Fixing the Access Crisis In Mental Health w/ Mark Frank, Co-Founder & CEO, SonderMind

More than 160 million Americans live in federally designated mental health provider shortage areas. Even those with insurance often spend months searching for a therapist who takes their plan and has availability.

Mark Frank, Co-Founder and CEO of SonderMind, joins host John Driscoll to discuss why fixing the provider infrastructure had to come before solving patient access, and how a fully integrated platform combining measurement-based care with AI-powered tools between sessions is producing outcomes up to 275% better than traditional therapy alone.

🎙️⚕️ABOUT MARK FRANK
As the CEO and co-founder of SonderMind, I lead a fast-growing and compassionate team whose mission is to redesign behavioral health to increase access, expand utilization and improve clinical outcomes. Our focus is to democratize behavioral healthcare for both patients and practitioners, by making it easy to access therapists with the right expertise, making it convenient by offering online or in person treatment, and making it affordable by matching patients with highly qualified providers that deliver the most effective care. I believe in leading with transparency, empathy, and courage, and my passion is to build an organization that has a positive and transformative effect on the field of behavioral health and ultimately the entire healthcare ecosystem.

Prior to founding SonderMind in 2015, I helped found three other successful ventures, including Next Oncology, TermScout and SafeImageMD. Prior to my career as an entrepreneur, I worked in healthcare investment banking at Morgan Stanley, as well as time with Lehman Brothers and CDI Global. Prior to my business career, I served as an officer in the US Army. During and after that time in the military, I saw friends and colleagues return from deployments and struggle to access appropriate mental health care. This experience shaped and strengthened my commitment to enhancing access to therapy to improve and enrich people’s lives.

I have a Bachelor's Degree in Computer Science from the United States Military Academy at West Point, a Masters in Computer Information Systems from the University of Phoenix, a Masters of Engineering Management from Northwestern University, and an MBA in Finance and Operations from the Kellogg School of Management at Northwestern University.

🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy. 

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Transcript

John: 0:07

Welcome to Care Talk, America's home for incisive debate on healthcare, business, and politics. I'm John Driscoll, the chairman of UConn Health System, and today we have Mark Frank, the founder and CEO of Sondermind, a behavioral health solution for what ails us. We've got a-- We're gonna be talking about technology, behavioral health, the founding story of Sondermind, and a little bit about how we solve the massive mismatch between what people need and have access to in terms of behavioral health and the solutions, uh, that are available and how Sondermind can help, uh, solve that mismatch. Welcome to the show, Mark.

Mark: 0:49

Thanks, John. It's really great to have, be on with you.

John: 0:53

So tell, tell me a little bit about, you know, you have a, a, a, a, an unexpected background for someone who in the behavioral health. Um, you went to West Point, you served in the military. I think as I recall, you, you maybe even hit Wall Street along the way. Um- Yep. What, what, what-- How, how did that path lead you to this, this, this, this, this endpoint

Mark: 1:17

It's even more winding than that, but everything in retrospect looks like a straight line, right? Um, and so yeah, but, you know, West Point, Army, business school, investment banking, focusing on healthcare. Uh, I was married at the time to a nurse, became a nurse practitioner, and so I was really interested in healthcare through the provider lens. But also it's a, you know, as we, as we all know, it's a, it's an incredibly ripe opportunity for disruption and for improvement. And after my time in investment banking, I, I left and moved back to Colorado, which is where I live now, and started an oncology company, specifically radiation oncology, so a radiosurgery company treating patients with brain tumor, prostate cancer, uh, lung cancer, et cetera. Built an MSO around that, ultimately sold that. But that was direct patient care, right? And so, you know, re- really engaging directly with patients, employing providers, et cetera. Uh, at the same time, about a year later, I started a business that was, uh, really about how can I take medical images that were coming from referral sources as well as those imaging centers that we were engaging with and enable easier transfer and collaboration between providers, so between the neurosurgeon, the radiation oncologist, and the med- medical oncologist. But

John: 2:36

sl- slow down, Mark. How do you get from kinda Wall Street to being an entrepreneur? I mean, you know, most people are just-

Mark: 2:41

I, um,

John: 2:42

so- ... abandon that path and, and, and stay kind of, you know, run- Yeah ... losing their desk for the rest of their lives in Manhattan.

