Alphabet’s Venture Arm GV Eyes Brick-and-Mortar SMI Investments

GV, previously Google Ventures, has been an active investor in behavioral health over the last decade. The firm is now eying serious mental illness (SMI) and value-based care as its next frontier.

In 2021, digital mental health companies raised $5.5 billion in venture dollars – an unprecedented amount. Yet historically, the bulk of digital health investments has focused on wellness and mild mental health health conditions.

As the industry matures, startups’ focus on mental health is shifting to more acute conditions – an area of interest for GV’s Dr. Ben Robbins, a trained psychiatrist who was recently promoted to general partner at GV.

“It seems like we moved from what I think of as sort of consumer models of mental health care into low acuity, clinical models around depression, anxiety,” Robbins said. “Really in the last year or so, we’ve seen a whole bunch of activity in areas that I find really interesting, as a psychiatrist.”

An increasing number of startups are focused on serious mental illness care, Robbins notes, a sector that is prime for innovation.

“The community of people that are willing to take the risk of starting a company are just getting smarter and smarter,” he said. “And [SMI] is an area that is complicated. You can’t have only content or only a lightweight chatbot. I don’t think that this is a space that’s really conducive to pure virtual. The combination of cognitive impairment, the social complexity, the clinical complexity – I think that pretty much has to be a hybrid model, if not fully in person.”

GV invests in both digital and brick-and-mortar companies. GV’s previous mental health investments include Headway, Brightline and Quartet Health. The firm is now actively looking to invest in serious mental illness, according to a spokesperson.

Founded in 2008, GV has more than $8 billion in assets under management. Its portfolio includes 400 companies.The venture firm has deployed over $1.2 billion into health care and life sciences companies since 2020.

“I think there’s a lot of work to be done around how to build a better health care system,” Robbins said. “I don’t think that we have figured out behavioral health [as an industry], and there’s a lot of work to be done. We’re super comfortable with brick-and-mortar-based investments. I love the idea of more hybrid care.”

There is also a business case for getting into the SMI space, in particular. The estimated lifetime burden of SMI is $ 3 million per patient, according to research from the Substance Abuse and Mental Health Services Administration.

“As the entrepreneurs have learned more and more about the way that health care works, the needs, the economic models, there’s an increasing acceptance of these more complicated operational models that involve hitting the streets and sending out clinicians that are willing to go find people on the street,” Robbins said.

Federally funded community health centers are already delivering high quality care to patients with SMI, Robbins said. Still, getting patients with SMI into care is a major challenge.

“These facilities are quite capable of handling patients who are already activated in some way to seek care for the illnesses, … especially in major cities,” Robbins said. “ I think there is a ton of need around a more proactive approach.”

Mobile clinics that pull folks into care could help solve this gap, Robbins said.

“Really in the last year or so, we’ve seen a whole bunch of activity in areas that I find really interesting, as a psychiatrist.”

– GV’s Dr. Ben Robbins, a trained psychiatrist

The federal government has made moves to promote community models. For example, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a new ruling, which among other items, would bring medication assisted opioid use disorder treatment into the community through mobile clinics.

Other companies, like firsthand, are using peer support networks to help engage patients with SMI and get them into care.

Value-based care

Value-based care – in the behavioral health space and beyond – is another major focus for GV.

“We spend most of our time in value-based care, and things that can enable value-based care,” Robbins said. “We’re spending a ton of our time just taking a step back and figuring out what has actually shown promise, because it seems like almost nothing has shown an ability to provide high-quality care and reduce cost, despite a lot of investment and experimenting.”

The GV team is combing through the industry and looking for models that have shown promise in providing measurable value-based care. There is a lot of potential for models focused on reducing the rate of hospitalization, for both behavioral health care and physical health care.

Intensive outpatient treatment programs (IOT) and community care programs are two potential avenues for helping patients access care outside of a hospital.

“I continue to be amazed that there isn’t more venture activity around intensive outpatient programs, partial hospitalization programs (PHP), which I think is the lifeblood of freestanding psych hospitals,” Robbins said. “IOPs and PHPs are super interesting just because of the tremendous need. You have outpatient providers that don’t have a way to escalate care short of sending people to the ED. You have an ED that has a 7- to 10-day wait. People are literally in the waiting rooms for weeks. So this idea that you can have a sort of scaled middle ground, where it’s not a locked inpatient unit, not just outpatient, you are seeing somebody all day, every day for a couple of weeks.”

Integrating physical health and mental health is another aspect to value-based care. Patients with SMI are more likely to have comorbidities such as diabetes and heart disease.

“I think where you can do value-based behavioral health is when you have patients that have medical and psychiatric comorbidities when medical costs are high,” Robbins said. “You can do value-based care that focuses on medical costs, but then mental health quality.”

Still, there are a number of challenges to integrating a value-based model into behavioral health care.

“I don’t think we’re very close to being able to measure outcomes,” he said. “I’m not even sure we’re using the right framework.”

Surveys originally designed for clinical research are now being applied as quality metrics, Robbins notes, which may not be sufficient for measuring value.

Measuring and delivering high quality care is a top priority for the investor in the future.

“In the world of behavioral health, I and the team are super interested in figuring out how we deliver great care, and how we measure it,” Robbins said. “Delivering great care, I think it’s currently within the scope … of things that we can do. But the idea of measuring, I’m not sure that we’re all that close, and so I would love to find ways that we can actually measure high quality care.”