Innovating Behavioral Health Solutions (ft Bruce Brandes)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now your host, Ed Marx.

One of my favorite parts of doing Digital Voices is it just gives me a chance to catch up with friends. Bruce Brandes, welcome to Digital Voices.

Ed, thank you so much for having me. It's great to be here.

This is fun cuz I think we've known each other for a really, really long time. I wanna say 20 years, maybe, maybe more. And so it's been great and I've watched your career very carefully and, you know, super proud to call you a friend. All the different things that you've done, not just professionally, but you always give back and maybe we'll, we'll hit a little bit on that a little bit later, but you've been affiliated with great organizations. You started some of your own. We're gonna talk all about that, but you know, Teladoc, Avia, Airstrip. Care AI, advisement to Stryker, advisement to Thomas F. Frist Jr. College of Medicine. I mean, all sorts of stuff. And, and you're a great citizen of the community in Nashville. So this is gonna be a great conversation. So yeah, we've known each other for a long time. Like I said, I appreciate you being a guest. But Bruce, you know, cuz you're also a longtime listener, that my very first and most important question, what songs are on your playlist?

Yeah, Ed, you know, I, I knew that question was coming and I always struggle with it because I'd like to say that I'm cool enough to name some indie rock band or sophisticated enough to to name some classical composer, but the truth is I'm largely a '70s on 7, '80s on 8 guy on SiriusXM. And if I am completely honest with you, I've had ABBA playing nonstop in my head for the last year since we were in London about a year ago and saw the ABBA Voyage digital show.

Oh, yes.

Which was amazing. And it gave me a whole new appreciation with the fusion of music and technology, uh, was really an amazing experience.

That was trippy for sure. I was there also last year in November, and I'm a big ABBA fan, and that was like over the top. I want to go back. I seldom want to go back to something twice, but man, that was so good.

Completely agree.

Too bad I'm not wearing my ABBA shirt. Sometimes I'll, I'll be rocking my ABBA shirt, but one last thing on ABBA, and I was like, So excited to see this. On my last trip to New York City, Mamma Mia is back on Broadway.

Yeah. And, and you know what's really cool about the ABBA show in London, if people don't know about it, you should look it up. Essentially, the band was approached about touring and they said, you know what? Nobody wants to see us in our 70s. They wanna see us from the 70s.

Yeah.

And that was really the inspiration. And then leveraging, you know, modern technology made it possible. Yeah.

I, I have so much more to say about that, but we could do a whole nother program. I, I, I've got some, things in my mind about that whole experience. It was just over the top good. What about life message or mantra? Are there sort of words that guide you or words that you live by?

Yeah, I have 2 that, uh, that I've told my friends I want them to, uh, recite at my funeral. So I'll, I'll share those now. The first is really more focused on how I try to treat myself, which is the Serenity Prayer, which is briefly, which briefly is God grant me the serenity to accept the things that I cannot change. courage to change the things that I can and the wisdom to know the difference. And then secondly, I have another that is really focused on the ideals that I strive on, how I want to treat others, which was really ingrained in me as a fraternity pledge in college by force, if not by example. And that's something called The True Gentleman by John Walter Whalen, which I won't take the time to read here, but it's worth Googling.

Yeah, I'm going to check that out. That sounds super interesting. And yeah, the Serenity Prayer, You can't go wrong with that. So I already shared a little bit about yourself, high level in terms of some of the accomplishments from a career point of view, but tell us about who you are. You know, what's your story? Start from the beginning and, and let's learn more about Bruce.

Yeah, well, that's kind. So at the very beginning, I was born in New York where my family and extended family are from, but I was raised in New Orleans and did all the stupid things that most people who were raised in New Orleans did back then. My, my sister, cousins, and I were all first-generation college in our family and Education was really important to my family. My mom actually took a job working as a receptionist in a doctor's office starting for me in 7th grade to be able to go to a private school and have opportunities that my parents and grandparents didn't have. So I was really grateful for that because it really did change my life in a lot of ways. I went on to study finance at University of Florida and dated my now wife all through college and got married right out of graduation. And And we now have 3 grown kids who we raised here in Nashville. And I'm happy to say 2 grandchildren, which has been a great reward for all the stuff that you have to go through as parents. But it's nice to have everybody here in one city.

Did you meet as freshmen, your wife, like on campus, or how'd you meet?

She's got me by a year, but yeah, we were set up on a blind date, which was actually not such a blind date, but that's a much longer story. But, but yeah. And 36 years later, here we are.

