The following interview is a conversation we had with Brad Kittredge, CEO & Co-Founder of Brightside, on our podcast Category Visionaries. You can view the full episode here: $150 Million Raised to Build the Future of Mental Healthcare
Brett
Hey, everyone, and welcome back to Category Visionaries. Today we’re speaking with Brad Kittredge, CEO & Co-Founder of Brightside, a virtual mental health care platform that’s raised nearly 150 million in funding. Brad, welcome to the show.
Brad Kittredge
Great to be here. Thanks for having me.
Brett
No problem. Super excited. Let’s go ahead and jump right in. Talk to us about what you’re building.
Brad Kittredge
All right, well, we are building the most comprehensive and robust mental health or telepsychiatry platform in the US. We offer psychiatry therapy, substance use treatment through IOP suicide risk reduction programs to over 130 million Americans through their health insurance benefit. We partner closely with health insurance companies and health systems to solve the hardest cases with the best care to align clinical and financial outcomes.
Brett
How have you seen this topic and this conversation around mental health care evolve since founding the company? Just from, like, the consumer lens, it seems like it’s shifted a lot. It’s normal to talk about these things. It’s okay to talk about these things. Was that the case when you started the company?
Brad Kittredge
No, I started the company in 2017 with two great co-founders, Mimi Winsberg and Jeremy Barth. And at that time, it was, of course, pre pandemic. And the idea of starting a mental health company was not very popular. The idea of being able to do psychiatry remotely was foreign to everybody that we pitched it to, and there was still a lot of worry about stigma in mental health. And so I think what’s exciting is seeing how fast those things have changed. Certainly the pandemic was fortunate for our business, although unfortunate for so many people, and in some ways fortunate for the broader cultural dialogue around mental health.
Brad Kittredge
I think certainly in younger populations, we see more and more people normalizing more conversation around mental health and being open with themselves and with each other about it, which is great to reduce barriers to getting mental health care generally. The heuristics that you would see in our space are that fewer than half of people with a mental health condition are actually getting care. And there are structural barriers to that and payment barriers, but also some of those are cultural and stigma barriers. And so seeing those come down so quickly has been really phenomenal, and in many ways, that piggybacks another trend that we saw over the past ten to 15 years, which is sort of consumerization in healthcare. And adding consumerism really has meant putting the patient at the center of the equation in healthcare. Surprisingly, it wasn’t very long ago.
Brad Kittredge
You only have to go look back as far as probably 2010, when you could still think of healthcare as very paternalistic and the patient as peripheral to a lot of healthcare considerations. That trend coinciding with this idea, this sort of trend of more focus on awareness, of an appreciation for mental health, have been coming together to make a great opportunity for our business.
Brett
As you started to have this idea back in 2017, did anyone not believe in this as a market? Or was it obvious at that time that eventually it was going to be a market? It was just a matter of when.
Brad Kittredge
Believe it or not, a lot of people didn’t believe in it as a market. This is a huge market. When we’re talking about direct spend expenditure on mental health services, we’re talking about over $100 billion a year and growing, and probably pretty far north of there, depending on how you calculate it. I think a lot of people weren’t sure whether consumers and patients would be interested in remote care, because it was very new. We had a couple of companies, like Teladoc, doing some basic primary care and urgent care kind of stuff online, but it had like single digits of adoption. So, you know, maybe six or 7% of people had used telemedicine in that way. And it didn’t appear to be growing at a very fast rate.
Brad Kittredge
Of course, when the pandemic hit, it was a forcing function for people to try remote care for the first time. And what we saw was generally that people liked it. So for mental health, about 60% to 70% of claims I, during the pandemic were for remote care, and we saw probably similar levels for other conditions and other uses. Post pandemic, most conditions or uses of telemedicine have come down to much lower levels, but healthcare claim or mental health care claims have stayed really high. Probably about 60% of claims still showing that once people are exposed to this kind of care, they actually really like it and value it.
Brad Kittredge
And I think there’s a lot of reasons behind that, but one just being when you have a chronic condition and need care over time, and, you know, perhaps when things feel a little sensitive and you feel a certain amount of stigma, being able to do that from home and make it fit into your life has a lot of value. And when it’s a condition where you don’t need a physical exam or, you know, sensors put on your body or injections or things like that, it works great in that. And you can not only not sacrifice quality of care, actually in some cases get better quality. Quality of care.
