Casting a Shadow of Mindful Leadership

Trip Hofer: It's good to talk with you, Andrew. I'm a huge fan of what you've done with Buoy. I've been in healthcare for over 20 years. My career began at a startup in Boston called Health Dialogue, which focused on population health. We supported patients with chronic conditions like diabetes and heart failure.

In 2007—seven years later—I joined Optum. At that time, it was a nurse line company. I was at Optum for about seven years focused on employers and ran the wellness business, which was very hot. If you think about behavioral health today, I associate it with what wellness was 10 years ago.

Then I went to CVS Health and ran a couple companies, including a technology company in Minnesota called NovoLogix, where I did some product stuff for CVS.

When the Aetna merger came about, they asked me to help run the integration. It wasn't something I was interested in. Some leaders are financially or clinically oriented. I am more sales and account management-oriented. And I didn't want to do an internal role.

I was upfront with my boss, Alan Lotvin. He said, "Trip, I'll help you find something."

AbleTo popped up because they were related to one of my first investors at Health Dialogue. Alan said, "Trip, I would run at that thing as fast as possible. Mental health is going to blow up in a good way."

He was right. I’ve been at AbleTo for three-and-a-half years now. Mental health is a completely different environment today. When I was at Optum, I would beg payers, employers and health plans to talk to me about mental health. Today I’ve almost got to stop them from talking about it. Mental health professionals are getting the recognition they need. This is really good for patients.

Trip: What's been most satisfying is listening to clients, understanding their problems and helping them solve them. I’ll give you an example. Our flagship program is structured care that has traditionally focused on people with a medical comorbidity.

At the outset of COVID, a bunch of our health plan clients said, "We need help. We don't have enough supply, and we'd love to get your program to focus on individuals who might not have a medical comorbidity but have a behavioral need. Can you still apply your structured care to that cohort of patients?"

We had planned to launch a product in the beginning of 2021, and we accelerated it by a year because of COVID. So, we are working with a bunch of plans that complement their network with high structured care—structured care that has outcomes.

It's an offering that they really like because they can see the evidence and outcomes. It's probably the product that most plans ask us for. That’s the most enjoyable part of it—sitting with clients and helping them solve these problems.

Working in mental health is extremely refreshing. I met with the CEO of Ginger and the CEO of Lyra, and the common theme was, "There's so much to be done here. We can all find our space and get stuff done." Yeah, we all have competitive juices flowing through us, but there's so much need that we can all exist together.

Trip: Everyone in this industry struggles with this question. We need more clinicians, period. Let me baseline that.

I was talking to a head of a behavioral unit in a hospital system. He said he's got about 1,000 patients seeking mental health support. He said, "Trip, about 750 of them don't need to see a therapist. If we got them into a good coaching program, that would serve three-quarters of my backlog. But I don't have access to one."

We need to complement a strong and growing clinical supply with other modalities for lower-acuity patients. I want to be clear that some people clinically need to see a therapist. But other people could receive appropriate care from a coach.

If we're going to get to everybody, we must be able to segment the population and think about clinically appropriate alternative modalities. Of course, some people may say, "If I'm going to get treatment, I want to see a therapist, not a coach." That's why these solutions are about “and,” not “or.”

Trip: There's still a lot of work in the severe mental illness and substance use disorder space. We’re seeing a lot of funding and organizations focused on that. You want to talk about total cost of care and value-based arrangements; that's where that space is.

But if you’re asking me, I think it's about adolescents and kids. The U.S. Surgeon General just issued a grim report about mental health for youth in the post-COVID world. I encourage everyone to read it. That report challenges plans and providers to focus on youth because this is a cohort that really needs support.

The space will continue to evolve. I was talking to an investor, and he said, "My kids talk about their need for therapy all the time, versus when I was growing up, you would never talk about going to see a therapist.” Now, it's become a social norm to talk about that.

Trip: The plans in the self-funded group are responding because employees who are parents are saying, "Listen, I need help."

And the employer is saying, "I want to help my population. They’re caregivers for their kids. If I don’t get them services, their head is not going to be at work. They might not even physically be at work because they’ve got to take care of their child."

Trip: I really appreciate what you said. Thank you for that compliment. In other companies I ran, I had to be aware of the mental health of my team. And when you run a mental health company, you really need to be aware of it, right?

For me, it starts with knowing who I am. I’m the type of person who consumes himself with work. My wife and I talk about it all the time. I try hard to not instill that as a cultural norm within AbleTo. If I'm going to work over the weekend, I'm not sending emails to make people feel like they need to be working, too. I want to respect the fact that people do things outside of work.

I readily admit that I have a therapist. I didn't really believe in therapy before I started here, and then I saw what it did. It's helpful for me to talk to somebody. My therapist has helped me understand who I am as a person and how my shadow casts itself on others. I know you are perceptive about that, too, Andrew. I just try to be cognizant about my leadership shadow.