Last week, I sat down with tech-savvy Dr. Carrie Singer, owner of Quince Orchard Psychotherapy based in Rockville, MD.  Together we discussed what it's been like to be a mental health provider during the pandemic, what the typical patient journey toward finding the right care is today, how she built a successful therapist network, and where she sees the digital behavioral health industry going. You can watch our conversation on our YouTube channel, or you can read the transcribed conversation below:‍

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Solome Tibebu (0:02): Hello everyone! Welcome back to Going Digital: Behavioral Health Tech. So excited to have our next guest here, Dr. Carrie Singer from Quince Orchard Psychotherapy. She has developed a successful practice from the ground up. And I'm super excited to talk with her today. So Dr. Singer, how about you introduce yourself real quick.

Dr. Carrie Singer (0:23): Hi, Solome. Thank you so much for having me. Hi, everyone. Like she said, I'm Dr. Carrie Singer. I own a group private practice in the Washington DC suburbs. In the last five years, we've gone from just me to 40 therapists and we still have 1400 clients on a waitlist, unfortunately. So I've just really gotten interested in the demand for mental health services and the tools and technologies that are coming out to meet that demand. I've gotten really interested in coaching and consulting in the space. So I'm glad to be here and try to lend a little bit of a clinical lens to the conversation.

Solome Tibebu (0:52): Fabulous. So how about to get started, can you tell our audience a little bit about what it's been like to be a mental health provider during the pandemic?

Dr. Carrie Singer (1:01): Sure, I don't want to speak on behalf of all mental health providers. But I think collectively we can say it's been a little rough. Because being a therapist is hard anyways, and you're carrying a lot of people's pain and suffering. There's some days where you sit and listen to people cry, or have suicidal thoughts for the majority of your day. It's hard to keep positive sometimes, especially during the pandemic, when we're all having our own collective traumas and issues, and grief and loss issues. It's just been compounded. Plus, not to mention, there's been so much more of a demand for services. Having to turn people away has been really hard. The people that are receiving the referrals tend to have more acute symptoms. So it's been a lot more time consuming to manage.

Solome Tibebu (1:40): Mm hmm. Definitely. In fact, let me ask you a little bit more from the patient perspective, what have you found the typical patient journey toward finding the right care?

Dr. Carrie Singer (1:53): Sure, I mean, the feedback that we hear is that there is a supply and demand imbalance. And that patients think it's going to be like finding a new primary care doctor. "I'll just look in my insurance directory, there'll be a lot of options. And I'll just call down the list until I find someone." And it's not really like that with finding a therapist. A lot of times the insurance directories might have incomplete information or be out of date, or they might look through therapists directories, but there's so many choices. They don't exactly know what type of treatment they need. And they start making the phone calls and emails just to realize that people don't have any openings, can't see them after school or on the weekends, don't treat the specialty condition they need help with, most significantly don't take their insurance, so the cost of care is going to be a lot more than they can afford. And so a lot of times people will just give up and not get the help they need until maybe they have a panic attack or crisis situation that leads them to the emergency room, which ends up being a real drag for the healthcare system. It's a lot more expensive than preventative care.

Solome Tibebu (2:48): Right. And yeah, clearly a lot of opportunity to evolve and augment access to care with different solutions. But I'll ask you about that next. So going back to your practice, as I mentioned earlier, you built this practice from the ground up. So many digital health companies right now are attempting to build large therapists networks. What have you found to be the secret sauce in terms of attracting and retaining talent?

Dr. Carrie Singer (3:20): Well, it's no secret, treat other people the way you want to be treated. It's nice if you can offer things like making people an employee and giving them benefits, like health care, or 401k, or especially paid time off. But above that, I think that therapists, almost as much as pay, value flexibility. They really like the ability to control somewhat: the patients they see, the hours they work, how many they see in a day. So for our therapists, that's been really critical. But I think sometimes these digital health companies too, they're sometimes led by non-clinical leadership. They don't have a long track record. People they're hiring don't know each other, don't know the management team, don't know what the company stands for. I think for us, having a personal connection with each employee has really helped us retain them and feel like part of a team and a culture where they can learn and grow professionally and personally.

Solome Tibebu (4:07): That's awesome. So bigger question, where do you see the industry heading?

Dr. Carrie Singer (4:14): Well, I think there's a lot of pockets of opportunity. But more specific to the type of work I do, we've seen a lot of consolidation of care through mergers and acquisitions, or through some big players coming into the space. And it's a little bit worrisome sometimes. You don't want there to be mental health monopolies. I think there's pros and cons. But I guess, if we want CVS and Walmart and Google and Amazon controlling our mental health care, I get a little bit worried about how that medical information is stored and used. But I think because of the access problem, if there's bigger people who can come in that have the funds to make it a streamlined process for patients to find the right care and aggregate providers to provide the care, I certainly don't have any problem with that. I think sometimes it's just the delivery of that that can be an issue. But I do I think there's also opportunities because there are so few clinicians to sometimes explore the use of non-clinicians to fulfill that need, so trained behavioral health coaches, and what does that certification process even look like? Or maybe blended care models where you're starting out, maybe offering patients some self help tools, mood tracking devices, and then maybe you're giving them some other supports, like digital CBT tools. And then you're blending that with therapy and psychiatry services that you're meeting patients where they're at and the continuum of care.

Solome Tibebu (5:29): Right. Yeah, I mean, talk about quickly changing times. I think in the last week, there was like three different mergers and acquisitions in the space and how many fundings just in the last couple of days. And so that is, of course, leading to new challenges as the industry evolves. So you started to touch on digital tools. Tell me a little bit about what are some of the ideas or tools in digital health that you're really excited about?

Dr. Carrie Singer (5:57): Sure. I mean, I really believe when it comes to like the Triple Aim philosophy of any tools that can make care affordable, accessible, and high quality are going to win. And usually you get two out of the three, but not all of them. So if there's anything that can make the care... Like us, we have care that it as affordable, we accept insurance. And I believe it's high quality, but it's not very accessible. We have a long waitlist. We see our patients for longer lengths of time. So if some of these bigger players started to get on health insurance panels and have in-network contracts, I'd be really excited about that. Because still, most of the time, they're going to be charging patients anywhere from $100 or more per month just for text-based chat therapy, whereas they could see somebody using their copay and pay nothing. So I'm also interested in like FinTech and AI solutions for making the treatment costs more apparent to the not only the patient, but also the provider at the time of care. So people go in with a better informed sense of what they're signing up for and what they can afford, so they don't drop out early. I'm also really interested in tools like remote patient monitoring tools or wearables that blend mental health and physical health data, because I believe we are moving toward a value-based behavioral healthcare paradigm in the near future. And if we can show, which research has proven, that if you treat your mental health, your physical health symptoms will improve. I think that could be some really exciting data.

Solome Tibebu (7:13): Right. I love so much that you address something interesting that helping consumers understand what it is they're actually signing up for. And now that there's just a plethora of everything from totally asynchronous text or self guided versus all the way to face to face and what kind of credential provider you're working with. I mean, I'm very excited about that aspect of continuing to teach consumers in general, what is it that they're actually getting into? So I'm glad you mentioned that. But as always, I wish we had more time to chat. Thank you so much, Dr. Singer for joining me today and your insights.