Health-E Law Podcast Ep. 5
Gamification: Playing for Health
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Listen to the podcast released February 15, 2024 here: https://www.sheppard.com/multimedia-550
Welcome to Health-e Law, Sheppard Mullin's podcast exploring the fascinating health-tech topics and trends of the day. Our digital health legal team, alongside brilliant experts and thought leaders, share how innovations can solve some of healthcare’s (and maybe the world’s) biggest problems, if properly navigated. In this episode, Craig Lund, co-founder and CEO of Mightier, joins us to discuss the role of gamification in healthcare, including its potential to improve both access to care and patient engagement.
About Craig Lund
Craig Lund is co-founder and CEO of Mightier, an innovative bio-responsive platform that helps children develop emotional calming and coping skills through fun video game play.
Before co-founding the company in 2016, Craig served as interim CEO of Selux Diagnostics, a company transforming antibiotic medicine, and the Chief Commercial Officer of 1366 Technologies, a solar company out of MIT. From 2004 to 2006, he worked for the US Department of Defense in Iraq to launch the government securities market and for Endeavor Argentina, where he helped entrepreneurs start new businesses. He is a graduate of Dartmouth College and Harvard Business School.
About Sara Shanti
A partner in the Corporate Practice Group in the Sheppard Mullin's Chicago office and co-lead of its Digital Health Team, Sara Shanti’s practice sits at the forefront of healthcare technology by providing practical counsel on novel innovation and complex data privacy matters. Using her medical research background and HHS experience, Sara advises providers, payors, start-ups, technology companies, and their investors and stakeholders on digital healthcare and regulatory compliance matters, including artificial intelligence (AI), augmented and virtual reality (AR/VR), gamification, implantable and wearable devices, and telehealth.
At the cutting edge of advising on "data as an asset" programming, Sara's practice supports investment in innovation and access to care initiatives, including mergers and acquisitions involving crucial, high-stakes and sensitive data, medical and wellness devices, and web-based applications and care.
About Phil Kim
A partner in the Corporate and Securities Practice Group in Sheppard Mullin's Dallas office and co-lead of its Digital Health Team, Phil Kim has a number of clients in digital health. He has assisted multinational technology companies entering the digital health space with various service and collaboration agreements for their wearable technology, along with global digital health companies bolstering their platform in the behavioral health space. He also assists public medical device, biotechnology, and pharmaceutical companies, as well as the investment banks that serve as underwriters in public securities offerings for those companies.
Phil also assists various healthcare companies on transactional and regulatory matters. He counsels healthcare systems, hospitals, ambulatory surgery centers, physician groups, home health providers, and other healthcare companies on the buy- and sell-side of mergers and acquisitions, joint ventures, and operational matters, which include regulatory, licensure, contractual, and administrative issues. Phil regularly advises clients on matters related to healthcare compliance, including liability exposure, the Stark law, anti-kickback statutes, and HIPAA/HITECH privacy issues. He also provides counsel on state and federal laws, business structuring formation, employment issues, and involving government agencies, including state and federal agencies.
Transcript:
Phil Kim:
We're pleased to have Craig Lund with us here today. He is the co-founder and CEO, Mightier, an organization which blends the latest digital gaming technologies with off-screen activities for emotional regulation of well-being for children. Craig brought his deep experience in global health and markets to digital health.
He previously served as an interim CEO of Selux Diagnostics, the company operating in the antibiotic medicine space, supported by the US Department of Defense in Iraq to launch the government securities market, and worked to support entrepreneurs in South America's emerging markets. Craig, welcome to the Health-e Law Podcast.
Craig Lund:
Thanks for having me, Phil. I appreciate it.
Phil Kim:
We'll start off with our first question for you, which is, what is gamification in healthcare to you?
Craig Lund:
I think one of the big challenges is a lot of stuff we build in healthcare isn't very fun. What is more fun than video games, especially if you're a kid? I think the challenge has been that there's been a bit of a silo. You talk to great consumer experienced designers, great content producers, and then you have the science. You have the people in lab coats who go off and do science and make sure things work.
The reality is we're human beings, we're not robots. We don't live in clinical trials. We live in real worlds with stress and no time and kids who don't want to show up and do a bunch of things that we want them to do. So, how the heck do you reach a kid and then truly build something for their life, which is filled with a whole bunch of competing interests and challenges?
I think for us, we're all about meeting kids and families where they are, and the truth of the matter is video games can be done well or they could be done poorly. When they're done well, they're an amazing learning tool. They're interactive, they are experiential, they are learning through play, which is what we're all about. So, for us, we really want to blend those two worlds and I think we do it unlike anyone's done it before, which is really world-class interactive content that truly engages a kid, respects the kid for how they learn.
