brand deals, helping New Zealand influencers earn an impressive six-plus figures. Rochelle Sheldon
However, after supporting others, she wanted to take the leap, back herself and start her own venture. The timing happened to be right in 2019 for Joyable to launch, and joining her as co-founders are her sister and actress Kimberley Crossman, Belinda Nash and Igor Anany. “People are already clubbing together to purchase gifts or fund parties and events together, but have to share their bank account details or give cash – like for wishing wells at weddings, or contributing to hens dos, or buying a 21st or 50th present,” Sheldon says. “It was time for technology to own this space. While technically people could set up a Givealittle or Gofundme page for life’s milestone events, it didn’t sound so Joyable to us to add to your wedding invitation.”
It’s a clever market play, considering a study has found that 72 percent of Millennials would rather open their wallets to experiences than material items. Meanwhile, in the US, there’s been a major shift in spending, with  4x more  money devoted to experiences rather than physical goods. Sheldon says the main competition for Joyable in the market is people to sticking to their old habits of buying a gift for a group, sending their bank account details to people to transfer them the money owed, and then waiting while it painstakingly trickles in. “At Joyable we have removed the awkwardness and hassle out of paying towards a shared gift and make it Joyable,” she says. “Other platforms like Givealittle have a similar model, but they target people giving to alleviate tragedy and trauma, or focus on community fund raising. We just do joy. Think weddings, engagements, Christmas gifts and parties, hen and stag dos, graduation gifts and celebrations, birthdays and religious milestones, anniversaries. “We’ve even used it in my family to purchase WOOP Christmas meal box together so no one gets stung with the entire food bill. Plus it has an RSVP function so we know who’s committed to coming.”
The other sector of the market Joyable targets is people who are mindful of the waste created by gift-giving, or those who feel under a lot of financial pressure when it comes to a festive and expensive time of year, like Christmas. “People can’t always afford to give what they really want to give, so are forced to buy cheaper items that lack meaning,” Sheldon says. “Then there is the added cost of buying wrapping paper, a card, then perhaps a courier bag and postage. “We believe in giving the purchasing power back into the hands of the recipient so they can buy a memorable, meaningful gift they’ll cherish forever, whether it’s an artwork, a tattoo, a neon sign, or something intangible, like an experience – bungee jump, ziplining adventure, a honeymoon or dance, rock climbing or piano lessons. “We’re also wanting to end the cycle of people having to buy more and more stuff that’s ending up in landfill.”
The process works as follows: one person creates a Joyable event or occasion, then invites friends and family to contribute funds via a unique URL. After everyone has contributed, the fundraiser or the recipient receives all the funds three to five days after the end date into the nominated bank account. As many people as you want can contribute, but each account that receives the funds is moderated and verified to ensure security is kept tight. Joyable charges a $3.50 service fee for each transaction of funds that are gifted. There is also an RSVP function that can be turned on for occasions, such as knowing who will be attending a birthday party and want to contribute to a present. Since launching in October, Sheldon says there’s been several challenges faced along the way. The first was having to pour over anti-money laundering laws pre-launch. “I read the entire legislation over and over because our lawyers warned we couldn’t do it. But it was my job as CEO to make it work, so I did… and we can absolutely do it.”
The other was finding part of the technology wasn’t working optimally just as they were about to launch Joyable, which meant the tech team had to quickly make some radical alterations. “We had a week of media scheduled with one of our founders, my sister Kimberley Crossman who had flown in for three days from LA. Our tech team said wait, I said ‘No, we’re launching!’ They worked around the clock to make radical changes. I went into crisis comms mode telling people as they registered to wait a few days before creating a Joyable occasion. “But it was great for me because it gave me a chance to get to know them and what they were going to use Joyable for. So whilst it was nerve racking for a few hours pacing my kitchen, the hardest moment turned out to be one of the best.”
Joyable is currently only able to be used in New Zealand currency, but Sheldon says the next step is marketing the new company to build up its user base, alongside seeking investment to roll out the platform into Australia and the US. She says the team want to build a community of ‘Joymakers’, as well as looking to collaborate with other brands, creatives and not-for-profit organisations. “We have launched our Joyable Fund which is all about supporting wellbeing for people and the planet, so lots to grow there,” she says. For every person who uses Joyable, money will be contributed to the charitable Joyable Fund, which will fund projects across the globe that help people and the planet. She says the focus is to look at new and innovative ways to create joy and enhance lives through connection and celebration. “The planet cannot sustain our hyper consumerism. It’s time to pull it back and returning gift giving to a joyful, positive place in a way that doesn’t harm the planet.”
Find out more at Joyable.co . Idealog has been covering the most interesting people, businesses and issues from the fields of innovation, design, technology and urban development for over 12 years. And we're asking for your support so we can keep telling those stories, inspire more entrepreneurs to start their own businesses and keep pushing New Zealand forward. Give over $5 a month and you will not only be supporting New Zealand innovation, but you’ll also receive a print subscription and a copy of the new book by David Downs and Dr. Michelle Dickinson, No. 8 Recharged (while stocks last).

