Closing the Mental Health Care Gap with Amy Edgar
Conversation with Amy Edgar, Co-Founder & CEO, Blackbird Health
Closing the Mental Health Care Gap
June 5, 2019
1. What is your business?
Blackbird Health is a digital health company striving to close the care gap in mental, behavioral, and brain health for children and adolescents. Our focus is to provide immediate care to kids who don’t have access to behavioral health providers.
For many families, this means a six-month waitlist to meet someone, sometimes over an hour away. As with many things in life, isolation can lead to precipitous deterioration. We are part of the emerging telemedicine field and use technology to offer clinical visits and provide support to young patients. There are many ways to provide care or to help children who may or may not have a diagnosable mental illness, but who have a hard time engaging with peers or making connections. We can support kids with cutting edge and proven preventative care using communication technology like video calls and texts, clinical visits, diagnosis, best-in-class interventions, and prescriptions.
The offering is really exciting because, in addition to being a direct-to-consumer product that our patients can choose on their own, Blackbird can provide children and teenagers in geographically challenged areas of the country access to the most promising, up to date diagnostics and intervention through traditional referrals from providers, health systems and employee assistance programs.
For example, if a child has an issue, it might not require full psychiatric intervention. If left untreated or unaddressed by interventions, it may become a psychiatric problem. We hope to help before there is a true psychiatric issue and of course help once there is an identified diagnosis. Right now, there are many parts of the United States with limited access to psychiatrists trained to help children. At Blackbird Health we believe this is wrong and correctable. We believe all children and adolescents everywhere deserve access to excellent brain healthcare, regardless of location. My co-founder and I have backgrounds that uniquely qualify us to fix the problem.
Currently, Blackbird supports patients in Pennsylvania, and we are close to opening up in Virginia, Maryland and New Jersey. Due to medical regulations, telemedicine providers need on-the-ground practitioners in each state, so that is our gating factor in expanding.
2. What made you decide to start your business and/or switch careers?
My original focus was my company, Children’s Integrated Center for Success, a practice based on a 360 degree, holistic view of a child, combining clinical neuroscience and precision medicine. At CICS, we use every tool and proven research method to improve care. We use genetics to understand brain chemistry and the metabolism of drugs in order to get our patients on the right medication in the right dosage. For example, this is a big issue with antidepressant medication because it’s common that you end up trying one [medicine] and then another and another until you get it right through trial and error.
We are trying to understand our pediatric patients at the deepest level so we can get it right the first time. At CICS we are accurate with dosage and [medicine], 80% of the time. There isn’t great data about what the first time success rate is across the country, but it looks like the standard is 50%. We are also starting to get deeper into microbiome testing to understand how metabolism and exercise are related to childhood obesity, depression, anxiety and other clinical symptoms that have been traditionally approached with medication and counseling.
My co-Founder, Matt Keener, the psychiatrist behind several successful startups, and I were working in a parallel space and felt that we could help more families if we joined forces. It made sense to take the precision medicine and integrated care model I created and take his expertise in telemedicine and psychiatry and offer it to patients digitally. Matt and his team were also in development of a system of gap and on-demand care that is uniquely situated in the context of a child, adolescent or families life. This was the generator for the creation of On Demand Gap and Transitional care offered anywhere when there is a need.
3. Was there one moment that gave you the confidence that this was a good idea?
There is a framework for understanding human beings that were established by the National Institution of Mental Health called RDoC. It helps us understand the human brain. It’s not common to be fluent in this language in clinical practice, but Matt and I both were. The fact that we both have clinical fluency in RDoC allowed us to easily connect and create something together.
Also, in 2012, the IOM reported that it takes about 15 years for research to be put into practice. This is mind-blowing. As the parent of a daughter with autism, I’m not waiting for somebody to commercialize something that could help her now. If it’s evidence-based, with good science behind it, using a clinical RDoC framework, then we’re going to use it now.
Our patients and families are also of the same mind. We share with our family clients the opportunity to get involved in an experiment or test out a working model, and we spell out the process. It’s their decision to get involved. It’s also their opportunity to be part of something that may be immediately helpful to themselves and also to others in the bigger picture.
4. Were your family and friends helpful or obstacles in launching your business? How so?
They were enormously supportive in ways that I couldn’t have imagined. This company really represents every penny that my family had in the world. They agreed to embark on this journey with me. From monetary support to the emotional support is everything.
Along with the money came the understanding that I may not make it to something on a given night, that this company was a level of commitment that I had to make. There are a lot of things around me that demand more than average commitment since I have one kid in college and another with autism. It was important for us to be in a place where I knew they would be taken care of and have enough people around to support them, cook meals, get them to and from places, or keep them overnight. Everyone has been so supportive and helpful. I could never have done this by myself.
5. Were there any partnerships or advice that were particularly helpful?
The partnership and intellectual synergies with Matt have been really important. So have partnerships with other clinical research focused biotech companies. Also having access to open source data from Apple ResearchKit has allowed us to innovate without having a million dollars. I also have a trusted advisor who knows so much about machine learning and blockchain and this has been tremendously helpful.
