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Mental Health Innovation Zone: From Clinic to Startup, Building Tools That Scale Care · The Medical Mind

• 0:02
  I'm here with Dr.
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  Monica Routes, who is a member of the Committee on Innovation at the APA.
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  Dr.
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  Routes, welcome.
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  Thank you so much for having me.
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  Dr.
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  Dries, tell us about yourself.
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  uh You've done an incredible amount of work and just share with our listeners a bit about yourself.
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  Well, let's see, it's hard to know where to start, but as a person, I am a child psychiatrist by training.
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  I live in Madison, Wisconsin, and I am the proud mom of two boys.
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  But I don't think that that's why we're here to talk about what I'm here for.
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  But, you know, I think it's the foundation of who we are.
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  uh I, along my career, have done many, different positions and uh opportunities along the way.
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  I started out working in private practice.
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  I had a couple of private practices.
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  I worked in inpatient units, residential, child protection, outpatients, really a varied opportunity to learn about different ways that we can work in mental health.
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  And that really led to
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  my then next steps, which turn into innovation and startups and growth from there.
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  You've done an incredible number of startups and tech companies.
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  ah Could you share a bit about your journey, uh what companies you've founded and started and what kind of things drive you?
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  Well, it all really started at the beginning.
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  In fact, my significant other at the time, who is now my husband, would frequently talk to me about my work.
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  And the funny thing about mental health, as we know, there's a lot of measurement, but most of what we do is a little bit of a gray zone.
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  It's not really a one or a zero, and he is a data scientist.
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  And so everything for him is a zero or a one.
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  But one of the things that he started to look at was new technologies.
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  And this was back in
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  2011, 2010, and one of the technologies that came out at that time was called SIFTIO cubes.
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  They were these mini cubes that you could interact with.
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  It would capture a data point at a 10th of a second, and you could create games for it.
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  He wanted to create something like Space Invaders, and I said, well, why don't you do something that could actually help me?
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  ah You know, as a child psychiatrist, we're frequently on the floor, we're playing, we're doing pick-up sticks, we're playing Monopoly.
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  but we're not just playing, we're watching how a child interacts, how they're talking to you, how they're moving.
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  And so we actually created a game and that started our first startup called CogCubed.
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  It was something that maybe I did on the side for a while, but one of the things that he said to me stuck with me, which is you can either help a hundred kids over the course of a
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  month, or you could be helping millions of kids by creating technology that others could use.
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  So that really
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  I guess that long my career has been the sentiment that I've carried forward, which is there's a lot of knowledge out there.
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  There are a lot of people who are doing amazing work, but there's also the opportunity to impact millions of people, not just nationally, but globally.
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  And that's really what drives me.
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  In addition to that, think I grew up in a household who I had a mom who had bipolar disorder and it was a tough place to be.
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  I think any child who grows up in a household where there is mental illness, it's very, very isolating.
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  And as a child, it was isolating.
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  And so in addition to that, I'm very much driven that I never want a child to ever feel alone again or that family to feel alone because it is a very isolating experience.
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  So that's another thing that I think drives me every day.
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  So at CogCubed, we created this amazing game.
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  We did multiple clinical trials.
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  We took it to pediatricians because we said, hey, you you could use this game, these cubes, and you could better diagnose ADHD.
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  And they said, oh, I don't want that.
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  That's weird.
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  That's new.
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  That's too different.
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  What I really want is can you just put these assessments online, send them to my patients, get the scores so I can monitor it?
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  We said, sure.
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  Created it over a weekend, called it Biotrenz, and that's the thing that blew up.
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  So one of the things I learned early on in my career is that you really need to interview and understand the end user because just because you have a really cool idea, just because
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  it works, their clinical trials or a CPT code does not mean that your end user actually end up using it.
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  So biotrans really took off many different clinics used it, everything from primary care to mental health clinics.
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  And it was also the time where telehealth was starting to boom.
