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An Operating System for Mental Healthcare | SonderMind CEO Mark Frank
16 Plays4 days ago
Today's guest is Mark Frank is the founder and CEO of SonderMind, one of the largest mental health platforms in the country that helps providers help patients and manage their practices.
In this episode, we unpack why the mental health care system has lacked the basic infrastructure that exists in nearly every other healthcare vertical. Mark walks through the provider side, where therapists are forced to become small business operators just to deliver care, and the patient side, where insurance directories are functionally broken and subjective screening tools like the PHQ-9 leave massive gaps in understanding. We explore how SonderMind is building an integrated system of care that captures what happens between sessions to give therapists better information and patients better outcomes. T
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Transcript
Introduction to Healthcare Theory Podcast
00:00:00
Speaker
Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
Mark Frank's Background and Journey
00:00:14
Speaker
And today on the Healthcare Theory, I'm joined by Mark Frank, the founder and CEO of Sondermind, which is one of the largest mental health platforms in the country, helping psychiatrists and doctors actually work more with their patients.
00:00:25
Speaker
And i'd say Mark's path to founding Sondermind is anything but typical. He worked in the army, started at West Point, and then moved into healthcare care banking before launching
Challenges in Mental Healthcare and Tech Solutions
00:00:34
Speaker
multiple startups. And while Sondermind is huge, it's a billion dollar company now, the idea behind it is what's most interesting.
00:00:41
Speaker
Many therapists struggle to actually work with regulations and building a private therapy practice is a months long battle that's much harder than it should be. So in this episode we dig into why mental healthcare has been so broken in the past few decades and how technology and AI platforms like Sondermind can hopefully fill in some of the gaps.
00:01:00
Speaker
So hi, Mark, welcome to The Healthcare Theory. area Thank you for coming on. Yeah, thanks, Nikhil. Of course, and it's great to have you. And before we get into Sondra Mind, I feel like your background is definitely unusual for founding in healthcare.
00:01:12
Speaker
You started in the army, you worked at West Point, then worked in healthcare, banking, and working in Stanley. And a lot of people with that background, even myself, They go into private equity, operations, some type of entrepreneurship. And i don't want to say the military is rigid, but it's a different environment than something like entrepreneurship. I've heard two sides to that. But can you walk into what pulled you into wanting to start your own company, into being a CFO?
Military Experience and Entrepreneurial Lessons
00:01:36
Speaker
What were those formative experiences, banking and working the army? And how did that position you well for working as CFO at Team Scout before doing Sondermind?
00:01:44
Speaker
Yeah, I mean, so maybe I'll give a little the background. I went to undergrad at West Point, as you mentioned, then served in the Army for five years, mostly in leadership roles. So platoon leader, company executive officer.
00:01:57
Speaker
My last year and a half, I did like strategic planning for the the commanding general for Fort Carson. um But I think it's ah it's an interesting like comment, and maybe for those who haven't served in the military, certainly in the Army,
00:02:11
Speaker
um there's always this thought that like, oh, it's really rigid. And like, it's not, it's sort of like, it's a big shift to them, like the uncertainty of entrepreneurship. um But I can say definitively for the army and and for the Marines, which are, you know, theyre they're very similar in terms of like how they operate, maybe a little less so for the Air Force and less so for the Navy.
00:02:29
Speaker
um But the army in the Marines, it's almost like you're, you're already like operating as an entrepreneur, right? Like as a platoon leader, as a 22 year old, 23 year old in charge of a a team of you know a platoon of 30 to 50 soldiers, particularly when you're deployed, but even in training exercises, you're you're given a mission, right? You're given like, hey, like what's this here's this thing you need to get done, the what, but not the how, right? You got figure out the how, and you got to get really creative. And then, you know again, certainly in ah in a combat sip situation, but even in a training situation where they're trying to emulate combat situations is
00:03:05
Speaker
you know, they'll put things in your, they'll like create adverse, uh, scenarios, right. And say, oh, this thing just happened. Or, you know, you're your, your, uh, staff sergeant just got shot and now you gotta like deal this. And so in my experience, least in the army, it was kind of the perfect training ground for entrepreneurship because you really have to learn to be fully accountable for everything. You know, like the army old manual of like, what is the job of a platoon leader?
Transition to Healthcare and Early Ventures
00:03:33
Speaker
Um, The first thing it said was a platoon leader is responsible for everything his unit does or fails to do. So i was like that to me sounds like being a CEO, sounds like being a founder, right? Like don't run out of money, like don't let anything you know happen adversely. You gotta figure out what what the strategy is, how to execute against it. So um after the army, i I went to business school up the up the road from where you are now up in Evanston.
00:03:59
Speaker
and And then i I was really interested in healthcare. ah my My wife at the time was a nurse, had become a nurse practitioner. So I'd seen healthcare care through her eyes. So that's that's how I got into so of healthcare care and why I was really interested in it. And it's also just really inefficient. you know it's ah It's a big part of our economy and it's it's not necessarily the best run aspect of our economy to say the least.
