The Detective 0:03
Imagine you're the CEO of Talkiatry. A trailblazing healthcare startup designed to revolutionise the mental healthcare landscape.
Speaker 2 0:12
Insurance is a big barrier. If it's not covered, even though they need service, they may not go because they can't afford it
The Detective 0:19
Talkiatry operates at the intersection of psychiatry and insurance, ensuring access to quality mental health care that's both affordable and convenient. If it wasn't so expensive. I'd maybe go to a psychiatrist would you be
Speaker 2 0:31
surprised to hear that there are psychiatrists who take insurance?
The Detective 0:34
Oh, I had no idea about it through the in network psychiatrist and state of the art tele psychiatry service. They offer personalised care to patients right in the comfort of their own homes. But this groundbreaking endeavour doesn't come without its challenges. How do you steer a healthcare startup through the tumultuous seas of a global pandemic, while shifting to a robust telemedicine model? How do you scale a burgeoning practice amidst an escalating demand for mental health services, and recruit top tier talents and leaders to propel your mission,
Speaker 3 1:08
you can choose what kind of patient population you want to work with, based on what your passion is, so that you can provide the best care for your patients.
The Detective 1:17
And in a competitive market? How do you attract skilled psychiatrists and provide them with a work environment that's truly unparalleled? This is beyond the couch.
Ben Kaplan 1:32
Robert, you've done all of this deep thinking you leased an office space, at the end of the year, you've got five psychiatrists on staff, you're ready to see your first patient, this is going to go great. And then you're going to scale to other locations, and COVID comes along. And suddenly, what happens
Robert Krane 1:48
so we hadn't accepted any appointments yet. So in the beginning of April, we were still planning our training on our electronic medical record, and some of our staff and things like that. And our training was planned to be in person. And this was right in the thick of its COVID a thing, is it not a thing, nobody really knows, right? People are concerned, it was very early. So up until literally the day that we started training, we were going back and forth on do we do this in person? What do we do? Do we even open our doors? Do we delay the launch of the business like, you know, now looking back, and it's like, Of course you don't delay it, you're a behavioural health company, but back then, it was still pretty kind of, we didn't know, you know, it was very difficult, we very quickly figured out now there's this, there's gonna be a massive need, and we're ready and we need to, we need to do it. But man, did it throw a wrench into the plans for training and everything, but to start shipping computers to people. And, you know, we were I was I was basically doing most of that work myself and my co founder, so we didn't really have, you know, a technology team to be able to set these things up and send it I was setting them up in my apartment. And so now we have to curry them, you had to get a courier to bring them to people's apartments and things so but it was always this question of, we're going to do telemedicine temporarily for right now. And we're going to come we're going to do patients in person. So we're still setting up the office on the side when COVID was in the middle of happening.
Ben Kaplan 3:00
So you're saying okay, COVID is happening had some support built for telemedicine, you'd be good if people hard to get across Manhattan to come to our office. And it might not be nice to like call in or come in and a video chat or something like that we can be fine, particularly psychiatry might there might be a lot that can be accomplished, they wouldn't have to be in person for so you're gonna have that it's a side thing. But then COVID plays that card. So now you're shifting to it. At this point, you're starting to see patients you're doing on a telemedicine basis, and you're waiting for COVID to stop, right? And then how much time is going by? And are you able to successfully operate on this basis? Are there unforeseen challenges, you're repairing computers in your apartment, what else is happening in your thinking just to kind of get through this time,
Robert Krane 3:40
I don't think you really have time to think to be totally frank about you just have to operate. You know what I mean? We we had I pulled the phones out of the office that we had, and I connected it with an Ethernet phone connected it in my spare bedroom, you know, when I was taking calls from the front desk there and I'd eat my dinner and they're just because you work 24 hours because we're working from home, right? And you know, the appointments kept coming in, there was such a dire need for care. And so we were super concerned about taking in patients who weren't going to be able to see us in person when COVID ended. And we would ask every single patient when COVID is over, are you within proximity that you can physically come into our office to see your doctor. I mean, we just didn't know and this went on for I would say probably a good you know, nine months of us kind of waffling and saying like we're going to have physical locations, we're continuing to look for other spaces, for example, the other practices growing we're bringing on additional doctors, the patient volume continues to increase. But we had to onboard we onboard hundreds and hundreds of employees remotely. We have 850 employees today, and most of them have never been in person. So I think it's a very different story when you had an in person culture that you then need to try a port to working virtually, but we just grew up with a virtual culture, if you will, right. So it's just natural to our employees and how we operate. But we just figured that out as we go. We didn't have an opportunity to do it any other way. And then you know, probably nine months in we started to survey our doctors, our patients saying, Do you need to come in? Do you ever want to come in? You know? And the answer was people moved around a lot. And the answer we got back was No, like I we saw better adherence, you come to your appointment more often, if you don't have to drive 30 minutes to get to it.
