Latest / CareTalk: Healthcare. Unfiltered. / Is Behavioral Healthcare Doomed or Salvageable? w/ Kyle Talcott & Missy Krasner

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Is Behavioral Healthcare Doomed or Salvageable? w/ Kyle Talcott & Missy Krasner · CareTalk: Healthcare. Unfiltered.

• 0:02
  Behavioral health care should work for everyone, but too often it's inaccessible, stigmatized, unreimbursed, and disconnected from physical health care.
• 0:11
  Today's guests, Kyle Talcott and Missy Krasner from Uplift and Redesign Health respectively are on a mission to change that reality for the better.
• 0:19
  So is the behavioral health system doomed to be in crisis forever?
• 0:23
  Or can technology, better business models, and entrepreneurs make the difference?
• 0:32
  you Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:40
  I'm David Williams, president of Health Business Group.
• 0:43
  And I'm John Driscoll, the president of Walgreens Health.
• 0:46
  Well, come join the ever -growing Care Talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access Care Talk content, and interact with the hosts.
• 0:56
  And please be sure to leave us a rating on Apple or Spotify while you're at it.
• 1:02
  Welcome, Missy and Kyle.
• 1:04
  We love...
• 1:05
  having entrepreneurs on the show and maybe starting with you, Missy, what intrigued you about this company that you invested in and helped start?
• 1:16
  What's obviously an important company meeting just a massively growing need for better and more creative approaches to behavioral health?
• 1:26
  John, it's great to see you again.
• 1:28
  It's great to be here today.
• 1:29
  I'll tell you, the journey was interesting.
• 1:32
  I've been an operator and I've been an investor and I was doing a tour at Amazon actually.
• 1:38
  I'd spent almost three and a half years at Amazon right before the pandemic.
• 1:42
  It was right before we bought a pharmacy with PillPack and we're gearing up to launch Amazon Pharmacy.
• 1:48
  We're working on Amazon Care.
• 1:49
  This is all pre one medical acquisition.
• 1:53
  Did a little time over in Alexa, putting Alexa in hospitals.
• 1:56
  And when COVID hit, You know what?
• 1:59
  I mean, Amazon's like a million plus people globally.
• 2:02
  They didn't have any, any way of dealing with the behavioral health crisis of global pandemic.
• 2:10
  I mean, our EAP programs were so poor as the AI programs are.
• 2:16
  And so I saw them sort of immediately put out three or four RFPs for point solutions in the employer space, try to help people find therapists.
• 2:25
  Fast forward a couple months later, it was during the Livongo Teladoc.
• 2:28
  merger of equals.
• 2:29
  That was a crazy comp.
• 2:30
  And I thought, you know what, I got to get back to money.
• 2:32
  Amazon's playing the long game.
• 2:34
  I really want to figure out how to take advantage of this sort of digital front door and what was opening after like, you know, we've been in this industry for 20, 25, 30 plus years, not seeing any movement at all, like incremental movement in digital health.
• 2:48
  And then all of a sudden that, you know, the system collapsed.
• 2:52
  People couldn't get in to see anyone.
• 2:53
  This is on primary care side, anything, right?
• 2:56
  Inpatient hospitals shutting down.
• 2:58
  So I jumped over to redesign a company creation platform.
• 3:00
  Some of us refer to us as a venture studio.
• 3:02
  I was super excited about figuring out how to actually incubate companies where there was a need.
• 3:08
  At the time, everybody was pouring money into behavioral health.
• 3:11
  Everybody was trying to solve the access issue, which is just the tip of the spear, right?
• 3:17
  And we really liked the idea of trying to figure out how to bring more therapists and more psychiatrists into insurance networks to solve both access and...
• 3:27
  you know, cost.
• 3:29
  And we thought, hey, let's just get going.
• 3:31
  Let's get in market.
• 3:32
  We know that this this this particular formula works.
• 3:35
  And then from there, we can innovate into value.
• 3:37
  So that this was, you know, almost what Kyle went two and a half, three years ago.
• 3:42
  Right.
• 3:42
  This was pretty.
• 3:44
  We're not going to take on the fact that you've been involved in big, impressive tech companies that have made no progress in health care.
• 3:51
  We're going to focus on where you know progress.
• 3:54
  So, Kyle, why don't you take it?
• 3:56
  take us down the path of solving the problem.