00:04:24
Speaker
And so Went to banking, um did that for a couple of years, focusing on health care mergers and acquisitions. And, you know, thought i would I would continue doing that for a while. But after a few years, realized I really missed, ah you know, building and leading people. Right. Like I missed sort of the the what I went to West Point for and what you learn in the Army is, you know, you learn to be a leader. You learn to really engage and and sort of like drive organizational behavior.
00:04:52
Speaker
And so that's when I left and I started my first company, um moved to Colorado and and started my first company, which was an oncology company. So a radiation therapy business treating patients with brain tumor, lung cancer, prostate cancer.
00:05:08
Speaker
So very much healthcare services. And then on the side, I started another company, which was a software platform for storing and sharing and doing medical imaging data a couple years later.
00:05:19
Speaker
You can think of it as like Dropbox for a CT and MRI. Well, so it was a SAS product for non-radiology physician practices and then a free application for patients to get like second opinions and store their, you know, their CT and MRI.
00:05:33
Speaker
Again, it's sort of easy to think about now, but at the time, um Dropbox was like 18 months old. Like Dropbox was a startup, right? Like it was a, like there was no such thing as Google Drive um or like Apple Cloud. Like none of that existed. This wasn't like a thing yet. And Amazon didn't even understand what HIPAA compliant meant. Like there zero companies didn't have BAAs, right? Like all that was brand new. So it was just a very early stage in healthcare technology.
00:06:01
Speaker
And then like you did, there was another company that I co-founded and was a part-time COO, CFO for also overlapping, which was a sales intelligence data company.
00:06:11
Speaker
So not healthcare focused, but still like in the technology world.
Identifying Gaps in Mental Health Access
00:06:16
Speaker
So that was like the background and all that sort of led to um sort of a you know a reasonably broad knowledge base across healthcare care service, healthcare technology, as well as sort of non-healthcare technology to start to think about the problems that I was seeing in terms of people not being able to access care, and not being able to use their insurance benefits, things like that for mental health, and ultimately for the outcomes not to be that great.
00:06:42
Speaker
in mental health. And then the challenges that a lot of providers like therapists and psychologists faced. A lot of the founding stories based on my younger sister, who's herself a therapist.
00:06:53
Speaker
So I saw her journey into private practice and the struggles that she faced with it. Yeah, I think and it's it's great that you came in with, I guess, a diverse variety of experiences. I can imagine that the military gave you the execution experience knowing how to handle ambiguity. And then also, i mean, Innova, I can imagine so much reimbursement issues working with insurers, large payers is a whole separate problem from the tech side at SafeMD.
00:07:15
Speaker
um So then getting to now working with psychiatry and psychology, now I think it's a very much understood issue that there's a supply-demand discrepancy in healthcare. care But when you started, i don't think it was something that would be mentioned on the news or in colleges nearly as much as it is today. It's um almost like with Dropbox, it's kind of ah a nascent problem. So back then, you kind of speak on your sister. I'd love to little hear a little bit more about that.
00:07:40
Speaker
What was their kind of initial entry or discovery of this problem? And um How did that kind of shape the way you think about what needs to be done or what are the main issues and roadblocks in this area? Yeah, absolutely. And and and you're right. It was very much like a two things you're right on. One, it was very much a set of personal sort of engagements, myself as well as my sister, that led to sort of this, oh, wow, there's a huge, huge problem here and then an opportunity to solve it. And then two, it was not at all being...
00:08:09
Speaker
discussed. And I think that was one of the other insights that I had maybe a little bit earlier than than some other folks. um But yeah, I mean, that the two it started really with, um i guess maybe I'll start on my sister's side, but not because it's it was sort of like they happened sort around the same time. But my sister went from an employed w two setting as ah as a therapist, as a licensed professional counselor, into private practice. And a lot of these therapists, all these providers in this space in particular, more so than a lot of other verticals in healthcare go into this field because it's both a lifestyle choice and a career choice. right they look they They go into this because they're like, this is a way for me to, when I'm in private practice especially, have the flexibility to see clients to treat when I want to treat. you know If I want to take Fridays off, I can when I'm private practice because unlike private practice for a lot of other verticals in healthcare,
00:09:03
Speaker
where you have a group, you have employees, you you know you're open Monday through Friday in mental health, even before sort of telehealth and things like that. It was very much like, hey, I'm gonna maybe only work on you know Monday, Wednesday and Thursday, right? And tuesday and friday you know Tuesday morning, I'll have off and Tuesday afternoon or whatever. It was just like, it was a very much sort of a lifestyle slash professional interest. And and and and I'd say that plus for most of these therapists, and and I'd say broadly speaking,
00:09:32
Speaker
broadly speaking, I say all medical professionals, but especially for mental health professionals and especially for master's level, it is like a calling, right? it's like It's like a draw into being a clergy member, right? It's like it's that sort of like, I feel like I'm pulled into this profession because of my desire to help people, because of my desire to influence through this through this form. right like That's like my purpose in life. And I would say so many therapists and so many mental health professionals, that's true. and That was true for my sister. so
00:10:05
Speaker
When she went from this employed setting into private practice, she just struggled with all the things of how to find clients. When I say client or patient, that usually means the same thing.
