Ember Health’s model of care
At Ember Health, we have designed all elements of our care model to lead to the best outcomes for our patients. Below, we have outlined three core commitments that we believe set the foundation for the gold standard of care in our field.
Evidence-based, personalized care
Despite the nascent stage of the ketamine industry for mental health, there is a vast body of literature from the past fifty years that has informed our clinical protocols at Ember Health. A search of “ketamine for depression” on Pubmed surfaces nearly 5,000 publications and over 500 clinical trials. In 2023 alone, 687 papers were published on ketamine for depression.
Source: PubMed
This literature landscape has informed every decision we make at Ember, from dosage, to infusion duration, to foundational care design, to long term care protocols. Most importantly, clinical data has informed our commitment to only providing ketamine for depression, via intravenous (IV) administration.
The effectiveness of ketamine in alleviating depression varies widely depending on how it is administered. Data supports that intravenous (IV) ketamine helps 75% of people with treatment resistant depression (TRD) (source) whereas intranasal helps around 30-40% (source), oral helps 20-30% (source), and intramuscular helps around 30-50% (source). Further, IV ketamine has been far more thoroughly studied, representing 87% of studies on ketamine for depression through 2020. While there have been over 450 clinical trials studying IV ketamine, IM has only had 6, Intranasal 5, and Oral/Lozenge 22 clinical trials.
Efficacy rates for treating depression and number of clinical trials and random control trials by route of administration, quantified as of 04/24, papers sourced from PubMed.
Evidence also reinforces the importance of delivering IV ketamine in a safe, medically monitored environment. A recent meta-review showed that IV ketamine for depression remains exceedingly safe when used with careful medical and psychological screening. In these studies, medical serious adverse events (MSAEs) occurred in fewer than 1 in 1,000 treatment sessions. With medical monitoring, clinical, and psychological support, all of these events resolved without long term consequences. This is why the FDA states that ketamine should only ever be administered in a monitored setting, with medical personnel on hand to address the rare issues that arise.
More common than these clinical occurrences are psychologically adverse events. About 1 in 10 sessions result in what our patients would describe as “difficult” psychological content, be it the remembrance of difficult memories or the experience of unsettling thoughts or content in the altered state. Evidence supports that the initiation of an infusion in a safe, calm, focused, and monitored environment leads to better therapeutic outcomes. For this reason, Ember Health trains all clinical staff in therapeutic communications to ensure the best outcomes, and delivers care in a strict 1:1 patient to clinician setting. See here greater detail about the in-office patient experience we’ve crafted at Ember.
We also share patient outcomes data with each of our collaborating partners, to ensure that together, we can take a measurement-based care approach to how we establish unique care plans for each patient. We send bi-monthly emails to our partners about each patient who is active in our care, summarizing their PHQ-9 data and infusion cadence over time.
Evidence in the field is what has influenced the FDA to release safety guidelines in October of 2023, advising against the use of all compounded ketamine (oral, intranasal) and the administration of ketamine without the presence of a trained medical professional. Ember Health is committed to being in compliance with these federal guidelines.
Ember Health is also contributing to the literature landscape with our own data. Committed to an evidence-based approach in our patient care and guidance, we have collected longitudinal PHQ-9 data from each of our patients, and have conducted over 20,000 infusions as a team. We have one of the largest data sets in the world on IV ketamine for depression. We are working in collaboration with Columbia, Harvard, and University of Pennsylvania to publish these findings and advance this developing field.
A commitment to an evidence-based practice is why we:
Focus on depression
Administer ketamine via intravenous (IV) infusions
Monitor patients in a 1:1 patient to clinician ratio
Stay within studied dosage windows (0.5 - 1 mg/kg) and infusion duration (40 minutes)
Provide four infusions over two weeks as a foundational course of care
Track patient wellbeing over time through bi-weekly PHQ-9 survey data
Treat patients for long term care when depressive symptoms recur
Will not treat long term patients more frequently than once every two weeks
Understand the efficacy and safety of ketamine care over time
Treat depressive subpopulations with confidence (e.g. breastfeeding mothers, teens)
Partner with leading academic institutions to publish and learn from our data
Patient-Centered Experience
At Ember Health, we’ve focused on understanding the patients we’re serving, what excellence and safety feels like to them, and the value they seek in their care.
While we focus on treating Major Depressive Disorder and the depressed state of Bipolar Disorder, we recognize that the lived experience of depression looks different from person to person. Based on extensive “patient archetyping” work, we’ve identified a few different profiles of individuals navigating depression who have realized benefit from our care. This includes individuals who are severely depressed and seek taking control back in their lives, those who are functional yet depressed and may want to wean off of other medications, and those who are navigating substance use disorder and seek a trusted environment to address their underlying depression.
