New Healthcare Company Designed to Serve Neurodivergent Adults

Hopper Health is serving neurodivergent patients in California and New York.

A new healthcare company has launched a digital-first primary care platform to serve neurodivergent adults.

One in five U.S. adults is neurodivergent, with a range of conditions such as autism, attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder, and Tourette syndrome. These adults can struggle in healthcare settings; for example, dense paperwork can overwhelm them and bright lights can lead to anxiety.

Brooklyn, New York-based Hopper Health is serving neurodivergent adults in California and New York. Hopper CEO and founder Katya Siddall-Cipolla told HealthLeaders that she was inspired to create the company from personal experience.

"I am an autistic and ADHD person myself, and I also have Crohn's disease, which is a lifelong chronic illness, and I have spent the past 20 years of my adult life not getting medical care that understands people like me. Whether it is not understanding my sensory needs in a medical environment or communicating differently the way that I might explain or experience pain, I have gotten care that sometimes was not the right care or sometimes was delayed by many years. … For me, the inspiration for Hopper is I do not want my daughter's generation to go through the things that my generation has had to go through to get to some semblance of health," she said.

Siddall-Cipolla said there are two primary elements to providing quality care for neurodivergent adults.

"One is clinicians understanding the population, being very curious, being collaborative with patients, and understanding that they must take time and energy to deeply understand what is going on because if they operate at the surface level, oftentimes they might miss cues that neurodivergent people are sending that are important from a diagnostic perspective. The other piece that is incredibly important is the peer support component. Many neurodivergent folks like myself struggle with executive functioning—things like planning, task follow-through, and following steps in a certain order. So, the red tape of healthcare such as insurance, specialist visits, and who is in network and out of network is so challenging that oftentimes people like me will just avoid care and shut down. The peer navigation component is designed to be the support system for health for the individual patient," she said.

Clinicians selected to cater to neurodivergent adults

Hopper clinicians offer culturally competent care, Siddall-Cipolla said. "One thing we have done is we want to be neurodivergent-affirming, which means we need to understand the experience of neurodivergent people. We need to be thoughtful of sensory needs, information processing, and communication differences. In addition, all of our providers go through a training process for people of color as well as LGBTQ and transgender issues so that they have a broader perspective on inclusion. Unfortunately, there are a lot of neurodivergent folks who are multiply marginalized, and they have the least access to care and tend to have the lowest success rates finding clinicians who can understand them."

Hopper offers contextual primary care, she said. "Context is the patient's environment and experience—it is what is happening with them. We are saying that we are meeting people where they are instead of expecting them to come to where we are. We are wanting to understand all of the context around a person's experience, so that we can accommodate them appropriately in a healthcare setting, versus saying, 'This is how you must show up. This is how you must access care. This is our process.'"

Peer navigators

Peer navigators are a key aspect of Hopper, Siddall-Cipolla said. "Our navigators have been through health challenges. Our navigators have dealt with the mental health system. Our navigators live challenges every day, and they also have the additional education around the healthcare ecosystem as well as how all the parts and pieces fit together at a level that most patients do not have."

The navigators can help neurodivergent patients with tactical healthcare challenges such as prior authorization for medication as well as other issues, she said. "They can also help with things like asking for accommodations at work, or things like getting an MRI. For patients who have never had an MRI, our navigators can tell the patients about accommodations they can reasonably ask for at the imaging center. Navigators can call ahead and have conversations with office staff for other types of visits to make sure our patients are understood even before they walk in the door. They do advocacy work on top of the navigation component."

Visit length and financial model

At Hopper, telehealth visits are usually longer than typical primary care visits, Siddall-Cipolla said. "Our first 'welcome' visit with each patient is a full hour with their primary care provider. Prior to that full hour, patients have an opportunity to connect with their navigator, talk through some of their challenges, and give more context. So, by the time the patient sits down with the clinician, the clinician has a ton of contextual information about the patient's life, and the clinician has time to ask questions. … A typical urgent care visit is anywhere from 20 to 30 minutes, depending on the issues. There is time with the patient and time for good charting and documentation as well as follow-up."

For now, Hopper is operating with a direct-to-consumer financial model, with patients joining monthly or annually. The monthly fee is $99. Hopper hopes to establish relationships with payers soon, she said. "The near-term goal is to be in a capitated model with payers. We want to offer true value-based care and take on risk for managing our patients' conditions."