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  And so around that time, I started to work with Teladoc.
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  ah I actually created their behavioral health line of business, but biotrends became very interesting to all of the telehealth companies because measurement was something that's
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  really necessary when you're working in a virtual environment and ended up selling Teladoc uh biotrends as well as COG-Q.
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  Over the course of that time, I then really created their behavioral health line of business and then went on to actually oversee quality across all of their lines of
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  business, including pediatrics, general medicine, tobacco cessation, dermatology, sexual health.
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  So really overseeing how we can do telehealth across multiple different uh areas of medicine and mental health.
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  That was then global.
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  had two little kiddos, so took a step back.
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  ah
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  But of course, know, my desire to continue to really understand the healthcare ecosystem led me to become a physician utilization reviewer.
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  So really understanding the plan side of things, really understanding the billing side of things really helped me to understand how that side of the business thinks.
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  And then over time, I was actually invited to join a company called Sanbello, which was out of UHD Ventures, which is a, yes, a payer, but
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  creates an incubator internally to create new and innovative solutions.
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  And so that was Sam Bello.
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  We created that in 2019.
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  If anyone remembers, it's also when COVID hit.
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  ah And so everything really took off ah and we ended up taking care of millions of people globally.
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  It was an amazing experience.
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  Really focused on quality care for adults and young adults where we
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  offered the opportunity to have content through an app that was really engaging and immersive.
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  But then we also had coaching, therapy, and psychiatry on top of that.
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  So really you could get all of the care that you needed in one app.
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  And that was really successful and sold into Optum.
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  And then I was deciding, hey, what am I gonna do next?
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  And one of the things that I noticed at both Teladoc and Sanbella was that though mental health
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  care can be extremely effective.
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  It's most effective when it's done in collaboration with primary care.
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  And though there was the opportunity to send the facts, it really wasn't integrated.
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  And so the opportunity presented itself to create something new.
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  And really people were not taking on kids and teens and families.
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  And so that started Bent Health.
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  Bent Health was really focused on creating a
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  Family System Solution for kids, teens, and young adults to access mental health, but really focus on primary care integration and really closing that gap.
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  ah That was able to grow and then recently sold to Lyra.
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  That's extraordinary.
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  And I got to say, not just your team at Ben Health has won accolades, but you yourself have won awards for the work you've done.
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  You were named EY Entrepreneur of the Year Midwest in 2024.
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  And we'll go to another award that you've also won.
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  I'm just curious, from your perspective, what kind of behaviors and the way you're thinking
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  the decision frameworks have helped you not just build credibility with clinicians, but also investors.
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  And are there any lessons that things that you would do differently now looking back?
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  so many lessons along the way.
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  I think the biggest thing that you can learn in this world, and this is being a clinician, an entrepreneur, a mom, a parent, whatever it is, you will mess up.
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  There is no perfection.
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  I think if you can lead with that and understand that there's a humanness to this and we're all in this to learn, that's really a framework that I bring to my work every day.
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  I also really try to lead from the second row.
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  So what I mean by that is I try to surround myself with individuals who know more than me, right?
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  And there may be experiences that I may bring to the table that I have had, but it's really the opportunity to teach and let them thrive.
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  And they do need to make mistakes to learn from them.
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  I think sometimes as an entrepreneur or a leader, it's very hard to let our team fail.
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  And it's not big failures, right?
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  But being able to make mistakes and learn from them, we know as children, that's actually what you want.
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  You want them to have adversity to learn.
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  There is no difference from that in the work environment.
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  You want your team to have adversity and learn and for you not to fix it for them.
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  I struggle with that every day.
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  I will admit I am a perfectionist.
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  I don't think there's anyone in the medical field that doesn't tend to be a type A perfectionist.
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  And it's something that I have to wake up every day and remind myself.
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  So in doing that, think as I have grown over time, it is really as I've created businesses, it's really to look at what are the places that are hurting people?