00:10:16
Speaker
Find clients, you know run the business, ah even get office space was you know challenging. And so I remember talking to her and she we were living in the same state and I remember saying, oh, there must be companies that do this for you because pretty much in every vertical on health care, there's MSOs and sort of like corporate entities that can allow physicians and other healthcare providers to focus on delivering
Systemic Barriers in Mental Health Access
00:10:41
Speaker
care. And they handle like the business stuff or the administrative or the marketing or the client generation, the contracting or the insurance, all that sort of stuff. Right.
00:10:48
Speaker
And in mental health at the time, kind this is circa 2012, you know, there really weren't, there really weren't those sort of models. i it was like, you could be an employee somewhere, but if you wanted to work in, you wanted to have your own practice, there weren't, I mean, there was a couple little EHR platforms here and there, but it weren't really like sort of your practice in a box, but you, you sort of hold the,
00:11:10
Speaker
the keys to that box in terms of how you want to practice, at least from ah from an administrative standpoint. So that was like one thing. And I go, wow, that's you know interesting because I was operating an MSO in oncology. And I'm like, well, this vertical exists in like this model exists in every vertical in healthcare. right And so that was thing one.
00:11:27
Speaker
Thing two is that I started looking for a therapist. and I could have paid out of pocket. At the time, I was running a business that was profitable and doing well. And I was a major owner of the business as well as an employee, as well as the CEO.
00:11:47
Speaker
And it was healthcare business. right So i knew how healthcare worked. So I'm like, well, and I knew that this was probably 2012 timeframe. I knew the Parity Act had been passed. So the Parity Act is what placed at par mental benefits with physical health benefits. it was passed in 2009. And so I'm like, all right,
00:12:04
Speaker
this is a covered benefit, this being mental health care, right? Finding a therapist or a psychologist. It's covered benefit. i want to find somebody who needs my benefits, right? I'm like paying paying that premium as ah as an employee, you know, for my health benefits.
00:12:18
Speaker
And I'm sort of playing it paying it as the employer as well, right? Because I'm i'm an owner in the the business. And so I'm like, damn it, I'm going to get use out of these benefits, you know, like I'm paying for it. I might well get some use out of it. And so I just thought, oh, it'll be easy. I go on the insurance directory, you put in your zip code, you find a therapist, and then you call them and you get, you know your session schedule, right? That's simple.
00:12:41
Speaker
um That wasn't the story, right? The story was go on there, find there's a list of people, you call them, first number is disconnected, second number, you know, and there's no information about who these providers are, right?
00:12:54
Speaker
There's just a phone number. call the next one, you know, goes to voicemail, leave a message. You wait a few days to hear back. You don't hear anything back. Go to the next one. Same thing. Go to the next one. Finally talk to them. She says, I'm not accepting new clients. I'm like, what? That's weird. yeah but on the directory go to the next yeah I don't take insurance anymore. like, what? But you're, you're a network. You have to like, you're, you're on the list. Like that means you're a network. and Like they would take you if you're not and contracted anymore.
00:13:18
Speaker
Well, I don't care. I'm not doing it. and I'm like, well, that's not really legal. Okay. That's fine. You know, on and on it goes. I mean, it took months, months for me to find to find a therapist who even just said yes.
00:13:29
Speaker
And then it was like, you know, another month to get just in network or just just to get the the the time scheduled and actually get the appointment scheduled. And I remember the whole time thinking like, this is so different than every other healthcare, like vertical.
00:13:44
Speaker
Again, even, I mean, the business I was running, we worked with the neurosurgeons a lot, right? Like one of the most specialized, highest educated and and sort of like and like narrowest fields, you know neurosurgery, intracranial neurosurgery. and So not even doing spongebob only brain. um There's not like tens of thousands of them running around, you know, there's like, there's not that many. And so, you it was like, even in that was like, I know I could get a patient, you know, that we were seeing a consult with a neurosurgeon within a week or two, you know, but there's these, but there's 800,000 therapists in the country. yeah
00:14:18
Speaker
And for some reason I can't get it there. can't get appointment but for another six months. Right. And so that just kept bugging me. And again, I'm stubborn. I was like, kind I could have found somebody more easily just to pay out of pocket.
00:14:30
Speaker
But I was like, this isn't right.
Mental and Physical Health Interconnectedness
00:14:31
Speaker
Like, I, you know, I should, like, I can afford it, but what about all the people can't? What about students? What people, you know, who who are not able to afford that $100, $150 a session? It doesn't, it's like, again, it's covered benefit. It should be part of your health and health plan. It is. And so,
00:14:47
Speaker
That bugged me and even more bugged me was like, I was just dealing with some stress and home stress and things like that. And I was like, it wasn't anything that was super critical. I could afford to go three, four, or five, six months without seeing somebody. But what about if you have, you know, some serious mental illness? What about if you have, you know, severe levels of anxiety, due depression? Like, what about if it like it's debilitating and it's really changing your function and aptitude in life, right? Like it's a crime not to let, not to enable those people. And so that really bugged me. So that, Those were like the personal experiences.
