The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.
Anna Lindow: We are going to accept insurance and we’re going to focus on making sure that we can expand access broadly, and specifically create an access pathway for people who get their health insurance through Medicaid. From early on, we said, “We’re gonna be a virtual company and we don’t have a headquarters.” There isn’t one place where the majority of team members live. People are distributed all over the regions that we work in and beyond. And that’s intentional to get coverage so that we can then distribute that coverage to the places that need it, and virtual care lets us do that.
Meg Escobosa: Welcome to the Game Changing Women of Healthcare, a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them.
I'm Meg Escobosa. Join me in conversation with some of the many brilliant, courageous women on the front lines of the future of health.
Hi everyone, and welcome back to The Game Changing Women of Healthcare. I'm your host, Meg Escobosa. Today we're joined by Anna Lindow, Co-founder and CEO of Brave Health, a telehealth service that provides counseling, therapy, and psychiatry for a range of mental health and substance use disorders.
Brave Health offers same day assessments, reduces wait times, and works closely with Medicaid case managers, providers, and major Medicaid plans across the US to increase patient engagement and lower overall costs of care. Most recently, they've announced an important partnership to support women with The Doula Network to support maternal mental health for Medicaid populations. Anna, welcome to the show.
Anna Lindow: Thanks so much for having me.
Meg Escobosa: So, Anna, you have been quoted comparing starting a company to getting a tattoo. You said, “You can't just, you can't just flip through a book and pick out an idea. The idea, like a tattoo, must find you and it's always gonna be part of you.” Tell me about that. How did the idea for Brave Health find you?
Anna Lindow: Yeah. Well, it's funny, I did say that and now I'm thinking about one of my tattoos I didn't really think very hard about, so I meant to say like, you know, sometimes tattoos - they are with you forever. So I had always wanted to do something in the mental health space. It had always been an interest of mine. And when I say “always”, I mean going back to when I was 12 or 13 years old, it became something that was relevant to me.
I had lost a parent and I got really, really great psychiatric care that changed the course of my life. And at that time, you know, a lot has changed since then, since I was 12 or 13 years old. And awareness is so much greater and stigmas - less, and those are wonderful things, but at the time, it was really meaningful for me and something that stood out as something that changed what happened from there, and I kind of filed that away, and then I did other things for a long time and finished high school and college and started working in the media and then ended up in the startup-world working for a company called General Assembly that does technology-skills training. And I still had this interest, personally and on some level kind of abstractly professionally in doing something in the mental health space, but I was really focused on the work we were doing at GA and it was really mission-driven, and it spoke to me we were helping people find new careers and that was, it was really fulfilling and exciting work. And for me it was a really influential several years of my life. And then it was time, it was time for me to leave New York. It was time for me to do my next thing. And I didn't really know what that was, but I knew it was time to do something different and just, you know, the way that sometimes happens, right when it's time to start a new chapter, and this is when I think, you know, sometimes the thing finds you or it chooses you.
I had obviously worked closely with the CEO and Co-founder of General Assembly, whose name is Jake, and he said, “You know, I think you might have an opportunity to work on this thing that you're really excited about and passionate about this might be a time, you know, to start to think about something in the space,” because at that time, you know, there was increasing attention, very rightfully, on the need for increased capacity for services in the pursuit of treating opioid use disorder. As we were starting to really, you know, there was starting to be more national coverage of the opioid epidemic, obviously incredibly, incredibly important work.
And so the moment kind of coincided between me being ready to take on something new and thinking about something new and something happening in our society that made it very timely. But what was interesting was as soon as I started working on Brave, you know, of course that work is incredibly important, but we also started to hear from health plans. There is a broader need too, right?
Meg Escobosa: Beyond opioid.
Anna Lindow: That's critical and then there's a broader behavioral health need happening as well and dozens of companies could be started to address these needs and it wouldn't be enough. Right. Like there is just the need is so big.