Elevator pitch: Joyable, the online platform bringing joy back into gifting

Companies like Joyable, Lantern and myStrength have all been acquired in recent months
During Vator and  UCSF Health Hub 's first salon of 2019, called  The Future of Mental and Behavioral Health , VCs, innovators and adopters (payers/providers) discussed how mental and behavioral health startups are creating solutions to help those suffering from mental health conditions. One of the aspects of the mental health space that came up multiple times during the event was the consolidation happening in the industry. In March, Joyable, a solution for overcoming social anxiety, was  bought by AbleTo , a provider of technology-enabled behavioral health care. Before that, Lantern was  bought by Spring Health , after ceasing operations last July; the company signed a perpetual license deal to add Lantern's digital therapeutic technology to bolster its own behavioral health platform. And, in January of this year, Livongo signed an  agreement to acquire  myStrength, a provider of digital behavioral health solutions. The topic was first broached in the second panel of the night, moderated by  Bambi Francisco Roizen  (Founder & CEO,  Vator ) and Archana Dubey (Global Medical Director at  HP ), featured panelists Alex Morgan (Investor,  Khosla Ventures ), Lynne Chou O'Keefe (Founder and Managing Partner, Define Ventures), Eva Borden (Managing Director, Behavioral and Medical Solutions,  Cigna ), Blake Wu (Investor,  New Enterprise Associates ), and Danielle Ramo (Director of Research Operations,  Hopelab ). Francisco brought up what she called "light touch" companies, such as Calm, a $1 billion company, which she said, "isn’t really addressing the more critical mental health conditions," but apparently is so easy and simple to use that it's getting adoption. “It’s super light touch; it’s totally dumbed down; it’s totally mindless; but it’s useful to the broad public [everyone needs some calming time]," she said. "Yet, at the same time, we’re seeing companies like Lantern and Joyable and MyStrength consolidated. They're the ones offering the more hard CBT (cognitive behavioral therapy), validated type of products." Her question to the panel therefore was: Given Calm's traction, and acquisition of more complex apps, is the light-touch ubiquitous application of Calm the right Trojan Horse model to get the most adoption from which more serious mental health problems can then be screened and addressed? Dubey also asked whether consolidation could be due to the products just being ineffective or not given enough time to bake. Borden was the first to answer, noting that, to Cigna, it's not an "or" situation but an "and." "At least from the way we think about it, it’s not and or, it’s not a light-touch or a clinic hub or a diagnostic. And I think that’s a really important piece," she said. "We’ve got 14 million customers who access out behavioral healthcare, they all need very different things, and so it’s actually how do we take the best of all of them to bring it together. So, I don’t think I can dismiss the light touch or say, ‘It needs to be in exchange for another.'" Francisco asked for the investor insight into the question, to which Morgan answered. "You can have a business that has a little bit of value out of many customers, or lot of value out of fewer customers, and both multiply out to same thing. You can be an app or you can be a provider organization that may see fewer people. I think both succeed," he said. When it comes to consolidation, he noted that a lot of companies don't work out, and that doesn't necessarily have to do with the space itself. "These are very high risk endeavors, and so lots of them aren’t going to work out. I don’t think that’s necessarily signaling, there are lots of companies that try to e-commerce companies, there’s only one Amazon," said Morgan. "There are still opportunities out there; just because companies haven’t succeeded doesn’t mean there aren’t breakthrough opportunities pending. These are just generally true things, I don’t think they have to do with mental or behavioral health." Francisco responded by comparing some of the mental health apps on the lighter weight side to the weight loss industry, to which Morgan replied that that doesn't mean they won't change and evolve over time to do other things in the mental health space. "Lots of companies start out doing one thing and then stack on. Sticker sold a couple of bone saws and now they’re a multi-million dollar medical device company. If someone came in and said, ‘Im going to build a bone saw as my company,’ I don’t think many Silicon Valley investors would be very