00:15:19
Speaker
And as I started digging more and more, i was like, wow, there really aren't solutions for this. And I think one of the reasons was what you mentioned is that the stigma was still very much there. The stigma of like mental health and, and you know, the the idea that it was a really important aspect of our overall wellness was not yet readily accepted, but it was very clear that the data from a number of studies already released at the time was showing how important it was, you know the connection, but the mind-body connection. mean, we all know it, right? It's I used to say in 2016, 2017, in the early days when I still had to convince people that this was a big big deal, was like people separate mental health and physical health like they're two different things. but
00:16:00
Speaker
the last time I checked, my head is still connected to my body. yeah right like yeah I can't disintermediate the two. right They are completely integrated. you know and If I'm hungry, I'm probably going have a different mental state than if I'm not. If I'm tired, but you know like there's all like that that affects your physical well-being. and Everybody knows that now and knew it fundamentally then, but didn't really take that knowledge and place it into action in terms of how they thought about the delivery of care between mental health care and physical health care. Yeah, that' that's a really a great story. I think that first you have the supply side.
00:16:37
Speaker
I think, I mean, just I know a family that's a psychiatrist and um yeah, you have that passion, but you don't really want to be a small business operator and running an SMB. You're just trying to deliver care, but somehow it becomes way more complicated than kaal kid and than that. And it's interesting from my experience just investing in this space um through an internship, it's like the best so as practices, they're basically run by business owners and business is the intuition that helps you scale, which is not exactly what people want. And then obviously the demand side, it's so surprising how complicated it can be, whether you're out of pocket or not. And think some companies have been addressing this then, but back then I imagine you didn't have headway or talk space or um the roll-ups haven't really entered as much as they are at this point today.
00:17:22
Speaker
So
Founding and Vision of SonderMind
00:17:23
Speaker
when you're getting SonderMind and you're thinking about like, this is something that's nagging you, really bugging you, um and you want to think about a solution, where did you really start? Because it seems like you had a couple strands. You had the WeWork for Therapist idea, which I know you guys worked on a little bit. And then now you have where you are today, but I guess, could you walk through like the initial thinking about a solution where you'd want to approach this and how has the product evolved to kind of where it is today and what you guys are doing today?
00:17:49
Speaker
Yeah. so the vision then was really the same as it is now. I think like what we've actually been doing is sort of taking some pieces out of it and and actually shifting off and mentioned like humanly, which is the the part of the company that we spun out.
00:18:02
Speaker
um But the idea was first enable providers to be under our umbrella, therapists, psychologists, psychiatrists, et cetera, and give them all the tools necessary, not just to run their business,
00:18:18
Speaker
but also to, most importantly, deliver great care, right? So create our own clinical tools, treatment planning, create you know a community model for therapist who could join Sondermine and and have you know peers who they could connect with even though they're in private practice, have education, continue education that's included. All of that was part of the initial vision, inclusive of the entire technology platform that can enable that.
00:18:43
Speaker
And then the same is on the other side for the consumer, for the patient, or for the client, was create the the sort of, not just the ability to access those providers, that's part of it, but more importantly, create a continuous care model that actually allows you to sort of like engage with an organization or with ah with a technology and service solution that becomes your mental health home, right? So um literally, like if you looked at the pitch deck from 2017 that I had, um it had those, it had these four components, right? It had
00:19:17
Speaker
data and analysis, i.e. machine learning, which is now a lot of what we do with our AI tools. um It had you know provider support and admin, and had clinical treatment planning and EHR, and then it had patient engagement and digital
Impact of Pandemic on Therapy Practices
00:19:31
Speaker
interventional tools. right like Those were like the four components that I thought that i thought of you know nine years ago and what we are doing today.
00:19:40
Speaker
Um, there was a component that had kind of a real estate piece to it as well, because again, one of the biggest barriers for therapists getting into private practice was how do i find office space? yeah That barrier was effectively removed during COVID because so many providers were forced into, uh, you know, doing video sessions, um,
00:19:58
Speaker
as we're podcasters and things like that, like i used to have a podcast a long time ago, you know, I had to do them all in person. feel like yeah good If I wanted to do ah do it like an episode with somebody in you know Austin, I needed to hopefully be in Austin at the same time and bring my microphone and reporting material. So, you know, all that sort of like shifted with um obviously technology improvement is also like the the appetite for people to engage in ah and a video manner, which didn't exist as much pre-COVID.
00:20:29
Speaker
And so that's really, that's always been sort of the core vision. And I think it's been driven by this need and this desire for us to solve access and utilization. But the main thing has always been how can we solve and improve outcomes, right? And I think the the key was that, you know, early on we recognized that the behavioral health space is very, very subjectively driven.
00:20:53
Speaker
right like If you think about how you measure quality, ah you use you use sort of patient questionnaires like PHQ-9 and GAD-7, nine and seven question surveys effectively that are completely subjective. right' I'm asking you nine questions and you tell me an answer, but there's not like there's not a definitive, like you could change your you could just change your answer a minute later.
00:21:17
Speaker
if you wanted to. And, you know, then like people have to take your word for it, right? So you could literally give one answer it's to one person with PHQ-9. You know, like I could, you could ask me the nine questions and I could answer one thing and 10 minutes later, I could answer something totally different.
00:21:34
Speaker
And it could give a score that indicates severe depression, another score that indicates no depression. And it doesn't take a genius to figure out how to answer those, those, those, those surveys, you know, like you can just sort of like you Do want somebody to think I'm depressed or not? Right? Like, no, nobody does that. You know, I'm not saying that's like the nature of it, but it's very subjective.
