Having endured a major health setback, Brad Kittredge was pushed to think of ways to address a lesser-known but more pervasive problem: the lack of quality mental health care. The healthcare sector faces many issues, including bureaucratic structures, guess and check diagnosis systems, and inadequate access. Fast forward to today, Haas alum Brad Kittredge has contributed to the digital health space by developing tools that enable data-driven health care services.
Brad is MBA 09 and the Founder and CEO of Brightside, a company that provides expert depression and anxiety treatment from home comfort.
Listen to this podcast with Brad Kittredge as he tackles the gaps in our health care systems. He impacts the digital health space by building a whole new type of mental health care delivered with telemedicine technology and data.
How did the pervasive issue of lack of quality mental health care affect you on a personal level?
[00:06:55] It hit home for me because my father has managed depression my whole life. And I saw the ups and downs that he had as he went over ten years from seeking care to finding a treatment that worked. And so, it just really set me off on this mission of how do I take these tools that I’m excited about and this trend of empowering people to drive their healthcare and apply it to really fixing mental healthcare delivery. That one event of having a personal health setback turned into a positive and set me on a track to do work that I find really interesting and rewarding.
Did you ever doubt that putting all your time, energy, and resources into digital health would pay off?
[00:11:58] I never felt afraid of failing. Maybe that was something I already had, or maybe that was something I learned in part at Haas, being around great people and the things we talk about that you can’t do anything great without trying and failing. And so I wasn’t worried about that. It didn’t hold me back. I, of course, had tremendous self-doubt about whether I could do it or what are my chances of succeeding. But that allure of really trying to build something and create something from scratch, and honestly, the thing that got me over the edge was picturing the people out there that needed help and didn’t have any solutions today, and the potential impact we’d have, just feeling that inspiration or even imagining that made it really easy for me to want to take the risk. And it’s the thing that really keeps me motivated and going every day.
On what inspires him to continue Brightside on difficult days
[00:14:44] It always comes back to the impact. There are hard days where I go look at our reviews page because the voice of the customer and the feedback of the impact that we’re having never ceases to make me feel happy and inspired, and is the reason we’re doing it.
(Transcripts may contain a few typographical errors due to audio quality during the podcast recording.)
[00:00:06] Chris Kim: Hello, and welcome to the One Haas alumni podcast. I’m Chris Kim, and I’m joined by our host Sean Li. Our guest today is Brad Kittredge. Brad is a Haas MBA alum, and the founder and CEO at Brightside. Brightside provides expert depression and anxiety treatment from the comfort of home and has completely reimagined anxiety and depression care. Hi, Brad. Great to have you on the show today.
[00:00:30] Brad Kittredge: Hey, Chris, hi Sean. Great to be here.
[00:00:33] Sean Li: Welcome. I’ll start right off the bat. Brad, my favorite question is, what is your origin story? Where are you from? And where’d you grow up?
[00:00:40] Brad Kittredge: Thanks for asking Sean. It’s not often that we reflect way back to where things began. To me, I’m gonna start with sort of where the origin of my current professional identity and the things that I’m really focused on and spending time on today. Started just a couple of years before I went to Haas. I actually did my undergrad at Cal as well, uh, and studied psychology and explored, and worked for a few years after undergrad. And I’ll admit that I was a late bloomer, that I wasn’t that focused studious undergrad, who, you know, made the best of my time at Cal and went and did really cool things. Part of what was holding me back was I was trying to like, over plan my path and that I was an idealist about it. And so I was looking for that thing that was gonna get me excited about work.
[00:01:22] Brad Kittredge: And I was having a hard time feeling passionate about the roles and opportunities that I was seeing and seeing my friends going into finance or consulting or, um, other things. And so I ended up kind of bouncing around a little bit and trying to figure that out. And maybe just enjoying that time. And interestingly, I was actively disinterested in healthcare. I looked at the healthcare system, and it was big and bureaucratic and slow and just seemed boring to me honestly. And then when I was about 27 overnight, I had some health issues and I had felt kind of young and invincible until then. And then, all of a sudden, I was thrown into that healthcare system. And unfortunately, I validated all of those things I had been afraid of and worried about. I had a really hard time finding the right care providers for me.
[00:02:10] Brad Kittredge: I couldn’t find anybody to help me navigate the spaces between those care providers and figure out where to go next and what questions to ask. And I even had a hard time getting data about myself from the places where I was getting care. And the truth is that I felt really unempowered and I felt kind of scared. I didn’t really know what to do and I didn’t know how to solve it in this really complex system. And so I went online and just to betray my age a little bit, this was like 2007 and digital health wasn’t even a space yet. What there really was like Yahoo groups and Google groups and people sharing information. And I found some information that was helpful for me, but what I really found were millions of other people like me who were motivated, more than anyone to try to do something about what was going on with their health, but they really lacked the tools and resources to do it.