Mark: 2:49

I mean, um, a- again, I think in retrospect it's how it always sort of makes sense. I, I didn't think it at the time, but if I really go back, when I was a little kid, I wanted to be-- When, you know, when I was four, my parents went, "What, what do you wanna be?" And I said, "I wanna be an inventor." And, um, and then over time, I was always sort of trying different things and doing little businesses or doing different jobs. And even, you know, in high school and college, I engaged in a lot of different activities that were seemingly not, you know, like they, they weren't really connected to each other. Um, I think what I, what I realized, uh, I probably have professional ADD, you know, where it's like, um, I, I, I just, I like to focus on a lot of different things. So these companies were always overlapped. But what I've, what, what I've really been drawn to is, is inefficiency and, um, and where can I make, you know, an improvement in, in making things more efficient and more effective. And, and then I think I, I, I don't-- I hate to say this 'cause I usually don't believe that it's It's just in my nature, so it's even-- it's not like a conscious decision, but I've always just been drawn to things that matter and trying to improve people's lives. So like my time in investment banking was, uh, incredibly rewarding, and I learned a lot. But I realized, hey, I don't wanna effectively sell a complete commodity, um, service for the next fifteen to twenty years. And, and, you know, I was at Morgan Stanley, which is an amazing firm, and Goldman Sachs is an amazing firm. JPMorgan's an amazing firm and all. You know, these are all amazing firms. Lazard's an amazing firm. And at the end of the day, you know, they're, they're all offering the same service, and it's about the people relationship, which isn't something I, I think is bad. I just was like, I wanna build things. And I went to West Point because I wanted to lead people, and I wanted to, to, to, you know, really, really have the opportunity to affect people's lives who I was engaging with from a management and from a leadership standpoint. So that was the, that was sort of the transition into starting these, these companies. And Sondermind was really... Go ahead.

John: 4:54

Well, just MSO's. What is, what is an MSO?

Mark: 4:58

Management service organization is really a construct for sort of a, you know, I'd say almost a managing principle or managing opportunity to, to combi- combine providers into a more, uh, more of a sort of streamlined setting where they don't need to be focusing so much on deliver- on, on sort of running the business. So, you know, if you, if you think about it in oncology, uh, for example, the, the first MSO that I created, again, started with a radiation therapy center. So I was, you know, the owner of the technical facility, and then had a, a, a collaborating set of physicians. And then the MSO created on, on top of that was one where I could say,"Hey, physicians, you don't need to worry about any of the business stuff. Um, we, the MSO, will handle that. I, I will handle that for you." Um, and that's on the how do you get patients in? How do you deal with billing and collections? How do you deal with hiring and firing, et cetera?

John: 5:55

You're basically trying to, you know, esta- you know, you'll focus on the business, they focus on the care.

Mark: 6:01

That's right. Yeah.

John: 6:02

Got it. So, so why... How did you go from- Why not?... what sounds like is a, a pretty good business to, to starting a harder startup in, in behavioral health where there's not enough caregivers and, and, and e-everything's a little bit more complicated.

Mark: 6:19

Yeah. It, it, it's, it's... On surface, it seems really simple, right? You, you know, what, what is mental health? And, and certainly in the-- when I founded the company, you know, about 10 years ago, it, you know, it's, it was all in person. And it's like, oh, you get two people in a room and they talk and, and that's, that's it, right? There's not a lot of coordination. There's not a lot of, "Oh, I gotta send somebody here to get this scan," or, "I gotta prescribe this thing," or, "We gotta do this diagnosis," or,"I gotta collaborate with 16 different physicians to understand what's going on." You know, on-oncology is, is complex in that regard. Behavioral health is simple in that regard. However, behavioral health is complex, and I think what drew me to it in the regard that we know really nothing about what goes on up here in the brain And the, that's the opportunity, right? And so the, the draw for me was my own journey of trying to find a therapist. I had three kids in three and a half years. I was running two businesses that I had started. That's, uh, you know, that, that, that's, that's a pill- you know, gets the field set for a really, uh, a really stressful home life. And wanted to find a therapist, and I knew that Parity Act had been passed. It's a covered benefit. I know how insurance works. I know how to, you know, I'm the, I'm the, I'm the employer and the employee, so I'm sort of paying premiums out of both pockets, if you will. And that was nearly impossible, right? Finding a therapist, who's a good match? Do they, do they take my insurance? What's the schedule availability? Et cetera, et cetera. And then even when I got into care, the care was good. The clinical care was good. But the consumer experience was horrible. I mean, that's sort of like you go to this little dingy basement office and there's no windows and, you know, you gotta like write a check for the co-pay even if they take your insurance and all that. So that was sort of like one problem. I said, "Well, this has gotta be solved, and maybe there's companies that have done this." And I was like,"Look, there weren't." The other side is my younger sister is a therapist. She's a licensed professional counselor. Uh, I have a cousin who I'm pretty close with, uh, a year older than me, who's a clinical psychologist. Her husband's a psychiatrist. So these family members who are operating in mental health as providers

