Aligning Incentives

Teresa Chahine (TC):

Welcome to Impact and Innovation. I'm Teresa Chahine, and I'm inviting you inside my classroom at Yale School of Management as we grapple with questions on social entrepreneurship and impact.

TC:

Welcome back, everyone. This is the third episode of the new season of Impact and Innovation, and we are transitioning from the first module of my public health entrepreneurship course, which focused on drivers of health like food as medicine, to the second module, which focuses on capitalism and health equity. And we're asking the question to what degree and how do current capitalistic frameworks like venture capital fit in with our health equity goals? And so to help answer that question, we're gonna have three amazing women entrepreneurs in the next three episodes. The first is Sofia Noori, the co-founder of NEMA Health. Thank you so much for being here with us today, Sofia.

Sofia Noori (SN):

Thank you, Teresa.

TC:

I have so many questions for you, but first, just share with our listeners what NEMA Health is and what you do.

SN:

Yeah, I'm happy to do that. So I am a psychiatrist by training, um, and, um, have always been really passionate about trauma and PTSD, which is what NEMA focuses on. So we're, um, a tech enabled services clinic that focuses on treating trauma survivors with, um, trauma, like evidence-based treatments for trauma and stress related disorders. Um, uh, I'll pause there.

TC:

Okay. I'm gonna ask you more about how it works. Okay. But first I wanna rewind because something that you said in class really stood out to me, which is that you went to school at UC, Berkeley, and you were very like grassrootsy and socially oriented and working on like organizing and movements.

SN:

Yeah.

TC:

And then you went from there to clinical work. Mm-hmm

SN:

<affirmative>.

TC:

Doing your residency at Yale and from there to raising 19 million in venture capital. So tell me more about like each phase and you, how you got from there to here.

SN:

Yeah. Yeah. I'm happy to. Um, yeah, and, uh, and, and, and, and also just give you like a, a little sense of my background and like why I'm so like, passionate about this too. And then go into all of those, um, all of those pieces. But I, yeah, I've always been like very interested in mental health and like, like psychology. Even before like going to college, um, my family survived the Vietnam War of Refugees here. So I grew up hearing about how like intergenerational trauma had affected them and also me. And then unfortunately was, um, uh, assaulted in college and developed PTSD and um, uh, was like, yeah, then got super fired up about, about it <laugh> and about how we care for trauma survivors or not. Um, but, um, when I was, I went to, I'm from the Bay Area originally, so went to college at Berkeley, was always really interested in like, um, uh, social impact.

Lived in a co-op for five years when I was at Berkeley, um, both in undergrad and then back in grad school. And so, was really interested always around like how we just like, sort of build better societies, um, was very like idealistic in it. And then, you know, then I got assaulted, developed PTSD and totally thought that I was like, screwed. And that like, my life was like irrevocably changed and I had this like, scarlet letter. Um, and then got like extremely, I would say, angry <laugh> about how we treat trauma survivors. 'cause it's, you know, the, the, the, the traumas that are most likely to cause, uh, PTSD or actually rape and domestic violence. Um, and, um,

TC:

I always thought of PTSD as like combat veterans or something.

SN:

Yeah, exactly. Yeah. And, um, and I think that's what most people think of when they think about PTSD. And so, to be honest, I didn't even think I had it because I didn't think I could have it because I didn't go to war or like, you know, it wasn't a combat veteran. And so, um, I learned like so much, uh, from like, sort of like just, um, just like sort of like increasing my consciousness around like trauma and then became a rape crisis counselor after college too, um, um, at the YWCA in Silicon Valley. Um, so that was all really, I, I mean, it was just super high eyeopening to just see how like, um, how like deeply raum informed like most systems are, and like really trying to think about like how we can, like, how we can like fix those. But at the time, like I was, you know, a 21-year-old kid, like, with very few like, sort of like systematic tools at my disposal. So it was just helpful to like, get involved and just see how things work too and try to be part of a solution.

TC:

I'm just digesting this all and imagining your journey. And then it sounds like that first part of your journey was really about your exposure to the problem mm-hmm

SN:

<affirmative>.

