A vanguard of virtual behavioral health startups are attracting investor interest. The latest: Equip, which provides online treatment for eating disorders, announced Wednesday it has raised a $13 million Series A round.
The round was led by Optum Ventures. New investor .406 Ventures joined, as did F-Prime Capital, which led the company’s seed round. Total investment in the company so far is $17 million.
Equip was founded in 2019 by Kristina Saffran and Erin Parks. Saffran was diagnosed with anorexia at age 10, and at 15, founded Project Heal, a nonprofit that works for equitable access to eating disorder treatment. Parks is a clinical psychologist who spent the last decade at the UC San Diego Eating Disorders Center.
Saffran and Parks initially met six years ago, around the time Saffran was considering a career in academia. But after years of watching the status quo fail patients, she reached out to her friend with the idea of trying something new.
“I said, Erin, I think nonprofits are not capitalized enough and academia is not risk-tolerant enough, and we have to try a new solution,” said Saffran. “We should start Equip.”
The startup offers virtual treatment for a range of conditions, including anorexia, bulimia, and binge eating disorder, to adolescents and young people up to their early 20s. Equip plans to expand to all ages later. The company’s program uses family-based treatment, or FBT, delivered by a five-person team — a therapist, dietitian, medical provider, peer mentor, and family mentor — to aid recovery. All of its providers are salaried and trained in treating eating disorders.
Equip completed a successful “beta test” last summer with eight patients and a case study based on two of the patients has been submitted for peer review. Since then the company has treated dozens of patients in California, New York, and Texas.
Saffran and Parks spoke to STAT about their plans for expansion in the year ahead. This interview has been edited for length and clarity.
Saffran: Really the catalyst for moving over to Equip was seeing over the last two decades that our research has improved dramatically. We have evidence-based outpatient treatments that work really well and simultaneously it was horrifying to see that while that all happened, the actual quality of our treatment landscape declined pretty precipitously with the rise of lots of residential centers. And so more and more people were having access to treatment that didn’t work very well and was pretty expensive and not quality outpatient treatment.
Parks: Kristina reached out to me in spring of 2019, and she’d been really focused on the financial access issue — not a lot of people had financial access to evidence-based treatments. And at the same time, I was really interested in the physical access issue. So while I was faculty at UC San Diego and one of the directors of their eating disorder program, I was noticing that people are traveling from all over the country to get treatment at UC San Diego. How can we get evidence-based treatment in people’s backyards?
So in the spring of 2019, we talked with the heads of many different insurance companies and just talked about this difficulty in accessing evidence based treatment. And they kind of said, if you build it, we will come.
Tell me about the challenges of transferring eating disorder treatment from in-person to a teletherapy context?
Saffran: I think Erin and I were always going to build this 100% virtual, because access is really at the core of what we’re doing. It’s hard enough to find quality treatment teams in places like New York City and San Francisco. It’s pretty impossible in other places of the country.
We probably would have told you 18 months ago, if you can find an in-person treatment team — it’s going to be challenging. But if you can do that, do it, it’ll be better. We have totally changed our tune after seeing our first couple of dozen patients. I think that’s for a couple of primary reasons.
One, a big part of our philosophy is that we want adolescents to be at home. Treatment works better when you can be at home, living life, building up reasons to get rid of your eating disorder and drowning out the eating disorder. Two, it’s a lot of appointments. It’s just logistically kind of a hassle and a nightmare.
Third, treatment works best when you can bring in multiple carers. Family-based treatment, the treatment that really forms the cornerstone of the program, is a lot of hard work. Our adolescents typically need to eat 3,500 to 4,000 calories a day every single day to gain what is the gold standard of 1 pound of weight gain per week. And they’re usually fighting the entire time. So it really does work best when you can bring in multiple family members. And we’ve had four family members, mom and dad and grandpa and grandma and an uncle and stepdad come into treatment in a way that just wouldn’t be possible in a brick-and-mortar setting.
Parks: We heard from families who’ve done other treatment before, and we ask “why did it not work for you?” And they described treatment fatigue — that after a family therapy session, they’re like, OK, I got it, we’re going to do 3,500 calories a day. But what would happen is by day two, it’s 3,200 calories, day three, it’s 3,000 calories and they kind of just regress to the mean, and then they hit the reset button with every family therapy session. With Equip, they have unlimited sessions with us, but also unlimited between-session messaging. So they’re engaging with one member of the five-person treatment team every day. So that’s the beauty of virtual.
You got this nice Series A round. How are you planning to spend it?
Saffran: Access! I think it’s incredibly important to us to get in-network with as many plans as possible, so this is really financially accessible to everybody. In addition, we’re working as fast as we can to expand to new states. We have inquiries from all over the U.S. and internationally. So really working as hard as we can to be able to meet the needs in those geographies and then really continuing to build out our team. There’s just such massive need. And we have a five-person provider team [for each patient], so recruiting and training high-quality providers throughout the country, across the disciplines.
What are your specific strategies for tackling issues of diverse access to this kind of care?
Parks: So a couple examples of what we’re doing. One, we know that, for instance, the trans population experiences eating disorders at a rate that is significantly greater than the rest of the population. And so we have hired providers who are trans themselves. We’re hiring people who are Spanish-language first.
We are also professionalizing mentorship. So oftentimes or before now, eating disorder mentors would be unpaid. They’d be volunteer. And so we’re professionalizing this. It gives us an opportunity to hire people from the communities that we are serving.
We’re trying to make it more comfortable to show up and work with people that understand some of the lived experiences you’ve had.
What payers are you partnering with?
We can share Optum right now. And there will be others launching shortly afterwards. Unfortunately, well, you know how this goes. We can’t announce it until we can take patients actively on day one. So we’re waiting for the contracts to be loaded.
Are you concerned the payers are just experimenting or are they buying in for the long run?
Saffran: Look, we’re early in the conversations. As you know, these conversations take a long time, but we’ve had tremendous success. I think payers are really waking up to seeing that while this may be a smaller segment of their population than depression or anxiety, it is a very severe population and one that they’re realizing that the current treatment landscape is not adequately addressing.
I’m sure payers would like to see clinical validation. Can you go into a little more detail about what you’ve done on that front?
Parks: So one of the things that’s great is that family based treatment, the treatment we use, has been in numerous randomized controlled trials over the past 15 years. Kristina likes to say that everything that we’re doing has peer-reviewed evidence behind it. We’re just baking the pie by bringing it all together.
We have been able to achieve the gold standard of 1 pound per week for our patients. That rate of weight gain is really important because many symptoms of eating disorders are actually symptoms of starvation or often messing with your nourishment. So whether you’re bingeing or purging or restricting the medicine is to get on this regular eating cycle. So we were excited and exceeded our wildest expectations and our beta trial last summer.