SonderMind Transforming Mental Health with Precision Technology

“Mental health care is still living in the mid-20th century,” says Mark Frank, CEO and cofounder of SonderMind. Frank joins Bloomberg Intelligence analyst Jonathan Palmer to break down how SonderMind is reimagining behavioral health from its antiquated roots by layering technology and data, and while seamlessly integrating digital tools into therapy. The pair also discuss the company’s pandemic pivot to virtual care, its move toward risk-based contracting and the role AI will play in transforming behavioral care from a subjective art into a data-driven science — which Frank sees as the key enabler for mental health to be treated with the same precision as physical health.

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Episode Transcript

Speaker 1 (00:18):
Welcome to another episode of Bloomberg Intelligence's Vanguards of Healthcare podcast,
where we speak with the leaders at the forefront of
change in the healthcare industry. My name is Jonathan Palmer,
and I'm a healthcare analyst at Bloomberg Intelligence, the in
house research arm of Bloomberg. I'm really excited to welcome
today's guest, Mark Frank, the CEO and co founder of Sondermind,
a player in the behavioral health space. Sondermind isn't Mark's

(00:40):
first foray into entrepreneurship. He started and exited a handful
of other businesses, and he did that after a short
time in finance. He also spent five years as a
captain in the US Army after attending West Point. So
thank you very much for your service and for joining
us today. Mark.

Speaker 2 (00:56):
Thank you, Jonathan, it's really great to be here.

Speaker 1 (00:57):
Well, I think it's pretty well known for the listeners
of this podcast that we have a mental health crisis
in the United States. So maybe let's start with an
overview of that problem and what sonder Mind is trying
to fix, and maybe like what gave you the foresight
to start a company in this space.

Speaker 2 (01:12):
Yeah, it's a really interesting. It's an interesting time in
the space just to start there, and I'll go backwards
in time and then kind of lead us up to it.
When I started sonder mine, I was really trying to
solve a couple sets of problems that I had personally
experienced or witnessed. One set of problems was the difficulty
in trying to access high quality in network care that

(01:33):
metro schedule the metric needs. So this was circa back
like twenty thirteen, twenty twelve, even so way before I
think it was on top of everybody's mind the way
it is now. And again, as you mentioned, I had
operated in healthcare and was at the time operating on
coology mso that I had co founded Folks on Radiation Oncollegy,

(01:54):
and so I knew healthcare. I knew from healthcare delivery,
and I knew that the parody active in pasted a
few years prior which mental health care and benefits required
to be delivered at par with physical health benefits viing
commercial insurance plans and Medicare. And I was like, wait
a second, why can't I find a therapist for some
of the needs that I was facing? Just to use

(02:16):
my insurance benefits. It seems like this should be normal.

Speaker 1 (02:18):
That's always been a challenge.

Speaker 2 (02:19):
That's always been the challenge, and that was really really difficult.
And so I found somebody in relatively tenacious, you know,
people who know me better, M mclaughy, stubborn, and so
I was sort of thinking about that through the lens
of the patient, of the consumer. And then the other
side is my younger sister is her self a therapist,
she's professional counselor. And I have another family member, my cousin,

(02:42):
who's a clinical psychologist. Her husband's actually a psychiatrist. Side
of these family members who were operating the space as clinicians,
and particularly my sister, I saw her journey from being
in an employed setting to then going into private practice,
which was always her goal. When she entered the field,
and she really struggled with all the things around operating

(03:04):
a private practice, finding her patient base, engaging, you know.
She she tried to get a network with the insurance plans.
This was again, you know, ten twelve years ago, and
they all said, no, you know just where we're closed, right,
We're closed for any new providers. And I said, what
you know, I know a little bit about healthcare delivery,
and I know, this seems like this should have been solved.
So those two things were really the genesis. But the

(03:26):
next thing that as we my co founder and I
Sean Sean Boyd is my co founder, is some self
a therapist. As we started really building the early phases
of Sondermine in twenty fifteen, twenty sixteen, twenty seventeen, way
before the pandemic, way before you know, a lot of
the explosion in virtual actual care. What struck me was

(03:47):
how little data and technology was used in the space,
like this field is still very much living in the
mid twentieth century, just in the way we operate, you know,
I think the way it strikes me you if you
were to walk into an urgent care and say to
the doctor I hurt. They would say, well, what hurts,

(04:07):
and you'd say, well, my arm I broke it or
something like that, right, and then they okay, let's take
an X ray and we'll fix it. In mental health,
it's like you walk in and you go, I hurt,
you know, I don't feel good, and they go, well,
tell me more about that. It's like and then you
spend you know, actually, the treatment is a long part
of it is the diagnosis. So that's one thing that's
really difficult is that there's not an understanding of actually

(04:27):
what's going on with the needs you might have. And
then the second is the way we actually deliver the
treatment is in and of itself, it's like it's like
this what we're doing. We're having a conversation and it's
you know, it's an expert in the field and a
cleinsion who's got thousands of hours of practice and in
training in terms of how to suss out exactly what's

(04:47):
going on with their with their patients. But at the
end of the day, it is sort of like sifting
through and I, you know, the realization with my technology
background and the understanding of more objective parts of healthcare
was weak. Really build a system of care that connected
the patient to the provider and use a seamless technology
solution underpinning all of that that could actually really improve outcomes. Really,

(05:11):
at the end of the day, our mission is to
improve outcomes, and we talk about improving access and utilization
of care, but all that is a means to an end,
which is improving the outcome and really solving this mental crisis.

Speaker 1 (05:22):
There's a lot of tun packed there. Maybe maybe I'll
start You know, when you think about that those early days,
you know, and you had that experience at an mso
maybe you should have stayed there and given with the
price tags on those today, that's another discussion. You know,
what did you initially strive to build? You know, what
was the product in those first couple of years. And

(05:42):
I guess as you think about the evolution over those
that last ten years, you know, is that vision that
you started with then still very much the cornerstone or
the foundation of what sonder Mine is today.

