Tag Archives: app

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Not It!

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(Or the difficult case of monetizing mobile Mental Health Care Solutions)

Get a crowd of people together and ask who should pay for mental health treatment, and the likely result is a race to see who can shout out “Not It!” the fastest.

With the stigma that still exists around mental health some individuals can be embarrassed or uncomfortable to even seek treatment, let alone contemplate spending their money on it. When they do think about spending their money, they end up with bumper stickers saying “Gone Fishin’! ‘Cause it’s cheaper than therapy!” There’s also the large population that needs help but simply can’t afford it.

Outside of individuals, you certainly cannot go asking the trained professionals to stop making a living by demanding they give away their expertise for free. Prior to the Affordable Care Act here in the U.S., some of the insurance people would be the first to flee, and depending on your country, your government organization may have just ran out of the room pretending they didn’t hear the question at all, while others flat out say: “What? Health care? Wait! Not even health care, you mean mental health care? We’re not paying for that!”

Sure that’s a broad generalization, somewhat exaggerated for effect, but I bet you know exactly what I mean. And that’s for mental health care as a whole.

What happens when you start to throw technology into the mix? Who pays for that? 

At the beginning of our journey here at WeFeel, we had to figure out that exact question. Something that is often forgotten is that technology costs money to develop, and companies must have a revenue stream to exist. The ridiculous amount of “free” apps have conditioned people to think that if it is on your mobile device it shouldn’t cost anything, while they having given in to being inundated with ads. We knew from the beginning the monetizing a mental health care service via advertising was fundamentally a horrible idea. I’m sure you can imagine some of the damaging scenarios that could occur when the two are mixed.

We decided to go out and talk to experts to see what had been figured out so far, but what we found was disappointing in the lack of quality and quantity of information. The vast majority of our research and advice showed that no one really knew. We were told people won’t pay for anything considered an “App.” We found that people had tried with mental health care apps before and failed because they couldn’t crack this one issue. We spoke with local practitioners, and the overwhelming feedback was they couldn’t see adopting technology if it meant they had to purchase something for their clients to use. So we sat down and decided we’d have to figure it out ourselves.

When data is lacking, logic and experimentation come to the rescue

Here is our thinking about different models:

Advertising revenue: As mentioned above this was simply a “No.” If it was the only way, then we’d simply rather not create the company.

Free: From the beginning, we knew that WeFeel had to have a plan to make money. That’s not why WeFeel exists, but we knew that we wanted features that no one was doing yet, like the ability to share data between individuals. That meant servers and technology running in “the cloud” (specifically Microsoft’s Azure in our case). That costs money, as does continuously improving the service and providing tech support. While we looked into creating the company as a 503c nonprofit, from a practicality side it just couldn’t work that way. So free was out.

One-time fee: Many apps are sold by paying a fee to an app store and then you get the app. The problem with this model is it generally only works if the data is stored locally on the device, because you don’t have the overhead of the cloud and often you don’t provide technical support (or if you do you charge a lot more). Storing data locally doesn’t allow for sharing between people, syncing between multiple devices, or restoring data if you loose your phone. Those were all key features we wanted in WeFeel, and so this model simply couldn’t work, unless we started releasing new versions and requiring people to purchase them each time one was released, and that gets old…fast.

Provider-based subscriptions: In this model, each mental health care provider pays a monthly subscription, and in return gets a number of licenses that they can give to their clients. The overwhelming feedback we found here in Utah is that many of them simply couldn’t afford it, or couldn’t be bothered with that. We talked to some people who had attempted that model before and couldn’t gain traction. Another drawback we found is that if a person switched therapists they would loose access to WeFeel unless the new provider also had a subscription. This made no sense to us. A person’s mental health is theirs to own, and if WeFeel can help the individual we don’t want access to be controlled by someone else. In fact a core tenant of WeFeel is that the individual owns and controls their data. A provider-based subscription simply won’t allow us to meet that objective.

Individual-based subscriptions: Thanks to companies like Netflix, Microsoft, Amazon, Spotify, and Pandora consumers are becoming more and more used to buying technology as a service. And yes, while we also sometimes think “not another subscription to pay!” in this case we think it makes sense. Our costs are tied to the usage of the service. More importantly it gives us some unique benefits. First,it also allows us to have a base, free-version of the app for people to try that limits access to the things that cost us the most to deliver: sharing, journaling, and hosting large amounts of data. Then because we can sell the subscription via app stores directly in the WeFeel app, it means we don’t have to store any identifiable information from the customer on our end. No credit cards, no email addresses, or phone numbers. We simply get paid a percentage from the app store.