• 4:00
  Because Missy, you're absolutely right.
• 4:01
  During the crisis, people were willing to fund solutions because all of the invisible problems became worse and became visible.
• 4:11
  But what, Kyle, are you doing to help solve this massive mismatch between need and care?
• 4:20
  Yeah.
• 4:21
  I first met Missy, I was coming out of a little over a year at CityBlock Health, where I just launched a lot of their virtual care programs, which was just an incredibly serendipitous moment coming into CityBlock, COVID hitting New York City being affected first.
• 4:40
  And that's where all of our members were.
• 4:42
  And so having to shift them over to virtual and a big part of their model is, and has always been how they integrate behavioral health first and foremost into the overall path of treatment for a patient.
• 4:54
  And that really, for me, opened the eyes around how the integration of behavioral health and the primary care and other specialties had a huge impact on not only the ability to engage patients and get them to a higher quality life, but also the medical side.
• 5:10
  How did you see that?
• 5:11
  What was it in the programs you put together that kind of broke through the conventional view, which is highly siloed, the medical being very separate?
• 5:21
  from the mental.
• 5:22
  So typically you go in, you focus on maybe an inpatient stay and post discharge program, something around sort of a medical episode.
• 5:29
  And instead we're really addressing behavioral health social first.
• 5:33
  And then that led us to the ability to engage on the medical side.
• 5:37
  And this very much was in contrast.
• 5:39
  I mean, it had helped start Clover.
• 5:41
  So it would work with duals populations, large Medicare advantage populations, also work on the self -insured side.
• 5:47
  So provider, payer.
• 5:49
  And this was a different model.
• 5:51
  And when I looked at where the investment was going in behavioral health as COVID hit at the same time, what I saw was a lot of emphasis on access.
• 6:01
  But what I also saw was a fragmented landscape, not only from a number of companies, but also the level of comprehensive care they could or could not deliver.
• 6:12
  So a lot of focus on low acuity conditions, anxiety, depression, but not a lot.
• 6:17
  across the spectrum of clinical acuity, also saw a lot of solutions that were in some ways leading towards higher fragmentation of care delivery.
• 6:28
  And so whether it was, you know, exists or sort of new networks that were popping up, a loose collection of providers, all using different systems, really no ability to measure impact, what I saw was a first version sort of knee -jerk reaction to COVID of, hey, we need better access.
• 6:46
  We still need better access and we're getting there, but ultimately we need better access to high quality care that we can move the market forward, not only from the fee for service moment, also to the future of value.
• 6:59
  So it's taken as an article of faith that there's a severe provider shortage actually throughout healthcare, but in behavioral health in particular.
• 7:06
  And I know you don't exactly have that view.
• 7:08
  So I'm wondering, you know, is there a severe provider shortage?
• 7:11
  What are the data tell us about that?
• 7:14
  depends on how you slice the data as usual.
• 7:18
  There is a severe shortage of psychiatric providers, psychiatrists, psychiatric nurse practitioners.
• 7:25
  However, what's often missed when we're looking at behavioral health workforce in general are all the master's level clinicians.
• 7:33
  And so independent licensed LCSWs, LMFTs, there are close to 600 ,000, 700 ,000 providers that are out there in total.
• 7:42
  that are licensed to independently deliver behavioral healthcare and treat a host of mental health health illnesses.
• 7:50
  And a lot of the data fails to include them in those numbers.
• 7:54
  The reality is they're often missed when we're thinking about, you know, payers, now we've got to see Medicare for the first time ever just included LMFTs and some of the other masters level clinician types within they're allowable to see Medicare patients.
• 8:10
  And that was this year.
• 8:11
  It's actually It's actually a really good point, Kyle.
• 8:14
  I know, you know, as David, you know, because you're in the People's Republic of Massachusetts, which is more psychiatrists for per population than any other part of the country.
• 8:21
  It still takes you longer to see a psychiatrist in Massachusetts than in most states.
• 8:27
  And so by just looking at psychiatrists, you're in a bubble within a bubble.
• 8:33
  But how do you get, Kyle, all of those folks recognized, reimbursed and integrated?
• 8:39
  into networks because as Missy and I know, it's been brutally hard for A, to pay attention to the psychosocial and value it as importantly as the physical.
• 8:51
  But then it's been really hard to get health plans to actually integrate mental health professionals at every level into their networks.
• 9:01
  Yeah.
