July 29, 2025 • 28 mins
In this episode of the Personality Couch Podcast, I (licensed clinical psychologist, Doc Bok) take a different approach and lean into the clinical practice part of this podcast. I spill the tea on significant changes in the healthcare landscape, particularly focusing on the rise of telehealth and the influence of venture capital-backed mega telehealth companies. I highlight the conflicts of interest with wealthy investors, ethical and privacy concerns, and market consolidation that threaten the integrity of mental health care and private practice as we know it. This episode emphasizes the importance of patient and clinician awareness, and I provide actionable steps to navigate the evolving healthcare environment.
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Chapters 00:00 Healthcare Changes Post Pandemic 03:24 What is a Venture Capital Company? 04:13 How Venture Capital Telehealth is Different From Private Practice 05:29 Meet the Telehealth Companies’ Investors 08:02 Conflicts of Interest for Investors 09:52 Privacy Concerns 12:19 Ethical Concerns 14:28 Market Consolidation 19:02 Vertical Integration 20:09 Therapists’ Stories & Lawsuits 23:12 What Can Patients Do? 24:08 What Can Clinicians Do?
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Personality Couch podcast,
where we discuss all things personalityand clinical practice.
I'm your host, Doc Bok,
licensed clinical psychologist andentrepreneur in private practice.
Today, I'm taking a little bitof a different approach.
So while I normally talk aboutpersonality and
personality disorders withmy co-host, Doc Fish,
(00:22):
today we're in between series.
So why don't you join me for Tea Time?
As I spill the tea on some behind the
scenes changes to healthcarethat are not good.
If you're a patient, these changes impactyour privacy and security.
If you're a clinician, these changes impactyour autonomy and reimbursement rates.
(00:43):
And for all of us, these changes have the
potential to consolidate thehealthcare market
into the hands of billionaires, which couldforce private practices to close
and for patients to lose accessto good and ethical care.
Y'all, we got to talk about the venturecapital telehealth companies.
(01:03):
Pull up a chair. It's tea time.
Okay, so we need some contextfor this tea.
So let's start at the beginning.
It's easy to see how telehealth has boomedover the last several years,
but you have to understandthat prior to 2020,
in mental health, online therapywas still fairly rare.
(01:24):
It was seen as more of like a niche area.
Insurance didn't always reimburseus for it.
And honestly, I didn't have a single colleaguewho offered it in private practice.
Even still, in the 2010s, thistrend of investing
in digital healthcare was justgaining traction.
(01:45):
So a few tele-mental health companiespopped up during this time,
but the online experience had a heavy focuson technology and symptom monitoring,
less of the one-to-one therapy.
But things changed drasticallyin early 2020.
Any wonder?
The pandemic brought with it a globalphysical and mental health crisis,
(02:10):
and also a growing need for virtual care.
So while most of us in private practice
quickly adjusted to providingservices online,
there was something much more sinisterhappening behind the scenes.
Enter venture capital telehealthcompanies.
If you do an online search, I guaranteeat least one of their ads will pop up,
(02:34):
telling you to schedule an appointment.
And no matter what state you're in,they have a therapist for you.
And of course, usually their names give sometype of clue about their services,
often mentioning the head,the mind, help,
talk, or the psyche, among manyother brand names.
(02:55):
Some have nothing to do with psychology.
But let's peel back that curtain.
What are these companies andwho is behind them?
So the short answer is that these areventure capital companies,
and they're backed not by mental health
professionals, but by extremelywealthy investors.
(03:16):
Okay, so hang on.
We're going to unpack what this meansand why it's not good.
So let's start by asking, what isa venture capital company?
So if you've ever watched the showShark Tank or Dragon's Den,
this is venture capital madeinto a TV show.
An entrepreneur presents a very expensiveidea to extremely wealthy folk.
(03:40):
And then these billionaires chooseto invest, or not,
if they see the idea as profitable.
So then if the wealthy investor thinks theycan make more money in the long run
by lending a large sum of money now,then they come out ahead.
So it's a high risk, high rewardtype of situation.
(04:01):
And this model is how most of these onlinetelehealth companies started,
because really big companies need reallybig money upfront from investors.
So you might be asking, howis this different
from your private practice therapistup the street?
So glad that you asked.
So your average mental health professionalin private practice
(04:22):
does not need millions or billionsto set up shop.
Not by a long shot.
Most of my colleagues and I started our ownprivate practices from either savings
or maybe a small business loan, maybe someof the bigger practices in the area,
used investors, but again, likenothing on this scale.
(04:43):
If they did, we're talkinglike thousands versus
millions or billions, like noteven on the same plane.
Okay.
So just a quick example of this typeof scale and the reach.
It used to be that clinicians could hangour shingle on psychology today,
and we could have a full caseload.
However, many of us clinicians now arefinding it harder to bring clients in
(05:07):
because these massive companies areclogging the ad space online,
because their marketing budgetis beyond what
we can even conceive as smallbusiness owners.
So we'll get to how this impacts providersand patients alike in a minute,
but we need to understand who the investorsare behind these companies.
(05:28):
So I ask you, who do you think wouldinvest in these companies?
Any guesses?
