Ep 13 – How Cerebral Upgraded Online Mental Healthcare with David Mou
In the thirteenth episode of Telehealth Heroes, we interview Dr. David Mou, the CMO of Cerebral, one of the largest online mental healthcare organizations in the United States. Dr. Mou tells us about the company’s meteoric rise, partnership with Simone Biles, and how their practitioners maintain the highest quality of care in the business.
View Episode Transcript
Brandon:
On today’s episode of the tele-health heroes podcast. I get to welcome Dr. David Mo, who is a chief medical officer of get cerebral to the episode. If you guys have watched TV lately, you’ve seen these commercials about get cerebral. And so it’s, it’s exciting to have Dr. Moe join us. And, and I’m very proud to say that good cerebral are huge docs, many users among our top users in the company. And so it’s, it’s, it’s thrilling to be able to talk to one of the leaders of get cerebral. So, Dr. Mou, welcome to the show today.
Dr. Mou:
Thank you. Thanks Brandon. And thanks for having me, what your guys are doing at doxy is really enabling tele-health to take off. So we have you to thank for that.
Brandon:
Oh, definitely. It’s it’s teamwork, right? It takes, we provide the tools, but it’s companies like yours that take it to the people. So, so tell us a little bit about gets cerebral and the problem that you you’re solving. Yeah,
Dr. Mou:
Absolutely. So I’m a psychiatrist, data scientist by training. I have to say that the mental health system is completely broken right now. The status quo. If you want to see a psychiatrist, you look up your directory. If you are lucky enough to have insurance and you have a list of all these different clinicians, you can call you, call them in the average, wait time to see a clinician is two to three months, right? So you’re severely depressed and you have to wait months before that happens, then you say, maybe I want a therapist. And when you, you have to find a different directory called the therapist and wait six to eight weeks to find a therapist. Very importantly, the therapist and the psychiatrist never talk to each other. They don’t coordinate care. They don’t measure outcomes for our over 90% of our mental health professionals do not measure outcomes on a systematic basis.
Dr. Mou:
So that’s just a broken system and tele-health has completely changed that because now what we do is first of all, we make sure that access is very good. When patients come onto our website, they could find a clinician within two days. And not only that, this is a condition specifically a match to them. So if they come in and they’re, let’s say they want an African-American therapist, who’s female who has a, let’s say experience in trauma-informed care. We can honor that because we have over 2000 clinicians in all 50 states, right? So they are able to be matched to a better clinician, and then they’re able to be, they are able to see that clinician within days instead of months. And that’s the real value there. You know, on the other side, we measure outcomes. So over 80% of our patients fill out these clinical surveys on a regular basis and we’re able track how they’re getting better or not getting better, and then adjust the level of care depending on that. And so all of that has allowed us to become that literally the fastest growing healthcare company ever within two years, around 21 months, 20, 21 months, we were able to go from zero patients to 200,000 patients in all 50 states and the UK. And we are launching a number of different operations that happy to talk about that are pretty, pretty unique to mental health. But we are closing a $300 million round in the coming weeks. And we’re hoping to become the global leader in tele mental health.
Brandon:
David, do you have a background in psychology? How did you get connected to get cerebral? And what made you make the decision to jump in and become the CMO there?
Dr. Mou:
Yeah, that’s a great question, Brandon. So I always actually running my own tele-psychiatry company PR previous to this and it was going very well. That company Valera, they, we just closed around prior to me alleving and it was growing very, very quickly. As a matter of fact, we just closed another round a few weeks ago. And so I, I was not intent on leaving, but when I met this cerebral team, there was something very, very special about it. Their commitment to outcomes was just second to none. And there, you know, I, I really trusted my CEO when he said, look, I’m going to give you the reigns over clinical quality. And if that means it’s going to be expensive, there’s going to be resources that are needed. I’m going to let you run that. And that’s hard to do, because if you think all of our company, I would say a lot of our competitors really focused on that scaling piece and they don’t focus as much on the quality piece. Right. So I thought it was a, an opportunity to really transform the top Keller at scale in a way that I wasn’t able to do previously where at a smaller scale, I would say. And so that was an opportunity to actually not pass by. And since I’ve joined, it’s one of the best decisions I’ve made in my life. And, you know, we’ve been able to redefine what high quality medical healthcare is and hopefully continue to do that going forward.
Brandon:
Do you still see patients today?