TC:

And about how current systems are not built to really support survivors and being a survivor yourself. And then you moved to Yale for your psych residency. And so then what happened after that? And how did you end up here as a venture backed entrepreneur? Yeah.

SN:

Yeah. So I, so, so like after, you know, um, I was definitely like a very passionate young person in general, right? Mm-hmm <affirmative>. And so I think what was really helpful before I came to residency, or like started NEMA, was I started to learn a lot about how systems work and how to like affect change in systems. Um, and I think, I think like, especially as like a young person sometimes, you know, you just wanna like burn it all down. <laugh>, proverbially and like start over.

TC:

Oh, one entrepreneur who sold from last season, Rashika Fernandopulle, who started Oh, I know Rash. You know him? Yeah, yeah, yeah. He's, so he started IRA Health

SN:

Yeah, yeah.

TC:

Which sold to one Medical Yeah. Which sold to Amazon. And he was talking about the movement he wants to be part of which is shifting from fee for service to value-based care. And he quoted Mother Theresa, if I'm not mistaken, who said, or maybe it was Florence Nightingale, one of these like epic change makers Yeah. Who said, you know that every 10 years we need to burn all the hospitals down. And um, you know, to just like cleanse the bad rumors that had, um, humors that had accumulated there and start from scratch. And he felt the same way about the US healthcare system. <laugh>. <laugh>. That's so funny. So not alone.

SN:

Yeah. Yeah. Well, and that's also probably why he was able to build something, like, to build something new in like a legacy infrastructure is so hard to do. So I have like a ton of respect for him for doing that. And I

TC:

Well, that's what you're doing now.

SN:

Yeah. Well, one thing that he, when I talked to him, I, I can't remember when he, he was still, he still sees patients, you know, in his own companies, which I think is like so powerful. I still do too. Um, but anyways, I, I digress <laugh>

<laugh>. So yeah, it's like, that's how, um, I think a lot of us feel about how like the healthcare system is right now. It's like so broken <laugh>. And so I spent a lot of time just like trying to figure out like, why, like why is this what we have? Right? And I also like really like taking care of patients. Like, I like being around like patients and it's like, like hearing their stories and like doing what I can to help. So I went to medical school, um, and before I went to medical school, I actually worked at a healthcare innovation center at Stanford and was like an administrator there. 'cause I was like 21. But I learned so much. 'cause what they did is design value-based care models. And so this was like in the early innings of like healthcare innovation, like after Obamacare and was so, so like, just, it, it made such a big impression to me to like learn about what the triple aim is, which is like, you know, the goal of like improving outcomes, quality and satiSNaction and reducing costs too. 'cause it's the quadruple aim, but still. And then, um, uh, thought I wanted to do something innovative in healthcare at some point. Um, then went to medical school at UCSN, which is known for being very, like, involved with community, like, um, and I was part of a, a dual degree program there called Prime, which stands for program in medical education for the urban underserved.

Um, it's a dual degree program for students who want to be heavily involved in communities, especially for underserved populations.

So we used to like, take literally like tours of neighborhoods with community leaders, learning about like what are the, what are the big health issues like in that community. Um, and you know, what the community was also doing for itself to like improve some of these issues too. Um, and we would take tours for different neighborhoods, like all around the Bay Area. And so that also really impacted me too because I was always very much like if I was going to be an entrepreneur, there had to be some sort of big social impact to it. Um, uh, and, uh, I didn't know what it was gonna be, but it was like extremely important to me that I felt like I was like a servant leader.

TC:

And it sounds like you got your medical degree with that in mind of

SN:

Yeah.

TC:

Of both treating patients and designing an innovation to improve the healthcare system.

SN:

Yes. Yeah. And I like, um, severely disliked medical school <laugh> because it just, I mean, you really get like exposed to like how the sausage is made. And like some like, I mean, I, again, like healthcare is not pretty, especially in the United States. And it was also like very personally, I felt it like it was very personally dehumanizing. Um, because there's like so much moral injury that occurs. Right. Oh, wow. And like, not feeling like you can do what you need to do for your patients. You really see all of the different types of health disparities, you know, in medical school. Um, and so I was really grateful. Part of the, the program that I was in pays for a second degree. So I got my master's of public health at Berkeley, was able to take a year off and like breathe a little bit, learned a ton about public health and like entrepreneurship and stuff like that. Um, and then was able to like come back to med school and actually like re like I, I think I stopped missing the forest for the trees Yeah.