Brett
I don’t know if I have this totally right, but I think I was reading about some of the regulations that got loosened up during COVID that allowed for access to just telemedicine in general, that they’ve kind of been clawing those back and bringing those back. Is that accurate? Am I remembering that correctly, or am I completely off there?
Brad Kittredge
You’re directionally right. There’s some nuance to it. And obviously, healthcare regulation is super complex. But the main thing that people tend to talk about in that space is called the Ryan Hate act. And that act was meant to protect people from the online prescribing of controlled substances. There had been abuses of that resulted in some high profile deaths, and therefore some protections against that. That generally prohibited online prescribing of controlled substances. And that means things like benzodiazepines like xanax, or stimulants like Adderall, or things that have addictive properties like, and physical dependence and street value. And so during the pandemic, that was suspended so that people could still have access to those medications when they truly need them and couldn’t, weren’t able to get them in person. And similarly, there are a lot of legitimate use cases where that added value for people.
Brad Kittredge
There are also anecdotes and some reasons to believe that there was plenty of abuse of that, too, right? Where there were not systems in place to prevent people from trying to get medications on multiple platforms or using multiple identities that didn’t get checked. And so the DEA is still in a position where they’re trying to find the right balance with rolling some of that back and trying to maintain the availability for people who really need it, but to really get ahead of the potential for abuse, that can also cause some very real damage.
Brett
I can’t remember his last name right now, but we had Michael, one of the co-founders of Teladoc, on probably like two years ago, and he was telling me this story about the early days. The DEA raided his offices and came storming in. And he said that was a pretty scary moment for him.
Brad Kittredge
I think all of us that operate in this industry should have a lot of appreciation for Teladoc and a handful of other companies who were real innovators in that when they started, the regulatory landscape was very unclear about how telemedicine would work. And when we started Brightside, one of the reasons that I had confidence in knowing that the business opportunity was there is that many of the regular, the regulations, both at the federal level and the state level, had been harmonized to create clarity in an operating environment for telemedicine applications. And that was hard work.
Brad Kittredge
When you’re going in state by state and actually trying to change policy, and in some cases sort of bring attention to rules by breaking them like he was doing there, that’s a really tough business model and a lot of risk, but they were able to make progress and harmonize things that have benefited the entire industry and notably a lot of patients.
Brett
How do you think about regulations? Do you ever worry of death by regulation, that someday some regulation could come down that just crushes the business, a fear that you have, or is there too many other things that you’re thinking about when it comes to building a high fat or a fast growing business? That you can’t even think about that.
Brad Kittredge
I mean, we have to think about those things. And I think any Founder operating in a regulated industry needs to think about those things, because those are things that. Where you have existential risk, right? Most of your risks are things that might, you know, accelerate your growth rate or diminish your growth rate. But regulatory risk can, like, put you out of business overnight if you are on the wrong side of it. And so we spend a lot of time, or I spend a lot of time thinking about that. What I believe in our sector is that the clear trend is that rules around telemedicine have been consistently liberalizing and harmonizing. And so the trend is in a positive direction. We don’t prescribe controlled substances, for example. We made a decision from a clinical and a safety standpoint.
Brad Kittredge
Even when that was very easy and straightforward online, we chose not to do it for what I think are some pretty obvious reasons. And so we’re not exposed to the regulatory risk there. And so, yeah, we. It’s important to watch it closely. If anything, the interesting opportunity is actually to try to get ahead of it and try to influence policy. And that continued liberalization, that balances the safety and efficacy of these solutions with a lot of the checks and balances and safeguards that healthcare has tried to build in from the start. And so anyone in healthcare or financial services, or perhaps education is going to see a lot of those things. And I think that’s part of the assessment of finding the right business opportunity, the right timing and the right risk tolerance to be able to thread the needle.
Brett
Going back a little bit to that founding story, what was it about this problem that made you say, yep, that’s it, I’m going to go spend the next 1020, maybe longer of my life building this product and solving this problem?