Dr. Mou:
You know, unfortunately, no. I, I used to see patients on the weekends in the evenings, but you know, this is the fastest growing healthcare company ever, and that requires 90 to a hundred hours of work a week. And I just couldn’t do it,
Brandon:
You know, in, in a way though, it’s like, you could see one patient could spend an hour seeing one patient, or you can spend that same hour improving a process that will improve the quality of thousands of patients. And, you know, in a way you are still seeing patients, you’re just doing it at a larger scale.
Dr. Mou:
That’s right. That’s right. And I, you know, I would say I do miss it. I really enjoy seeing patients. I actually do something that probably not the best use of my time, but I enjoyed it so much. So I actually have a clinical office hour where people will come and present cases and we would talk about cases and it’s, you know, we have a lot of these educational, they’re all free these sessions for our clinicians. And it’s one of my favorite, you know, times of the week to sit down and just talk about patients and, and see how we can help them. And they get updates on them.
Brandon:
That’s fantastic. You are well on your way. Now, what you’re proposing is probably been done before and other people have tried to do it. What do you think gets cerebral has done? That’s made it successful and the others haven’t been as successful.
Dr. Mou:
Yeah, it’s a great question. So I think a couple of things, one is the focus on quality. If you look at how other tele-health services work, they focus on scaling. They focus, focus on access, getting access to care. These are both important things. Don’t get me wrong. But if you just focus on those two, you’re not going to focus on quality and the outcomes are not going to be really there. And what ends up happening is that the insurance companies look at it and they’re not going to be very impressed, right? They’re not going to really want to work with you, right? Employers are going to look at it and they’re not really going to be impressed either. They don’t want to work with you, right? So institutions will not work with you. So they are solving a problem, but they’re not solving at the right level.
Dr. Mou:
So if you think about this, just Google top tele mental health companies, and look at their chief medical officers, most of them are not even psychiatrists. It’s very, very interesting. And it just tells you how little they prioritize the clinical side of things and how much they prioritize the other side of that growth side of things. Right? So that’s one major thing. We really focus on quality and a level that others do not. We publish papers on this. We’re actually running a quality study on suicidal ideation right now in conjunction with one of the largest insurance companies in the country. We, you know, when we showed our data, this is example of when you focus on quality of the other doors, it can open. We had a sit down meeting with the chair of the national health services in, in the UK. And he was so blown away by our outcomes that he’s, he’s helping us break into the UK.
Dr. Mou:
And we won our first NHS grant recently. So when you focus on quality, there are many, many other opportunities that begin to open up. Maybe I’ll need one more, which is that where our data infrastructure is so good that we were approached by pharmaceutical companies to run clinical trials. So in a couple of weeks, we’ll be doing that. We’ll be helping developing new treatments for pharmaceutical companies, for depression and anxiety and things along those lines. And you know, once you, once you have the quality piece, a lot of those others fall in place. The second piece is operations. And I think it’s not sexy people don’t like to talk about it. It’s not interesting, but it’s critical. And we have really the best operating team I’ve ever seen in any unit. I’ve been in a lot of startups. It seen a lot, a lot of operators and we really focus on outcomes. We focus on, okay, ours, we hold each other to it. We set very aspirational cars, but we, for the most part we do, we do get them.
Brandon:
That’s fantastic. I’m curious about this quality. So I get you guys focused on quality, but what does quality mean from the perspective of the patient? What do they notice about gets rebuild that they won’t experience with other other companies?
Dr. Mou:
Yeah. A couple of things about quality. One for the patient perspective, there’s the UX. It just has to be super simple and they’re able to do that, right? So the thing about the experience here, right? You go online, you either download the app, fill out a five minute survey immediately. You’re matched with a clinician. At any point you want to cancel appointments. You don’t have to jump on the phone, you just text it and they reschedule appointments, right? Very, very simple. You can get your appointment through the phone or on the web. So the UX is very, very easily done and conducive to people engaging in care. And if they don’t fill out a survey, we could just send them a brief message saying, Hey, can you fill out the survey? It’s really important for us to understand how you’re doing, right? So that’s, that drives a lot of adherence.