Who has lots and lots ofmoney and would be
interested in seeing these telehealthcompanies succeed?
We have massive tech companies andprivate health insurance.
All right.
If you haven't choked on your tea yet,you're not listening close enough.
(05:53):
I said your health insurance company is
investing in the telehealthplatform you're using.
That is a massive conflict of interest.
More on that in a minute.
So these bloated companieshave created a huge
power imbalance in the privatepractice therapy
(06:13):
world. A company that has this much moneyhas so much market sway, like so much.
I've already alluded to thiswith the psychology
today marketing, but especiallyif these are the
same billion dollar companieswho own your private
health insurance or who ownthe technology you're
(06:37):
using right now to tuneinto this podcast.
Yuck.
So these types of companiesare among the top
investors in the very platformwhere you speak
with your supposedly private therapist.
Do you have red flags popping up yet?
I know I sure do.
(06:57):
So these billionaire backedstartups have paved
the way for multiple partnershipsbetween tech
and consumer industries likeGoogle, Microsoft,
and Amazon, to name a few,all taking their shot
at the healthcare world.
Also fun fact, if you do a quick search forthe top 10 richest people in the world,
(07:20):
these companies founders will pop up.
You heard that right.
Some of the investors in these telehealth
companies are the wealthiestpeople on the planet.
Hello.
Does that alarm you?
So out of the mental health crisis, we're
continuing to line the pockets ofthe world's richest people.
(07:42):
Really?
Oh my goodness.
And the problems just keep coming.
And let me also just say too that I'mnot alone in my concerns here.
Many of my colleagues from across the countryare also in an uproar about this.
Anyway, back to the problems.
Let's start with the most obvious one.
So the first one is the huge conflict of
(08:06):
interest for private health insurancecompanies to own
the platform in which yousee your therapist.
This creates a power vacuumwhere insurance
companies can create sweetdeals with these
larger companies.
So for example, I'm hearingfrom colleagues,
multiple reports of higherreimbursement rates
for providers on these venturecapital platforms.
(08:28):
Then they're getting fromtheir own private
practices from the same insurancecompanies.
So venture capital, higher reimbursement,your own private practice,
not the higher reimbursementfrom the same company.
That's what I'm saying.
So this could mean perhaps even smallercopays for patients too,
(08:49):
or cheaper insurance based services to
incentivize you to use theirplatform over here
instead of the private practiceup the street.
Like that's the type of powersway they have.
And that's so concerning because of courseinsurance wants to see a return on their
(09:11):
investment in these companies.
So they lure therapists onto these platformsto increase their own profitability.
And they're also luring patients too.
Like we are all pawns in thismoney making game.
Yuck.
So all of this makes me wonder how privatethat information you share really is.
(09:36):
Like are investors seeing morethan they should?
Are they seeing session notes?
Transcripts?
Recordings?
Like where is that going?
Especially if this is online telehealth,which brings me to privacy concerns.
All right.
So since venture capital companies arealso backed by tech giants,
(09:59):
what type of technology isactually being used?
Is it HIPAA compliant?
Is AI involved?
Or are there other invasive new tech featuresthat they're trying out on us?
Like tech companies aren't interestedin mental health.
Tech companies are interested in growingtechnology and making a profit.
(10:20):
So again, I've heard from some of my colleaguesthat they have been forced to give
non-clinical company membersaccess to their
private session notes inthe name of ethical
and legal care and compliance,which is totally bogus.
Like we know how to write session notes
and the company is being thenice guy looking
(10:43):
through them for us.
I don't think so.
But then my other question is who exactly
is combing through thesenotes for supposed
compliance?
And what my colleagues andI fear is that AI
is looking through sessionnotes or listening
in on sessions to better understand humanbehavior and mental health.
(11:06):
Because as we know, AI doesn'tknow anything on its own.
We have to feed it information.
And if it needs to learn more about human
behavior and specificallyhow to be a better
therapist, of course, there'san interest in
having AI be part of the sessionsor the session
notes.
So that's our major fearhere as clinicians.
(11:29):
But then we're also concerned about AI potentiallybeing trained to replace us.
Because again, the bottom line is that thesebots are cheaper than us clinicians.
And honestly, we already know that chatbots are impersonating psychologists.
(11:51):
And there was a complaintthat the APA filed
actually with the FTC becausethese chat bots
are impersonating us.
And that's not OK.
But again, these companies don't care.
They care about the bottom line andgetting that information.
And with that HIPAA reallydoesn't seem to
matter because any fines thatthey incur are just a
(12:14):
slap on the wrist because these companieshave that much money.
So then that brings me toethical concerns.
So in these companies, mental health professionalsare not running the show.
These are owned again by tech giants, wealthyinvestors, and insurance companies.
So we mental health professionals,we have a
(12:35):
code of ethics to followto provide the best
care possible for our patients.
We also have licensing laws to follow.
And not adhering to these puts patients'well-being and even lives at risk.
But again, these investors don't care.
They really don't.
And we're fooling ourselves ifwe think that they do.
(12:57):
But really, what's at risk is ourlicense as professionals.