This is huge for us in maintaining things like HIPAA compliance, and more importantly for us to help people feel comfortable logging their deepest emotions, since we physically can’t know who they are. The individual also gets to not only own their data, but to control who has access to it, including the ability to stop sharing with their therapist. By doing it this way we’ve created the concept of a mental health record that transfers from therapist to therapist at the control of the patient. We think that’s pretty cool.

But there are some downsides. What happens if a large organization wants to buy subscriptions for people? We solved that by creating a licensing portal that maintains anonymity, and when an organization buys a license they are purchasing it on behalf of the individual. Once a patient is licensed that subscription is tied to the patient, and not the organization. This is pretty much a hybrid of the individual-based and provider-based models.

The final hurdle is what is the right price? And to be honest we’re still working that out. Typically you price this things based on the utility they provide, but how do you value the ability to improve one’s mental health? We could compare it to medication and say many people spend upwards of $30 a month on pills, and so we could randomly state “we’re easily worth half that so $15 a month sounds right!” We could argue one’s mental health is worth more than watching TV, and Netflix is around $10 a month, so $10-$15 a month is still about right.

The problem is when comparing to those kinds of things, people simply do not want to pay for mental health services.  Showing the value of the service doesn’t necessarily work, and we don’t have enough data yet to make definitive statements like “WeFeel reduces the need for the number of sessions per patient by 10%”

So here’s where we are right now, we spent some time looking at subscription prices that we felt in general most people could afford. Then we did some experimentation. We initially tried $60 a year, which was seen as a bit high but doable by most of the people we spoke with. We didn’t randomly pull that number out of a hat, it was based on cost projections and helping to grow the company rapidly.

And it seemed OK, until we had couples come into the mix. In couples therapy you really need two subscriptions, and $120 a year per family was higher than some of our early adopters could afford.

We changed our growth model and dropped the price to $40 a year, and for many that was OK, even couples. But we were finding that the therapists in our test program were reluctant to ask a patient to go out and spend $40. So to alleviate that concern we put WeFeel on sale at $20 a year. Now the therapist could say that its roughly the same price you would spend on pens and notepads for a year, which you’d be buying anyway to do your “homework.”

For the sake of transparency, I don’t know that as a company we can sustain that $20 sale price for the long term (though I’d like to be able to). That low of a rate means we have to have 3 times as many subscribers to break even. But in the early stages of a company, especially when you are trying to create a market, sometimes a “low low price of just $19.99!” is what you have to do.

If you’ve made it this far, I’d love to get your feedback as to what you think is not only fair, but practical for your patients.

Finally, for those in the industry, we’ve also heard your concerns regarding people who can’t afford WeFeel at any price. How do we get WeFeel into their hands? I’ve been thinking a lot about that lately. And I’d like to run something by you all.

What if we instituted a pay it forward program?

Essentially it would work like this, each paid subscription would include the one for the individual who paid for it, and one to be donated to someone in need. To do this it would have to be all or nothing. Remember we don’t have a way to track who paid for what. That’s on purpose, but means we can’t allow a person to buy two subscriptions at a discount and then choose to donate one. It also means we’d have to at least bring subscription prices up to a point that we could cover the operating costs of a second subscription. So what are your thoughts? Would your patients be encouraged by the fact that in getting a subscription they are also helping someone in need? Would they see it as an added burden?

I look forward to hearing responses. Feel free to comment here on this post, or to email me directly at jeff@wefeel.us


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WeFeel: Therapist’s Toolbox vs. Therapy Substitute

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It’s hard to believe that it was almost two years ago that we came up with the idea for WeFeel. Despite there being hundreds of “mental health” apps already on the market we saw a huge hole that no one seemed to be interested in or willing to fill. Organizations have been racing to create apps that help treat specific issues, and there’s even some really cool tech out there that is trying to automatically diagnose individuals using machine learning and artificial intelligence to analyze an person’s environment, and physical response.