[00:02:59] Brad Kittredge: And so finally, I had this sort of silver lining of my own challenges. I had a personal and professional epiphany that I wanted to spend the rest of my career-building tools to help people better manage their health and their healthcare. I had the other good fortune that it was just a perfect time kind of in history and the development of these markets that my interest in them coincided with a few really powerful trends. Interestingly, at that point, it was just the beginning of this trend called the empowered patient, where for a long time, healthcare had always been really paternalistic. And it wasn’t until actually somewhat recently that people started saying, wait a minute, the patient should have a central role in this and have all the rights and privileges to information flow. Believe it or not, like in the ’70s, doctors thought that it wasn’t even appropriate to tell patients if they had a cancer diagnosis.
They thought it was better to keep it a secret from them but fast forward to today, and they’ve come a long way where the patient really is at the center of the healthcare experience. And everybody would agree that healthcare needs to introduce elements of consumerization to really make it easier to consume and, and navigate care. And so that it was happening right. As I had my epiphany, telemedicine was really starting to emerge as a potential solution that the system was exploring overall. And of course, we’ve just had this, these parallel trends with machine learning and data management tools that have evolved at the same time. And all those forces came together to really spark my imagination about what was possible if we use technology to address a lot of these challenges in healthcare. And so that’s why I went to Haas. I went back to school because that was a pivot for me.
And I really wanted to dive deep into the way the healthcare system works. Start exploring ways that you put together solutions and try to figure out how to go to market with them. So I actually did an MBA and MPH. I did the dual degree program and spent a lot of time thinking, getting out of the business plan while I was there. And really, that just set me on a track to where I’m going and where I am today. So right out of school just started working on building products. I went to a company called Jawbone. That was an early competitor of Fitbit, really thinking about behavior change using wearables and using data as these feedback loops to form habits. Then I joined the team of 23andMe making genetic testing available and accessible and useful for people. What was interesting there was on my third day of work at 23andMe; the company got a letter from the FDA saying that we had to stop selling our healthcare products.
And it was really a front-row seat for me into the clash between the sort of Silicon Valley mentality, trying to change healthcare and the traditional incumbents, and the really big and sort of risk-averse industry. But I got to be part of a small core team that really got to dive into that, understand the FDA’s requirements, modify our product and resubmit it, and actually get the first approval of a direct-to-consumer genetic test. And that was a really formative experience for me where I said, you know, I love these consumer-centric approaches to healthcare, but I appreciate the reason that the healthcare industry has these structures and constraints. And that the real way to find solutions is to bring consumerism inside of the system rather than try to attack it from the outside in. And so spend a little bit of time with another small startup in the mental health space.
And while I was there, I was really exposed to the challenges and shortcomings of mental healthcare in the traditional model. We talk a lot about access to mental healthcare and access is a huge issue, but the quality is a much lesser-known and perhaps even more pervasive issue when it comes to mental health care, we’ve got a major shortage of psychiatrists in the country, and most mental health care is actually delivered by primary care doctors. And the reality is that they in general don’t have the training tools or resources to do it well, and we’re not using evidence-based approaches that we know can work. And when I saw that up close and really understood that in a deeper way, it hit home for me because my father has managed depression my whole life. And I saw the ups and downs that he had as he went over 10 years from seeking care to finding me a treatment that worked.
And so it just really set me off on this mission of how do I take these tools that I’m excited about and this trend of empowering people to drive their healthcare and apply it to really fixing mental healthcare delivery. And so was fortunate to just find a phenomenal team and get to work on it. And about two years into that COVID hit, which dramatically accelerated telemedicine adoption. It really brought mental health to the forefront as a real secondary effect of COVID and has continued to accelerate the growth of our business and the set of problems we’re working on solving. So I can trace it all back to that one event of having a personal health setback that I was able to turn into a positive and set me on a track of doing work that I find really interesting and rewarding.
[00:07:26] Sean Li: Did you have family members that are in healthcare or the healthcare industry?
[00:07:28] Brad Kittredge: No. And I didn’t really know what it was gonna be like to work in healthcare. My only understanding of it was just the things I had observed as a patient, which was very limited.
[00:07:37] Sean Li: By the way, we are currently— totally side comment, but we’re currently producing a podcast series for this Google-backed John E. Martin mental healthcare challenge. I have you heard of it before?
[00:07:49] Brad Kittredge: Yeah. I’m friends with Michael Martin. Great, he was in that class.
[00:07:51] Sean Li: I figured you might know each other, but there’s even better.
[00:07:57] Brad Kittredge: Hey, Michael Martin, miss you, buddy.
[00:08:00] Sean Li: Yeah, I interviewed Michael a couple of months ago, and we had a great chat for this was for May for mental health care. Is that May mental health healthcare month awareness month? Or is that June? I think, yep.
[00:08:12] Brad Kittredge: There are a few there’s suicide prevention awareness month and mental health awareness month and there’s self-care month and there’s lots of different events’ dispersed in through the calendar, but I think you’re right about May. Awesome.