So for example, again, I'veread reports of
clinicians being forcedto see patients in
states that they aren'tlicensed in, which
is so risky because if there'sa crisis and
you don't know the laws of the state and
(13:17):
how to act accordingly, youcould be in legal
trouble as the clinician,not to mention for
the client that could be potentiallydangerous.
So the business is not so concernedabout this, right?
It's the clinician becauseit would be the
clinician that loses their license versus
the slap on the wrist fine forthis mega company.
(13:40):
And then sometimes these companies will
also make these shiny emptypromises to pay any
legal fees for the problems that theirstinky business structure creates.
I mean, come on, that doesn't coveranything up adequately.
And clinicians, we should not beimpressed by this offer.
(14:03):
Absolutely not.
But as with all things venture capital, hugeprofit margins are the primary focus.
It's at the expense of client care and atthe expense of us as clinicians.
Ethics and laws are inconvenient and basicallyjust get in the way of making money.
So they'll pay you or anyone else offto make the problem go away.
(14:27):
All right.
And then another problem I referenced it
before is something calledmarket consolidation.
So these companies funnel private practiceclinicians to them with those big,
shiny promises and bonuses, as well as higherreimbursement rates from insurance.
And insurance can do this because they're
(14:48):
double dipping from the samepot, which is so gross.
But at a networking event that I attended
earlier this year in a groupof about 15 of us,
all but just a few were usingthese venture
capital companies for billingor to help fill
their caseload. And multiple people said
(15:08):
that they just couldn't doit on their own.
That's so concerning.
Like we're only a few years into thisventure capital telehealth boom.
And the market has alreadyconsolidated to
the point that many providersfeel financially
reliant on these companies to stay afloat.So this is a dangerous place to be.
(15:33):
I liken this to the ideaof the notion that
someone can't leave theirabusive relationship
because their partner makesthem money. Like
that's kind of what we're settingourselves up for.
So we need to be really wisehere and start
coming up with our exit planoff of these companies.
The other thing that wehave to look at is
(15:54):
these companies are exceptionalat marketing because
they have literally entiredepartments and
hundreds of thousands of dollarsdedicated to it.
And they have professionalsworking on it.
So they are quick to findour pain points.
And for potential patients, they tell you
it's about convenience orlow cost or therapy
(16:17):
adjacent services like emailingand texting.
So they're cheapening thetherapy experience
to rake in the billions using their verycrafty marketing techniques.
So there's a reason why inprivate practice, we
historically haven't offeredtexting sessions or
email sessions because it'snot a thing. It's
(16:40):
not a therapy and it's riskywhen you can't see
the person for context. Butagain, here's that
shiny carrot that we're goingto dangle with all
these different marketing techniquesfrom these
venture capital companies. Andthen for providers,
they tell us like, Oh, we'llmake a deal with you.
Like we'll deal with insuranceso you don't have to
(17:03):
or we'll give you a betterrate. And I've heard
from multiple colleagues wherethese platforms
are requiring us providersto sign over our
insurance login information,what we call CAQH.
So there's reports of themabusing that and
changing this informationwithout our consent,
(17:26):
including changing business information
that goes back to the venturecapital company,
especially when the clinicianworks at multiple
different companies. And thenthe venture capital
company is changing all ofthose names back to
their own. So they get thechecks from insurance
for this clinicians work.Like that is wild to
(17:49):
me. This is absolutely wild.And who's to say also,
if you quit, like that theywill give you your
login information back, likethis could be so
detrimental in the futurefor your business
and for your ability to keepseeing patients like
clinicians, we need to wakeup. These platforms
(18:10):
are grooming us to be dependenton them by saying,
Oh, take go to sleep. We'lltake care of this.
We'll take care of that. I'malso hearing from
my fellow clinicians that theseventure capital
companies knowing that we'renot good at marketing
or knowing that we don't reallyknow much about
SEO. They'll say, we'll takecare of your website.
(18:34):
We'll take care of your psychologytoday profile
to bring you clients. Like we'llmake sure to get
you good SEO and take careof your marketing.
So you don't have to thinkabout it. Meanwhile,
they're using our websitesfor their search
ranking and their backlinks.It doesn't help us.
(18:55):
Like we clinicians are sonaive and signing
over this much power. Thenwe have to talk about
something called vertical integration. So
big companies combined withother big companies
to increase profit margins.And sometimes it can
be hard to track these companynames because they
keep absorbing other companies,most like the,
(19:17):
was it the Russian nestingdoll where it's like,
Oh, and it's, it's anotherone within another
one, then another one. But thishappens also with
insurance companies as well.Private health
insurance has, especiallyin recent years,
started to gobble up othersmaller insurance
companies. So with more moneycomes more ability
(19:37):
to buy things and buy outother businesses and
then offer more services thatwe could never compete
with in private practice. It puts these
companies in a place where theyare too big to fail,
like bigger than fines, bigger than
regulations. And it puts them ina better position to lobby
(19:59):
and make political decisionsin their best
interest because they have thefunds and the sway
politically to do so. Now there's a few
different other stories from providersthat I think are
worth mentioning here. SoI've heard stories
about providers whose ideasand expertise were
exploited because the CEOand the board wanted
(20:23):
to learn more about the marketand wanted to learn
more about what we do. Andthen that person or
those people were immediatelyreplaced once they
got the information that theyneeded. So I've also
heard from colleagues, reportsof being forced to
use and promote the venture capital's
digital tools as part of therapy.So taking up very
(20:47):
valuable therapy time with thepatient, promoting
the company's nonsensical tools,like that's not
okay. That's not our job. We're not their
little marketing minions. Likewe are here to help.
