A Tucson Startup Tackles The Loneliness Epidemic

Cindy Jordan is neither a psychologist nor a techie, but she founded a company in 2017 that blends elements of both: Pyx Health.

Based in Tucson, Arizona, the startup contracts with insurers to identify and alleviate loneliness among at-risk members through an app and a call center.

“To me, this is just about the straight line between ‘Here’s a problem, we’ve got seriously lonely people,’ and ‘We’ve got to find a way to help them,’” said Jordan.

Like many digital ventures in the field of behavioral health, Pyx is seeing a surge in demand related to the COVID-19 pandemic. Pyx had been expecting to book $5 million in contracts with insurers by the end of 2020, Jordan said. It is now on pace for closer to $7 million. 

“There’s now a personal understanding on behalf of the executives about what this feels like,” Jordan said. “So rather than having to do a lot of convincing about why loneliness is a severe health epidemic, they get it instantly.”

Loneliness is more than just a feeling. Seniors who experience social isolation or loneliness are at greater risk of depression, heart disease and death, according to a report earlier this year by the National Academies of Sciences, Engineering and Medicine.

It also comes with a financial cost. A 2017 report by AARP found that Medicare spent an extra $134 per month on socially isolated seniors than it did on those who were more connected. Seniors with arthritis cost an extra $117 per month, while diabetes cost an additional $270, AARP found.

Pyx Health reflects how the field of behavioral health startups is evolving to take loneliness into account. Many initially sought to address the lack of accessible treatment in many parts of the U.S. Some, like BetterHelp and Octave Health, seek to connect people to lower-cost, remote therapy sessions. Others, like Pyx Health, combine people and technology to deliver services. A startup called Papa uses technology to match seniors with college students who can provide companionship. There also are mass-market apps like Replika and Woebot that simply offer companionship via chatbots.

“We’ve seen that this is a complex challenge and it requires creative, innovative solutions,” said John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center in Boston, which is affiliated with Harvard Medical School. 

But what’s missing is clinical evidence that the new crop of behavioral interventions actually works, said Torous, noting that novel behavioral approaches should be treated no differently than new surgeries. “We recognize it’s early, so we don’t want to penalize people for being innovative. But that does put the burden on these companies to say, ‘Here’s why it really does work’ and to really be kind of transparent.”

In the absence of clinical data, though, investors can look at factors like engagement, said Alyssa Jaffee, a vice president at Chicago-based venture capital firm 7wireVentures. That’s what 7wire used in early measurements for one of its most successful startups, Livongo. Its app encourages people with diabetes and other chronic conditions to adopt healthier lifestyles, which reduces costs.

“That was the leading indicator,” Jaffee said.

A personal connection

Jordan began working on Pyx after a family member dropped out of college and wound up in inpatient care for a bipolar disorder.

“The first thing that happened to her is she became socially isolated,” said Jordan. But friends and family didn’t notice until it was too late.

Jordan, who began her career as a police officer in the suburbs of Washington, D.C., figured there had to be a better way. So, she began to research loneliness and its link to other social and environmental influences on health. “Our traditional health care setting is not set up to handle social determinants of health, and most particularly not to help people when they’re showing signs of clinical loneliness,” said Jordan. 

Now, the issue is squarely in the limelight, as policy makers confront a surge in anxiety, depression and loneliness stemming from the pandemic. It has hit especially hard in Arizona. Jordan has witnessed the impact on her family member, a young adult who had been working and thriving before COVID-19 arrived.

“In case anyone thinks this is just a business, it isn’t,” Jordan said. “It is a true passion for me. I see firsthand every single day what it looks like to suffer with mental health disorders and how loneliness and social isolation are affecting that.”

Pyx is Jordan’s second business venture. Her first, also based in Tucson, was a medical referral service that she sold in 2013 for $11.5 million to The Advisory Board Co. in Washington, D.C. She worked for The Advisory Board for a few years before starting Pyx.