Speaker 2 (05:52):
Yeah. So I had this vision of actually what we're
realizing today with sonder Mine. And it's really exciting because
even for my team earlier this year, I brought out
a pitch deck from twenty sixteen, you know, to these
angel investors and friends and family and stuff like that,
and it had you know, all right, we're gonna we're
gonna solve this crisis by first solving the needs of

(06:16):
the providers right to the therapists and the psychologists and
the psychiatrists in operating under an umbrella to deliver high
quality care? Am I doing? So? We're going to meet
this access need for patients who are seeking care can
use their insurance means confide and high quality care, and
it can be delivered more effectively because we've removed from
the administrative and technology burden from the therapist. So we've

(06:39):
like worked toward that. But then the other piece that
was much more like forward looking, was and we're gonna
have all these digital tools that actually enable the patient
to engage in between sessions, right, and engage and for
that information to be again in one ecosystem, to be
delivered to the therapist, to the provider, and for that

(07:00):
information to actually inform the way that the prider delivers care. Right.
So that was I think really like the long term
the way. So then that was like, all right, we're
going to.

Speaker 1 (07:09):
Get from So first you were going to start by
fixing the friction on the product.

Speaker 2 (07:12):
So it was like all right, now now you know,
if that's the vision we want to get to, how
do we Where do we start? Well, the first place
we start is all right, let's build a solution for therapists, right,
And so we started with that, and then as we
did that, that then created now let's go to the
insurance plans. Let's create a plan where we can bring
those those therapists in network under under one umbrella, right

(07:32):
and do that with our own EHR platform, with our
own practice management solution, and then say okay, now we've
made it a little more seamless to just get the friction,
like you said, around getting into care, scheduling care. Is
that true access piece? Then we said okay, now what's
you know, what's really unique about this is that the
part of the the efficacy of care is about how

(07:54):
good is the therapist for you? Right, Like a therapist
who might be a great fit for your needs might
not be a great from mine, and that actually means
that they're not as high quality for me, but they
would be high quality for you. So it's quality in
mental health is a relative measure, but it's relative to
the patient, which is again very unique. In mental health is.

Speaker 1 (08:14):
Like a very different than orthopedics.

Speaker 2 (08:16):
Right, Like a surgeon you know, is a great surgeon
and that they're operating pretty quarknee surgeons operating on is
not going to inform the quality of care, right, But
the individual that any given therapist might be working with,
it's going to inform their care. Why because the specific

(08:37):
experience that that therapists might have is going to drive
how good or or you know, less effective they are
in in treating the needs of that individual. So I'm
a veteran. There's a lot of veterans who find that
therapists who have experience working with veterans they don't need
to be veterans themselves. And that's a really common misconception.

(08:57):
It is like, oh, you have to have this this
own experience, whether because of your demographics or because of
your culture, because of your back background, in order to
treat that population. I don't think that's true. I think
you do need to have experience in dealing with that population.
So you know, when we talked to veterans, because we
work with a VA and we work with a lot
of veterans, and I say that these therapists are really
great for me because you've matched the ones that actually

(09:18):
get what I'm dealing with. Now, maybe that means they
get it because they've dealt with a lot of trauma.
Maybe that means because they've actually dealt with a lot
of veterans. So when they hear an Akroman acronym, they're
not saying what does that mean? Right, They're not trying
to like I've heard it before. I've heard this before.
I understand what you're talking about. I can pattern match right.
So for for us, that next stage was okay, how
can we improve the matching algorithm? So we we had

(09:40):
we had all this data, We had all this it
was our it's our technology platform, it was our clinical platform.
We were already doing measurement based care early days, I
mean twenty seventeen, twenty eighteen, we were collecting in our
system PHQ nine for a depression, GAD seven for anxiety,
these different measurement tools to define outcomes. So we could see, all, right,
now we see all these thousands of therapists, we have

(10:03):
who is treating, what demographic of patient, what background, what diagnoses? Right,
how were they actually improving or not improving for you know,
down to an individual provider. And then we can say, well,
now we know generally speaking, which providers are good for
which which patient populations. And so we started building some matching,

(10:23):
machine learning and some outcomes around that. We bought a
company called Quantify, which was an AI wasn't called AI
back then. It was machine learning and a data science
company really focus on improving the ability for technology to
influence the diagnosis of a population. So they actually worked

(10:44):
with veterans and then they worked with the r physicians
to say, we can start to predict with a lot
of inputs when these people would would sort of self
report issues or symptoms around PTSD or for er physicians, suicidality.
But the underpinning of that was really helped build it infrastructure,
can improve our matching outthor That was step one and
sort of the continued journey of the technology, and that

(11:05):
there were a few steps after that.

Speaker 1 (11:06):
Well, we're gonna we're going to dive into that in
a second. If I think about the business model, you
have the provider and that's maybe where you start. Is
that is that correct in my thinking there? And so
if I'm a provider? Am I only working for soundermind
or am I working for a local system? Can I
be just self employed? How does the how does it work?

Speaker 2 (11:26):
Yeah?

Speaker 1 (11:27):
We so we from a network perspective, I guess.

Speaker 2 (11:30):
Very early on, you know, there was a decision we
had to make around Okay, do we want to have
these providers be employed? Do we want to say okay,
they're not employed, but they're effectively exclusive? Are they sort
of completely free for all? You know? Where do we
want to fit in the spectrum of how we could
operate this. And this is again before there were a

(11:52):
lot of companies that look like us, as you know,
back in this decision was around twenty seventeen, twenty eighteen.
The decision we came to was one these providers, unlike
a lot of providers in healthcare, nurses and physicians and
physician extenders, nurse practitioners and pas et cetera, even you know,
radiation technologies and things like that, generally speaking, those providers

(12:15):
work in a full time setting. Now that doesn't that
doesn't mean that they don't have their own practice or
that you know, they give doctors that have their own
practice and you have a group. But usually they're working
forty fifty sixty hours a week right on that. And yes,
there's the edge tail that might do some other things
in board work, or they might you know, also be
a medical director or the system. But therapists, you know,

(12:39):
often say it's a lifestyle choice as much as it
is a career choice. Right, it's a calling in many ways,
so they're compelled into this field. And so that's one
thing is like they're really a helping helping you know
individual that is saying, this is what I want to do.
I want to improve people's lives. So that's the thing.
One then thing too is they're often going into this

(12:59):
field because they go in my career. I want to
engage in different ways. You know, there might be a
period of time. I'll use my sister an example. When
she finished her master's program, she worked in a full
time setting for a number of years. Her goal was
always to go into private practice. Why because she said,
at some point, I want to raise a family, and
I think that'll give me more flexibility of my schedule. Right, So,
but I'm going to start my private practice doing it

(13:21):
pretty full time. Now. She still practices, but she's got
two kids in elementary school, one's about to enter middle school,
and she has a pretty busy schedule. And she's at
a point in her life which says, you know what,
I want to deprioritize a little bit the number of
sessions that I'm doing per week and focus a little
bit more on the family aspect. And that will change

(13:43):
again in a few years, I'm sure when the kids
are now in high school, you know, and she says, oh,
now they have their owns or lives and I want
to back up, right, and so this is like sign
curve of activity that these providers, So that the way
that informed the way that we work was said, let's
let's not push against that current, right, let's actually take
it and say, all right, let's meet them where they are.