John: 8:27

and-

Mark: 8:27

Honestly, it doesn't

John: 8:28

s- I don't understand why it was so hard for you to find a therapist. You should have

Mark: 8:31

talked to your family. Like all the favorite cities and states, but I was in Colorado and then we were in Atlanta and, and, you know, California and, you know, and Florida and stuff. But, you know, but when my sister was going from an employee setting into private practice She was, she was struggling and I helped her and her husband helped her with some, he was a, a marketing person and, and, you know, she struggled with, you know, three things. H- how do I find office and sort of deal with that, the office space piece itself. Um, two, how do I get clients? How do I get patients in the door? And, you know, I thought I could hang my shingle. I've been doing this for a while. I thought it'd be easy. Everybody needs it. Um, but that's been really hard. And then three, all the administrative, running the business, all that sort of stuff that I was saying, you know, an MSO does anyway. And I talked to her and I talked to my cousin and I, you know, I talked to 30 other of their colleagues that were in private practice that were in different settings, and I kept hearing those same three things in different order for different people. And I thought, "Well, wow, there, there must be MSOs that are doing this," because basically every vertical in healthcare has been, um, corporatized, right? And 10 years ago, this had not happened in behavioral health. And I said, "Well, wow, that's really strange." So those were the two things I said, "Well, there's an opportunity to solve this," and it's such a huge need. I saw this wave of activity. I mean, when, when the cancer patients we were dealing with, it was not just the patients who had mental health struggles, it was, you know, their families. It was, it was, you know, cancer affects the entire, you know, the, the entire family unit and, and really even the broader community of that person's life. And so y- I saw that firsthand. At my time in the military, I saw a lot of my friends and colleagues struggle with PTSD, things like that. They had problems accessing. So I saw this wave coming that, you know, in, in 2014, 2015, 2016, maybe it was not as apparent to other people, but I was like, "This is a tsunami. It's gonna hit us with, with full force." And then the last thing, which has really informed how we structured and, and how I built the company, was as I started to dig in, what s- what really started to bug me was that we, we didn't have any object-- like, any objectivity around, certainly around quality measurement. Um, but even if you dig a, if you peel that onion a little bit further, there's not any objectivity in terms of diagnosis, right? Think about how we, how we diagnose.

John: 10:47

Is that the, is the nature of behavioral health that it's just impossible to set up those registers for, for quality and fit?

Mark: 10:56

Uh, no, I think the, I, I think it's part of the nature, yes, but I don't think it's because of not having sort of the, the, the, the broad enough scale for access. I think it's because how much do we actually know about the brain? How much do we actually know about what influences our emotional state at any given point in time, right? Depending on what you ate this morning, depending on what the weather is today, depending on what that last email you got was, depending on how many times you've checked the email, depending on what you were... I mean, there's so many environmental factors. I mean environmental from the standpoint of everything that's hitting our body. Oh, by the way, what's inside, right? But, you know, got, got, got biome sort of connection. Like, there's so, there's so much, like I was into it. And the, the- But

John: 11:41

Mark, that sorta, that sorta g- when you add all that list up, I, it, it's like that scene in The Beautiful Mind when things just start g- going out of control.