[00:08:20] Chris Kim: Right. But what was it about that experience that really pivoted you? I know your entire life is professional, and your personal career has really pivoted out of that one experience. What was it about that experience triggered you to want to move in that direction? It’d be great to hear that.
[00:08:35] Brad Kittredge: You know, you’re gonna pivot this a little bit into a therapy session, Chris, but the reality of it is that I felt scared and that’s not a good feeling. And my, when I can’t figure something out or when I feel unempowered, my default stance is to go try to do something and to figure out how to attack it. How do I regain a sense of control? Because I didn’t wanna feel like I just had to sit there and things that were happening to me were not happening. I wanted to feel empowered in some way, or like I had some way to move forward and to reduce the uncertainty. And so that was really what motivated me and kept me going. And so it started kind of selfishly that I didn’t that feeling anymore, but then I quickly saw that there were so many other people with that same feeling and that the ways to reduce that were to just give people tools, give them control, give them the opportunity to engage and to find solutions because the solutions were out there in many of these cases. And that continues to be a motivator at every step I think.
[00:09:29] Chris Kim: Did you know Brad, when you were, it’s always interesting to hear people’s story here, but when you were applying to business school or doing the MBA, MPH program, did you have that pipe dream of, Hey, this is what I want to do in the future or was it just taking that energy and that drive and just wanting to put it somewhere?
[00:09:45] Brad Kittredge: Well, I didn’t know Brightside was what I wanted to do in the future, but I did know I wanted to be a founder and an entrepreneur. So I was really fortunate to be a Maxwell fellow at Haas and a really phenomenal program and have so much gratitude from Jennifer Maxwell and Scott Sowry and that team who provide these fellowships, for a handful of students focused on entrepreneurship. So it came into Haas with an idea and it was really an idea that was driven out of that experience that I was working on trying to facilitate the sort of global process of complex diagnoses. And so I knew I wanted to do something in space. What I quickly learned was that I had a lot of learning to do. Starting a company includes a lot more than an idea and just figuring out how to turn that idea into a set of product requirements and a marketing plan and build a team around it and fund it.
[00:10:35] Brad Kittredge: It was my trial run at Haas to sort of play with that idea and think about it. And once I realized how much I still had to learn, I knew I needed to go join a few other companies that were further along where I could get better exposure and build my skills in the real world before I’d be ready for it. But yes, I was constantly scanning and ideating and evaluating things until I found the right one. And all the forces came together in the right way at the right time for Brightside.
[00:11:00] Sean Li: On that point. How did you know you were ready to jump ship from, you know, the corporate job to a startup?
[00:11:06] Brad Kittredge: It’s so hard, you know this Sean, when I started Brightside, I had two kids under three years old and my wife was really nervous about it, right?
[00:11:14] Brad Kittredge: When you make a decision like that, it’s a family decision. What we did as we’d sort of talked about the guardrails and how long we might be able to go without income for how much risk we were willing to tolerate as a family, how much of my time would be spent working on the startup versus at home and really not sacrificing that really critical time our kids lives and our family’s time. And so we just kind of came up with a set of rules for ourselves. And I said, here are my milestones, and here’s the timeframe. And if I can hit those milestones in this timeframe, I’m gonna keep going. And if I can’t, I’m gonna go get another job and was willing to take a certain amount of risk. And I was fortunate to have a family and sort of a circumstance that gave me at least the chance, but I also knew when it was gonna cross the line and when it was gonna become too much risk for me.
[00:11:58] Brad Kittredge: And so those things really included finding a co-founder in a certain amount of time and then getting funding in a certain amount of time to be able to pay ourselves a salary. And those were both really tough but got really fortunate that they worked out in the right way and gave us enough confidence to keep going with the business, start getting paid enough of a salary to justify it, even though still below-market rate for a long time, or I guess still is today but made it so that we could sort of keep going and checking back in on that at each step. And I didn’t have any doubt about the process itself. It was really more about the externalities of it, about the impact on my family. From my standpoint, I never felt afraid of failing. Maybe that was something I already had or maybe that was something I learned in part at Haas being around great people and the things we talk about that you can’t do anything great without trying and without failing perhaps.
[00:12:44] Brad Kittredge: And so I wasn’t worried about that. It didn’t hold me back and I of course had tremendous self-doubt whether I could do it or what are my chances of succeeding, but that allure of trying, really trying to build something and create something from scratch. And honestly, the thing that got me over the edge was to picturing the people out there that needed help, and that didn’t have any solutions today and the potential impact we’d have. Just feeling that inspiration or even imagining that made it really easy for me to want to take the risk. And it’s the thing that really keeps me motivated and go on every day.
[00:13:15] Sean Li: I have two quick questions to follow up. One is I know circumstances are gonna be different for everybody, but I’m pretty sure some listeners are curious how much time did you give yourself? That’s question number one. And you kind of answered this question. Number two is how do you get up in the morning during difficult days as there sure were knowing that there’s this big mission you wanna solve and all these people it’ll help, but just really curious, what else got you, kept you going?