• 9:02
  Kyle, before you answer, I think it's really a misallocation.
• 9:07
  of resources and a navigation issue.
• 9:10
  And that's the crux of where Uplift starts and a lot of other folks that are trying to figure out how to develop these networks.
• 9:21
  So we can talk about shortages all day long.
• 9:24
  And the other thing that I would say is that for years now, behavioral health has been the ugly stepchild of traditional allopathic Western medicine.
• 9:32
  If you have a mental illness, right?
• 9:35
  and you get a diagnosis, you're in the traditional medical establishment.
• 9:39
  But if we're dealing with mental wellness or mental health, that's an everyday speed.
• 9:45
  That's how are you responding to your life, your stress indicators.
• 9:49
  And for the longest time, that has not been considered the core part of healthcare, which is why payers are only now starting to respond.
• 9:58
  And it really took a global pandemic for people to really recognize that.
• 10:02
  I didn't mean to interrupt Kyle, but I think that that's an interesting place to start from.
• 10:06
  Oh, you're good at interruptions.
• 10:07
  Don't you worry.
• 10:10
  In some ways, the silo aspect or how mental health has really been ignored for a lot of times by the payers has led to the situation we are today.
• 10:22
  I mean, most of behavioral health care benefits were delivered by a third party.
• 10:26
  And you talk to those third parties even today, you talk to health plans, there is no real interchange of data, right?
• 10:34
  And so how do they know the impact of behavioral health, the lack thereof?
• 10:38
  being delivered by your third party benefit manager if you can't see the impact, which actually comes up in medical claims.
• 10:45
  So that fragmentation or silo effort has actually held back the industry for quite a while.
• 10:51
  And we're starting to see that, start to integrate, start to break down more, even the benefit the managers themselves are becoming more around medical management from delivering care versus restricting care, which ultimately...
• 11:05
  you know, benefit managers were set up underneath the cap and their incentives are to reduce as much care as possible at the lowest unit cost per possible, right?
• 11:13
  Now, what we're seeing today is that, you know, health plans are starting to increase rates, you know, they have, and they had to, honestly, and the back of COVID in order to, you know, build bigger networks and include more providers.
• 11:26
  But what we still see is this imbalance of...
• 11:29
  the effort that it requires to accept insurance for a lot of behavioral health providers, whom are mostly solo practitioners, is still too much for the amount they're getting paid.
• 11:40
  When you talk to a payer, they can't pay more.
• 11:42
  You talk to a therapist and they can't afford to hire anybody to help them.
• 11:46
  And so where Uplift has started is to give them the tools and services, the capability and really take that, the burden of accepting insurance off of their plate.
• 11:57
  and do so by moving them into Uplift underneath our group contracts, but also really importantly onto our purpose -built software platform that allows them to deliver better care as we move the industry towards value.
• 12:10
  And I think that's what we started to do.
• 12:11
  are you more of a rev cycle, credentialing rev cycle software reimbursement enhancement for the network you're bringing on?
• 12:21
  Is that the right way to think about Uplift?
• 12:24
  I would say a core piece of what we do.
• 12:27
  is the unsexy part of health care, which is making sure you're credentialed well, making sure patients can see you and lower their out -of -pocket cost.
• 12:37
  And so credentialing, rev cycle, all the things that you need to do really, really well are a core piece of that.
• 12:43
  And that is often overlooked, honestly, by a lot of health care companies.
• 12:48
  But that's where it starts.
• 12:51
  So if you can do the basic part of getting people to be able to accept insurance in the first place without losing money on it is still a long way from then we talked about the integration into primary care and then a step beyond which is how does it actually a value based future here for behavioral health so how do you think about going beyond the sort of credentialing and you know onto that vision is that is that a doable thing or is that something we're gonna look back in twenty years and say still trying to work on it.
• 13:20
  Yeah, and that's a key question, right?
• 13:22
  And so when we started out, we were building towards that future and working backwards, even though the market's not quite there.
• 13:29
  How do we not only prepare for it, but help facilitate it?
• 13:32
  And a big piece that one of the reasons we're not there is even immune stems back to the lack of adoption of EMRs and behavioral health.
• 13:40
  They were not given the same incentives that medical providers were for EMR adoption.
• 13:45
  Well, if most of your provider delivering care on paper, How do you begin to impact, influence, and improve the care that's being delivered, let alone track it, which is the core of many value -based programs, right?