Was able to like, see that I, I do really love taking care of people and that brought me to a psychiatry residency.

TC:

Okay. So now tell us about how the idea for NEMA Health formed and the nuts and bolts of how it works.

SN:

Yeah. So, um, so I, so as part of like me forming this idea, like, so I had also some background in, in consulting and like, on like innovation already. So, um, I had like worked at a number of different startups when I was in San Francisco and then consulted for startups when I was at Yale too. And then, um, also was, uh, my, my co-founder slash friend is a child psychiatrist. And um, and also came from like a similar like, like entrepreneurial like background. Um, but also like we COVID happened when we were in residency. So basically we were back on the COVID wards and our coping skill during COVID was like to think about different areas in mental health where we really thought we could make an impact like post COVID. Mm-hmm. And we kept thinking about the fact that like, honestly like trauma and P ts D is like the next pandemic because we're constantly traumatizing people as a society <laugh> unfortunately. Yeah. You know, and like who's doing anything about it? Like, where do these patients go? And people think that these patients are going to existing mental health clinics and getting the right treatments. But as a psychiatry resident, I knew that that was like not the case because

Well, so, um, rotating through all of the different settings, like people don't realize that there are treatment guidelines for every condition, right. For a depression or anxiety, like generalized anxiety disorder, like PTSD. Right. And what we saw was that the biggest disparity between what is actually written in the treatment guidelines and what people are actually getting is in PTSD because there's so much, I think there's like a lot around PTSD or trauma that like people think is intuitive, but it's actually like really not intuitive and not following the treatment guidelines. And um, like for example, I think that people, and this is part of like the symptoms of the condition is like once you have PTSD, you sort of think this is like lifelong and you're screwed and like you're not gonna get better and your life is like irretrievably broken. Right. And um, then what happens is when you, um, when folks go to see a mental health specialist, most of them are not, uh, trained in actual trauma therapy, like cognitive processing therapy or prolonged exposure or EMDR. Right. And there's a difference between trauma-informed therapy and trauma therapy.

TC:

Right. Right.

SN:

So a trauma therapy is an actual protocol of, of treatment for PTSD that takes about 10 to 15 sessions to complete and can lead to permanent recovery. That we know that from the data. Most people get informed talk therapy, which is you, you meet with someone once a week, you, um, they ask you about how your week was and they support you through whatever's coming up for you right now.

TC:

And the informed is just like, oh, they're kind of sensitive to your situation. Exactly. But it's not a specific therapy to heal.

SN:

Exactly. It's not a specific protocol. Right. And so what happens is people sort of get stuck where they're not actually getting trauma therapy. And the research shows that if you, um, uh, if you see, um, a clinician, it takes about six years to get diagnosed with PTSD and it can take two or three more years at least of talk trauma-informed talk therapy to see an improvement Hmm. Which is like eight or nine years. Right. And so that's why it feels really permanent to people is like, 'cause they're just not getting better.

TC:

Mm-hmm.

SN:

But that's also because they're not actually getting a treatment. So there's like, so that people are in treatment, but they're not getting the treatment. Right. And so this like really drove me like up a wall.

TC:

Yeah. This just seems like a really,

SN:

It's super confusing,

TC:

Missed opportunity to keep people.

