Digitalization of the counseling industry is disrupting an industry where you’d least expect it. Naomi Allen, serial entrepreneur and mother, founded Brightline – the online platform making counseling easy and accessible for families all across the US. Allen, inspired by her family's experience and pain points came up with the solution to digitalize the counseling industry. Brightline has fundamentally disrupted its industry and created a visualization for the progress a child makes in their health journey. It is the future of healthcare – paving the way for a more self-serve approach.
- Serial Entrepreneur and Family Challenges
- Steps After Needs Identification
- Caring for Kids is Multifaceted and Complex
- Reinventing Insurance Models in Healthcare
- Flexibility in Healthcare Support Services
- Disrupting an Industry is a Complete OverhauI
- Funding Before the Doors Even Opened
- Tips for First Time Entrepreneurs
Mimi Maclean: Naomi Allen started Brightline because of the challenges she and her family faced on her son's behavioral health journey. Together, Naomi and her team are re-inventing pediatric behavioral health care with technology science backed care and focus on family all to help kids and their families thrive. Naomi is a serial entrepreneur that has started several companies and taken one of them public. I'm excited to hear about her new venture Brightline. To get your top 10 tips, every entrepreneur should know, go to The Badassceo.com/tips.
Naomi, thank you so much for coming on today, and I'm really excited to hear about your story, just from personal experience, I do think it's a much needed service that you're providing. So I would love for you to just touch upon how you came up with the idea. And once you came up with the idea, where did you start?
Serial Entrepreneur and Family Challenges
Naomi Allen: Great, thanks so much for having me, Mimi, it's a pleasure to be here. I'm a serial entrepreneur. This is the third company I'm involved in as an early stage venture, so I founded a company and then was there for eight years in my last couple of years was involved in building and growing our behavioral health offerings for adults. Then I actually bootstrapped a company for couples therapy, so using technology plus virtual care telehealth sessions for couples. And then I shut that down.
My husband went to a series A company and I needed to go make some money. So I shut down my bootstrap company and went to another company that's in the digital health space before that company went public Livongo, and I was responsible for a bunch of things, including integrating an adult behavioral health offering, so I had three times being involved in adult focused behavioral health.
The third time, while I was helping to grow that company, my oldest son who is, was five at the time, had a pretty acute onset anxiety, Generalized Anxiety and had a number of things happen as he entered kindergarten that made it evident that he had some developmental delays.
As parents, we were thrust into what I call the gray zone, which is, is this normal? What do we do about it? Where do we start? Does our son need clinical support? Will he get school-based services? Kind of all the questions that families ask when they're first navigating pediatric behavioral health, made a little bit complicated by the fact that my husband's multi-racial and so, and didn't grow up in the United States and grew up in an Asian culture. So we both had these very disparate kind of family perspectives and beliefs around the role that therapy can play for kids. Do you talk about that openly in a house? Do you talk about it in front of the kids?
We went through this journey as a family, trying to get high quality care, and we also have two younger kids and felt like I just felt as a mom, that sense of guilt of I've got my career, I've got a lot of time on trying to dedicate, to getting my oldest son into the type of support he needs. My other, I mean, my twins weren't getting the type of like my time and attention that they needed. It just became really clear that the system for pediatric behavioral health is pretty broken, kind of at every turn. It's very expensive.
Half the counties in the country don't have any mental health providers at all. We've got a huge racial and diversity inequity in terms of affordability and access to high quality care. As a mom of three kids, as an entrepreneur, as a serial entrepreneur, within the healthcare space, it became the thing that was just most obvious that I needed to go work on. So here I am.
Steps After Needs Identification
Mimi Maclean: Okay. That's amazing and it is much needed. Okay. You have this great idea. Obviously you had some experience already in the field, especially as far as developing an app and the technology behind it. So what was your next step? Did you find it other team? Did you do it on your own? Did you outsource, did you raise money?