Brad Kittredge
Yeah, there were a lot of things that were really dots that connected for me and sort of a pattern of things I saw, but I was. I was working with another startup and were doing some work with a large health system that was a very, like, prominent, well respected us health system, and found that most of the mental health care that was happening there was happening from primary care doctors. And these primary care doctors were overwhelmed by the demand for mental health care, and that’s really not what they were trained for. Everyone’s been to a PCP knows generally what they’re good at. Mental health care is kind of tangential. Most get very little training and they have short appointments, and it’s not a good fit for a longitudinal condition like depression or anxiety or other mental health conditions.
Brad Kittredge
Yet at this really well resourced health system, they had a twelve week wait for the next therapy appointment. So the PCPs didn’t want to refer anyone to therapy. They literally couldn’t get anyone in with psychiatry unless it was a life or death situation. And so they were left to sort of guess and check and do their best with these patients. They felt underwater and they were confident those patients weren’t getting the best care. As I started to see that in more detail on the ground, I couldn’t stop thinking about it, because my dad has struggled with depression his whole life.
Brad Kittredge
And when he first sought care as an adulthood, from his first encounter to when he finally had some treatment work for him was about a ten year gap, because he fell through the cracks with referrals and follow ups and failed medication trials and a lot of those shortcomings. And so, as I saw these challenges, even in our best healthcare settings, and saw that weren’t using approaches that I had learned were evidence based, proven to support better outcomes, not even that hard to implement from a logical standpoint, I just couldn’t sit with it. I couldn’t say, like, we’ve accepted this status quo as good enough, when there are tens of millions of people who need great care, are getting subpar care, even at our best health systems, and we know how to do better.
Brad Kittredge
And so it just ignited a spark for me, where I said, like, we know how to do better. And I think I have an idea how I couldn’t stop thinking about it and I decided just to go for it.
Brett
After you decided to go for it, what happens next? How long until you have a platform or a product that you can sell?
Brad Kittredge
Yeah, well, I’m not a technical Founder, and so I had all these ideas that involved using technology to do this. And really one additional sort of part of that was refining my understanding of the market and my thesis on how we could do better. And that involved largely looking at the other companies that were out there. And at that point, it was sort of Teladoc and American. Well, and a couple of others that are sort of these more horizontal online platforms, and thinking about how if everyone was just talking about telemedicine as a way to improve access to care, which access has always been a big problem in mental health care. But as I was looking at it, I saw a quality problem, and I started thinking about, what is thesis here, and how is our angle different than what everyone else is doing?
Brad Kittredge
And what I realize is that in everyone talking about access, we’re sort of treating mental health care as a commodity, acting we just need more appointments, and if we have more appointments, we’ll solve this problem. But I said to myself, if we take that same crappy care that I saw at a great health system and move it online, we’re not solving the problem. What we need is to use this transition from traditional care to virtual care as an opportunity to remake them all from the ground up, to build it in a way that addresses the root causes of the quality issues and that we know can sustainably scale high quality care with proven outcomes.
Brad Kittredge
So I had to refine my thesis and get that titer and have a great story to tell if I thought I might be able to convince anybody to try to do it with me and to have any confidence that it was worth taking the risk. So I spent a good amount of time on that and tried to talk to a lot of people who are smarter than I am to get their feedback and to sort of bang on that with me until I felt like I had a good story to tell. And then I knew I needed a technical Co-Founder and a clinical Co-Founder to be able to make it work. And so I reached out to Jeremy Barth, our CTO, and he was really happy in another CTO at that role, at that point.
Brad Kittredge
And he said, I’m not really looking anything for anything right now, but sure, let’s meet up and we’ll talk about it. And so we met up. I gave him the pitch. I assumed that it was kind of just going to be a practice pitch. And he called me up the next day, and he’s like, I can’t say no. And I found that to be a trend as we built our team that just so many people are touched by this challenge and this problem and inspired to want to do something about it that we’ve been able to attract just a really phenomenal team of people who really want to change the way that care is delivered.
Brad Kittredge
And then were just so fortunate to get connected with Mimi Winsberg, who’s a Stanford trained psychiatrist with 30 years of practice experience, to really bring the rigor of, traditionally, how things have worked and the openness and understanding of how they could work better to make sure that all of our clinical model and the way we manifested these opportunities were really well grounded, and we could build a great provider network that we could publish papers to demonstrate what we’ve done and sort of build trust within the help community. So just getting the vision and getting the team together was the most critical part of it. And it was really hard at that point. You sort of doing your best to make it feel real.