[00:13:39] Brad Kittredge: So I gave myself a year, but we sort of just looked at our finances and said, we could do a year, but not more. And so that was the deal had to raise a seed round within a year.
[00:13:49] Sean Li: Did you have to get to revenues within a certain amount of time too? Or was it just a seed round?
[00:13:52] Brad Kittredge: No, just the seed round, but we actually got revenues before the seed round because we needed that as a proof point to raise and they were small but they were revenue.
[00:14:01] Sean Li: Well, how much time did that take?
[00:14:03] Brad Kittredge: Honestly, when we started building in November of 2017. Our first revenues were in January of 2018. We put up our alpha release, the simplest possible release we could get out. And we had a purchase within about two hours, which was just the most amazing validation. I expected hopefully in the next week we’ll get a purchase and it came right away. So it was yeah, a very good sign. It was a crazy pricing model. And the happiest site, I can’t imagine who that was, who trusted us and purchased from us. But yeah, so we had good excitement and optimism there that gave us momentum through to raise a seed ground.
[00:14:35] Brad Kittredge: It’s a good, question I’ve heard a similar question asked in sort of broader entrepreneurial environments and what keeps you going, what gets you up on those days that are tough days? I’ll tell you that. Honestly, if I look back at the last four years of working on Brightside, there has not been a day that I’ve had a hard time getting out of bed. It’s just not a feeling I’ve had. And I think I’m really fortunate that way, that I just love building this thing. There are days that are hard. Like once I’m up, there are days were at lunchtime, I want to head out and go do something other than my last few meetings, but yeah, it always comes back to the impact. There are days where I go look at our reviews page because it’s just the voice of the customer and the feedback of the impact that we’re having never ceases to make me feel happy and inspired and is the reason we’re doing it.
I’m fortunate to be in a space where that feedback loop is really self-apparent and obvious. And the impact is really clear. And I mean we literally have people telling us almost daily that we save their lives. And so it’s not hard to get inspired and motivated by that. And by the magnitude of other people out there that need it. Yeah. The hardest days for me are like fundraising and pitches and getting told, you know, ‘No, this isn’t our thing, or we’re not sure about this or that.’ And it’s tough building the product, building the team, serving customers, all that stuff. I don’t think I’ll ever get sick of it.
[00:15:51] Chris Kim: Yeah. Brad sounds like when you were about to start the company, you had a very solid strategy, you had a timeline, you had metrics and you knew you wanted to hit them. But how much of that do you think you knew before getting into this startup or starting Brightside and how much of that do you think maybe was your exposure from the other companies that you worked at and just kind of seeing all of those experiences and trying to channel that into your own?
[00:16:14] Brad Kittredge: A really good question. I think it’s really challenging to disentangle those and to like to draw direct line attribution from any one perspective or idea you have to where you formed it. I’ll say that the time between graduating from Haas and founding Brightside, I think was really critical for me. I don’t think I had the tangible skills to be able to follow through with a lot of the things that I’ve been doing at the company, particularly around prospecting and building the product and identifying a lot of the market dynamics and the strategy. So for me, that was really critical to learn that and hone that skill in some other companies that were already doing a great job interestingly, or I feel really happy that our strategy since founding the company has not included any pivots. It’s really been a linear execution of the opportunity that we saw the competencies we decided we wanted to be great at and how we were gonna differentiate and then a linear path to execute on those. That’s not to say there haven’t been some mistakes and missteps along the way, but all in all, we set out to build a whole new type of mental health care delivered with telemedicine technology and data and to measure our success by the quality of outcomes we can deliver. And that remains our same mission today.
[00:17:27] Chris Kim: Could you share Brad, a bit about how the platform works and how people interact with it, and what are the common use cases or different tech types of things your customers are trying to solve by coming at Brightside?
[00:17:37] Brad Kittredge: For anybody that works in healthcare, they realize that’s actually a, a very multi-layered question. There’s never one straightforward answer to that because you’ve got a unique arrangement in healthcare where you’ve got one person consuming, a service, another person providing the service, and a third party paying for the service in many cases. And you’ve also got a lot of different legal and regulatory dynamics that sort of overlay all of that. And so as we put together our market strategy and looked at where the real opportunity is healthcare in the biggest part of the market is driven by the large health insurance companies. But when you’re a startup, those companies do not have time for you. And they’re very risk-averse. They don’t want to give contracts to little startup companies. And so our strategy was to start directly to consumers so that we could drive revenue and data from day one and start to build the business in a way that we had control over.