And we started talking to Medicaid health plans in particular. They said, “We really are interested in how, what you’re building could be used for a broad range of conditions when we think about our patient population.” So there are kind of two things there where the idea finds you, right? The first is you kind of are open to something and then a moment comes where it makes sense, and then the second is you start to work on something and then you get new information about how it fits into a bigger picture and it has been really interesting and exciting working with health plans on thinking about how are we gonna meet the needs that you have in the way that's best suited to us? And then there are lots of other fantastic organizations that do focus on specifically treating opioid use disorder as their main, primary thing that they do. So we felt like, or I think, I felt like there's also this element of being willing to evolve as you get feedback from your partners, from the people who are using what you're building, and then also from the market, right? Like what else is existing in the market and how is what we're doing, fitting in with that and responding to all those things at once.
It's not like you can pick something and then say, this is never gonna change. So maybe my tattoo analogy breaks down a little bit. Maybe it's a tattoo that you keep adding onto or evolving. Some people do that, but that has certainly been the experience for me has been you start with a concept of a place you want to have impact. Then you get new information and that evolves how you think about what that impact could be.
Meg Escobosa: Totally makes sense and I feel like I'm sure all the entrepreneurs who hear this episode will relate to that. I mean, you have a concept and you're getting the reality on the ground and how the need is different, and what is the bigger priority?
The idea that you went in first with the notion to address opioid use disorder and recognize that first of all, there's an ecosystem already serving that market. And your partners, the health plans wanted support in another problem area that you could solve, which wasn't, you weren't aware of. So that sounds like an amazing evolution and appropriate evolution.
How long between that early concept to shifting to a broader set of needs? How long did it take? Just again, I mean our audience is a really diverse audience. We have people in corporations who are innovating within that context and then there are founders, like you, who have a concept. They need to find the funding, they need to find resources and focus on a problem. So I think that this question is really probably tailored more to them, but just kind of what is the, what was that journey like? How long did it take to shift?
Anna Lindow: More than a year. Oh, I mean, there have been many evolutions throughout this experience over the past several years, but you don't get all the pieces of information at once, right? Like what other people are doing evolves and you see the great work others are doing in certain places and say, “I want do work that compliments that.” And those are vectors that are changing. And then you're getting feedback as you start to talk to potential partners, to existing partners. That takes time.
And then you're kind of doing a lot of setup and ground work laying and so yeah, it was an evolution over time and is still an evolution, right?
Your product is never done. Your service is never done, but it's always interesting when you look back and ask these questions, like these, are so interesting because it compresses a lot of time into sort of narrative that makes it seem you, it's easy to look back on something and say, oh, then that completely makes sense. And yeah, but throughout the experience, you know, you're reacting to things in real time and it takes weeks and months and years to have things transpire that then are one sentence in a podcast someday.
Meg Escobosa: Absolutely, and it's true, you're operating a little bit in the dark. You're getting a shimmering light over here that reveals something, some opportunity or some growth potential. And you still don't know what you can't see.
Anna Lindow: I mean, right. That is a good way of thinking about building an organization that's kind of like those, you know, coloring book things where you have to like, scratch it off with a coin. You know, you don't get all the information about what's under there. Except in this coloring book, the actions you take to scratch off one part impact the illustration that's under on the other side. So those things that are dynamic.
Meg Escobosa: That’s a really nice idea. Sounds like the health plan partners have been a crucial element, but what are some other enablers that allowed you to enter the space with your solution? Was there a technology that came together that was finally available to allow for sort of HIPAA compliant interaction? Was there something, or were there financial resources that made a difference? Something that made you kind of market-ready?
Anna Lindow: So what I like to say about how I see the past few years, there's the quote, “Necessity is the mother of invention,” but the way I think about the past few years is I think about the concept of necessity as the mother of adoption because there wasn't, like, we're not necessarily using things that didn't exist five years ago in the sense that you could do, you could have an appointment via video. Technologically, you know, Zoom isn't new. Two-way video, video conferencing isn't new. It's relatively new, but it's not new in the very, very recent past. But the adoption, right, patient behavior changed a lot during COVID because it had to, and then some behaviors were not gonna change permanently.
