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Supply and Demand in Mental Health | Backpack Healthcare's Calvin Harjono
17 Plays4 months ago
In this episode of The Healthcare Theory, we sit down with Calvin Harjono, Chief of Staff at Backpack Healthcare, to explore the transformative approach Backpack is taking in pediatric mental health, especially within underserved Medicaid populations.
Calvin shares his journey from public health studies at Harvard to venture capital and operational roles, discussing how these experiences shape his mission at Backpack. He delves into Backpack’s innovative mental health app, which offers therapy, psychiatry, and self-care tools designed with a culturally competent and tech-forward approach. Calvin explains their unique clinician residency program, aimed at addressing the therapist shortage while building cultural competency within the Medicaid system. Learn how Backpack is pioneering accessible mental health solutions by combining technology with value-based care models, creating sustainable, scalable support for youth. Calvin’s advice for aspiring healthcare entrepreneurs? Find your “why” and let it drive you to reshape the future of care.
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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.
Guest Introduction: Calvin Hargano
00:00:14
Speaker
On today's episode, we're with Calvin Hargano, who studied in public health at Harvard and is now chief of staff at Backpack Healthcare. Backpack Healthcare is trying to really revolutionize what mental health looks like for youth through their self-care app and telehealth
Calvin's Journey into Healthcare
00:00:28
Speaker
providers. So, I mean, thanks so much, Calvin, for doing hopping for joining on today. I'm super excited to get into your story. Yeah. Thanks for having me. Looking forward to the conversation.
00:00:37
Speaker
Of course. Yeah. And before we get to the backpack and your work there, I mean, could you start by telling us a bit more about your background, why you got into public health and kind of what brought you to healthcare in general? Yeah. Um, I think it's a great way to sort of get us grounded. and My background is, and has been across, I think several different lives, all within the domain of healthcare. care um Which I think has added to a bit of the perspective that I'm able to bring to the team today and maybe sort of sit setting the foundation for where things may go in the future. um So I am a former management consultant working for our
00:01:20
Speaker
healthcare payers and providers, ah predominantly in the Medicaid space, thinking about introducing new pilots, new concepts, measuring the impacts of certain programs and initiatives.
00:01:34
Speaker
um i I was an operator and I spent a ah bulk of my career in the dialysis space at a company called Soundlight Healthcare. It's a regional dialysis provider. I got to do some very fun things there. um And if you think of healthcare being broken, dialysis, I think, is a great example of that.
Innovative Kidney Care with CVS
00:01:58
Speaker
There are a lot of legacy practices and incentives that lead and do not incentivize the best outcomes for patients, and does not prioritize the needs of patients. And so it was a very sort of eye-opening experience for me, stepping out into my second job to to really get under the hood of what's wrong with healthcare at large.
00:02:24
Speaker
um I got to do some fun things within the space. Notably did a joint venture with CVS Kidney Care, where we were thinking about and executing it against how might we redesign kidney care here in the United States. If you think about the statistics, especially for those that are predominantly in the Medicaid space and being so local, 90% of Americans live within one mile of a CVS site.
00:02:52
Speaker
So how might you create more accessibility to things like dialysis services um and get towards this sort of preventative side, the chronic care disease management, before things become chronic diseases at large?
Medicaid Focus at Rock Health
00:03:08
Speaker
And so that was really the ah genesis of the concept behind the joint venture. So got to get into the world of introducing services to health hubs and CVS sites, to joint ventures with our actual dialysis facilities, to value-based care arrangements, introducing Aetna to the table, and how might you sort of incentivize the best behaviors for the benefit of the patient.
00:03:35
Speaker
And the last life I sort of had, um but still very remarkable in terms of the perspective I bring today is on the venture side. I was a venture fellow at Rock Health doing early stage digital health investments on a sort of opportunity I took on while in grad school.
Backpack Healthcare's Mission
00:03:56
Speaker
And for me, I thought about it as a sort of year-long exercise of finding the best in class Medicaid services providers.
00:04:05
Speaker
When you think about getting so deep into certain sectors, um being able to step back, which is what I think the venture world allows you to create that wide aperture across the healthcare care landscape, um provides you an ability to understand what is truly going out um going on in the field, where there's still opportunities, where things may be perhaps too saturated.