(14:04):
So let's just make it as simple as possible. We
don't make it exclusive. We do say, when you join Sondermind,
you will be provided patients or clients as they're often
called in our field, that might use any form of reimbursement,
and we're going to pay you the same thing regardless, right,
So we're not gonna we're not going to create an
incentive for you to cherry pick. Right, Oh, this this

(14:27):
cash pay patient who came in is going to pay
me more than this, you know, this Medicare patient or
this Medicare advantage patient always going to pay me less
than this commercial you know. And so we said, let's
let's actually remove all that complexity because that way, you
as a provider can just focus on making sure that
this patient is the right fit for you and that
you know, you can deliver care and there's not sort

(14:49):
of adverse incentives involved there.

Speaker 1 (14:51):
So maybe dive into the just the reimbursement piece of it.
I know, from from my own experience, finding and finding
a therapist who takes in you know, in network insurance
is a challenge. What is historically been the challenge there? Right?
And why why is that a gating factor historically?

Speaker 2 (15:12):
So historical? You know, I have some opinions, right, So
sometimes there's uh, there's answers, and sometimes there's opinions. I'll
call this an opinion. In my opinion, there was an
external pressure on the insurance plans to deliver the service.
So even with the Parody Act, even with a you know,
with a law that was passed, there were some there

(15:32):
were some class action lawsuits against some major insurance plans
in the in the you know, twenty ten to twenty
fifteen timeframe, which some of these insurance plans lost because
they weren't meeting these network adequacy needs, that needs that
were created by the Parody Act. So what then changed?
I know, really in kind of the twenty twenty timeframe

(15:54):
with COVID was all of a sudden, who is the
customer of the insurance plan the employer at the end
of the day, right, and so the employer started saying,
wait a second, this is a this is something all
my employees are asking for, and the media started saying
this is a really big problem. Therefore, that influenced policymakers
and regulators and people focusing on state level network adequacy

(16:16):
and they said, you need to do this. So prior
to really the pandemic, it was pretty difficult to go
to some of these insurance plans, not all. Some sort
of saw that there was a real cost savings when
you addressed mental health needs at the population level on
other aspects of the system. So some of the more
forward leaning insurance plans did push into this space more

(16:38):
aggressively pre pandemic, but post pandemic and during the pandemic
it became so important to meet the need for employers,
for members, and to satisfy media and sort of regulator
demands that they really opened this up. What we did
was we said, okay, we're going to make it easy again.
Most providers in this space, prior to companies like Sondermind

(17:04):
and some of the you know companies that have come
after us, we're operating is just single practitioner, you know,
single shingle therapists, right providers and where else in healthcare
is that the case nowhere? Right? I mean there's been
consolidation across all the healthcare right, Like there's no place
where you're like, oh, one tax id, one NPI number,

(17:25):
no staff is the norm. Like the only place that's
been the norm in the past fifteen years is in
mental health. And so we said, hey, we can remove
some of the burden. It takes for you insurance plan
to actually drive you know, drive an efficient delivery of care,
but it's hard for the plan to do credentialing and
all that on you know, thousands of individual providers. You know,

(17:47):
usually that's handled by a system or a large group
or an MS. So so we took some of that
friction away for the plan and that that actually allowed
it to open the doors. And now we're at the
point where you know the problem you're facing and we
we are now in all fifty states. We've got about
thirteen thousand therapists across the country, including about you know,

(18:07):
two hundred and fifty psychiatrists. So we get people into
care on average from the time that they say I'm
looking I'm seeking a therapist, we typically have them scheduled
for the first session within forty eight hours. That's great.
Ninety five percent of the care we delivers in network,
within commercial insurance, Medicare and Medicare advantage. So we are
solving that exact problem that you just identified. And you know,

(18:29):
we're building up our footprint in New York, so hopefully
we'll be able to solve that for you.

Speaker 1 (18:33):
Know, even more or more people. So maybe think about
let's think about the pandemic and that inflection point. You know,
what happened to your business. You know, I don't know
in March twenty twenty or are there shortly thereafter.

Speaker 2 (18:45):
Yeah, So in February of twenty twenty, we were delivering
all of our care in person. Now these weren't through
Soundermind centers. Most we did the.

Speaker 1 (18:56):
Prior as an affiliated provider.

Speaker 2 (18:58):
Yeah, it was therapist who are in our umbrella, and
we were delivering care in person, and so all the care,
ninety eight percent of the care was in person care delivery.
We were already building the technology, you know, the sort
of the telehealth components of our ecosystem. And again all
of our technology stack is is homegrown and is our footprint.

(19:19):
We were actually starting with the text therapy. So in
January of twenty twenty, we released Sonomine Text Therapy why
because better help and talk space. That was pretty much
all that they were doing in that time. I mean,
they had sort of a video component, but that really
wasn't the name. It was very nas it was very nasoy,
and we had been building for a few months the
video part of our platform. We were planning to launch

(19:41):
it in May of twenty twenty. I was just the
scheduled you know, part of our roadmap, and then all
of a sudden, this virus came, and you know, we
it's first week of March, and you know, people were
shutting things down, and you know, we're saying don't, don't
come in the office. And again all these you know,
all these patients were seeing sonder Mine therapists in person,

(20:04):
and all these therapists had their livelihood built on our platform. Uh,
And so we we said we need to fast forward
and bring this up. So, I mean yourculean effort by
our product and technology team to to basically pull that
up by a few months and launched that so that
by the third week of March, we had we had

(20:25):
actually put into into product delivery our our platform with
us and by April, ninety seven percent of all the
care was being delivered through sonder Mine's technology platform and
without a drop. So it was this that was like
the short you know, that was like over a.