Ben Kaplan 5:12
You were in a mindset because you're offering from one paradigm where it's like, how do I scale offices? How do I scale real estate you're looking at, I can imagine, like traffic patterns and areas and what hospitals are around this area? Or what other services are there, you're looking at? Where does it make sense? How can I serve those areas? Where is there a greater need? And now you're having to change that to actually talk about licencing? Because now you're not talking about multiple locations in Manhattan, you're talking about other states, and you have to think about was it the same thought process, just different set of challenges? Or did you have to think about things differently in the business differently?
Robert Krane 5:46
I think thinking about things the same way, but it changed the number one priority, right? So you know, when you're always looking at expanding to states, and we're in almost every state now. But when you're looking at it in terms of what you go into, first, you're looking at, what's your payment model? So our payment model was insurance, and we knew who we were contracted with? And we say, Okay, well, what's the percentage of the population in the states that have commercial health insurance? What's the percentage of patients of people in the states that have a mental illness, for example, that might need care, right? So you're doing all of this analysis? And you're trying to pair it with? What is the pool of providers that are in that state? Right? A lot of psychiatrists live in California, Texas, Florida, New York, New Jersey, Massachusetts. So if you're going into, you know, West Virginia, for example, or Ohio, and you're looking at it saying well, how many? How many doctors are here that are licenced that we can use as well. So that that analysis doesn't change. But what does changes? Before that the initial one is kind of again, where do you put an office? How much does that office cost, and it's it's significant, it's almost all of the capital required to move into a market to a certain extent, right, from from the way that we were doing it. And so you're looking at that saying, If I don't have a physical office, now, the entire state is open to me, I don't have to mark it on a local basis, I can market across the entire state, I can work with employers or health systems that are in the entire state. And I can have a patient a doctor treat a patient that is anywhere in the state, right? Because it's according to state law. So that changes things pretty dramatically, especially if you're saying, why have a doctor who's licenced in New York and New Jersey, and they physically live in Pennsylvania. And it says, well, they can actually treat patients in New York and New Jersey now, wherever they're licenced doesn't matter where they're physically located. So, you know, it's certainly then you have to take a step back, and you're just looking at the puzzle pieces move around pretty significantly, but the underlying data you need to make decisions you already had gotten?
Ben Kaplan 7:27
And how did you think about the leadership team of the company during this time, too, it sounds like you and your co founder has medical expertise, you're viewing it in this view of we're opening up sort of like a next generation psychiatry practice, but then you're starting now you're embracing telemedicine now, you can kind of be everywhere. And I know, you started thinking about the leadership of the company, especially the C suite earlier on, is it a different pool of people, different locations where there can be now that you're mostly everywhere in the US? Or how did you think about that?
