In this episode, Dr. Tamir Aldad, founder and CEO of Mindful Care, joins me to discuss strategies for addressing the challenges in mental health accessibility and costs. Dr. Aldad brings a unique blend of medical insight and business expertise, advocating for and implementing a model that integrates social impact with economic viability. He shares a tragic experience from his residency that exposed significant shortcomings in our mental healthcare system, which motivated the creation of Mindful Care.
Our discussion delves into the current issues faced by mental health providers, such as complex insurance reimbursement processes and the issue of patient selectivity due to high demand. We discuss the impact of social media and the role of virtual and hybrid care.
We discuss Mindful Care's success to date, plans for expansion, and how input from referral partners and community feedback is crucial in reaching underserved populations.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
In this episode, Dr. Tamir Aldad, founder and CEO of Mindful Care, joins me to discuss strategies for addressing the challenges in mental health accessibility and costs. Dr. Aldad brings a unique blend of medical insight and business expertise, advocating for and implementing a model that integrates social impact with economic viability. He shares a tragic experience from his residency that exposed significant shortcomings in our mental healthcare system, which motivated the creation of Mindful Care.
Our discussion delves into the current issues faced by mental health providers, such as complex insurance reimbursement processes and the issue of patient selectivity due to high demand. We discuss the impact of social media and the role of virtual and hybrid care.
We discuss Mindful Care's success to date, plans for expansion, and how input from referral partners and community feedback is crucial in reaching underserved populations.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
0:00:00 - David Williams
Have you ever tried getting mental health care? It can be exceedingly hard to find a provider who will see you, and even when you do find someone, they often don't take insurance. Does it have to be that way? Today's guest says no. Hi everyone, I'm David Williams, president of strategy consulting firm Health Business Group and host of the Health Biz Podcast, a weekly show where I interview top healthcare leaders about their lives and careers. My guest today is Dr Tamir Aldad, founder and CEO of Mindful Care, which seeks to infuse convenience into mental healthcare. If you like this show, please subscribe and leave a review. Tamir, welcome to the Health Biz Podcast, thank you. Thank you for having me Really interested to hear about what you're up to these days. I would love to start in the past, and it's not a psychological examination or anything, but I'd love to hear about your childhood, any childhood influences that have stuck with you throughout your career stuck with you throughout your career.
0:01:09 - Dr. Tamir Aldad
Yeah, so I was born and raised in New York on Long Island. Early on, I had a very entrepreneurial spirit. I think I opened my first dog walking business when I was eight years old. So I always was eager to build something, create something, influence people to support me, and so I think that started at a very young age. Had my real first job at 16. Was working for my senator at 17, capitol Hill, 18. So really I was very eager to be an overachiever early on and then was never satisfied, so kept pursuing more and more goals until it was medical school, getting my MBA, opening this startup, raising capital constantly chasing a moving target and increasing the bar and exciting myself by wanting to reach what feels like impossible.
0:02:07 - David Williams
Great, now that sounds awesome. Well, you partly answered my next question, which was going to be at your educational path, because I know about the physician side and MBA side International relations, I think as an undergrad. I'm guessing that came out of some of the Capitol Hill experience or things you were interested in at that time.
0:02:22 - Dr. Tamir Aldad
Yeah, yeah, you figured it out so. I went to GW for undergrad, was very interested in political science and international relations and GW had a really great IR program, so I thought that would pair nicely with my work on Capitol Hill.
I was working for Senator Schumer at the time. So did that while I was pre-med. After that went directly to medical school in New York and then after that was a research fellow at Yale School of Medicine for a while Thought I wanted to be a researcher for life and then eventually went back to do residency in general psychiatry, fellowship in addiction psychiatry, somewhere along the way there. Went to the University of Chicago to get my MBA. So certainly was very busy and then towards the end of my MBA wanted to solve a real problem that had social impact.
So started looking holistically at my education and my skill sets, the resources I have, the people I have around me, and thought that maybe we could build something to solve the mental health crisis with significant impact.
0:03:30 - David Williams
And that's when I decided to pursue opening, mindful care you know there's a lot of physicians who end up going to business school and sometimes then they get a connection, you know, with business people in different ways of thinking and something they didn't realize was a problem. Or they see it from a different angle, in different ways of thinking and something they didn't realize was a problem, or they see it from a different angle the way you just described it. It sounds like it was more of an analysis post that Were there, things in your MBA experience that said, hey, either there's a big need for this or you're not the only one that sees a problem, or there's a different problem from the outside. Or was it more after that, after that?
