Fall has arrived, and with it comes the annual migration of millions of young adults leaving their homes for the promises of higher learning. For a substantial portion of these students, the trek means a transition from their family’s usual healthcare provider to their campus’s health services or other nearby sources for care — a gap that telehealth vendors are eager to fill.

“These students are often far away from home,” Robbie Cape, CEO and co-founder of texting-based primary care startup 98point6, told MobiHealthNews. “As a demographic, [they] have the lowest percentage affiliation with a primary care physician. Over 55% of college students, Gen Z, have a PCP, so that means over 45% do not. They do not have a relationship with a PCP at all, which makes 98point6 a great option for them. Not only that, but … 1.7 million university students don’t have any access to healthcare coverage, which again makes our offer very, very compelling for them.”

What's more, with the rate of college enrollment ticking upward with each passing year, several universities and student groups will likely need a scalable solution to fit their healthcare needs, said Alon Matas, founder and president of BetterHelp, a Teladoc subsidiary that provides behavioral health and counseling services.

“I think there’s actually a crisis in the student population,” Matas told MobiHealthNews. “The schools have gotten bigger, more students, but the capacity of the counseling centers and health centers hasn’t changed. We hear all the time about campuses with 10,000 students and one counselor. They cannot handle that much, so there have to be solutions like telehealth that come in, otherwise this will escalate."

An appealing option for the tech-savvy generation

A critical component of services like 98point6’s or BetterHelp’s is convenience. Both platforms seek to lower the barrier of entry for their users, particularly by supporting text-based messaging between the patient and remote care provider. These interfaces are frequently the first choice of BetterHelp’s wider adult population, Matas said, but become especially vital when targeting younger demographics.

“[A] big factor is the modality and the support of asynchronous messaging and texting, which to students and with that age in general definitely resonates a lot more. They don’t call anyone on the phone, they don’t do video. They want to do messaging and texting. That’s what we offer, along with everything else [like video],” he said. “Most people choose to have messaging as their primary way of communicating with a therapist. That’s true, broadly, but in much higher numbers with this group.”

Cape — who’s also the father of three children around this age — describes these kinds of modalities as a natural culture fit for a generation long accustomed to apps and digital communications, and noted that some may not seek out health services without these types of options.

“In terms of comfort with technology and living a mobile-first lifestyle, young adults, college-aged students are in it. This is the way they live, this is what they expect,” Cape said. “They expect everything to be available on their phone, they expect it on demand, they expect it [to be] very high quality, and they expect it to work the way they want it to work. … Where one demographic might look at this and say, ‘Oh, this is an interesting way to access care,’ this demographic looks at it and says, ‘This is the only way to access care, why would I do it any other way?’”

Beyond the convenience of telehealth, Cape noted that many of the most prevalent health issues facing college students fall well within the capabilities of telehealth services. Conditions ranging from rashes and exhaustion to upper respiratory infections, UTIs and STDs can be quickly and discreetly identified via a remote primary care visit, he said. Matas, meanwhile, highlighted the flexibility of telehealth to deliver both quick and prolonged support as a particular strength for behavior health conditions.

“With mental health and therapy, this is a very long relationship,” he said. “What we’ll see is a lot of people who will have a video session every couple weeks with their therapist, but between weeks will have 30-40 messages going back and forth.”

And, because telehealth services aren’t grounded in a physical location, care doesn’t need to be limited to a central campus. Lori L. Sisk, director of student and alumni affairs at Rocky Mountain University of Health Professions (RMUoHP), said that remote care has been an ideal resource for “extremely satisfied” graduate students located across the country.

“We moved away from having an on-campus counselor, who could only provide services to our students living in Utah, to Betterhelp in August of 2019,” she told MobiHealthNews in an email. “Furthermore, the breadth of counselors at Betterhelp specifically meet the needs of our minority student population through the intake questionnaire by asking students questions specific to their demographics and matching them to Betterhelp counselors accordingly.”

Strong engagement, especially for mental health conditions

98point6 launched its first academic partnership last year with Ohio Wesleyan University. Now moving into the next term, Cape said his company has so far been pleased with the student body’s engagement of its services, which he described as “dramatically higher” than the 6% utilization rate the company reports among its general users.

“We also see higher than normal repeat utilization rates,” he continued. “While in a normal population we’ll see between 40% and 50% first-time users will use the product a second, third or fourth time within four months of their first utilization, we’re seeing that number as dramatically higher with those college students. Not only do they have that first visit sooner, but they have that second or third or fourth sooner as well. Again, that kind of goes back to all those different ailments that have high incidence with students.”

He said that the company has also seen strong rates among students outside of the school’s immediate program and noted that this avenue might actually be preferable for the students depending on their family’s existing coverage.