• 13:57
  And so a big part of our shift and one of the things that makes us unique is that as we're building this network of providers, we're also moving them onto our EMR that we've built to deliver high quality, evidence -based, and measurable care.
• 14:12
  And that only is prerequisite for moving to value.
• 14:16
  because you have to measure what the outcomes are and the improvements that you're making, but also data sharing.
• 14:22
  How do you, I mean, you can certainly fact something.
• 14:24
  So Kyle, I want to, I want to double click on that.
• 14:27
  That sounds really important because most EMRs actually start with clearing a transaction and every so often focus on clinical indicators, but largely to clear a transaction.
• 14:39
  And we obviously have a healthcare system that does too much and delivers, costs too much and delivers too little.
• 14:46
  So.
• 14:46
  In the effort to try to improve that in mental health, how do you in your tech stack actually measure value and how do you define value or improvement in mental and psychosocial status?
• 15:04
  Yeah.
• 15:04
  And so it begins with what are the tools that are out there?
• 15:08
  That is not only what payers are looking for, but there's a wealth of evidence around using those.
• 15:12
  And so as you're tracking different clinical conditions using you know, the sort of the evidence -based or at least the studied measurement tools is the first step.
• 15:23
  And what that does is it allows us to establish those baselines.
• 15:27
  So whether it's the PHU -9 or GAD -7 or DAS -21, there are a number of assessments that have been studied more than they probably should have to understand, hey, this relatively tracks symptomology and how somebody is progressing.
• 15:43
  We use that as really to establish that baseline.
• 15:46
  And then as we work with health plans, we can layer in total cost of care data.
• 15:50
  We can look at episodes of care and inpatient utilization, other sort of downstream impacts of, hey, if we can say this patient is improving, how does that impact the things that then show up in costs?
• 16:04
  And I think that's the key piece here is we look at, well, let's measure the basics, but also improve the trajectory of patients going through the system.
• 16:14
  and then seeing what the output is.
• 16:16
  I'll just add that I think it's a crawl, walk, run, right?
• 16:20
  Because essentially once you aggregate a network, right, you have market density, you've got the supply side, the clinicians, right?
• 16:30
  You've got the patient side, you're doing the matching, you've got people that are dealing with, you know, sort of a step team based therapy approach where you meet them where they're at.
• 16:40
  depending on what their mental health and or mental illness needs are.
• 16:45
  Then once you've established that, you're measuring them, right?
• 16:48
  Because we, Uplift's invested in building their own end -to -end platform.
• 16:53
  So whether it's an EHR, it's a credentialing stack, it's an RCM stack, or it's a patient -reported outcome stack, whatever it is, right?
• 17:03
  Like in the full technology suite.
• 17:05
  Once you start grabbing that base data, you can at least start doing some baseline reporting back to the payer partnerships that you have where they're sort of reimbursing.
• 17:15
  And particularly if you have a large market that you're serving on one of their geos, what they're most interested in the beginning, moving from sort of a traditional fee for service into starting to think about value is really trying to create a preferred, like high quality clinical network that they can reward at higher rates.
• 17:35
  People that are, you know, essentially like delivering evidence-based care, have a baseline showing that their patients are getting better over time, and then they can be a preferred high quality network.
• 17:46
  And so we're starting to see payers at least bend in that direction.
• 17:50
  I think the issue is twofold.
• 17:52
  And, you know, certainly John knows a lot about this given his career.
• 17:55
  I think one, payers really talk a good game.
• 17:59
  They're like measurement -based care.
• 18:01
  We want outcomes.
• 18:02
  We want outcomes.
• 18:03
  We want to know what total cost of care are.
• 18:06
  data is.
• 18:08
  But when you when you actually give them the data, they don't really know what to do with it.
• 18:13
  They don't know how to ingest it.
• 18:14
  They don't know how to mine it, particularly with outside partners that are helping them with network development.
• 18:19
  And so I feel like the payers have some work to do as well.
• 18:22
  They have their own in -house tech, but it's a lot of legacy tech.
• 18:25
  So we're still in the early innings.
• 18:27
  I think back in my, you know, Office of the National Coordinator HHS days with David Braylor, like you rewound 10, 12 years ago when only like I don't know, close to 29 % of all US doctors were on an EHR and now we're close to 98%.