Brad Kittredge
But it all came down, I think, to having clarity and a different point of view than were hearing in the market and a reason to believe that something different could work and then a good amount of inspiration that we could all agree on.
Brett
How long did it take from then until you were generating revenue?
Brad Kittredge
Yeah, good question. So we started working on defining the product, and probably Jeremy started writing code in, let’s say, September of 2017, our first revenue. We launched our alpha in January of 2018, and we had our first revenue within a week. Wow. And so, yeah, probably five months from actually sitting down to work on it to first revenue.
Brett
That’s quick. That’s fast compared to a lot of the other healthcare technology companies that I speak to. How do you make that happen?
Brad Kittredge
Maybe so. It felt agonizingly long at that point, but I think Jeremy and I paired really well together because I come from product background and he’s a great engineer. He is super pragmatic about what do we truly need as our alpha? What are we really trying to prove in this phase? And were able to define what our launch product needed to look like and focus on that and then quickly spec it out, get good enough designs, and he could build it quickly. I think it was just a collaborative exercise of the right definition and focus on really what we needed to prove first. And really, again, like I had been trying to pitch it in parallel and a lot of people said, I don’t know if consumers are going to be comfortable with that.
Brad Kittredge
I don’t think someone would choose to like see a doctor online that way. And I said, I think they will, but okay, I get it. This is what we have to prove. And again, I think within two days of maybe putting up our site with no ad spend or maybe $100 of ad spend, we got our first purchase. And so Jeremy got a text message on his phone with the stripe verification of a charge and he kept that screenshot. And the feeling that we had when that happened was like, oh man, this is real. This is going to work.
Brett
From a marketing perspective, what did that early marketing strategy look like? And then how have you seen that evolve over the years?
Brad Kittredge
Yeah, I think when I look back at what I’ve been good at and not good at, the early marketing is probably what I was not good at. And again, I wanted to really build a great product and sort of my order of operations in my head of solving that big and complicated problem that I laid out was, well, we can only do it if we have a good product and we’re not willing to put anybody at risk. And so the sort of surface area and bar, even for an MVP, is higher than most things you might do. You can’t move fast and break things.
Brad Kittredge
And so I wanted to spend sort of plenty of time on the product, but I knew we also had this pressure to demonstrate some sales so we could raise around, I should say that I had two kids under three years old at this point. And so I was really worried about my ability to earn a paycheck and like felt a lot of pressure and had agreed with my wife on a certain period of time that I was going to work on this. And if I had know couldn’t raise around then, were, I was going to go get a job. And so, you know, I did some keyword testing and I was new to Adwords and so I was doing some very basic stuff, but I saw lots of cheap clicks and sort of account creation and thought, oh, like, oh, this isn’t that hard.
Brad Kittredge
I’ve got this figured out. But, you know, getting to purchases was a lot harder. What I found and what I learned about myself in retrospect was when I had items on my to do list that were either like some product or design work or some marketing work, I naturally gravitated towards the product tasks and the marketing tasks kind of stayed on my to do list because they were harder, they were less intuitive to me. It required a learning curve, and that was just a mistake. In retrospect, I should have and wish I had, or if I could do it over again, would lean much more into forcing myself to accelerate my marketing learning curve, to get much more adept at that sooner and really understand our funnel instrumentation and our sort of Adwords process to be able to drive better results sooner there.
Brad Kittredge
So it worked out. But some of my lessons were a little bit painful there in terms of how it’s evolved from then today. Starting a healthcare company. Another reason that it’s hard is that obviously most people want to pay with their insurance for any health care that they get. When you’re starting as like a digital health startup, you have so such little credibility with any sort of traditional healthcare stakeholder, including the health insurance companies. So one of the dynamics of how the mental health care market is broken is that a lot of people, even if they have insurance, they’ll pay cash for services. So we decided that the strategy we might take is to start by accepting cash and that we can get customers that way, and that the way to build credibility was going to be with data.
Brad Kittredge
Instead of just going and telling people what we can do, let’s go show them with the data. And so the idea of sort of the stepping stones of how were going to evolve our sort of payment model, and therefore our marketing model, was that we would gather data, package it up, and go show payers or health insurance companies the impact were having with their members. And so our first, we got 500 patients, or we call them members, who had, we started collecting their insurance information. Even though weren’t charging it, were still charging them cash. So we learned that we had 500 people who had Cigna insurance that were customers of ours after they had been customers for at least three months.