“We’re also able to target university students through our direct-to-consumer channel,” Cape said. “We see many students coming on board through that channel, but also for those individuals who aren’t covered under their parents’ plan, we are also able to treat some students based on their parents have coverage through our self-insured employer channel.”

However, what stood out to Cape more than anything has been the extremely high demand for mental health care among those using his company’s primary care platform.

“We’re still observing … but an important element to us is we’re seeing a higher incidence than typical of behavioral health issues,” he said. “We do see that in the general population, close to 10% of our cases are behavioral health related, and we resolve over 90% of those patients, though we’re seeing a higher incidence of behavioral health with the college — which is not surprising, it’s what we would have expected. Although, I have to admit that the number is even higher than we thought it was going to be.

“At a sociological level, it’s concerning, but at a value level, we’re super glad to see that we’re able to address that need,” he continued. “We wholeheartedly agree that a great behavioral health, text-based, digital-first experience is essential for this population, and one that goes even deeper than what primary care can even do. We think there’s an opportunity to go even deeper there and offer more support.”

Cape’s observations fell in line with those from Matas, whose 6-year-old company has provided mental health care to students via its D2C channel as well as through arrangements with roughly 200 campuses and student organizations. These young adults are placed in a near-perfect storm of stressors and unfamiliar situations, he said, and very often are in need of a lifeline.

“I completely agree that the utilization and the uptake and attraction that we’ve seen in this sector is outpacing many other sectors that we see,” he said. “We get, every day, multiple messages from people about how we changed their lives or sometimes saved their lives, from students and non-students. But with students, I’m sure you’re aware of all the statistics and staggering numbers of suicides at schools. There are students in need, and counseling can have a huge impact — especially students in their first or second years who have been in a very safe environment for 18 years and suddenly they’re away with a large stressor.

“Having someone on their side that’s non-judgmental, that’s professional and can work through the issues that come with this transition is extremely important.”

Effective rollouts require outspoken schools

Of course, many college campuses already have an array of healthcare resources available to their population. Unfortunately, Cape said, it isn’t uncommon for a student to be unaware of the services that are already at their disposal, especially among those whose mental health condition would keep them from actively seeking out help.

For these patients, a telehealth app can help inform students of their options and open the door to the school’s other offerings.

“What we’re finding is that merely, in some cases, informing students about those resources they have already is a huge help, and a step beyond anything they might already have at their fingertips,” Cape said. “For whatever reason, when students are in that state they might not be as likely to do the research on their own to see what resources are available to them. So we’re excited to be able to bring that insight to them and help navigate them to those resources that can provide even more help than we can.”

Still, companies also need to ensure that their telehealth offerings are on the radar to begin with. In most cases, this involves active messaging alongside the campus health services or student groups with which the companies are working.

“RMUoHP has promoted student usage of Betterhelp as a preventative support measure, indicating to students to utilize Betterhelp services as a preventative measure, not just for when a crisis occurs,” Sisk said. “This is paired with our strategic effort to support student health and wellness.”

Not every school has had success in this regard, Matas said.

“This definitely varies dramatically from one school to another, and depends on how they are willing and effective in getting the word out,” he said. “We see such variety in schools and their approach, but when the school is invested and willing to put the effort into promoting the service, we see great results. I’m looking at the last school that we onboarded last week for 1,100 students, and already 67 of them are getting counseling within a week.”

While both 98point6 and BetterHelp aim to have their products promoted alongside the school’s other ongoing health service awareness campaigns, Matas noted that there are some key reasons a telehealth care provider might want to keep one foot out the door. Chief among these is patient privacy, a concern that BetterHelp has often heard from students and schools alike.

“The students will go to the BetterHelp website with a code that will let them get the services at no cost, being sponsored by their campus or student organization, and then they will go through the typical BetterHelp experience,” Matas said. “That’s actually very important because, especially with mental health and therapy, the last thing people want is for their school to know about their troubles or that they get counseling. So, having this as a separate experience from the usual health center and consult services is actually encouraging people to use it, versus trying to integrate it too much. We made the decision, with feedback from the school themselves, that they wanted to be separate gateways, separate services that the students are using.”

98point6’s primary care offering is still in its early days of campus partnerships, so the company is still taking a “crawl-walk-run approach” to its deployments, Cape said. Deals have already been signed to launch the platform in two more yet-unnamed schools alongside Ohio Wesleyan, he said, and the company will be giving each a careful look as it hammers out the best way to handle initial rollout and other challenges in the future.

“We want to be learning along with our initial university partners on how best to support this demographic,” Cape said. “These are the leaders of tomorrow. They’re away from home, the stakes are very, very high, and we need to be very confident that we can deliver at the level of quality that is necessary before we expand to other universities, because the needs are different than other populations.”