00:04:31
Speaker
um And so for me, it added me it ah added that sort of broad perspective. So coming out of grad school where and I got my MPH at the Harvard School of Public Health, um it allowed me to be very definitive and be very prescriptive with where I wanted to go thereafter leading me to the role that I have now, which is Chief of Staff here at Backpack Healthcare.
Virtual Therapy & Training Programs
00:04:57
Speaker
um Okay.
00:04:58
Speaker
That makes a lot of sense. I like that idea, the way you phrase like the VC framework. you and like the way when i was in the vc space You start with a problem and see and where are the opportunities within this? Where can you kind of be value additive? and Of course, I know you've probably spent years trying to answer this question at Harvard. um like What is wrong with the healthcare care system? In terms of like backpack healthcare and mental health space, in your opinion, like what is wrong with healthcare care there?
00:05:24
Speaker
Yeah, let let me share maybe a little bit about who we are. So ah we are a pediatrics mental health company with a particular focus in the Medicaid space. Today, our sort of bread and butter, if you want to call it, has been our therapy and psychiatry services. So this is a pretty, and it's all completely virtual. So this isn't anything I'd describe as being earth shattering.
00:05:50
Speaker
ah One thing neat about what we do with our virtual therapy and psychiatry is that it's fueled by what we've developed in-house, which is a ah residency program. We are literally addressing the shortage of clinicians within the space. It also allows us to control the quality of care we deliver, and it allows us to add diversity within the space.
00:06:13
Speaker
with our focus in the Medicaid space, over 60% of the population we serve is on are people of color in the Medicaid space. And
Scaling Mental Health Services
00:06:24
Speaker
over 60% of our clinicians are also people of color. And so that sort of cultural congruency really adds a next level type of relationship aspect between therapist and patient. So that's one side of the house.
00:06:41
Speaker
And that's really sort of where we've come from, the genesis of the company, which is to move the needle at the midst of the mental health crisis through COVID. and And I think where we're at today is this very defining moment for us as a company, which is moving into the ether of technology. We've seen the market pull us in this direction.
00:07:05
Speaker
And I think this is very notably distinct within the Medicaid space because of the challenges of scalability. So the question that is begged from that is how might you create scalable solutions to serve those in the Medicaid space?
Clinician Diversity Challenges
00:07:22
Speaker
And that's where technology can come in to enhance the impact, improve the experience for patients, um improve the sustainability of your clinicians.
00:07:34
Speaker
So we've created a whole host of infrastructure for pediatric mental health providers. We've created a suite of AI solutions that allow us to put in the hands of our clinicians to allow them to do their work more impactfully and more sustainably. um And for us to to create the sort of business synergies that we need to be able to operate within the space.
00:08:02
Speaker
So that's a little bit about who we are. you know I think when you think about, to answer your question more directly, like where are there what's what's wrong in healthcare care in the pediatric mental health space? Well, I alluded to one, and maybe we'll start there, which is the shortage of clinicians. um And it's ever-present, especially in the mental health space. um Therapists are hard to come by, now especially good therapists.
00:08:31
Speaker
And that's what our residency program aims to address, this supply and demand imbalance. What's unbeknownst to people, however, is that when it comes to clinicians, especially mental health clinicians, a majority of clinicians here in the United States are people that identify as Caucasian or white. And there's a reason to that.
00:08:58
Speaker
When you look at the statistics of who passes the test so to get your full licensure, at a far greater proportion or percentage, white clinicians are passing that test than persons of color. and And if you ask yourself, why is that happening? It comes down to the way that they're trained and the hours that they need to become eligible to take that test. And the training for those that our people of color have predominantly not prepared them well for taking that test compared to their ah white counterparts. And that's where our residency program aims to address the the cultural competent training that's not only needed in the space, but also to move up the socioeconomic ladder to get your full licensure.
Improving Medicaid Services
00:09:52
Speaker
There's also the barrier of cost, which is that
00:09:57
Speaker
When you take your license your full licensure, what you need before that are ah ah a number or actually quite many of hours called supervisory hours. And for some folks, you got to pay out of pocket and it can be upwards of like $200 an hour to to then prepare you to be eligible to take the test. So that becomes an issue.