• 18:44
  Behavioral health is just not there yet.
• 18:46
  We're in the very early days of trying to actually have data liquidity in behavioral health and trying to figure out how mental wellness, the fact that I might be having a relationship issue or marriage problems with my husband or what have you, and I'm in therapy for it, how that relates to my overall stress and my health.
• 19:04
  Like we just haven't done a good job of that yet.
• 19:06
  And so that's absolutely true, Missy.
• 19:10
  And I completely agree with you.
• 19:12
  Are you finding that payers are actually willing to pay for performance?
• 19:15
  Because in addition to not always knowing what to do with the data, sometimes, I know this may just be my experience, payers are a little bit shy about paying for performance.
• 19:28
  They are starting to.
• 19:30
  It has started in Medicaid a little bit more than on the commercial side, which is where you'd expect a little bit.
• 19:37
  That's exciting, Kyle, because honestly, that's, as you know, from your background at CitiBlock with dual -eligibles, that's probably the psychosocial is the biggest impact in the area.
• 19:47
  That's really exciting.
• 19:49
  Yes, and that's a great example.
• 19:51
  I work with AmeriHealth in DC.
• 19:54
  They have an existing quality program, but a lot of the providers that we're bringing into their network and helping them, who already accept AmeriHealth even for that matter, are too small to even participate in the quality programs because the panel size, even to get to a high enough and with the denominator, you know, just doesn't work with solo practitioners.
• 20:14
  And so not only, you know, are we helping them move towards that model, but even their existing network providers, as they transition and uplift, now they're part of the uplift group practice, now they can start to participate.
• 20:26
  And so, This is where we are in the early innings, but we are starting to make that transition and helping move things along.
• 20:35
  Johns Hopkins Health Plan in Maryland is another example.
• 20:38
  They don't have a quality program yet, and we're actually helping them create one.
• 20:43
  And so that was part of our partnership that we're really excited about.
• 20:47
  Missy, I want to ask you about something you've talked about, which is the role of the big tech companies in healthcare.
• 20:53
  You were already referring to it with Amazon and Google, but I'm thinking about, You know, the early stages, you're trying to get payers to do something.
• 20:59
  It's like half the people in the country have a mental health issue.
• 21:02
  And while I can understand a lot that a startup can do, I mean, does this really play to the strengths of the really big tech companies and even the federal government, as you're talking about with ONC, where we expect that uplift is going to uplift us all?
• 21:17
  I think the US government has a huge role to play in policy and certainly in leading reimbursement reform in this area and parity when it comes to virtual.
• 21:26
  and telemedicine.
• 21:27
  And we've seen that through COVID and we'll continue to see that.
• 21:31
  Big tech, look, I've worked at Google.
• 21:33
  I was at Box when they did the IPO and you know, Box was more of a utility and a tool.
• 21:37
  I led the industry's team there.
• 21:38
  We sold into healthcare a nice HIPAA compliant filing sharing solution.
• 21:42
  And then I went to Amazon.
• 21:43
  The only reason they made progress in healthcare is because of you.
• 21:46
  Let's be honest.
• 21:47
  I don't know.
• 21:49
  I mean, look, I still think that Amazon's going to disintermediate.
• 21:54
  supply chain, I think particularly.
• 21:57
  As speedy more so than they have in grocery 10 years in with Whole Foods?
• 22:02
  Yeah, I really do.
• 22:02
  I think they're playing the long game.
• 22:04
  I certainly think that they're in no rush.
• 22:06
  And, you know, there's been lots of compression on big tech right now.
• 22:11
  They're certainly not running out of money, but, you know, clearly they're making some changes in their their overall employee counts to sort of weather this this macro economic time right now.
• 22:22
  But.
• 22:23
  Make no mistake, Amazon and Google will be doing innovative things and I think Apple will return to healthcare.
• 22:30
  Will they be focused on behavioral health?
• 22:33
  Categorically, no.
• 22:36
  That's not where they're going to play.
• 22:38
  They are focused on primary care and primary care innovation.
• 22:42
  As much as behavioral health can be an adjunct in the way that they're going to be serving primary care, yes.
• 22:48
  But that is not like, it's not like, hey, We're going to attack all the issues of behavioral health first.
• 22:56
  They're going broadly and they're trying to go after convenience and they're trying to go after access.
• 23:01
  And I think pharma is definitely a place.