Naomi Allen: The gentleman that I founded a company with in 2008 and worked with for years, he was also a personal friend before that he and I founded the company together. So we're both serial entrepreneurs and we're repeat co-founders, which I think makes the fundraising process a little bit easier because people kind of know what that dynamic is, and it's a very stable relationship.
We approached a person who had funded our previous company. That all came together nicely. We got venture funding from day one. As part of that, the team that we took an investment from this very well-regarded healthcare investing team, they had a junior partner who was really passionate around behavioral health. He sort of managed to negotiate like, "Hey, will you give us seed money? But also just as importantly, can this partner be part of our team?" Because I knew that he would add a ton of value for answers.
Market research for validation
It was basically the three of us spending time together. The first thing that we did was market research was basically talking to families. I had mapped out a set of pain points of problems that I wanted to solve for my own family. We wanted to validate where those pain points common.
- What were the real problems that other families face?
- What were the problems that kids face?
- What were the problems that the people who pay for care from a health plans, perspective, or employers, what do they face?
We spent a lot of time doing, what I would consider to be essentially problem mapping or pain mapping, and then working backwards from that sort of standing up ideas of like, if it looked like these two products together, or if it would buy these clinical services, how would that resonate with you?
So it's just, as one does a fair bit of market research, we were fortunate in that we were able to do that by sort of grassroots conversations with families who either were in treatment or had not been able to access treatment, getting treatment through their schools.
Listening to the whole ecosystem
Then we also went and talked to insurance companies, we went and talked to employers, so we kind of went on a tour of the whole ecosystem to hear, is there a common ground if we build solutions kind of, how do we help create high quality, scalable, accessible, affordable care for families and build that in a way that allows us to get that care paid for by insurance companies on a network basis, which is, I think been one of the historical big challenges in this industry.
Mimi Maclean: And when you were doing that market research, did you find that there were any other competitors?
Naomi Allen: I think that there's really not. If you look at kind of how behavioral health is provisioned for, for kids today, there's kind of three buckets, there's mom and pop solo practice clinicians that typically operate out of networks. So there's almost no reimbursement structure. They typically don't have much of a technology stack. So you don't know, like it's hard to even schedule appointments. You have to sit on the phone and wait lists.
The kind of the type of care that we're delivering, which is a pretty big reinvention of the whole care delivery model is telehealth care for kids, but it's wrapped the whole technology that allows families to engage in the care.It creates a visualization of the measurement of how care is progressing. There are coaches that you can ask questions of. There's coordination back in school systems. So the mom and pop practitioners, they're individuals in their own private practices.
They don't really have a way of scaling the type of support that families [inaudible 00:07:55] involved and engaged. They don't have a way to scale what we call dyadic care, which means parents or caregivers plus child that dyad is involved in the journey. Dyadic here, treatment outcomes are about twice as effective as care if you just support the child, you just have the child in treatment, but it's really hard to scale dyadic care without robust sophisticated technology. So [crosstalk 00:08:16]
Mimi Maclean: …nobody's doing it, technology-wise, you're the only [crosstalk 00:08:19].
Caring for Kids is Multifaceted and Complex
Naomi Allen: The other model, the other sort of big aha, big market insight was that for kids much more so than adults care is multifaceted. So if you have a kid with ADHD, they're very likely to also have anxiety. So that kid may need behavioral treatment for their anxiety, occupational therapy or executive functioning treatment for their ADHD.
Then they might need medication depending on whether that's clinically indicated. So in that case, you would in a perfect scenario, have three different people involved in that care team, but that almost never happens today. Families go to the first place to get off a wait list. Maybe they're starting with a behavioral therapist for anxiety, but they never get the ADHD under control, or they start with the ADHD, but the kid never gets the medication for anxiety.
So the ADHD treatment is not very effective because the kid's so anxious. Right? And so the other sort of big market insight that we had was like, we need to have multidisciplinary care teams. You come to us, you don't actually have to know where to start. We're going to map that out for you and create that [crosstalk 00:09:18] with the right clinicians in the care team based on what you need.