00:10:23
Speaker
um And of course, like barriers to then who actually ends up becoming therapists and who ends up becoming and serving the patients at large. So I think that's one piece of it. The second, I think, challenge within the space is, ah particularly in Medicaid, which is government-sponsored healthcare, care um scalability can be challenging and reimbursement rates.
00:10:45
Speaker
and so We know Medicaid to be challenging because it's very state by state, and that's how it's administered here in the United States. And the rates that come along with it also have been relatively lower than they, than you would see in the commercial side. So from a venture perspective, why invest in Medicaid when it's so difficult on this side, when you can go commercial and go national with one contract and be done with it altogether? Yeah. Yeah.
00:11:13
Speaker
and And so there's a couple of things that we're doing to maneuver that. I think one thing that that's been really interesting for me personally is we've been able to secure value-based care contracts with a national payer that allows us to introduce actual like outcomes and get paid for those things on top of your traditional fee for service. It truly supports our gross margins at the end of the day to be able to work the economics out.
00:11:43
Speaker
which is great. And the last piece I'd say is the big challenge within the healthcare space at Piazza Healthcare is um the inability to get care. I've heard tales, horror stories really of ah parents having to wait weeks, if not months for their kid to see that first appointment with a therapist. It's especially difficult if you're not on a commercial plan.
00:12:14
Speaker
Um, I think the last statistic I saw and to back up 50% of all kids in the United States are covered by Medicaid or chip 50%, one and two. And only 14% of mental health providers except Medicaid. So if you think about a mental health crisis, you know, double click that into Medicaid space and it becomes
Accessibility in Children's Mental Health
00:12:38
Speaker
even more bleak of a situation.
00:12:42
Speaker
So accessibility is is a truly difficult piece. And so for us, we think about how might you create the right level of care or for the entire spectrum of patients with behavioral health needs. There may be some, I'd argue there's about 20%. So if you're on a spectrum and you need some sort of mental health service, I'd argue probably 20% of them require therapy or psychiatry.
00:13:12
Speaker
And those are probably, you know, you've already gotten to what I would describe as severe and I'm no clinician. The other 80% have some sort of need, but maybe they don't necessarily qualify for therapy or psychiatry. So what do you do to support them? Think about like yeah times of like, you just feel down, you feel depressed. Maybe you're going through a really rough patch with your relationship or it's cool.
00:13:38
Speaker
And so that's where our technology can come in to support both on the preventative side, but then scale up or or triage upwards. If patients need therapy and psychiatry, that's where our services can come in. That way we can serve the full spectrum of kids up and down, whether they need you know one time a month service and very low frequency and low interventions to very high
Preventative Care Strategies
00:14:04
Speaker
levels of support.
00:14:05
Speaker
Um, so it allows us to be very flexible to the needs of the population. Okay. Thank you. Thank you so much on that. I mean, that was a really deep and long, like there's a lot to unpack there, but I think like one of the last things you mentioned, like, I think it was like an all or none approach with mental health care, where like, if you're a student, for example, if you have a problem, you refer to like your students, schools, like psychiatrists or therapists on hand or counselor. And I think we need some sort of intermediary where.
00:14:33
Speaker
If you have a problem, say you're in the other 80%, right? I think a psychiatrist might be too much for you because you're taking away resources from those who need it, but also nothing having nothing to do, like no other solution is also just as bad. So, I mean, how do you do you guys at Backpack Healthcare care solve for those other 80% where a psychiatrist might be too much, but I mean, not addressing them could just lead to worse issues, which would end up putting them in that 20% later, right? So how do you guys navigate that at Backpack?
