Latest / Becker's Healthcare Behavioral Health / Natalie Schneider, Founding CEO of Fort Health

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Natalie Schneider, Founding CEO of Fort Health · Becker's Healthcare Behavioral Health

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This is Laura Dierdle with the Becker's Healthcare
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podcast. I'm thrilled today to be joined by
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Natalie Schneider, founding CEO of Fort Health. Natalie,
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it's a pleasure to have you on the
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podcast today.
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Hey, Laura. Thanks for having me. It's great
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to be here.
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Absolutely. Well, I'm excited that you're here on
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the podcast today because I know we've got
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a great discussion and really truly will be
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able to zero in and spotlight some of
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the cool things you're doing at Fort Health.
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But before we do, can you take a
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minute to introduce yourself and tell us a
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little bit about your background?
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Sure.
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My career has always been in health care,
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technology,
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consumer experience,
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and I started out as a software engineer,
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moved to The US from South Africa,
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via London during y February.
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And my first job was in management consulting
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with McKinsey. And funny enough, one of my
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first clients was in health care. And I
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remember asking
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foolishly,
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what is the difference between Medicaid and Medicare?
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So that was fifteen years ago.
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And ever since then, I've been hooked. I
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spent eight years with elephants,
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you know, really getting to know the payer
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side of health care, then moved into consumer
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health technology
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and commercialization
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of of Samsung's digital health services.
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And then lastly,
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moved to share care. It's a start up
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that that was sort of a a digital
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health platform and helped them go through a
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IPO.
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And then
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COVID happened.
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And
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like so many parents,
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I saw firsthand
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the mental health struggles
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our kids were facing. My partner and I
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have have five kids,
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their friends were facing.
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So it wasn't surprising
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to hear the national data, which is one
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in five kids has mental health condition.
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What was
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really shocking and upsetting was only thirty percent
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of them are getting care.
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The biggest barrier is cost.
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And the as I sort of dug in,
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the staggering
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statistic that was sort of the genesis behind,
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you know, Fort Health
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is that a mental health visit for kids
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is a thousand times
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more likely to be out of network than
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primary care. So that was a Milliman study
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from 2019
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that hit me like a ton of bricks.
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So
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shortly after the Sharecare IPO,
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you know, that that was the thing that
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activated me to start Ford Health.
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Wow. Those numbers are shocking and, you know,
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fascinating to hear exactly your story and origin
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story into Fort Health. Let's talk about your
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model. How is Fort Health tackling this issue?
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It's it's all around
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pediatricians.
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So if you if you look at
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what happens with a family, their sort of
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first port of call is a pediatrician. It's
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the most trusted relationship in health care.
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Seventy five percent of kids that are diagnosed
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with mental health condition are diagnosed
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by their pediatrician.
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And,
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pediatricians
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today prescribe about eighty five percent of all
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psychotropic
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medications. So that's that's where we are today.
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However,
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many of them don't complete a single child
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or adolescent psychiatry rotation.
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And studies show that, you know, most of
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them are saying, I'm I'm just not comfortable
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with this.
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And that became evident in, a conversation I
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had with a friend of mine who's an
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excellent pediatrician.
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And she said, Natalie,
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you know, I I was trained in primary
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care,
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and here I am.
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I've become a frontline
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medical or sort of behavioral health provider.
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And in fifteen minutes, I have to diagnose
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and sometimes prescribe,
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and I just wasn't trained to do this.
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And, unfortunately,
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she she resigned to her post. It was
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becoming so stressful.
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And, Laura, this is this is a real
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problem with pediatricians today. We have 78,000
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pediatricians,
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and we need to get them back to
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primary care.
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Not only is there a shortage today, but
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I'm sure you've read this. You you've probably
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even reported on it. But, you know, in
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2024,
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about a third of all pediatric
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residency programs,
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did not fill their available
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positions.
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So
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we're in the business of getting pediatricians
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back to primary care
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by being that trusted mental health care provider
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that they can refer to. And our whole
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model,
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our go to market,
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our technology stack,
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everything, including our clinical model is built to
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snap fit into those pediatric practices.
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That's fascinating to hear. And and what an
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amazing resource for pediatricians
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as well as families that are dealing with
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these really, really challenging issues. Now I'm wondering
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from your perspective,
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what are some of the opportunities and headwinds
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that you have your own right now,
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both just in the broader marketplace and then
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for Fort Health too?
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So the broad marketplace,
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youth mental health has really benefited
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from some social,
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you know, tailwinds that are shining a light
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on this. Yeah. It's almost daily that you
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see an article about youth mental health. So
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it's getting a lot of attention.
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Great. That's great.
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And I think that's really helped with destigmatization.
