Transforming Behavioral Health and Improving Patient Outcomes with Mark Potter of Mirah

Announcer: Welcome to The Ignite Podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Alex Membrillo: Guys, this is fun. You know, we’re usually interviewing healthcare marketing leaders at provider groups or our department leads, but more so, I’m trying to bring different partners, vendors, and thinking to the table on Ignite. This will be cool. We’ve got Mark Potter of Mirah here with us, and he’s based out of Boston, but he’s in Maine. He’s in the backwoods of Maine right now, so this is going to be fun. Hopefully, the interwebs, maybe Starlink will fly over and catch him good when he’s going over. Mark, welcome to Ignite.

Mark Potter: Alex, thank you so much for having me here. Thanks for calling out the internet. It is 4th of July week, so we’re spending some time with family in the backwoods of Maine where everything is beautiful, a little bit less so on the internet side, so hopefully, the interwebs will cooperate here and get all the signal back.

Alex: Save us, Elon Musk. We’re going to be good. We’re going to be good. First of all, Mark, what was Mirah? Tell us all about it. You started it, right?

Mark: I did. I did.

Alex: It’s all your fault. It’s all your fault. All right. Tell us all about it.

Mark: Aside from being, as what you just said Boston for mirror, we are a behavioral health outcome company. We are enterprise SaaS. We do measurement-based care and collaborative care. Our mission is to prove and improve behavioral health outcomes, and our vision is to make behavioral health the gold standard in all of medicine from a metrics and accountability standpoint.

Hopefully, that comes across as ambitious as it’s intended to sound because to date, behavioral health has largely been the dark corner of medicine from a metrics and accountability standpoint. Medicine itself has lagged much of the rest of the economy when it comes to metrics and accountability. We’re trying to bring data and discipline into this field that so desperately needs it. Behavioral health is on the top of everybody’s minds right now, but what are outcomes? How do we know if we’re doing a good job? That’s where Mirah comes in. We try to make all that easy for our provider customers.

Alex: You must run EOS because you got the mission statement, the BHAG, the vision very clear there. I like it. I like evangelizing very well. I got it. Boston for mirror. All right. Outcomes-based, that’s where we’re helping, more data. Tell us more about that. What is or are the data you’re tracking, types of clients? Walk us through an engagement because I looked at your website, you can work with patient, providers. How does the system work to get better outcomes? Walk us through a use case there.

Mark: Use cases, we partner with typically large enterprise behavioral health providers, so think large outpatient providers like Refresh, Geode, these are customers of ours, Quartet. These are all the names that you know quite well. Community mental health centers too are our bread and butter. We’ve been working with FQHCs and community mental health centers from the very, very beginning. We’re working with passionate evangelical folks who care about good outcomes.

What we do is we swoop in and connect to their EHR because we know that if we are not easy and seamless and part of their data infrastructure, none of this is going to work at scale. We connect to their EHR. We do all the clinical training because measurement-based care is itself an evidence-based practice. In addition to proving that other evidence-based practices are working, so our providers are doing things like DBT and CBT and ACT as evidence-based practices. Measurement-based care, in addition to supporting those evidence-based practices by putting data infrastructure all around it, is itself an evidence-based practice.

If you care about outcomes, if you care about making people better, measurement-based care and collaborative care are the tools to use, and Mirah is the best solution for those two things.

Alex: I love it. I love it. Let’s walk through an actual use case. I get it. On your website, it says, “Patients, Mirah helps raise issues they may not feel comfortable addressing out loud.” How? The patient is getting a version of the Mirah white-label dashboard or something? Walk me through this.

Mark: Exactly. What we do is when I said we connect to the EHR, we pull demographics and scheduling information. Say we know that Mark Potter is coming in for an appointment on Thursday, we send Mark an assessment on Tuesday or Wednesday in advance of that session, and we do that because we know Mark is an adult in the substance use program, so we have all my demographics in there. We send me the assessment. I fill it out in advance, and then I come into this session, and my behavioral health provider can see how I’m doing in my own words and track that progress versus when I first started in the program, perhaps, and they’ll know if I’m making progress.