Mark: 11:49

It, it, it really was this, I had a sort of crazy belief that in the future there would be a, a world where if we had an immense amount of data, we as society, and, and, and Sondermind is a catalyst toward that, would be able to better understand, u- understand the human mind and the, and the, and the human emotional condition. And that it would only come with an immense amount of data, and it would only come with an immense amount of computing power, machine learning, et cetera.

John: 12:20

So when you're starting Sondermind, you've got this hypothesis, you've got this big complex problem that spiders out into a m- number of different inconsistent directions.

Mark: 12:30

Yes.

John: 12:31

Why'd you think you could pull it off?

Mark: 12:34

Um, naivety? I don't know. I, I, I- That's

John: 12:38

okay. That's a good answer ... you know,

Mark: 12:40

I think, um, no, I think, um, it's that plus a little bit of-- I always, uh, when as, as an entrepreneur, I've always taken sort of like one foot in front of the other kind of approach, right? So our mission back then was, was to redesign behavioral health through improved access, utilization, and outcomes, and I thought about it in that order. So first was access. Okay, if you're gonna get-- the, the end goal is how do we improve outcomes? How do we actually, like I said, how do we take all these data points? How do we really get the system of care in a place where it's meaningfully better? Because we have-- we can really get objective information around how our, our mind is, and therefore, can sort of walk backwards from there to what works well and then change diagnosis and things like that. We're not there yet, but we're, we're marching toward that as, as a society, as an industry. But the first thing, before you get to all that, is, "Hey, Mark's gotta find that therapist more easily than calling 30 therapists for four months and waiting another two months to get into care," right? Like, you gotta start with that.

John: 13:48

Your first step in access, as I intuit it, is a nav tool that allows you to do better matching. Is that where you started?

Mark: 13:56

First step was we actually collat-- we, we consolidated providers. So we actually said, "Okay, you go backwards from that first step to the patient journey. Well, how do you solve the patient journey? You first gotta solve the provider problem." So we said, "You know what? We're gonna make this really-- I'm gonna make this easier for my sister, and I'm gonna build a s- a s- an MSO model that's technology first, that gives her a full EHR practice management solution, credentialing, everything under one group ID, so that she doesn't have to worry about any of that." Oh, by the way, it's a really good

John: 14:29

idea- You start, you started by making it easier for the actual practitioner.

Mark: 14:34

That's right. Wow. And that's always been our focus, is the, is the practitioners, our number one stakeholder. The, the provider, the therapist, the psychologist, the psychiatrist is our number one stakeholder. So we built all that, and we said,"Okay, now we can make it easy for you." And once you have that, then you go, "Okay, we can make it-- we can re-reduce isolation for these providers. We can, we can build a community for them. We can enable, uh, them to not, you know, to have a spigot that they turn on or off for client..." Client means patient, just in, in mental health it's usually intertwined. Um, so between client and patient volume And they don't have to write payments, all that sort of stuff, right? And by doing that, and then you have, okay, you have-- now you have ten, you have a hundred, you have a thousand providers, you, you work with the insurance plans, right? You say, "Hey, we, you know, now we can, we can actually put in place measurement-based tools." I mean, we had measurement-based care in place in twenty eighteen in this space because we had built our own EHR around it. And so then you say, now we're making it easier for the provider, or sorry, for the provider to get this patient, but also for the patient to get in. And then you have all the data on the providers as well, who they treat. Not just what do they say on their profile, what, what boxes do they check, which is important, but maybe more important, again, I'm, I'm, I'm an objective data person, less subjective data. Subjective data is tell me what you're good at. Objective is I can see what you're good at. How can I see what you're good at? Well, I can see the demographics you treat. I can see whether they are improving or not improving on a, a better or, or, or worse rate versus other demographics, versus other diagnoses. I can also see objective measures like how quickly do you respond. And now we have all these other tools built in and all this other technology treatment planning AI-

John: 16:15

Well, it sounds like Wisunder's built an enablement layer for the practitioner. Do you sell to the practitioner?

Mark: 16:22

They're-- There's-- They're, they're, they're providers under our group practice. So we're, we're effectively the provider group in, in an MSO structure. So

John: 16:30

they, they effectively join you.

Mark: 16:33

That's right.

John: 16:34

And, and then, okay, how do, how does-- then, then how do you get included in health plans networks, and how do patients get to Sundermind?

