Get relief from Mark Goldenson’s start up service that connects people with mental health providers for online counseling and telepsychiatry. Find out how communication plays a major part to one’s well being.
Hometown: Scottsdale, AZ
Current residence: Palo Alto, CA
Occupation: CEO of Breakthrough.com
Areas of focus: Online counseling and telepsychiatry
Is this your first start-up? What other start-up companies did you help develop?
Breakthrough.com is my fourth startup. Another of the startups I helped develop is Woosh, a tech platform that lets small businesses build simple websites that integrate their inventory and sales systems. We raised $21M in the dot-com boom and made a lot of rookie mistakes. Then there’s Stanford Bazaar, a marketplace for the Stanford community that Stanford acquired.
Then we have PlayCafe, an online game show network that let anyone watch and play along with our game shows. We raised $1M from First Round Capital and other prominent angels. We created over 300 episodes with an average playtime of 87 minutes per player. Unfortunately, we did not reach enough users. Live online programming is a very hard niche.
Can you tells us more about Breakthrough as a company? What is “telepsychiatry”? Tell us more about the treatment process and how it is conducted virtually?
We connect people with mental health providers for online counseling and telepsychiatry. Therapy clients and providers can talk via live video, phone, and chat, or asynchronously via email. We also enable online scheduling, signing of disclosure forms, insurance claims processing, online co-payments, and other care-enabling components.
How did this come about? What made you decide to start Breakthrough?
My two long-term interests are internet entrepreneurship and psychology, so after PlayCafe I found myself looking at the intersection of those two areas. Mental illness is prevalent. One in four American adults (58M) suffer from one. There are major barriers to getting care: high costs, extremely limited access, poor provider fit, and social stigma.
I was fascinated that the internet could help with all of them. After about two months of research, I was convinced that there was a big opportunity to both build a strong business and do good. The Breakthrough team has over thirty years of experience in health and Internet technology.
How did you recruit them? Are some of them from your previous employment at PayPal?
I think recruiting strong people for a startup takes a lot of time and effort. I talked with over 30 engineers to find our founding engineering team, went to a lot of networking dinners, and pestered my network. Some of those people were fellow PayPalians who have a strong network.
We found Julian Cohen, our sales lead, through a VC that liked what we were doing. Other members of our team reached out to us based on the press we had received. As one friend put it, if you’re looking for needles in a haystack, it’s best to create a magnet (press, a strong team, growing adoption) that brings the needles to you.
One of your team members, DeeAnna Merz Nagel, is a founder of the Online Therapy Institute. How did you meet her? She has an avatar instead of a picture on her profile. Is there any particular reason why?
I reached out to DeeAnna since she is a leader in the field. I think she has a Second Life avatar because she likes the platform as a way to deliver richer online treatment.
Can you briefly share with us a particular case study that showed that teletherapy can be as effective as in-person treatment? How substantial is the research? Is there enough evidence pointing to teletherapy’s benefits? What are its disadvantages?
Sure. There is a list of studies on our effectiveness page. You’ll see randomized, peer-reviewed studies from leading institutions like Johns Hopkins; studies that are published in major journals. There are over 30 years of research showing that distance counseling and psychiatry work as well as in-person. It’s a controversial finding but it’s true.
There are indeed a few disadvantages: people need a computer, a webcam, and broadband internet, which not everyone has; especially in rural areas where telehealth is extremely suitable. It’s less suited for crisis situations and severe psychological conditions like suicidal depression or schizophrenia, neither of which are recommended as candidates for treating on Breakthrough. Also, it takes some open-mindedness from clients and providers. Although acceptance is constantly growing, it will take a little more time for it to become mainstream.
How secure are video, phone, email, and chat therapies? What specific steps does Breakthrough take to ensure therapies are private and secure?
We know security is essential in this area so we’ve taken a lot of steps. Our entire site is encrypted via 256-bit SSL and compliant with HIPAA. We don’t store any of the live communication from sessions, while confidential records are stored on a separate and encrypted database. Our servers are compliant with the rigorous PCI standards that credit card transactions require. In addition, users must log in to view secure messages and we don’t send sensitive information outside the system. Users are required to complete a two-step authentication to reset passwords, and there are even more security features.
It seems that teletherapy may miss out on visual cues, gestures and speech intonations. How does Breakthrough remedy these issues?
That is true but research shows that does not prevent online counseling from being effective. I think one reason is that people are more open when they feel safe and establish what’s called a therapeutic alliance – trusting their provider – which can be hard if people feel stigmatized from going in-person.
Communication is – more than in just about any other medical field – the major part of treatment in mental health. This ports well to the internet. However, providers must be especially careful to prevent misunderstandings and to listen for any crisis cues.
In what ways will Breakthrough transform the dynamics of doctor-patient relationship?
I think online counseling and telehealth in general will unlock value in several major ways:. It reduces costs, increases convenience, decreases time spent on treatment and time lost to no-shows, enables stronger/better matching with providers, and decreases the stigma attached to getting mental health treatment. Doctors/providers are late adopters of technology so it will take some time for all of these benefits to become fully realized. Gaining reimbursement has historically been a major barrier, but Medicare, Medicaid, and over 130 private insurance companies are now reimbursing distance counseling and psychiatry, which is greatly accelerating the pace of adoption.
Can you tell us how you got the investors to invest in your venture? How did you approach them? What were some of the challenges in getting them to invest in your company? For the people wanting to start-up a new Internet venture, can you provide few tips on how to meet the right investors that will help launch your business forward?
I was fortunate to have a good investor network since I have been in internet entrepreneurship for twelve years. I tapped some of my network to meet early investors and used that funding and our progress to find new investors. The best way to meet investors is through shared connections so some of our advocates made those introductions.
Raising money for bleeding edge applications like telehealth is not easy and I think we’re fortunate to be one of the few companies with top-tier investors like Charles River Ventures and Keith Rabois. The single best way to raise money is to show ongoing adoption of the product, since fundamentally investors want to buy low and sell high. There are also a lot of seed funds like Y Combinator now to fund the earliest stages of the company, which traditionally have been the hardest stage to raise money at.
What changes do you foresee in online therapy?
I think the main growth areas are:
-Wider reimbursement from public and private health care payers. 87% of mental health spending is reimbursed so this step is critical for online therapy to go mainstream.
-Wider adoption of the internet by mental health providers, particularly younger ones that are more comfortable with technology.
-Greater awareness among the public that online therapy is an option and can work.
One reason I am so excited about Breakthrough.com is that we believe we are working on the inevitable. That’s not true of all startups; some are truly stabs in the dark. But I think there is a consensus in mental health that says that online counseling will become mainstream. The question is just when it’s going to happen and which companies will lead that trend. We want to be one of them.