Brad Kittredge
We analyzed all the data and turned it into like a 30 page report with a bunch of, you know, charts and takeaways and insights. And then I just went knocking on every door I could find at Cigna and tried to get intros and finally found an audience and said, here are the results of the pilot you guys didn’t know you were doing with us. Because a lot of healthcare companies get stuck in pilot purgatory. And I didn’t want them to even suggest that’s how we start together. And it was a great start to the conversation, and were really trying to show them that we’re a different kind of provider. And that we’re not just trying to churn through people and have more appointments, but actually change the way care is delivered and be a partner to them, getting insights into their members.
Brad Kittredge
And so were still quite small at that point, but got a national contract with Cigna, and that was the beginning of the next phase of the revenue model. And I think right before that, we had raised our a. And part of the story with a was we’re going to get insurers to cover this care. And a lot of people didn’t believe that was going to be possible. Unfortunately, some did. And so that then led to contracts with other insurance companies. And part of thesis there was more people are going to want to pay with their insurance. And when you think about the value proposition, if you’re going to get healthcare, whether you’re going to pay out of pocket or pay with your insurance, obviously your out of pocket cost is just way lower with your insurance.
Brad Kittredge
And so people would pay much less but get the same value from us. And so that translates back into this assumption or thesis that we could acquire those customers for a much lower acquisition costs, that our CAC would be much lower, and that our CAC to LTV ratio would be much more attractive inside the insurance networks rather than cash outside. And so that was a core thesis of that phase of the company that we wanted to go prove and say we think the future of the company and the future of our payment model, and therefore our marketing and acquisition models is really through using insurance.
Brad Kittredge
And that proved to be the case that we have dramatically lower acquisition costs because of the value proposition when we can accept someone’s insurance, we have a great LTV with insurance and great unit economics and revenue dynamics, and that sort of proved to be the case. So now we continue to expand that out. And as I may have mentioned, now about 135 million covered lives under contract, and that spans commercial insurance, which you get through your employer, Medicare, Medicaid and the healthcare exchanges, and continuing to grow. And so we also move beyond thinking of direct to consumer as our way to acquire. Healthcare has really become omnichannel. If you’re a patient and you’re looking for care, there are lots of ways you find that care these days.
Brad Kittredge
It might be a program through your employer, it might be a recommendation from your PCP, you might go on your health insurance website, or you might talk to family and friends or go online and search. All of those ways are going to influence your choice and how you’re finding care. And we want to show up in all those places. And so we’ve got really a multi pronged strategy now trying to build and drive trust and partnership and earned referrals from healthcare stakeholders like payers and health systems while still showing up to consumers in a really friendly way wherever they’re looking for care and bringing them in through a really efficient, effective funnel to become customers. Right side.
Brett
Are you only available in the US?
Brad Kittredge
We are. We are. And that’s really a byproduct of that thesis and focus on accepting insurance because the US healthcare system and the way we pay is just so complex and convoluted and doesn’t scale to other countries. So if we wanted to go deliver our service in other countries, some of our functionality would work, you know, the patient experience and the provider experience. But the whole payment model is different, right? So many other countries, if you took Europe as a logical place to go, they have a single payer, so there’s one payer contract to get and it’s all or nothing and a lot of different ways that payment happens. And so the US market is so big and so complex that we’re really optimized for that market and I don’t currently have any plans to go international.
Brett
So that’s a big chunk of the US though already, right? That’s not quite 50%. What’s the population right now? Something like 330 million, 340 million. So it’s a good chunk of the population you’re serving?
Brad Kittredge
That’s right, yeah. So we’re covering all 50 states in DC, a lot of population, most of the big plans. Our focus at the moment is really continuing to drive our offerings in Medicaid and Medicare advantage and exchange. So we’ve got phenomenal partnerships on the commercial side with UnitedHealthcare, Aetna Cigna, and just some great work in partnership with Centene and a number of other plans at the state level for Medicaid. And so really excited about where that’s going and ultimately would love for every american to be able to use their health insurance to get great care at Brighten.