Mark: 16:44

So now we're, we're commercially-- we're basically operating in all 50 states right now. We are contracted with all the major plans in all those states. So Blues, United, Cigna, Aetna, Medicare, Medicare Advantage, the, the VA, TRICARE, you name it. So we are, we're one of the largest, but- You've,

John: 17:04

you've solved the network connection problem.

Mark: 17:07

Solved that

John: 17:07

connection problem. And, and, and I think, and I think what, what people may not realize is that, you know, while a lot-- there's been enormous consolidation in many practices, in many areas of medicine, the area of behavior health in general, there's a lot of onesies and twosies out there. And so this is a substantial- Mostly private practice. Yeah. No, it's- That's right ... it's substantially different. It's very different. And

Mark: 17:27

so

John: 17:27

to-- when you, you get those, you, you aggregate those providers, you're developing, you're basically the business layer for folks who are-- got into business to care for people, not to run their own independent businesses. That's right. How do you then enhance access and make sure people are actually getting the care they need to the point where they're, they're, they're healthy again, Mark?

Mark: 17:50

Yeah, so this is where, again, having the data is so important, right? And having, having a c-- the c- fully integrated, consolidated system of care. So what we have now, and we've been building this obviously over the years, is if you think about on the provider side, as I mentioned, it's the entire tool set, if you will, for, for the therapist, for the provider, for the psychiatrist, um, inclusive of really deep treatment planning tools. Um, obviously we have all the, all the AI bells and whistles that you can imagine. So AI clinical notes, uh, built-in auditing, you know, c- medical record auditing, things like that. All, all that's built in so we can make recommendations and understand what's working. But the, the key difference between us and a lot of these other larger groups or even aggregators, as, as you call them, uh, is that we've built all this other tooling on the client or the consumer on the patient side. Because when you really think about, okay, how does mental health work? Like, how, how do you get to outcome? Like, what, what is this, what's this magic of therapy we're talking about, right? It's, you know, you and I are having a conversation now. So if we have this conversation, am I gonna all of a sudden, you know, have some epiphany and then I'm gonna feel better about something? Well,

John: 19:12

maybe.

Mark: 19:13

Maybe that happens, right?

John: 19:15

Unlikely. Highly unlikely, but

Mark: 19:17

possible. Yeah. And, you know, and so you go... And, and the same is true, like, okay, why can't a therapist just do her magic in, in that one session, right? Like, why, why does it need to take 10 sessions or 12 sessions or whatever? Well, because there's work. It'd be like saying, "Well, why can't the physical therapist just improve that rotator cuff injury in one, in one thir- in one session?" Because you know what actually happens in the physical therapy app- you know, appointment? In a physical therapy appointment, the, the physical therapist says, "Here's the stuff to do," and you work on it. But then they say, "All right, John, now you're gonna go home," right?"The hour's up, and here's this piece of paper, and here's maybe a couple rubber bands. And I know you're traveling this week and probably the next week as well. So when you're in your hotel room, you gotta do this rubber band thing three times a day, and you gotta do that other thing twice a day. And if you do that five times a day for the next two weeks, I'll see you again in two weeks, and then we'll see where you're at." Right? Which means you gotta do the homework. You gotta do the work, right? Not the physical therapist does the work. You have to do the work. And then you do that over 10 weeks, 12 weeks, 16 weeks, whatever, and all of a sudden you are better, right? Your, your, your injury is improved. Now, the interesting thing is, if you didn't do all that, generally speaking, up to a certain age, our bodies, the human body is a, is a miraculous thing, right? It will actually heal itself in most cases, right? Like, generally it does, you know?

John: 20:42

But, so how do you pull that through for behavioral?

Mark: 20:45

So behavioral's the same thing, right? So you go, well, why does some therapy work and some therapy not? Oftentimes it's because h- what is that connection between the... So people talk about this therapeutic alliance between the provider, the therapist, and the, and the, the client or the patient Therapeutic alliance is just, it's just a means to an end, right? It's not, "Oh, well, we're aligned." It's when you're aligned, you now are able to, you as the therapist, when you've gained that therapeutic alliance, when you've gained that trust, when you get-- when you have the experience, you can actually influence that person's behavior. You can actually get them to do the things that they need to do outside of the therapy room or the video session. That's the key, right? So it's like, how can we build tools that can actually enable that out- that work outside of the therapy session to be not just, not just more effective, which is important in what we do, but to be done in the first place, right?

