Culturally-responsive care: Anise Health transforming Mental health and serving diverse communities.

• Please share the inspiration behind starting Anise Health. What motivated you to create this company?

After the COVID-19 pandemic, Asian Americans saw the greatest increase in the prevalence of depression and anxiety across all racial groups due to a 339% rise in anti-Asian violence. In fact, 41% of Asian Americans report currently experiencing symptoms of anxiety or depression, 62% of whom do not have access to effective treatment due to the exclusion of cultural factors in care and limited provider expertise in addressing unique cultural stressors. Despite significant innovation in the mental health industry overall, Asian Americans are repeatedly being left behind, resulting in massive health inequities and poor clinical outcomes.  

After experiencing all of this firsthand during their own therapy journeys and through encounters with untreated mental illness within their own communities, co-founders Alice Zhang and Nisha Desai knew there was an unmet need that they were well positioned to solve with Anise Health: the first culturally-responsive digital mental health platform built by and for the Asian American community. Read more about Anise’s founding story here.

• What is the why behind Anise’s culturally responsive care model? Is there training for providers?

 “Culturally-responsive care” is an evidence-based approach to providing therapy and/or coaching, which acknowledges the role of cultural context and recognizes the rich variety of experiences that each individual confronts due to their racial background, enabling clients to feel understood and receive care that is tailored to their unique needs.

To deliver this specialized care effectively, we equip Anise providers with training in cultural sensitivity, beginning with an overview of our culturally-responsive care model, and then covering topics of collaboration between therapist/coach, progress measurement using culturally-adapted assessments, and a deep dive on the Asian American lived experiences and unique stressors. We also offer monthly consultations where key opinion leaders (KOLs) and expert clinicians deliver training on a diverse range of clinical topics such as case discussions, evidence-based practices, latest research, and etc.

Our training program strengthens the sense of community and collaboration among our mission-aligned providers who believe in the power of culturally-responsive care. Finally, we equip our providers with client feedback and clinical data to support the delivery of high quality of care and establishment of strong therapeutic alliance with each client.

• Is it safe to say your initial personal experiences with mental health services are what prompted your passion for mental health and the start of Anise?

Absolutely, Alice and Nisha’s personal experiences with mental health services lie at the core of Anise Health’s mission. For Alice, as a 1.5-generation immigrant, she experienced firsthand the feeling of not belonging, the pressure of demanding expectations, and the struggle of being caught between polar opposite cultures. But when Alice finally sought therapy to work through those challenges which were inextricably linked to her Asian values and immigrant upbringing, she ended up cycling through multiple therapists, each time feeling more defeated. She knew that if finding effective care was hard even for someone like her who had an understanding of mental health from her undergraduate degree in neuroscience, career in healthcare, and training as a Health and Wellness Coach, she thought it must be nearly impossible for many others to find effective care.

Nisha grew up in a traditional South Asian household as a second-generation immigrant where mental health was never discussed. Nisha’s emotional personality was viewed as “weak-hearted” and it wasn’t until college that she realized it was ok to not always be ok. Unfortunately, her school had a broken mental health system and, like her, many classmates weren’t able to get the support they needed. There was a tragic loss of lives – 14 suicides – and she noticed many of them were people of color and Asian Americans, specifically. This rang alarm bells for Nisha and left her asking: if POC in this country had better treatment options to help process emotions, could the outcome be different?

At every stage of their lives, the needs of their community were underserved by existing one-size-fits-all mental health care. After meeting at Harvard Business School, Alice and Nisha realized that a solution for Asian Americans did not exist because very few healthcare executives experienced the problem firsthand. Thus, they took a leap of faith to create Anise Health themselves and build the mental health solution they had been envisioning their entire lives.

• Anise is centered on the concept that culture matters a lot in mental healthcare. Can you expand on that?

The 130M people of color (POC) in the US, including Asian Americans, have long faced unique barriers with one-size-fits-all mental health care, such as provider incompatibility, under-/mis-diagnosis, stigma, and language gaps. As a result, POC are ~5x times more likely to drop out of care prematurely and ~50% more likely to report treatments being ineffective vs. their White peers.

