[HN Gopher] Launch HN: Legion Health (YC S21) - Smarter Staffing...
___________________________________________________________________
Launch HN: Legion Health (YC S21) - Smarter Staffing for Mental
Health
Hi HN! We're Yash, Arthur, and Daniel, the founders of Legion
Health (https://legion.health). We're an online marketplace for
health care professionals, starting in mental health. Basically, we
sell psychiatrists' and therapists' time to telehealth companies by
the hour. Professionals sign up for shifts that fit their schedule,
and telehealth companies can scale more quickly by not needing to
hire them full time. Telehealth companies and other health care
organizations (hospitals, medical groups, home health, etc.) face
huge problems around recruiting, managing, and scheduling
clinicians to meet patient demand. This is getting worse because of
a large (230,000+) shortage of mental health professionals in the
US. Staffing companies exist, but they solve only one piece of that
problem, are expensive, and don't mitigate risk for their
customers. We heard how bad things were during a 2-hour call with
the Director of Business Operations at a large telehealth company
last December. She told us in amazing detail how difficult it is to
recruit doctors to her platform and how much gets spent on that
sole task. In addition, she talked about the weekly fluctuation in
patient demand and the pain felt when scaling her physician
workforce up and down. Independently, over the next week, Arthur
started thinking about "Uber for doctors" and Daniel conceived "AWS
for doctor time," and then we realized they were two sides of the
same marketplace. While honing our idea, we found that it is most
applicable to mental health. In the US, mental health has undergone
a boom in demand in recent years (whether at hospitals or
telehealth companies, like Modern Health, Daybreak, and Ophelia--
all funded by YC). However, supply has not kept up--there just
aren't enough professionals. Mental health is also a field that is
quite suited to care delivery via telehealth. So we started there.
Our product solves problems on both sides of the market. On the
supply side, many mental health professionals are looking for
additional work to supplement their existing part- or full-time
jobs at a hospital, the VA, etc. On the demand side, health care
organizations are looking for a more affordable and flexible
solution for their staffing problem. We find out what time is
available from our network of clinicians, divide it into hour-long
chunks, then sell those hours to our customers (the health care
organizations) who only pay for the time that they use--that is,
the hours when the clinicians are actually working with their
patients. Unlike staffing companies and in-house recruiters, we
turn health care companies' fixed costs into variable costs,
significantly reduce hiring risk, and have no upfront fees.
Compared to other telepsychiatry solutions, we are much less
expensive because our network consists mostly of psychiatric nurse
practitioners and social workers who, in many states, do almost
everything that psychiatrists do but (for historical reasons)
charge lower rates. Unlike other telehealth staffing solutions, we
are obsessed with quality (in regard to both clinician performance
and building our product to facilitate long-term clinician-patient
relationships), ease of integration, and not having minimum usage
amounts. Our product doesn't exist in a public form. Rather,
health companies white-label our network to better meet their
patient demand. We currently have a network of 131 mental health
professionals whom we match with our customers manually ("do things
that don't scale"). We are building software for scheduling,
clinician-customer-patient matching, clinician onboarding,
notifications, etc. COVID-19 has made telehealth normal for
patients, clinicians, and institutions, so the opportunity here is
huge. Even traditional institutions (hospitals, rural clinics, home
health, assisted living, hospice, etc.) need a smarter staffing
solution because hiring health care professionals is incredibly
hard for them as well. At present, we are figuring out where to
show traction first as we scale. So far, we're seeing that the
organizations with the shortest sales cycles tend to be smaller,
more agile, more tech-friendly companies. If I could end on a
personal note: although all this marketplace talk sounds cold and
fungible, all three of us first encountered this problem from the
patient side. My father had brain cancer last year, and getting
ahold of his hospice nurses to do simple tasks like refilling his
meds was a pain. The nurses wanted to help; there just weren't
enough of them. For Arthur, when he was a child in rural Colorado,
his brother had a nasty string of epileptic seizures brought on by
inadvertent exposure to chemicals from a meth dealer down the
street. It took 2 months (after over 150 seizures) for his brother
to see a specialist in Denver who could treat him. For Daniel, it
was when a close friend in crisis tried to schedule an appointment
with her psychiatrist and found that the earliest she could see him
was in 3 months. The latter experience hits closest to what we're
tackling first at Legion Health, but the fact that we all know how
desperate it feels when care is needed, but not available, gives us
motivation to keep going, even when running into the notorious
intractability of the US health care system. We'd love to hear
what you think, even if it's constructive criticism on our
approach. If you or a friend hires health care professionals
(especially in mental health), we'd love to talk to you to figure
out what parts of our tech product you find most valuable, so we
can figure out where to build next. If you or a friend is a mental
health professional, thank you for doing such important and
necessary work during these difficult times. Excited to answer any
questions and hear your ideas, feedback, and experiences in the
comments!