We have crafted patient care journeys that fulfills a range of needs and expectations for these various patient archetypes. This has translated into “patient journey mapping,” or the intentional design of the details of care that create a patient experience.
Central to the patient experience is the team we have built to deliver care. We are highly selective in our recruitment process, and look for candidates who share a commitment to compassionate, evidence-based care, thoughtful attention to detail, and ongoing professional growth and development.
All of our Clinical Directors are board certified, Emergency Medicine physicians, who are on site for all patient care. With extensive experience administering IV ketamine, medically monitoring patients, serving as the frontlines for acute mental health issues, and coordinating with a team of clinicians and consultant colleagues, EM physicians feel uniquely positioned to lead our facilities.
Each office has two full time infusion nurses on staff, one of whom supports the Clinical Director coordinating long term patient care. We screen for strong IV skills, as well as high EQ and therapeutic communication, particularly in handling emotional distress. We’ve found that nurses with a background in labor and delivery, critical care, holistic medicine, and emergency medicine are often a great fit for our practice. Each office has a full time administrator, coordinating patient care and curating an environment that feels safe and beautiful for our patients and our team.
At the start of their appointment, every patient is welcomed by their clinician to a private infusion suite for the entirety of their session. Patients are never left alone during their treatment, allowing us to create a safe and supportive in-office experience. See here more about the in-office care experience. While our team has been extensively trained in therapeutic communications to “hold space” following treatment, we do not take on the role of therapists. We help patients take a stance of curiosity towards their experience, and encourage them to consider themes that surfaced for further personal reflection and therapy work. Patients often desire at least 24 hours for their reflections to crystalize before engaging with their larger care team about their session.
A commitment to a patient-centered experience is why we:
Do not charge patients for an initial intake call with a doctor from our team
Take care of all administrative details before a patient has their in-office care
Practice transparent pricing, offer sliding scale, and help patients make the most of their out of network benefits
Put a premium on beautiful, calming spaces
Engage patients in intention setting leading into their care
Help each patient establish a supportive ritual with aromatherapy, music, and tea
Have a monitoring clinician in the treatment room at all times during the infusion
Invite patients to relax in a common reflection area following their treatment
Provide evidence-based guidance on follow up care over time
Have established extensive resources for patients to make the most of treatment
Hire compassionate, talented staff who believe the details matter in excellent care
Train our staff extensively in therapeutic communications
Partner-driven, collaborative care
We have designed Ember Health as a specialized service to work in conjunction with a broader mental health community, rather than as a silo of care. We are not a silver bullet solution to depression, but rather a powerful tool patients can engage with as part of a larger mental health care plan.
We only work with patients who are actively under the care of a certified mental health provider. That provider has to confirm the patient’s diagnosis of depression, and be willing to partner with us in our shared patient’s care plan. We enforce this policy to ensure the medical appropriateness of our treatment, and to help patients gain the most benefit from their ketamine care.
At Ember, our objective is to provide our partners with a safe and trusted outlet for a highly specialized service that has a high likelihood of providing relief for their patients. We alleviate the administrative and legal burdens that providers encounter when trying to administer this treatment themselves. We provide the gold standard of care in this specialized service for our shared patients.
Our partners offer critical services that complement the care we provide at Ember Health. They serve as the mental health hub for patients, coordinating care and making recommendations based on their deep understanding of mental health. They help patients prepare psychologically for their sessions with us, and integrate psychologically fruitful content that can surface. They help patients take advantage of the neuroplastic windows that result from care. And they work with patients to manage medications and provide psychopharmacological support beyond the scope of ketamine services.
We engage with our partner teams to align on bespoke care plans, seek input on wellbeing and changes in patient circumstance, and share patient data from our bi-weekly PHQ-9 monitoring over time. We provide partner education on ketamine for depression, share relevant research advancements over time, and learn from the expertise of our compassionate community of colleagues.
A commitment to partner-driven, collaborative care is why we:
Only work with patients who are actively engaged with at least one mental health provider who can confirm a working diagnosis of depression
Seek the input of these provider partners when assessing treatment success
Stay in contact with our provider partners over time, especially when adverse events arise for our shared patients
Endeavor to learn about our partners’ work and distinct approaches to care
Provide ongoing partner education events and networking opportunities
Have curated these resources, to help deepen our collaborative approach to care