Yeah, no, that's awesome. What prompted the move to Nashville?

Well, I was actually artificially traveling a lot. I've always been in healthcare and I was artificially traveling a lot more than I needed to. And as we had 3 young kids, I decided and told my wife, hey, let's move to Nashville. It's the healthcare capital of the world. And if I'll take a role where I won't have to travel so much so I can be home with the kids and drive carpool and coach baseball and all those good things. And so that was what originally brought me here. And then I was fortunate to, to get embraced into the, what is affectionately known as the Nashville Healthcare Mafia, which, yeah, long before Nashville got discovered. And it was really fortunate because there's amazing, amazing talent and resources here in Nashville for healthcare. Yeah. Yeah.

I don't think most people realize it back then, right? They realize it today how important Nashville is to healthcare. But back in the day, like when you first got there, it was really emerging. That's pretty cool. How'd you choose healthcare as a career where you ultimately spent the most of your time now? Obviously your mom's maybe the influence when she started working in a physician practice, but yeah, how did you land into healthcare?

Yeah, actually my mom did have an influence, but not directly. I'll share that story. I really just got lucky. And actually in my last semester of business school, I had actually accepted a job with Ford Motor Company, which was the only offer I had out of 200 resumes that I sent and actually had put a deposit down on an apartment in Dearborn, Michigan. And while I was waiting to graduate and take that job, I was mentioning to a friend of mine who I met at the fancy private school, I was rattling off all the companies that I sent resumes to and never heard back. And, you know, GE, Procter& Gamble, and IBM. And her mother happened to overhear me say IBM. And it just turns out that they were friends with the branch manager of IBM in New Orleans. And the next thing I know, I had an interview, which led to a job offer. And then I was fortunate that when I started at IBM, they assigned me to the healthcare vertical. And had that not happened, I, I probably would've been in the automotive industry and living in Michigan.

Yeah. Isn't that cool? You know, IBM back in the day was really well known for all of their training. So when I saw the IBM in your background, I was curious, did you, did you have that? I can't remember the book I read. It wasn't a Jack Welch book. It was someone else about Big Blue or something. And it was about the culture, you know, all in a very positive way, the culture and all the training that went into developing young leaders. Did you have that sort of experience?

It was an amazing experience. My whole first year was really just training, although I got engaged into client work, but I was, I spent half my time in Atlanta in training programs. And I would say the lessons that I've learned at IBM at the beginning, I take with me to this day. And it was unparalleled experience, especially coming out of business school. Everything that I was taught was so much more practical. And so I learned a lot.

Yeah. From that, when you, when you read advice books and things like that, they often talk about, you know, having a great base in sales can really help propel your career. And obviously for you it did. So you got this great experience and then you moved into executive leadership. What skills helped the most?

Yeah, actually 2 skills that I think I've developed that really go against my natural instincts and probably is also true for many salespeople. And I've worked really hard to this day to keep these skills up. One is learning to listen more and speak less and to focus on active questioning so you can truly understand an issue before you start talking. And secondly, making sure that you prioritize the needs of your customer and your team ahead of your own. And I think that that's staying true to those, those tenets, I think, has served me well.

Yeah, those are, those are great. And you continue to evolve yourself and then you become a CEO and providing advice to many great companies. What about that? How, how have you continued to evolve yourself?

Yeah, well, I really try to stay close with a network of friends that I have that, like yourself, that, that have played key roles in running health systems and health plans. And I stay connected also through great org— to them through great organizations like the Health Management Academy and the Leadership Institute in Health Evolution, where I can really deeply understand their challenges and their opportunities. And I also I also try to spend a lot of time studying and engaging on how emerging technology is impacting other industries to think about how those technologies can best be applied in healthcare. And that's probably a common theme through my career is trying to find those opportunities. And I've been fortunate enough, you know, through the network of health leaders and investors that I know to get connected some really amazing entrepreneurs. And that's really led for me to have a series of opportunities to come in alongside or behind founders. who had proven a concept on how to apply technology in healthcare, but needed help to achieve scale and maturity and maximize the value of those solutions across the industry. And so my whole career has really been a series of 3 to 5 year stints doing, doing that.

That's very cool. And one of the big ones, you know, that happened around the time of the pandemic was the M&A activity, Teladoc, Livongo, InTouch. That was just an amazing thing, maybe perhaps the biggest M&A at that point in healthcare. What, what are one or two things you can share about that experience?