Author : ympatel
Score : 22 points
Date : 2021-07-28 13:02 UTC (5 hours ago)
| digitaltrees wrote:
| How are you going to handle billing, stark law, and anti-
| kickback?
| arthurmacwaters wrote:
| Great question. At the moment, we don't. Our customers can bill
| using the providers' NPIs. We stay out of that part and just
| facilitate the relationship. Because we aren't routing patients
| to specific providers, we also aren't violating anti-kickback.
| Jommi wrote:
| On first look it seems like a scary way of commoditizing one of
| the most personal connection requiring forms of care there is.
|
| How do you ensure quality and aligned goals with the patients if
| it's literally just selling hours?
| ympatel wrote:
| Great question, and I really appreciate you bringing that up.
| This is one that we get from many of our customers.
|
| First, we have consulted with experts from across health care
| to implement the most rigorous quality standards for the
| professionals in our network. Not only do our clinicians have
| to pass tests of baseline quality (background check, licensure
| check, etc.), but they are also directly assessed based on
| their level of clinical expertise, years of experience,
| education level, etc. We even speak with all of our clinicians
| to do a basic sanity check and determine how they will present
| over video.
|
| On the back end, we are currently creating processes to assess
| post-visit performance in a number of ways, including
| timeliness, patient satisfaction, etc. That will allow us to
| weed out lower-quality professionals and reward our higher-
| quality professionals.
|
| Lastly, a key part of quality in mental health is continuity of
| care (a longitudinal patient-clinician relationship). Features
| in our product allow for our customers (health care
| organizations) to view our clinicians' availability and
| directly schedule their patients to match that availability,
| such that the relationship is maintained. Then, we have a
| number of ways (one of them being highly favorable
| compensation) to ensure that our mental health professionals
| stay with us.
|
| I hope this helps, and happy to explain further.
| fakedang wrote:
| I don't know about this. Most psychiatrists I've known have
| always recommended to meet in person rather than holding
| something over call. Always set up extra appointments and
| made time for them at no expense. The ones who would do
| anything lower than that would come off to me as sub par (and
| I've had online psychiatrists too, and all of them were
| subpar).
| ympatel wrote:
| Interesting observation, and this very much was likely the
| case for private practice psychiatrists pre-COVID. Now, we
| are seeing that more mental health practitioners (high-
| quality included) have become comfortable providing care
| over video because care quality is actually the same
| (several studies show this), no-shows are reduced for the
| psychiatrist (equals more revenue), and patients really
| prefer it.
|
| Furthermore, psychiatrists who take insurance or who are
| affiliated with a hospital/telehealth/other health care
| institution (i.e. not in private practice, plus these are
| the health care companies that are our customers) are more
| likely to bill for extra appointments because rates are
| lower than in private practice (although equal regardless
| of in-person or over video due to government mandates) and
| because the customer is less price-sensitive anyway as
| insurance is footing some of the bill. Therefore, these
| (still high-quality) folks just have different behavior
| patterns based on payment and based on response to COVID. I
| hope that helps.
| rdtwo wrote:
| Do you have a triage system in place where you have a phd
| level provider that diagnoses and funnels to the appropriate
| level person to do ongoing treatment? Also why would Good
| provide join your team what are you offering that makes you
| competitive to a provider.
| ympatel wrote:
| I actually really like that idea because it fits into one
| of our longer-term visions of providing an off-the-shelf
| turnkey "care team" solution, whereby a cadre of
| professionals work together to provide care for our
| customers' patients.
|
| Currently, we don't have such as system in place, but our
| customer might! In that case, a customer might use a PhD or
| mD from us to provider higher levels of care and then a
| social worker or nurse to provide ongoing higher-touch
| treatment. We are simply providing the health care
| professionals (and their time) to augment a health care
| organization's existing staff.