00:21:54
Speaker
And so if that's, if like, that's how you measure the severity of something, that's how you diagnose, you know, then and how do we think about actually
Using Data and AI to Enhance Therapy
00:22:02
Speaker
the treatment? So the the thought was, how can we build a system of care that actually takes in an immense amount of data and then uses that data to map the brain, right? To really get a better understanding of all the environmental, uh,
00:22:17
Speaker
you know all the environmental sort of like triggers that create different emotional states, and then use that to say, how can we let give that information to therapists and to providers to actually allow them to do their job better? right like If I know yeah what you are you know what's going on in your life between the second session and the third session and a much more fulsome way, I'm, as a therapist, going to be able to treat you better. right if If all I know of you is the hour i spend with you, and then maybe two or three weeks later, the other hour I spend with you, and then maybe two or three weeks later, the other hour I spend with you.
00:22:57
Speaker
For one, I have to take you at your word that you're telling me exactly what's going on. And I'm not saying that you would say something untruthful, but people do. um I'm saying that, hey, maybe one of the reasons you're in therapy is because as humans, we all succumb to cognitive biases, right? there's There's nearly 100 different cognitive biases when you split them up into different variants.
00:23:17
Speaker
that affect our point of view. So, you know are you actually delivering like a a very clear understanding or a clear you know recollection of what the events were that you know you're talking about in therapy? Maybe, maybe not. you know like those Those sorts of things was like, how can we actually use technology to improve outcomes by creating a system that that really enables a therapist to actually have more information at their fingertips so that they can do what they're so uniquely good at.
00:23:48
Speaker
Yeah, I think that's really interesting because I know, just think about it, when you have a session every three weeks, the way your your day goes it can probably influence that one session. So you have a terrible day, but the past two weeks were good. You might have worse answers than you would have otherwise, and then it sounds like the past three weeks were bad or vice versa. You had good news and the past three... It's like there's so many confounding variables here when you have such intermittent therapies and and touch points with therapists. And honestly, this easy solution is, okay, meet the therapist more, but that's expensive, time-consuming, and therapists, unfortunately, um it's hard to get enough supply to do that. So I think something you guys have been doing that's interesting is like AI-assisted note generation. I mean, um you have an app and a patient interface. And that's something I've been thinking about a lot is how can you keep a patient engaged
00:24:35
Speaker
So not like forcing them to go track their mood or forcing them to go talk to an AI, but how do you want them to stay engaged with your platform when a therapist isn't actively involved? And I think that's hard to do, but very important. um So for you guys, I would love if you walk me through the product vision. You have the supply and the demand, but in between those meeting sessions, how do you keep patients engaged and in a way that's productive for the provider, but also engaging and not forced for the actual patient too?
00:25:05
Speaker
Yeah. So I mean, right now we have and anybody can download the Sondermine app and it has about 80 different tools in the app that are all tailored toward various mental health interventions.
00:25:18
Speaker
Right. So it has things like meditation and neuro tunes for improving your your thinking during, you know, when you need deep thought or even for improving sleep. So there's like sleep tunes, things like that. It has brain games that help change like emotional biases, right? So there's there's a lot of coming out of Harvard and some other um some of the institutions, we've we've built a lot of tools that actually enable you to change your emotional bias. There's cognition improvement to to improve your memory and to improve your your sort of critical thinking. And so all of that is built into the app. So that's just something people can use and for now use and download for free. There's a, you know, it'll likely start having ah a bit of a paywall in the future. But for now, you can you can get all those benefits free, whether you're in therapy or not.
00:26:03
Speaker
Right. And so inclusive in that is an AI concierge and an AI coach that allows you to engage And it can recommend, hey, you know what, like it seems like that you're dealing with this thing. And so maybe you should try this tool or maybe let's talk about that more. You know, let's actually like, let's tie that into what your goals might be if you do get into therapy. And so I think that's that's been always a key component of where we saw this going. And so the way it works when you're actually in therapy then, right? But that can be used outside of a therapeutic episode of care. But when when you're in one of those episodes of care for eight or 10 or 12 sessions,
00:26:37
Speaker
um the work happens in between the sessions. Right. So even your comment of like, oh, maybe it'd be better if I saw my therapist more frequently.
00:26:48
Speaker
well only if you're also doing the work in between those sessions more frequently. Right. It's like it's like if you have a you know, my my my daughter had surgery recently, so she's seeing a physical therapist.
00:27:00
Speaker
Right. Well, she's a physical but physical therapist was once a week right now because she just had surgery. One, her body will heal from that surgery even if she doesn't see the physical therapist because the body, A, she's young and B, bodies heal, right? The natural state is it's actually gonna heal itself.
00:27:17
Speaker
The mind does not heal itself necessarily. In fact, more often than not when you're dealing with a with a mental health issue, it actually can have the opposite effect. Not only will it not heal, it actually leads you to other negative behaviors or it'll lead you sort of down sort of a confirmation bias path of like, oh, I'm i'm anxious. Therefore, I'm going to like pay more attention to the things that that make me anxious. Therefore, I'm going to like get becoming even more anxious. And it's like a negative price. figure out a way to break that cycle.