Dr. Mou:
It drives a lot of quality as a result of that other metrics that are really important. So for every mental illness, there is a validated scale validated clinical scale. And we follow this, right? So for depression, it’s the PHQ nine. That one that a lot of people are familiar with, but the brothers, there are many others as positive for anxiety disorders. It’s a GED seven ADHD to SRS, et cetera, et cetera. And based on the patient’s diagnosis, we would follow those scales on a monthly basis going forward. One other metric that’s really important. And it’s commonly glossed over, which is very strange to me. It’s medication adherence. So if you actually look at medication fill rates, so of all of the psychiatrist’s patients who get prescribed someone, some, some medication, what percentage of them actually fill the medications? It’s 50 to 70%. Yeah. That’s pretty alarming. Let’s just think about that. These are patients who see their psychiatrist say, oh yeah, doc, I’ll fill the medication. And they continue to see their psychiatrist, but only half of them, some, a little bit more than half of them will actually ever filled their medication.
Brandon:
Yeah. Let alone even take it. They might fill it and I haven’t take it. Right. So
Dr. Mou:
Exactly. So you wonder why a depression care tree, right. And I’m not just, it’s not just the U S it’s across the world. So what we do well, we realize that, Hey, we have to drive quality. If we prescribed the medication theaters and then taking what’s the point, what is the point? Right? And so what we do is we actually have our own pharmacies in our own partner pharmacies. And we ship those meds directly to patients’ homes. In our adherence rate, the fill rates for medications is 94%. So that’s industry leading. And part of the reason that we’re able to drive industry leading clinical outcomes, I think is because we’re able to drive adherence to those medications.
Brandon:
And it seems like you drive adherence and, and adoption and utilization just by making it easy as possible for the patient. Like it, you don’t really have to do much, just show up. We’ll do this, we’ll fill out this form. But it’s part of the experience. We’ll ship the drugs to you. It’s taken that burden than the onus off of the patient and just giving it to them. And lo and behold, they, they will do it if it’s easier to use.
Dr. Mou:
Absolutely. Yeah. So think about it this way. If you have diabetes, you go and see your endocrinology. See a doctor who specializes in that. You’ve got the motivation to do that. They tell you things and you understand them. And you’ve got, you’re able to go to the hospital, find parking, walk to the clinic, right. Wait in line, and then wait half an hour because American doctors, that’s what we do. Right. We make our patients wait, right? Yeah. If you have depression or anxiety, that’s much, much, much harder. Right. If you’re depressed to begin with part, one of their major symptoms is a motivation. You don’t have the motivation to do things. If you have an anxiety disorder. And the whole reason that you need to seek help is because you don’t want to be in crowds. Are you going to sit in a waiting room with other patients? No. Right. So
Brandon:
The butts or subway or something. Yeah,
Dr. Mou:
Exactly. Exactly. So this is, I think the whole system has been very catered towards the clinicians it’s been designed for the clinicians and it may work for other specialties at some level, but it certainly does not work for behavioral health. And this is where I think telehealth really transforms the service because it, it, it opens a lot of ways for patients to engage. And it makes it much, much, much simpler. I’m not talking about a little bit, right? This is a game changer in terms of, you know, how, how things are thought I thought through. So I think that’s a major thing. I’ll give you a couple of examples that I think are really interesting. 65% of our patients have never sought a, have never met a mental health professional beforehand. And I was alarmed by that. I said, well, that’s, that’s, that’s really, that’s a new, I started asking the patients will, well, what happens?
Dr. Mou:
Well, they say, look, I live in rural area. The city is an hour and half, two hours away. I can’t afford to take an afternoon off every week in order to go get therapy. So I don’t, but I know I need it. I didn’t really want it. And it’s been very helpful. Right? So th the, the distance has been basically not a non-issue with tele-health, here’s another one. And, you know, we should completely de-stigmatize mental health. I get that. We can’t avoid the fact that stigma is still there. Right? So we have patients, this is a very jarring for me and really changed my, how I think about this. We had a patient who kept on showing up on therapy appointments in his car. He’s just driving around. And we’re thinking, you know, I haven’t read the therapist called me up and said, Hey, this is this. Okay. And I said, no, it’s not okay. You can’t do that. You know, we might be talking about very serious things and, you know, he’s driving, you know? And so I said, yeah, tell him like, look, it’s this. He has to be in a quiet space. He can’t be driving. You know, we don’t want to put him at risk. You know, if we’re talking about past trauma, things like this lies.