00:15:00
Speaker
Yeah, I think the goal is to get, is, is, well, I think one to meet patients where they are, whether they're in that camp or the 80%. I think our our philosophy of it is, is if you're able to do and introduce preventative interventions upfront,
00:15:20
Speaker
that can either delay or even replace the need for therapy or psychiatry down the line. It's kind of like before something gets bad, you like do the right things upfront. That way it doesn't get bad. ah number It's bad. Yeah, sure. And so that's I think where you can introduce a lot of like self help, wellness tools, resources. And of course, like you've got to be sensitive to who is it that your target demographic is. ah If you think about kids between the age of four to 26, which is who we serve, these are these are kids that are very young to being like yeah like young adults, right? And then adults, really. And so you've got to think about how do they like to interact? What are they sensitive about? What's what's really convenient for them when it comes to how you deliver your service?
00:16:15
Speaker
because like kids these days, we often get this question around like using like telehealth versus like in person, but you gotta understand these days, like the youth, even myself, like we're so we're such digital natives that it would be kind of odd for us to to think about a world where it might be different. Now that's not everyone, but I'd say it's a broad swath of who we are today as a society.
00:16:46
Speaker
And so when we think about like from a UX, from a product design perspective, it is it is of the utmost importance we think about who is the end user. And by the way, the end user is not just the patient themselves, but you gotta think about the ecosystem. To your point, there's a school counselor that's involved. um Oftentimes with the kids that we serve, their parents involve their caregivers. 30% of the population we serve come from foster care.
00:17:15
Speaker
And so it's a very high needs population. um They're removed from the home. So it's usually some sort of guardian or caregiver. And so you got to be sensitive to who that person is, their relationship to the patient, and design your product to make sure that it accommodates the right stakeholders with the right information um to ensure that you get the best care you can.
AI and Quality in Mental Health Services
00:17:40
Speaker
Okay. Yeah, that makes sense. And I think like, I mean, i with telehealth, for example, I kind of want to touch more on this because For example, in 2020, when I was in quarantine, we had Zoom classes. And that stuff is hard to pay attention to. And it's hard to be engaged and get the same like education quality. right And we have this like pressing issue where there's not enough supply, they residency bottlenecks. like You're not getting like enough good psychiatrists or therapists. like i mean Can you kind of walk through like how your residency program ensures that like these students and kids like get the best psychiatrists possible and also like develop that cultural competence? because
00:18:14
Speaker
I mean, these are like intangibles that like are hard to kind of train and build. Like what, how do you guys approach that backpack and make sure that if someone's having a telehealth class, like they will get like the best provider possible, even though that they're in Medicaid or not as wealthy as maybe some others might be.
00:18:31
Speaker
Yeah, yeah, I think there's two big levers. I i would probably share that that we do specifically to sort of tackle this like relationship and ensure like the best outcomes are elicited. I think one stems from training. And so that's like ensuring that your clinician is trained with with the best sort of like intentions to serve this specific population.
00:18:58
Speaker
ah We developed our program with John Hopkins. It has specific elements in it that's around cultural broaching, talking about differences and perspectives. um And so for us, it's baked into the way we train our clinicians, that they are able to understand different viewpoints, be accommodating to different cultures, which is not something I would say that is present at large today within the industry for for like therapist
Self-Care App Features
00:19:30
Speaker
training. And one of the key pieces that makes us really unique and then trick trickle into the relationship that that clinician has with the patient. The other part of it is ensuring that the right sort of infrastructure is set up. And so that might sound a little odd.
00:19:49
Speaker
But yeah here's another way of thinking about it. We have, for example, one AI solution I'll highlight, which is an algorithm and that stems from our large language model we've developed in-house that matches patients to therapists.
00:20:07
Speaker
And so what what comes about of it is is that it analyzes a number of different components to what their relationship looked like. And it learns as you go as well, of course. So things like um like preferences on, of course, like the gender, the the cultural congruency,
00:20:29
Speaker
The age range that's preferred in terms of like, I'm a clinician and I generally work with those that are this age, the clinical indicators that the clinician is known to make impact scores on. And when you, when you layer in these really sophisticated tools that streamline the process, it it adds for even more ability for not only the training to like kind of shine through,
00:20:58
Speaker
But ensure like that, that patient based off the factors that we're able to see in the clinician, based off the factors we were able to see are matched up in a way that makes a lot of sense when it comes to their therapy and psychiatry relationship. Okay. That makes sense. So so with the onboard now you have like AI to kind of dissect what's the best match and kind of pair them up. And I know like, I mean, like that's I think that's a good segue into like yourself care app. I think, I mean, I had.