Pyx has raised almost $6 million from investors including Desert Angels, the Arizona Founders Fund and Todd Davis, the co-founder and former CEO of identity-theft protection company LifeLock. In 2017, Davis sold LifeLock to Symantec Corp. for $2.3 billion.

Davis, who is based in Phoenix, said he was not looking to invest in more startups. When he kept hearing about Jordan, he arranged a meeting through a lawyer friend. He was impressed.

His due diligence into Pyx’s potential helped seal his decision to invest. He expects Medicare will eventually pave the way for greater reimbursement around loneliness and social isolation

“Our objective is to go be that brand leader in the space as it’s now being defined,” Davis said.

How it works

Insurers, mostly in Medicare and Medicaid, furnish Pyx with lists of members at risk for clinical loneliness because they are coping with one or more chronic physical or mental health conditions.

Pyx’s call center staff contacts the members and asks them to download the app, which is free to patients, Jordan said. The phone call makes people more likely to act than they would be if they got only a text or email. Nearly 70% of people end up downloading the app.

Once downloaded, Pyxir interacts with users through jokes, questions and other commentary in a guided conversation. It also prompts users to take a shortened version of the UCLA Loneliness Scale, a widely used test for loneliness. About 42% of users now test as lonely on the UCLA scale, up from less than 30% last summer, Jordan said.

“When they test lonely, it’s time for human intervention,” Jordan said. During the pandemic, calls between Pyx staff and the app’s users are lasting an average of 47 minutes, up from 21 minutes previously.

“It’s heartbreaking, actually,” Jordan said. “We talk about this every single day, these stories, how lonely people are and how scared they are.”

Closing the reimbursement gap

The challenge is convincing insurers to reimburse services like Pyx. 

Federal agencies fund programs to screen seniors for loneliness, bolster food-delivery programs and train them to use devices like iPads, said Edward Garcia, co-director of the Coalition to End Social Isolation and Loneliness. The coalition’s members include health plans, consumer groups and even transportation companies Lyft and Uber.

Recent rule changes allow private-sector Medicare Advantage plans to reimburse services related to loneliness, as well as services like transportation, meal delivery and personal care attendants, Garcia said. But the money comes from the same pool the insurers tap into for vision and dental benefits

“One of the issues that we see here is that many of the health plans are not taking advantage of those flexibilities,” Garcia said.

Even if the financial trade-offs disappeared, insurers would need evidence that interventions for loneliness and social isolation make a difference, Garcia said. To gather data, the coalition recently started a scientific advisory board.

“There’s a real lack of quality outcomes data around a lot of these,” he said.

Hoping to close the gap, Pyx is planning to publish a case study this year conducted by a third-party epidemiologist. The goal is to show the app can improve health outcomes and reduce costs Jordan said. The company has already conducted a pilot study at Phoenix-based health system Banner Health, which has a small ownership stake in Pyx and contracts with the company.

The study followed 81 Pyx users and a control group of 200 non-users, all enrolled in Medicaid, Jordan said. Banner spent 46% less on the Pyx users than it did on the control group. A follow-up study is tracking 800 people, 400 with Pyx and 400 without.

“There was significance to what we were seeing there, and not only just purely on the cost side,” said Dr. Ed Clarke, chief medical officer of the Banner Health insurance division, which covers about 1 million people in Arizona and northern Colorado. He said data on loneliness could influence how case managers interact with patients on issues such as diabetes care.

The diabetes company Livongo, in fact, is something of a template for Jordan. She said Livongo was among the first to argue successfully that insurers should cover diabetes prevention in addition to treatment. Based in Mountain View, California, Livongo is now a public company that expects to bring in nearly $300 million in revenue this year.

“There’s a lot of green space in front of me,” said Jordan. “Rather than just let off the gas, I want to step on the gas. I do see this as Pyx’s moment.”

Cindy Jordan began her career as a police officer in the suburbs of Washington, D.C. She introduced the Pyx Health app, designed to fight the loneliness epidemic, after witnessing a family member’s struggles with isolation and mental illness.