SN:

Exactly. And it's so confusing for survivors too, right? Like they're just trying to get help. Right. Um, and so if you're not aware that there's treatment guidelines, then um, then, then you're not gonna figure this out. And then, and also even if you are aware that the likelihood you're actually even able to find a therapist who can do trauma therapy is like almost zero. So like I mentioned this in the class, but I worked at the, at a state run, like one of the largest like state run clinics in Connecticut. We had like a hundred, 150 clinicians. None of them were trained in trauma therapy mm-hmm <affirmative>. And we were seeing like thousands of patients and like frankly, like a, a huge proportion of them had trauma like in PTSD. So people just languish and then,

TC:

And P-T-S-D-I just realized we didn't define it. Yeah. Maybe not everyone knows it's post-traumatic stress disorder, which Yeah. Unlike many diagnoses is not a misnomer. It's like self-explanatory. Mm-hmm <affirmative>. Post trauma stress disorder, <laugh>, like you, I'm, I'm thinking about how important that is for all the comorbidities and downstream effects.

SN:

Yeah.

TC:

That trauma will then cause on your life and your health.

SN:

Exactly. For your, because it's a stress condition, right. It's like being in fight or flight all the time. Right. Um, being scared that, you know, something else will happen to you, blaming yourself for what happened to you. Right. Um, avoiding triggers, um, having flashbacks, emotional people, like emotional or physical re-experiencing symptoms of something that brings you back to that moment or those, those series of moments. So yeah, it's, um, uh, uh, it's one of the only conditions where people can point to the day when their symptoms started. Um, which I think is like very powerful because also it's extremely treatable. Like I actually think it has a really good prognosis compared to other conditions, um, because the therapies are so good. Um, but they're extremely not well disseminated <laugh>. It's really hard to find people who are trained in the trauma therapies too. And if you do, they're probably cash pay. Yeah.

TC:

Okay. So, um, now we have a sense of the problem and how you came about to creating the solution. So while you were implementing it, you shared that you looked into some different models to get it up and running, right? Mm-hmm <affirmative>. Like grant funding, small business innovation rounds Yeah. And ended up with venture capital. So tell us more about that. How you ended up with venture capital and what it is about your model that made you eligible, that made it work, and also that made you need it, like it was the best fit for your success. So tell us more about that.

SN:

Yea, happy to do that. And, um, yeah, and we, we spent, so Isabel and I spent like, um, my last two years of residency just like doing the research to understand like how to best deliver care here and like what, what are the most effective treatments? Like how do we create like something that will get better people better as much as possible, as fast as possible, and to ensure, hopefully ensure that the gains are permanent. Um, so fortunately there's actually, because the data around PTSD treatment is so good, we were able to design something right. And, um, we very much felt like at the time we didn't think that we were starting like a VC backable company or anything like that. That wasn't like the goal, the goal was like to become a national center of excellence for PTSD, where like your mom or best friend, like can, um, afford and access this, um, and, um, trust that they're getting good care. Right. So in the beginning we, we, uh, we applied for a lot of non-dilutive funding. So we applied for an SBIR, a small business innovation and research grant. Um, uh, and then we, we looked at other types of grant funding as well. We bootstrapped, um, and then we raised money. Um, and uh, we didn't get the SBIR actually, but the, but like the process of just writing the grant application, which is like 80 pages <laugh> actually really helped us like understand like what is it we're trying to do here? Your value proposition. Exactly.

TC:

Can you summarize it in a sentence? You're probably used to that by now.

SN:

Like the value proposition.

TC:

If someone asked you what is, what does NEMA Health do? How is it packaged

SN:

To, I guess, so that is always like a complicated question to me because it depends on the stakeholder. Mm-hmm <affirmative>. And we talked about this in the class too. It's like there's so many different stakeholders in healthcare. So the way that I present it is a little bit different for every single person. But generally what I say is like, you know, um, is what I said earlier is that like our companies, uh, and our clinic, it's just like focused on helping people get better as much as possible, as fast as possible. Um, and to ensure that the gains are permanent from their PTSD. Um, the longer that you have PTSD, um, um, and most of our survivors see us for 18 years, um, the longer you have it, the more conditions you're developing. 'cause it's literally a stress disorder.

TC:

Right. So your company is a clinic?

SN:

Yeah, it's a tech enabled services clinic.

TC:

Okay. So it's online.

SN:

Yes. Um, uh, so you wanted like a one liner of like exactly what we do.

