[00:00:28] Rich Roth: Hi, I’m Rich Roth. I’m the Senior Vice President and Chief Strategic Innovation Officer with CommonSpirit Health, which is one of the nation’s largest healthcare systems across 21 states and servicing millions of people each day with a variety of their healthcare needs. My role at CommonSpirit is really how we work together with entrepreneurial organizations to lever the best and the brightest of creative minds and new ways of looking at the world with the caring hands and hearts of our clinicians and caregivers, and hopefully creating something better for the future of healthcare. Great to be here today with the Day Zero team to really talk about founders’ journeys as a way to understand entrepreneurial companies a little more and support the growth of future founders that are looking to improve our author system. So with me today is Dr. Virna Little, as well as Spencer Hutchins, who are both the co-founders of Concert Health. Concert is a phenomenal organization that we work with which is really touching upon one of the most important needs in our society, which is behavioral health care and especially an integrated care model with physical health care so things aren’t separate. So thanks Virna, thanks Spencer, for being here today and I’d love to just start out with, tell us a little bit about yourselves and tell us the journey that got you to start Concert.

[00:01:59] Spencer Hutchins: Well, thanks Rich for having us. It’s great and you and your team have been great partners, so it’s fun to be here with you and talk about this. Why don’t I have Virna start because really the idea for Concert predates it existing for a long time because, in many ways, it’s Virna’s expertise and passion around a particular model of care called collaborative care that’s a heck of a lot older than our decision to get up and partner and come up with a name for a new entity. So Virna, do you want to kick us off?

Sure, really glad to be here. I’m Virna Little. I’m the Chief Operating Officer and Spencer’s partner in crime, co-founder for Concert Health. Have a background in psychology and social work and have been working in primary care and integrated care for a long time. Really started the journey around collaborative care when the research project ended in the late 90s, early 2000s, and working with both my own organization and primary care organizations around the country and saw it work really well in places and saw it not work in places for reasons that I knew were fixable and could be overcome. And so the idea was to really allow for primary care providers to be able to partner with someone, offer collaborative care for their patients, and really, personal mission to really expand access to quality behavioral health services for people who wouldn’t get it otherwise, who weren’t going to their primary care provider, which is where most people go. And so it’s been really great to just know that, I always felt it, but it’s been great to actually see it and be able to live it.