|
| Per your second question, that's actually one of our
| competitive advantages! Right now, we are finding that many
| awesome providers who are already reputably employed at a
| hospital, at the VA, etc are looking to make more money (by
| the way, the fact that they are already reputably employed
| is a good screen for quality too). They would like to work
| an additional 10-40 hours on top of their main job in the
| mornings, evenings, days off, and weekends. That is a large
| source of potential supply that is going unused and that
| could help so many people! Simply put, we offer these
| providers a chance to make more money by using their
| expertise to see more patients whenever they want. We
| provide the patient volume and the competitive rate. All
| providers have to do is show up and provide the excellent
| care that they already do.
| rdtwo wrote:
| There are a couple issues I see with this model.
|
| 1) Credentialing is super slow in medicine and probably
| quite expensive. It will take your provider months to
| come online.
|
| 2) If you aren't paying high at 65-70% of billable rates
| you will have trouble finding providers that want to go
| through all that hassle when they can just work more
| hours at their regular job.
|
| 3) It's not clear to me that you are doing anything
| different than what a regular private practice would do.
| Everyone is full online now post pandemic so they are
| mostly limited by availability of clinicians. They could
| hire parts time folks and offer the same deal I think
| many just choose not to. You would get stuck with all the
| compliance costs and little actual revenue.
| ympatel wrote:
| Thanks for highlighting these issues.
|
| 1. Credentialing is definitely super slow. We want to get
| to the point where we can handle billing for our
| customers as well, so we'll have to create relationships
| with payers to speed the process up. Right now, many of
| our customers and clinicians are already used to this
| long process, so nothing is really different here.
|
| 2+3. We are providing the patient volume at 0 cost to the
| clinician. This is all just extra income for the
| clinician at the cost of their time, regardless of
| whether the clinician is in private practice or working
| for a hospital with a fixed salary. Opportunity cost
| requires for the private practice to do marketing, etc to
| drive patient volume to them. Also, the private practice,
| again, has the same problems around recruiting and
| scheduling that a hospital would have.
| mritchie712 wrote:
| Is this what BetterHealth does? I haven't used it, but I hear a
| ton of ads for it on podcasts.
| ympatel wrote:
| Thanks for your question. BetterHelp is a direct-to-patient
| telehealth company that allows the therapists on their platform
| to see patients. We are B2B and are trying to provide a better
| staffing solution for those companies that want to scale or
| better manage patient demand. TLDR: BetterHelp is a potential
| customer!
| rdtwo wrote:
| I don't understand why anyone won't want to get cut rate mental
| health treatment when they don't pay for it. In the us folks are
| not price conscious for health care so why pick the minimum
| qualified person to provide care?
| ympatel wrote:
| You're totally right - no one wants cut rate mental health
| treatment. If you see my response to Jonni, I explain what our
| quality process is. Hopefully that convinces you that these
| aren't cut rate folks and rather very high quality
| professionals.
|
| And you have good intuition about most of the US health care
| system, but mental health has some nuances that should be
| shared. First, many mental health practitioners do not take
| insurance (only 56% of psychiatrists, for example, take
| insurance). That makes patients more price sensitive. It's hard
| to pay $350/hour for help. Secondly, and more importantly,
| there is a massive shortage of these clinicians relative to
| demand. Wait times to see a psychiatrist in rural areas can be
| up to 6 months. That's a big part of the issue that we want to
| solve: i.e. how can we use our solution to really expand access
| to the services people need?
| phren0logy wrote:
| Disclosure: I'm an MD who specializes in psychiatry.
|
| The idea that Nurse Practitioners and Social Workers "do almost
| everything that psychiatrists do but (for historical reasons)
| charge lower rates" doesn't feel like a fair characterization. I
| have worked with many excellent NPs and Social Workers, and have
| a tremendous regard for their work, but the level of training is
| - objectively - much different.
|
| Here's an infographic comparing training, which is more or less
| accurate, but there's some variation between programs:
| https://i.redd.it/ixgg0l7v6lv51.jpg
| ympatel wrote:
| This is a very good point, and thank you for sending this
| information. However, the infographic is quite misleading
| because it doesn't stack up nursing school vs. medical school
| (i.e. it doesn't show the type of courses and training taught
| in a 4-year nursing program at all). A undergraduate bachelor's
| degree even in biology is not comparable to the clinical
| training in nursing school.
|
| That being said, I see your point. There some types of complex
| care that only MDs/PhDs should be providing, and we will have
| psychiatrists and doctorate-level psychologists for that care.