I think the other sort of really big insight was most care isn't delivered in a multidisciplinary way. And so you'll go to see a therapist, you'll go to see your primary care doc. And they have one tool in their lever, right? Your primary care doc has medications in their lever, right? That's the thing that they can give you. They can't give you behavioral therapy or you start behavioral therapy. And it turns out you actually also need medication.
You can sit for six months on a wait list to see a psychiatrist. So by bringing all those disciplines together on a shared clinical record and having those care teams operate as one team, it just allows us to create all that, like reduce all that hassle factor, like trial and error, going to the wrong doctors for the wrong stuff. And that doesn't exist anywhere really at all.
Mimi Maclean: That's amazing. So you don't just deal with behavioral health, you also deal with like an academic and you do both. You do all three, not just behavioral.
Naomi Allen: Well, when you say academic, we support families whose kids are dealing with developmental delays, [crosstalk 00:10:20] so whether that's a speech, language challenge, or kids that have social communication challenges, like speech delays, social [inaudible 00:10:28] communication challenges are two of the more common ones-
Mimi Maclean: Like dyslexia and ADHD, do you do that?
Naomi Allen: There's a whole bunch of domains around occupational therapy that we don't support. There's stuff around like my son had sensory avoidance, so some kids are seeking some are sensory avoidance, so we haven't launched those protocols yet, but they're on the to clinical roadmap.
Mimi Maclean: That's amazing. Okay. Great idea. You did your due diligence and your market research. Now your business model, is it all dependent on the insurance companies at this point? Is that how you're getting paid?
Reinventing Insurance Models in Healthcare
Naomi Allen: Well, we're trying to, I think the challenge is, one of the industry challenges in behavioral health writ large, is that there's, I'd say a kind of a fundamental shift underway, globally, not just in the US, but globally where it used to be that nobody talked about mental health, right? Like 25 years ago that we never would have had this conversation. My company wouldn't have existed.
When I started in healthcare in 1996, so, 25, almost 25 years ago there was the Mental Health Parity Act, which meant that the insurance companies were required to create networks, and to create reimbursement for mental health. But I think what happened was there were many cases what's called a shadow network, which means that, in theory, if you have an insurance company, then there's payment for the services, but they pay so little to the therapist that most therapists don't even bother.
Like they don't even bother to be a network. So what we're trying to do is drive forward a new dialogue with the insurance companies to say, look, we're going to do all the types of things you want.
- We're going to measure care effectiveness.
- We're going to track each week, how the child's progressing. So they're not in treatment forever.
- We're going to get them out of treatment when it makes sense to move them in the maintenance.
- We're going to give you transparency into what our quality measures, what's our evidence-based protocols.
- We're going to do all the stuff that care is supposed to do to help kids get in and out of care effectively, reduce wait times, et cetera.
In exchange for that you need to reimburse us at a rate that allows us to pay our clinicians a living wage. So that's the contract we're trying to set up with health plans. It just takes a real journey to get [crosstalk 00:12:32]
Mimi Maclean: While you're waiting, are you charging or is it just out of pocket at this point?
Naomi Allen: While we're waiting, we're cash pay. We're supporting families in California right now in [inaudible 00:12:40] model. We're launching five new markets in April, we'll be across the country by end of year in 50 States. So we'll be across the country and working [crosstalk 00:12:49] in network for insurance.
Flexibility in Healthcare Support Services
The other really big aha that we've had is that I think the way that the industry has evolved is, in some ways, unfortunately kind of stuck in this very monolithic mindset where if you need care, you go to a licensed therapist or a licensed prescriber or a speech language pathologist, or an occupational therapist. And we all know, as I just talked about kind of the challenges there with lower reimbursements means that people pay a lot of money out of pocket. There is a very clear set of scope and domains that could be done by coaches with training and protocols that are very effective.