Yeah, that’s awesome. And I was really fortunate enough to intervene years later in the summer of 2016 when I came across research papers that showed, hey, when you put a team in primary care that includes therapists and psychiatrists, and you put a system around that, which is actually screening everybody to get care. When you identify people with depression or anxiety and be able to make warm handoffs, which is just a fancy way of saying an introduction that feels more personable, not, hey, Spencer, you’re depressed. You should think about seeing a therapist. But, hey, Spencer, sounds like you’re struggling a lot with your sleep or your nerves. Would it be alright if one of my colleagues, Virna, calls you? She helps me care for my patients, a lot of patients going through the same thing, and she can check in with you in between our visits. And Virna and I collaborate really closely and make sure you’re getting better. That sounds a lot better. And not only does it make sense and that in this role, Virna is one of our what we call our behavioral care managers of which we now have a couple hundred of, and then checking in with patients on video or phone visits, sometimes in person, in order to be able to do a spectrum of interventions: therapy, goal setting, but always anchored to monitoring symptoms to find out if you’re getting better or not. Really tracking, not just do you like your therapist, not just you feel good, not just are you picking up the phone, not just can we bill you, but are your symptoms getting better? Are you healthier? Are you happier in your life? And using that to really titrate the interventions, both on the talk therapy side and then through a weekly consultation with a psychiatrist to help that primary care physician make decisions on diagnosis or medication. It makes so much sense. And you go, man, I wish I got that care. I wish my family, the people I loved got it. And like everybody, I had not only been an innovator in health care, but had been a patient and a consumer of it. You’d seen how transformative great behavioral healthcare can be and how hard it is not to get it in this country, and how rarely it connects with everything else in your body. So it not only made sense, but there was something like 80 randomized control studies that have been done that showed the outcomes were better, right? Better than primary care acting by themselves. Frankly, normally better than therapists acting by themselves, better than outpatient behavioral health interventions. And oftentimes the interventions can pay for themselves by avoiding higher cost care down the line. And it was just one of those moments when you’re kind of like, well, why, why doesn’t this exist yet? His has been happening for decades. And I started to ask everybody I knew, and it was interesting. There’s two reasons, one which is so common in healthcare, one, the money didn’t work right. And two it’s kind of hard to do it well, to put this team together and make it all happen. And it was about that time that I was getting fascinated by this…that we got word that Medicare was going to finally make this team model of care a covered benefit. And I said, oh my God, that is amazing. Doctors across the country are going to love this. But if we ask every primary care physician to figure this out herself, it’ll probably take 30 years and a lot of them will mess it up. And so that’s when the lights started going off. This could be an opportunity for someone to start something new. I knew that me, personally, was only part of the founding team. I knew how to build businesses. I knew how to hire teams. I knew how to do some technology. But I thought it really would require a true clinical expert because we would need to organize as actually a service delivery organization, one that actually did it, not just built the apps, but employed amazing clinicians. And so I started asking everybody that I had met, who was the best person in the country to do that with? And a bunch of folks gave me Virna’s name and one was silly enough to give me her cell phone number. So I called her out of the blue thinking that I had some interesting information, which was Medicare was about to make a change and, she had known that because she was on the advisory group that had been yelling at them to do this for seven years. She was, like, “late to the game”, but had had the same job for 15 years and kids in college and all these reasons why startups seemed like a totally different world. And I caused her to make a set of bad decisions in a row, starting with picking up the phone call and then agreeing, if I flew to New York later that week, that she’d carve an afternoon out for us and asked her to work nights and weekends for awhile, as we were figuring this out. And then she was kind of being an advisor to it right at the beginning, and then got enough traction that she finally had to jump with me and, make it a full-time job as we grew and scaled across what’s now nine states and several hundred employees.

[00:07:49] Rich Roth: One of the things that’s so interesting to me is behavioral health has seen such an incredible growth over the course of the pandemic period, and obviously recognized long before that it needed it. But through so many different avenues, so direct to consumer companies, digital companies, pharmaceutical interventions, and other types of things. Virna, I’d love from your perspective, you are betting on collaborative care being the best model or the model that you’re putting Concert on. why do you think that is the way or an optimal way to access care, maybe opposed to some of these other methods that are out there, or maybe in addition. How are you characterizing it?

[00:08:36] Virna Little, Psy.D.: I think one is that, again, people often know their primary care provider. They trust them. And being a part of that clinical team is really helpful. I would also say one of the things that I love most about collaborative care is how flexible it is. Lots of models and lots of organizations will say they’re patient-centered. But when you actually look, do the patients get to choose the cadence? Do the patients get to choose what it looks like for them, how often they talk to someone or what happens during those contacts? Do they get to choose the modality? Do they really get to take part actively in the treatment? And oftentimes the answer is no. And I think that, to me, what we bring to the table around that true patient-centeredness is incredibly helpful. I also think access, our ability to get someone into care within hours after that provider referral, we’re at about one and a half hours now. And I think someone needs care when they need care. And when they ask for care and when they get identified. And oftentimes the access issue is really problematic. And if you’re scheduling someone out a month or six weeks, or it takes time for them to figure out an app or to be able to engage, then you lose them. And I think our ability to engage people in care where they are in a very, very, truly patient-centered way, and to really have the flexibility. Most of our patients we talk to multiple times in the first week, which is very different. And most patients really appreciate that kind of support.

[00:10:18] Rich Roth: Yeah, I think in some ways you both chose the noblest of startup approaches, which is selling to health systems, which is long, it’s arduous, requires deep integration, requires thinking about your brand and the health system brand and clinical pathways and all those other things. So what is it like selling to health systems in the middle of a pandemic?