Speaker 1 (20:39):
Talk about the two percent changing to the other two percent.

Speaker 2 (20:42):
It was a complete flip flop. It was so interesting.
And and then what's happened now is we you know
about it's a little less than eighty twenty is video uh,
telehealth to in person care across you know, across our
entire footprint across the United States. What we are seeing
is more demand from individuals, from the consumer or from

(21:05):
the patient for in person care. So it's another flip
flop that I'll describe, which is prior to the pandemic,
the real challenge in sort of getting adoption of telehealth
was actually on the provider side, most providers side. I
don't I can't do what I do over a screen.
I have to be in the same room. I mean,

(21:25):
And there's actually research around like the human connection of
being in the same physical space is improved then, you
know versus I mean, it's not like night and day,
but it's slightly better if you're doing it in person
versus if you're if you're doing over a video.

Speaker 1 (21:40):
But that makes sense.

Speaker 2 (21:41):
It just makes sense, right, But not so much so
that to the extent that the therapists were saying it was right.
So they were really resistant and the demand was coming
from the patients who were saying, this would be a
lot more convenient if I maybe not for every session
had to come into the office. Right, It's like you
got to go fight traffic and what if it's knowing
or whatever. And now it's sort of flip flop where
the therapists are saying, I love doing I love the

(22:03):
flexibility this provides me as a you know, as somebody
running my practice where I can do this whenever and wherever,
and I don't need to go find off a space
and things like that, and the patients are the one
going Can I get a little in person connection? Can
I get some human connection going here?

Speaker 1 (22:18):
So you mentioned to the competitors, I think more in
the d T C T DTC space. Can you maybe
parse out what the landscape looks like today? I mean,
how how much are you going against those DTC options?
And I know some of them are moving into the
insured space as well. It sounds like you have a
little bit of a first mover advantage there.

Speaker 2 (22:38):
Yeah, I think I think I would I would define
the space into maybe like three categories. Okay, there's this
this D two C foot printed and they they are
moving into you know, which I was more like text
you know, so D t C consumer app kind of model,
and whether that's because of something that's that's focused on
a digital solution, right like meditations or di CBT things

(23:01):
like that. It was kind of more subscription or consumer base.
All these things, by the way, are sort of emerging together.
The second was the Employer Assistance plan right, so the
EAP space. The EPs are a very long standing model, right,
there's big been around.

Speaker 1 (23:17):
They drive a lot of volume though.

Speaker 2 (23:19):
I think that drives a reasonable amount really, but my
again opinion not sort of fact here, is that it's
going to continue to decrease over time. I think that
actually COVID propped it up a bit, you know, propped
up the employer the employer space on the on the
care delivery side. So that's the other kind of major categories,
the direct to employer space for mental health benefits. Again,

(23:43):
it's covered by insurance, so it's kind of one of like,
why why would we carve it out. It made sense
to carve it out twenty years ago when it wasn't
a covered really a covered benefit. That's why EAPs existed
and had mental health as part of the benefit plan
in the past. And then the third are sort of
what I term as the like MSO model, right, and
so that's where we've hit and so a lot of

(24:03):
these things are starting to blend together where we've started
to differentiate, and I the real I'd say start because
it's in a you know, it's like it's like the
you know.

Speaker 1 (24:12):
The law.

Speaker 2 (24:13):
We never stop, right, Like it's like we we we
started seven years ago, but we're we're sort of now
really realizing it is we've been able to pull together
aspects of all of those components. So I mentioned, you know,
we did this acquisition of Quantify. We acquired another company
called Total Brain, who was a you know, predominantly selling
direct to the employer, but not selling a service offering.

(24:34):
They were selling a technology solution to employers that was
really focused on digital interventions, so things like meditations, things
like really science backed brain improvement, neuroscience backed brain improvement,
so that could be around cognition, memory, emotion, and feeling
and uh and then CBT tools. So they they were

(24:55):
and we still are to a small degree selling this
digital solution to employers purely as a tech offering. And
we integrated that because we said, wait a second, we
have this therapist, we're delivering care, it's under our platform,
we're matching them. We have a lot of data. And
what happens in between session three and session four you

(25:16):
live most of your life, right, So you have a
sixty minute session and then you get out back into
your normal day to day life and there's all the
stressors and all the things, and hopefully your therapist sort
of said, here's some homework for you to do. Here's
some things I want you to keep track up. Hopefully
you're doing your reflections every day at night and you're
writing down and hopefully you're taking some notes and bringing

(25:37):
those with you so that when you have your fourth
session with the therapist, you can say, here's what I'm
thinking about for the last two or three weeks. But
that doesn't always happen, right, and the way that that's
integrated into the therapist treatment plan is very difficult. So
we've actually smoothed all that out both with the solutions
we offer direct with the patient. So the Sono Mine
app which is freed to everyone, can be downloaded in

(26:00):
fludes a whole host of resources, so it has tons
of meditations, sleep improvement tunes, videos, podcasts, and then all
these brain training games that can help you really improve positivity,
bias and emotional biases and memory and cognition. We actually
partnered with ARP on some of the underlying technology, the

(26:22):
powers the ARP have for for for brain science and
for improvement around memory and cognition for seniors. And so
we have all this which is now is delivered directly
to the patient, which again that's so that's like a
whole category of businesses themselves. The magic is that we've
taken that and integrated that seamlessly with the care delivery experience.

(26:43):
So the analogy I like to use is if you've
ever had physical therapy.

Speaker 1 (26:47):
I have. Okay, so.

Speaker 2 (26:51):
Let's say it was for your shoulder. I want to
ask what it was for. Let's say it was for
your shoulder. Okay, So you've had some injury and you
prescribed maybe eight sessions of physical therapy, and you go
to the physical therapists and they do the you know,
the sort of like stretching and the and the workout
stuff kind of thing. And uh, and then you get
your next your next appointment, you know, two weeks later.