It's not therapy, but it's skill building. The example, the big difference that I always talk about is if you have two families right now with a 14 year old at home, that's got disruptive behaviors, disruptive sleep patterns. And that 14 year old comes to us. Some of those families might actually have a kid on their hands who's got anxiety or depression. They need a six month treatment protocol. They might need medication, but some of those families need four coaching sessions to kind of steady the ship, so to speak.
The first session is for the parents or caregivers, where you spend 30 minutes talking about how to talk to your teen about their sleep hygiene, without them slamming the door on your face, how to set up better habits, and patterns around evening routine to get the sleep back on track, what to look for for signs of depression.
So that's coaching session one. Coaching session two is for the team themselves. It's a parallel conversation. And in coaching session three is making a plan with the parents and the team together. So for the next month, we're going to measure these things. We're going to look for these signs of improvement around sleep hygiene, around disruptive behaviors. And then a month later you have your last sketching session and you're checking in on that plan and calibrating it and setting up a reward system.
That's four 30 minute coaching sessions that span about seven weeks. That's very effective for a lot of families, they never need a six month protocol for depression. And so what we're doing is we're layering in two products in addition to our clinician model one product is what we call Brightline Connect, which is content journeys, webinars, small group classes for parents and kids.
It's really intended as a scalable self-serve solution. Coaching, which is short duration, skill-building telehealth, virtual care visits, but with a coach and then for people who need it, Brightline Care, it's reserving that clinical capacity that's expensive that is evidence-based reserving that really for the families that need that, but giving them alternatives if they don't need that level of care. And so what we're doing now is creating an end to end continuum that meets families where they are. [crosstalk 00:15:27] …it creates options for them. We can guide them into an option and they can help self-select the options that they want as well.
Disrupting an Industry is a Complete OverhauI
Mimi Maclean: That's great. Now, what part has proven to be the hardest thing for you at this point?
Naomi Allen: I think the thing that's frankly, hardest is just the monumental change that we're trying to lift in the market, right? It's not just that we're trying to get reimbursement rates the right size to support care. It's not just that we're taking all these protocols and this care delivery that used to be delivered in brick and mortar clinics and scaling it for telehealth and creating digital exercises that families can practice. It's that we're also launching this continuum of care with the Connect platform plus coaching plus Brightline Care. It's a complete overhaul in the same way that [crosstalk 00:16:12]
Mimi Maclean: You're just disrupting an industry pretty much.
Naomi Allen: Complete overhaul of the care delivery system and the same way that, if you look back and you look at like a Lyft or Uber relative to the taxi industry, right? It is disrupting an industry! There's no incremental change there. It's completely break apart the way drivers are paid and the technology stack and the way you attract riders and the service model around delivering food, as well as passengers, like it's a complete industry change.
So what we're doing is a complete overhaul of a care delivery system, but you have to do it in a way that is incredibly clinically sound supportive of families contextually appropriate, so you've got privacy infrastructure, data privacy for teens and adolescents, right? You're doing that in healthcare, and so it's even more important to really get it.
Building the brand
Mimi Maclean: Right. Right. That makes sense. Now, how are you getting your name out there and building your brand to attract clients?
Naomi Allen: Yeah. I think we've been really fortunate just to have an incredible tiny, but mighty marketing team. They've done a really nice job, but I'd say more grassroots organizing and press and brand building, but we also have been really fortunate. We launched, a handful of months ago, the first and to our knowledge, only indicator tool that allows families to evaluate their kids' behavioral health wellbeing as a result of COVID.
Impact of COVID
We all know that during COVID the incidents rates of pediatric anxiety, depression, isolation, suicide risk have doubled in some places, tripled, ER utilization due to mental health crises is 30 to 40% higher for kids than it was before. So we know that we're in a time of acute challenges and crisis for families. And I think most clinicians believe that that wave is actually just growing now, so we have a coming wave of pediatric need for behavioral health services.
We created an instrument, that's got four parts it's called CBHI, it stands for COVID Behavioral Health Indicator. And we rolled it out with 30 partners that are nonprofits, hospital systems, health plans, the Mental Health America Association just rolled it out to all of their partners. So I think what's been really great about CBHI is it's free and it's in the hands of families. And they're using that to evaluate what's going on with my family is my child [inaudible 00:18:25] need of behavioral health services as a result of COVID.