And then to use that data and to build our credibility and show it with our outcomes, then approach the payers and to earn our way in the door. And so then as we, now, we have assigned a number of national contracts with major health insurance companies that give us the opportunity then to go build programs with constituencies related to and inside of those payers. And so it’s really kind of a stepwise ladder up strategy in the market. You’ve gotta get a foothold and level up and then get a foothold and level up. And so in the consumer market, we were really targeting early adopters of telemedicine when we started. So that tended to be women 18 to 44, a little more weighted towards urban environments because women tend to experience depression at a higher rate than men and have sort of fewer cultural barriers to seeking care for it.
And of course, younger people are earlier adopters for tech solutions. As we expand and work with our payer partners, there are a bunch of different segments and opportunities where payers work closely with large self-insured employers. And so you can think about employee populations like people with a different set of requirements and needs. Payers also have special programs for people who are at higher risk and higher cost and wanna make sure certain people are getting the right care. So they’re steering people towards certain care providers and those individuals have certain needs. And then you’ve got a lot of other bigger healthcare providers in the ecosystem who take on risk for mental health care outcomes, but actually don’t have a great ability to manage that risk and can also be collaborators and customers, so to speak with us. And so it’s a pretty complex environment that all starts with us delivering scalable efficient and effective care and allows us to serve a number of different people in the channel.
But in the end, it all comes down to delivering mental health care to an individual. And for that starts with anybody can go to Brightside.com, take assessment includes looking at sort of where you stand when it comes to depression and anxiety, what it means and what you can do about it. Generally, our focus is on the higher complexity and severity of mental health issues. So a lot of the early digital health market is focused on kind of wellness and mild to moderate. And that’s great. Those are all important tools, but we’re unique and different. And that we treat the higher complexity and severity cases. And so our offerings include medication management and therapy. And so in contrast to the traditional way to deliver that kind of care. So medication management is usually delivered in a primary care office and the convention for a long time has been guessing and checking like, Hey, it doesn’t matter which medication you prescribe.
Just try this and come back and see me in six weeks. And tell me how you’re doing. We’ve actually applied a precision medicine approach to that problem instead and said, how do we actually use data to inform a better understanding of each individual and match them to the treatment that’s uniquely suited to serve them? So we’re moving it from the kind of a commoditized care model to a precision care model. And so we gather a bunch of data in our intake process about each individual, analyze it in our models, and surface it up to the prescriber so they can complete their full diagnostic evaluation and make a data-driven care plan. Then we’ll mail the medication to the person’s house and then help the provider remotely monitor them over time while we’ll continue reassessing their symptoms and side effects so that we have this data-driven feedback loop.
So we can see are people improving? Do they have any setbacks? Do they have side effects that are intolerable and might they have any kind of suicidal ideation or any kind of risk scenarios that we need to support and intervene in? That’s one path. The other is therapy is generally recommended for anybody with mental health conditions. And so, that will treat people from mild up through severe with that. And what’s important when it comes to depression and anxiety is following what’s called an evidence-based therapy approach. So while our common mental model of therapy might be sitting down and talking with a therapist about our past and kind of unpacking feelings that we don’t fully understand, what the evidence shows works is actually more of a skill-building approach, anxiety, and depression are these negative avoidant cycles that self-perpetuate.
And in order to actually break them, you sort of have to recognize and understand them and then make a plan and build new habits to replace those negative cycles. And so evidence-based therapy has really codified that and turned it into a structured program that can deliver really reliable and repeatable results. And we’ve taken that very seriously of how do we institutionalize the best practice among evidence-based therapy and make sure all of our providers are set up to deliver it in the right way, and that we’re using technology data in the right people to change that care experience and make sure everybody gets that level of care. And we’ve been measuring our outcomes from the start. That’s what really matters to us. And they’re really phenomenal. Most notably, you know, the easiest way to understand them is to compare them to treatment as usual.
So we went to one of the best health systems in the US and proposed a study and compared our outcome data against theirs in a more traditional treatment setting. And the way we measure it is treatment response, which is essentially a minimum amount of symptom reduction from where you start your treatment and remission, which means sort of bringing people’s symptom levels below what would be clinically diagnosable and our rates of treatment response and remission were 50% better than one of the best health systems in the US. And that data creates this feedback loop that helps the system just keep learning and getting smarter and smarter. So we offer that kind of care and that level of care, wherever someone might find us from. And we really think of ourselves and want to be omnichannel providers because of that complexity in healthcare.
Someone might find us through their employer, through a sort of a portal or referral. They might get referred by another provider, say a primary care provider. They might find us in the directory on their payer, or we might target them on Facebook or on Google, but either way, as people are really healthcare consumers, now we want to bring them in through this same experience, deliver the same high-quality care and really be able to deliver repeatable outcomes, which has been a thing that’s never been part of mental healthcare. And surprisingly, if you rewind five years, you’d be hard-pressed to find any mental healthcare providers that even measured their outcomes. So it was just about care delivery and spending a lot of money for a lot of therapy sessions without even knowing if that care worked. And so it’s fun to be in the midst of really a revolution and a remaking of behavioral healthcare. What I think of is kind of redefining mental health care for the telemedicine age.
