Marketplace Responsibilities in Healthcare: Thoughts Spurred by The Verge Piece about Talkspace

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BY|Mark Frank View Bio|18th Apr 2019

Is Facebook responsible for fake news disseminated by its users? Is Google profiting from top rankings for Holocaust deniers? Is Uber ensuring adequate rider and driver safety? Should Craigslist actively prevent illegal activities emanating from its platform?

All of these questions are variants of a broader discussion about the role of technology-enabled marketplaces and the responsibilities that those marketplaces have to their customers, users and society. Are platform companies ultimately responsible for the actions of their users? What about platform companies innovating in healthcare — should they be held to an even higher standard? The recent Verge investigative article about telebehavioral health company Talkspace brought about a great internal conversation within the SonderMind team regarding the responsibility we have to clients and therapists using SonderMind’s services and software.

Before getting to the meat of this discussion, some background: this MobiHealthNews article presents a summary of the aforementioned Verge article and Talkspace CEO Oren Frank (no relation, by the way) wrote this response. Without making any judgment either way, the issues addressed within the report delve into the balance that Talkspace must maintain between its own goals as a behavioral health technology platform, the goals of those therapists using that platform, and the potential conflicts that may arise between both parties.

Are platform companies in healthcare more responsible for monitoring safety and efficacy?

The initial questions about Facebook, Google, Uber and Craigslist frame an ongoing discussion about the responsibilities that these types of online platforms must accept for the well-being of their users, in addition to their societal roles as their platform’s influence grows. I believe that there are varying levels of responsibility, which depend on the type of platform, its core focus and the breadth of exposure. The only certainty is that this discussion will persist for many years, as the prevalence of virtual marketplaces continues to expand.

However, when it comes to healthcare, we must be very clear that digital health platforms and innovative care delivery models (such as telehealth) have a greater level of responsibility than other marketplaces if only because the stakes are so much higher. This shouldn’t seem surprising, since there are already very different rules for healthcare-focused businesses than for other service-based companies: HIPAA regulations, business associate agreements, licensure requirements, ethical guidelines, etc. all represent challenges for which healthcare companies must account.

Being an “online platform” should not exempt a digital health company from ensuring that its users are appropriately protected.

During our internal discussion about the Verge/Talkspace article, we chewed on this matter involving the need for a therapist to really know their clients. We landed on the belief that great therapy stems from a valuable, unique relationship between the therapist and client. While an online platform can allow that relationship to develop via anonymous means, it is in the interest of the client for the therapist to know how to intervene when that client poses a threat to themself or another human.

Let’s be clear — SonderMind is not your traditional “platform company” (or maybe it’s that we’re too traditional) — SonderMind therapists primarily engage with clients in a face-to-face setting. This is very different from telebehavioral health companies like Talkspace, where client interaction is all online. One of our primary objectives is to improve the client’s experience associated with this important part of their health regimen. However, with regard to client privacy protections and the ability for therapists to contact authorities, we hold ourselves (at a minimum) to an equivalent standard as that of our independent providers.

We believe that healthcare innovation— especially within behavioral health — must start by enabling providers to be successful, on their own terms. SonderMind is, in essence, providing a platform for consumers to find, access and engage with high-quality therapists in an safe and comfortable physical environment.

However, unlike many marketplaces who focus on the demand side of the equation first, SonderMind’s mission is to create this marketplace by building software and services that better connect behavioral health professionals to each other, clients and the broader healthcare community.

Our mission is to use software and services to better connect behavioral health professionals to each other, clients and the broader healthcare community.

An online behavioral health platform such as Talkspace, creates anonymity for the client… does this have the potential to create a negative impact on the therapist’s ability to forge a relationship? Yes. However, I think Talkspace is doing this to achieve a similarly-admirable goal: making behavioral health more accessible and convenient for people in need. Perhaps one potential solution for the problems perceived by The Verge article with Talkspace’s platform is to enable therapists to “escalate” client cases or engage with other therapists about specific client needs.

I’ve found that behavioral health providers in private practice often struggle with the isolation and loneliness that comes from being a sole practitioner. Ideally, platforms such as Talkspace and SonderMind can help reduce that isolation. To that end, we recently launched a free, online professional community for licensed counselors, psychologists, psychiatrists and other behavioral health providers to join and engage one another. This community will always be free and allows these providers to share information with each other, give and get client referrals, create their own private groups, etc.

The desire of healthcare professionals to take care of their patients/clients typically trumps all other motives. Should platform companies in healthcare be held to a higher standard than other marketplaces? Where are the lines around using online methods and anonymity to address a greater problem, such as combating the stigma associated with mental health? How can government, non-profit, and private companies tackle these issues?

Finally, I want to be absolutely clear that I do not believe therapists are misusing the Talkspace platform or others like it. Rather, they are accessing technology to provide the best possible care for their clients, which is extremely admirable and necessary in today’s world.