00:27:45
Speaker
But let's get back to like a physical therapy example of my daughter. She's got this appointment once a week. She's healing anyway, but to improve the healing, she's see's a physical physical therapist, right?
00:27:55
Speaker
Physical therapist gives her a number of foot exercises, does some things in the physical therapy session. oh But she needs to do the those exercises five times a day, right? And so if she doesn't do them for the next seven days before the next appointment, her progress will not be as fast as if she does them, right? She needs to do the work.
00:28:20
Speaker
And then when she does the work, the physical therapist will say, okay, let's evaluate you. Let's see what's going on. Let's talk about what's happening. Let's, you know, my hands on and sort of, and then go, all right, now I see where you are. You've gone from here and you've gone from this, from a level, whatever, three to level five. we're trying to get you to 10, right? And so, cool, you've gone from three to five.
00:28:39
Speaker
Maybe if she hadn't done the exercise, she would go from three to 3.5. Well, mental care, for the most part, needs to follow the same paradigm. And it does when it's when it's when it's effective.
00:28:52
Speaker
So when when therapy is effective, when it's most effective is when you as the patient, when you as the client are actually doing the work in between those sessions.
00:29:03
Speaker
And when you have a therapist that is good enough and has built enough of the therapeutic alliance between the client and her and the and her you know and then the provider, to say, you know what, I'm going to influence you in a way I'm going to get you to do that.
00:29:18
Speaker
So what we aim to do is actually remove the friction from that. Because again, unlike the physical therapy sort of and and analogy, like my daughter feels pain in her foot post surgery, obviously, right? And so and she has to wear a boot and she has to have a crutch. So she has a constant reminder because of her physical, because of like the physical indications,
00:29:42
Speaker
to do those those like exercises. But you may not have the physical, you may not have that sort of constant reminder around like whatevers whatever it is that you're seeing a therapist for.
00:29:54
Speaker
Right. And so with our app, we can say, hey, here's here's the reminder to do this thing. Here's the don't forget to like do this exercise. Don't forget to do this journaling or or, you know, make sure you you like get from a level, you know, like one of the games is like the emotional bias game or the or the positivity bias game. Right. Like, hey, your last score was an eight. You know, try to get up to a ten on that on that game. Right. And like that's a fun little game and you do it. And it's like so you get those triggers and in place and then all of a sudden,
00:30:23
Speaker
A week or two later when you see your therapist, there's not a scoring, right? But you can say, hey like it seems like you've gone from that three to five. The same thing that like the physical
Evolving Industry Models in Mental Health
00:30:32
Speaker
therapist would say. Yeah, I think that's I think that's very important. And it brings up a really good point that, yeah, even repeats about keeping them engaged in between the sessions and not just about meeting them more. And that's a very hard thing to do. And I would like actually like to hear, I think. We've had different, the industry structure has really changed a lot recently, and I think people have taken different approaches on this, but I would like to like take a step back and think about from like the top level. I mean, the way I think about it is that most players are trying to like aggregate supply. They get as many so therapists or psychiatrists as possible, but it seems like the delivery and paying mechanism seems to vary a lot throughout all of them. So you have the PE roll-ups, the private equity roll-ups that have their physical practices. Then we'll have like Headway and Talkspace, which seem to work with employers and direct-to-consumer. And then you guys are working a lot with insurers.
00:31:19
Speaker
um And um obviously, everyone does a little bit of the stuff in between. It's not so black and white like that. But um with your company, I mean, of course, you've built this these great AI tools. You've had the supply. You have patients. And now you're trying to like bring them together and get the plumbing of the system to work based on who's paying for it.
00:31:36
Speaker
um What was that kind of trade-off working with insurers versus other stakeholders? I mean, you guys also work with health systems too. So, i mean, could you talk to me through like how you see this overall industry and like in terms of um direct to consumer versus like insurers and things like that? And what made you guys pick your decision in terms of working with the insurers and health plans directly?
00:31:58
Speaker
Yeah, i think like, i think one of the misconceptions is that these are like unique things that that ultimately you're dealing with like unique populations, right? So, you know, the last time I checked, I have like, I'm and i'm employed by a company, right? So I have an employer, Sondermind, and i have a health plan, right? The health plan happens to be, you know, selected by my employer and every three or four or five years, like it changes, right? So goes from, you know, Cigna as a United Healthcare to,
00:32:34
Speaker
Anthem of the cluster shield or whatever. And so that means though, I'm an im employee. I'm a member of a health plan, right? I have health insurance benefits.
00:32:46
Speaker
I have a primary care physician who's affiliated with a hospital. So I'm also sort of like a patient in a hospital system. um I'm a consumer. I buy stuff, you know, I shop on, you know, on Amazon and things like that. Right. So it's like,
00:33:02
Speaker
So I'm all for, right? I'm a member, I'm employee, I'm a i'm a patient, and I'm ah and a consumer. So now I'm but I'm one person. So it's like, oh, wait, like, you know, this idea of like, oh, it's an employer focused model, or it's a health plan focused model is like, well, if it's a health plan focused model, it means almost by definition, it's also dealing with employees, because almost all insurance employ you know All commercial insurance in the country for the most part, the vast majority is employer sponsored insurance, right?