And then the other piece that I'm hearing
reports of is really a push formore metrics and number
(21:10):
driven care. So for example,having the provider
get paid or not get paid basedon the word count
in a note or in an email. Andthen there's also
this kind of over emphasison outcome measures
as telling the full story of health and
healing. But as we know, there'sso much that goes into
(21:33):
therapy that can't just be condenseddown to some
rating form that you fill outafter session. But
in a metrics world where venturecapital is going,
Oh, I want the bottom line.They're trying to find
a way to make it numerical.And it's just not
going to happen with clinicalcare. And then
another concern that I have is that these
(21:55):
companies are recruitingclinicians without
discretion. So it's what Icall indiscriminate
hiring. So it's not aboutgoodness of fit for
the companies or even, youknow, is this person
ethical and fit for the job?It's about bodies in
the chairs to make money and you can be
replaced. And then similarly withclients, it's not about
(22:16):
matching you with the therapistwho's the best fit
for your needs. It's about gettingthat placement,
churning out money. So it's about mass
quantity, but not about ethicalcare. And then the big
kicker with all of these isthat there have been
multiple lawsuits with multiplecompanies where
(22:37):
they have been selling informationto other
billion dollar companies for marketing.I kid you not.
Yeah. If you just researchthe company name and
the word lawsuit, like you'llsee what I mean.
So the one in particular thatstands out to me is
one of these venture capitaltelehealth companies
(22:58):
was selling protected healthinformation to meta.
So that's Facebook and Instagram.I'll link that
one in the show notes. Thisis really, really
important to know. Okay. Sowhere do we go from
here? What do we do? So let'sstart first with
what patients can do. The firstthing is do your
(23:18):
research. Like where doesyour therapist work?
Who owns the company? AndI just encourage you
to support local therapists and small
businesses and stay away from themega companies who have
already been sued for sellingyour private
healthcare data, but thenalso read the fine
print in the paperwork at your first
appointment. Is your data protected?Is AI in your sessions?
(23:43):
Then also use your gut. Likehow is the vibe of
the onboarding process? Likeare you cared for
as a potential patient ordo you feel like a
number? Are you matched withthe therapist who's
competent in the area of help that you're
seeking or are you just matchedwith the first person
that's available and it's reallynot a good fit
for you. Like do your researchand always trust
(24:06):
your instincts. And nowI'm going to speak
to my fellow providers here.Do your research.
Same thing. Like what areyou signing up for?
Read the contracts for onboardingbefore you
agree to work with this company. And also dothe research of who owns this company.
Search for that name, but also any other
(24:26):
names that might be affiliatedwith that company.
Are there carve outs ofthat company under
a different name? Is therea bigger umbrella
company that actually this is kind of a subpart of that company? It can get very,
very confusing when theystart buying each
other out or sometimes they'llpop up and rebrand
because they already got suedor did unethical
(24:47):
things. And so it's like, Oh,we're a new company
now, but do your research.Really know what you
are getting yourselves into.And then also look
at how are they classifyingyou? Are you a 1099
or are you an employee and howdo they treat you?
Do they treat you like an independent
contractor or do they treat youas an employee? There are
very strict laws about thisdifferentiation,
(25:10):
but then also what are otherthings that you're
required to do either withinor outside of the
therapy sessions? Are yourequired to promote
their icky products? Are yourequired to answer
texts or emails as if theyare therapy? And then
what are the requirementsfor seeing clients?
Are notes private? Are sessionsrecorded? Is an AI
bought involved in the sessions?Where does the
(25:32):
data go? Ask hard questions.And if they don't
give you a satisfactory answer, that's an
answer. So one of the biggestthings that we can do as
fellow clinicians is connect with other
professionals in our areaand to stay alert.
Like there's lots of differentgroups that meet
and discuss these concerns,whether it's locally
(25:54):
or online, like check your local
professional resources and checkwith your colleagues.
They may be part of thattoo. Similarly, if
insurance billing scares youas it does for a
lot of us, like look for asmall local company
that does insurance billing,ask your colleagues
and don't use these platforms.And of course,
(26:15):
support local and support yoursmall businesses
in your community. And youcan learn about these
businesses by connecting withother providers in
your area. Okay, so in sum,I spilled the tea
today on venture capital companiesand the dangerous
power that they have to continuechanging the
landscape of healthcare andnot for the better.
(26:36):
So stay alert, read up onthese companies and
know what you're signing upfor both clinician and
client alike. These companiesare the definition
of corporate greed. And don'tbe fooled by their
nice offers. They're notnice. These aren't
mental health professionalsbehind there. Like
they care about the bottomline and making the
(26:56):
wealthiest in the world evenwealthier at your
expense. And on that note, that's a wrap.