We do great research coming from Boston Shoulder, in our medical school, funded by the NIMH. You need both and if you don't have both, then you can't make a serious impact on what is a growing problem, which is that pediatric mental health crisis. That's not going to solve itself unless we come up with new ways, like gamification.
Sara Shanti:
I think that's a great segue into it's fun and it's research-based, but for those listening and not familiar with Mightier or gamification, and you spoke a lot about learning, but what solutions is gamification, including Mightier, meeting that the healthcare industry is struggling with?
Craig Lund:
Well, I'll just give you a very simple example. We all know deep breathing is very helpful if you struggle with anxiety, you struggle with anger. A lot of the tools we know work if only we convince ourselves that they work and apply them to our lives. So, you have a child. How are you going to teach that child to deep breathe and to actually convince themselves that it's beneficial for them?
You can take that child, put them in a chair, and tell them that deep breathing is helpful for them and to put them through a reading exercise that tries to get them to think about deep breathing, or even simulated. Sit there in a chair and say, "Okay, let's do some breaths together, Sarah. What does that feel like?" Problem is that doesn't feel real to the kid. They're not actually feeling anxious or upset or frustrated in that moment.
So, it's a little bit in one ear and out the other. How do you take that core learning that everybody in the field of social work, in clinical psychology, know if you're struggling with anxiety, these tools can be very helpful, they're scientifically validated, and make it into a game that kids care about? To take that specific example, we take a child, we put them into a challenging situation, which is what games do.
Say, you struggle with anxiety. Maybe, we intentionally make you feel a little bit anxious and then what we do is in those moments, we teach you how to do breathing through those moments in real time. So, you're actually having to walk and chew gum, as opposed to sit there and think, "Well, when is the last time I felt anxious? Maybe, I could have taken these breaths."
So, that's an example where the learning is real, it's immediate, and it builds that muscle memory because you're actually feeling the thing. It simulates life in a very interactive way. That concept you can explore across all clinically validated concepts. It really has no end. It's just, how do you take these clinically, scientifically validated concepts and then turn them into interactive experiences with deeper learning?
Phil Kim:
You alluded earlier to the pediatric mental health crisis. We've all heard about a crisis in terms of behavioral health. Generally, in this country, one of the biggest issues that seems to drive this crisis is a lack of access to care and continuous interception of those in silent crisis. How can gamification help to address those needs in particular?
Craig Lund:
We have no scale limits. It takes years to make a therapist. The other unreported fact is that we're using clinicians faster than we're hiring because they're burned out. So, you have demand going through if these kids struggle and you have supply dropping because, I don't blame it, clinicians are being burned out. So, we have no limits.
Mightier's delivered digitally. We can arrive anywhere. This is where I think we're getting a lot of good traction in Medicaid. We are building multiple languages and we can show up on the doorstep of any child anywhere in the United States within three days. Whether you're in remote Iowa or you live in the mountains somewhere, we can show up and we can help that kid and we can speak the language that that kid needs to hear.
Sara Shanti:
I think that's crucial, access and scale. What about stigma? I imagine that there's still a lot of individuals, including those that Mightier helps, there's a stigma attached to reaching out or asking for behavioral health assistance or support. How do you think gamification and video gaming in healthcare helps facilitate losing some of that stigma and then ultimately making care and services more accessible?
Craig Lund:
Well, I think it's the language we use as the medium and then how we communicate with kids. The medium matters. What do most ten-year-olds know better than their forty-five-year-old dads? Often how to play that video game. So, you've flipped the power dynamic and you've turned a child from often an object into an agent. Instead of a child that has a struggle that all these adults are telling, "You need to fix this," and often using words to do it into, "We believe in you and you're the center of this experience and you can figure this out."
That is what's really cool about how we design this world is the child becomes the master. There are these activities, where a kid can bring a parent in or another sibling in and challenge them and teach them on their terms. This includes what we're doing, where some of the kids we work with are getting traditional therapy and the clinicians that are working with those kids love us because all of a sudden the kid's excited to talk about these concepts and to bring them into the therapy session because the kid is the expert. So, they feel that growing confidence and then they want to share it.
Sara Shanti:
I think that really captures something that Phil and I have discussed before, that's patient engagement, and showing that where surprisingly it sounds like it's the child who is not only engaged but growing engagement into their family and into their community, their classroom, to spread health and behavioral regulation without probably even knowing it. But that seems something really innovative that we see a lot of healthcare solutions not growing that so organically.
Craig Lund:
I think those are probably one of the things we love the most is where these little characters called Lavalings in the Mightier world, think about them as Pokémon with emotions. The Pokémon’s either have a hot or a cold state. When they're hot, they're annoyed, get it out of their system, when they're cold, they're a cool customer working through difficult moments. In this world, the kids are collecting these characters. But what they also do is they can make their own. Actually, we'll design competitions where kids create their own Lavalings and they're amazing, what they come up with. To your point, it doesn't feel like they're being treated as if they have a deficit. They're actually thinking about it and being creative and putting their stamp on this world. So, very much a world that's built for kids by kids in a way that promotes that engagement and ownership.