(27:12):
Let's say, does the theraphysical therapist sy okay, great, you know,
let's schedule that and then I'll see in two weeks
and that's it. No, they probably gave you a piece
of paper. They probably gave you some like rubber bands
or like a ball or something, and they're like, all right,
you want to do this like five days, five times
a day, every day for the next two weeks. And
then you show up and if you didn't do that,
guess what. You didn't progress as much, did you. And

(27:34):
if you did do that, you're gonna actually improve. That's
the that's the beauty of it, right and then and
then the next session with the physical therapist is really
engaging in that. And so mental health is actually more
like that. Think about that. You know, you have your
your session with the therapist and you're trying to working
through and unpacking things and maybe there's some tools of
the therapists thing and you should really think about this.

(27:56):
And then you go off and what happens, you know,
if you don't do the work. If you don't do
the mental orb we're band exercises multiple times a day,
you're you're not going to progress as quickly. You're not.
The care is not going to be delivered as effectively.
And if it's not and this is where it's different
than physical therapy. If if that isn't provided to the
therapist in a way that actually measures and allows the

(28:19):
therapist to do what they do best, which is continue
to push and understand what's what's the real need that
you have, the care is not going to be as effective.
So we've we've invented all that. I mean, like now
we have a solution that you know, like as an example,
we have a daily reflections tool in our in the
son er mineap. Every day, you know, every day, my
Apple watch pings me and I set the time. I

(28:41):
said the reminder for nine thirty two pm, and it
says time to do your daily reflection. And I can
do it more than once a day if I want to,
So you know, maybe after this this time, I'll say, oh,
like I feel really energized and maybe a little tired,
but you know, really excited. And and then we implemented
an AI coach alongside that, so I can sort of
measure and I can put some some specific points around

(29:03):
how I'm feeling in that point in time for my day,
and then I can engage with this AI coach as
part of the daily reflection and say, okay, well here's
how I'm feeling, and I can have you know, maybe
I'm gonna take a cab to my next meeting and
I'm going to spend five minutes just having a bit
of a conversation with my AI coach. It's going to
summarize that. And then if I'm in active therapy, I

(29:23):
can opt in to share that with my therapists in
a summarized fashion. And if I'm doing that multiple times
a day and these are their over band exercises right
that I'm doing in my brain, then my therapist can
get a summarized view of that so that in advance
of my next session, I can be reminded to say, okay, now,
create you know, what are your goals for the session?

(29:44):
Mark and my therapists all right, what are your goals
for the session with Mark? And that's part of the
treatment plan. And instead of that requiring sort of you know, time,
you know, to set really like set an hour to
prep It's like this is part of my seamless daily
life and that's our view that that really doing that
really drives toward better outcomes.

Speaker 1 (30:04):
Is there clinical research around that that that is the
underpinning for why you're doing it.

Speaker 2 (30:09):
So there's a lot of clinical research around measurement based care.
In fact, we have a research study that was done
in association with the University of Denver that demonstrated that
when our therapist is years ago, when our therapists engaged
with our with our measurement based care tools, meaning when
they just looked at the day that we provided to
them about how their patients were doing based on the

(30:29):
measurements that we were taking in the clinical assessments that
were taking in between care, that alone improved outcomes, just
that alone, right, So there's but there's not clinical research
on what I just described why because we're the only
ones that are doing were so early in this. But
that is what we're planning to do is really measure
this and you know, I think we'll have some exciting

(30:50):
news later on this year, probably toward the back part
of the year, you know, mid toly Q four around
some partnerships we got with with some large organizations that
are really saying this is a new way of delivering
care that combines the best of both worlds, the human
intervention and the digital intervention, and seamlessly ties them together.

Speaker 1 (31:09):
So, at the beginning of the conversation you talked a
little bit about quality, and just as you were speaking,
there popped up again in my head. How do you
ensure that that your cuinicians are following clinical guidelines or
best practice across you know, a very wide swath of
different cases.

Speaker 2 (31:26):
Yeah, so this is where again having our our technology
footprint that underpins this, we launched so it's again it's
our it's our EHR, it's our video platform. We launched
AI session notes, not a third party. This is Sondermine's
AI session Notes. Again opt in from both parties. We
had thousands of our therapists that signed up for this immediately.

Speaker 1 (31:50):
Or is that just is that for the clinical piece
or also for the back end, the back office piece
as well.

Speaker 2 (31:55):
It's it's for the session. So you know, if if
the if the therapist in and the patient opts in,
they say okay, we will enable this session to be
uh effectively transcribed. It gets it gets deleted, but it's
transcribed and then and then created. It moves then into
our clinical notes for the therapists and they can edit
it and and adjust it as well as it moves

(32:18):
into our treatment plans. And that is again part of
recommendation engine that we have, as well as the you know,
the expertise that the therapist has. And then we so
now we say, okay, every session that's using this, we
actually have visibility what's what's happening you know, from a
from a at A in a sort of aulation population level.

(32:40):
And then we do we do audits across the entire
medical uh note audits across the entire platform, and then
we measure again back to what we've been doing for
very long, it was measure those outcomes. So at the
end of the day, you know, it's like, how are
people progressing? Right? And then we we we will you know,
we not that often, I'm happy to say, but we

(33:01):
do at times need to remove certain providers, whether they're
psychiatrists or therapists not It's very very infrequent, but.

Speaker 1 (33:09):
When you can't have thousands of providers, you can't have thousands.

Speaker 2 (33:12):
That everybody is perfect all the time. And I want
to go back even to the original premise, which is
at the end of the day, you know, it's our
belief that all these providers they want to do well.
They want I mean that the reason they're in this
business is to help people. And so what we're doing
is giving them tools to actually make it not just

(33:33):
easier for them from an administrative state, but we are
doing that very, very very in a very big way,
but actually give them tools to be more effective. And
that's what they want. Like, you know, if I can
help my patient get to a better outcome in a
shorter period of time, and I know that you're going
to keep sort of filling that leaky bucket of patient funnel,

(33:56):
that's amazing, Right, That's more impact that I, as a
therapist am having on people. And that's why I went
into this business in the first place, is to help people.

Speaker 1 (34:04):
We spend a lot of time on the platform, maybe
just transitioning to the business model a little bit, so
how to soundermine very simply make money? You know what's
the revenue engine?

