19 connected strategy in the healthcare industry actually signed a perpetual licensing deal for the software, curriculum, and content of Lantern to expand its own offerings into mental health. Lantern started with a direct-to-consumer revenue model, charging customers $50 per month for access to the application.37 However, the company struggled to scale fast enough in order to get sufficient customers to survive. Ultimately, Lantern tried to pivot and focus on self-insured employers followed by traditional health insurers to get its services to be provided as a benefit to employees/patients.37 However, employers and insurers were skeptical to cover such a service at the time without strong evidence supporting its value. While Lantern did eventually conduct a study demonstrating the cost-effectiveness of its program, it was not started early enough and the results were only released in 2018 after the company had been struggling to stay afloat and had to shutter operations.38 joyable Joyable was founded in 2013 with the goal of being an app-based digital therapy for mental health issues, focusing on anxiety and depression. The company created an online program that leverages key aspects of cognitive behavioral therapy to help individuals manage their mental health conditions through daily activities and exercises.39 Addi- tionally, Joyable matches individuals with a trained coach, available by phone, text or email.40 However, roughly three years after its founding, Joyable was struggling to grow its customer base and see any horizon for profits. It was focused on a direct-to-con- sumer model in which individuals paid $99 per month for the service.40 In January 2018, Joyable laid off half of its staff and pivoted from its DTC model to an enterprise revenue model focused solely on self-insured employers.41 It took Joyable some time to adapt and start winning the business of employers. Ultimately, it was acquired only one year later by Ableto, a provider of virtual behavioral health services that connects patients to its network of 600 therapists for telehealth sessions.42 Similar to Lantern, Joyable did not focus on or prioritize demonstrating the clinical value and/or cost-effectiveness of 37 https://medcitynews.com/2019/01/omada-health-launches-mental-health-programs-using-shuttered-startups-tech/?rf=1 38 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190554#ack 39 https://joyable.com 40 https://www.bizjournals.com/sanfrancisco/news/2017/10/05/digital-health-joyable-art-medical-medrio-amino.html 41 https://www.mobihealthnews.com/content/joyable-lays-20-shifts-focus-d2c-employers 42 https://www.ableto.com/news/ableto-acquires-joyable-2019/