At Anise, we’re doing things differently. We have built culture into every inch of our business, acknowledging the fundamental truth that our cultural identities shape our experiences, how we see the world, and relate to others. By holding the shared understanding that intersectionality and cultural context impact our values, emotions, and behaviors, our providers are able to build trust quickly with clients, keep them engaged in care, and drive clinical outcomes, reversing many of the trends we see among POC with the current standard of care. With growing diversity in the US, we believe that increasing access to affordable, effective, and culturally-responsive care is a necessity.

•  What challenges or gaps in the healthcare industry did you identify that led to the formation of Anise Health?

Through our personal experiences with therapy and careers in health tech, we identified a key gap with the current standard of care: clients were only being seen as a set of symptoms and diagnoses, and culture was largely being ignored in clinical treatment. This comes as no surprise given the majority of evidence-based practices for psychological disorders are based on research and mental health models developed in Western contexts, with Asians representing <0.1% of clinical trial participants. As a result, minority communities have seen disproportionately high rates of chronic depression, suicidal ideation, and disability. 

Furthermore, despite the wide prevalence of mental health needs among Asian Americans, they remain the minority group that is least likely to seek help. This is partially due to the stigma and shame associated with mental illness in Asian subcultures, but also closely tied to the model minority bias, which asserts that Asians are smart, successful and hardworking. This stereotypical view of the Asian community can render Asian American needs invisible within communities of color, resulting in exclusion from critical DE&I conversations and ‘culturally-competent’ provider networks. And when mental health needs are left untreated, as they often are within the Asian community, there are devastating long-term impacts, including Asian young adults being the only ethnic group with suicide as the leading cause of death.A deep understanding of these challenges made it clear there was an urgent demand for tailored mental health services among Asian Americans, which ultimately led us to create Anise Health.

• How does Anise Health leverage technology to improve healthcare outcomes? Can you give some examples of the innovative solutions your company has developed?

Anise’s digital platform is establishing one of the largest datasets on Asian mental health needs and outcomes with the highest security and privacy standards in mind. Leveraging this data and AI technology, we intelligently match patients to clinicians, accurately assess for cultural stressors one layer deeper than traditional DSM-5 diagnosis, recommend resources in between sessions and personalize treatment plans based on clinical need. Our extensive digital resource library also curates topics that Asian clients experience every day, such as people pleasing, perfectionism, and bicultural tension. And finally, clients have unlimited access to a wide range of other wraparound services on our online platform to enable high quality care, including secure chat, progress measurement dashboards, online scheduling, medical record management, and more. 

For our providers, we are in the early stages of piloting an AI-driven clinical decision support tool that is the first of its kind. The tool is being trained with protocols from our culturally-responsive care model and our outcomes dataset to ultimately support clinicians with diagnosis and treatment planning. This will help to standardize the quality of care across clinicians, regardless of their experience level or demographic background, and provide our clinicians with the value propositions of skill building, validation, and efficiency. 

• How does Anise Health address issues related to accessibility and affordability in healthcare?

Access to effective care is especially challenging for the Asian community, a population that is 2x more likely to experience symptoms of depression, anxiety and stress yet 3x less likely to seek care. We believe that the first step to reversing this trend is to drive awareness. We partner with many community organizations to offer psychoeducational workshops and group services that help normalize the conversation around Asian mental health. This outreach and content is critical for establishing Anise Health as a trusted source of care and reducing barriers to seeking help.

Second, Anise’s telehealth services are convenient and rapidly accessible, with all clients getting matched to a provider in less than 2 business days and able to book appointments within the comfort and safety of their homes. Our holistic suite of services, including coaching and peer support groups, also help reduce the stigma associated with seeking care and make the process of getting started more approachable. 