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  What are the imperfections?
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  What are the systems that are not working?
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  What are the gaps?
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  And that's really where I go.
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  But then obviously taking that original learning opportunity I had at CodCube, which is just because you have a great idea does not mean it's going to be successful.
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  If it's not useful to the end user,
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  then it will never actually be effective.
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  And that has actually resonated in all of my conversations with investors, with collaborators, with partners, which is, yes, I may have experience, but I think the most
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  important thing is the experience of your end user and the problem that you're trying to fix for them.
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  I wanted to ask you something that is, you've dived into some very personal material as well.
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  And I would like you to think back to when you were a medical student or a resident.
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  And did you think that you'd be an entrepreneur at that time?
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  Did you think that you'd be leading huge companies?
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  Absolutely not.
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  I was focused on, look, I think anyone who's a medical school and a resident is just trying to get through it and not fall asleep ah during a procedure or something like that.
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  I can even remember opportunities where, you know, in medical school, I remember being on call at a hospital and being woken up at three o'clock in the morning to place a central
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  line.
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  And you're just trying to get through it.
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  That's all you can do.
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  But even in those moments, let's face it, we look at the head nurse who knows more than anybody else and you say, please help me.
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  And then later you bring them cookies because they just saved your life.
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  You know, I think it's those opportunities that you learn a lot from.
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  But being a resident, I very much thought I was going to work at a hospital.
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  I very much thought that I was going to have a typical career being on call.
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  But one of the things that I think started to bother me towards the end of residency and fellowship was that unfortunately, we as clinicians and physicians don't always get the
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  opportunity to practice the kind of medicine we want to practice.
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  There are multiple constraints.
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  There are the constraints that payers put on us, health systems put on us, different infrastructures put on us.
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  And so for me, I wanted the opportunity to see could I think outside the box to start to help those problems instead of being in the middle of it and not being able to have the
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  effect that I wanted to.
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  It's extraordinarily, again, what you've done.
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  You've clearly done an enormous amount beyond medical school, residency, attending life, uh and in fact uh have learned a ton.
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  I'm just curious, where do you get your support to do such extraordinary roles?
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  Do you join entrepreneur groups?
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  Are there conferences, masterminds?
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  Does the APA play a role or could it
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  a bigger role?
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  Just curious what your thoughts are for those who want to follow in your footsteps.
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  Well, there's a few things.
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  I think everyday wake up would be a sponge.
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  There's so much you can learn from people around you always.
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  So even when I think about when I set up my private practice, there's so much I needed to learn.
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  How do you set up an LLC?
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  How do you do the accounting?
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  How do you pay people?
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  How do you contract with payers?
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  These are all things that were not taught in medical school.
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  And so I really had to not just Google, ah but actually
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  connect with people who knew how to set up a business infrastructure, who knew how to set up relationships with people who are gonna work in your office.
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  And those are really some of the tenants that I've continued on.
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  I've had the opportunity to have some amazing mentors, amazing mentors.
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  For example, Dr.
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  Henry DePhillips at Teladoc, one of the best things he taught me, and I will never forget, which is when someone submits an expense, approve it right away.
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  And really what all he was trying to say is that your team and their health matters and the way that you lead and how you take care of them matters.
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  And granted, he was a chief medical officer of an enormous global telehealth company, but it was really pearls like that that I have remembered always going forward.
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  Another great men.
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  mentor for me is Dr.
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  Martin Rosenzweig, who I met at Optum.
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  He was the chief medical officer there.
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  He continues to be a mentor and advisor to me today because there's just so much that he has learned along the way, moments where he has banged his head against the wall and he
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  tries to give back.
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  And so I think as we think around these individuals, they've had such great life experience.
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  But I think one kernel that brings them together is they are members of associations like American Psychiatric Association or the American Medical Association.
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  I do think that there's more and more responsibility as these larger organizations to foster entrepreneurship.
