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Our Investment in Cartwheel: Improving Youth Mental Health

September 26, 2023

The single greatest health concern facing American kids and teens today is a crisis in mental health.

Over the last decade, our children have experienced unprecedented challenges to their mental well-being, including the COVID-19 pandemic, social media, and violence in schools. We believe that every child struggles with mental health at some stage of growing up, and it’s getting harder for our kids.

The data backs this up: the number of kids with clinical depression have doubled since 2010 and overall incidence of diagnosed emotional, developmental, and behavioral disorders is up to one in five children today. The situation is so severe that, even in the era of COVID, the U.S. Surgeon General calls youth mental health “the defining public health crisis of our time.” 

Despite soaring increases in need, affordable and timely mental health care designed for kids remains frustratingly difficult to access. Parents and children across the country and across demographic and income levels typically face months-long wait times to access qualified, appropriate mental health resources or even any support at all. What’s more, available providers often don’t accept insurance, forcing families to pay out of pocket or forgo care altogether. Support needs also change as kids develop and grow, and parents are often the only link in an end-to-end care journey with no continuity or coordination between other stakeholders (e.g., schools, doctors) responsible for a child’s well-being.

At Menlo Ventures, we see within today’s challenges and limitations a generational opportunity for digital health providers to help bridge the care gap and improve outcomes for our children. To succeed where existing resources fall short, a new platform needs to dramatically improve access to care, coordinate between kids and the adults who care for them, and deliver care more efficiently, from identifying and onboarding to providing high-quality care at scale. 

It’s this thesis that led us to Cartwheel Care.

Our partnership with Cartwheel has been more than a year in the making. We started last year with extensive research that we published in STAT News on the opportunity and unmet needs. Our data reinforced our conviction that adolescent mental health care will be one of the largest digital health opportunities, with today’s $3 billion market continuing to grow rapidly as demand has outpaced supply. 

We canvassed the market—talking with mental health professionals, pediatricians, school administrators, non-profit leaders, parents, students, and others on the front lines of youth mental health. We engaged dozens of entrepreneurs pioneering a broad spectrum of different models. Ultimately we believe Cartwheel is uniquely positioned to most improve mental health for our youth. 

Cartwheel’s model integrates with school systems, where young people spend most of their time, to efficiently identify and onboard kids who need support. Cartwheel provides kids with rapid access to telehealth and coordinated care among relevant stakeholders. And Cartwheel removes financial barriers via in-network insurance coverage that improves equity and enables access to everyone who needs it.

Partnering with schools helps Cartwheel meet kids where they are

Schools are not a traditional focus for healthcare in either patient acquisition or care delivery. But for youth mental health, schools play a pivotal role, both as a front door for care and in ongoing care coordination.

Apart from parents, teachers and other school staff are usually the adults whom students know best, spend the most time with, and trust the most. School staff often have considerable breadth and depth of insight into their students, including a complementary and sometimes different perspective than parents. Schools could be the most efficient and scalable channel for identifying youth needs and enabling earlier intervention.

Schools are also important participants in care coordination, including intake metrics like referral conversion and session completion, “closing the loop” communication with adult stakeholders like teachers and counselors, and assessing external quantitative outcomes like attendance and academic performance.

In our interviews with superintendents, they consistently rate youth mental health as a mission-critical issue. However, teachers and school districts are neither resourced, prepared, or skilled to serve the volume and range of demand. That’s where Cartwheel can partner with schools to connect to and extend their existing systems of support. Cartwheel’s range of integrated offerings includes personalized, individual therapy for kids, direct coaching and workshops to support parents and staff, and medication support, tied together with both direct and tech-enabled care coordination.

Cartwheel’s operating model improves financial equity and delivers superior outcomes at scale

Cartwheel differentiates from other telehealth providers through its care model, based on comprehensive in-network insurance coverage to allow students and families to access the level of care they need—including one-on-one therapy, prescribing, and caregiver coaching—all specifically designed for youth and covered by health insurance, including commercial and Medicaid.

In-network coverage in Cartwheel’s early markets is now approaching 100%, removing financial barriers as an obstacle to care for most parents. Cartwheel also removes logistical weight from parents, who rely on Cartwheel to match their kids with an in network provider, typically within seven days of referral, instead of months-long waiting lists and very limited time constraints for most local providers.   

By positioning as a virtual in-network outpatient clinic reimbursed by insurance that also serves schools, Cartwheel is also better able to grow efficiently to serve more patients. School costs are reduced, increasing adoption and utilization and enabling broader access to everyone who needs support.  

Cartwheel’s team are world-class experts who care deeply about youth mental health

The Cartwheel team, led by CEO Joe English, COO Daniel Tartakovsky, and Chief Medical Officer Dr. Juliana Chen, brings an incredibly complementary range of experiences that position them well to successfully navigate the complex, multi-stakeholder system of healthcare delivery and school-based patient acquisition. At Menlo, we recognize that the heart of many problems is building an integrated solution to problems that cross multiple disciplines, and that successful teams combine complementary expertise. 

Joe previously worked with more than 1,000 schools in 50 states on implementing a social-emotional learning curriculum around LGBTQ+ identities. Daniel served as a policy advisor to the U.S. Surgeon General and led the development of the office’s public advisory on youth mental health. Juliana is a well-respected child-adolescent psychiatrist with 15 years of experience serving students and families, including at top research hospitals like Mass General and Boston’s Children Hospital.

But perhaps even more importantly, the Cartwheel team shares a deep passion for their mission. “I’ve been in education for 18 years, and Cartwheel is like nothing I’ve seen before,” one district superintendent told us. “They deliver. Their level of care and responsiveness is unparalleled.”

We are excited to lead Cartwheel’s Series A round alongside our friends and fellow investors at General Catalyst and Reach Capital as they continue to build the leading pediatric mental health platform in the country. Amid an unrelenting crisis in youth mental health today, we share their vision for a world in which every kid and teen can get the support they need, wherever they are in their mental health journey.