I think that that sort of public service aspect of our business has just really given us a lot of halo effect. And we've gotten hundreds of hundreds of responses there and it's just been tremendous. I think CBHI has been a really powerful way for families to evaluate their needs. And then we do a lot of partnership based outreach with schools and primary care providers [inaudible 00:18:48]
Mimi Maclean: Has it been pretty easy to get providers to come and doctors to come on board?
Attracting clinicians to join
Naomi Allen: Clinician recruiting has been really interesting. I would say it's gotten easier, certainly, we've kind of figured out what are the things that matter to clinical staff in terms of flexibility and supporting them and how do we develop that recruiting brand and how we talk about what's unique about our model, but I'd say we've also just been super fortunate because we've had a lot of clinicians come to us and say, I've been in private practice, and I know that there is all kinds of things I can never pass to parents because they're not digitally enabled or there's all kinds of coordination with their schools that I don't have time to do that a coach could do.
That there's all kinds of services that I'd love to refer them into, but I don't have a place to refer them to. And so we've had a lot of clinicians just validate like the vision of what we're doing, what we're building, the multidisciplinary care teams, the coach led coordination, the digital exercises and family interventions, the way we measure outcomes of care.
That that model is exciting for them because these are people who are in it to change families lives for the better, right? Our clinicians are just remarkable human beings. Every Friday as a team, we come together and we hear the stories. We hear their personal journeys, quotes from families we're serving that week. And each one of them is there to make a huge impact in the world.
I think it's exciting to them to get to partner with a company that can scale that impact. Right? If you think about this time at the end of the year, well, if things go well have about 80 clinicians across the country. One of the things that we're doing is talking about each of those clinicians comes with a very specific set of backgrounds and skills and domain.
One example, a woman, I was interviewing in Massachusetts that we've just recently hired. She has a real background in supporting families that don't kind of look like a cookie cutter family. Kids that have a double military parent, and so half the time they're with one parent, half the time with others. And it creates all kinds of family, dynamic challenges like kids that are raised by foster parents, or you've got a situation where one parent is incarcerated, right.
Those families have very specific needs around how to run the relationships when you've got a child with anxiety, who's got a parent who's incarcerated and you've got one parent or one grandparent as the primary caregiver. And so there are these amazing clinicians across the country now that we're starting to source, okay, like how do we stand up a training just for all of our clinicians specific to that content and that need, and that domain of knowledge and expertise, right? It's so exciting to see, as we expand our clinician network, it just also turbocharges the type of care and programming and content and resources we can provide to all of our families.
Funding Before the Doors Even Opened
Mimi Maclean: That's great. Now you're, I'm one of the first CEOs or founders that I've interviewed that actually had funding before they even opened up for business before they had their first sales or their app was built. Can you talk a little bit about that with the valuation, if you don't mind, as far as like, you don't have to give me the numbers of that, but like, it's interesting, because usually when you go for outside funding and you're going for their valuation, you have some kind of a background of like what your sales have been and attraction of your product, like you're right off the bat.
I would assume that your valuation is based on what your background was and what you were bringing to the table with your team, but big picture, how did you come up with the valuation without even having you for sale?
Naomi Allen: Yeah. It's a great question.
It's just so much art, not science at that stage. I think, to your point, it was the scope and magnitude of the vision. What's nice about our industry is pediatric behavioral health, and there are very established adult behavioral health companies. So our investors could sort of map out like, "Okay, if you hit these milestones and the journey, here's what the valuation would be two years now, five years now."
That's still, I think, we get a lot of that. I just had an investor, prospective investor, call this morning and I could see her doing the mental math of like, "Okay, if you hit that, then you're going to be valued there in your next round", right? They have analogs, even though we're pretty different business there aren't analogs that they can sort of relate to.