• 23:06
  Google is really leaning in on AI right now and that's where they're going to be contributing a lot.
• 23:13
  And I think they're going to be catching up with Microsoft.
• 23:15
  They're going to lean into what they're good at, which is their search functionality.
• 23:19
  Amazon's going to lean lean into what they're good at, which is bringing you, you know, bringing you anything you need to buy in commerce to your house, including care.
• 23:28
  And I think, you know, Apple's going to return more with we're going to see some interesting, interesting handhelds and devices.
• 23:35
  But I definitely think that behavioral health, what I can see is a big tech company buying, there's going to be a huge amount of M &A, there's already been a lot of M &A in the field.
• 23:46
  You know, I mean, what we had like close to it.
• 23:48
  five billion dollars go into behavioral health.
• 23:50
  It was the largest clinical integration indication of digital health investment from like 2019 to 2023.
• 23:58
  I mean, it was close to five billion aggregate.
• 24:00
  And that was because everybody was going crazy throwing money at, you know, point solutions.
• 24:05
  The employer market got slumped.
• 24:06
  arguably, we were all going crazy.
• 24:08
  We were all going crazy.
• 24:10
  Right.
• 24:10
  Just like maybe maybe let's be honest, it was just the we was it was a blinding.
• 24:17
  but we're so far behind, Missy.
• 24:19
  But I think your point about $5 billion contextualizes it.
• 24:23
  In that context, Kyle, how do you differentiate yourself from everything from LifeStance to Quartet and Magellan?
• 24:32
  How do you think about yourself as, to your point, Missy, a lot of these are point solutions.
• 24:39
  And it sounds like, Kyle, you're making more of a platform bet.
• 24:43
  Yeah.
• 24:43
  Yeah.
• 24:44
  So the first thing I, you know, I think to me, you know, everyone talks about the number of companies, the number of funding, but how many people can know where to find affordable behavioral health care and can actually get it.
• 24:57
  It's still way too, too few.
• 24:59
  Most people still are not getting the care they need.
• 25:02
  And even in all those companies that you just named and many others, right, it's still a small part of the overall piece.
• 25:09
  So I think.
• 25:10
  Within healthcare, even within health insurance, there's three at the top and everyone else and they're all massive businesses.
• 25:19
  I think within behavioral health and other specialties, elder healthcare, very few, one winner takes all.
• 25:26
  It's just not healthcare works.
• 25:27
  Healthcare is very much a local game.
• 25:30
  That said though, we begin at Access and as I mentioned before, big piece of what we're doing.
• 25:37
  across our hybrid network, which is both virtual as well as in person, really is the ability to deliver care, engage with the patient all on the platform, delivering the right level of care.
• 25:49
  We begin with therapy, but very much escalate into psychiatry through a team-based model, again, all enabled by the ability to deliver care on the same platform that we have built.
• 26:01
  And so what we really see ourselves as is a new delivery system.
• 26:07
  Right?
• 26:07
  You know, we are insurance line agnostic.
• 26:10
  And so we accept insurance across commercial Medicare and Medicaid, which is incredibly rare.
• 26:15
  We deliver therapy and psychiatry through a team based model, which makes us the ability to deliver care across the acuity spectrum.
• 26:24
  And so we think of ourselves as condition agnostic as well.
• 26:28
  We treat low acuity conditions.
• 26:30
  So all things to all people behavioral.
• 26:32
  We are building the platform to do that, which is very...
• 26:36
  very contrarian to what a lot of people do, right?
• 26:39
  Especially in venture, you start with a niche and build out.
• 26:42
  And what I saw was the exact opposite problem.
• 26:44
  One of which was point solution exhaustion.
• 26:47
  But behavioral health is one of those things that, you know, cross cuts a lot of co -occurring conditions.
• 26:53
  And if you only treat one condition, well, what are you doing for the rest of their mental health?
• 26:59
  Nothing, or you're referring or trying to find a partner, which just chops it up more and more and more.
• 27:04
  And so how do we get to better outcomes?
• 27:07
  It's a harder road and it takes a little bit longer, but building the delivery system so that regardless of where you are today in your mental health journey, you can find care, you can afford care, and you know that you're gonna get better.
• 27:21
  Those are the things we have to build towards.
• 27:23
  So Missy was talking about acquisitions to be done that the big tech companies will make from time to time.
