San Francisco health startup Ginger.io went public today with a major pivot that the company has been undergoing over the last year and a half. While the startup began life as a passive monitoring company that sold its artificial intelligence technology to hospitals, it has reinvented itself as a healthcare provider in its own right, offering a full service online and app-based mental healthcare service, either direct-to-consumer for a fee or via insurers and self-insured employers.

“The realization for us was that trying to convince that whole industry to change their way of operating and adopt this technology would take a lot of time,” CEO and cofounder Dr. Anmol Madan told MobiHealthNews. “Not that it couldn’t be done. We were making a lot of progress there; we had 40 different hospitals that were using our technology. But it was just a slow process and we felt that … by bringing to bear the clinical components and combining it with the technology, we could work directly with the people who are paying for healthcare — i.e. the employers, the average consumer, the health plans — and we could offer the full service.”

So for the last 18 months, the startup has been reinventing itself as an online medical practice that provides users with an escalating range of options for mental and behavioral healthcare.

“The way Ginger.io works is as soon as you install the app you’re connected to a mental health coach,” Madan said. “You have a dedicated team of three coaches who are available 24 hours a day seven days a week and they provide a starter kit. In addition, they also guide you through a variety of self-care content built on cognitive behavior therapy, mindfulness, resiliency, covering a vast range of issues that help you build skills in those areas based on those symptoms and needs. If required, we can escalate you to a video visit with a licensed therapist or a board-certified psychiatrist. And the psychiatrist can also, if appropriate and relevant, prescribe medication to you if that’s what’s required for you to get better.”

The company’s big data roots come into play when it comes to scaling the system, finding efficiencies, and tracking whether patients are really improving.

“We practice a membership-based care model where we measure everything that happens within the system,” cofounder Karan Singh told MobiHealthNews. “Every interaction with a coach or therapist or psychiatrist — it’s similar to how after you take a Lyft ride you rate your driver. After this you rate your coach, therapist, and psychiatrist, and we use that data to improve the kind of care we deliver and improve the quality of the support we’re providing.”

Madan says the average rating for a clinician on the system is 4.75 out of 5. Collecting data has also allowed them to tailor the system to people’s needs — for instance, observing that peak usage of the coaching service happens late at night and adjusting coach availability accordingly.

Ginger.io also measures patient progress in more traditionally clinical ways.

“Really every member who comes through our system we measure their progress on regular rhythms,” Singh said. “So we might use standard clinical assessments like a PHQ-9 or the GAD-7 and we match that against best practice. So I think that’s pretty unique in this space in that we continue to track member progress and if we don’t see symptom responses, reevaluate it and we have our clinical supervision and the rest of our clinical team review those cases and determine if a different course of treatments is required to get them the level of support that’s needed.”

Just 12 months after launching its employer business, the company now has 25 large to mid-sized employer customers over a range of industries.

“We’ve been working in mental health and behavioral health for a number of years now,” Singh said. “I think that experience working on the front lines and really understanding how the business of healthcare actually works, how incentives operate, how workflows might need to change and, frankly, how culture might need to change in order to ultimately integrate technology led us to evolve from offering just the technology solution, to actually becoming a full stack behavioral health provider that integrates that technology and that data at our core, which allows us to deliver great care, and measure that it works.”