Dr. Mou:
And then the patient said, I don’t want to tell my wife that I’m seeing a therapist. I don’t have an office at work. And so the only way I can do this, the only way I can get help is by driving around the block. And so your choice is to either help me get help this way and adapt your systems to me, or force me to give up help and not have help. And that completely reframed it for me, because there are these people who, for whom the stigma is still a very big problem, but for that reason, we should not limit health to them. So after that, we made our framework much more flexible so that we’re able to, to do some of these things. And, you know, and I think at the end of the day, what really matters is clinical outcomes. Not some principle that we’ve created a hundred years ago, that we want to, you have to lie on the couch. And if there’s not a couch, no therapy, right. We don’t want to do that. Yeah.
Brandon:
Yeah. And it’s really, the focus is on the patient, right? It’s not about the provider and, and that the healthcare system, or the payers, it’s about what does the patient need, what does the patient want and how can we get them? What they want is simply an easily as possible. And it certainly sounds like you guys have nailed that, which so kudos you guys. And, and so you guys started in January of 2020, is that, is that correct? And if everybody wants to roll black, Robeck their, their time, time work, 2020, January, 2020 was two months before COVID hit the United States. It was already hitting in, in, you know, overseas. How did COVID influence the, the, the meteoric rise of get cerebral and what would happen if COVID wasn’t here? What would you have still seen the uprise or would it have gone slower? Tell me, tell us how COVID had an impact on your growth.
Dr. Mou:
Yeah, very frankly, the answer to your question is, no, we wouldn’t have seen that kind of rise. I think they would have been a good business, but, you know, value that many billions not no chance within two years, no chance. So here’s the interesting about COVID there are some silver linings for, for COVID. One of them is that telehealth has been taken as a norm. So here’s a really fascinating thing. And it just blows my mind when academics study a specific intervention, let’s say telehealth, and they show that it’s valuable and it works. And it’s just as good. If not better, it usually takes 15 to 20 years before it actually trickles down to actual practice. That’s ridiculous to me. And this is actually true across all fields of medicine, right. That, that interface is 15 to 20 years. And that’s just outrageous to me, COVID changed people’s mind very quickly.
Dr. Mou:
So just some stats here before COVID 90% of telehealth. Right, right. After COVID, within three months, 90% of patient clinicians were using telehealth. Right. Those who didn’t retired. Right. So the idea here is that it was a real catalyst to unlock all of this clinical capacity and make telehealth normal. Right. So I think that was a major driver. Certainly the other thing I would say is, you know, the advent of zoom and doxy, me and companies like this have made this more normal, right. It used to be weird. And I don’t think people think about this through just two years ago, three years ago, to be on it. Like a video call was weird. A call is something, what that video is kind of the idea, right. And now w th the norms are changing. And so this is becoming less and less weird to patients. And that also is a major tailwind for, for the market.
Brandon:
How do, how do patients find get cerebral?
Dr. Mou:
Yeah. Good question. So we certainly advertise. So you probably saw that as Simone Biles is our chief impact officer. I mean, maybe a word on that too. I’m sure. Simone really had the pick of the litter over. I think 20 tele mental health companies were trying to get to her. And why did you choose us? It was actually because of our quality, she’s actually a patient of ours. And she, she is very well supported and she just loved the fact that she, things are measured and things are convenient and she’s on the move all the time. And we make it really, really convenient for her. So that’s been very, very helpful. And she is just such a fantastic human being. You know, I haven’t spoken to her, her mother now the few times they are just so mission-driven so humble and so willing to take risks in order to help other people.
Dr. Mou:
We’ve actually had patients say, I’m here because if someone likes, Simone can say that they have a mental illness, I could, I could do it too. If someone that powerful, that strong, that, that goldish can, can do this. It’s not weakness. This is actually a strength to, to have, you know, to be able to understand your own vulnerabilities. So, sir, that, to answer your question marketing is certainly a very large piece of what we do otherwise word of mouth travels. Very, very far, a lot of our patients are actually recommended by other other patients. And the last thing I’ll say is like, we’re beginning to publish more of our outcomes with insurance companies and whatnot. And so some insurance companies look at our outcomes and they say, wow, that’s really interesting. We want to make you a preferred provider. And so we want to steer patients directly your way. And so the first time insurance companies, literally, when they look up mental health, instead of that directory, I was telling you about where they have to call those numbers. The first thing that shows up is a cerebral and they could just go and get care that way. And we take insurance as well. Right. So these are the ways in which we’ve been able to get the word out.