Thank you for joining me todayon this episode of
the personality couch. If youlike this style and
are watching on YouTube, commentbelow and let me
know your thoughts. If you'relistening on a
streaming platform, drop mea line at
(27:18):
personalitycouch.com/contact.Link will be in the show notes
Next episode, Doc Fish will be back and
we'll be starting our newseries on schizoid personality.
You don't want to miss it.
Be well, be kind.And we'll see you next time
on the personality couch.
This podcast is for informationalpurposes only and does not constitute a
(27:41):
professional relationship. If you'rein need of professional
help, please seek out appropriateresources in
your area. Information aboutclinical trends or
diagnoses are discussed inbroad and universal
terms and do not refer to anyspecific person or case.
Welcome to the Personality Couch podcast,
where we discuss all things personalityand clinical practice.
I'm your host, Doc Bok,
licensed clinical psychologist andentrepreneur in private practice.
Today, I'm taking a little bitof a different approach.
So while I normally talk aboutpersonality and
personality disorders withmy co-host, Doc Fish,
(00:22):
today we're in between series.
So why don't you join me for Tea Time?
As I spill the tea on some behind the
scenes changes to healthcarethat are not good.
If you're a patient, these changes impactyour privacy and security.
If you're a clinician, these changes impactyour autonomy and reimbursement rates.
(00:43):
And for all of us, these changes have the
potential to consolidate thehealthcare market
into the hands of billionaires, which couldforce private practices to close
and for patients to lose accessto good and ethical care.
Y'all, we got to talk about the venturecapital telehealth companies.
(01:03):
Pull up a chair. It's tea time.
Okay, so we need some contextfor this tea.
So let's start at the beginning.
It's easy to see how telehealth has boomedover the last several years,
but you have to understandthat prior to 2020,
in mental health, online therapywas still fairly rare.
(01:24):
It was seen as more of like a niche area.
Insurance didn't always reimburseus for it.
And honestly, I didn't have a single colleaguewho offered it in private practice.
Even still, in the 2010s, thistrend of investing
in digital healthcare was justgaining traction.
(01:45):
So a few tele-mental health companiespopped up during this time,
but the online experience had a heavy focuson technology and symptom monitoring,
less of the one-to-one therapy.
But things changed drasticallyin early 2020.
Any wonder?
The pandemic brought with it a globalphysical and mental health crisis,
(02:10):
and also a growing need for virtual care.
So while most of us in private practice
quickly adjusted to providingservices online,
there was something much more sinisterhappening behind the scenes.
Enter venture capital telehealthcompanies.
If you do an online search, I guaranteeat least one of their ads will pop up,
(02:34):
telling you to schedule an appointment.
And no matter what state you're in,they have a therapist for you.
And of course, usually their names give sometype of clue about their services,
often mentioning the head,the mind, help,
talk, or the psyche, among manyother brand names.
(02:55):
Some have nothing to do with psychology.
But let's peel back that curtain.
What are these companies andwho is behind them?
So the short answer is that these areventure capital companies,
and they're backed not by mental health
professionals, but by extremelywealthy investors.
(03:16):
Okay, so hang on.
We're going to unpack what this meansand why it's not good.
So let's start by asking, what isa venture capital company?
So if you've ever watched the showShark Tank or Dragon's Den,
this is venture capital madeinto a TV show.
An entrepreneur presents a very expensiveidea to extremely wealthy folk.
(03:40):
And then these billionaires chooseto invest, or not,
if they see the idea as profitable.
So then if the wealthy investor thinks theycan make more money in the long run
by lending a large sum of money now,then they come out ahead.
So it's a high risk, high rewardtype of situation.
(04:01):
And this model is how most of these onlinetelehealth companies started,
because really big companies need reallybig money upfront from investors.
So you might be asking, howis this different
from your private practice therapistup the street?
So glad that you asked.
So your average mental health professionalin private practice
(04:22):
does not need millions or billionsto set up shop.
Not by a long shot.
Most of my colleagues and I started our ownprivate practices from either savings
or maybe a small business loan, maybe someof the bigger practices in the area,
used investors, but again, likenothing on this scale.
(04:43):
If they did, we're talkinglike thousands versus
millions or billions, like noteven on the same plane.
Okay.
So just a quick example of this typeof scale and the reach.
It used to be that clinicians could hangour shingle on psychology today,
and we could have a full caseload.
However, many of us clinicians now arefinding it harder to bring clients in
(05:07):
because these massive companies areclogging the ad space online,
because their marketing budgetis beyond what
we can even conceive as smallbusiness owners.
So we'll get to how this impacts providersand patients alike in a minute,
but we need to understand who the investorsare behind these companies.
(05:28):
So I ask you, who do you think wouldinvest in these companies?
Any guesses?
Who has lots and lots ofmoney and would be
interested in seeing these telehealthcompanies succeed?
We have massive tech companies andprivate health insurance.
All right.
If you haven't choked on your tea yet,you're not listening close enough.
(05:53):
I said your health insurance company is
investing in the telehealthplatform you're using.
That is a massive conflict of interest.
More on that in a minute.
So these bloated companieshave created a huge
power imbalance in the privatepractice therapy
(06:13):
world. A company that has this much moneyhas so much market sway, like so much.