John: 21:47

So is the right way to think about Sondermind is, uh, sort of first you build the infrastructure to, for the providers, then you bring the data in that will allow you to actually identify what works, and then you're gonna provide tools to patients to work with the therapists to kind of create that... Honestly, a therapeutic team where the patient's part of the team

Mark: 22:13

A hundred percent. And where we are part of the team as well, because that time between that second session and the third session is actually where the work happens, right? It's not really in the session. Yeah, there's work that happens in the session, but the real work

John: 22:28

happens

Mark: 22:29

after. And, and do you--

John: 22:29

I mean, this is an area where everybody talks about need, but very few people talk about outcomes. Do you have any suggestion that, that your, your, your approach or integrated approach is actually more effective than anyone else's?

Mark: 22:43

It's incredibly more effective. And so when you look at-- when we look at the data, what we see is that for one, I mean, we did a, we did a peer-reviewed journal article about five years ago that was just looking at measurement-based care. Now, everybody knows when you use measurement-based care, the outcomes are better in any setting in healthcare, right? Meaning when, when you, when you see what's actually happening and then you feed that information back to the, to the doctor, to the provider, oh, wow, it actually helps them, you know, ma-ma-- overall make the care better for the patient. So we did a study with the University of Denver, had that published, and what we found was meaningfully higher outcomes for our providers who were using our measurement-based care tools. Fast-forward to today, where we have a fully integrated platform for the provider, but also for the patient, right? Where like, where you can download today the SondiaMind app, and you can use any one of eighty different interventions that are digitally enabled interventions. So think digital CBT, meditation, cognition improvement, memory games, things like that for, for senior-- like all kinds of, all kinds of tools. And obviously an AI coach that allows you to inter-interface, goal setting, AI journaling, all of that, right? When you use those things and when the provider is engaged in, in, in, uh, the utilization of those tools, we're seeing on upwards of two hundred and seventy, two, two hundred and twenty-five to two hundred and seventy-five percent improvement versus those, those clients and providers who don't use them. And that's a-- This is a unique set of tools that we- we've- we've- we've created. And so we-- To us, it's this continuous care journey. It's this, this opportunity to say improving behavioral health is not this episodic, you just go in and you treat it. You-- It has to be there throughout sort of the, y- your life. That doesn't mean you should be in therapy, by the way, for perpetuity. In fact, if you are, something's wrong. Maybe some

John: 24:39

of us need to be.

Mark: 24:40

Well, I would argue unless you have a serious mental illness that, you know, schizophrenia, bipolar, cer- certain things that really do need constant, uh, care and attention, we, we sh- we should... It, it probably means if you're in therapy- So it's

John: 24:58

possible if you're-- which I think what you're suggesting, Mark, is it's possible for folks with pain and challenge to actually find solutions.

Mark: 25:05

You have to. There-- It's 100% possible to find solutions. And if you look at it like, "Hey, I'm gonna deal with this episode. I'm gonna improve this, this component of, of my life or of my mental state, and I'm gonna work on that." And then you say, "Okay, let me work on that. Let me solve it." And then you move on to the next thing. Yeah, maybe you could do those in a continuous setting, mean- meaning you could just be in therapy for years and years and years. But the reality is, you're probably better off actually letting some of those new behaviors set before you try to tackle a whole set of new behaviors that you want to, to implement into your life.

John: 25:40

Maybe, maybe let's leave it there, Mark. You've, you've given us a lot of hope, I think for, for therapists and practitioners who, who don't have a platform for patients that are looking for access, and that the fact that some of these tools and platforms, and perhaps the one that Soundermind first can actually create real solutions for a lot of folks in one of the biggest unmet needs in American healthcare. Um- Absolutely. I'm John Driscoll, the chairman of the UConn Health System and the co-host of Care Talk. And I just wanna thank you, Mark, for joining us today.

Mark: 26:13

Thank you, John. It was a lot of fun.

John: 26:15

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