00:21:27
Speaker
I kind of like this idea a lot and I was thinking about like what other avenues are there are to approach this and for like our student accelerator on campus. And it's cool to see that someone else already is doing this and successful. So I mean, can you kind of walk through kind of what this healthcare app does and how you guys approach that? Because I definitely think like being able to kind of track your mental health and gamify it, not really gamify it, but kind of make it engaging for students and kids is what's important. But I mean, with bibliotherapy and things such as that, I mean,
00:21:56
Speaker
I don't have the most familiarity and neither does the audience probably. be So love to hear more on kind of how you guys approach that. Yeah. The app is a ah key component to like our platform, which has a whole bunch of other stuff. Um, and the app itself is to your point intended to be this patient facing caregiver facing solution that centralizes the care that's needed.
Gamified Mental Health Treatment
00:22:24
Speaker
Um,
00:22:25
Speaker
It first starts off with the onboarding process. And that's us getting to learn about each other. We we share a little bit about how to use the app, what it's good for, but we also learn about you. And it starts with understanding where youre where you're at with your journey. There's a series of questions. It's a very sort of easy sign-up process. And it establishes what I like to call like that baseline.
00:22:51
Speaker
Yeah. um It's both like baseline from a, from a clinical standpoint. Um, there's also social terms of health that are incorporated into it as well. And based off what it learns upfront, it then triages you to the right level of care. It may say, Hey, look, you go like you very qualified for therapy or psychiatry. Like, have you considered doing it? And by the way, we have some clinicians that you can get connected with if you need it.
00:23:20
Speaker
For those that may not qualify for therapy in psychiatry, that's where the app really begins to shine. There's a whole host of different tools and resources for the patient and the caregiver. One that you alluded to earlier was is bibliotherapy. It's a form of reading as a form of therapy. um Those not familiar with it, it's actually the first form of therapy ever created. ah The way that we harness it is we we use um sort of this gamify experience for kids.
00:23:51
Speaker
We think about do dopamine manipulation for good, and it's it's a sort of gamified experience where kids walk through modules. There's four different age groups, so of course it accounts for different level of competencies, different experiences that help build self-help, help build perseverance on topics like how to deal with anxiety, how to deal with loss.
00:24:19
Speaker
And it's all gamified to make things a little more engaging. So you win like golden tickets, you create your avatar, that avatar walks you through the different modules of it. And the purpose of it is, is really to adapt to my my earlier point where I'm like,
00:24:37
Speaker
who we are as a society these days, which is like really comfortable with like these sort of gamified experiences with like the attention spans that we have today, which is not a great thing too, by the way. um yeah And so that's, that's probably one one of the cornerstones of the app. The other parts of the app are things like um patient, patient generated treatment plans. So it tells you what you should do on a daily basis, like take some moments to meditate.
00:25:07
Speaker
um You know, go on walks, clear your mind, and and that's based off what your you're your baseline is. And it will continue to to update that care plan as it collects more information about you. And of course, you can't forget about the caregiver. So a lot of the patients that we serve are under the age of eight. And so the caregiver is very involved in their care. And they often have questions around, what do I do in certain situations?
00:25:37
Speaker
Another cornerstone to our app, the last thing I'll mention is we have a care companion. Um, and so think of it as like a chat GBT, but specifically based off our large language model that can be used as a caregiver, as a patient that is specific to mental health.
Partnerships for Accessibility
00:25:56
Speaker
So you can ask it things like, Hey, I want to have a conversation with my son around, um, some experiences he's going through at school around bullying.
00:26:05
Speaker
And it'll give you some recommendations on how to approach that conversation. Oh, you can ask it things of like, Hey, I need to get connected to therapy or psychiatry. And then I'll connect you to therapy and psychiatry and see what the uses are. So it becomes a very interactive way to engage with the audience that also tailors to their specific needs. Okay. That's, that's really, really cool. I think, um, I like you guys have a gamified approach because I think it's unfortunate, like how and apps like TikTok and kind of make people like shorten our attention spans, but you still have to appeal to that anyway. So I think it's definitely a really unique approach. And I mean, you have all these different services. I assume it costs like quite a bit to develop your own LLM. How are these engineers? Like, how do you pitch the economic incentives to insurers to kind of get this covered for Medicaid and make sure like people who can't generally afford this stuff can finally now afford like the best qui care possible. Yeah. We don't like to charge the patient at all.