[00:24:28] Sean Li: That is amazing. I had this question and you seem to have answered all of them which is my must ask. CEO question is how do you look at your competition? Because without naming any, any names, you know, they’re through podcast ads, I just see so much of this one provider, and I actually tried it out. And that’s what I felt was missing was where’s the follow-up? It was more like just a matching service. It’s like, great, that’s right. You can match me with somebody. And even the matching service didn’t feel that catered even there was a questionnaire and I thought it was very much catered towards me, but then you get this person who was just seemed like they randomly picked out of a hat somewhere in the US and you write their profile and you’re like, this is not related at all. And obviously, there’s an option to say, pass on this person. They just pick another random person. And that was the experience I had. And I was just like, screw this.
[00:25:18] Brad Kittredge: Yeah. And if you had continued with it, it’s really unclear what kind of care you would’ve gotten and because there’s no structure or accountability for that. And it’s how the therapy’s kind of always been and listen, therapists are great. They provide such a vital function and I’m a huge advocate of therapy. But the reality is that there’s no excuse not to measure outcomes so that we’ve gotta know what’s working and what’s not. And be able to course-correct as we go. And that when there are evidence-based approaches that have been proven to work, we’ve gotta follow them more consistently. And so when you’re building a network like that company, you might have tried or like Brightside, you’ve gotta build in that standardization and quality and accountability mechanism so that you don’t have a hundred different providers each performing their own interpretation of it, which might or might not be adhering to what works.
So yeah, I think early entrance for any other healthcare nurse out there. I think the last almost 20 years has been sort of like telemedicine 1.0, and it’s all of a sudden we take telemedicine for granted, but 20 years ago, very few people in the healthcare ecosystem felt confident that remote healthcare could be safer, effective. And so there were some really hard one gains over that period of 20 years at all of the stakeholders to agree that like, yeah, telemedicine can be a meaningful part of our mix, but those first iterations of telemedicine were really just web visits. It was moving a discussion between a doctor and patient online to a webcam, but everything else kind of remained the same. And that definition of telemedicine as a web visit is already outdated. We’re quickly moving into telemedicine 2.0 now that we all agree that it can work well online and that it works pretty well for primary care and urgent care style applications.
We’re really redesigning those care models for chronic care and things that require longitudinal relationships with very specific clinical protocols that are aided by data to support better decision making and where outcomes really matter. And by the way, have a major impact on care costs and where everybody’s got an aligned incentive to make things work better. So it’s a really interesting dynamic. There’s a lot of noise in the market of people chasing kind of that early froth around access. But from the start, we’ve been betting on the long-term differentiation of quality as where the real market’s gonna shake out.
[00:27:27] Sean Li: Out. And the pandemic really accelerated that. My wife’s a pediatric hospitalist and I was just asking her the other day, you know, do you see telemedicine at her hospitals staying around post-pandemic? And she was saying, yeah, absolutely. They’ve already incorporated that in. They just found it more efficient.
[00:27:44] Brad Kittredge: It’s more efficient and they’ll, they won’t be relevant if they don’t keep doing it. Interestingly, telemedicine has really changed the basis of competition in healthcare where healthcare was always a captive market. In any one area, you had these big consolidated health systems that did everything and you usually had one or two choices of where to go get care. And the reality from a market perspective is that in most cases they were kind of average at everything they did. They might have one or two areas they excel, but you might actually get subpar care everywhere else. And it was all under the same brand. Telemedicine came along and took away those geographic barriers to finding the best care for you. And so it turned that local market into a national market for certain things that are appropriate for telemedicine. And so your search costs to find the best diabetes solution or the best depression solution are so much lower.
Now, you don’t just need to go to that big hospital system near you. You can find the best care for you wherever it’s delivered. And I think those big health systems are trying to adapt to that world and figure out how this will change their care delivery, they’re certainly adding in and keeping telemedicine. And there are many conditions and many patients who might want a hybrid model where they’re gonna want to be seen in person and remotely. And in those health systems will have a real asset and advantage there, but they can’t ignore telemedicine because it’s here to stay. And I would predict that in five years, 80% of mental health encounters are gonna be by telemedicine.
[00:29:07] Sean Li: I’ve always struggled to figure out how hospitals are going to solve this patient records issue, right? Because they have these different systems that don’t talk to each other, but it just hit me that I think telemedicine might actually lead the way there because if there is this central provider of sorts, they can serve as a source of truth for our medical records. Potentially. Do you see that happening?