There's sort of a reversion to some incarnation of what it was before, but in our field, that's not what we saw because in behavioral health we're seeing people frequently. If you see your therapist weekly and you have to drive an hour to see them, that's two-hours driving there and back every time, and so the concept of getting services virtually, something that resonates in this just really clear, straightforward, logistical way, and there are a lot of other factors too, but I think when we started working on Brave, you know, when I started looking at this and working on this in 2016, 2017
Meg Escobosa: It was pre-pandemic.
Anna Lindow: So I never could have thought, “Oh, people's relationship to how they feel about getting care virtually is gonna change dramatically.”
I thought it would change incrementally over time. This is something that's changing as a trend thematically, but it's very uncommon to get an accelerant where everybody on the planet has to try something at the same time. It's very unusual. But it's not just for the patients, it's also for providers. It's also for people who are practicing clinically saying, “This might not have been something that I was that interested in, or I would've tried just because I wouldn't have, because I was doing something else,” and now everyone has tried it.
I think the other thing that has changed over the past several years that has been important for our journey as a company is awareness. I feel like when we started, we talked about mental health with health plans, often it was something that was more treated as, you know, just a vertical that was separate from other things that were going on, and there were reasons for that, but we've seen that shift and we've seen mental health become really central to conversations about health overall, and healthcare overall. And that's not just from within the industry, it's also culturally in the United States, just like in popular culture. I really never thought I would see the day that the NFL did an ad about de-stigmatizing getting mental health services. That's like Roger Goodell and Snoop Dogg and a bunch of other people like that just was amazing to me. And that changes how people think about, I mean, I can't opine on the particular impact of the NFL ad, but I think it is representative as of…it's like the zeitgeist-type of things that are happening in our society that people are responding to. And part of the reason that Brave Health is called “Brave Health” is because it requires an immense amount of courage to embark on behavior change in your life. It is so brave what patients are doing when they say, “I wanna do something differently in my life.”
Meg Escobosa: I wanted to talk about your initial focus on the Medicaid population and the unique needs of this underserved population for mental health services, and typically the payment rates are lower for. Providers who provide me mental health services, in general. And then on top of that, those who accept Medicaid compensation, they too are getting lower rates. So I know that there's been a steady decline in the number of professionals who are working in this space and accepting even insurance, overall. How are you guys approaching those challenges?
Anna Lindow: So we, like you said, started out from the beginning saying, “We are going to accept insurance and we're gonna focus on making sure that we can expand access broadly, and specifically create an access pathway for people who get their health, their health insurance through Medicaid.”
And to your point, there is a supply and demand imbalance. Full stop. We just don't have enough providers in our country right now, and that can create certain areas of pressure that are specifically acute. So for instance, in rural areas, yeah, if you live in a place that just doesn't have a large population, the likelihood that there's gonna be specialists of, you know, and various kinds of healthcare is less, right? So I think this is where when we think about access and the harder access gets, or the, the more there's a supply and demand imbalance, the more we want to look at ways to address that. And virtual care really is one of those ways.
And that's part of why we have held constant from early on, we said, ”We're gonna be a virtual company and we don't have a headquarters,” in the sense that there isn't one place where the majority of team members live. People are distributed all over the regions that we work in and beyond, and that's part that's intentional to get coverage so that we can then distribute that coverage to the places that need it, and virtual care lets us do that.
What I'm describing means that we can do this at scale. And that's, I think part of the really important part is if you start from the place of this is the population that we know we wanna serve, we're gonna hold that constant. We're gonna do this at scale because it makes sense to build certain infrastructure that will scale, then that's the lens you're using and I think that's been really important for us, is to start with that lens and then evolve with that lens still in place because then you make decisions that would be different if you were saying, you know, “Hey, five years maybe we should consider this.” It might be harder at that point to kind of retrofit.
Meg Escobosa: There is also a technology element to this. You know, there needs to be access to tech to enable virtual care. Have we hit an inflection point that makes a difference in terms of your target audience, your customers?