Having a very strong female cohort of leaders around me has been so valuable. Lisa Maki has been instrumental in helping me think about intellectual property and development. Mara McFadden with LifeX has been helpful in developing my investor network as well as providing mentoring along the business side of this equation. Erin Keeley Moore is a patient advocate and has been a luminary in patient engagement and advocacy. She has helped me stay focused. She is really a soul sister because she has a child with Cystic Fibrosis. She keeps me focused on the mission of one child at a time, to remained human-centered. It’s about the human at the end of this. Everything has a different shape and form, but I wouldn’t have gotten to where I am without their help.
In terms of advice, Paul Farmer, the author of Mountains Beyond Mountains is my hero. His work has been formative and foundational, he’s really in the DNA of Blackbird in the sense that we are looking to build a community and help each and every person we can. We are committed to a journey with each child to help them find their way from within the community. So, instead of having psychiatrists everywhere, we need people in the community who can provide connections which is ultimately what is most important.
6. Was outside funding/cost a challenge to getting your business off the ground?
Matt bootstrapped his company and put all of his savings into the development of a system, the design construction, and the protocols for gap care. He worked on Blackbird for four years while also working a full-time job and created an amazing team who is committed to the idea of care. On the CICS side, my family invested over 2 million dollars and five years to get the clinical model, precision medicine protocols and integrated care delivery system solidified. We invested all of our savings and made some radical lifestyle changes to be able to do this. It has taken a great deal of commitment and risk tolerance for us to get this far.
Right now, we are evaluating funding options and determining the best strategy for moving forward. We’re looking at angel money, federal contracts, and grants. Right now we have a verbal commitment from an angel investor who believes in the mission. We really are trying not to take outside money or venture money until we absolutely need to. Of course, when we talk about accessibility and scaling, there is no way to do that without raising big money. Right now, we are looking at getting two million dollars to accomplish everything we need to do in the next year. Then we’ll be ready to raise big money.
7. What would be your biggest piece of advice you would give to yourself ten years ago?
Ten years ago, I was naive about the business part of things like business cycles, the status of the economy, and the bank’s willingness to lend money. I wish I had spent more time trying to understand those things. Part of me worked really hard on some of it, but unexpected things happen that you can’t predict like elections and infrastructure changes. I had a pretty high level of understanding, but I was overconfident, and I would tell myself to not be so sure of everything.
8. What was the best and worst piece of advice you have received as you were starting your business?
So many people have told me that our concept could be franchisable, that no one else is being this innovative. We have had many exciting, energizing, and heady conversations with brilliant minds of our time. And here I am a nurse practitioner, not a doctor or Ph.D., so there was this sort of imposter syndrome. Along with the really great conversations, there have also been some really deflating and grounding conversations.
Some of the best advice I got was during calls with investors. I had zero experience in that world, but early on I took a call with a regional investor who invests in small medical practices. He was really candid right away and told me that this concept was going to be hard to cultivate and that I had to be aggressively patient. I had to have those meetings and interactions and connections and conversations to find the 1% that would actually materialize into something real. You have to do both: aggressively pursue and patiently wait. I hadn’t really thought about that, but now I think about that every day.
That really applies to picking partners, collaborators, co-founders, advisers. There are very few people I actually trust and whose input I value. The tension is trying to be open and willing to take it all in, and also very selective.
Being patient throughout this whole process can be really challenging when you are under the pressure of running a startup. There was a lot of pressure for me when everything was out of my head: from the design of our space to diagnostic front-end to digitizing it. It was all happening and I was doing it all, living it all. Seeing it happen and knowing it would help families was the greatest joy. There is also so much pressure: paying bills, developing and keeping a team, refining the clinical model, helping cover patients, speaking at conferences—all of that comes with tremendous pressure and it will allow us to get to the next level.
9. Do you use social media for marketing your business?
I have made great connections on Twitter and LinkedIn. That might sound ridiculous, but it’s true. I honestly can’t say I would be doing any of these things if it weren’t for Twitter. Shout out to my #Pinksocks Tweeps!
I’m not native to the digital environment but as a professor for over a decade, part of my interaction with students was finding a way to create a community with digital resources. That was when I really embraced technology; it’s a universe where you can really reach anyone. Our goal is to target social media in ways that are native and important and necessary to the people we are working with.
We use social media and technology whenever we can, like tech-enabled texting and Zoom because they are HIPPA compliant and because it gives us access to any region where our families might be. One of the components of the Blackbird engine is creating community. So we’re using social media to curate and cultivate a community that provides wisdom, resources, and connections. This community is one we can learn from, and one we can teach as well.
10. What are your hopes for your business for the next five years?
There are so many like the tech build-out to reach a national scale. That is something I am really excited about because I know it will help families. We have divided the country into regions, and to be able to build out the infrastructure to meet the mapping is my greatest hope and expectation for the next five years. We have all the pieces and parts, we just have to put our heads down to put it together.
Our original plan wasn’t to build tech but to take the best tech out there and put it together in the way we wanted to use it. But right now, tech is still built in silos and there was no already-created platform that could do what we needed it to do. We had to start from scratch to build what we needed. That’s what we will be focused on for the next 18 months. Then scale.
Conversation Date: October 16, 2018
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