Robert Krane 8:00
I would say that, you know, we brought on to executive very early, so you had myself, right, and my co founder, who's our chief medical officer, Dr. Greg Harris, and in the beginning of 2021, so we hadn't even opened a year, we're still very small, we, we decided to bring on a really seasoned Chief Operating Officer, someone who's had decades of experience in the space managing physicians at real companies that are doing, you know, billions of dollars in revenue, as well, as a chief technology officer, before we even had any technology personnel at all. And someone who is just, you know, healthcare technology, through and through in New York City, working at places like city block or remedy, you know, ZocDoc, all of those places, so to really seasoned people in both technology and operations, so they've got four executives at a company that's barely a year old, and not doing the revenue that to support anything near that, right. And that's it, that's an alternative view, most people would not do that. Most of the time, like, if you're building a technology company, one of the co founders is the CTO, the other is a marketing person or product person, and they use that for a long period of time, right. And I think with us, we were so confident in the work that we had done, you know, for years prior to this, that we said, we can either not hire those folks now and make mistakes, for sure, you're gonna make mistakes, because neither Georgia or I were experts in either of those two fields, or, you know, you can spend the money now and invest in in bet on yourself, basically, to hire people that are smarter than you in those areas, so that they can build the infrastructure needed to support, you know, 1000 physicians, which is very different from 3040 or 500. And so, you know, we we paid up early on, to bring on two really seasoned executives. And that's hard, you know, because you've got to convince them to come to a place that is just so small compared to where they're used to working for, and they got to really believe in the mission and really be bought in and how
Ben Kaplan 9:38
did you do that? Was it the vision of what you could become wasn't just a sense of they understood that there was this hype of medical practice should be done differently. Are you just wildly charismatic? Robert, is that the secret?
Robert Krane 9:50
I'd love to say that but, you know, maybe that's a small, maybe it's a small part of it. I think. I think it's two separate things. Right. I think when you're talking about from the I'll talk about the operations and the technology Besides, because there's different reasons, right? So the operation side was looking at it saying, you know, this was built the right way in terms of, of the idea of managing physicians and employing them, right? That was very different from what people see in the behavioural health space. So so a seasoned operator in healthcare knows what what can work at scale. So they saw the bones and what we're building though, they also saw a massive need in mental health care, and it was after the pandemic happened. So they saw that, hey, there's an opportunity here, but there's this company is doing it right. And you're in
Ben Kaplan 10:27
the pandemic, so much of that is steered you towards telemedicine as people are experiencing some mental health issues from being isolated and having their lives disrupted and being worried about whether they're gonna get COVID or not, and worried about other things with family members and all that. So that's actually pushing you forward as well.
Robert Krane 10:45
Yeah, I remember he asked me when he came to the office to visit get to fly in because it wasn't you didn't live in New York. And he said, you know, after meeting myself, Georgia, and he said, why, you know, why do you need me here, I'm expecting to find something that's broken, there's a lot of problems, but I'm not finding it. And I'm not clear why you need me at this stage. And our answer was very simple, which is, you know, neither Giorgio or myself specifically have a lot of experience, you know, managing a practice with it with so many doctors he did, but it was kind of looking at it saying we are so confident in where this is going to go that we want to make sure that we're building and laying the right groundwork to do it at scale, rather than building something that then have to change a year later. And that's never great when you when you're providing care to patients and ultimately responsible for their life at a certain point. And I think that was exciting to him, you know, it's like, wow, I can I can get in here. And I can, I can build something really significant. And it's got the bones and the framework built to do that. On the technology side, my CTO told me no, when I first offered him the job, and I got introduced to him through a friend and I don't want him work to work on a project creating an intake for us online. And he'd liked that, that, that opportunity. But he didn't want to work here full time. And he didn't understand that, that it was sustainable, what we were doing, perhaps, and it took some time to convince him or he said like, well, I don't understand why you can do this, and nobody else can. Like I've talked to my friends that are psychiatrists, everyone's basically saying that you can't do what you're doing. It doesn't work when you take commercial insurance. And I had to explain to him kind of the work that we had done for years. And then he finally got