And finally, we have several initiatives underway to reduce the financial burden on our clients. Our self-pay rates for our 1×1 services are affordably priced at ~$250/month on average, which is roughly ¼ the cost of typical private practice rates, and are HSA/FSA eligible. We also offer a suite of group services, such as clinician-led peer support circles for only $25/week and psychoeducational workshops that are heavily subsidized by sponsors. We are also going in-network with several new payors, in addition to our existing coverage with HealthNet of California, which enables eligible members to receive our fully integrated care model for only a small co-pay. For those in further need of assistance, we also launched the RestorAsian Scholarship – a dedicated program that covers a full month of services on Anise Health’s platform for free. 

• What is the philosophy that guides Anise Health and sets it apart from other healthcare companies?

By building Anise Health on the foundation of culture and personalization, we are establishing the gold standard of mental health care for underserved populations, starting with a focus on Asian Americans. Our targeted program drives value in 4 key ways that go above and beyond existing one-size-fits all matching platforms:

1. Our holistic care model is evidence-based and tailored to address the unique cultural stressors faced by the Asian community. By integrating therapy with coaching and digital tools, clients benefit from increased behavioral activation and see results in just 8 weeks of treatment – shorter than current average wait times for appointments in the US.
2. We have trained an expert team of providers in our culturally-responsive care model to establish trust with clients and deliver a consistently high-quality experience (instead of simply relying on ethnic matching which has limited correlation with outcomes).
3. We leverage AI technology and our proprietary dataset on Asian mental health to personalize care and drive outcomes through more accurate diagnoses, targeted resources, and culturally-sensitive treatment plans. 
4. We engage our community regularly through psychoeducation, content generation and partnership with trusted organizations to harness the power of shared lived experiences and normalize the conversation around mental health.

• Can you elaborate on the significance of culturally adapted interventions being 4.7 times more effective than conventional or unadapted care, and what research supports this claim?

Robust evidence for the superiority of culturally-adapted care was established by a meta-analysis covering 14k participants, which indicated that psychological interventions which have been culturally-adapted are 4.7x more effective than unadapted or no intervention. The study also shows a low correlation between patient-therapist ethnic matching and clinical outcomes, suggesting that the solution actually lies in offering culturally-adapted mental health care delivered by a wide range of clinicians who are trained in cultural sensitivity.

• What would you say are the biggest contributors to mental health challenges facing individuals in the Asian community?

There are several contributors that make the Asian American mental health experience unique, validating the need for culturally-responsive care models. A few of these are:

1. Stigma – Being perceived as “weak-hearted” is not a tolerable trait in many Asian families, let alone admitting mental health problems to a stranger. As a result, many Asian Americans may look first to families for help and delay seeking help until conditions worsen. This societal stigma can also result in masking psychological decline with physical symptoms that have no organic cause. Discussion of physical symptoms, such as headache, fatigue and back pain caused by psychological distress, is relatively more accepted, often leading tomis- or under-diagnosis of the underlying mental illness. 
2. Emotional Suppression – Being able to communicate the complexity of our emotional experience is especially challenging when being emotional is considered a weakness, particularly in collectivist cultures, where ‘saving face’ is a common practice to preserve familial dynamics. It can be challenging to identify our emotions, and even more difficult to communicate the complexity due to the lack of words in many Asian languages to describe those emotions. 
3. Intergenerational trauma – Parents and grandparents who immigrated to the US often carry remnants and reactions to political instability/persecution and economic hardships they endured when moving to a foreign country to begin their lives anew. More often than not, the trauma related to each of these endeavors are passed on to the children, and as a result, conflict can ensue in various forms and incompatible values can surface between children and parents.
4. Bicultural tension – Asian Americans are expected to navigate between two, almost polarizing, cultures: the traditionally collectivist Asian culture and individualistic American culture. Asian cultures often value obedience to elders, conformity to social norms, hierarchical family structure, and emotional restraint. Having to manage affiliation with the Western majority culture while maintaining a minoritized identity adds a unique psychological and emotional burden on Asian American individuals that requires specialized care and attention.
5. Feelings of ‘Otherness’ – Due to the ‘perpetual foreigner’ stereotype, Asian Americans have not only been discriminated against on the basis of race and skin color but ‘othered’ as foreigners who can never be completely assimilated. This results in a particular kind of social/cultural exclusion that is not sufficiently acknowledged. For example, being told that Asian American racism is “not as bad” is extremely jarring.