[00:29:38] Brad Kittredge: I think we’re actually seeing the opposite of that, where we’re seeing the fragmentation of the medical record. So there was this whole period of driving EMR adoption among healthcare providers through the ’90s and 2000s that sort of drove the rise of big consolidated EHR, like Epic and Cerner. And they tried to do everything for these big hospital systems. So they do one EHR implementation. It was not very good for any of the departments in the hospital because it had a really bad UI and UX and was really hard for them to manage. Brightside for example, we built our own EMR because we look at everything that’s off the shelf and none of it could do what we wanted to do. And none of it could support some of the efficient care models we want to build, or the clinical decision support we want to build in, and delivering this sort of verticalized specialized care means having the right technology tools to do it. And one of the things that were really critical to us was physician efficiency and decision-making. And so by building our own, the reality is we’re creating a little bit of a data silo, right? So all of someone’s mental health data and treatment data might be with Brightside. And certainly, everybody has mental health considerations as well as physical health considerations. And so it’s incumbent on us to make sure we can share data in and out and there’s been good progress, but so a lot of work to do in the last few years around a more modern standard called the Fire APIs. So HL seven was this previous standard that was pretty outdated. It wasn’t in line with any kind of modern tech stack you would build Fire is getting much closer. And so I think as we see more and more verticalization and specialization among services, we’re going to see more of fragmentation, the EMR and need and embrace you just better data sharing within and among EMRs.
[00:31:15] Sean Li: Yeah, that’s actually a really interesting challenge. I remember, this is back in May, I think when this article came out about that Swedish mental healthcare company tech company that had the data leak where everything, you know, that was told to their therapist was leaked and it was pretty crazy, but that’s actually very interesting, yeah, there are some interesting challenges there for sure. In terms of just your flexibility of sharing the information aside from the legal applications.
[00:31:41] Brad Kittredge: That’s right. Yeah. A lot of it has standardized structures. A lot of it people do in different ways. And so mapping those and having good standards where people can move data around and make sense of it. It’s been a problem in the broader healthcare system that has been trying to solve for probably 30 years now. I think now, though, if we’re, if a lot of people are coalescing around more modern sort of API standards, that it’s going to open the opportunity for new solutions, that might actually be better than some of the ways tried in the past.
[00:32:08] Chris Kim: Brad. I had a thought and I think it’s maybe because I’m a little bit of an outsider. With the amount of money that we spend, especially in the states around healthcare, you can imagine that just over time, quality would get better and better, but what you’ve said and the way that you’ve positioned Brightside, it seems unique. You know, I wonder if you had thoughts about that. How can we be spending so much money, but not getting, or even focusing on the outcomes to get better and better outcomes over time?
[00:32:31] Brad Kittredge: Yeah, Chris, it’s a great question. It is the question in healthcare that you’re asking the data’s really sad. If you look at healthcare spending per capita among OECD countries, the US is by far the highest and among every objective measure of health, we are by far the lowest. So we’re getting the least for our healthcare expenditures and get anything it’s a complex answer, but there is one simplification of that answer. And it’s the fee-for-service nature of the way we built for and pay for healthcare. It’s created an incentive for care delivery where every provider is just incented to provide more care because every time they do, they can send off a bill and get paid for it. So there’s been no accountability for outcomes at the provider level. It’s not to say providers are bad, the providers are great, and they do a lot of great work, but people respond to incentives.
We all know that. And financial incentives drive a lot of decision-making, whether that’s conscious or subconscious and the healthcare system at large has been optimized around that forever. And so cost inflation in healthcare is out past broader market inflation, you know, pretty much every year for the last like 40 years, it’s outrageous. And we’ve all talked about it for a long time and we haven’t been able to do a lot about it. The answer that I think we’ve known for quite a long time too but had a hard time moving towards is broadly termed value-based care. And what it is, is trying to take some of that accountability for care, quality, and create financial incentives for the providers to be able to do it. Payers have been trying to get closer and closer to that. And there are certain models for it, like accountable care organizations, which sort of get a single monthly fee per person or bundled payments where a payer might pay a hospital, a single fee say for birth rather than like all the line items of what you might bill for as part of that.
But there’s a long way to go. I think those are pretty light accountability mechanisms and missing a lot of the things that we want. What’s really cool about this way of innovation and telemedicine of having technology as sort of the foundation or backbone of care delivery is that you get a bunch of data and that you get a bunch of efficiencies. And if you can use that platform to deliver great care and have measurable quality, those are the key ingredients in value-based care. And so I think as we get a little bit further down this path of digesting telemedicine and some of these technology-driven solutions, it opens up the opportunity to change the billing paradigm and to provide more incentive around outcomes. And honestly, that’s really what we’re angled toward as a company that we think we can unlock value-based care for mental health care because we’re willing to stand behind our outcomes in a way that we’ve never seen another mental health provider do. And so we’re getting a lot of support for that and positive feedback from the health insurers. Now, health insurers are kind of like governments. They take a lot of time to change. And so this isn’t just something that’s going to happen overnight, but I would definitely watch this trend over the next five years as well. Because I think we’re going to see some major moves.
[00:35:16] Sean Li: Well, I’m sold on Brightside. I’m signing up right after this interview. And to that effect as a CEO, I feel like I need a lot of anxiety and depression help from time to time. But I do have to ask, do you use your own service?