Maybe the easiest way to think about what we do is imagine the reciprocal. Imagine a world without this, that would be a weight-loss clinic without a scale, a hypertension unit without a blood pressure cuff. This would be diabetes treatment without A1C monitoring. All of those things sound almost blasphemous, right? How could you possibly go to a behavioral health clinic and not get measured? Well, how would you go to a weight-loss clinic without a scale? You don’t go there and just say, “Mark, you look great. You must be losing weight. I can tell by the bounce in your step.” You would find that unconscionable, right? That is not high-ethic treatment.

That’s the same expectation we should have for behavioral health care. When I go in and I filled out this assessment in advance, my behavioral health provider can say, “Hey, Mark, it looks like you’re making progress, or it looks like maybe you’re not making progress. Maybe we need to change treatment.” I will have there, in my own words, how I’m doing now versus how I was doing two weeks ago, versus how I was doing three months ago when I first started treatment, and we’ll see if I’m making progress or not.

So much of the inspiration for this came from my own interactions with the healthcare system and seeing through my wife’s eyes how behavioral health was lacking the same tools that we use everywhere else in treatment. Let me give you the quick example. I’ve had the misfortune, I guess, of having four knee surgeries. I tore my ACL twice.

Alex: Me too.

Mark: Oh, right? Right on. You know what it’s like. The only thing worse than tearing your ACL is tearing your ACL again because then you know what you’re in for. First time around, I actually did reasonably well and progressed right through treatment. I went to PT every single time. We could see flexion, extension. I got measured for everything. In fact, my physical therapist said to me, “Look, Mark, I’m not here to be your personal trainer or your best friend. I’m here to get you better and get you back out the door.” That’s outcomes, by the way.

This mysterious thing that we call outcomes is pretty easy to understand from a seat-of-the-pants perspective. You know what outcomes are when you’re the patient, right? For me, outcomes were I want to be able to run, and jump, and do all the things that I used to do before I tore my ACL, and my physical therapist was my partner in helping me get there. The second surgery, I ended up having a deep staph infection, and the measurement help us figure that out. We saw that I wasn’t making progress in treatment. My flexion and extension weren’t coming back. That was a good sign that-

Alex: You tore your ACLs and your internet connection. Are you back?

Mark: Yes. Well, we just knew something was off, and went back to my orthopedic surgeon, and realized that I had a deep staph infection, and that needed to be treated. It was the very act of measuring that helped us figure that out. I saw the power of data to really drive to better outcomes. In the first case, we knew that I was making progress. The second time I tore my ACL, we saw that I wasn’t and found that there was a deep underlying cause for that. We should be doing all the same things in behavioral health. In fact, I’m married to a child and adolescent psychiatrist.

When I said my wife was the inspiration for this, she really is. I saw through her eyes that behavioral health was lacking those same tools. When I met her, she was in residency and she went on to lead behavioral health outpatient services for McLean Hospital. Even at McLean, which is ostensibly the world’s number one psychiatric hospital, routine assessment tools were missing as an everyday practice.

They’ve subsequently become much better about that. In fact, they’re a customer of ours now, but when we first met, we saw that behavioral health just didn’t have the thermometer, the blood pressure cuff, the scale that you’d have in a weight loss clinic, didn’t have any of those things. By instrumenting the behavioral health practice, you can see not only the severity of your caseload but whether or not your patients are progressing, which is the whole point of any sort of care that needs to get better.

Alex: Why do no-shows drop in the first six months of using Mirah?

Mark: That’s a great question. No-shows drop for the same reason no-shows would drop anywhere. If you’re making progress, if you can feel yourself getting better, you’re going to be more committed to treatment. Patients, when they fill out the assessments in advance of those sessions, not only are they getting more invested in their own treatment, but they can also see the progress of those sessions. They come back because they know that it’s working for them.

Alex: I love this. Do you ever see yourself expanding outside of behavioral? I could see this for a lot of different services.