TC:

Yeah. Just for those, just for the listeners who are still like, but what is it? You know? Yeah,

SN:

Yeah, yeah. Of course. Okay. Yeah. So I get what you're saying. So yes. So NEMA is a tech enabled services clinic. So, um, where a clinic where folks with trauma survivors get clinical treatment for their PTSD or stress related conditions. Um,

TC:

Virtually.

SN:

Virtually. Yeah, exactly. Um, and, uh, our program is intensive. So we generally are seeing folks multiple times a week, um, to help them get better as much as possible and as fast as possible. And then we also offer a recovery program for folks after they hopefully, you know, experience like improvements, um, with their, with their symptoms so that we can help people start to like build their lives back up after PTSD and start to like design their lives that are, that they believe are worth living.

TC:

And I think that's why it worked for venture capital, because venture capitalists want results fast and are actually the, the payers, the insurance companies want results fast. And usually there's a trade off because many public health interventions take a long time to show results mm-hmm <affirmative>. But in this case, you're not sacrificing patient outcomes and there is no trade off. Actually, this is just a therapy that works that fast like in 10 to 15 sessions. And what I understood was that your innovation was not the therapy itself, it already existed. It's just that way your packaging it into this tech enabled online clinic is the innovation itself. And it's like the patient wins and the payer wins. Right.

SN:

Exactly. It's like the innovation is actually the design of it.

TC:

Yes.

SN:

Um, and aligning all of the incentives so that like, like we can do good care.

TC:

That's the hardest part. Aligning

SN:

The incentives that is so, such the hardest part. I mean it took us like years to figure out like how to design this in that way. Um, uh, because like that's where a lot of, I think a lot of clinics like go wrong is like the incent the financial incentives aren't aligned for them to actually like, do you know good care. Yeah. Sometimes. And also it's like always a push and pull, like it's like an inherent tension for any clinic, right. Because we're not nonprofit clinics. Um, um, and um, and even being a nonprofit clinic has its own challenges and issues Yeah. Right. With like inertia and, and, and other things like that. So, um, yeah. So that was definitely part of it

TC:

That would you say it, the incentives were aligned by nature or that part of your research and design was to make them aligned?

SN:

Um, it was definitely not aligned by nature. And, and also like, I don't think that every single care model or condition has like a venture backable idea necessarily. Yeah. Right? Yeah. Yeah. For sure. Like the incentives all have to align and it has to make sense. Right. Um, um, and so when, when Isabel and I were like landscaping different areas in mental health, that was one thing we, we were looking for is like, where do the incentives like naturally align here? Yes. Um, um, and where are they like least intention? Um, and, and also like we didn't decide to take investor money until we actually realized that the incentives were aligned and that, um, growing, um, growing nationally was also in our best interest. And in the interest of like public health too.

TC:

Yeah. 'cause that's what VCs want is that scale and that speed. And I think there's just something distinct about PTSD therapy that allows that where it is in the best interest of the patient Yeah. And the investors.

SN:

Yeah. And um, and I would say like with the caveat that like, I think the speed, there's like the speed of treatment and then there's like the speed of growth, right? Mm-hmm <affirmative>. Of the company. And so I think the speed of treatment actually helps us, um, kind of prove that we're, we're like that uh, you know, the gains the patient is seeing is actually like from our program, because they're actually getting better very, very quickly, right? Mm-hmm <affirmative>. Because again, they're just doing trauma therapy. Yes. None of this is like new. Right?

TC:

Right

SN:

We just do the therapy super well, um, and translate the outcomes research and in a

TC:

Targeted way.

SN:

Exactly. Yeah. Exactly. And then, and then there's like the speed of growth. And one thing I think we've been really fortunate about is that, um, we've have, we have investors who really believe in the mission and I made sure of that like when I was vetting them for like investing in us. Right. And so they have not, they've never been like, you need to necessarily like grow like faster at the expense of anything. They truly understand that what matters is growing with quality. Um, and we

TC:

Which sometimes the first thing that goes when you're trying to stick

SN:

Fast. Exactly. Yeah. And so one thing that like, and you know, we're both Isabel and I are both clinicians. We're like so all over this like white on rice <laugh>, we really care about making sure the outcomes stay the same at every stage of growth. And fortunately they have. Um, and that's very much by design. 'cause we're so mindful of this. Um, uh, uh, the other thing too is like with every one of our investor meetings, we actually start with like an anonymized and authorized like patient testimonial essentially. 'cause they wanna hear the stories too, you know? Um, it's just like inspiring to everybody to like see people get better. Um, and so, uh, it's always a challenge to like grow with quality. It's like the challenge that like keeps me up at night. But, um, we're doing our best <laugh>.