[00:10:47] Virna Little, Psy.D.: It was interesting because I think we saw some partners say, you know what? We suddenly realized that this needs to get fast-tracked and really sort of jumped to the table. Like we were kind of taken aback. And others, said, oh, we’re, completely caught off guard by COVID, we’re really having difficulty getting organized and we’re going to put this on the table. And so I think we saw it from both angles. And I think what’s been really interesting is that providers have really started to see some of the impact of the behavioral health difficulties that people are having. The suicide rates, the isolation, the difficulty sleeping, some of the other struggles that are just really starting to be way more prevalent in the day-to-day stories that they’re hearing. And they’re not just hearing it from patients. I’ve been struck by one of the organizations we partnered with in New York and some of the initial referrals where the providers, they referred themselves. And I’ve never in my entire career had that happen. And at first we thought they were just testing, like to see if the referral system worked. But I think that that has been helpful. And I also think it’s been really helpful to talk primary care, to understand primary care, to really understand what their experience is right now. I think not having spent so many years working in and with primary care, I probably wouldn’t have been as prepared to really partner with them during some of the most difficult times in their careers.

[00:12:26] Spencer Hutchins: It’s been great. Most importantly and most satisfying is the patients we’ve gotten to serve to date, but almost as cool is that is getting to support the primary care physicians. Already they were overtaxed, overworked, under-resourced and supported. And being able to show up and feel like we can make them a little better doctors, that they can get better care to their patients, that we save them some time and stress, that the economic model is sort of sustainable for everybody, and that it helps them today and helps them get ready for transitioning their practices away from get paid per visit into a get paid to keep people healthy. We all make a lot of jargons for it in the industry and call it value based care or something. But all of that and getting to support them across that spectrum has been great. I’d say one thing that’s been fun for us and Rich, I mean, you and I knew each other, I think, as I was starting Concert and it was sort of, I think it’s important for young companies to understand when the right time is and the right organizations. And it’s like, because our model has technology in it, but it’s also a service delivery model, it was like, let’s go do this with a practice with four doctors in one office, or four offices and 15 physicians, and let’s make sure we can do it. Let’s make sure the clinical model and others work because at a certain point there’s a scale of certain organizations and it’s like, you got to make sure that, one, this startup’s not going to be out of business in four months and, two, that they can actually deliver it. I also think it’s easy for the disruptors to talk about how slow and bureaucratic big systems are and there’s moments of that. I know more lawyers at CommonSpirit health than I wish I did. I know more layers of internal IT organizations. But you know, that’s, part of scale and that’s part of recognizing that you are responsible of managing the health of, like you said, millions of people on a given day. And so there’s some of that conservatism and structure that frankly makes sense. I think a lot of times, disruptors like to, startups like to pretend that the complexity of healthcare doesn’t exist. It’s like, oh, I create this theoretical value. But it’s, well, how does it work with my doctor that’s seeing 30 people a day? Where’s the information going to go? Who’s supposed to be paying for this and how and where, and do I need to turn around and write a new contract with all my health plans or all those things and I think what’s important for any organization that’s going to try to partner with the health systems or the medical groups, or both, is live in that muck with them. Bring some of the answers and be honest you don’t have them all, but actually say, listen, we’re committed to figuring that out and we’re figuring out how this can work for everybody across that continuum. And I think when you bring that approach, you can do some exciting things and you can ride on the back of the competence and the scale and the organization that folks that CommonSpirit have built over literally decades and decades of time and work in communities all across the country.

[00:15:08] Rich Roth: We certainly bet on one plus one is greater than two. Things definitely take time, but I think working together with the health systems can accomplish so much. Obviously one of the greatest challenges that we have right now is, and I think, Virna, you know about about this, is taking care of our own staff. This pandemic has taken tolls physical, mental, and otherwise. Here you are building this phenomenal company that requires great talents to help with behavioral health needs of people all across the country. They probably are struggling with their own things. And also, you’re competing against other organizations that are seeking that great talent. So love to hear the story about your hiring, your partnering with groups, how that’s going, what you believe is important to these, I guess, almost incredible ambassadors, a sense of what you’re trying to do in the behavioral health field.