Yeah, well, I, I had the chance to work with Glenn Tullman in the mid-'90s, the company that I left IBM for before he went to Allscripts and I went to Eclipse. And, and I have incredible respect for him and Lee Shapiro and the whole team that built Livongo. And so I was really honored when they asked me to join the team ahead of the merger with Teladoc, as you mentioned, in the height of the pandemic. I subsequently, in the combined company, led health system innovation, trying to integrate 3 very complementary assets that were assembled. One was Teladoc, the leader in virtual care, Livongo, the leader in consumer-centered chronic care, and also InTouch Health, which was really the leader at the time in virtual inpatient care on the hospital side.

Yeah.

And I would tell you that I had a front row seat experiencing how culture eats strategy for breakfast because it was absolutely the right strategy. But I will say openly that poor execution led to a tremendously missed opportunity. You know, innovation slowed and the advantage of the combined scale was never properly leveraged and exploited.

Yeah.

And there's a lot to unpack there, but, you know, it's really unfortunate because I think what was possible there was all the capabilities that we built at Care AI to create smart hospitals and what Glenn is now building for large employers at Transcarent. All that could have been done Uh, in my opinion, within Teladoc, if there was just better execution of that combination.

Yeah. It's always tough. You know, I, I've, I've been part of mergers on hospital side and it's always, it's always tough. Uh, the execution is, is obviously where the rubber meets the road.

For sure.

That's amazing experience you have. That's why I'm so excited about what you're up to next. So share with the audience, because I think this is, uh, a bigger game changer than anything you've ever done.

Well, thank you. I'm really excited about it. Have you ever played the game 6 Degrees of Kevin Bacon?

Yes, of course.

Yeah. Well, sadly, I think we could also play a game called 2 Degrees of Robin Williams. And what I mean by that is so many of us have a loved one who is struggling with behavioral health issues, and we may or may not really see it. Um, and, and I think you and I both know that we in healthcare have underidentified and underserved the people with behavioral health needs for, for way too long. And actually, I would say our healthcare system by design from its roots over 70 years ago really banished mental health care to be an afterthought.

Yeah.

And yet today we've got like 40% of the people in the United States that are just— that are struggling with a behavioral health issue. And, and it's growing since the pandemic and social media explosion. And 5.7% of our population is diagnosed with an acute behavioral health issue. And those people, with all their comorbid physical issues, account for almost 44% of all of our health care spend. And so with that as an issue, I realized that that was the next problem that I wanted to tackle.

Yeah. Well, I know sitting in the C-suite of many hospitals and even boards of some others, always a major issue forever. And careful with my words here, I'm not passing any negative judgment. It just never was something that we prioritized to the point that it should have been. And executed on? Going back to execution, we talked a lot about it, but very difficult to execute on it.

I think a lot of things that were not possible before for a health system to really lean in on this are— make it possible now. One, culturally, we're ready. I think we have the will as a society to lean in without stigma. And 2, if you think about all the digital data we have and the ability for AI to help us make sense of that data, to give us insights, and the financial business case for action has never been more compelling. So I I think it probably, none of this was probably really possible even a couple years ago.

That's a good point and very, very fair. Very well stated. We're at a different place now with technology and capabilities. Culturally, we are there. Everyone understands the importance. And I will say, like at Summa Health where I'm on the board, we've done a lot actually in this area, built a building. I know I was recently up in Vail with Vail Health and they also built an inpatient center, beautiful up there in the Rockies. So we are seeing movement that way, but as you and I both know, and I think everyone understands, you know, we, we need to do a lot, a lot more. And so tell, I know you have a unique, uh, sort of driver for your interest and engagement, not only for the reasons you cited with the statistics and, and things we all know to be true, but I think you have something even personal that has kind of driven you down this mission.