0:04:03 - Dr. Tamir Aldad
So the greatest impact came during residency. When I was a resident, we had a patient named Lauren who came to the emergency room. She was a college student who came home from school to visit her family. She found her mom had overdosed in the bathroom. Her baby sister was home alone. They were all rushed to the hospital. They were all rushed to the hospital. The mom had died and Lauren came to us. We were managing the psych emergency room at the time and certainly a really really upsetting, traumatic situation for her to be in. But she didn't meet criteria for inpatient hospitalization. So we sent her home with an appointment to see a psychiatrist in the community and then we found out a few days later she died by suicide and that was really upsetting. But also it really impacted me in that that shouldn't have happened. Yeah, the system is broken that we couldn't get her an appointment soon enough and we had no room to hospitalize her. And why? Was there a lack of resources?
So that story stuck with me and then when I was in business school, I was committed to figuring out is it possible to have a business that has social impact with sound economics? Your knee jerk reaction is no. Yeah right, they're almost mutually exclusive. You either have social impact and then you have golf outings and fundraiser dinners or you build a business, and I wanted to prove that they're not mutually exclusive. That was really exciting in business school to find other like-minded individuals at Chicago Booth and tell them that this is a riddle we have to solve. There has to be a way we could do this where we could put food on the table for our families while helping people, and we ran the concept through a competition called the New Venture Challenge and the Global New Venture Challenge. We won first place in one of them, second in the other, and that's when we realized that the demand is extraordinary and we really need to go to market with this solution.
0:06:21 - David Williams
You know the way you described I don't want to call it an anecdote, but the kind of the patient and the whole family experience that you had in residency, looking back on it as sort of like the perfect.
Your solution is designed to go against that sort of that problem, you know, writ large. I want to talk about that, but I want to hear a little bit first about kind of broader set of issues that are affecting mental health in the country today and maybe beyond. There's a lot of things that are pointed to, but I'm interested in your perspective, partly for your clinical background and also what you're seeing on the business side. Some things that I hear about and see maybe in my own family or circles are about social media. That's a big issue, the whole political climate, economic distress, even the less taboo to talk about mental health, which also may increase the demand for it. I don't know. But how do you see the whole kind of mental health situation and, of course, more broadly, behavioral health and thinking about opioids and other drugs as a factor in there as well?
0:07:28 - Dr. Tamir Aldad
Yeah, there's certainly a lot to unpack there. I mean you hit on each one. It could be a podcast episode. I would say the common denominator across all of them is an access to care issue, an access to affordable care. Them is an access to care issue, an access to affordable care. We have patients with Medicaid and managed Medicaid and Medicare and even some patients with commercial insurance that have to wait six to eight weeks to see a provider. In that time they could decompensate, meaning their symptoms worsen. They could be a danger to themselves and others. If they have substance use disorder, they could relapse if they're triggered.
So it is very, very high risk in terms of the environment and there aren't enough solutions in place to protect these individuals, so it's very fertile ground for mental health crises. Now juxtapose that, you know, the lack of access to care with the fact that people are more aware of their mental health and more triggered, so it's a very terrible, frightening combination of the two, because care isn't isn't really getting better, significant even the work that we're doing.
We're dropping the bucket. Yeah Right, we aren't small by any means, but we're not moving the needle that much. We're trying. We're certainly trying, but I wouldn't say that the problem is much bigger than just than we could single handedly solve. But, like I was saying, people now on social media um are seeing things that that they can't avoid. Let's say, constant triggers. Yeah, um, they're. They're constantly comparing themselves to others. They have an unhealthy pattern of use and behavior with electronics and social media and engaging with others.
And also the increased awareness and you mentioned that it's less taboo. That increases incidence and prevalence, even if it's partially artificial, right? I mean, there's that idea that if you create a new test or a new imaging, suddenly more people have the disease. Do really more people have the disease, or are you just better at detecting it? Right, and that's what we're still trying to figure out. That's what we're still trying to figure out. But I can tell you all three of those people being more aware, us being more sensitive to it and identifying it sooner, and access to care, being poor is really a very dangerous trifecta.
0:10:21 - David Williams
Yeah. So I mean you see this kind of throughout healthcare where you've got things. Let's say you know chronic illness where the near-term results are not as dramatic as what you described. You know somebody who has, maybe has or could potentially have suicidal ideation can turn into action very quickly. Somebody has diabetes. You know they missed their appointment or they can't get care. You know it has an impact. It takes a little bit longer. A lot of often talk about like kind of the iron triangle in healthcare. Right, you know access, affordability, quality, pick any two. So other people realize there's a problem, but not that many people think they could really solve it. And I'm wondering you know what made you think you could not solve everything, at least address it? You know in mental health, and are you able to do that to some extent?