TC:

I think, uh, a piece of advice that you gave to my students in class today that really resonated was be choosy. When selecting your investors, you do have negotiating power. It is really important. Even if they're venture capitalists and they're, you know, obliged to have as much of a financial return on investment as they can as fast as they can, that still doesn't exclude them being really tied to your mission.

SN:

Mm-hmm <affirmative>.

TC:

And in your case, I think you just found a group of humans who were personally vested in this. Like either they or someone in their family was a survivor, right? Yeah. And so that's why they, they want both mm-hmm <affirmative>. So it was like clinical outcomes and the financial growth.

SN:

Yeah.

TC:

And it sounded like once you did get VC backing, that actually was the key to unlock your financial viability because you needed to get those national contracts with insurance companies and they helped you get in the room.

SN:

Yeah, they did. Because I didn't have like to, basically our model doesn't work in like a fee for service environment because, um, like the whole point of our model is to get people better so that they don't need us anymore. Right. And they don't need to stay with us. Right. And I don't think that a fee for service, like model of care incentivizes that at all. Right? Mm. Because in fee for service, you get paid more the more times you see a person Right. Regardless of the, whether or not you're actually helping them get better. Right. Which

TC:

Is how most healthcare in the US works.

SN:

Exactly. And so, um, I think it's like really doesn't, it doesn't necessarily incentivize you to see to, to actually graduate the patient even if they no longer need you. Right? Yeah.

TC:

Yeah.

SN:

It also doesn't incentivize you to, um, um, make sure that they're actually getting better. Right. Um, and um, so I I really think that like this model, like we would just like close our doors basically if like we were doing this like fee for service. Yeah. Or we'd have to be completely cash pay, which is basically what therapists already do now. Right. And so, and one of our goals is to make the succesSNuls like to take every single type of health plan like Medicaid, Medicare, commercial. Right. Um, and there's like, I, I don't know, like 3000 health plans <laugh>. So like the, it's like a behemoth problem. Like this is actually a much bigger, um, and harder problem to crack, like getting in network with insurance versus with, with like a financially sustainable model than it was to actually get people better from PTSD <laugh>.

TC:

Yes. Definitely. Because the science is there on how to get people better with PTSD, but then there's no formula or publication about how to then integrate that into US healthcare system.

SN:

And so what was really helpful is that like, I don't have these networks, but our investors do. Right. And so they were able to help us like understand how to get in, in, in the door with, with payers and insurance companies, um, and to, um, like just structure our pitch and also like sort of structure, you know, the contracts in a way that like benefits their bottom line, but also helps the patients actually get better.

TC:

So one thing I understood from what you've been saying is that this really only works in value-based care systems where the incentive is to get the patient better. Yeah. It doesn't work in fee for service where the incentive is to just keep the patient coming back. So how are you scaling nationally when most of us healthcare is fee for service?

SN:

Yeah. So this is where we have custom contracts with payers, um, in value-based care arrangements.

TC:

Okay.

SN:

Um, where they pay us essentially like a case rate, um, or a per diem essentially for, um, for seeing their patients. So they give us a sum and then a lump sum and we're like, okay, we're gonna do whatever we need to do to get this person better. Right. And then we don't bill further for the care. Um, and I think that incentivizes us to, like, it gives us like the freedom to like to do things that generally wouldn't be reimbursable that we know from the data and from the research actually help. Right. Um, and then, and also it caps their costs. Um, so like we're given this amount of money we have to do whatever we can to like help somebody get better. Right. If they need a second therapy, we're gonna do it, whatever it is, because we're saying that we're essentially going to like really make sure they actually recover. Like if we're held to that then something else. Now of course not everyone will recover with the first out of like therapy or whatever. And like that's that's fine. Like we'll do whatever we can or refer them to somebody who can do it essentially. Um, and you know, to be able to get these, these, these types of contracts, you also have to measure your outcomes. Right. Um, but we had a leg up there 'cause I am a clinician. Um, I was the first trauma therapist, um, trauma.