[00:16:10] Virna Little, Psy.D.: Yeah, I would say, one is it’s really important to rally people behind a mission. Like at the end of the day, what we want to do is bring really good behavioral health services to people who really need it. And I think that that really just reverberates around the organization, I really feel every day, very mission-driven and I would also say that it’s really helpful to train clinicians really well so that they know what their experience is going to be, and that they know how to care for the people that they’re charged with caring for. And I think we spend a lot of time and are very diligent about doing that because in my experience, clinicians who know how to care for people are less likely to be overwhelmed, are less likely to feel powerless, are less likely to experience some of the burnout or the frustration or some of the hopelessness that might come from some of the work that they’re doing. And so we really take time to be able to do that, to make sure that they’re prepared, even if they’ve been in the field for a while. And just in my experience, that oftentimes really creates a workforce. And also to give them some diversion. Everybody needs a little diversion. So maybe we’re taking time and we’re writing something or we’re looking at quality or we’re advancing our technology or we’re just sitting around being innovative. And I think that that really gets people energized around the work in a way that feels good to them. And giving them some personal flexibility, not drawing a line in the sand. I’ve never been one to draw a line in the sand to say, here’s work and here’s personal. Figure it out. That looks different for everybody. And giving people the ability to make that decision on their own and to come up with a balance on their own and then support it. And so I think those are some of the things that we’re intentionally trying to do to help that.

[00:18:18] Spencer Hutchins: Yeah, Virna’s always reminded us, and we talk a lot about, career, not a gig. And so what we want to be is an organization that people feel like they can build a career with and they can get better clinically. It is a place that they can do the most good for the most number of people. And they’re always learning and have an opportunity. Obviously, part of that’s being paid fairly and having benefits and all of that. But it’s a much broader value proposition around how to support. The calling that they have and the desire that they want to do that’s good. I also think from folks that are used to building companies, and there’s a lot of amazing talent that’s coming in from technology or other businesses that are trying to create healthcare companies for the first time. I think that’s wonderful. We need that talent in the industry. But it’s important to think about, are clinicians part of your product, or are they the core of your company? There’s not necessarily a one size fits all. Are you a software business or others? You have to understand what you are. You have to communicate those values. And I know we’re very clear that, at our core, we’re a clinical delivery organization. We’re a place that is about great clinicians doing great care. And then yes, we have a world-class engineering and product and design teams to enable that, to make their lives better, to make their workflows better and all of that stuff. But it’s really important. I think a lot of people fudge that. And it can be really critical, particularly if you’re thinking about day zero. What are our genes going to be? What is the type of organization we’re going to build?

[00:19:43] Rich Roth: I’d love to hear a little bit of the story of you as individuals, outside of you as leaders of Concert and founders of Concert. I mean, you’re not two Stanford MBAs in a garage. Virna, you’ve had a great clinical history and such leadership in advocating for change. Spencer, you worked in the government. You had a start up before. You have young kids. So tell us a little bit about you as individuals and kind of, why does that make you strong as a founder, recognizing there’s so many different types of founders out there?