00:33:34
Speaker
Again, most people have access to healthcare through a doctor or through hospital system. So you have that most, you know, we're consumer based economy. And so like you're, you're a consumer too.
00:33:45
Speaker
So in my mind, it was always a sort of like, like the the framing was always like a little bit artificial. And so the question that we answered initially was where is the gap? right Is the gap in the fact that people can't afford to pay out of pocket for you know a health, and for like a mental health session? and It was like, well, yeah, most people can't.
00:34:11
Speaker
ah And yet the question was like, then do most people have insurance? Well, yeah, they do. And you know when we thought about like the employer versus non-employer model, At the time, there was a lot of these EAPs, but the business model of the employer assistance plan is little bit at odds with the aim of the employer. Yeah. Right. When you think about it, where it's like, hey, you're paying for this this fixed amount of a volume effectively. Right. you're saying here's Here's a dollar. arm amount I'm going to play the pay the EAP.
00:34:43
Speaker
Now it's different for some of the newer ones. Right. They have more of like a flexible model. But ultimately, all those employees also have insurance. Right? So why, why you know, and i and I don't like go to a special yeah EAP kind of thing for my pediatric benefits for my kids or for my dental or what, know, it's like, it all gets paid through my insurance benefits and I pay a copay or coinsurance and then i I craft the plan that works for me.
00:35:07
Speaker
So that was, it was really more about like, where is the need in the market and how do we address that? Now what's happened over the last 10 years is that need has been met, right? Like the access to care is vastly different today than what it was a decade ago.
00:35:22
Speaker
And so that's wonderful. That's a really good thing. What it happens now is, okay, you have these like you have a lot of consolidation that's starting to happen because those you know think it's it's like,
00:35:34
Speaker
the the organizations, those enterprise customers and and and partners, the health plans, the you know the employers, et cetera, are starting to realize, wait a second, this is all sort of like the same thing. So why why are there so many different variants when they're all sort of doing a similar thing? And so then the question is, well, how do we differentiate How do we know, you know how how can we as a partner peck who ah you know pick which mental health company is differentiated? And that's where I think the question comes down to who is actually doing something different to deliver better quality, right? a lot of
00:36:05
Speaker
a lot of companies out there are like, oh, well, we have you know like a better recruiting mechanism or whatever. And it's like, well, no, we've we've built a system of care. that is incredibly powerful, right? Where we have, you know, treatment planning and and like you know and clinical notes and all these things that are directly tied into how those providers, patients are engaging outside of the session.
00:36:30
Speaker
So that it's not this fragmented thing, right? It's not like, oh, I have my EHR and I have this other thing. I have this other, you know, ah like tool that I recommend to my client or to my patient.
00:36:42
Speaker
um And maybe therapists are recommending different things and they get that. in It's like, know, we've made it really, really integrated so that you can actually measure what's what's happening more effectively. And what we see, for example, is for those clients who engage with the Sonoma and App in between sessions, they get to outcomes um that are about 250 to 300% better.
00:37:04
Speaker
So two to three X better than the people who aren't engaging with it. So it's validation of the fact that our, the model works from a quality standpoint. And what's happening now is I think some of the the employers and the insurance plans are starting to recognize, oh, wait, like what we ought to be paying for is quality and not just quality in terms of quality masquerading as access, which is important. but You got to get access first, but speed to care isn't quality, that's access, right? And, you know, having done, you know, seven or eight or nine or 10 sessions isn't necessarily quality, right? That's just volume.
00:37:39
Speaker
So how do we get from an idea around access and volume being the indications of quality to actually quality being the indication of quality, like people are getting better, like their lives are improved and they don't need as much care going forward.
00:37:52
Speaker
And I think it's going to be incredibly important. Just think about, I mean, think about the congressional level. There's been a huge push for like healthcare care affordability and it's come to like, i know you guys have been working more like value-based care, trying to bring the cost down, like, oh, hopefully profit off the spread by giving better care. This was like Medicaid and i think insurers have been trying to, um i think realizing that like healthcare or mental healthcare is super important in terms of getting long-term costs down. It's so many confounds of different things in your life and having good mental health is,
00:38:20
Speaker
extremely important in terms of having a good life and also not spending too much within healthcare, care which is great for insurers too.
Future of Mental Health: AI and Affordability
00:38:27
Speaker
And kind of my final question here is that, I mean, mental health as an area probably has changed so much over 10 years. I think it's my generation's equivalent of like the AIDS crisis. It's very well talked about. People very much acknowledge it But when you're thinking about these new trends like affordability, AI, private equity, I mean, all these different things, um what keeps you up at night, whether it's ah something scary or exciting over the next five or 10 years, like what keeps you up at night in terms of how this is going to change for better or for worse?
00:38:56
Speaker
I mean, I'm i'm really, i'm I'm an optimist, right? It's hard to be a founder and not to be an optimist. comes in And so i'm ah I'm an optimist, but I'm not just really because of, i mean, I used to say this like, you know, 10 years ago, i was like, one day there will be so much access to data and we'll have so much computing power that we will begin to better understand the human mind and what makes us tick. Like we know nothing. No. Yeah. As a society, we really know nothing about how the mind works and why do you feel a certain way? We're starting to pick at the edges.