Anna Lindow: I'm glad you mentioned that because that is actually another thing that we've seen shift over the past several years, just smartphone ownership. There was a Deloitte study that came out maybe a couple years ago that had a data point in it. When I saw it, I said, “Oh yeah, that's what we've been seeing,” and it basically showed smartphone ownership among Medicaid beneficiaries increasing in the past several years, such that by, I believe it was 2018, the ownership or smartphone, you know, used usage within the Medicaid audience of Medicaid beneficiaries became the same as just the general American adult population.
And that's really important because, people are using smartphones often to access virtual care, and so that is one of the pieces, you're absolutely right, but I think as well, one of the things that happened during the height of the pandemic was people were using virtual platforms to access things, like their kids going school.
You were sort of having a crash course in using virtual services in all kinds of different ways on different devices for things you really needed, and that also I think has just societally made people more comfortable with trying a new technology. We still have technology support as one of the things that we do and when people need support. You know, helping them learn to use platforms is important, but I think generally the awareness and facility with. Just generally using two-way audio video to do anything is something that changed for people.
Meg Escobosa: Has this also been a potential area for innovation in terms of partnering or removing this potential barrier? It sounds like the audience that you are serving there has just been a natural increase in access to tech to use the services. If there's anyone that's left out, do you anticipate needing to give them phones or give them tablets or, you know.
Anna Lindow: I'd love to continue to see more broadband coverage, or just accessibility to wifi because that continues to be something that, you know, there's some differences by region and it's something that really changes people's ability to access virtual care.
Meg Escobosa: And have you done anything to attract providers? How interested are providers in engaging on a telehealth platform? Is there any resistance?
Anna Lindow: So I think what has changed is now providers, everyone again, was put into a situation where they didn't have a choice but to try. What that's changed, I think for providers just across the board is I now have data points about whether or not this works for me. And there are some people who say, “You know what, it's just not my preference.”
And that's great too. But the idea that, you know, and you've been exposed, I think has just made so many people say, “Hey, this is interesting to me. This does work for me. I do wanna do this,” and then that creates a new channel for folks to engage in platforms like our.
Meg Escobosa: It's notorious that women-founded entrepreneurial ventures get much less funding and resources from venture capital. What was your experience in attracting resources? Did you get venture funding and do you have any thoughts or advice for other entrepreneurs like you who seek external resources to get launched?
Anna Lindow: We have been really fortunate to have fantastic investors who have joined us early on and stuck with us through the journey, which is wonderful. Union Square Ventures invested in our seed and has been with us throughout the years. City Capital came in not too long after, and then most recently, as we just announced, Town Hall Ventures led our most recent round, and we've just been really, really, really fortunate to have the support of folks along the way, both at those firms and broadly; I think there are just so many different people who have been a part of this journey, you know, in many ways, but including the journey of capitalizing the company. As a first-time founder, you know, there's no way you could prepare yourself. It's like raising money is one of those things you haven't done till you've done it. So the benefit of being able to learn from, from people who've supported us along the way has been huge.
And one of the things I'd like to highlight about organizations and individuals who've supported us throughout this process is it has been wonderful to see people who think about investing with a mission element. That is something that I think has been really resonant for us and continued to be, you know, important for many of the folks who've come on board. So to that end, you know, every company's different and it's a question of finding the organizations to invest that are aligned with what you're doing and what your goals are.
Meg Escobosa: You are currently in 10 states. Is that correct?
Anna Lindow: We are actually licensed to operate in 18 now.
Meg Escobosa: Are there regulatory elements in those states that make it easier for you to operate there? Or how did you choose which states to start in and are there, have you learned something in those first 18 that are gonna make the rest much easier to tackle and open for business?
Anna Lindow: We have learned a lot in the states that we're in. Operational, you know, in a number of states as, as you just mentioned, but patient density is not the same everywhere. Right? Because some have much larger populations than others. And so that was one of the things we did from the beginning is kind of focus on states with larger populations because to be able to operate in a state takes a certain level of work.