0:11:10 - Dr. Tamir Aldad
Yeah, I think in this scenario where you're trying to do it all, you end up doing none, and we've seen a lot of people before us try to uphold the greatest level of quality with being the most affordable, with the most accessible, and it's really when you try to do everything you end up failing at everything. And from our perspective, it was prioritizing the affordability and accessibility to triage and then focusing on quality for ongoing care. So it isn't that you have to do everything all at once. We assess the kind of global problem that we see in mental health and assigned which of those is the most appropriate at which time of the care, meaning at the time someone's in crisis. Access is the most important thing and for that we offer same day, next day, mental health urgent care visits to triage the patient and moving forward. Once we've established whether or not it is a crisis or it isn't, it's an emergency or it is not, hospitalization is warranted or it's not then we focus on what is long-term a sustainable solution here.
Well, it has to be affordable. We should accept insurance so people can continue coming and feel better. It has to be high quality, adhering to clinical standards of excellence. So we realize that you take the timeline, the urgency, and then assign what you could really focus on to each portion of that patient's mental health journey to make sure they're successful.
0:12:49 - David Williams
Yeah, I think sometimes I know I gave I called it the iron triangle and it makes it seem completely insolvable. On the other hand, sometimes the frameworks can get in the way and you could argue as I think you're partly doing that like if somebody is in a crisis, accessibility and quality are kind of the same thing. You talk to somebody who's competent, somebody competent and certified. You know that's quality because you're addressing something right away before it then goes off a cliff and becomes harder to recover from, more expensive and so on. So maybe some of these things, when you look at it, the way that you're describing it and getting kind of that key thing to intervene on, maybe some of those, some of these things that seem like they're incompatible actually do come together.
0:13:32 - Dr. Tamir Aldad
Yeah, yeah, I can tell you, the most of our competitors are very focused on accessible and quality, but on affordable.
0:13:42 - David Williams
Yeah.
0:13:43 - Dr. Tamir Aldad
And that is everyone's trying to fish for a big fish. Who's willing to pay hundreds of dollars an hour for services. I don't know. I mean, maybe that makes sense, but you're leaving behind a huge market share of people that need help, that are eager and willing and want support, and they're being neglected, and then those are the people that we want to be there for.
0:14:09 - David Williams
Can you help me understand what urgent care means in the context of mental health? It's funny, cause I don't even. I think Maybe it's straightforward, but I generally think it's impossible to get an appointment. You could go to the emergency room and I don't think of the equivalent being out there for urgent care, where I can go in, maybe wait a little bit, but I can be able to get access and it's not at the emergency level. What is the concept and how do you actually pull it off?
0:14:37 - Dr. Tamir Aldad
Yeah. So for us the idea of urgent care is we have designated slots throughout the day where we will do a risk assessment and triage a patient of visit which mirrors portions of a psych eval and a portion of an emergency room psych visit into what we call an urgent care visit with the focus of triaging and assessing how acute your symptoms are, meaning we'll give you our opinion if it is appropriate to wait a couple of days or a week or two to see a psychiatrist, or we don't think in your case it's appropriate. So we basically want to be a alternative to someone who is going to the emergency room inappropriately.
We certainly don't want to replace an emergency room. The same way, if you go to a medical urgent care with a heart attack or with a stroke, they're not going to treat, they will call an ambulance and send you to the hospital. There's nothing an urgent care could do for you. If you're actively stroking or having a heart attack, same thing with us. If you're having a real mental health emergency, you do belong in a psych unit or you do belong in a psychiatric emergency room.
Our goal, though, is to help the people that inappropriately go to the emergency room because they have nowhere else to go. Those are the people that we want to be an alternative for.
0:15:59 - David Williams
Help me understand the issue about insurance with mental health. I've mentioned in the intro that you can find somebody, but a lot of times you know they don't take insurance, so they don't take your insurance. Is this all because there's so much demand that they don't have to, or is it hard for the providers to get set up, or what's behind this issue?
0:16:17 - Dr. Tamir Aldad
So two things. One is for many insurances the reimbursement is offensively low. So if the demand is so high it doesn't make sense to see a patient at rates that don't even cover your overhead. This was in one of my op-eds a couple of weeks ago that I was negotiating a fee schedule in Florida and one of the therapy rates was $14 for 40 minutes. If you prorate that $14 for 40 minutes to an hour, that's $21. I don't know a psychologist that I can even hire for $21 an hour. And that doesn't even include the overhead of the lights, the electricity, the rent, the EHR, the computers, the support staff. Whoever did the math there just doesn't make sense. So you're up against that. And then the other thing that you're up against is the demand is so extraordinary that you could cherry pick the patients that you want. You know it kind of goes make sense to take on the more challenging cases or the low reimbursement cases. So the physicians aren't properly incentivized and the demand is so high that you could pick the cases that you want, got it.