00:39:31
Speaker
We're just starting to go oh, you know what? Like, yeah, there is a connection between what you eat and how you, and what your emotional state is. that, but like, and I don't mean just like people, some people would say that, but like now we, we know that's true.
00:39:46
Speaker
Oh yeah. There is a connection to just your raw genetics. Again, like it seems like, yeah, of course we sort of knew that, but we didn't, we didn't really know that. But the fact that we know that there's some connection doesn't mean that we figured it out because like a big data model that has influenced from lots and lots of factors, the the mind is like the most complex. And so the thing to that always I don't say bug me, but you know was was like what I always wanted to orient toward was the the analogy I would give was, you know hey, eight years ago, let's say, 10 years ago, so 2016, 2018, whatever you want to call it.
00:40:26
Speaker
What we had seen was companies that could take vast amounts of data about individuals and build models that with that data,
00:40:41
Speaker
they could predict your behavior and ultimately influence your behavior. Now, what are those companies called? They're called Facebook, ah you know meta they're called you know Google, they're called TikTok, right?
00:40:53
Speaker
mean They're called YouTube, right? that's what That's what those companies are, right? It's like vast, vast data collection companies that take a ton of environmental data, they map it against your social data, they map it against your behaviors in terms of how you engage with the internet basically, right? Like with your phone and with the with the internet more brit writ large.
00:41:13
Speaker
and And then from that, initially it was like, hey, we can predict the ads that you will click on better. And what it's gotten new now is we can actually ah we can actually modify your behavior, right? Like we can we can bring it down on a you know down a TikTok rabbit hole, right? And all of a sudden you're you're like thinking different things because you've been fed videos for days or weeks or, you know, months and you're and you've changed behavior. We can show you an ad that you never would have thought you wanted the thing. And all of a sudden you find yourself buying a pair of shorts in December and, you know, in Chicago. Right. Yeah.
00:41:49
Speaker
You weren't intending to buy a pair of shorts, but you go, oh, like this thing or. And it's like all that is behavioral. understanding and and modification, right? And it's like, wow. if so we So this was, again, 10 years ago, this was true. So i was like, wow, if we can do that with the idea that that can help sell more stuff which isn't a bad thing, it's fine, sell more stuff, then why can't we take that same sort of methodology and use that sort of for good, right? Like why can't we take that and say, let's not instead of, we don't want to stop selling more stuff, but on top of that, say with all this information, we can actually help people understand themselves better, know thyself, right? They can help them change their behavior for the positive.
00:42:35
Speaker
help them really like improve their own life and the lives of them those around them. And so I didn't foresee 10 years ago that we would have LLMs in the way that we do and have like this sort of massive improvement in the ability to take large amounts of data and have that at our fingertips. I thought that we would have to build that ourselves, which we started doing in 2021.
00:42:56
Speaker
with the acquisition of a company called Quantify. and And I thought we would need much more compute than we need. So I didn't i didn't see sort of the GPU revolution, right? i thought it had to come really more with like, with quantum computing.
00:43:09
Speaker
And so the fact that that's come, and what I expected is like 10 years earlier, yeah is an incredible, incredible opportunity for society in general to actually start to use these tools and better understand how to improve our mental health. And I think that like the the future is incredibly bright in terms of addressing the mental health crisis with the with the caveat, with the real caveat being that any any technology, any sort of major change in how humans behave has the risk of creating very severe negative effects.
00:43:47
Speaker
right We've seen that with social media. We've seen that with other, you know I'd say we've even seen that to certain degree with the the move to like more remote work and more interaction that is is done through the screen and through through webcams, as opposed to human
Conclusion and Optimism for Mental Health Advancements
00:44:03
Speaker
interaction. right like All those that have unintended effects that we have to be very cognizant of, and it's difficult to understand what the what some of the unintended effects will be of AI. So i'm ah I'm an optimist, but I'm cautiously optimistic about some of the broader effects that you know we'll see across society. Yeah. I would say cautious optimism is probably the type of mindset you want with any sort of techological technological change. I know, for example, like the social media stuff has hurt a lot of people, but it's also helped a lot of people too. um so I'm hoping AI will ah do the same, more of the latter, help a lot of people. And i think it will revolutionize lot of new industries in the same ways as past technologies like the internet or steam engines have in some ways. So I'm excited for that, especially as a neuroscience major, seeing how understanding how the mind or understanding of the mind will fundamentally change. But it's been really great to have you on, Mark. Thank you so much for walking through your story, what's going on in the industry, what you guys are doing. And then um I think it's been a really interesting discussion and hopefully more and more attention is going to be shed light on like what's going on here and how we can better orchestrate this whole mental health industry. Yeah, thanks, Akhil. was fun.
00:45:13
Speaker
Thanks for listening to The Healthcare Theory. Every Tuesday, expect a new episode on the platform of your choice. You can find us on Spotify, Apple Music, YouTube, any streaming platform you can imagine.
00:45:25
Speaker
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00:45:38
Speaker
Repeat, thehealthcaretheory.org. Again, i appreciate you tuning in and I hope to see you again soon.