Just to be, just to do it at all. And it's not necessarily proportionally more work or less work depending on how many people live there, which is kinda interesting. And then now I think we've. Tried to look at various factors that have to do with what's the regulatory landscape, but also what are the payer partners, you know, the health plans that are operational in the state because those are our partners.
And so they can give us feedback about, “Hey, we really want your services in X place,” or you know, we can look and say, “Oh, this is a place where we know that these organizations that we're already working with somewhere else and have good data and know that it's working as a partnership are they operational here.” So it's kind of a combination of factors, but have been pleased to be able to see that the landscape for telebehavioral health is definitely continuing to evolve in such a way that it's supportive of this is something that's available nationwide. Obviously, the state-by-state regs are different, but from even, you know, when we started to now there's a lot, I think there's a lot more sort of general broad based support for the idea that. People living in any state, you know, across every state that we see, we see just generally the trend heading in the direction of this is something that people need.
Meg Escobosa: You know, you weren't always, you've mentioned this, you weren't always a Founder and CEO of a mental health innovator. You actually helped drive growth for. General assembly and tech innovator, tech educator. So what do you think your most important contribution to General Assembly was?
Anna Lindow: Being part of the GA team was an incredible experience and so meaningful to me mostly because it really was a team effort. It was such a tight-knit group, my place that I worked, and also my place where I met some of my closest friends, people who were in my wedding, like, you know, lifelong important relationships. So when I look back on it, I think, really about things that we did together. And what was meaningful to me was seeing people come in and say, “I was doing work before that didn't feel right to me.” Sometimes it was - I was at the very, very beginning of my career and I had just maybe done a job for a year that I said, “I know I'm not gonna do this forever.” And sometimes it was people who had been doing something for 25 years and wanted to do something dramatically different, and a lot of times it was people who had been successful at other things or sometimes had been in completely different fields, and then seeing the transformation and the fact that on the other side of a relatively short amount of time, like we're talking a few months, they would build things that they cared about and they thought were cool and they thought were interesting and inspired them in their classes, you know, in their coursework, and then they would go on to get jobs that they were passionate about. And it was really cool to get to do that at scale, right? To see that happening for many, many, many people. And I still remember clearly the, some of the first students that we had and seeing the amazing work that they did and saying, “Wow.”
I remember I talked to this person, you know, I talked to this person three months ago, like I remember what they were doing three months ago and it was completely different. And I think that for me then kind of laid some of the track of thinking about the amazing power people have to change their lives because if you can change your career in that amount of time, what else can you do in that amount of time? And so that experience at GA was inspirational to me because it was kind of creating a pathway for people to say The future doesn't have to be like, my future isn't the same as my present. And yeah, I don't know that I've ever fully made this connection in this way before, but that was so meaningful to me that I wanted to keep doing it more and find different ways to do it.
Meg Escobosa: That's very interesting because it connects also to the service you're providing to patients today. I mean, that's a very interesting notion. What would you say is the most important lesson you take from your experience at General Assembly that serves you now as you lead Brave Health?
Anna Lindow: Yeah, it's interesting to think about one, because I feel like I, you know, when you kind of grow up professionally and to some degree personally somewhere, you kind of, you learn a lot of different things.
Meg Escobosa: I can relate to that.
Anna Lindow: Yes. But that was the place, that was the situation and the environment where I became connected to the idea of doing work that really meant something to you and what that could feel like on a day-to-day basis, and how that could motivate you, and then being able to do that in a team. So maybe that's, you know, the thing that I take with me the most is just wanting to cultivate teams and be around teams and develop and grow teams that work on things that everybody cares about together, you know, working towards a shared mission because when that is happening, it's a really special experience for people.
Meg Escobosa: I completely agree with that. I grew up in my first job and built those kinds of relationships and was very guided by a mission, and so I appreciate your story.