it. And he said, Okay, wow, this is really interesting. But the reason why he came here is because we're not a healthcare. We're not a technology company, we're a healthcare company. And the big things that technology folks and engineers have is, when you build software, you want to build it for an end user, and you want to see the impact of your work, you want to be closer to them to get to build the best piece of software, you need to really understand what their problems were. And so you're at a software company that's selling the software to a bunch of people, you don't have that. And if you're if your goal, if you're in healthcare technology, you're doing it to impact the outcome of patient care. And if you if you're so far removed from that, you're not going to be as impactful. So what attracted him and his entire team to talk, it really was the fact that we were a healthcare provider, and that they were being so close to the physician, they could walk across the hall, or they can call someone and they can say, hey, I've got a question I'm building this, yo, do you want it this way or that way, and you don't get that when you're out of sass company building something for an end user, that's a lot harder to do, you gotta get studies, you got to ask to reach out to people. So the collaboration was closer. So the development cycle could move a lot quicker, and you could end up with a better product and an outcome at the end of the day. But they all wanted to work for a health care company, not a technology company. At the end of the day, which I think you know, helped us there, get the right people mission driven,
Ben Kaplan 13:15
let's say you do the right pivot, where the kind of the world is going, you get the right leaders, you're investing for the future, you're confident in where you're going that maybe you can spend a bit more a bit earlier to try to set up to scale. But then if you don't get psychiatrists, or if they don't have a good experience, then you've got a problem. Even if you're doing a great job marketing people are coming in, you're just not gonna be able to they can easily spiral the other way. Because people your psychiatrists are are slammed, they can't get to everyone, people are not getting a great experience, then they tell other people, it could start going the other way, too. So if there's few psychiatrists to begin with, relative to the population, and they tend to work in hospitals, or places that are not what you are building, how did you think about that? And how difficult was it to try to give a work experience where people would stay for very well educated, highly paid people
Robert Krane 14:07
talk about reviews, healthcare is a three sided marketplace, right? It's the physician who provides the care, it's the ensure who pays for it, and it's the patient who you deliver it to. And, you know, we thoroughly believe that there's an order to that in terms of how we were going to build it, and we want it to first serve physicians, just to your point, right. And if you don't have high quality physicians, this doesn't, doesn't work. And so, you know, we're just laser focused on providing the best experience for them the best place for them to work and, you know, we certainly have paid up for things that we couldn't afford at the time. You know, our health insurance is a great example. It was free from day one for doctors, you know, incredibly expensive, but for us, we said like listen, the and these are, these are these are people who are, you know, not being given the tools that are needed to be able to do their work to the best of their ability.
Speaker 6 14:57
continued treatment is especially important for People needed help with addiction of psychological issues. But what if those offices are closed
The Detective 15:05
amid the chaos of the COVID 19 pandemic, Robert crane identified an urgent need for accessible mental health care. His vision toward kya tree would face significant challenges.
Speaker 7 15:17
The use of telemedicine is a great way to keep infectious diseases from jumping from person to person to sudden
The Detective 15:23
shift to telemedicine, whilst promising proved a daunting task, especially as the demands of the Mental Health Crisis amplified. Building a scalable healthcare practice was no simple feat. With the recruitment of experienced leaders and tech talents posing an additional hurdle. Robert also grappled with the task of securing high quality psychiatrist in a competitive market, requiring innovative approaches to benefits and work conditions.
Speaker 8 15:50
Experts say that the COVID-19 pandemic created a mental health crisis across the globe with a 25% increase in anxiety and depression the first year of the outbreak.
The Detective 16:00
As we journey onward, we'll revisit the early days of Takatori. exploring how Robert confronted these challenges and laid the groundwork for a company set to revolutionise mental health care in the post pandemic world.
Ben Kaplan 16:17
Robert, take me back because you officially launched in April 2020. If we're thinking back to our calendars of momentous things happening at the time, this is when really it COVID is spreading, it's becoming a thing. And you had been working on psychiatry for three years prior to get to that point. So start off with taking before April 2020. What was the three years prior? What were you doing? What were you working on to get to this moment where we're here, we're gonna launch what was that three years, like?