• How does Anise measure patient satisfaction in the context of telehealth services?

We collect a variety of data points to measure overall patient satisfaction with Anise, including a post-session feedback survey, provider ratings, retention, qualitative focus groups, and more. We are so proud of the results we’ve seen across the 2000+ sessions completed on our platform, including a 95% engagement rate with the first 4 weekly sessions, which far exceeds the industry benchmark of 50%+ dropout after just one session. This retention is due to the strong therapeutic alliance between our providers and patients. In fact, 95% of our patients report feeling heard or understood by their provider, our average therapist rating is 4.96 out of 5, and our NPS score of 89 is nearly 45 points higher than industry average, indicating unparalleled satisfaction.

All of this data is further supported by testimonials that highlight how beloved Anise is by our clients:

• “Therapy had not worked for me before, but after meeting my Anise clinician I have regained confidence in the process and am excited to continue working with my therapist.”
• “Through Anise, I was able to talk about struggling with emotions and problems with communication stemming from my family of origin that still affect me today. I felt heard.”
• “I was impressed by how much improvement I saw after every session and the program as a whole because of their ability to understand where my thoughts were coming from.”

What lessons have you learned since starting your organization?

The founder journey is truly one of the hardest but most rewarding experiences; the amount we’ve learned in the 2 years since we launched Anise is probably more than we’ve learned in our prior career years combined. So, while there’s a lot of learnings we could share, a couple of key ones come to mind. 

First of all, starting a company is hard and it is even harder for female and minority founders. Experiencing countless rejections from investors, partners, and other stakeholders can definitely make us question ourselves. As Asian Americans who have perfectionistic tendencies, the early days of failing quickly were no easy feat to overcome. Over time, we learned that we didn’t need to know the answer to every question and didn’t need every deliverable to be perfect. And by taking on this more iterative mindset, we are able to come to work every day feeling more positive, which in turn empowered us to be better leaders for our team! Ultimately, learning to have conviction in ourselves and the unique strengths we bring to the table as women of color is what helped us build the confidence we needed to push forward.  

Second, finding ways to simplify was the only way to survive. Coming from a background in private equity, we were used to developing and executing comprehensive strategies for well-capitalized companies. We had a grand vision for Anise and initially wanted to do it all. However, this approach quickly got overwhelming for our small team and started to spread our resources thin. Ultimately, shifting our approach to speaking to customers to identify the biggest opportunities and pain points, and learning to ruthlessly prioritize have helped us generate best-in-class results, land payor contracts in record time, and get on a sustainable path towards scale. 

• Anise Health launched the RestorAsian Scholarship to lower financial barriers to accessing mental health care and coaching. Has this initiative changed the way Asian Americans view therapy?

The launch of the RestorAsian Scholarship was incredibly well received by our community and its success was covered by AsAm News and Cold Tea Collective. The demand was >2x oversubscribed, clearly validating the unmet need for tailored care in our community, and reminding us that affordability is a real barrier to receiving mental health care. 

This initiative reinforced the need to meet people where they are in their mental healthcare journey. This is why Anise Health’s program is designed to be easily accessible and affordable. Clients can sign-up for care in ~5 minutes by navigating to the website and submitting the intake form, after which they can complete a free trial consultation to confirm compatibility with their provider. 

The Scholarship helped to make taking this first step, often the hardest part, even easier! From there, RestorAsian recipients were able to join our Immersion Program, which is a structured 4-week program that helped them orient to our integrated care model and build rapport with both their therapist and coach. At the end of this first free month of care, they received an individualized treatment plan, a progress report, and a recommendation for which monthly ongoing care plan to subscribe to, which many chose to try after experiencing the benefit of our culturally-responsive platform for themselves.  

• How does the provision of peer support groups contribute to fostering a sense of community among Anise Health’s clients?