Speaker 2 (34:11):
Yeah, So we a core right now is we are
we are an mso basically right, and so we get
paid by the patient, by the by the plan, by
the insurance plan and again in some small cases by
the employer, and we deliver care or we deliver digital
digital services to that end user, whether it get it's
the member for a plan, or it's a it's an employee,

(34:31):
or it's the direct patient. And we pay our therapist
the vast majority of ten ninety nine therapists and psychiatrist
and so broadubly speaking of our providers, and and we
handle for them. You know, they they basically know that
when they join sonder Mine, they are going to have
enough patients to fill whatever their needs are. You know,

(34:52):
some are going to say I want to do twenty
sessions a week and others are going to say I
want to do two sessions a week, and whatever that is,
we will get them that number and the right population.
We will pay them appropriately and competitively within the market.
And that's done state by state, region by region, and
then we remove all these administrative tools. And so the

(35:12):
way we make money is that you know, we're we're
generally paying them less than what we're directly getting paid.
And we handle the building, We handle all the you know,
like the patient collection for patient portion, things like that.

Speaker 1 (35:24):
So the friction of running your own business is basically
taken away, is completely taken away. And so then where's
the where's maybe the operating leverage in the model? Is
it just signing up more providers and patients?

Speaker 2 (35:33):
So that's been up to this point. The primary appan
leisure levers for us and other emisods that are in
the space, right, which is like scale, it really gets there.
Where it's leaning to though, is we've we've entered into
a number of value based arrangements with the plans, and
again the plans have a lot of data that demonstrates
that when you address this population on a broad level,

(35:56):
you're going to reduce other costs from the system. So,
for example, emergency department visits, there's a high, high correlation
between ed the population that's entering into the emergency department
and mental health needs. And so unfortunately, it's very difficult
to identify, Okay, who's going to be that highly persistent

(36:16):
user that's going to use the emergency room four times
a year, right, that has a mental health need that
might be driving a portion of that of those visits
down to an individual, Right, So you see, how can
we address the entire population? So we we we are
working with a lot of plans with value based CARETRAGEM.
So that's where there gets to be additional leverage as
we start to improve on the outcomes. And I think

(36:37):
over time the real magic is going to be demonstrated
in this intersection of human delivery care and digital intervention,
and say, the leverage comes from the fact that if
we can reach more people and intervene pre you know,
I describe this like physical therapy and analogy right where
you're you're doing the things. You got the session with
the therapist, and then you've got you know, two or

(36:58):
three hundred hours of awake time until your next session
with a therapist, and we intervene in that and we
make the care better. Right, if that reduces our our
length of episode of care, right instead of doing instead
of getting to a subclinical outcome for depression in twelve sessions,
we get there in eight sessions, that's a good thing
for the health.

Speaker 1 (37:18):
It's a great apist.

Speaker 2 (37:19):
However, as a fee for service provider, that's not a
great thing. Right, Like our customer acquisition costs wasn't reduced
by thirty percent in for that pasion, right, we just
delivered it more effectively, are you know? We are actually
making less money and still spending the same to acquire
acquire these patients. And so that's where we're working with
the insuranceplants, say how can we actually create a model
that appropriately incentivizes all parties?

Speaker 1 (37:41):
So do you see yourself eventually taking risk in some way,
shape or form and what would that look like? Are
you doing any pilots right now.

Speaker 2 (37:48):
Where this is? You know, I think the risk will
come with this combined model of a digital intervention with
the service delivery because the reality is there's another point
of view which says, well, highly efficacious care delivery treatment
is actually more sessions. You know, there are some provide
organizations who will say that the insurance plans don't want

(38:09):
to hear that, but you know, others say will actually no, clinically,
maybe you need to do fifteen sessions instead of ten, right,
And so what we're what we're doing is saying this
this field needs more objectivity. There's just it's it's a
completely subjective part of healthcare. Right. You can't do a
blood test. And although there are some startups that are
that are trying to measure corded all and things like that,

(38:31):
but you know, generally speaking, it's not standard practice, say
we're going to do a blood test assession depression, right,
And oh, by the way, depression includes components of the
definition that is, like you might be sleeping too much,
or you might not be able to sleep, or you
might be you know, hyperactive, or you might be lethargic,

(38:51):
and so like both the ends of the spectrum sort
of define some of these diagnoses. Which is a separate topic.
So you know, our some of the things we're doing
with the plans and some of the exciting announcements we'll
probably have towards the end of this year are about
how we're how we're delivering a really unique model of
care that truly intertwines digital intervention with AI with human

(39:16):
delivered care.

Speaker 1 (39:16):
That's great. You mentioned customer acquisition costs and and you know,
i'd like to ask, you know, kind of what's your
strategy there. And then obviously you know that's been in
the public market. It's a pain point for one of
the DPC competitors. So maybe just what's been your experience
and the strategy around customer acquisition.

Speaker 2 (39:32):
So it's multi pronged, as I think any you know,
good businesses that have multiple customerpquisition strategies, right, you have
to hopefully, and so we've had, we always had a
bit of a DTC component. It's actually not how we started.
We started really by partnering with a lot of health
systems and primary care providers because again, if you think
about where is the front line of defense for most

(39:53):
parts of healthcare, it starts with the PCP right where
it makes sense you're doing that and to visit and
you know you have a you do a screening so uh,
you know, as an example, I had a I had
an audiology visit with the VA a couple of weeks ago,
and uh, and the veteran as I went to the
VA from my audiology visit and the audiologist said, oh,

(40:14):
like it's been a year. We need to do this,
you know this like suicidality and depression screener because we
try to do that every So health systems are starting
to do screen screenings on their patients, not just in
the primary care setting, but in all settings, right and saying.

Speaker 1 (40:28):
So being much more proactive, much more.

Speaker 2 (40:30):
Proactive to understand where like which patients are dealing with needs.
And then the challenge that they face is, well, what happens.
If Mark says, yes, what do I do? Then? Right,
what is the ologyst going to do? Like where do
I I don't know what to do? You know, I'm
not a therapist, then what And so we partner with
a lot of these health systems uh in you know,

(40:51):
at at sort of the the regional and you know,
all the way down to the practice level. So that's
sort of from a top down and a bottoms up
to say, we are here in your local market as
a high quality provider of care and we'll get this
patient into care and more than that, will actually interface
with with your your technology system and ensure that you
know that Mark did see that therapist, right that actually

(41:14):
there was a handoff and it was in the Mark
was treated and and we're not sharing clinical notes and
things like that, but you know, we're sort of closing
that loop connectivity basis. So that's one one way we're attacking,
uh you know, the integration of this medical behavioral and
a way that we're sort of solving from a from
a business standpoint customer acquisition. And then we work again

(41:37):
work with insurance plans and as as as everybody in
the ecosystem of healthcare gets more and more understanding of
how intertwined mental health is to physical health. There's more
opportunities for us to partner and to say, hey, we
are here as a high quality, highly integrated provider who
can ensure that your patient, or your member, or your employee,
whatever monarchery you use to define an individual as it's

(42:00):
aholl you know, I am an employee, I am a patient,
I am a member, right like I am all those
and so regardless of how like which which sort of
hat I'm wearing when I'm looking for a mental health solution,
Sonomon is there to sort of enable that.