Brett
As you reflect on this journey, what do you think has been the most important go to market decision that you’ve made and take us behind the scenes on that decision and how you arrived at that decision?
Brad Kittredge
Yeah, I would say that the most important decision we’ve made is to launch our crisis care program, which is a suicide prevention program. And the reason is, as you know, rewinding all the way back, of course, to the insight I had and the mission and vision that we had for the company was to build a better care model, not just more access to care, but actually measurably better outcomes. We still found when were going to talk to payers and that we had many other competitors enter the market in that interim, that people were having a hard time telling us apart from everybody else, saying, like, everybody talks about quality, everybody says they’re great and that they can offer more access.
Brad Kittredge
We said, okay, how do we zero in more on the specific niche that’s going to matter and how we differentiate and where we add unique value? And so it’s true for many conditions in the healthcare industry, and very much so for mental health care, that the distribution of costs within a patient population is very uneven. So you’ve got a small portion of people that have more complex, severe, or acute conditions driving a massively disproportionate share of the total costs of that population. And so we said, if we’re really going to help payers achieve their goals and help health systems achieve their goals, that’s where the high costs are, that’s where the complexity is. And so we’ve got to really double down on treating the hard cases, and that’s where we’re going to have the biggest clinical impact and achieve our mission.
Brad Kittredge
And so we had been hearing that suicide risk was really one of those places. And it’s, of course, intuitive, but out of caution and in our earlier phases, were referring people who had elevated suicidal ideation. But what we heard, actually, an executive from a suicide advocacy nonprofit approached me and said, you know what happens when you refer those people out? And I said, well, we’re trying to get them into in person care, which we assume is better for somebody with suicide risk. She said, those patients are a hot potato. No one wants to take them because no one’s trained specifically, or very few providers are trained specifically to treat suicidality. And everyone perceives it as a risk. And by the way, it’s hard enough to get a routine appointment, let alone an urgent suicide risk appointment.
Brad Kittredge
And she’s like, I really urge you guys to revisit your protocols there and your ability there. And so our clinical team dove in and said, you know what? There’s some great evidence based approaches that we could apply here. We think we can deliver great care for this. And so we built our crisis care program. And to me, that was just really planting a flag, saying, we are going to be the best at treating the hardest cases. We’re not going to shy away. We’re going to do the hard work. And that’s how we’re going to differentiate from everybody else in the market. I don’t think anybody else has the DNA to want to follow us in doing this and doing this really hard work and impactful work.
Brad Kittredge
And we’re going to be the highest value partner to health systems and to payers to solve the intractable problems in behavioral health that are driving the majority of their cost and risk. And so that was the start. We also, in this past year, then acquired a substance use treatment company because substance use is a big part of those hard cases. And that company uses a care approach called intensive outpatient programs, which is also another part of these higher ends of severity and acuity, and really solidifying our positioning there and positioning, again, us to really own that vertical or that part of the market and be that kind of partner to change the way care is delivered.
Brett
Now, final question for you. Since we’re almost up on time, let’s zoom out three to five years into the future. What’s the big picture vision look like?
Brad Kittredge
The big picture vision for brightside has always been to fundamentally change the quality of care that people receive for mental health conditions in the US. Certainly that involves timely access to care and a great experience with care. But in many ways, it really means changing mental health care from art to science. Historically, it’s been thought of more in the realm of art and just sort of individual practitioner discretion. And there’s so much opportunity to use evidence and data driven feedback loops and predictive analytics and AI to ensure that every patient receives personalized, data driven, evidence based care that drives measurable outcomes. And so the vision is for everyone to receive that quality of care in a consumer friendly experience with their insurance.
Brett
Amazing. I love the vision. There’s been an awesome conversation before we wrap here. If there’s any founders that are listening in, they want to follow along with you. Where should we send them? Where should they go?
Brad Kittredge
I am too busy to spend time posting to social, so you’re not going to find much presence from me on Twitter or Instagram or anywhere else, but you can find me on LinkedIn and happy to engage in dialogue there.
Brett
Amazing. Well, thanks so much for taking the time.
Brad Kittredge
All right, thank you, Brett.
Brett
All right. That was awesome, man. You’re a great guest.
Brad Kittredge
Thank you. Hopefully that was okay. I know.
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