TC:

How many are there now?

SN:

Um, there's fewer than you think because, um, there's like seven to nine full-time ones and then 11 total, including including me. <laugh>. Yeah. <laugh>.

TC:

Yeah. That's awesome.

SN:

Yeah. So, um, we're a small but mighty team. <laugh>. Yeah. Um, and growing of course. Um, so if anybody is interested in becoming a trauma therapist for us <laugh>, like we're hiring,

TC:

You're recruiting <laugh>. Okay.

SN:

Yeah. So, um, it it just takes a long time because it, um, you, you need to be able to pr like show or convince them that like what you're doing actually will move the dial measure outcomes. Yeah, exactly. And then, um, and then you have to structure the contract in such a way that like still aligns the incentives. Um, and, and then also again, like there's so many things that we do that like, that probably help the outcomes that we just can't get reimbursed for. So like surprisingly case management not reimbursable for mental health clinicians. Um, it's only reimbursable generally in physical health. Um, like and medical conditions. I don't know why, but case management is so important.

TC:

Yeah.

SN:

<laugh>. So, so like, um, all of that is not reimbursable in a fee for service environment. We also do peer mentorship, right? Mm-hmm <affirmative>. Which is really important to these folks who oftentimes don't have support. Right. Also not reimbursable, you know. Um, so there's, then we do a ton of stuff on the technology piece to make it super easy for people to actually do their worksheets or like skills practice. Um, and that actually we know that in PTSD treatment, the amount of homework that you complete, which is part of the therapy protocol, but the amount that you do actually imp influences outcomes. Right. So we make it super easy for people to complete, or at least as easy as we can to make people complete that, which is a, a predictor of treatment outcome. But no one's paying for the fact that like we have a product and tech team who's doing that. Right. Right. Yeah. Like you're

TC:

Like you’re a fee for service environment.

SN:

Yeah.

TC:

I'm glad you mentioned your product and tech team because all this time you've been talking and I've been wondering like, okay, it's been what, like four or five years now since you were like studying the science behind PTSD therapy and you're a clinician and you have the skills to do that, but then how did you recruit a team and build a company and draft these contracts and all those other skills? You don't have <laugh> <laugh> like

SN:

Yeah, I mean I, um, uh, you know, it's, it's so funny 'cause I like don't actually reflect on this question very much. <laugh>, <laugh>.

TC:

You're just like, I did it. I don't know how.

SN:

Yeah, exactly. So I think one of the things that helped me realize that like I could build a team was, um, I helped co-found this like student led conference called the Women's Mental Health Conference when I was in residency. And like I'm very proud to say that it still runs, it's a trainee led thing. It was actually sort of like my like push to start a movement. Yeah. Really like around like women's mental health, um, um, because, um, women's mental health is actually not even, it's not a required thing to be taught in psychiatry residency, which I thought was wild. Yeah. Like, you literally don't need to learn perinatal psychiatry, um, to go to a, that's not part of the A-C-G-M-E requirements for psychiatry residency.

TC:

People don't study like postpartum depression, for example.

SN:

Exactly. Exactly. So, um, so that, for that conference, it was completely train led. We raised money, um, from, um, different internal stakeholders at Yale. And then, um, and then we got this like incredibly, after the first year we got this incredibly generous, um, donation of $250,000 and I like keeled over in my chair, right?

TC:

Hmm.

SN:

And then, and also like we had a team of like 20 people. I was one of the co-chairs and then my friend slash co-resident, Stephanie was the other one. And I think it made me realize that like if you have a mission that's like big enough and like that really resonates people with people, they'll follow you. Right. Like, um, and they'll help you build something together. Right. And it, it is very important to me that I'm like, I, I I do really try to be a servant leader in a lot of ways. Um, and so I I wanted to like, lead by example and, and, uh, make sure that I'm like including people's voices. Right. Um, and so I think that helped me realize that like I could actually build a team, like, and, and motivate people, like around a common cause. Um, so then when I started NEMA in the beginning true.