• 27:29
  But Kyle, you've been doing at least one acquisition so far and hinting at more.
• 27:34
  What are you doing there?
• 27:35
  What's the strategy?
• 27:36
  Well, that's the advantage of building more of a platform is you know, you can go to these point solution type companies that you know from an appear investment standpoint in my opinion shouldn't be standalone businesses or maybe don't have the full sort of market or return on capital to survive long term as a standalone business and plug them in and so, you know, we we announced our acquisition of minded a couple of months ago.
• 28:01
  Um, you know, that for us was a great sort of complimentary, uh, acquisition around, you know, psychiatry, which is a growing focus of ours.
• 28:09
  Uh, we, we do have another one, um, it's going to be being announced next week, I believe.
• 28:14
  You can announce it now.
• 28:16
  Nice try.
• 28:18
  Um, we'll be announcing it, but that really, you know, for us brings our platform to millions and millions of people.
• 28:26
  Right.
• 28:27
  And so how do we distribute going back to one of Missy's earliest comments, how do we help them navigate to the right care?
• 28:34
  And it begins with, you know, how, how did they find us and how do we distribute the platform?
• 28:39
  If you will.
• 28:40
  And so I think there's a lot of opportunities.
• 28:42
  I wouldn't say we're done yet, but, um, you know, my team, uh, has, has told me that they, they can't do a third.
• 28:49
  So I'll give them a little bit of breathing, but, uh, there is an opportunity now that we are through.
• 28:55
  you know, hey, what are the point solutions and, you how do they plug into the platform that we can build?
• 29:01
  I mean, David, I think this is a tremendous opportunity because of where we are.
• 29:05
  I mean, digital health is an all time low as far as where venture is going.
• 29:11
  And we've seen, you know, we've seen a backing up and a conservatism.
• 29:15
  I, on the other hand, find this to be an incredibly interesting market because...
• 29:19
  We're basically in digestion mode.
• 29:21
  We've been bloated for a while, particularly as it relates to behavioral health.
• 29:25
  And so you're going to see a lot of separation of wheat from the chaff.
• 29:32
  So there's a lot of opportunity to go pick up some fantastic solutions that have a narrow market and it expands your platform.
• 29:41
  And when I was at Amazon, we would look at, there was a corp dev team in healthcare across Amazon and we would...
• 29:48
  our rationale would be like, does this solution hopscotch our product roadmap 18 to 24 months?
• 29:56
  And if it does, then it's definitely worth diligencing because it just gets us to market faster.
• 30:02
  And or does the talent team, right?
• 30:05
  The talent that would be coming in with the acquisition essentially give us a tremendous amount of subject matter expertise that we would have to go out and hire and train, right?
• 30:14
  Into the Amazon way.
• 30:15
  And I think that...
• 30:17
  It's just going to be a really interesting time.
• 30:19
  And if I could loop back to the big tech question, the only way that a big tech company is going to hop into this is the way that they've always hopped into it, right?
• 30:25
  Which is to actually pick up a couple of point solutions or a roll up.
• 30:31
  So I think that our approach has been more platform centric because it gives you that extensibility to go out and figure out how to do bolt -ons so that you have a nice, well -rounded, you know, whether you need...
• 30:45
  You need sort of self -serve guidance, you need groups, you need point solutions that are servicing what I would call more narrow mental illnesses like OCD or ADHD or even eating disorders.
• 31:06
  Not to say that that's where we're out looking right now, but essentially being able to really give...
• 31:12
  anyone that comes into the platform, the kind of care they want, moving into the MSI space, all of that stuff.
• 31:18
  So that, I think, is - That's exactly where she's looking.
• 31:20
  But, Kyle, I just, you gotta be excited about the platform you've built.
• 31:24
  But, David, I think we need to wrap before I start to argue with more - That's it.
• 31:28
  That's it, John.
• 31:28
  Well, I'll say that's it for yet another episode of Care Talk.
• 31:32
  We've been speaking today with Kyle Talcott and Missy Krasner, innovators and acquirers in behavioral health.
• 31:39
  I'm David Williams, president of Health Business Group.
• 31:42
  And I'm John Driscoll, the president of Walgreens Health.
• 31:44
  Kyle and Missy, really congratulations on building a platform where one is needed.
• 31:48
  And for our listeners and folks who are watching, if you like what you heard or you didn't, we'd love you to subscribe on your favorite service.