Insert 42:01-46:25 here
So you’ve got Simone as your chief impact officer, and she’s going to take this effort to help de-stigmatize mental health care. What else is it going to take to help healthcare become further? De-stigmatize de-stigmatized
Dr. Mou:
Yeah, it’s a good question. So it’s that principle, right? Where you take someone who is a role model, who is strong, who is the top of his or her game, and for them to show that vulnerability, that’s what it takes. So what does that mean? That means the best athletes in, in every sport. It means the CEOs of the most successful companies. It means the most successful entrepreneurs. And when it becomes clear that these high performing people are taking time for their mental wellness, that’s going to be stigmatized in a way that’s a very, very different. So we were talking to some employers. So we, we do work with companies as well.
Dr. Mou:
The biggest difference, whether it works or not for a company, the engagement rate for, for a service like a cerebral is whether the CEO is involved or whether there’s someone in the C level is involved and says, this is important and shares a story and mentions this because everyone is, you know, there’s a stigma there already. They don’t want to seem weak, but when someone who they respect and they want to emulate, demonstrate this, it changes everything. So, you know, my hope here is that another is a thin silver lining of a COVID is that it really de-stigmatize mental illness in a big way. We still have a ways to go, but I think we’re definitely headed in the right direction.
Brandon:
You know, the other thing is there was a lot of stigma with going into a psychiatric unit at a hospital and walking into that and having that feeling of I’m not crazy, what am I doing here? Right. But, but that’s going into a physical location, but if you can go and get the care you need, well, now I have to go, you, the care comes to you in the privacy of your own home, and nobody else knows about it. There’s no stigma to worry about it at that point, because the whole stress of going into that environment, being seen by a neighbor at the unit is it’s vanished at this point
Dr. Mou:
A hundred percent. Yeah. So this really allows it. And you know, it begins, you begin to compare it with other things like, oh, I use Peloton, right. And I have a fitness buddy. Right. Oh. And oh, and I see a therapist, right? These are things for yourself care. Right. And so the equivalency becomes very different. It’s no longer compared to, oh, I had to get my colonoscopy or, oh, I had to go see my primary care doctor. And oh, I had to see my psychiatrist. Right. It becomes a much more normative thing to say, Hey, that’s, that’s, that’s normal. Right. And so the other thing I’ll say about this, as I know this is a little bit controversial, but you know, I think mental illness is, is a, you know, becomes a priority for wealthy countries, right? Because once you, you know, if you go to a place where healthcare systems are really shoddy, I wouldn’t say the first thing you want to do is focus on psychiatry.
Dr. Mou:
Right? You want to focus on infectious disease. You want to focus on surgeons, you can fix broken legs, right. And then eventually once you have those setup, then you want to focus on psychiatry. People deserve to feel better. They deserve to have the right to be more productive. Right. So, you know, I, I can understand like why, you know why this has taken a while to really just these ties. But if you look at the wealthiest cities in the country, you know, for example, it’s a joke in New York city, Hey, who’s your therapist. Right. People will just talk about it. It becomes a very normative thing to talk about. So I’m optimistic that we’re going to get there, but it’s going to take some time.
Brandon:
And it’s going to, like you said, the wealthy countries, this mental health is probably the one top one, two or three issues that Americans are facing today, but you’re right. You go to a third world country and that mental, those mental health issues still exist there, but they’re just not killing people. The same way that infectious diseases are, or other diseases that have been eradicated 30, 40 years ago are, are killing people. But eventually when those things get taken care of, well, guess what? That mental health is still there. It still exists today. It is going to become a number one issue. And so why not provide and make it available to everyone a hundred percent
Dr. Mou:
Completely agree with you.
Brandon:
What percentage of your patients have never had mental health care before and likely wouldn’t have got mental health care? If it wasn’t for gets rebuilt
Dr. Mou:
A hundred percent. Yeah. Great question. So we have very, very clear numbers at 65%, 65% of the patients here, the way I put it is never had the privilege of accessing mental health care. And these are people that maybe they can’t afford to drive in for an hour appointment. Even if they have insurance, they can’t really do it. And so, you know, a big part, a big part of our mission is democratizing mental health care. It should not be a privilege it’s healthcare. And, and we shouldn’t be able to provide people with it. Then people deserve to be able to be happy, especially those who are really wanting to find techniques and discover ways to where they can better themselves. The same way that we say people should go to the gym. People should really focus on their mental health as well in the same way. And so that’s a, that’s a, that’s a big piece of that.
Brandon:
Now, in order to support all these patients that you have coming in, you’ve got to have great providers. What is your process of going out and finding the best providers and getting them to have the quality, the standard quality that you have, that you want to maintain that quality of great care. What does that process of who do you look for and what type of training do you provide to make sure that the providers are top-notch meet your criteria?