Phil Kim:
We understand that gamification is used outside of the behavioral health space, such as in the wellness space. How do you see gamification growing to be most effective in the broader healthcare industry, whether that's beyond Mightier, looking at smoking, weight health, adult suicide, so on and so forth?
Craig Lund:
Well, I think a lot of our big health challenges, we know what we should do and it's more a question of motivation. We know we should eat better, we know we should exercise more. We know we should not smoke. I mean, the end goal or even the methods to get there are often not unknown. The challenge is the motivation. How do I inspire someone to get out of bed and run that extra mile or take those extra steps? Ultimately, what games, when done well, are is they are great motivators.
You need some talk about this, you need some longer-term intrinsic goal you're going after, but you also need those short-term carrots to get you there. So, it's accommodation. If it's all short-term carrots, and there's no longer term goal motivation, then it's fleeting and it's not deep and the learning can fade. But games done well, they both provide that intrinsic, like, "I want to get better at this scale. I want to become the emotional master of my house. That's my long-term goal because then I feel more powerful and more confident." They combine that with very well-balanced carrots along the way to keep me feeling like I'm growing and learning.
Sara Shanti:
That's really exciting, to hear that it can be applied so easily to all these different facets of wellness.
Pivoting a little bit, let's talk about the commercialization and reimbursement. At the end of the day, even though there's a lot of healthcare solution here, from the business perspective and the offering pathways, can you talk a little bit about the pathways to making it available, whether through educators, providers, direct-to-consumer, and ultimately the reimbursement schemes that are going to be really crucial to not only managing a successful business, but ensuring that the end user is able to afford to continue the services?
Craig Lund:
The ultimate goal is to get insurance to pay for it and to figure out ways to reach kids and families who are in the need of care with as fewest barriers as possible, while maintaining strong clinical guardrails. What I mean by that is people have gone after digital prescriptions and going to require a prescription and the whole DTx movement and go through primary care and all these things. Again, it plays into the stigma a little bit. Now, I need a prescription for this thing. I'm trying to medicalize it in a way that doesn't necessarily feel great, and I'm putting it behind the barrier of a primary care or somebody in the medical field having to sit, do all this evaluation and prescribe it.
I've not been a huge fan, frankly, of that approach for those reasons. Our goal has been, we've successfully done this. We've worked with one large national payer and then we're about to have a second one, where we are being reimbursed from CPT codes, but as a behavioral health solution, not behind a prescription wall, and then work with the plan to do member outreach to people in need, but do a lot more of this direct outreach, as well as referral networks. But really, like a multichannel, reach these families where they are instead of forcing it behind, let's say, a prescription barrier behind a pediatrician.
Phil Kim:
We'd love to hear what you're excited about relating to gaming's future.
Craig Lund:
I think there are two things. One is on the CPT code reimbursement side, which is, I guess, more of a plea to the powers that be and the regulatory bodies. There are these new Remote Therapeutic Monitoring codes, RTM codes, I think could be a game changer for delivering digital solutions around behavioral health. They exist, they're tier one codes, they don't have reimbursement rates. My main point there is we're still so driven by CPT, code-based delivery fee, for service. I know everyone's trying to move to value-based care. It's still a big thing and essentially the kids can't wait. We just don't have the providers and the standard model of just one-to-one therapy, pay for the session.
There has been progress on value-based care, but I think just validating that these digital programs are worthy, that have the evidence, of the CPT code reimbursement schedule. In terms of on the plan side, it is virtually an openness to work with companies like us. Yes, it requires a bit more time. It requires a bit more creative thinking. But again, this problem is only going to get worse and I think if we don't deal with this, not only could we leave a bunch of kids behind. Just from a pure business member engagement cost standpoint, there's no greater dollar spent than early pediatric mental health interventions. There's no question. We all know that if you have a 10 to 20 year horizon, addiction rates, all range of medical problems, everything that hits this. So, it's just a plea to continue to be open, engage with companies like us because I think there's really interesting, creative things we can do and we can't wait.
Sara Shanti:
Excellent. Where can people go to learn more?
Craig Lund:
Mightier.com. M-I-G-H-T-I-E-R, the English word, dot com.
Sara Shanti:
Perfect. Well, lovely, Craig, speaking with you today. I think we all have learned even more about gamification and are really excited to see its growth. Thank you for being with us today.
Craig Lund:
All right, thank you all.
Phil Kim:
You can learn more about Craig Lund and Mightier in the episode description of the podcast. That’s it for us here today. We will see you next time, unless you need us in the meantime.
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