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  I really do think it needs to be a central track.
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  We need to be able to teach our clinicians and physicians what the business of medicine is.
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  We are not well taught this in school.
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  And even if you're not gonna run a company, you're part of a company.
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  And so to really understand how a business works, I think is really important.
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  We can't just shutter our eyes and say, hey, I just wanna focus on my clinical work, because at the end of the day, you still garner a paycheck and that paycheck comes from
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  something.
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  And so I think it's really important to understand how that works so that you can also protect yourself and your own rights and responsibilities.
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  I love that.
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  And I share that same sentiment.
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  And it's something that also drives me to attend conferences and meet others and network too.
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  So thank you for sharing your thoughts on that.
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  You you're also on adjunct faculty at the University of Wisconsin, Madison, UW Madison.
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  And how does academic teaching inform your work?
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  Does it play a role in what you do?
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  And I just curious what your thoughts are there.
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  One of the great things I get to do at the university is actually help medical students learn how to interview patients.
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  That is one of my great joys as part of my work.
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  Yes, I can teach pharmacology, but I actually think it's the human skills that I love to teach the most.
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  And it's things like eye contact, or if you are interviewing a person over telehealth.
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  Have you looked at their background?
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  Did you look at what's on their walls?
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  There are things that are clues about how your patient is doing, as well as ways that you can communicate to let them open up, or there are things that you can communicate that
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  will actually shut them down.
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  And having those conversations, I think, is so important because at the end of the day, medicine is a human practice.
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  We can have as much AI as we want.
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  We can have as many tools as we want, but I think of them as tools to facilitate human connection.
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  And without human connection, we really can't get at the core of what may be going on.
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  And unfortunately, sometimes with tools, can unfortunately be a little too superficial, meaning, are you feeling depressed?
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  How was your sleep?
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  How was your appetite?
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  But think about your sleep last night.
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  There are so many
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  details about what did you do before you went to sleep?
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  How did you sleep?
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  Did you wake up?
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  How did you feel this morning?
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  There are details.
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  And the only way to truly elicit that, I believe, is eye contact, human connection, reflective listening, and truly being present.
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  And so I'm excited for all of the technology.
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  I think it affords us the opportunity to be much more present than we have been before.
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  Well, you we appreciate you being present here with us on this podcast.
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  Now, I wanted to take a few moments in our final few minutes together to just open the floor up to see if there's any parting words that you have for our audience, anything else
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  you'd like to share with our listeners.
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  I really want to encourage this audience to think about your everyday life.
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  What are the moments that are fantastic that maybe you want to teach other people about how you did that one thing that really returned the experience that you hoped it would?
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  So for example, when you go into the office and you open up your email and you answer them all and you hear later from a patient, wow, thank you for getting back to me.
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  That's an experience that you can teach someone else.
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  And that is very much what innovation is.
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  It's the things that you do or it's the rubs or abrasions that you're feeling.
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  Those are all the kernels of opportunity to change how things are done.
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  So just take your everyday.
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  You are your best teacher in some ways, or even your colleagues are your best teachers.
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  Ask them how their day is going.
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  What are the parts that feel like, hmm, I wish that was a little bit better?
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  And sometimes the innovation is actually a very simple change that can have a massive impact on the quality of life of not just your colleagues and yourself, but your patients,
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  the organization, and the ripple effect is really the fun part to watch.
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  So I encourage everybody listening, you absolutely bring innovation to every day that you wake up and you take on and tackle a day.
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  actually coming at it every day from an innovative and new framework.
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  That can be in your work as a physician, it can be your work as a therapist, but it can also be your work as an entrepreneur in teaching people the small things that could be
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  changed to really.
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  Well, thank you so much for those final parting words.
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  Your story is so inspirational and I just got to say I learned a ton from our conversation.
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  Thanks so much for being here with us.
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  Thanks for having me.