Dr. Mou:
Yeah. Great question. So certainly when they come in, there’s an interview process and a training process to see where the people are. A lot of our great clinicians, you know, a sizable minority of our clinicians are actually referred in by other clinicians because they enjoy working with us so much. Once they’re in, I would say, this is one of the most innovative features of, of cerebral. We have an internal quality program, like, like no one else. So every month, every clinician is required to sit down and look at their data report. It’s a personalized data report. It shows them all of their patients by depression, anxiety, whatnot, and how they’re doing it’s score was here. Now it’s here. There’s a list of patients that are at high risk because their scores are very high. Their depression scores are very high. And the idea is that this is an actionable piece of data.
Dr. Mou:
Go after them, go talk to them. We set up another appointment with it, maybe change the medication. Maybe the dosage is incorrect, right? In addition to that, we have other metrics that are very helpful. So we audit their charts every once in a while. And we send back the feedback from other doctors, it’s all there. We also provide anonymous feedback from other patients, right? So patients can write feedback and give a star rating for their clinicians. And so all of that data is in one simple report. Every clinician is required to sit down and look at the report in, do better. And we, we have a, a paper actually that shows that month on month patients, our clinicians, sorry, do get better by a sizable amount. Right? So the idea here, Brandon is to really create a continuous learning process for clinicians. It’s something very counterintuitive for all of healthcare, not just mental health care, to have really direct feedback. And, and the reason is because no one measures outcomes. So it’s very hard to provide feedback, but because we do, we’re able to build this continuous learning system that keeps on improving the quality of care more and more
Brandon:
Now with the, you mentioned that the patients provide feedback and they, they take surveys and whatnot, is, is it the same provider that meets with the same patient continually? And they’ve developed this relationship long-term
Dr. Mou:
Yeah. Yeah. So that’s, that’s a big part of it, right? That strength of therapeutic Alliance is really important, right? So we actually care about longevity. I hear Insta care is what we call it, right? So does a patient stay with them because we actually, we actually make it such that patients could request a different therapist or different prescribers if they want. And we make that pretty frictionless actually. But the idea here is that, you know, we don’t want that to happen, right? If you’re a good clinician, your, your, your adherence should be high, your hairspray should be very high. And so what we do is every month we have a qual metric of the month, and this is like a quality metric that we say is important. And we actually give gifts to people if they are talking to farmers. And so the idea here is that we’re urging, there’s this, you know, the very rudimentary versions of pay for performance.
Brandon:
No. W the, so if I’m a provider and I have my scorecard or a report card, and I see, I see a patient that’s just not getting better. Do I have the initiative to go and follow up with that patient, even though the patient’s not asking for it, do I still have that drive the initiative to go help that patient proactively? Okay.
Dr. Mou:
Yeah. I mean, I think, I think that is the idea to be proactive here. And now, you know, the challenge of being proactive and mental health is you never knew when your patients weren’t doing well. You just never had the data, right. So if you let’s say a prescriber, you see your patient once a month, once every two months, they’re suicidal two weeks after your visit, how do you know they’re not going to call you and leave you a voicemail? They’re not going to text you. Right. So you just don’t know. And then you find out after the fact, right. But we have that data now and we’re able to arm our clinicians with that data so they can walk into appointments and they can be proactive about reaching out and talking about issues. And, you know, so it really changes the, the treatment model to optimize for the patient outcomes.
Brandon:
So obviously the patients are incentivized to, to they’re, they’re paying for this incentivized to get better. Are there other incentives that you guys use to help engage patients and keep them coming back so that they keep coming back and keep subscribing to the service?
Dr. Mou:
Yeah, so we, you know, I think the best way to do it, it’s just to provide high quality care and patients recognize it. If you look at our star ratings, 4.7 out of five, because patients come in they’re, I mean, they’re sick, they’re depressed. You know, they lost their mother to COVID. They, you know, they’re anxious, they’re not in a good spot. And when we really hold them and help them out, they are they’re, they get better. And they see that it’s a, it’s a very strong, emotional thing when you get better. And then for them, it’s very clear and they’ll send us messages and say, this is fantastic. You know, one thing that we do is that we do monitor patients, even when they let’s say leave, we say, Hey, you can come back at any point because mental illness is not one of these things where it’s like, it’s not like an infection. You treat it done. You don’t have to worry about it ever again. It’s something that comes and goes. Some people, for example, during the winter, their mood gets a little bit worse. Right. And then during the spring, they’re fine. Right? So for those people, they come in during the winter, they leave during the spring and that’s, that’s perfectly fine. We, we can adapt our care based on that. Right. So, you know, patients are, you know, very, we, the way we encourage patients to stay with us is just to unite behind the quality piece.