I've already alluded to thiswith the psychology
today marketing, but especiallyif these are the
same billion dollar companieswho own your private
health insurance or who ownthe technology you're
(06:37):
using right now to tuneinto this podcast.
Yuck.
So these types of companiesare among the top
investors in the very platformwhere you speak
with your supposedly private therapist.
Do you have red flags popping up yet?
I know I sure do.
(06:57):
So these billionaire backedstartups have paved
the way for multiple partnershipsbetween tech
and consumer industries likeGoogle, Microsoft,
and Amazon, to name a few,all taking their shot
at the healthcare world.
Also fun fact, if you do a quick search forthe top 10 richest people in the world,
(07:20):
these companies founders will pop up.
You heard that right.
Some of the investors in these telehealth
companies are the wealthiestpeople on the planet.
Hello.
Does that alarm you?
So out of the mental health crisis, we're
continuing to line the pockets ofthe world's richest people.
(07:42):
Really?
Oh my goodness.
And the problems just keep coming.
And let me also just say too that I'mnot alone in my concerns here.
Many of my colleagues from across the countryare also in an uproar about this.
Anyway, back to the problems.
Let's start with the most obvious one.
So the first one is the huge conflict of
(08:06):
interest for private health insurancecompanies to own
the platform in which yousee your therapist.
This creates a power vacuumwhere insurance
companies can create sweetdeals with these
larger companies.
So for example, I'm hearingfrom colleagues,
multiple reports of higherreimbursement rates
for providers on these venturecapital platforms.
(08:28):
Then they're getting fromtheir own private
practices from the same insurancecompanies.
So venture capital, higher reimbursement,your own private practice,
not the higher reimbursementfrom the same company.
That's what I'm saying.
So this could mean perhaps even smallercopays for patients too,
(08:49):
or cheaper insurance based services to
incentivize you to use theirplatform over here
instead of the private practiceup the street.
Like that's the type of powersway they have.
And that's so concerning because of courseinsurance wants to see a return on their
(09:11):
investment in these companies.
So they lure therapists onto these platformsto increase their own profitability.
And they're also luring patients too.
Like we are all pawns in thismoney making game.
Yuck.
So all of this makes me wonder how privatethat information you share really is.
(09:36):
Like are investors seeing morethan they should?
Are they seeing session notes?
Transcripts?
Recordings?
Like where is that going?
Especially if this is online telehealth,which brings me to privacy concerns.
All right.
So since venture capital companies arealso backed by tech giants,
(09:59):
what type of technology isactually being used?
Is it HIPAA compliant?
Is AI involved?
Or are there other invasive new tech featuresthat they're trying out on us?
Like tech companies aren't interestedin mental health.
Tech companies are interested in growingtechnology and making a profit.
(10:20):
So again, I've heard from some of my colleaguesthat they have been forced to give
non-clinical company membersaccess to their
private session notes inthe name of ethical
and legal care and compliance,which is totally bogus.
Like we know how to write session notes
and the company is being thenice guy looking
(10:43):
through them for us.
I don't think so.
But then my other question is who exactly
is combing through thesenotes for supposed
compliance?
And what my colleagues andI fear is that AI
is looking through sessionnotes or listening
in on sessions to better understand humanbehavior and mental health.
(11:06):
Because as we know, AI doesn'tknow anything on its own.
We have to feed it information.
And if it needs to learn more about human
behavior and specificallyhow to be a better
therapist, of course, there'san interest in
having AI be part of the sessionsor the session
notes.
So that's our major fearhere as clinicians.
(11:29):
But then we're also concerned about AI potentiallybeing trained to replace us.
Because again, the bottom line is that thesebots are cheaper than us clinicians.
And honestly, we already know that chatbots are impersonating psychologists.
(11:51):
And there was a complaintthat the APA filed
actually with the FTC becausethese chat bots
are impersonating us.
And that's not OK.
But again, these companies don't care.
They care about the bottom line andgetting that information.
And with that HIPAA reallydoesn't seem to
matter because any fines thatthey incur are just a
(12:14):
slap on the wrist because these companieshave that much money.
So then that brings me toethical concerns.
So in these companies, mental health professionalsare not running the show.
These are owned again by tech giants, wealthyinvestors, and insurance companies.
So we mental health professionals,we have a
(12:35):
code of ethics to followto provide the best
care possible for our patients.
We also have licensing laws to follow.
And not adhering to these puts patients'well-being and even lives at risk.
But again, these investors don't care.
They really don't.
And we're fooling ourselves ifwe think that they do.
(12:57):
But really, what's at risk is ourlicense as professionals.
So for example, again, I'veread reports of
clinicians being forcedto see patients in
states that they aren'tlicensed in, which
is so risky because if there'sa crisis and
you don't know the laws of the state and
(13:17):
how to act accordingly, youcould be in legal
trouble as the clinician,not to mention for
the client that could be potentiallydangerous.
So the business is not so concernedabout this, right?
It's the clinician becauseit would be the
clinician that loses their license versus
the slap on the wrist fine forthis mega company.
(13:40):
And then sometimes these companies will
also make these shiny emptypromises to pay any
legal fees for the problems that theirstinky business structure creates.
I mean, come on, that doesn't coveranything up adequately.
And clinicians, we should not beimpressed by this offer.