I think those are all great things. In fact, as someone on the autism spectrum, the idea of getting help without having to actually go get help is very appealing. But as we looked at things back at the beginning of 2015, we found the same results that have been reported in articles published more recently: many, if not most mental health care apps aren’t backed by any studies or clinical evidence, and worse…many are flat out damaging to an individual’s mental health. The problem, as we saw it, was that most of the apps and services being created were designed to be a substitute for therapy,

So what did we do? We went out and talked to psychologists, psychiatrists, marriage counselors, certified therapists and anyone else willing to provide input to find out what physical tools they already used, what proven techniques existed that merely needed to be converted to a mobile format, and then we got to work. Our philosophy became how do we help therapists by augmenting what they already do, instead of how can we replace them with an app.

We were lucky enough to have found Dr. Scott Seaman, a forward thinking psychologist based out of Orem, UT who was willing to test WeFeel with his patients (with their consent of course!). We spent six months or so refining WeFeel in a clinical setting, adding tools to help a therapist treat things like depression, anxiety, and addiction, and to help with couples therapy, and autism spectrum disorder.

The more we worked together, the more flexible WeFeel became. Our initial idea of having WeFeel prompt you once or twice a day to create an entry grew into adding up to 10 random prompts and three scheduled ones. Early concepts like the ability for a couple to share their emotion entries turned into the ability for a patient to securely share their data with a care provider, who then could remotely monitor the status of their patient. A quick and simple way to enter core emotions became a fully customizable interface that could track anything from a single item to 19 separate items- the 19th was because a customer emailed us and asked for just one more custom slider to help her track an item that would help her meet her goals.

Once we had data, we found that we could do really cool stuff with it. There were the obvious things like Dashboards to help visualize and narrow down patterns and triggers, and we used a bit of if computing power to be able to find topics to discuss via word clouds and sorting through entries to find those with the deepest feelings.

But, as we got results from real world use, we found that while it was nice to have all that data, data without action is only part of the solution. We knew that a common treatment step is to give the patient a plan or “coping strategy” like counting to ten whenever you are angry, or calling a friend when you are feeling depressed. We were missing that ability to help treat symptoms, and so we took a look at how we could help a therapist work with their patient to provide customized action prompts. We wanted to create a generic toolbox for the therapist to use to treat anything. It was just a matter of converting this existing and proven technique into something a mobile device could perform.

WeFeel already knew when a person was angry, since they already created an emotion entry for it, so it was just a matter of adding the ability to provide the therapist’s directions as a reminder. The solution was to just take that existing practice and simply add Coping Strategies to our toolbox. Now, the therapist can work with their patient to devise an action or behavior and enter it into the toolbox. Then when the patient logs that they are feeling a certain way, WeFeel will automatically prompt them to follow the strategy that matched. It can even have up to 16 different strategies to match different situations.

The next thing we knew we had patients using WeFeel to help them overcome addiction by prompting them to take action at the early states of feeling a craving. In this case, we made a super-customizable tool, and Scott came up with an awesome way to use it.

It turns out, as we created WeFeel, we were giving hope to people as they worked with their therapist to come up with their own unique way to use it. We helped enhance the bond between care provider and patient, instead of isolating them from their therapist. By working in clinical setting, getting real world feedback, and most importantly listening to our customers WeFeel is now making a difference, and I think that’s pretty cool.

 


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Visualization to let you see what you feel

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In the world of emotions what you feel right now colors what you remember you felt before. And that’s ok — it is just how the human mind works. Usually this doesn’t cause too much difficulty, until you are trying to work through a complex emotional problem on your own or with a therapist, or if you are suffering from depression, anxiety or other mental illness. If you track your emotions on a regular basis, in the moment, you have a way to overcome that. A paper emotion journal is good for that, but you’ll have to go back through the entries, page by page and even then you’ll only have a feeling of what was going on. This is where WeFeel excels over a paper journal. All your emotion entries in the cloud means we can show them in a variety of ways. For you, that means you can SEE what you’ve been feeling, and so can anyone you share it with.

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The dashboad on a tablet

The dashboard starts off with a view of your outlook trend. By default the dashboard pulls in the last 10 entries, but you can use the filter button at the bottom to choose any number of entries up to 21 or 180* depending on the version you use. More than that, the Outlook trend gives you the ability to see how your outlook has changed over time. Using the other filters with outlook trend will let you see if a specific location or activity affects your outlook. For example, if you have a better outlook in one location than another, you might want to take some time to consider why  this might be and what you can do about it.