Like when I was raising the seed round, it was basically a woman and woman show. It was like me. Yeah. My co-founder, Isabel was still in training at the time, and so she was, she could not work on this like full time. She was still like, you know, like she had bigger fish to fry and like, uh, psychiatry residency. So, um, uh, at the time it didn't feel like I could build a team <laugh> because it was just me. Right. But then I think what happened, and this is something I've had to learn about myself, is that like I can sell, like, I can like really like sell a vision of like, um, and, um, because I also believe in it so much. Yeah. And it gets people, other people excited too. And

TC:

It's personal. Yeah.

SN:

It's like so personal, right. And so I was able, I think it's like the first couple people like Mariam, who's our co-founder, like met me, we like instantly hit it off and she was like, also like, everyone is so motivated by the mission at our, our company. Like, so it was, it was actually like, it just came, it, it came together. It like, and so I, I don't know if it was like anything about me or anything that I actively did, but it was basically like, we're doing this, there's a huge mission. Right. This could really help a lot of people. And just that actually got so many people interested

TC:

Because, you know, raising money as a solo founder is hard. Like most people will not invest in a one woman team. Yeah. Or even a one man team, but then you have even more disadvantages being a woman and a woman of color.

SN:

Yeah. Yeah. Um, it was tough. Like <laugh>, it was really tough. And like, I think the, the investors, like our main investor, um, uh, from the seed round Laura is like wonderful. Like, like they, they were people like we also, um, originally our entire board was women. Right? Like, so, um, I, I think I was really fortunate that like we were able, like there's some like kick ass women investors too. Like, there's like a lot of people who do really care about the mission and it's not like, like it's not, I think even if you're an investor in healthcare, I mean you could make frankly, potentially more returns in tech, right? Like you could do some other industry, right. You don't have to be a healthcare investor. Right. And so I think by definition, a lot of healthcare investors already just care about the mission a lot. Right. And we made sure to only raise from funds who really understood healthcare. 'cause you cannot, you can't like, cannot take like expectations of a software company and superimpose them on something like this.

TC:

Exactly. Yeah. And I think it's also not negligible. It's worth mentioning that you raised your first 4.2 million as a solo founder and then you went and raised 14.5 million when you were like nine months pregnant. <laugh>, <laugh>. I mean, these things are like

SN:

Yeah.

TC:

Talk about juggling a lot. <laugh>, <laugh>. So that's huge.

SN:

Thank you. Yeah. Yeah. Um, I, I, um, I was just telling you this at lunch, but like, because people ask me like, how do you do it all? It's like, I just like don't remember the pain <laugh> like, you know, like, um, and also I really like what I do. Like I love doing it. I think it's like a lot of fun. I it's scary, right? And like you always, I I'm always anxious that like, we're gonna go off kilter. Like, so like, we're not like doing something well, but like I also think that like, as the founder of this company that deals with something that's like, so important, I should be worried about things, you know? Um, and it should not feel like a walk in the park. <laugh>. Yeah.

TC:

I'm glad you're doing this. I'm glad you took a personal experience and built it into a clinical profession and then built it into a tech company and raised millions, $19 million to scale this nationally and hopefully reach everyone who needs it. And in the process are, is are also pushing forward value-based care because that's an inherent part of your model and creating jobs for women and voices for women and other survivors of trauma like veterans and others. So thank you for doing this. I think it's amazing. I'm so excited to just watch your success and thank you for taking the time to be here with us and share your thoughts and stories.

SN:

Thanks, Theresa. Thank you so much for inviting me. It was a lot of fun.

TC:

I'm Teresa Chahine and you've been listening to Impact and Innovation. Subscribe to stay tuned and follow us at Teresa Chahine and SOM Ventures. Special thanks to the broadcast center at Yale School of Management.