(14:03):
Absolutely not.
But as with all things venture capital, hugeprofit margins are the primary focus.
It's at the expense of client care and atthe expense of us as clinicians.
Ethics and laws are inconvenient and basicallyjust get in the way of making money.
So they'll pay you or anyone else offto make the problem go away.
(14:27):
All right.
And then another problem I referenced it
before is something calledmarket consolidation.
So these companies funnel private practiceclinicians to them with those big,
shiny promises and bonuses, as well as higherreimbursement rates from insurance.
And insurance can do this because they're
(14:48):
double dipping from the samepot, which is so gross.
But at a networking event that I attended
earlier this year in a groupof about 15 of us,
all but just a few were usingthese venture
capital companies for billingor to help fill
their caseload. And multiple people said
(15:08):
that they just couldn't doit on their own.
That's so concerning.
Like we're only a few years into thisventure capital telehealth boom.
And the market has alreadyconsolidated to
the point that many providersfeel financially
reliant on these companies to stay afloat.So this is a dangerous place to be.
(15:33):
I liken this to the ideaof the notion that
someone can't leave theirabusive relationship
because their partner makesthem money. Like
that's kind of what we're settingourselves up for.
So we need to be really wisehere and start
coming up with our exit planoff of these companies.
The other thing that wehave to look at is
(15:54):
these companies are exceptionalat marketing because
they have literally entiredepartments and
hundreds of thousands of dollarsdedicated to it.
And they have professionalsworking on it.
So they are quick to findour pain points.
And for potential patients, they tell you
it's about convenience orlow cost or therapy
(16:17):
adjacent services like emailingand texting.
So they're cheapening thetherapy experience
to rake in the billions using their verycrafty marketing techniques.
So there's a reason why inprivate practice, we
historically haven't offeredtexting sessions or
email sessions because it'snot a thing. It's
(16:40):
not a therapy and it's riskywhen you can't see
the person for context. Butagain, here's that
shiny carrot that we're goingto dangle with all
these different marketing techniquesfrom these
venture capital companies. Andthen for providers,
they tell us like, Oh, we'llmake a deal with you.
Like we'll deal with insuranceso you don't have to
(17:03):
or we'll give you a betterrate. And I've heard
from multiple colleagues wherethese platforms
are requiring us providersto sign over our
insurance login information,what we call CAQH.
So there's reports of themabusing that and
changing this informationwithout our consent,
(17:26):
including changing business information
that goes back to the venturecapital company,
especially when the clinicianworks at multiple
different companies. And thenthe venture capital
company is changing all ofthose names back to
their own. So they get thechecks from insurance
for this clinicians work.Like that is wild to
(17:49):
me. This is absolutely wild.And who's to say also,
if you quit, like that theywill give you your
login information back, likethis could be so
detrimental in the futurefor your business
and for your ability to keepseeing patients like
clinicians, we need to wakeup. These platforms
(18:10):
are grooming us to be dependenton them by saying,
Oh, take go to sleep. We'lltake care of this.
We'll take care of that. I'malso hearing from
my fellow clinicians that theseventure capital
companies knowing that we'renot good at marketing
or knowing that we don't reallyknow much about
SEO. They'll say, we'll takecare of your website.
(18:34):
We'll take care of your psychologytoday profile
to bring you clients. Like we'llmake sure to get
you good SEO and take careof your marketing.
So you don't have to thinkabout it. Meanwhile,
they're using our websitesfor their search
ranking and their backlinks.It doesn't help us.
(18:55):
Like we clinicians are sonaive and signing
over this much power. Thenwe have to talk about
something called vertical integration. So
big companies combined withother big companies
to increase profit margins.And sometimes it can
be hard to track these companynames because they
keep absorbing other companies,most like the,
(19:17):
was it the Russian nestingdoll where it's like,
Oh, and it's, it's anotherone within another
one, then another one. But thishappens also with
insurance companies as well.Private health
insurance has, especiallyin recent years,
started to gobble up othersmaller insurance
companies. So with more moneycomes more ability
(19:37):
to buy things and buy outother businesses and
then offer more services thatwe could never compete
with in private practice. It puts these
companies in a place where theyare too big to fail,
like bigger than fines, bigger than
regulations. And it puts them ina better position to lobby
(19:59):
and make political decisionsin their best
interest because they have thefunds and the sway
politically to do so. Now there's a few
different other stories from providersthat I think are
worth mentioning here. SoI've heard stories
about providers whose ideasand expertise were
exploited because the CEOand the board wanted
(20:23):
to learn more about the marketand wanted to learn
more about what we do. Andthen that person or
those people were immediatelyreplaced once they
got the information that theyneeded. So I've also
heard from colleagues, reportsof being forced to
use and promote the venture capital's
digital tools as part of therapy.So taking up very
(20:47):
valuable therapy time with thepatient, promoting
the company's nonsensical tools,like that's not
okay. That's not our job. We're not their
little marketing minions. Likewe are here to help.