Core emotion trends chart

Core emotion trends chart

The core emotion quick summary shows you two things: the strongest amount you have felt each emotion and the average intensity that you feel each emotion. You can get a better view of your core emotions by going to the Core Emotion Trends chart. On a phone, just use the arrow to go to the next page, on a tablet click the straight face icon and you’ll see a chart of how you’ve been feeling. Any filters you’ve set carry through all your pages views. On the core emotion trends pages you can also isolate individual emotions by turning the other emotions off by tapping on them. If you want to get an idea of why you were feeling especially happy or angry, just tap on that bar to see the note you wrote when you added that entry. These controls work the same for the custom* emotions chart.

The word cloud in the Themes from my Entry Notes

The word cloud in the Themes from my Entry Notes

Clicking over to the notes or journals* brings up a word cloud of what you write about most often, either in the quick note on an emotion entry or in a journal entry. The larger the word is, the more often you added it to a note. This gives you a quick way to see the why behind what you are feeling. This provides an easy way to start a conversation about your emotions, especially with a therapist or loved one.

There is a lot more you can do with the dashboard and filters, so we invite you to play around with it. If you find a cool way to see something, please share it with us in the comments.

*These features are part of the paid subscription version.

 


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And now for something completely different…

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A little over a year ago I found myself in need of a job, and more importantly a purpose.  I had been diagnosed with Asperger’s syndrome a few years before and last year during Autism awareness month I decided to go public with that information.

The amount of support I received was great.  From comments from good friends of “that explains it!” to people thanking me because they too were in the same situation I found it encouraging to know that I had done what the right thing, despite the fact that I was terrified it would mean the end of my career as an executive.

What does someone on the spectrum do when faced with that kind of fear?  

To be honest, a huge part of me wanted to just give up, move in to my parent’s basement and play video games. I have to fight that guy off quite frequently.

Plus,  it’s hard to do that with a wife and kids. Another part of me wanted to face the fear by going out and finding a job and proving that you can still be successful and open about your differences. That part lost. Instead, I decided to do something even more difficult, and the hardest part is still ahead.

An idea is formed:

I’ve been seeing a psychiatrist off and on since I was diagnosed, and during a session I realized that some of the way that industry works doesn’t make a lot of sense.  For example, why would someone be asked to keep a mood journal, or a log of their feelings in a paper notebook of all things? Everyone has a smart device on them that is far better qualified for the job.

For that matter how can one even understand their feelings when they don’t have any data? Coming from the business world we have dashboards, charts, and ways to filter data in order to come to evidence based conclusions.

How difficult must it be for professionals in the mental health care industry do their jobs as effectively as possible when they don’t have technology to give them insight?  A doctor can use an EKG,  MRI, CT scan, or even a good old x-ray to get more data about their patient, and from that make far more accurate and helpful plans of treatment.

Why don’t we have that in mental health care?

The question of course triggered an obsession with solving the problem.  Next thing you know it’s been a year of 60-80 hour weeks, learning to program (which I’ve never done professionally before) to create cloud based storage systems, synchronization routines, dashboards, and mobile apps to address the issue.  Being autistic may have its drawbacks, but when that obsession turns to something useful there’s really nothing we can’t do.

With the help of my amazing, supportive, and creative wife Kim, we’ve created WeFeel, a service that allows a therapist to actually have data to facilitate treatment through emotion tracking, journaling, and data visualization. And a great side effect is it helps me better understand my better half because it was built to allow you to share that data with a loved one or a care provider. If you want to know more about it check us out. 

 

Step one: create first revision of a service that can completely revolutionize mental health care…Check!

But like I said at the beginning of this, the hardest part is yet to come.  You’d think creating the WeFeel service would have been the hard part. Now we’ve got to get people using it, and that means selling. And selling means talking to people.

Technology is easy. Talking to people…not so much.

Selling is something I’ve been good at, but as you can imagine it causes huge amounts of stress. I have to put on my I’m just a normal person like you outfit, and it chafes.  But without it (selling that is not the chafing)  we don’t get to eat…and I need chocolate in my life.

I’m not sure if the past year has been a way of avoiding a fear, or facing a new fear of can I build a company versus just helping someone else build theirs. But either way,  the time for burying my head in computers has come to an end and now it’s time to put myself out there again.

I’m glad I don’t have to do it alone.

Wish us luck.


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