I think, for so many entrepreneurs I think that there are other ways that you can essentially defer the challenge of establishing valuation pre-launch. I think a lot of that… I think of the company I bootstrapped, I was looking at funding around using a safe instrument rather than using a priced round for my seed round. [crosstalk 00:23:18] …essentially differs the valuation until you've got a little bit more proof points underneath you.
We were fortunate in that we priced our round was a seed round, and then we subsequently raised another round of financing this summer, so we raised twice: once at inception, once about seven months later. They were both priced rounds, but I recognize that that's pretty unusual, certainly for most first time entrepreneurs, and first time founders, I think it's hard to get a price to see [inaudible 00:23:41] and so safe is a perfectly good instrument.
Then frankly, Angel Investing, I think there's a lot of really talented angel consortium now, individual high net worth investors that are comfortable with joining [inaudible 00:23:53] brown. And I think that's a good avenue for a lot of entrepreneurs as well.
Tips for First Time Entrepreneurs
Mimi Maclean: That's true. That's great advice. Any advice that you would give someone starting out or a first time entrepreneur that you wish you knew the first time out?
Naomi Allen: I think it's really context specific when I started entrepreneurship, I wasn't married, didn't have any kids wasn't dating my now husband. And I think it's funny when we took my first company public in 2000, gosh, what year was that? I should know the answer, I think it's 2014, we took my first company public.
I was on the floor of the New York Stock Exchange and they have like this kind of roaming camera crew that goes around and like interviews the executives and they live simulcast it back to your home office. So I knew that they were hundreds of people and their spouses and maybe even kids there to celebrate our IPO. And so as I was getting interviewed on the camera, I said for those of you at home in the office:
look to the person to your left and the person to your right and just thank them, give them a big hug, because entrepreneurship is inherently a selfish journey.
I think surrounding yourself with folks who are really in it with you as your team and your squad is so important whether you're bootstrapping and you're using your own funds or your in-laws funds or your family's funds, right. That is inherently risky. And it's placing a bet on you and your beliefs and your capabilities, whether you're raising a venture back company, as I have in the, in my last ones, when things are going well, you're just going to be incredibly busy because the pressure to grow the business for venture back is just incredibly hard and if things aren't going well, you're going to be distracted and worried about company.
Surround yourself with people who love you
And so there's no world in which entrepreneurship is not an inherently selfish career path and it's incredibly rewarding and thrilling. And it brings you into incredible personal growth and surround you with a handpicked set of folks, if you're lucky that you get to work with that you learn from and grow to admire and respect and love, but it is a selfish, selfish journey. And so the advice that I give folks it's just surround yourself with a squad of people who love you, and trust you and are there for you as [inaudible 00:25:54] partners in that journey.
Mimi Maclean: That's great advice, no it's true, right? Because it's 24 seven, you're your own boss. You have your own hours and you're in charge of your own destiny, but it never turns off. Right? All weekend long, all night long, you're dealing with fire drills or your mind's always thinking and distracted or…
Naomi Allen: In times of growth you're growing the business in times of dearth, you're worried about the business, right? There's I think very few things other than maybe early Parenthood, that are quite as consuming as growing a company, so.
Mimi Maclean: Naomi, thank you so much. This has been amazing. I wish you the best of luck. I really think this is a phenomenal idea and I think it will help a lot of children and I think it's a much needed area, especially now with what's going on with COVID and mental health. And I'm glad that people are starting to talk about it a bit more, but it's a much needed conversation. If anybody who's listening and wants to learn more, you go to hellobrightline.com to learn more and to use their services. Thank you so much, Naomi.
Naomi Allen: Thanks, Mimi, great to be with you.
Mimi Maclean: Thank you for joining us on the Badass CEO. To get your copy of the top 10 tips every entrepreneurs should know, go to the badassceo.com tips. Also please leave a review as it helps others find us. If you have any ideas or suggestions, I would love to hear them. So email me at Mimi@thebadassceo.com. See you next week and thank you for listening.