Speaker 1 (42:16):
So maybe thinking down the road, you know, as we
think about technology and just the speed at which AI
is moving, you know what is what are you excited
about in your technology roadmap? I don't know what you
can share or not share, but you know, as you
think about where technology is headed, you know what gets
you excited and where do you see some of those
applications in your business?

Speaker 2 (42:35):
This is such an exciting time, Jonathan. I mean, I
know you You've had a lot of these discussions with
folks who are on the on the leading edge, and
we consider ourselves a beyond the leading edge. Of this,
certainly in the mental health space. The ability to start
to use massive amounts of data to understand and to
to understand, diagnose, and to treat mental health is I am,

(42:59):
my opinion, is actually the highest application, maybe with the
one exception of I think drug discovery. I think that's
like the other AAI is going to do massive things
in my opinion, for drug discovery and for life sciences.
But from a care delivery we're seeing a lot you know,
you know, there's a lot of news about these amazing
tools for providers across all parts of the healthcare ecosystem,

(43:20):
which that are you know working on AI scribes and
are yeh.

Speaker 1 (43:23):
So I was going to ask you about the ambient
piece of it, because we've had one one company on
that does digital biomarkers that they can diagnose depression and
clinician burnout, that sort of thing. Are you seeing that
becoming a big.

Speaker 2 (43:35):
Part of the I think that that, I mean, that's been.

Speaker 1 (43:38):
A paradigm going forward.

Speaker 2 (43:39):
I mean, I again, if you pulled my pitch decks
from eight or nine years ago, I was sort of
I didn't know that lem's were going to come in
the way that they've come by any means. But I
did believe that with the amount of data we're able
to collect, we would better understand how the human wind
mind works. And by better understanding how the human mind works,
we would be able to better uh, diagnose and treat

(44:02):
mental health issues. You know, the analogy I used to use,
and I don't need to use anymore because everybody so understands,
Oh my gosh, all this data really can do amazing
things from a technology standpoint. But the analogy I used
to use was do you ever watch mad Men? Oh? Yeah, okay,
so you know, right, like it's a great, great show,
right set, you know, nineteen late sixties, early seventies, Madison Avenue,

(44:24):
right like, you know, advertising, Think about how marketing and
advertising was executed fifty years ago, right in the sixties
and seventies. It was focus groups. It was creative people
going off into the room. It was Don Draper getting
drunk and going back to his office at midnight and
banging away a typewriter and then cleaning himself up and

(44:45):
delivering some really awesome pitch to the client. Right and
it was this, you know, this magical insight that he got,
you know, in the shower or something like that. Is
that how marketing has been done for the last fifteen
or twenty years. Absolutely not right. The way it's done
now is with massive amounts of data. Right, What are
social media platforms and and you know so Meta and
Google and you know, TikTok? What are they if they're

(45:08):
not actually insights into how the human brain works? Right,
They're able to predict things that you might be more
interested in seeing, and from those predictions get a better
understanding of things that you might be more interested in buying.
And that's fine, Like it's it's like, but you know,
it always struck me and said, wow, we've been able

(45:30):
to crack the code on a few parts of the
human uh brain and how we think toward the end
of selling more stuff, which you know, like, that's that's fine, right,
Where a capital is society is a capital society. That's
there's nothing I'm not that that's not a bad thing.
I mean there's maybe some some unintended effects of social media.

(45:50):
I mean, I have three kids myself, and I worry
about some of the things around that, but that's a
different discussion. What did strike me though, is like we
haven't actually used that technology that and I say technology
very broadly. We haven't used that that ability to collect
massive amounts of data environmental and I mean that like
not internal to you, but also uh explicit and implicit

(46:12):
to you. Right now, we have, you know, things that
are measuring our own biomarkers. I'm wearying. You know a
ring that tracks you risk to watch? You know that
that has that tracks all this information. I'm measuring what
I'm eating. I'm maybe recording my sleep and things like that.
It knows what the weather is, it knows who I'm
traveling here or there. I'm doing my daily reflections in

(46:35):
the solder Mine app and I'm telling about how you
know good or bad my day was. We can take
all that information and in the same way predict buying
behavior and actually influence buying behavior and other behaviors too.
Start to say, how can we better understand and maybe
create even a different model for how we diagnose, and
then from that, because you can't treat better without diagnosing better, right,

(46:56):
how can we then take that and start start to
move the needle. That's what excites me the most about
the next I think about the next three, five, ten
years is I just think we're going to see, well, do.

Speaker 1 (47:06):
You build that yourself or do you partner? I guess
maybe is the both the question both?

Speaker 2 (47:10):
Okay, So you know, I think we have some uh
some great partners that are more on that. I'd say
the even the deeper science side, where we're talking to
folks who can measure voice inflection and things like that, right,
And and then we a lot of stuff we build ourselves, right.
And so we have thousands and that I mean, you know,

(47:30):
every day we've got thousands of hours of session data
that's happening, right, and we're and it's it's there's audio,
and there's then we're transcribing and we were you know
that we're the data. We've got all the data. And
then we've got thousands and thousands and thousands of interactions
per day in between sessions outside of the therapeutic setting, right.

(47:55):
And then when we start to link up with other
ways and people, And this is again everybody needs to
opt into this stuff. But if you really want to
understand your mental health, you have to say, well, I
need a holistic picture. It's you know, we don't really
understand as a as a species, as you know, how
does the mind really work like there's you know, like

(48:17):
we're learning so much more and will continue to but
it's like it's just fascinating. I think it's such an
interesting space.