Brandon:
Right. And focus on them because there are times where they have an acute episode and they’re struggling after a death of a family member, or it’s a winner, but they don’t need that same level of care. You’re longer in perpetuity, but it’s just kind of, you adapt your service up and down, according to what the patient needs.
Dr. Mou:
Exactly. That’s exactly the way you said it. It was perfect. So we titrate the level of care based on the need of the patient. So for example, let’s say someone lost their mother to COVID and it was a traumatic experience. They have PTSD. So at the beginning of they use weekly therapy and medication management. So on a regular basis, let’s say it’s six months later, they’re better. They’ve learned coping techniques through the therapist, they’re on good medications. They probably don’t need to see their prescriber once a month, once every two months they could. That could be once every three months, even right. Therapy, they could take a pause from the therapy aside. And if these get worse, let’s say the it’s the anniversary of the event and things are getting worse. They can always come back and say, look, I need, I need that therapy again.
Dr. Mou:
Right. So the idea here is that we don’t want to again, make the system work for the clinicians. We want it to work for the patients and maybe a word about that you might ask, well, why isn’t that the case? That just makes too much sense. Why isn’t, why, like, why isn’t that the status quo, the Frank truth of this is that the business of mental health, it’s better just to keep patients on for indefinite therapy. Yeah. You just get paid more. You don’t have to see new patients, insurance paying for it, where they’re paying for it. What do you care? Why do you need to see new patients? You don’t want to create more work for yourself. Right. So that’s a problem, right? So there’s a monetary incentive against stopping care, right? And that’s what Claus clogs up. All of our mental health professionals, they have their panels and they’re not going to pick up new patients. They have no incentive to do that. Right. So for us, if your north star is clinical quality, you do have an incentive to do that. Right. And that’s why, that’s why we’re, we’re so focused on, on that piece.
Brandon: highlight miniclip: Combine 30:04-30:14 with 30:33-31:16
It really is a perverse incentive because your measure of success is them getting better. And if them getting better, it means they don’t need you anymore. It means you’re out of a job. So in some way, your measure of success is putting yourself out of a job, you know, in, in conceptually. But in reality, it just shows that you’re effective, which brings more people in. So while some people graduate from the program, it shows that you were effective and other people will come in, fill those holes.
Dr. Mou:
Yeah. And Brandon, I’ll say this, you know, in 50 years, 20 years, I don’t know what it is. I’ll be happy to be out of a job. If mental illness is
Brandon:
Eradicated mental health issues, right.
Dr. Mou:
That’s like a great thing. You know, what, what have to put into water to make that happen, but I’d be very elated for that to be the case. Right now, we’re very much on the other side of the spectrum. Like 18% of all human beings have mental illness and a tiny fraction of that tiny, tiny fraction that are getting the treatment they need. Right. So less than 2% are actually getting the treatment they need. Right. Let’s, you know, get them to care. Let’s get these people to care. And yeah, one day I hope that we could get so good with preventative mental health care that we don’t need this service. Right. But I think that’s probably going to take, take a little bit of time.
Brandon:
So in just two years, you’ve grown to, how many providers do you have now
Dr. Mou:
Around 2000?
Brandon:
So 2000 providers, where were those providers two years ago? Were they in other practices or are they just graduates or were they working at big hospitals? Where were they before? And, and what did they leave to come to you? Yeah.
Dr. Mou:
All of the above. And, you know, what’s interesting is that, you know, we were talking about how before COVID only 10% of people used tele-health and now 90% of clinicians use tele-health. Right. So they all had to go on telehealth. This was a brave new world. And so they, they talked to each other, what’s a good experience. What’s a good place. And we’re one of the top places to work for. And so they come and a lot of them are, you know, still have hospital shifts. Some of them are part time and others are seasoned therapists who just want to fill their panel. They may have, you know, 80% filled and they just want to fill out the rest. And, and others are like the flexibility. They could travel the world, travel the country as they’re, as they’re doing their clinical care and working. Yeah.