[00:20:19] Spencer Hutchins: You know, I spent my early career advising things. I was a management consultant way back. Then I was in the government, advising policymakers at the Federal Communications Commission and the White House. I spent a little time investing in a family office. And I think at its core, I wanted the accountability and ownership that came with running things. And so, my first company, Reflexion Health was more of a pure digital health software business in the MSK musculoskeletal space. And it was a constant lag for the four years I ran that. Oh, the technology is critical, but we need the physical therapist to act a little bit different. We need the orthopedic surgeons to act a little different. But from day one, we conceptualized that as we are a software company that does this. And when I decided to step away from that and we had a acquisition and then was going to do my next thing, it was to say, let’s solve the problem. Let’s figure out something and then make sure that I think we have a team around that can do it and there is a business. There is an operating model. There’s a path to sustainability. But let’s not presuppose what it is until we know the problem we’re solving and how to solve it was. And that’s when I got fascinated with collaborative care, this research base, this idea of a team-based approach in a primary care setting and this kind of engineering mindset of testing and learning, testing and learning, intervening. If they’re not getting better, change the intervention. It made so much sense with my understanding of the research and my understanding as a human that we have so many effective depression and anxiety and behavioral health interventions, but they’re all imperfect and they need to be centered on what does a patient want to do and what ends up working for them. And all of that made so much sense. And there were companies around there that were trying to do the same thing and they were going to, I’m going to build this app that does something. And as we were learning, as I was meeting Virna, I said, I don’t think there’s a bunch of primary care physicians that just read the Medicare registry and know there’s a new code that are saying, I’m desperate to hire social workers and psychiatrists. I’m desperate to figure out how to do this whole model. I really want to get into that. I just need a workflow tool that’ll help them manage themselves a little more efficiently. Like that was a question that no one is asking. What they were asking was, oh my God, I see so much depression, anxiety every day. I have a bunch of patients that if I tell them they’re anxious or have depression, they’ll yell at me because they think that’s something that happens to someone else. Or others that want help and they can’t get a therapist or psychiatrist to take their insurance. Or I’m begging someone I went to med school with 12 years ago to give me a tip on what I should prescribe them because I did one week rotation and now I’m the only one that could prescribe them an anti-depressant or an anti-anxiety med. And I need help with. And that’s where I got passionate. That’s about collaborative care generally. And why I got passionate about finding Virna was because it was like, we need to build great software, but we need to build a heck of a lot more than that to solve this problem that we knew doctors had and we knew their patients had. And that’s what got me excited and out of bed.

[00:23:19] Virna Little, Psy.D.: Yeah, I think, everybody has a road for a reason and I would say, sort of starting out, actually started out in HIV work and working in the prisons in New York State. And I think when you’re a much younger than I am now intern working in New York State prisons, you realize pretty quickly you’ve gotta be tough. And I think that made me tough enough to work in primary care with all of the providers. So, I think that that was certainly helpful. And I loved working in the primary care practices and working along with the primary care providers. And I think that it really sort of let me see firsthand that people were coming there and what they needed, and then working along with collaborative care and getting to start that for the first time in the real world. And the experience to work with the innovator behind collaborative care, who is certainly one of the kindest, smartest people in the field. And that experience, and the opportunity to really get to see it in different systems and help it to get up and running was incredibly helpful and really sort of gave me some of the tools and the ability to take some of that learning and say, okay, if we’re going to do it and we’re going to do it well, what works and what doesn’t work. And that doesn’t mean there haven’t been some bumps and bruises because boy definitely there have been a few of those today alone, but I think that actually, at the end of the day, you have to really want it. You have to really be mission-driven and saying, I know we can bring really good care to people. What does it look like? How do we do it? And everyday figure out how we could do it better.

[00:25:00] Rich Roth: So you’re both living on beaches, I guess basically. One in South Carolina and one in San Diego now. What’s it like running a company together in two different time zones and, barely a chance to ever see each other physically?

[00:25:14] Virna Little, Psy.D.: I think it’s also flexibility, but knowing that I’m going to be looking at a screen with Spencer, knowing that it’s 4:00 AM his time, and he’s going to be looking at me looking a little groggy on my end, knowing that it’s 10:00 my time because practices want to have meetings at 7:00 AM and 7:00 PM. And, that’s, kind of what it takes and maybe trying to pinch hit a little bit. I think it’s been helpful to learn as we’ve grown. Like I think it has looked differently as we’ve grown and it probably will look differently a year from now. I wouldn’t say we’ve got it to a science, but I wouldn’t say it’s broken.