Mark: That’s a really great question, too. For the time being, we’re definitely sticking with our knitting in behavioral health care, but notably, collaborative care, which is really the second act in the play here that is Mirah, collaborative care is all about bringing those great disciplines together, the routine outcomes and monitoring of behavioral health care into a primary care setting and helping behavioral health and primary care talk to each other in more coherent, sustainable ways.

As we’re moving towards value-based care, having a common data language is how all the subspecialties of medicine will better coordinate their efforts to lead to better health outcomes, which is ultimately the goal for all of health care. In that environment, you can easily imagine a world where Mirah is tacking on some supplemental measures like the asthma control test, for example, might be comorbid with some other behavioral health issues, smoking cessation. These are things that are in that gray area between behavioral health and physical healthcare

Alex: That’s right. That’s right. I’m digging it. I’m digging it. ABA, I also see this. I think it’s harder to track outcomes there. I wonder how that could get done there. I think that’s a big talking point I saw on LinkedIn recently. How are these ABA groups doing with actual outcomes, not just patient growth? Very cool.

Provider groups, do you find a lot of behavioral groups are coming to you because they want to move to value-based care because it’s going to generate more revenue? Is that why they’re coming? They want to get out of fee-for-service because they feel like it will generate more revenue, and of course, they care about better outcomes. How do you attack that with provider groups? What is the incentive? I’m still learning about value-based care, so I’m trying to understand from their perspective why they’re excited about Mirah.

Mark: All of the above, I would say. Our earliest customers were the salt mines of behavioral health doing really good work in the toughest areas of behavioral health care, and this is really because they were evangelical about evidence-based practices, wanting to do the right things by their patients.

As we have grown and evolved as a company, we’re seeing more, and more, and more need for these services, and it’s coming from large healthcare providers who are doing exactly what you just said, trying to make the case for value and get compensated better for the good work that they’re already doing, which is why we have these [unintelligible 00:10:56] for your customers like Geode and Refresh and Quartet really proving their value story to payers and also to their patients and clients, right? Those are their customers, and if they can tell them a value story, if they can get that engagement, they’re going to be able to better monetize the good work that they’re doing already.

If you think about what value-based care is the only value that really matters is outcomes, and the only way to know what your outcomes are are to track them through measurement-based care and collaborative care.

Alex: I love it. What do organizations have to do? If they’re in behavioral, they’ve got to sign with Mirah. What else do they have to do to move to a value-based model? Is there other technology, other systems they have to put in place? Is there any other stepping stones listeners can start taking on now or no?

Mark: What they’re trying to do is prove value and get paid more for it, right? That’s ultimately the promise of value-based care. If you’re a provider and you provide better services, you should be able to command the premium for those services. First, you need to define what better outcomes are, and that’s the first challenge that we have in behavioral health. There aren’t great baselines for these things.

There’s a baseline-setting period where you’re saying, “Is it reasonable for 67.3% of patients in this particular demographic to experience a remission of their depression symptoms? Then, doing better than that should get you paid more. I think, as we’re talking about the great challenges that are perplexing healthcare right now, like the shortage of behavioral health providers, we have to solve this quality problem immediately.

There’s almost no point in talking about the quantity or lack of access until you know whether or not what you’re delivering is producing anything of value. If you go to a weight-loss clinic and you don’t lose any weight, then adding 100 more weight-loss clinics is not going to improve your capacity for weight loss. Similarly, if you’re in a behavioral health environment and you’re not actually getting people better, then adding more clinicians or more locations is not going to solve the behavioral health crisis. You need to get better at doing those services. Measurement-based care helps you prove that. That’s why payers are motivated by this, as well.

Alex: Mark, I’m going to end on one question because we’ve got mostly marketers listening to this. This feels like it’s an incredible tool for marketers because I get actual statistics to throw on my marketing materials website, et cetera because we have outcomes data. What’s your advice to marketers on how they can reach patients, help them understand the benefits of value-based care, and help them differentiate their behavioral group?