| However, many of the services that our customers provide can be
| done by other clinicians in our network under the supervision
| of an excellent MD or PhD.
|
| Part of our goal is to really figure out the "matching" problem
| so that we can triage care to the clinician type with the right
| amount of training for the patient situation. By doing that, we
| feel like we can really increase access the way that we hope.
| anonymouse008 wrote:
| I may be a customer if the price is right -- but I'm wondering
| how this actually fits as a standalone product. My customer cost
| and your profit are hard to mentally balance in my mind. And
| maybe I've been wrong in evaluating these markets, but recruiting
| for a Telehealth offering is tablestakes, and a core competitive
| advantage to this space.
|
| Also to echo Jommi's comment, these aren't plug-n-play
| relationships from what I've seen. Especially from the Apps that
| try the text based therapy route to get around the 1:1
| relationship
|
| This also sounds like its about to run into the classic problem
| with hair stylists in the US. You're going to end up having
| clients want to see their therapist on their schedule - making
| the load balancing a super tough problem, because you can't just
| hot swap a new therapist in. You're going to have to run
| predictive modeling on the demand side to know when to have your
| supplier free.
| arthurmacwaters wrote:
| Thank you for the interest. You're right that there are many
| providers interested in telehealth, but filtering for quality
| folks and keeping them from churning is a non-trivial problem.
| In addition, it is a very supply-constrained vertical in
| medicine, so these problems are especially pressing. Part of
| the reason our current partners use our solution is because we
| do the upfront filtering, and we de-risk churn to a large
| extent. If you only want to use 20 hours a month from a great
| provider in NM, you don't have to worry that they're going to
| run off for a better offer, because we use their other time
| with other partners - and they remain satisfied.
|
| Regarding continuity of care: these providers mostly have
| recurring availability, which makes it very easy to schedule
| them in advance for CBT or other types of recurring visits. We
| lean into continuity, rather than trying to avoid it with async
| approaches.
|
| Regarding folks going around our platform to see our providers:
| frankly, that would more a liability to our customers than it
| would be to us, because they are the ones trying to maintain
| patient stickiness. Oftentimes, these services are employee
| benefits, so there's less problem here with patients trying to
| go around the platform. But the long term answer is we want to
| make it SO much easier for providers to see patients via our
| channels that they don't have any reason to go around us (and
| have to deal with malpractice insurance, payments, scheduling,
| and video infrastructure on their own).
| anonymouse008 wrote:
| Very cool and good luck!
|
| I poorly rephrased the continuity of care in the third
| paragraph... I highly doubt someone is going to circumvent an
| EMR/scheduling platform to go see the provider direct, but
| I've been wrong about worse things. The comment was just to
| say I believe you'll want to invest in those predictive
| analytics down the road to make sure continuity is paramount.
|
| What is more interesting in what I'm seeing you guys write is
| maybe you're going for acute and crisis care... which is
| smart.
| ympatel wrote:
| Totally agree about having to get good at demand
| forecasting. Good thing we have Daniel; his college thesis
| involved creating revenue forecasting model for BMW North
| America that they still use!
| markbernardo wrote:
| Hey Yash & team, just wanted to say looking forward to what you
| guys accomplish! This is great to see. Legion Health's business
| model is interesting & cool to see because the current company I
| work for, the business is basically the same but we're just in
| the manufacturing & logistics industries.
|
| Supply side: Operators aka independent contractors who are
| looking for flexible work in the manufacturing & logistics space.
| Demand side: Businesses in the industries that face labor
| shortage & don't want to hire full time employees & want to only
| meet demand depending on the marketplace.
|
| So, really cool to see this! I love how you guys are focusing on
| mental health because that's something really important to me & I
| value because I've been through it in the past year. Had all the
| mental health illness symptoms including anxiety, loss of
| appetite, depression, loss of sleep, no social interaction, etc.
| Looking forward to seeing the big things you guys accomplish!
| arthurmacwaters wrote:
| Thank you! Very cool to hear it's a business model you've seen
| work well in other industries. What we saw is that this is
| supply-constrained space - where many folks such as yourself
| need convenient access to behavioral health services - so
| anything we can do to increase the liquidity of the labor
| market (while maintaining quality) will be beneficial to
| patients. Thank you for the well wishes!
___________________________________________________________________
(page generated 2021-07-28 19:01 UTC)