A Conversation with Cerebral's CMO, Dr. David Mou

Last week we hosted Cerebral’s CMO, Dr. David Mou, to chat with us about Cerebral’s model and the mental health landscape more generally. Here’s a rundown of some of the topics we covered, and you can view the full video below:

• The care coordinator role at Cerebral

• Supporting clinicians

• Delivering comprehensive mental healthcare

• Pill mills

• Value-based care

Our overarching takeaway from the talk is that there is a lot of space for us all to create a better mental healthcare delivery system in this country. Cerebral’s rapid growth in the space - they’re now up to ~4,500 clinicians - shouldn’t come as a complete surprise given the challenges today with both access to and quality of mental healthcare, as David highlighted. That said, there are still lots of questions that need to be answered about the impacts of Cerebral’s model, both for patients and providers.

David highlighted during the conversation that the number one quality metric from his perspective is access to care, and it certainly feels like that flows through Cerebral’s approach today. From our perspective, this approach also invites philosophical questions about whether more access is always a good thing, particularly when operating within a FFS construct that generally incentivizes doing more. And this it seems is the thrust of the critique of Cerebral - that its pushing clinicians to see more patients, to prescribe more, all in less time.

Yet when you hear David talk about the direction he is pushing Cerebral from a clinical quality perspective, it sounds very similar to other best-in-class value-based care delivery models we all associate with high quality healthcare. His examples of things like curbside consults and care team huddles make it sound like he is taking every effort to help Cerebral deliver high quality mental healthcare. It is hard to square that approach with the recent public reports on Cerebral recently highlighting recounts of negative experiences both for clinicians and patients.

David shared some helpful data points on Cerebral throughout the conversation, including:

• The W-2 / 1099 issue Cerebral only influenced ~200 clinicians out of its workforce that is at 4,500 today

• Cerebral’s typical clinician spends 20 hours/wk with Cerebral.

• 3% of patients who indicate anxiety as their primary complaint receive a controlled medication like Ativan or Xanax

• Cerebral has higher fill rates (90%) than industry average (50-70%)

• Initial visit lengths vary significantly by the condition or type of conversation

There were also some areas where David wasn’t able to share data that would have been quite helpful to know - e.g. clinician turnover, clinician satisfaction, or how widely the value-based care model elements are implemented. These would be helpful data to really understand and evaluate what’s going on behind the scenes in order to square the difference between what’s been reported on and what’s being said here. Without Cerebral sharing more information about its model publicly, and context for how its been trending over time, it’s hard to evaluate what is really going on inside the organization.

Ultimately, the proof will be in the pudding for Cerebral moving forward. David mentioned their work with payors to move toward value-based contracts. He also shared Cerebral is moving forward partnering with value-based primary care orgs. If Cerebral is able to sustain success moving in that direction and making value-based care a meaningful part of its business, it has a massive opportunity to improve mental healthcare in this country, as does every organization in this space. If it gets stuck in the fee-for-service D2C world, it is hard to see how Cerebral moves beyond its current state, providing more access to virtual mental healthcare services in an environment where FFS incentives seem to reward the wrong behavior and have led to a poor standard of care.