Anna Lindow: I want that for people, and I think that was part of what. We were doing at GA was to say, we want people to find that in their careers. I felt like I was doing that there, so it was. It felt really special to say, “Hey, someone's gonna be able to go do a job that might really be just as special to them.”
Meg Escobosa: I think that the last couple of years with the pandemic people working virtually, there was an article recently in the New York Times. It was about, you know, “my work friends,” the sort of value of work friends, and it's a certain age, perhaps, I don't know if it's the age that we are when we have those experiences that make such a difference, but I feel for the young people who are starting their careers who had to kind of start virtually and you know, potentially miss out on what is all those sidebar, you know, not just the work meeting, but the things that happen in an office or that happen immediately after work, going out and spending time together. But we invest a lot of time in creating ways to connect virtually. And we've learned a lot about doing that as well.
Anna Lindow: We have learned a lot about connecting virtually, and that's something that's gonna keep happening. Gonna keep being important.
Meg Escobosa: I know you also started your career working in marketing and, and sort of getting the word out, helping to build a market for companies. That, of course, was a long time ago, or you know, at least 10 years ago. So I'm curious if there is anything, when you look back between then and now, what are the sort of enduring methods and tactics or lessons from, you know, how to effectively build a market for your business, help get the attention and draw your market to you.
Anna Lindow: I started my career in audience development and it was all about getting traffic to websites first in the media, and then I worked with startups doing the same thing. And it's interesting because when I started doing that work, I remember doing an internship in my senior year of college where one of the projects I worked on was to compare the search engine performance for the publication across different search engines.
The list was like, yes, Google, but also things that have been consolidated into other things. It was like a long list like Altavista and Ask Jeeves and whatever was on the list that time. And you really couldn't gain an audience through digital paid channels the way that you then could not too long after that. So there was, you know, social media was happening, but it wasn't, the paid social media wasn't the same. Like barely existed when I started doing this kind of work. And so you were coming at it through the lens of where is the community of people that I wanna reach now? How do I reach those people with this message?
And that's often, in my experiences, that was, they've done a lot through partnerships. We're really working with health insurance companies as important partners and we accept certain insurance. Right. And we're offering services to people who have that insurance. And we really don't do work where we're directly, you know, going direct-to-consumer and people are paying out of pocket. Like we don't really have that self-pay component. When people are congregating on the internet, they don't really do that around what health insurance they have. You know, you don't like hang out in a Facebook group with other people who have your same policy 1, 2, 3, 4, 5, you know?
So that concept of going to where the audience is, and partnering is part of what has led us down this path of working directly with health insurance companies and figuring out the best ways to reach people who need what we're doing together. That is an important principle. Looking for where the people you wanna reach are and figuring out how to use partnerships to help reach them.
Meg Escobosa: So Anna, we are coming to the end of the hour. It's been really lovely talking to you. I'm just curious, how do you continuously grow and nurture your own creative side and your own innovative thinking?
Anna Lindow: I get to work with some of the most creative, brilliant people, right? So, yeah, I like to walk and talk. I think that's one of the things that helps. So I have wonderful colleagues who are willing to, I'll be like, “I'm going on a walk, can we talk for a minute?” And that I think, yeah, my neighbors have seen me do a lot of walks around the walk, and they're probably like, “What is she talking about.” And if I gave them a lot of guesses, I think they probably wouldn't be like, I don't think they wouldn't, we get into a lot of different things, but I am so inspired by the people that I work with, by my colleagues, by our team, by. Our advisors and you know, the folks that are involved that constantly have creative and cool ideas and a lot of them. I get to hear when I'm gonna pick up the mail.
Meg Escobosa: That is awesome. It has been so nice to connect with you and hear about what you're up to with Brave Health. We wish you the very best as you continue to knock out more states. We want to see you come to California and we wish you the best.
Anna Lindow: Thank you so much. Thanks for having me.
Meg Escobosa: Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho, Medina Sabich, Wendy Nielsen and me, Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts.
It really does make a difference, and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions. Please email me at meg@thekrinskyco.com and you can visit us on the web at thekrinskyco.com.