Dr. Mou:
So it’s a, it’s really a wide range. But again, you know, the beauty of all of this is that if you take all of these different attributes and just hyper target on clinical quality, you know, it doesn’t matter. Right. So sometimes, like for example, some new nurse practitioners are fantastic. They’re very good at following the correct treatment algorithms and staying with the treatment noggin. And then sometimes you get some very experienced clinicians who are not very fantastic. And there we say, Hey, look, that’s not, evidence-based prescribing, you gotta get a lab. They say, no, no, I know, I know better. I’ve been doing this for 20 years and I don’t think, you know, better than science. And so it’s actually not what you would expect, where the more years of experience you have in mental health, the better clinician you are in many cases
Brandon:
Right now, I could definitely see that because it’s hard to teach an old dog new tricks. And there’s a lot of new tricks out there that old dogs just aren’t up to date with where that’s exactly where the younger students are taught. They don’t know any better. Right. They’re just like, oh, this is, but you know, the data shows, the science shows, the research shows you follow this process, the patient will get better. Right. And if you don’t, you know, there’s randomized trials to show, show that it works and so follow it. And it works. So where you guys are in mental health now, do you, do you expand beyond mental health? Do you go to other diseases and specialties and where’s your next blue ocean?
Dr. Mou:
Yeah. Good question. So first of all, mental health is really going to be our bread and butter and anything we go into will be related to mental health. So first is international expansion. So we are in the UK, which is really, has been exciting. And we want to move to other countries as well. The other is that because our equality, again, you know, I sound like a broken record, but because we focus on clinical quality so much, we’re actually been chosen by pharmaceutical companies to run clinical trials, to develop new drugs. Right. And usually that’s reserved for the large academic hospitals, like Harvard and Stanford and you know, the top institutions, but they’ve chosen us to run trials because we we’ve been able to demonstrate outcomes. So I’m very, very excited about that. We have adjacent programs that are being stood up right now as well. So for example, I’m very excited about our substance use disorder treatment line. We’re going to have child psychiatry in a few months and the other one, that’s really a fascinating, so we have actually like a nutrition and weight management program, which is very, very, you know, dependent on mental health, right. That you are very related. And so, but the idea is that before we move into any of these, we just make sure that we have the best clinicians, the best treatment algorithms, and we go from there.
Brandon:
Right. So you guys are very much disrupting the mental healthcare space. What does mental health care gonna look like in five to 10 years?
Dr. Mou:
Yeah. Yeah. Good question. So in five to 10 years, I really think telehealth is going to be the modality for outpatient care. Of course, you’re going to have a small percentage, maybe 10, 15 percentage of people who prefer to see their therapist or a prescriber in person, main modality. And, you know, and I think what’s going to happen is we’re going to be able to do much more positioned mental health. Right. So instead of right now, the way we treat is actually very random. It’s a trial and error in terms of medication selection. So when you’re depressed, literally kind of trial and error and I’ll start you on. So, oh, that didn’t work. Sorry, I’m frozen. Oh, that didn’t work. Let’s try it. Yeah. There’s no, there’s no data to drive that. So eventually I think we’re going to be like cardiology, where it’s you come in and you have these symptoms and based on your heart rate, based on your EKG, basically what we’re going to go down this path, because that’s where the most evidence is.
Dr. Mou:
Right. We don’t have that right now. We don’t do that right now. So I think in a few years, we’re finally going to be able to do that. I actually think telehealth will enable that, but because telehealth, we’re able to collect much more information on our patients. And so I’m really excited about that. You could think about it this way. Let’s say I’m seeing you Brandon as a patient. And if we could record this session, right, I could actually probably assess your voice, your mood, the word choice that you’re using things along those lines that could be predictive of whether you’re going to respond to a certain medication. We’re not right now. No one’s doing that. And we can do that. Right. So there’s a lot of cool stuff that can be done with the data. Is there, we just have to do it right. So I, I’m very excited about what, what tele-health has been able to do above and beyond just increasing access, but it’s really laying the foundation to increase quality as well.
Brandon:
Well, definitely keep using docs me, cause we have some things come down the pipe that is going to be addressing directly the things that you were just talking about right there about using the data, using it, to deliver up that data and make use of it in the future. So exciting things. And so David would thank you so much for your time today. This was very enlightening and very fascinating and appreciate all the words of wisdom that you shared. And thank you for being with us today.
Dr. Mou:
Absolutely. It was a pleasure, Brandon. Thanks for all you do for the space and best of luck going for it. Thanks.