Robert Krane 16:47
It was a lot of research, you know, I think starting to psychiatry was born out of me going through a personal experience, trying to find care myself, and then trying to have having trouble understanding why I couldn't find a psychiatrist that accepted insurance in one of the most densely populated cities in America, which was New York at the time. And looking back, I was involved in healthcare for for the last five years prior to 2020. Looking at, you know, interesting businesses or large practices and how they solve this issue in other areas of medicine, and then understanding, trying to understand why nobody has really solved this Well, in my opinion, in psychiatry. And so really, the three years was spent trying to understand that. And, ultimately, at the end of the day, when, when that's completed, when we completed it, it was understanding that healthcare at scale is a three sided marketplace. And I think some people still don't understand that, which is you have to serve, you have to you have to serve the physicians who provide the care, you have to serve the insurers who pay for it, and then the patients who need it? And if you don't do all three, so are you really a full health care company or provider of care? Or not? And are you a technology company? Or are you a health care practice healthcare company? And I think you have to make those decisions very early on. So those three years were really spent figuring that out, understanding, you know, what the answer was, so that we didn't have to pivot, or we could lower the number of times we had to pivot. And granted, we could have started to Gayatri a lot earlier, if we would have figured that out or just, you know, decided we were going to pivot more, and then planning it out from the business model to the financials to understand that the economics worked, and this was going to be a sustainable business. So it wasn't something that we said, we're gonna launch because we have a revenue model. And we're not sure how it's gonna be profitable. This is something that we we launched with a with a really concrete understanding that this was going to be a large sustainable business, which informs you know, how we build it early on, if you if you have such a high conviction, it's going to be something larger.
Ben Kaplan 18:43
If you enjoy this show, you'll love top cmo with me, Ben Kaplan, it's never been a better opportunity to
Speaker 9 18:52
do that. I would definitely encourage marketers to be engaged in the product development process, because you're banking,
Speaker 10 18:59
brands, great moments, but it's the great brands that create movements. And that's the spirit of justice.
Ben Kaplan 19:06
This is the podcast where we go around the globe to interview marketing leaders from the world's biggest brands, fastest growing companies, and most disruptive startups
Unknown Speaker 19:15
available wherever you get your podcasts.
Ben Kaplan 19:21
Hearing you describe sort of what you knew back then and maybe what you didn't know quite yet and certainly what you didn't know that was coming with a pandemic as well, because you knew a couple legs of the stool, it seems like pretty well which still serve you well to this day and maybe a leg of the stool that maybe you didn't know at the time or that might change meaning you knew that one for psychiatry that you're going to be a business model that wasn't direct to consumer you knew that you wanted to serve the insurance industry is as well because you were a person yourself that had insurance. You needed this sort of why is it difficult so you knew that you were going to be focused on payments from insurance to it sounds like there's A lot of companies that will be a marketplace for connecting some type of doctor, this case of psychiatrists with a patient, and those doctors are going to be contractors in the system, they're just kind of using your platform to be connected. Maybe they pay a fee for that maybe something else to get patients. And that's it. But the second part of this tool is you're going to have employees, right, you were gonna build a practice that had psychiatrists, and that you knew from early on, what did you know that side of it,
Robert Krane 20:26
I think, you know, when I look at an industry, the first thing I'm looking for is what's the most constrained resource here? What's the most impactful thing that everyone needs? And that has the biggest impact? And when you look at behavioural health, you know, therapy and psychiatry are two really different disciplines, if you will, and they're two different types of providers. When you look at therapists, yes, there's a shortage of them. And they're, we're in dire need of them for sure. There's also, you know, three quarters of a million therapist in the United States, and what's the time it takes to have a therapist go through training? Right? And, you know, what part of a patient's treatment do they own? And is that the most impactful part on the patient's total cost of care, physical medicine and behavioural health. And, you know, so we didn't believe that it was necessarily focusing initially on on therapists, we didn't believe that it was focusing on other types of mid levels. And we didn't believe that it was focusing simply on applications or connectors, what we believed was that the most constrained resource was, and still is the number of psychiatrists in America, right. So there's only 45,000, psychiatrists, you know, 60% of counties in the US don't have a psychiatrist at all. And so when you look on that, you then you look further, and you say, Wow, so there's a shortage there. 