AngloAmerican Anxiety

Last month in the US we saw the snapshot of what private practice in therapy will look like in the UK within the next five years.

Alma, one of the largest clinical practice management platforms in the US, unilaterally announced that therapists in private practice with clients who have private medical insurance with Aetna will see their session times reduced and a subsequent 40% cut in pay. Although Alma is not owned by Aetna,  it’s business model relies on being a contractor to the large private medical insurance companies who determine the parameters of therapeutic practice. This is why therapists who use Alma although not directly working for Aetna can take a 40% pay cut with no warning or negotiation with them. In the same week Aetna announced its new service, Mental Health On Demand, offering single session therapy with non-clinical staff or, marketed as the emerging preference of consumers, an AI agent who will respond within 13 seconds.

Alma provides billing, marketing and other practice management tools including note taking and digital capture of client information for therapists in private practice. Part of the draw of Alma is that it is part of the AI architecture that allows therapists to work within the labyrinth of digital on-demand therapy and navigate its financial and algorithmic logic towards uberization.

What happened at Alma includes the ABCs of uberization - the unilateral announcement that they would be lowering the clinial categorisation of therapeutic labour and session times from 60 to 45 minutes, and with it the rate paid to therapists. After the 2024 cut of Alma rates by another of the largest US insurance companies Optum/UnitedHealthcare reducing rates by $10 per hour in Texas and Florida I guess we should have seen it coming.

Insurance watch groups and trade unions like the National Union of Healthcare Workers did see it coming since they’ve been in this movie for some years now. NUHW famously organized a hunger strike in California of the Kaiser Permanente workers, a company like Alma who are being targeted for cuts in pay precisely because they are historically good payers – between $15-25 above the industry standard.  The cuts at Alma represent a loss of income for therapists ranging from a drop of  $4800 a year for 5 Aetna sessions a week to $14400 for 15 sessions.

Feeling anxious yet? Well, you should do particularly if you’re a UK therapist providing sessions to BUPA clients – already cutting its previously generous hourly rates in the growing Employee Assistance Programme (EAP) sector led by companies like HealthAssured.

Until recently nobody really felt anxious about all the ‘free’ billing and administrative platforms now available for professionals in private practice. For US therapists the use of these platforms is regarded as essential in a highly platformized sector of medical care. For both the clients who pay via private medical insurance and the clinicians prepared to navigate the seventh circle of administrative hell involved in actually being paid by PMIs, you can understand why an AI agent on both sides might be the preferred option.

Given that the 40% cut in pay is likely to drive yet more therapists out of the private medical insurance system, and diminish even further the possibility of people accessing clinical care, it does make you wonder if those clever people behind the Mental Health On Demand algorithm and all those Application Processing Interfaces being inserted into clinical care packages built on years of clinical data extraction might have planned this all along.

Just when you think UberTherapy can’t get a higher score on the attrition-by-design scale used by investors in digital health.  

Last year a groundbreaking report by the US Psychotherapy Action Network came out about Practice Management Companies exposing how these ‘free’ administrative platforms are inextricably linked to the private medical insurance sector, and the business model behind them. Not enough was made of this report coming out – no front page news or key notes at professional conferences, and even less in the UK where we are only now about to seeing the links between private practice and UberTherapy.

What maybe wasn’t so clear until now is that it is the XYZ of uberization that meant that Aetna’s cut in pay for therapists was followed shortly by the introduction of dynamic AI systems that pave the way for automation. What you see in the case of Aetna/Alma is the roadmap towards UberTherapy in the UK where the practice management tools offered for free today becomes the gateway to a financial logic determined by the AI era of Uber and Lyft where therapy becomes an on-demand e-commercial sector.

If you’re a therapist heading off to supervision today the question isn’t what are the benefits of AI in therapy, the question is how anxious do you should be about UberTherapy?

Read PsiAN’s report  New Research Reveals Therapists’ Concerns About Corporate Practice Management Companies (PMCs).

Use PsiAN’s Private Practice Toolkit with the key questions you need to ask prior to using a practice management company.

If you’re an UberTherapist and want to be part of a MuchBetterHelp launching in September 2026 join our mailing list here.  

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@UberTherapy.bsky.social @ubertherapies