Aaron Gani’s virtual reality venture includes paying solutions for behavioral health “meta comorbidities.”
“I’ve been a technology nerd my whole life. I have always worked in technology, creating new applications and experiences.”
The desire to take this further and create his own business led Aaron Gani to leave his role as Humana’s CTO and found BehaVR, a digital therapeutics (DTx) company applying “the neurological power of VR” to curb anxiety disorders and chronic disease at scale.
“I had always wanted my own business and just couldn’t not do it anymore,” says Gani, adding: “Which is the only good reason to start a business.”
Gani’s technology advancement work at Humana—”looking into the future and thinking about how various technologies would impact the things we could do to understand and improve our members’ health”—put behavioral health and VR on his radar. The result is a problem-solution-market fit that, for many health tech startups, now includes payers among its B2B target segments.
The problem side
Behavioral health “meta morbidities” are Gani’s focus.
“Because of my role at Humana, I had become aware of this cluster of things that so many people are dealing with around stress, anxiety, depression, chronic pain, and substance use disorders. It’s this big comorbid bundle that is connected with a whole range of other chronic conditions.”
Gani, also BehaVR’s CEO, targets both the human and industry sides of the problem.
“Where there’s so much pain and suffering, there’s also so much extra consumption of resource in the healthcare system. It’s a huge opportunity to improve lives and unlock value.”
“For me,” he adds, “that was the right problem to tackle.”
The solution and market sides
“Initially, it was just a hunch but as I dug deeper, I found ample evidence over a 20-year period of the unique neurological advantages of the VR medium,” says Gani, who explains how the technology works.
“Everything we do on a 2D screen—whether it’s a smartphone, a laptop, a big screen TV, or an IMAX theater, it doesn’t matter—your brain processes all of those in essentially in the same way, which is it’s not happening to you; you’re just looking at it,” he explains.
VR is completely different.
“We’re replacing your sensory inputs, primarily visual and auditory. The only way your brain has to process that simulation is as a new reality,” he adds. This involves activating the brain’s fight-or-flight mechanisms and eliminating distractions to trigger arousal (exposure therapy) or calming responses.
“That is really powerful when you apply that to mental and behavioral healthcare.”
Gani believes that these benefits align with multiple industry tailwinds, including the rise of tech-enabled healthcare consumerism and digital fitness.
“Fitness in VR is exploding. A huge chunk of Apple’s App Store revenue is driven by fitness. And it is the most retentive application or type of experience in VR. People spend more time in VR doing fitness than gamers do.”
Other tailwinds include better, more accessible VR technology and a growing interest in the metaverse.
“This kind of metaverse moment that we’re all living through, it’s not a surprise to us in this company,” says Gani.
Using the wellness market as an entry point
There are also headwinds, including what are still the early days of both VR and DTx uptake. But BehaVR is focusing on multiple therapeutic areas and commercialization pathways to account for them.
The company has used VR wellness products as an entry point to gather the real-world evidence (RWE) that payers and other prospects want, including from DTx. “VR wellness products cast a very wide net and help a lot of people at a very low cost,” says Gani.
He adds: “If you’re going to expect people to adopt your solutions in the healthcare space, you better be evidence based—you better design your products from proven science and be prepared to prove outcomes.”
Current BehaVR products include NurtureVR and PNE+ (Pain Neuroscience Education+). NurtureVR is an immersive maternal health and wellness program “designed to support expectant moms and their families through the third trimester, labor and delivery experience, and postpartum phases.” PNE+ targets pain management through a “progressive and personalized program designed to help physical therapists reduce patients’ Pain Catastrophizing Score.”
Delivering clinical and cost outcomes
NurtureVR and PNE+ do not rise to the level of prescription digital therapeutics (PDTx) nor do they require clearance from the Food & Drug Administration (FDA). This was intentional on BehaVR’s part.
“Starting with wellness allowed us to iterate, to leap between platforms quickly and build learning into the dataset as the [VR] technology is becoming more consumer grade, low cost, and highly available,” notes Gani.
He adds: “Randomized controlled trials (RCT)—which are really just tables takes to demonstrate safety and efficacy—are not necessarily enough to convince the key decision makers, whether it’s clinicians or payers, that your program should be adopted. You have to go beyond that to real-world evidence of clinical effectiveness.”
“Beyond that, particularly for payers now, you need to show economic outcomes and savings. I think that’s reasonably well understood in the DTx space. You’ve got to do it, and there are no shortcuts. It’s one thing to prove some set of endpoints in an RCT. But what about incomes over six or 12 months? Does your solution really change lives in a way that’s persist?”
Expanding clinical partners and pathways
“We built all of our programs with great clinical partners who have a lot of domain expertise in the space,” says Gani. “It’s about how you meet the market in terms of clinical design and utility, as well as commercialization models and go to market.”
These partners include Complement Health for BehaVR’s chronic pain programs; Dr. Eric Garland and his proprietary intervention MORE (Mindfulness-Oriented Recovery Enhancement) for opioid misuse and chronic pain; and Sumitomo Dainippon Pharma for anxiety and depression.
“We have a very deep partnership with Sumitomo youo jointly develop and commercialize our anxiety and depression therapeutics—starting in the US, but ultimately around the world.”
The partnership reflects the iteration of BehaVR’s wellness products base and its approach, as the Sumitomo products for Social Anxiety Disorder, Generalized Anxiety Disorder, and Major Depressive Disorder will require FDA clearance.
“Now we’re ready to go down these FDA pathways that ultimately require a lot more structure, rigor, and careful change management,” says Gani.
The press release for the partnership adds: “The intent of these three products, in this collaboration, is that they will be classified as a Software as a Medical Device and will fall under the FDA regulatory framework that supports innovation and commercialization of digital tools while protecting patient health.”
“There’s not one right way to do this,” says Gani. “There are some PDTx companies that have only brought products to market through the FDA pathway. Then there are others—BehaVR is in this group that have chosen to develop products that steer clear of making any claims about treatment, cure, and prevention in order to get out into the market and get real consumers and clinicians engaged.”
Gani adds: “Getting data drives learning. If you jump straight to an FDA-cleared pathway, you’re missing out on that opportunity to get a lot more people involved and iterate very quickly on product design and engagement.”
Laura Beerman is a contributing writer for HealthLeaders.