Speaker 1 (48:22):
Well maybe along that same vein of you know where
you invest coming forward. You know, you did your ask
capital raised a couple of years ago, four years ago, Yeah,
do you have to raise more capital at this point?
You know, if you think about the vision from five,
you know, five years out, what is what does Sounder
mind look like in five years you know, twenty thirty?

Speaker 2 (48:40):
Yeah, this is so this is a really exciting time
in the industry. There's I think the first wave of
the industry was we needed to solve access, right, and
then this pandemic hit and that created a bunch of
good things and a bunch of bad things. I think
in the mental health industry. One of the good things
is actually I believe access is sort of that the

(49:03):
train is completely Leftestation isn't speeding away, and it's being
solved right. Like, people in most parts of the country
can access high quality in network care through right you know,
through Sono Mine as well as through others, which is great.
But what we're seeing now is that utilization is increasing.
That's good. However, we have not seen yet from you know,

(49:26):
publicly available data that actually the prevalence of mental illness
reported mental illness has decreased. So one stat that really
strikes me is that on average, between twenty thirteen to
twenty nineteen, forty million Americans received mental health care, and
then from twenty nineteen to twenty twenty three it increased

(49:49):
to about sixty million, so fifty percent increase. And then
if you look at twenty nineteen, there were about fifty
million Americans that were reporting a prevalence of any mental
illness of pumenting quotes because it sort of covers sort
of any you know, like depression, anxiety, but other things
as well. And so in twenty twenty three, well, if
we've increased the number of people who are accessing care

(50:11):
for a condition by fifty percent, ideally we would see
at least a fifty percent drop in the prevalence. Right,
We'd go from fifty million people reporting any mental illness
to twenty five million. Right, and maybe not, because we
say the people who are reporting it are actually going high.
Maybe won't be fifty percent. It should go from fifty
million to forty million. Right, It went up fifty million

(50:32):
to sixty million. So what does that tell you? It
tells you that the outcomes are not really there yet.
And so what we're starting, we've we've solved access, we
haven't really solved outcomes. So I think that's what we're
going to see a lot of and it's going to
take and I believe companies like us. So for us
in particular, you mentioned fundraise, We've been fortunate not to
be able to not to need to be able to fundraise,

(50:53):
not to do to fundraise. In the last four years.
We raise our Series C with a number of great
investors in twenty twenty one. There's no immediate plans, but
you know that that may change as we sort of
think about the market. I believe there's going to be
consolidation in the market, and I think that that's going
to come in the form of I hope it comes
in the form of companies that are seeking to improve outcomes,

(51:15):
because if it's only continues to be about access, then
we're not really actually solving the root problem.

Speaker 1 (51:23):
Right right, So maybe thinking about some of the things
you just said there, you know, where are you spending
the majority of your time? I mean, I'm sure that's
changed over the years. You know, today when you sit
down and say, you know, what do I want to
accomplish over the next year or two years or five years,
you know, where are you devoting most of your personal energy?

Speaker 2 (51:41):
So my personal energy, I mean, I'm so fortunate to
have just an amazing leadership team and broader team, and
we've got a tremendous board. So a lot of my
energy is is less focused on the the execution of
you know, as we continue to expand our footprint in
many many markets, as we architue to partner with these

(52:01):
health systems and these resurance plans. I've got great team
members who are really focused on that. Of course, I
try to help wherever possible. Sometimes they say, get.

Speaker 1 (52:08):
Out of the way, Mark.

Speaker 2 (52:11):
I spend a reasonable amount of my time in engaging
with our product and technology teams, and I think a
lot of my time in really working across the ecosystem
to say where where can we work with other parties
who are on that leading edge of improving outcomes? Right?
And that's that's where I spend some of my time,

(52:31):
is you know, engaging in various commercial and strategic partnerships
that we look at again you know, these acquisitions we've
done have been really transformative from the company. The third
one I didn't mention was mind strong, which was really
a tremendous technology set of technology tools that were developed
by a team focus on improving outcomes through machine learning

(52:54):
and understanding of data that's coming in and then actually
creating data driven technology, data and treatment plans for the
therapists that we're part of that. So integrating that has
been a big focus for the past few years, and
looking forward, I think that there's probably more activity for
us to come.

Speaker 1 (53:09):
Oh, that's great. One of the ways I like to
wrap up these conversations is I always ask the guests
to maybe focus on a life lesson are something that
really drives their day to day and informs their mission?
Is there is there something you could share that drives
your day to day mark?

Speaker 2 (53:22):
Yeah, my. I think one of the things that I've
learned over the years is authenticity is a word that's
used a lot today, and it really does take a
fair amount of reflection to say what does it mean
to be authentic? So for me, when I get stressed,
it's actually when I feel like my actions and my

(53:44):
activities for the day, for the week for the month
are not aligned with my priorities. So I think it's
important for leaders and really any you know, a leader
is like everybody is a leader, you know, at a minimum,
releading yourself. But for people to really think about how
they're spending their time and if that is when they

(54:05):
look back on life, you know, like five ten years later,
they look back, that's how I should have spent my time.
It can be you know, an error of omission or
co mission, right, and so what you want is to
make sure that if you made a mistake, it was
because not because you didn't think about it, right. You
want to think about what how am I spending my time?
So for me, the biggest, the biggest learning has been

(54:26):
really spend the time reflecting on you know, how am I,
how am I organizing my day? How am I organizating
my week? Who the people I'm spending with? And that's
been I think the biggest reflection.

Speaker 1 (54:37):
That's great. Thank you so much for sharing that. Before
I let you go. One of the things you mentioned
was all the different tools on the Sounder Mind app,
which one's your favorite?

Speaker 2 (54:45):
My favorite is the self is the daily reflection. I
I just I love it, but there's more, there's more
and more coming. But I think that's the that's.

Speaker 1 (54:53):
The one, all right, So for everybody who listened to
the end, go check that out.

Speaker 2 (54:56):
That's right.

Speaker 1 (54:57):
And with that, that's Mark Frank, co founder and CEO
of Sonder. Thank you so much for joining us for
our latest episode, and please make sure to click the
follow button on your favorite podcast app or website so
you never missed a discussion with the leaders in healthcare innovation.
I'm Jonathan Palmer, and you've been listening to the vanguards
of healthcare podcasts by Bloomberg Intelligence. Until next time, take care,