45,000, that's a shortage of about 50% by 2025, to put it in context, so about half of what we need between 25. And then you say, but those 45,000 aren't available to people like you and I who have commercial health insurance, most of them work in hospitals, and half of them don't accept insurance. So it's even harder to make them accessible. And so that was our understanding. And doing that work takes a lot of time and understanding why, why. And then then, if you if you find that out, then it's understanding, well, what are psychiatrists looking for, to make that switch? What's missing in what they're trying to do, and that that frames the solution that you try to build, in our personal view, when we created this was, we talked about a three sided marketplace, but there's an order to that three sided marketplace, and it is very important. And the order is first you have to get you have to be the best place in the country for psychiatrists to work. Right? Number two, you've got to solve the problems for payor, if you do those two things, then you enable the doctor to solve the problem for the patient. And if you go the other way around, and you try to solve the problem for the patient, well, what about and who's paying for that care? Can the patient actually pay for it, even if you've stopped there other problems and so that order was something that was very important for us in terms of how we tackle this this problem.
Ben Kaplan 22:48
So you have a sense of the business model, you have a sense of what are the constraints that are the key things that you have to get done, even have a sense of the order, you have to do it, you kind of have to do it in this order, and you're moving towards April 2020. That's the time that when I say we we say you launch, you're going to see your first patient, right? Someone's going to actually walk in the door. And at this point, how are you delivering that service? Are you going to open up practices all over? Are you starting in New York? Because that's where your base physical store in New York? Was it one space? Was it five spaces? How many spaces were you trying to do? How many patients did you want to see? Yeah, we
Robert Krane 23:24
had five providers, initially, including my co founder, who's a triple board certified psychiatrist,
Ben Kaplan 23:30
I see a five psychiatrists on the payroll that can see people okay,
Robert Krane 23:34
yep. And we had a location that we signed a lease on back in that previous December. So December of 2019, we signed a lease for a small space of about 2500 square feet. And we had about five offices in it, in addition to a small waiting area, and the thought process was is that you know, March, right? We were going to have people come in in person to do our training to get trained on our electronic medical record and all of those additional pieces. And that was the plan and the plan, the financial model, and everything was driven by, you know, physical locations throughout the country. Starting in New York,
Ben Kaplan 24:06
the flat iron office goes great, then what were you going to do after that you were going to scale were like more at Manhattan, expensive place to scale. But you could do it there. And then we were to go into New York State, and then it deals with kind of health care and states and licencing. And other things. What was going to happen? What was the model that you had projected out for investors?
Robert Krane 24:23
Yeah, the the model was, I mean, I was, I was the only investor at that point. So you know, it was it was even more, it's even more important. But the model was starting in Manhattan, because that's the most densely populated area. We think that that market is very different from others, but it's also extremely expensive. As you mentioned, if it worked here, we thought it would be great to work in other areas as well. The thought process was to expand throughout Manhattan, the physical locations, and then move to Brooklyn and Queens and throughout New York, New Jersey, Connecticut in the New York metro area, predominantly first.
Ben Kaplan 24:53
Was this a plan for a total US domination and that's how you were going to scale or was it there was plenty of business? to do in New York State tri state area there, you are fine to grow. And now or did you want to scale all over the place?
Robert Krane 25:06
Yeah, I mean, we want it to scale to a lot of other areas throughout the United States. I think that, you know, the, the thesis and the concept has certainly evolved over time, we knew that this was a need, we knew that the core model of what we were doing, which was employing physicians to provide care on an in network basis was something that was not going to change. But I think now we have a much better understanding of, it's not just simply becoming the largest provider or employer of psychiatrists in the United States, you know, psychiatry, five to 10 years from now will will look something much more like managed behavioural healthcare organisation where insurers actually outsource their behavioural health care to talk Gayatri and we take that risk, and we own own that, which is true value based care if you will. But that really was something that was pretty far away. Back when we first started when we were looking at saying, Hey, there's this big need, and we think we can do it and I think we can do it really on a high quality basis.