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That said, you know, I think the tendency
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is
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we
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enjoy
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spending
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quite a lot of time villainizing
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social media. It's the root cause. And don't
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get me wrong. It plays a role.
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And I I see my kids on their
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phones all the time.
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So it definitely plays a role, and there
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are 12 states that are working on laws
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requiring parental consent for kids 16 g social
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media platforms, etcetera.
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But that
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that is not gonna solve the problem. We
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have, like, some system wide issues
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that limit access.
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And I'm talking about
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massive shortage of therapists.
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So only 30% of kids needing care are
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getting it today.
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That's partially because the shortage of therapists, and
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it's partially because of of affordability.
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And with therapists,
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as it is, we don't have enough of
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them, but what amplifies the problem
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is
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very long state licensure processes
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and payer credentialing processes. So we've got a
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lot of therapists sort of sitting on the
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on the sidelines
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waiting to go through this.
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That's a less sexy topic than social media,
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but those are some of the real issues
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that need to be addressed at a at
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a system wide level.
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On the positive side,
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in terms of opportunities,
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I think there's a really
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nice opportunity to rethink the traditional
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clinical model. You know, when we think about
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therapy, you think about
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once a week, every Tuesday, 2PM,
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you know, is my therapy session.
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And that doesn't necessarily
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work
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for kids
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that need probably more
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flexible,
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integrated
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approach.
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So that's why at Fort Health, we launched
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collaborative care.
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It is a different clinical model that integrates
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directly with the pediatrician,
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sort of frequent
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shorter interventions.
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But the most important part, the sort of
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the the bottom line here that we're super
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excited about is it keeps the pediatrician
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at the center of that care team, and
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it helps connect the pediatrician,
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the psychiatrist,
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the parent, the patient, the mental health provider,
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and it's been shown to be highly highly
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effective, you know, over over 90 randomized controlled
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trials that support.
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In some cases, this is twice as effective
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as usual care for anxiety,
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depression, ADHD.
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So really nice win win.
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I love that. And, you know, it really
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truly presents a multi pronged approach to tackling
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the issue, especially of mental health within the
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pediatric population in in bringing in more support
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and specialists into the the primary care space.
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From your perspective, how are you thinking about
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growth and adding value for health overall?
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That that's a great question.
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Early on, we had to make a decision
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whether we adopted one of two strategies, and
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you're seeing both of these play out in
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the market.
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One is
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develop a national
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network
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and serve as many families in as many
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states.
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The other model is local market density and
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go really, really deep and sort of insaturate
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particular markets.
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I opted for the second, and this was
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really informed by my time at Anthem, now
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Eleventz,
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where, you know, we saw
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health care innovation
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is super local.
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It's super local. And it happens with the
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local provider groups, the health systems,
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relationships with that payer,
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and you can get the flywheel going because
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now pediatricians are speaking to other pediatricians. You've
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got word-of-mouth.
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So we launched in New Jersey.
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And since 2023,
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we now have over 30% of all New
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Jersey pediatricians
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referring to Ford Health.
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And it it's this wonderful
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sort of, you know, flywheel type of effect
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whereby
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the moment we walk into a pediatrician's office,
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they were really telling us, we've heard about
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you from other pediatricians, from other parents.
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So our model is more state by state,
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but get to
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high density. And we are now in New
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York, New Jersey, Pennsylvania,
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Texas, and Illinois.
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And
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to to anticipate maybe your next question, which
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is, you know, why did you pick those
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dates?
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It's it's driven by partnerships. Where do we
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have
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a provider group that wants to enter into
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a contracted
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relationship with us, a a collaborative care
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contracted relationship
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with us,
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or where is the a payer that's super
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innovative
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and,
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you know, is willing to reward
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measurement based care, evidence based care with better
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than market reimbursement rates. So we've we've we've
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entered into a large partnership with,
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with NovoWell as an example, which is a
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a managed behavioral health organization. They spun out
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of Horizon,
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Blue Cross Blue Shield,
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super innovative,
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and they are focused on two things. The
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one is integrated care combining primary and behavioral
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health because the the data from Milliman suggests
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it'll reduce claims costs. I think it's nine
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to seventeen percent or something like that. The
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other thing they focused on is evidence based
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care and measurement based care
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because shockingly,
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and unfortunately,
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only twenty percent of mental health care today
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falls into that category.
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So in summary, local market density
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and always in partnership with a payer or
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a provider group.
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That's amazing to hear. And certainly having those
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connections and partnerships
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to get this done and really, drive the
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best results makes a lot of sense and
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is helpful to know and understand from your
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perspective.