00:27:05
Speaker
And I think that's where it goes down to maybe and more so my wheelhouse, which is sort of enterprise and go to market. And so if you think about the ecosystem of care, you definitely have like your your healthcare providers, like your hospitals and health systems. And so we contract with hospitals and health systems to get the the app fully fully paid for on behalf of their patients.
00:27:34
Speaker
We do the same thing with um payers. So when you think about improving network adequacy, reducing total cost of care, improving accessibility, payers are all over this. And so we work directly with payers to package our solution and make sense for their members. And the last angle that we're really, really, really, really, really excited about and have seen a lot of traction is with government.
00:28:04
Speaker
So Department of Social Services, foster care, these are all agencies that need help. um They have constituents that they are directly responsible for. And so our service like ours can come in and really support their population, um not only the ones that are in foster care, but um of other residents within particular counties, within particular zip codes, so forth.
00:28:31
Speaker
Okay. That makes
Advice for Healthcare Entrepreneurs
00:28:32
Speaker
a lot of sense. Yeah. I think like having these partnerships with governments, even like schools to get this technology, like that's as students when they need it. I think it'd be really great. And i'm I'm like, before we kind of wrap ah wrap up here, I mean, I've really appreciated kind of the walkthrough through like backpack healthcare, care but I want to learn like a little bit more about you. I mean, you have this background in public health, not backpack healthcare. You learned a lot about the mental health space and you're here to kind of help and scroll a scale and grow the business. But I mean, if you could step back to when you first kind of had the interest in healthcare,
00:29:01
Speaker
I mean, what's your advice to entrepreneurs and kind of our audience of the podcast too, or maybe a bit like less, of course, less educated on the space to kind of get more involved in healthcare care or like kind of entrepreneurship. What's, I mean, do you have any advice for yourself back then? Yeah. um I guess there's no way to really say this without being cliche. Uh-huh. But to, to one of the earlier points around,
00:29:27
Speaker
One of the unique things that I think healthcare brings that maybe other industries don't as directly is I think healthcare care is and healthcare leadership is so stemmed to how you resonate with the mission of an organization, of a vision, unlike other types of industries. When you so when you talk about things like mental health,
00:29:55
Speaker
And I look around the table of my teammates, my colleagues, even myself, who've all had unfortunately bad experiences with how mental health care has played out for either ourselves, our friends, our family members. And it's a really driving force in being relentless in your pursuit of finding a different reality not only to change the status quo for yourself, but to make a lasting impact for the next generations to come. So my advice for but really anyone rising or looking to make an impact in the healthcare care space is to find what what gets you so jazzed up about the work.
Closing Remarks
00:30:46
Speaker
Be very introspective with yourself. Be very real with yourself. I know my why. I think people at Backpack know their why.
00:30:56
Speaker
And for others, you know, you you really have to find your why. And the good news is, is that healthcare makes it a little easier than maybe other industries do. Yeah. I really love the way you phrased that, actually. It's something for me to think about after this episode, because like, what's my why? I think um that's a really good takeaway and I think a great way to kind of, I mean, on this episode, I've really appreciated, I mean, like kind of your background on the mental health industry and then.
00:31:23
Speaker
backpack health care tackles. And I really love that piece of advice at the end. I think i think students as a whole, it is hard to kind of grasp your head around that. It takes time to be in this space to understand. I'm i'm sure health care definitely speeds that process up. But I mean, thank you so much Calvin for but coming on today. I really enjoyed this conversation and um I hope you enjoyed the podcast. Thanks for having me Niko.
00:31:46
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. We'll also be posting more short-form educational content on Instagram and TikTok. And if you really want to learn more about what's gone wrong with healthcare care and how you can help, check out our blog at thehealthcaretheory.org. Repeat thehealthcaretheory.org. Again, I appreciate you tuning in and I hope to see you again soon.