Yeah, I think, I think we all have a personal story. For, for me, actually, my best friend growing up, when he was an adult, was diagnosed as bipolar, and I watched him struggle for decades as our healthcare system really failed him to get the help he needed. And tragically, 6 years ago, he took his life. And so this has really been on my heart. And then when I met Bill Batty, who's the founder of Mindira late last year, I just felt compelled to lean in. And I'll, I'll share a little bit of Bill's why also, because it's, it's a unique one. 72 years old, never started a company before and never worked in healthcare, which doesn't necessarily fit the profile of, of what medical entrepreneurs coming into the space do. But he had a loved one who was having a complex behavioral health condition and experienced all, all of the deficiencies in our system and naively asked the care team, how do you measure progress for patients like her? And they looked at him like he had a third eye in the middle of his forehead, and he realized the systemic deficiencies that we have. And Bill's background, he spent a career as an investment banker on Wall Street leading Credit Suisse First Boston's data and analytics business. And earlier in his career at First Boston, he worked with Mike Bloomberg as his first customer as he created Bloomberg that we, we know today for risk management. And, and so after experiencing, you know, our industry's shortcomings firsthand, Bill came out of retirement to start Mindera and apply predictive analytics toward reimagining behavioral health and care. And what I saw when I got to know Bill was the opportunity to take what we learned at Livongo for chronic care and apply it to behavioral health, combined with what Bill learned in managing risk for security portfolios at Bloomberg, and, and felt like we could could do better than what we've historically done.

Yeah. And share more, 'cause I know we are recording here late August. I know something big is about to happen with Mindira, so share more.

Yeah. So, well, first of all, in terms of the company's history over the past 5 years, Mindira has partnered with great behavioral health organizations like Acadia and NewSeason to more comprehensively assess a person's needs upfront and subsequently measure their progress to help drive standards for best practice. And today we are now partnering with an array of health systems and managed care organizations with a value proposition that, that actually applies across both fee-for-service and value-based care to go further upstream and downstream from measurement-based care. We have an amazing data analytics team that has created a predictive analytics model that leverages machine learning and LLMs to find patterns in data across EMR claims, social determinant, and in the near future, leveraging digital phenotyping and vocal biomarkers to really be able to laser focus in on this subset of a population or patient panel with rising behavioral health risk. And then from there, we can do what we're doing today to more proactively and comprehensively assess what their needs are. One, one lesson I've learned is sadly many caregivers don't want to know about these folks because they simply just don't have the time or resources. to properly care for their behavioral health patients that are already in front of them in primary care and in their EDs. But the other, at the same time, we have these amazing innovations across the industry that have been created to help, ranging from some that are more limited, like inpatient psychiatric beds and addiction treatment centers, to digital tools, which are unlimited, you know, with chatbots and the like. And certainly there's no more compelling use case for virtual care than scaling access to behavioral health caregivers. So this, the downstream work that we're now doing is we believe we can do a better job allocating those available resources in the moment as we identify the people with rising risk and understand their needs to guide them and navigate them toward the best possible resources for help. And as we build that out, we're also building out an engagement app that keeps people connected, similar to what we did at Livongo, where we could hyper-personalize a consumer experience that between treatments not only empowers the person, but with their permission, their friends and family to help them to advance their journey toward improved health. And I think collectively kind of being the glue across all these disparate fragmented assets that we have. I think together we can go on a journey to really do much better. And we're really launching that journey today alongside the release of this podcast, along with us making some other announcements today and in this coming week.

Yeah, this is super exciting because taking all the leadership experience, which I think is the most important aspect, having leaders like yourself who've done this, the founder who did this and transformed, you know, what we know as Bloomberg today, all the data science, then the evolution of technology, which you touched on earlier, the known problem that everyone has a heart to solve, but just could never, you know, align incentives. And now we've got the aligned incentives, the tech capability, the leadership all coming together to really address one of society's biggest problems that has been unaddressed. And so super excited in that you're involved with it. Makes my heart glad because I, because everything you've done in your career seems to have gone pretty well.

So, well, thank you.

We're excited about that, but we'll drop in the show notes everything about the company and what's happening. Hey, let's, let's shift to leadership. When did you realize you were first a leader? So you told us a little bit about growing up and going to school and, you know, getting hired out, outta school by IBM and so forth. But was there a moment in time where you kind of knew, hey, I'm, I think I might be a leader.

Yeah. You know, that's a little awkward of a question for me because I, you know, I, my joke was it might be right now that you're asking me that question that I'm realizing I'm a leader. But in truth, some of my earliest memories in elementary school were comments that my teachers made in my handwritten report cards that referred to me as a natural leader. And I'm sure I didn't understand at the time, but I actually have kept a memorabilia box that those are included in. And over the years, I've looked back on it every once in a while and it kind of affirmed for me, okay, Maybe there is something here that God gave me some capabilities for leadership.

Yeah, I do think you could see it in youth, but yeah, when you're the youth yourself, you don't necessarily know it. You know, it's funny because my handwritten report cards say all of them are the same. They don't say Ed's a leader, but they say Ed has a lot of opportunity if only he would apply himself. So I thought it was kind of spot on. Anyways, Anyways, for, for young leaders listening, you know, here's Bruce Brandes, who's done amazing things with teams. What are one or two words of advice you might give?