Our peer support circles are clinician-led small discussion groups, which creates a more welcoming introductory pathway into mental health care. In our recurring groups, individuals of Asian descent can connect with their peers to discuss culturally-specific topics and experience what it’s like to work with an Anise clinician. Participants meet for one hour a week across 4-6 weeks to understand the impact of Asian cultural factors, intersectionality, and stigma’s impact on our current emotions, grow their feelings dictionary, apply strategies for stress management and boundary-setting, and dive deeper into topics such as guilt, boundaries, and burnout. 

• Can you share some success stories or notable achievements of Anise Health?

We are so excited to announce that we are now officially in-network with two new payors in California, Aetna and Magellan Health, marking a major milestone in our ongoing pursuit of improving accessibility and affordability of the Anise Health platform. We are also especially proud of the record time in which we were able to negotiate these contracts, which underscores the strong unmet need for solutions addressing health equity and the value of the differentiated impact Anise has demonstrated on outcomes! 

Additionally, as reported by the Associated Press, we recently expanded to three new markets – Massachusetts, Florida, and Washington – in addition to our current operations in California and New York. This geographic growth enables us to now support ~50% of the Asian population in the US with several additional geographies expected to go live in the coming months. 

And finally, last year we were able to successfully close a $2 million pre-seed round from Kicker Ventures, Gold House Ventures, Celtic House Asia Partners, Progression Fund and strategic angels! Amidst a very difficult macroeconomic environment with the odds stacked against us as female and minority founders who receive less than 2% of all venture funding, this was not an easy process. But we are humbled to have welcomed incredibly smart investors into our team in an oversubscribed round in order to fuel growth. Thanks to this fuel, we were able to >5x our active users, >2.5x our provider capacity, engage 3000+ lives through community partnerships, and grow our full-time team to 6 people in one year – all notable achievements that inspire us to keep building each and every day!

• Collaboration is often crucial in the healthcare industry. How does Anise Health collaborate with other organizations, healthcare providers, and stakeholders to achieve its goals?

We collaborate closely with a variety of community organizations for referral partnerships, including advocacy groups (i.e. Stop AAPI Hate, Asian Leaders Alliance), universities (i.e. UCLA, Stanford), and employee resource groups (i.e. Netflix, McKinsey) that can help us reach individuals who may otherwise have let their mental health go untreated. We engage with these organizations in many ways (e.g. psychoeducational workshops, interactive community-building events, support circles) and help its members harness the power of shared lived experiences to address burnout, stress, and feel a sense of belonging. This also serves as a great opportunity to destigmatize mental health and build awareness around culturally-responsive mental health services. 

We are proud of the testimonials and case studies that highlight how positively our collaborative efforts are viewed by our partners:

• “I had never thought about burnout through the lens of cultural identity and how that may impact me. This session helped me understand deeper elements of what I was dealing with.” – Linkedin Employee
• “I’m typically skeptical of mental health workshops but this was hands-down the best I’ve ever attended. I intend to hang up some of the slides about practical tips in my office” – Verbate employee resource group lead
• “We are very impressed with the level of work Anise Health is doing and hope to build on our work together to support students.” – Stanford University
• “Our employees have benefited from attending a variety of events hosted by Anise Health, including educational webinars and peer support sessions. The glowing feedback we receive from our employees speaks for itself. They’ve voiced feeling seen and supported, and that they walk away with increased awareness and tangible actions on how to live more authentic and mentally healthy lives“ – Accenture HR lead

• In a rapidly changing healthcare landscape, what are the key trends or developments have you observed, and how is Anise Health preparing to adapt to them?

Measurement-based care is here to stay: While value-based care (VBC) has been a hot topic for years, there has been a lot of conversation around how to effectively build VBC contracts specific to behavioral health. Step one of that is measuring the right outcomes, accurately. Outcomes measurement now goes far beyond traditional PHQ-9 and GAD-7 assessments, including measures that are specific to the needs of the target population, which is what Anise is building onto its platform with its proprietary Cultural Impact Index. Additional measures we can consider include therapeutic alliance, engagement, or anything that ties directly back to quality of care. 