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I'm wondering too, looking ahead,
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I know there's so much happening in the
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health care space right now, and really, truly,
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it can be a challenge sometimes to, focus
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on the most important things. So I'm wondering
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from your perspective, what is one risk or
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investment that you still see as being worth
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taking this year?
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You know, I'll I'll continue my response from
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the last question around evidence based care, measurement
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based care.
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And
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it it's interesting as I speak to my
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friends who who have kids
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in therapy,
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and I'll say, how how is it going?
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You know, the and their response is so
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often,
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I don't know, but my my kid likes
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her therapist.
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And or or you ask about licensure type.
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I, you know, I don't know. And I
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don't know what the statistic is, Laura, but,
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you know, there is some
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very high percentage of Americans that do not
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know the difference
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really well between a psychologist and a psychiatrist.
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And I put myself in that category, you
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know, before I entered into this field.
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And that means
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that a lot of mental health care is
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not being directed
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by objective
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measures and data,
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which leads us to these models where we're
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delivering therapies sort of into perpetuity. And you
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hear more and more of these ads that
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suggest that, you know, you should just everyone
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should be in therapy.
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And, unfortunately, that drives up
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claims costs. It drives up health care costs
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for everyone.
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And our model is very much
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discharge
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or graduate that patient once they have met
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their treatment goals. And
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we that's why measurement based care is so
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important. So we can objectively
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say, this child is ready to be graduated.
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Now today,
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why I say it's a risk is today,
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a lot of payers are not rewarding for
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that behavior. They don't necessarily have the mechanisms
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to evaluate quality, but there are some very
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innovative
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payers
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that are beginning to take those steps and
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are saying we wanna put daylight between
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high quality providers that are delivering evidence based
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and measurement based. And, yes, we recognize there's
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a cost to that, and we're gonna pay
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for it versus
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other providers.
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So we're playing to where the puck will
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be
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by investing in that, and that's also why
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we partnered with we were built in partnership
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with the Child Mind Institute, which is the
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number one sort of nonprofit in the space.
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So I think we're doing a lot to
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really distinguish ourselves
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as a very high quality
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provider.
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And along with that goes investment in a
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proprietary
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technology
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platform
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that will help us manage the complicated relationships
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between the parent, the pediatrician, the patient, etcetera.
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Everything from getting informed consent to
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to administering
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measurement based care. You know, all of that
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is is proprietary, and that's a lot for
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a start up to take on.
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But, again, you know, we're taking the long
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view, and that's where we see the market
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going.
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That's so helpful to know and understand it
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and really truly,
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see the proactive steps that you're taking now
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to fortify yourselves for success and continuing
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to be, of more and more convenience to
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that patient base. Before I wrap up here,
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I'm wondering, where do you see some of
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the best opportunities for growth in the future?
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I know you're moving into new markets and
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doing some really cool things, so I'd love
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to hear what's next for Fort Health.
15:37
Best opportunities
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for growth,
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you know, I'd say,
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overall,
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not for specific,
15:45
because I think I've I've spoken to sort
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of our model of of growing with with
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payers.
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But
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in general,
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the best opportunities for growth is through
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reimbursed models.
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I don't have a stat to support this,
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but
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I would I would suggest that most parents
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and families,
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if they can use their benefits to get
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mental health care for their kids, they will
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do that, you know, nine times out of
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10. Again, I don't have a stat.
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But
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people want to use their benefits. Mental health
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care, if you're paying
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cash or out of network, can run you
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2,500 to $3,500
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per child.
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So getting into network and increasing
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your
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number of covered lives is definitely gonna unlock,
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you know, a lot of growth for for
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any company in the mental health space.
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And then secondly,
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recognizing
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that
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this is a big problem for hospital systems
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and provider groups. Even those hospital systems that
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do offer psychiatry
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tapped out. Laurie, if you called, you know,
16:56
we did this when we entered into New
16:57
Jersey's and started calling hospitals and doing a
17:00
little secret shopping to find out what the
17:02
wait lists were. And a lot of them
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said, we're not accepting new patients
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or fifteen week wait list
17:09
on average.
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So
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while they are large incumbents,
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they also need help to be able to
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expand access for their for their patient population.
17:21
So I'd say
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partnerships with those hospital systems
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and provider groups
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as well as
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very good relationships with the payers, especially those
17:33
that that have a sophisticated
17:35
way of evaluating
17:37
quality and are willing to reimburse for it.
17:40
Got it. That is really helpful to know
17:42
and, seems like an important path forward, lots
17:45
of opportunities
17:46
to make the world a better place. So,
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Natalie, thank you so much for joining us
17:50
on the podcast today. This has been a
17:52
really fascinating and uplifting conversation, and I look
17:54
forward to hearing you again soon.
17:57
Likewise, Laura. Thank you for having me. It
17:59
was great to meet you.