Mark: That is another great question. It is, first of all, committing to the data story. We have customers from community mental health to tip of the spear, large commercial enterprise providers, and they’re doing the same thing. What we’ve heard from them is, “By virtue of the fact that we are measuring, we are communicating to our patients that they should expect to get better.” Think of how groundbreaking that is, especially when compared to behavioral health of years past, where you go in and it’s a giant mystery whether or not any of this is of any good effect or not.

We have providers saying, “By virtue of the fact that we are measuring every session, we are communicating that we have increased expectations around here.” On the other end of the spectrum, you’re talking about marketers. By capturing these data early and often and being able to tell a story from the very beginning, we have marketers out there on stage at major conferences communicating their outcomes in terms of all these statistics that we mentioned. Remission rate from depression. It would be remission rate from anxiety, it would be the time to reduction of symptoms, the amount that they should expect to improve over a certain period of time.

That is quality, that is value, that is gold for behavioral health marketers. Eventually, that consumer is going to get smart about this. Would you go to a laser eye surgeon that says, “There’s some chance that you’ll be blinded by this, but there’s a good chance that your vision is going to improve dramatically?”

Alex: I think they do say that. Yes, that’s right. We need statistics. That’s what marketers get out of value-based care and measuring outcomes like this. Mark, I want to challenge you on something. I’ve had a therapist for 13 years. What I tell people about therapy is, you don’t go when it’s broken, you go to keep it from breaking. In a value-based model, they look at improvements. Initially, 13 years ago, I was in and out of rehabs and jails and all that stuff, so there was improvement that needed to be made. Now, what is the measurement? Alex is staying steady Eddie. Is that okay? Does the provider still get paid well? Is that okay in value-based that I keep going just to keep this top-notch?

Mark: Well, then you think about things in a capitated model. Say a provider is responsible for an entire cohort, and in the cohort, there are lower-risk folks. In the cohort, there are higher-risk folks. If instead of ending up in an emergency department and relapsing, you are living a healthy life and the right amount of treatment for you is going in once a month, then that is much better for the total cost of the cohort.

That’s how we should be thinking about healthcare. Everybody is their own person. Some people have higher propensity for this, that, or the other thing. Those folks might need different attention, different preventative maintenance. Other folks are really easy, and that’s great. Every cohort wants to have those. If we’re going to solve the healthcare problem here in the US, it can’t be the way to manage your finances is to kick the higher-risk folks out of your pool. No, that’s not good care for each other as a society. We need to be able to care for the risky folks, the less risky folks, and everybody in between.

Alex: I love it. That makes a ton of sense to me. It’s the overall cohort making sure there’s no relapse, no hospital stays, and the payers are happy. Mark, first of all, who’s your target client within a behavioral group? Is it CEO, COO? Who do you look for?

Mark: Yeah, chief clinical officer, CEO. The beauty of measurement-based care and collaborative care is the same data that are so valuable for that patient-clinician dyad are the data that you aggregate for operations purposes at a supervisory level, are the same data that marketers care about in telling their story. It’s the same data that the CFO and payer negotiators are going to be using to insist on higher compensation rates and better go-forward payer contracts.

Putting in the right regime, if you collect data well enough and scalably enough, it’s going to be useful for all of those stakeholders across the organization. It’s really a question of who cares about it the most to get the party started, so to speak, at the provider location.

Alex: I love it. If anybody wants to learn more, if you’re a behavioral group leader, go to mirah.com or go to ChatGPT and type mirror said in a Boston accent. You will come across this website either way. His name is Mark Potter. We’ve had Amanda listening in. Very helpful. I love this. I was questioning how much I was going to learn. I knew I was going to learn a lot, but I was questioning how helpful it would be to marketers.

I love it because it’s all measurement-based, and we can start talking about actual outcomes instead of just, “We’re great at what we do. We provide great deals, great bedside manner, check our reviews.” I don’t like that. It’s not enough. We got to move forward. Mirah helps us do that. Mark, Amanda, thank you for joining us on Ignite.

Mark: Alex, thank you so much.

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