Yeah. You know, I remember early at IBM, all I ever wanted to do was get promoted to be a manager, 'cause I thought that that really meant that I had arrived. And what I, one thing I've learned is the words manager and leader are not synonymous because some of the best leaders that I know have no one reporting to them. And many of the managers that I know are horrible leaders of people. And then the second thing that I, I would say is the best leaders that I know are also really good followers, and they know how to read an environment to naturally discern what's needed of them in any given situation and either lead or follow. And I, I think that's a really keen skill to recognize. You have to be good at both.

Yeah, that's, that's well said. What's one thing that you learned the hard way? 'Cause, you know, we talked about all these greatest accomplishments, although you did actually mention when you talked about the M&A activity that you were in, But, you know, what's, what's one thing you learned the hard way?

Well, in healthcare, I think it's really important to understand the financial incentives and make sure that they're aligned, because if they're not, you're, you're not gonna have the success you need. And you'll appreciate this story, Ed, cuz you were one of my early clients, uh, when I was at Airstrip, uh, when you were at THR. And, and I remember just for your listeners, you know, we had invented what's now commonly called remote patient monitoring, where you could see real-time and historical waveform data on a mobile device. And it was really powerful in OB and in cardiology. And what I realized now looking back on it, I was going to these hospitals that lived in a fee-for-service world saying, hey, we can take all those babies you deliver and make sure they don't end up in your NICU. And we can minimize the chance of all your cardiac patients that they won't show up in your ED or need surgery. Isn't that great? And what I've realized is for all the right reasons, you know, people wanted to install it, but it was bad business for them if we were tremendously successful. Because that's where they made their money in a fee-for-service world. And so you really, the lesson I've learned is you really have to understand, put yourself in the shoes of the person that you're meeting with and put their needs ahead of yours and honestly assess whether or not it's a good fit. Yeah.

Yeah. That's great.

Or figure out how to align in financial incentives, which don't get me started on the fee-for-service pitfalls.

Hey, what do you do, Bruce, to recharge your batteries and remain fresh? Because, you know, you live a Act— very active life and grandkids and kids. And what do you and your wife like to do in your downtime?

Yeah, well, I am a history geek, so I love to travel to places where I can explore and learn more all over the world. But my favorite thing to do is probably be home with family and friends. I love to cook. My wife and I like to binge watch a good show. And of course, I travel all over to cheer on my Florida Gators. Yeah.

All right. So tell me what's one cool place you recently traveled to, like with the history thing in mind? What's a place that you'd recommend?

Yeah. You know, I think, uh, so we went to the Balkans last summer and, and I think a lot of people, the secret's out about Croatia, but if you haven't been to Slovenia, you're really missing something special.

Yeah, that, that's a good one. Wow, Bruce, we talked about a lot of things. Uh, ABBA Experience, if you haven't been, you've got to go to London. If nothing else, just to see that show, it's worth it. Uh, we talked about you growing up, born in New York City, raised in New Orleans, uh, but then how you got into healthcare and what you learned from IBM and really all your different roles that it have. Taking you from sales to manager to leader, and then, uh, very specific experience that sort of accelerated your trajectory. And then we talked about Garrett and all the great things that, that you're gonna be doing for behavioral health with that product and service. We'll definitely, again, put that in the show notes. Everyone has to check out, check that out. It's amazing. I love the whole concept of the 2 degrees of Robin Williams. Uh, that's, that hits the heart, I think, for everyone. What did I miss or anything you wanna double down on? I'll give you the last word.

Yeah. You know, I would say I've been talking about how technology was gonna transform or disrupt healthcare for my 35-year career. Uh, and, and I, I always joke that healthcare's the only industry that spent billions of dollars on technology to make people's lives harder, not easier.

Yeah.

And I think that, that sadly, that, that to some extent is true. But I do think that we're at this moment in time where technology truly is getting out of the way. And for the first time in my career, keeping the status quo in healthcare is no longer really an option. And I think it's possible now for us to really reimagine a lot of things in healthcare that we all know, just like what we've talked about with behavioral health, where we know we're underserving or we're not optimizing, where we can look at that with a fresh set of eyes and, and think about how could we do better. There's a tremendous opportunity for us to transform healthcare in the coming years.

Bruce Brandes, thank you for being a guest on Digital Voices.

My pleasure. Thanks for having me, Ed. Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this Subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.