[00:25:58] Spencer Hutchins: Yeah, I mean, when we started, I wanted to bootstrap. And so I was financing the business at the beginning and I said, hey, Virna, how about we start this? And how about you move to San Diego, but I can’t afford to pay you. And for some reason that wasn’t attractive for her or family. So, I guess we’re working remote. It wasn’t really the plan so much as it was just getting going and she was the best person in the country to start the business and we lived 3000 miles away. So let’s start. At that point, Virna still lived in New York. And at some point we got some traction and we could have, but then, a core part of the talent strategy, the operating model, was we wanted our clinicians to be as close to the primary care office as possible so they understood the geography. Maybe they could do some integration. And we thought a special thing, this was before COVID, so it was a little more unusual than then, but this work from home, the flexibility to work remotely, was a key differentiator to find great clinicians. And at some point we said, you know what, let’s eat our own dog food. If you centralize leadership, but ask your most important employees who are frontline clinicians, you’re remote, but we’re the headquarters, right? Talking to a a lot of other companies that built like that, you have to really watch out to not create. And then suddenly those clinicians, those are the most important people in your organization, they start feeling like part of the product. They start feeling like the intervention. The company is the engineers or the executives that are in the nice office in SoMa or in downtown San Diego, or the Flatiron in New York. And at some point we said, you know what, we like where we live. We love the idea that we can recruit everywhere in the country. And why don’t we put ourselves in the same place that we’re asking the rest of our team to be, which is let’s figure this thing out. And I’d like to pretend we were prophetic and we knew that we were all gonna have to learn that way, but we got an 18-month, two-year headstart. It made it a little bit easier for us to make this transition in COVID as everybody did. That’s helped us. As Virna said, it’s certainly not perfect and you’re always learning how to create communication and culture when you don’t have physical proximity. But, healthcare systems have been doing that forever. I mean, Rich, how many care sites does CommonSpirit have?

[00:28:08] Rich Roth: It’s measured in the thousands.

[00:28:10] Spencer Hutchins: So, you’re distributed. You’re not getting anyone together. I mean, you, Lloyd Dean, how many of your leaders you got to figure out how to do that. You’re not in the office with them. That’s the reality at even modest size health services businesses, that might have 10 offices. You can’t get to all 10 offices every week or you’re spending all the time behind… it’s really not that new. It’s not that novel. And it’s been helpful for us to do that. Kind of walk the walk if you will.

[00:28:36] Rich Roth: This has been a great conversation. My last question for you two would be, a lot of the audience on Day Zero is people who are beginning their own entrepreneurial journey and thinking about starting something hopefully for the betterment of healthcare in their own lens. What advice do you have for the next generation of entrepreneurs?

[00:28:56] Virna Little, Psy.D.: So this has been a learning. Certainly another part of my road that has been new, you know, this has been learning from day one. And sometimes I’ll still go back and say, what is that, Spencer, after five and a half years down this journey. But I think the one piece of advice that I might give is to find the right partner. I didn’t know I was going down this road, so I didn’t know that I…the right partner chose me. But if I knew what I knew now, I would never go down this journey without being really thoughtful about a partner because I just don’t, you couldn’t do it. I just do not think that we could have done what we’ve done, the way that we’ve done it so successfully, without that. And I think we happened into it a little bit more than we probably would say, but that would be my one piece.

[00:29:52] Spencer Hutchins: Yeah, I think in healthcare in particular, it’s so, some people are, they know the tech, they know the clinical, they know the business, they know…but I’m certainly not that. I think very few people are. So to me, that first nugget is really understand the problem that needs to get solved. And not with the buzzwords or not like the concept, but like the details. Does this need a piece of software? Does this need a great clinician? Does this need a new business model? Does this need to do… you know, really in those details. And then once you feel like you’ve really gotten it, not just the concept, not just the area of the industry, but the real problem you’re going to solve, then a lot of honesty about, how much of that solution are you? Or what part of that is it? And then go find the right partner, find people that are smarter than you and snooker them into leaving their high-paying jobs to do something silly with you.

[00:30:44] Rich Roth: That was great. Well, thank you so much. Spencer, Virna, I really enjoyed the conversation. I know a lot of the audience will too, so appreciate it and thank you.

[00:30:56] Spencer Hutchins: Thank you

[00:30:56] Virna Little, Psy.D.: Thank you so much. Pleasure.