And then the other piece that I'm hearing
reports of is really a push formore metrics and number
(21:10):
driven care. So for example,having the provider
get paid or not get paid basedon the word count
in a note or in an email. Andthen there's also
this kind of over emphasison outcome measures
as telling the full story of health and
healing. But as we know, there'sso much that goes into
(21:33):
therapy that can't just be condenseddown to some
rating form that you fill outafter session. But
in a metrics world where venturecapital is going,
Oh, I want the bottom line.They're trying to find
a way to make it numerical.And it's just not
going to happen with clinicalcare. And then
another concern that I have is that these
(21:55):
companies are recruitingclinicians without
discretion. So it's what Icall indiscriminate
hiring. So it's not aboutgoodness of fit for
the companies or even, youknow, is this person
ethical and fit for the job?It's about bodies in
the chairs to make money and you can be
replaced. And then similarly withclients, it's not about
(22:16):
matching you with the therapistwho's the best fit
for your needs. It's about gettingthat placement,
churning out money. So it's about mass
quantity, but not about ethicalcare. And then the big
kicker with all of these isthat there have been
multiple lawsuits with multiplecompanies where
(22:37):
they have been selling informationto other
billion dollar companies for marketing.I kid you not.
Yeah. If you just researchthe company name and
the word lawsuit, like you'llsee what I mean.
So the one in particular thatstands out to me is
one of these venture capitaltelehealth companies
(22:58):
was selling protected healthinformation to meta.
So that's Facebook and Instagram.I'll link that
one in the show notes. Thisis really, really
important to know. Okay. Sowhere do we go from
here? What do we do? So let'sstart first with
what patients can do. The firstthing is do your
(23:18):
research. Like where doesyour therapist work?
Who owns the company? AndI just encourage you
to support local therapists and small
businesses and stay away from themega companies who have
already been sued for sellingyour private
healthcare data, but thenalso read the fine
print in the paperwork at your first
appointment. Is your data protected?Is AI in your sessions?
(23:43):
Then also use your gut. Likehow is the vibe of
the onboarding process? Likeare you cared for
as a potential patient ordo you feel like a
number? Are you matched withthe therapist who's
competent in the area of help that you're
seeking or are you just matchedwith the first person
that's available and it's reallynot a good fit
for you. Like do your researchand always trust
(24:06):
your instincts. And nowI'm going to speak
to my fellow providers here.Do your research.
Same thing. Like what areyou signing up for?
Read the contracts for onboardingbefore you
agree to work with this company. And also dothe research of who owns this company.
Search for that name, but also any other
(24:26):
names that might be affiliatedwith that company.
Are there carve outs ofthat company under
a different name? Is therea bigger umbrella
company that actually this is kind of a subpart of that company? It can get very,
very confusing when theystart buying each
other out or sometimes they'llpop up and rebrand
because they already got suedor did unethical
(24:47):
things. And so it's like, Oh,we're a new company
now, but do your research.Really know what you
are getting yourselves into.And then also look
at how are they classifyingyou? Are you a 1099
or are you an employee and howdo they treat you?
Do they treat you like an independent
contractor or do they treat youas an employee? There are
very strict laws about thisdifferentiation,
(25:10):
but then also what are otherthings that you're
required to do either withinor outside of the
therapy sessions? Are yourequired to promote
their icky products? Are yourequired to answer
texts or emails as if theyare therapy? And then
what are the requirementsfor seeing clients?
Are notes private? Are sessionsrecorded? Is an AI
bought involved in the sessions?Where does the
(25:32):
data go? Ask hard questions.And if they don't
give you a satisfactory answer, that's an
answer. So one of the biggestthings that we can do as
fellow clinicians is connect with other
professionals in our areaand to stay alert.
Like there's lots of differentgroups that meet
and discuss these concerns,whether it's locally
(25:54):
or online, like check your local
professional resources and checkwith your colleagues.
They may be part of thattoo. Similarly, if
insurance billing scares youas it does for a
lot of us, like look for asmall local company
that does insurance billing,ask your colleagues
and don't use these platforms.And of course,
(26:15):
support local and support yoursmall businesses
in your community. And youcan learn about these
businesses by connecting withother providers in
your area. Okay, so in sum,I spilled the tea
today on venture capital companiesand the dangerous
power that they have to continuechanging the
landscape of healthcare andnot for the better.
(26:36):
So stay alert, read up onthese companies and
know what you're signing upfor both clinician and
client alike. These companiesare the definition
of corporate greed. And don'tbe fooled by their
nice offers. They're notnice. These aren't
mental health professionalsbehind there. Like
they care about the bottomline and making the
(26:56):
wealthiest in the world evenwealthier at your
expense. And on that note, that's a wrap.
Thank you for joining me todayon this episode of
the personality couch. If youlike this style and
are watching on YouTube, commentbelow and let me
know your thoughts. If you'relistening on a
streaming platform, drop mea line at
(27:18):
personalitycouch.com/contact.Link will be in the show notes
Next episode, Doc Fish will be back and
we'll be starting our newseries on schizoid personality.
You don't want to miss it.
Be well, be kind.And we'll see you next time
on the personality couch.
This podcast is for informationalpurposes only and does not constitute a
(27:41):
professional relationship. If you'rein need of professional
help, please seek out appropriateresources in
your area. Information aboutclinical trends or
diagnoses are discussed inbroad and universal
terms and do not refer to anyspecific person or case.
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