Medicaid is a critical population to consider: There has been a lot of buzz recently around Medicaid, which historically has been an underserved group that also has a significant POC population. The Medicaid sessions workshop at the Behavioral HealthTech Conference we attended in November 2023 was one of the most well attended events at the conference, demonstrating the rising interest among startups and investors alike on how to operate successfully as a business within Medicaid and win RFPs. Unsurprisingly, the answer among Medicaid MCOs was value-based care – Anise (and others) will need to demonstrate differentiated outcomes and member experiences in order to negotiate rates that make unit economics more attractive!

Tech innovation is no longer an afterthought: Payers have been more encouraging of digital-first services than we’ve seen in the past, but “human touch” is still a priority. So, while there is now an expectation of the use of technology to improve access, improve diagnosis, measure outcomes, etc., it may not necessarily be reimbursed as a standalone. However, having a robust technology platform that enables delivery of best-in-class care will certainly help in negotiating enhanced rates or innovative payment models that cover the end-to-end client experience (not just 60-minute therapy appointments). 

Tailored care models for underserved communities are needed: There is a clear emphasis on the need for tailored care models and culturally-responsive care to serve populations for whom one-size-fits-all doesn’t work. Many industry veterans are beginning to talk about how “culturally-competent” isn’t as simple as matching based on ethnicity, but is more so about education, holistic services, and building clinician expertise around intersectional needs via training. And consensus has formed that the best way to serve diverse populations is to uplift marginalized voices and ensure a diversity of lived experiences are represented within your organization and provider base, which Anise is certainly excelling at!

• What new partnerships or services is Anise Health working on?

In May, which is both Asian Pacific American Heritage Month and Mental Health Awareness Month, we are planning to work with several organizations and brand ambassadors to host community events to celebrate the beautiful intersection of the two causes we are passionate about here at Anise Health. If you are interested in hosting an event for your organization, contact us at info@anisehealth.com we would love to work together! 

We are also excited to share that we are establishing new partnerships with other mental health companies to serve as referral partners for clients looking specifically for culturally-responsive care. We have already kicked off a collaboration with Spring Health in certain geographies and will soon also be able to accept clients through Headway, helping us to expand our reach to those in need of specialized support.  

Our strategic roadmap for the rest of the year includes establishing additional partnerships with insurance plans, expansion into additional states, new service lines (e.g. medication management, couples therapy), introduction of AI-enabled tools for clinician training and treatment planning, and more. Stay updated on all our new launches and exciting announcements by joining our distribution list! 

• As co-founders, what do you believe are your ingredients for success?

At the center of everything we have achieved is our relentless commitment to Anise Health’s mission to empower everyone to live an authentic and flourishing life. We live and breathe this motto ourselves every day by remaining true to ourselves and always knowing the underlying why for all the blood, sweat and tears that go into building a company. We are big believers in the fact that the best companies are built by teams who have experienced the problem they are trying to solve firsthand; this is certainly the case for our team at Anise Health, which is a 100% minority-run business. Having a fundamental understanding of the challenges we face as minorities living in a majority culture has been a core driving force behind our passion and persistence to innovate and create a new gold standard of mental health care. 

Additionally, we have recognized the power of teamwork and a strong co-founder relationship. Many great businesses have failed at the hands of internal dynamics, and so we have been very intentional from day one about building a team culture that adheres to our core values – empathy & respect, honesty & integrity, relentless innovation, customer centricity, and measurement-driven. We start every conversation with a mental health check-in, have a ‘no questions asked’ policy when it comes to taking care of ourselves, and do bi-weekly team retros to ensure that we are both learning from our mistakes and celebrating our wins regularly. At the co-founder level, we’ve learned to celebrate and lean into our complimentary strengths instead of focusing on our differences or weaknesses – Alice is an ideator and an expert network builder, Nisha is an executor and an expert product builder, and together they have been able to take Anise Health to new heights!