The Detective 26:00
We've journeyed back to the formative years of Talkiatry . Exploring the extensive research and careful planning, Robert crane and his team undertook to crack the code of the mental healthcare industry. From personal struggles to a deep understanding of the industry's constraints, the launch of talk Gayatri in 2020 was anything but simple. Faced with a global pandemic, the team adapted and thrived, driven by the mission to make mental health care more accessible. As we move forward, there's one question lingering on everyone's mind. What does the future hold for Tokai a tree
Ben Kaplan 26:44
in order to get to the next level after this, is there any understanding that you need resource that you need capability that you need that you don't have now that you need to get to scale this to what it has the potential to be?
Robert Krane 26:57
Yeah, I mean, America needs more psychiatrists. Number one, I think that there are some additional components from our technology team that we're building to get there to be able to illustrate even better, the impact on Tocai attorneys care to the overall cost of the patient, so that we can illustrate those cost savings even more effectively, so that we can structure value based agreements with more transparency, right? It's tough. Now a lot of people say value based care, but in behavioural health care, it's really not like a performance agreement or something like that isn't true value based care. And doing that is difficult, and getting the industry to agree on KPIs is hard because you talk to payers, everyone's got a different. What about this? How can you track that. And so there's a lack of standardisation in the industry. But it's also because there's a lack of a large provider group who's saying this is the right way to do it. And I think that's exactly what psychiatry is doing. We're so large now. And we're working with every payer on this front, that we can be the one who standardises these things and say we did the work. And this is how you evaluate a value based framework in outpatient behavioural health care, and we're gonna be the ones doing it, where if you've got all these little pockets happening in a certain state or certain market with a certain payer, it just creates kind of more confusion because everyone's running after different metrics. And so someone needs to come and say, This is how you do it generally, industry and get the key players on board. So we're not there yet.
Ben Kaplan 28:12
What is needed to get to that next thing of becoming profitable? Do you need to expand the base of patients? Do you need to use technology to make yourself more efficient? Have you invested in areas that don't return on investment yet, but you need to get those to return on investment? What will get you there? If it's later this year?
Robert Krane 28:28
The interesting thing with us is the answer is none of those things, it's actually we actually don't need to change anything but slow down a little bit, and slow down and bringing on physicians, which is which is the biggest cost for graduates I mentioned in the beginning, like where do you put a lot of the capital that you raise, and we said, we really invested in our in our clinical staff, because they're not full on day one, right? There's a lot of things that go along with that. We funded this internally. And so, you know, the business had to make sense, it couldn't be something that you just, you know, say I'm going to, I can see a revenue opportunity here. And I don't know if it's gonna work because you're impacting people's lives and patients specifically. So we knew that it had to be sustainable. And so, you know, at a unit economic basis, you know, it makes sense. It always has, you know, it's never been an issue there. It's just simply that we've chosen to grow faster. And that's where we put that capital on reinvested in the business more than, of course, what we were what we were generating. And when you slow that down a little bit, you know, it catches back up very quickly. The you don't actually have to change really anything in terms of whether you're investing for things to pay off like you don't you don't have to do that, you know that this business is sustainable without that, which is I think something that's very different from a lot of companies that have been created where they're still trying to figure that out, or they've got to go through this massive, you know, change to make that happen. Or they're still figuring out how to do it at scale where they need scale to do it where where we did that from day one. We were a profitable business and practice when we had five providers and
Ben Kaplan 29:49
what is the next milestone after that you get there you slow things down a little bit you achieve profitability, what is the next challenge after that for you as you look ahead, what is it How to go from three to 30. Doctors, then you're scaling back up, you're gonna get to maybe, I don't know, 1000 doctors, you're gonna get to I don't know how many patients that is equal to, but what is the challenge of that
Robert Krane 30:08
we see about right now, probably 60 65,000 patients a month. You know, it's what we're seeing today. I don't think there's a significant challenge and increasing the provider count significantly, right? Like what I, what I view the challenges now. And of course, we've gone through a tremendous amount of challenges every every month, I call it like the sword of Damocles hanging over our head, you know, something is gonna, something's gonna come down and change and something's gonna be like, Oh, my God, how do we fix this? And we always do. But I think I think the industry in terms of changing to focus more on value based care is something that's very difficult because it just hasn't really been done successfully in outpatient psychiatry, there's no blood tests for depression. And so how do you really illustrate those things?