0:17:59 - David Williams
Talk to me about virtual care versus in-person, versus hybrid care. We've seen a lot of announcements just in the past you know couple weeks really about people getting out of you know getting out of virtual care or even in the case of Walmart, you know getting out of healthcare altogether and they actually had a behavioral health offering when they had started out. I don't know if they had continued with it. But what's going on in terms of virtual care, hybrid care? Where do you see the future?
0:18:29 - Dr. Tamir Aldad
Yeah, so interesting. I can't comment too much on some of the companies you mentioned but intimately familiar with the space of virtual care and behavioral health and different companies trying to do integrated care at different levels. I would say that our model is a hybrid model by design because of the flexibility that it brings and the added value from a compliance perspective and also the quality of care for patients. Patients who feel more comfortable establishing a therapeutic alliance and rapport with their clinician in person have that option. Those that want to sometimes come in person when they're feeling acutely symptomatic can, versus when they're stable they could stay at home. Some want to be at home for the entire journey. So we like offering that flexibility. I think it creates a better experience for the clinician and a better experience for the patient, and that's kind of anecdotal what I'm seeing at our facilities Assessing the entire landscape of the space.
I would say we have to be cautious with organizations that are purely virtual because it's unclear what exactly the future holds. So with billing and coding and fee schedules, it's unclear. With prescribing and controlled substances in the DEA, it's unclear. It's unclear. With prescribing and controlled substances in the DEA, it's unclear. Patient demand in terms of preference could change. So people who are doubling down on a very large, robust, virtual offering, I would just say we need to be cautious in case any of those change that could jeopardize those companies.
0:20:22 - David Williams
So we talked about how large the demand is and how varied, and also that, while you're sizable, it's hard to move the needle. Like mental health is affecting hundreds of millions of Americans, it's hard to move the needle completely on that. Where are you focusing? How do you decide what areas to focus on and what sort of success are you seeing when? You do Specifically Like from either patient population, type of disorder, you know, geographic focus.
0:21:05 - Dr. Tamir Aldad
Yeah, I think the you know, probably because we see every diagnosis, ages 12 and up, and every level of acuity, and we serve six markets, providing both individual therapy, group therapy, substance use, counseling, urgent care, long term care. We cast a very, very wide net. We cast a very, very wide net, so it isn't the precision is different from, let's say, organizations that compete with us that only want to see top tier, low complexity cases, they and depression for insurances that pay above the 75th percentile. Well, you have to really make sure you're dropping your hook in the right place, you know so we're not that we really try to treat everyone. I would say, though, say though, our target demographic mirrors the national incidence and prevalence data of mental illness. So we see primarily women 18 to 35 females and that's consistent with where we see the most incidence and prevalence for individuals seeking mental health services. So, which actually just further demonstrates our mission right.
We're trying to target the people most in need, and our averages meet national averages, so we're certainly landing in the right place, but that's kind of how we're targeting our patients.
0:22:45 - David Williams
Okay, that makes sense. I understand now why you're, I won't say struggling, but wrestling with my question, which is that your focus is on accessibility and affordability, which is inherently appealing to kind of a broad swath. So, it's more self-selected, as opposed to you described to me the cherry picking approach, which is what you're not taking in order to get there. So you've had good success. Where do you see things going over the next I don't know three to five years? What's the plan for the company?
0:23:14 - Dr. Tamir Aldad
So we're currently licensed in 14 states. We have brick and mortar facilities in six. The goal is to continue expanding and bringing the model to more and more states. We have brick and mortar facilities in six. The goal is to continue expanding and bringing the model to more and more states. Right now we're seeing through our referral partners that they have friends and friends of friends that wish our services were available in their states and our goal is to get there. So we hope to continue expanding and increasing access to markets we've yet to get to.
0:23:48 - David Williams
Have you had a chance to read any books lately? Anything that you might recommend?
0:23:53 - Dr. Tamir Aldad
So we recently implemented. There's a book called Traction, which is the entrepreneurial operating system of how to run a startup. So we recently as a leadership team, we recently finished reading that and implementing some of the strategies there to improve accountability and output and work together as a team. So that's certainly a good book. So that's certainly a good book. And then the Body Keeps the Score is an excellent mental health book on trauma and dealing with trauma. So on the clinical side, the Body Keeps the Score is also a really good book that we recently read.
0:24:36 - David Williams
Sounds good. It sounds like I should read both of those. On traction, I often say you know, there's no friction, there's no traction. That's what I usually say when people start arguing, and I do believe in that. But now I should probably read about it and learn something more.
0:24:48 - Dr. Tamir Aldad
There you go, there you go for sure.
0:24:51 - David Williams
Well, dr Tamir Aldad, founder and CEO of Mindful Care. Thank you for joining me today on the Health Biz Podcast. Absolutely. Thanks for having me. You've been listening to the Health Biz Podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.