enthusiastic about that model, but you can’t predict the future and they had a certain trajectory that wasn’t super fast but you don’t know," he said. "If you build a user base that loves your product there’s a lot of places you can take that. So, I wouldn’t underestimate where people can take their companies that look modest now and I’ll return to what I said before, lots of companies look shallowly linear that are actually at the leading edge of an exponential." Dubey then asked how Morgan advises companies he invests in on whether they should continue, pivot or allow themselves to be acquired. "How patient are you with your companies?" she asked. "What are the outcomes and questions you ask in your board meetings?" "We have the strongest record at CB Insights for follow-on investment, and we’ve invested in lots of technologies in spaces like energy and Rocket Labs that do take a long time. There’s kind of a minimum size to even be market viable, so some of these things that are trying to be profoundly disruptive can take quite a long time. So everything is very context dependent on the individual team and space," Morgan responded. NEA's Wu backed up what Morgan had to say. "If you look at our portfolio, what we think is representative of that trend is, our average hold appear in our technology portfolio is four and half years, our average holding period in our healthcare IT portfolio is 10 and a half years. So it’s more than double, so we understand that in certain instances it can take much longer to build a true transformational company in healthcare because of all the different existing stakeholders that are there." The topic of consolidation came up once again in the night's third panel, again moderated by Francisco and Dubey, and featuring Borden along with Ofer Leidner (Co-Founder and President,  Happify Health ), Alon Matas (President, Teladoc's  BetterHelp.com ), Brent Vaughan (CEO, Cognoa ), David Lim (Chief Mediacal Officer, Quartet Health )
Francisco started the panel off by asking Leidner what he believes he did right, and why others stumbled. "Maybe it’s not where they stumble it’s just that it was a lousy product or they didn’t have the right business model to get it out to commercialization," she said. Leidner said he believes that companies in the mental and behavioral health space fail for three reasons: their product doesn't scale, their engagement isn't there or they don't have a good go to market strategy. That's why Happify started with tackling the engagement part of the equation. "Prior to this company, I was the founder of a pretty large casual games company and it really kind of entertained and got people addicted to the dopamine enhancing loops. 60 million monthly uniques on our platform and, at that point, I realized it we can get people to do what we wanted with regards to gaming, what if we dosaged down that dopamine loop and married that with interventions to help people live better," he said. "There’s no shortcuts; years of optimization, four million users, before we even dared to start conversations with payers, with employers. Ultimately, we are holding the belief that software has a very important part of equation. It’s not going to be the only solution, I’m a big believer in cross competing, multi-tier ecosystem of solutions, so we want to be the software solution that is the best." Borden once again tackled this topic, noting that, when it comes to the scalability and commercialization, one of the challenges Cigna faces is, "a lack of understanding of all the stakeholders that are actually impacted, especially if you want to start working with a payer." The second problem is not having a good enough business model. "How does the money actually flow? The last panel, for example, you heard a lot about the fee for value versus fee for service type role, and in our reality a lot of the world is very fee for service-based. And, the fee for value world is still emerging, so when you think about what are reimbursements need to look like in a fee for value world, they’re not always clear," she said. Ultimately, though, she sees acquisition as a potentially good thing for the companies and the space. "Whereas, some might say, ‘Oh, actually the acquisition, or however you want to describe it, of those companies is a fail.’ I actually feel like they are better positioned as a result. It’s ultimately that combination of bringing the mind and body together that becomes really important; I look at what they’ve done now and I go, ‘Now we’re really starting to get into something super intriguing when you start combining them.’"

M&A in mental health: why is it happening and is it good for the space?