Ben Kaplan 30:46
And just reflecting back on everything that's happened three years prior to April 2020. Now we've gone about three years after that, do you think you would be where you are? And to Kai a tree would be where it is without COVID? Do you think that with that force, whether that's telemedicine, whether that forced focus on mental health? Was for your business, something that was critical to your journey?
Robert Krane 31:12
I think it was, I don't think we would be exactly where we are today. Right. I think, I think what COVID did was was shine a giant spotlight. It wasn't that these issues weren't already here. They've been here for decades. And most of the research reports are prior to COVID highlighting this issue, the shortage of psychiatrists were here for a long time before this, I think what COVID did was trying to make light on it. And everyone's saying, Oh, my God, now we can see who are unwell. And we're all concerned about it. And I think that that if you created a solution that solved all of those things, and now there's a massive spotlight on you and the industry where it wasn't there before, you know that only that only helps. And I also think, again, I mentioned the reduction of stigma was huge, but people seeking access to care and being okay with it. I think it's something that, again, is some it's a big focus, and, you know, all of the attention that mental health care got during COVID, whether it was from employers, whether it's from patients, insurance companies, providers, realising there's an alternative way to care for patients, right, well, so they were forced to do telemedicine, even if they didn't know if it worked or didn't work right back in the day, they were forced to do it because of COVID. And so they were forced to get comfortable with it. And they were forced to then now you had the ability to look at the efficacy of telemedicine versus in person care and come out with the data. So I think a lot of those things have would have taken much, much longer to do if it wasn't for a giant spotlight of COVID, which accelerated all of it, I think it accelerated tremendously than it would have happened before. That's kind of how I think about it. Starting to psychiatry was born out of me trying to find care myself having trouble understanding why I couldn't find a psychiatrist that accepted insurance in one of the most densely populated cities in America, which was New York, we
The Detective 32:48
journeyed alongside Robert crane, CEO of Talkiatry uncovering the company's audacious strides in mental health care.
Robert Krane 32:55
It's a very different story when you had an in person culture that you then need to try to work to working virtually, but we just grew up with a virtual culture, if you will, right. So it's just natural to our employees and how we operate. But we just figured that out as we go, we didn't have an opportunity to do it any other way.
The Detective 33:10
Amidst the global pandemic, he embraced telemedicine, ensuring essential care reached patients, even at the height of crisis is solution to scaling. An innovative business model that attracts top talent whilst offering psychiatrist a fulfilling work environment. This has been key to meeting the soaring demand for mental health services.
Robert Krane 33:33
But it's understanding well what are psychiatrists looking for to make that switch what's missing in what they're trying to do? Firstly, you have to be the best place in the country for psychiatrists to work. Number two, you've got to solve the problems for payer if you do those two things, then you enable the doctor to solve the problem for the patient.
The Detective 33:47
Talkiatry is not just surviving in a competitive market. It's thriving, most inspiring is how they've pioneered a path towards standardising value based care in outpatient behavioural health, aiming to create a system that's accessible, affordable, and stigma free. Their story is a testament to innovation and resilience. And it's clear that they're shaping the future of mental health care. And with that, it's case closed this amazing episode was brought to you by top thought leader don't forget to rate review and subscribe.
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