[00:35:27] Brad Kittredge: I’ll tell you, Sean. I have learned so much about mental health and mental healthcare in creating Brightside and collaborating with our physicians and developing and therapists and developing these protocols. And one thing I’ve done is kind of retrospectively diagnosed myself of a lot of the things I felt over the years where I always thought of myself as like a really motivated person and you know, a little bit type-A perhaps and always wanting to get everything done and work hard in school and excel in athletics and all this. And in retrospect, I think one of my big day-to-day motivators was anxiety. And I think a lot of high-performing people are actually this way is my hypothesis that we feel anxiety and we turn it into action because it actually reduces our anxiety. And it’s a mostly positive outlet for our anxiety, but it’s still anxiety.
And the truth is that in many cases, for many of us that can feel like a hamster wheel though, where you’re turning it into action, but you’re never reaching your goal because the anxiety is still there. And so that’s something that I’ve realized about myself and I’ve really tried to practice a lot of the techniques that we’ve talked about and a lot of self-care around recognizing and breaking those cycles. And so I’m not getting care today. I have gotten care in the past and I’d encourage everybody to do whatever kind of care is right for them. And that’s ranging from little bits of self-care really focusing on sleep and diet and exercise, carving time out for real connections with people, where you can truly be yourself and be seen and be heard. Mindfulness, I think is of course a great thing, but also if you need more help, there’s help is more easily available than ever, and good help is available that can really make a difference.
And it’s really about teaching you and arming you with the tools to navigate a lot of this uncertainty that’s in our world today. And that really seems to be growing. If we look at the effect of the pandemic here in California, if we look at how things are kind of feeling with growing wildfires every year and climate change more broadly, everywhere that we are, there’s a lot of uncertainty in life, and that uncertainty breeds anxiety. And there’s a lot of tragedy in life too, and a lot of setbacks and challenges and that can certainly trigger those cycles of depression. And so I think at one point or another, we’re all gonna need these things. And certainly someone we love needs them now or is going to need them. And so my goal is to make sure that we can talk about them more and that they’re easy to access, but most importantly when people do access them that they’re actually getting measurably effective care and not just care.
[00:37:35] Sean Li: Thank you for taking a lot of notes from this interview. I’ll be reviewing it again.
[00:37:58] Brad Kittredge: You seem like you’re doing great. You, and obviously that’s one of the things that we learned about depression, anxiety is that a lot of people that are really struggling or really good at putting on a mask when they go to work or when they engage socially and hiding these things. And we all, or almost all of us have a hard time like being vulnerable or knowing the right times to show the cracks in our armor or the challenges and the ways that we’re feeling. And so creating a space and creating a dialogue or creating relationships that allow you to do that, I think is a really valuable part of it all. And just realizing that we all have this at one time or another, I think makes it more normalized, more approachable. So yeah, if you want a little bit of help, first of all, you can reach out to me directly, I’ll chat with you, but also, yeah. We welcome anyone to visit Brightside and if Brightside is not right for you, I’ll help you find a resource.
[00:38:25] Chris Kim: Brad, anything on the horizon or in the near future that gets you excited either about just life or Brightside specifically? It sounds like you guys and the company are just doing so much awesome work. I don’t know if there’s anything else that you can do on top of all the things you’re already doing.
[00:39:06] Brad Kittredge: I just had my third baby. We had a son, so that’s what gets me really excited. And you know, it’s those moments when, you know, you’re caught up in work and you’re caught up in the goals you’re trying to achieve and you get to pause for a second. And remember, what’s really important. I’m really fortunate and excited to have that going on in my life. And yet to be working on a company in a space, that’s getting a lot of excitement and attention, but most importantly, that can have such a big impact on people. So I’m just excited to go scale that, as I mentioned, I’m excited about where healthcare is going and some of the major shifts that are underfoot and the way that we’re trying to help accelerate those. But most importantly, when you and I talk in a year or two years or five years, the way I’m going to measure our success as a company and mine as a contributor is how many people we’ve touched how many lives we’ve impacted. And just like, when I started thinking about whether or not to start Brightside, that’s what gets me excited.
[00:39:59] Sean Li: That’s awesome. Do you want to close?
[00:40:00] Chris Kim: How should I close?
[00:40:01] Sean Li: Do you have any other questions? Oh, man. I feel like Brad answered more questions than I could have ever thought of. Yes. You’re reading my mind.
[00:40:08] Brad Kittredge: You guys turn me on when you get a healthcare nerd like me, sometimes it just keeps going and going.
[00:40:17] Sean Li: No, this is perfect. Cool.
[00:40:18] Brad Kittredge: Hey, thanks for doing this podcast. You both, I think it’s a really cool thing and great to continue to foster community among Haas alums and Berkeley alums more broadly. So appreciate it. And if there’s ever anything I can do to help, just let me know. Go Bears!