From market consolidation to global expansions, the quarter saw a range of interesting deals. Share
The first quarter of 2019 started off strong with 17 digital health mergers and acquisitions, including five over the course of two days at the end of February. The quarter's acquisitions included moves by ClassPass and Teladoc to bolster emerging international businesses with the acquisitions of GuavaPass and Médecin Direct, respectively, as well as a number of consolidation deals in niche digital health markets, such as AbleTo's acquisition of Joyable. Still others represented novel synergies between similar but distinct companies, like Crossover Health's purchase of Sherpaa. Finally, we saw another major private equity deal as Qualcomm divested itself of its Qualcomm Life business. Read on for 17 digital health mergers and acquisitions from Q1 2019. And let us know if we missed one — we'll update this article. As usual, they're ordered first by price tag, with the undisclosed deals sorted chronologically. Remote patient monitoring company BioTelemetry announced in January plans to acquire startup Geneva Healthcare, maker of remote monitoring for implantable cardiac devices, for $45 million in upfront cash with additional performance-based earn-out considerations of no less than $20 million. Biotelemetry will gain access to Geneva’s cloud-based platform, which has the ability to aggregate data from device manufacturer systems. This gives physicians a platform to remotely keep track all of their patients that have implantable cardiac devices such as pacemakers, defibrillators and loop recorders, while also providing the doctors with the results of routine checks and monitoring. New York-based startup AbleTo acquired fellow virtual mental health startup Joyable for an undisclosed sum in the tens of millions. As part of the deal, AbleTo users will gain access Joyable’s mental health coaching app. AbleTo connects it users with a nationwide network of behavioral health providers, who use the company’s structured treatment protocols to treat the user’s condition. Currently it has 600 therapists and coaches in its network. The companies said that by combining its products, it will be able to expand its services. Online fitness membership platform ClassPass acquired GuavaPass, a similar competing service active in Asia and the Middle East, for $4.2 million. Along with ClassPass assuming control of GuavaPass’s operations, GuavaPass CEO Jeffrey Liu, President Rob Pachter and a number of GuavaPass employees will be joining ClassPass. Both services allow users to pay a single subscription price for access to local classes for yoga, cycling, Pilates and other workouts using a mobile app. Medical messaging company Medici announced the acquisition of Chiron Health, an Austin-based telehealth company. Medici is a medical communication tool that lets patients communicate with multiple providers. The system was designed so that a user could not only have his or her providers on the system but also their loved ones physicians, for example their child’s pediatricians. This new acquisition will give Medici access to Chiron Health’s platform, which was designed to facilitate provider-patient video visits. Those visits can be uploaded to five compatible EHR systems. The HIPAA compliant system caters to physician-run practices. The plan is to integrate Chiron’s capabilities, as well as its full team into Medici’s current system. Clinical information tool EBSCO Health announced the acquisition of HealthDecision, a clinical decision support and shared decision making tool for clinicians and patients. As part of the deal EBSCO Health will get HealthDecision’s educational resources, which includes a visual representation of medical outcomes. The tools were designed to help facilitate provider-patient conversations around treatment plans. PerfectServe, a Tennessee-based medical communication and collaboration platform, announced two acquisitions in the digital health space. The first is CareWire, which is a mobile patient communication platform. The second is Lightning Bolt Solutions, an artificial intelligence-run physician shift scheduling technology designed for hospital and healthcare system. PerfectServe said that the new acquisitions will help “the company’s strategy to unify the entire care team across the continuum, from inpatient, to outpatient, to patients at home.”
Private equity firm Francisco Partners acquired Qualcomm Life, the Qualcomm subsidiary focused on medical device connectivity. The terms of the acquisition were not disclosed. Qualcomm Life will spin out as a new company under the name Capsule Technologies — the name of a clinical data management company that Qualcomm acquired in 2015. The new Capsule Technologies will continue to use the Capsule and 2net brands for its medical device connectivity offerings. “FP’s acquisition will help Qualcomm Life (now CapsuleTech) continue to deliver market leading products and services to its world class customer base,” Rick Valencia, former president of Qualcomm Life, said in a statement. Crossover Health, which provides medical services to large employers, Apple and Facebook among them, acquired Sherpaa, an asynchronous telehealth company that has also mostly focused on serving employer populations. The terms of the deal were not disclosed, but Sherpaa founder Dr. Jay Parkinson and his team will all become part of Crossover Health. For Crossover Health, founded in 2010, the move to buy Sherpaa is an effort to address the changing nature of workforces, which are rarely anymore concentrated in one or even a handful of cities. With Sherpaa’s technology, Crossover Health will be able to offer a tiered system that provides in-person care to employees at a central site and comparable virtual care to remote employees. CareLinx, a digital health company focused on in-home care, acquired Optimal Aging, a fledgling startup still being incubated at Providence St. Joseph Health. The terms of the deal were not disclosed. Optimal Aging is a program that coordinates non-clinical services like home care, transportation and meal support for accountable care organizations and Medicare Advantage Plans. The program actually incorporates CareLinx’s technology, and has since its Seattle-area launch in 2016. Guidewell Connect, a consumer engagement company that shares a parent company (Guidewell) with health insurer Florida Blue, acquired Onlife Health, a health and wellness technology platform, from Blue Cross Blue Shield of Tennessee and Cambia Health Solutions. The terms of the deal were not disclosed. Onlife offers member engagement services that include wellness and chronic condition management programs, via both its My Journey app and other non-digital modalities. Post-acquisition, Onlife will be available to health plan and employer clients in 19 states, according to a statement from the companies. Guidewell intends to keep Onlife’s management intact. It will become a subsidiary of Guidewell Connect. Healthcare software and services company WellSky (previously known as Mediware) announced yesterday the acquisition of Health Care Software (HCS), which specializes in clinical and financial software for long-term care settings. The terms of the deal were not disclosed. Although HCS will keep its New Jersey office and continue operations, the company will gradually transition into the WellSky brand. According to WellSky, the acquisition provides the company with new analytics and care management tools, which will allow it to pursue new market opportunities as well as increase its offerings for existing clients. Interoperable health IT company Medsphere Systems Corporation announced that it is set to acquire Wellsoft, a company that specializes in ED information systems. As part of the deal Medsphere will be acquiring Wellsoft’s signature product, the Emergency Department Information Systems (EDIS), which is targeted at improving workflow in EDs and urgent care centers. Medsphere plans to create a comprehensive platform for urgent care centers that will employ the technology from Wellsoft as well as Medsphere’s RCM Cloud revenue cycle suite. Senior-focused EHR and health software company PointClickCare Technologies acquired post-acute care management company QuickMar. As part of the deal, PointClickCare will control QuickMar’s signature product, the CareSuite Manager. The system includes an EHR and electronic medication administration record (eMAR) that is targeted at post-acute care centers. The system has the ability to manage assessments, care plans, resident billing, behavioral management and charting notes. Zoll Medical Corporation, the medical device and software company that makes the LifeVest wearable defibrillator acquired patient charting and revenue cycle management company Golden Hour. The companies, which both offer charting and services related to the emergency medical services market, will now be able to combine their efforts. Zoll Medical has so far focused on working with larger operations, while Golden Hour has focused on a smaller organization. This acquisition will give the former the opportunity to work with EMS agencies of all sizes. Earlier in the quarter, Zoll also acquired Payor Logic a patient receivable and insurance discovery company for providers. Both deals had undisclosed terms.

17 digital health mergers and acquisitions from the first quarter of 2019

Joyable

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Companies developing and enabling evidence-based, software-driven therapeutic interventions to prevent, manage, or treat a medical disorder or disease. (*Scope follows the Digital Therapeutics Alliance definition)

Digital Health

This collection includes companies applying technology to problems of emotional, psychological, and social well-being. Examples include companies working in areas such as substance abuse, eating disorders, stress reduction, depression, PTSD, and anxiety. 

Mental Health Tech

Companies developing medical devices (per the IMDRF's definition of "medical device"). Includes software, lab-developed tests (LDTs), and combination products. *Columns updated as regularly as possible.

Medical Devices

Companies involved in the research, development, and commercialization of chemically- or biologically-derived therapeutic & theranostic drugs. Excludes vitamins/supplements, CROs/clinical trial services.

Biopharma Tech

Health IT 

Acquired

Joyable offers a comprehensive mental health system designed to address individual needs, ensure access to the right support, and track outcomes rigorously. This is made possible by Joyable's digital therapeutics, an app that's as effective as face-to-face therapy.

Wells Fargo Success Story

Professional Services

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Joyable

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