April Koh, Spring Health, on leading in precision mental health

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April Koh, Co-Founder & CEO of Spring Health

In this episode, we sat down with April Koh, the CEO and founder of Spring Health, a comprehensive mental health benefit for employers. April has received honors from the American Psychiatric Association and has been featured in Crain’s, Wall Street Journal, and National Quality Forum. April Koh was named Forbes 30 Under 30 2018 in Consumer Technology, BusinessInsider’s 30 under 40 leaders in healthcare, a Goldman Sachs 100 Most Intriguing Entrepreneurs in 2019, World Economic Forum Technology Pioneer, and is a Yale Entrepreneurial Institute fellow.

We discussed:

• Spring Health’s focus on providing precision mental healthcare through its proprietary predictive algorithms and science-backed methodology of collecting patient self-reported data
• The critical role data plays in improving the accuracy of Spring Health’s predictive algorithms, continuously upgrading customized member experiences, and helping clinicians enhance the efficacy of their care
• Upcoming plans to explore value-based payment models and investments for international expansion, family care offerings, and harmonizing workplace performance with employee work / life balance
• The challenges and opportunities of starting a company as a young woman of color, and how April’s entrepreneurial journey led her to be the youngest female running a unicorn company

Start to 9:23: The origin of Spring Health and its focus on precision mental healthcare

• An early start to entrepreneurship: April was six years old when she launched her first entrepreneurial venture: the tomboys’ club at her church. The club gained traction quickly, with all the girls joining the club. Safe to say, this was a precocious beginning.
• On the genesis of Spring Health: April started Spring Health five years ago in response to a gap in effective mental healthcare. Patients seeking mental healthcare often suffered long wait times and difficulty in finding clinicians that fit their needs. As a result, the innovation in mental healthcare at the time was focused on collapsing wait times for patients to see a provider. However, April’s own struggle with finding effective mental healthcare solutions helped her realize that faster access to care does not result in better care.
• Enter Spring Health: Spring Health’s differentiation is to combine precision care with faster, on-demand care to patients. Spring Health achieves this through a proprietary machine learning model that outperforms the average psychiatrist in matching patients with appropriate treatments. This algorithm was developed by April’s co-founder, Dr. Adam Chekroud (PhD).
• On precision mental healthcare: Dr. Chekroud’s research on mental healthcare revealed the most accurate methodology in predictive psychiatry is to use patient self-reported variables to determine the patient’s behavioral health outcomes. These self-reported behavioral health outcomes can be captured through digital questionnaires. Spring Health invested early on in refining the algorithmic capabilities of the predictive psychiatry models they built as well as a questionnaire for patients to capture self-reported variables. The predictive models utilized the self-reported information to generate a customized recommendation for each patient’s care.
• On mitigating user bias: Spring Health has refined its algorithms to account for the likelihood of user bias in self-reported metrics. Spring Health continuously tests the accuracy of its algorithms using real world data. Its models demonstrate efficacy in creating personalized care plans despite the limitations of imperfect data.

“We started the company off of the founding idea that faster access to mental health care is meaningless if the care doesn’t actually work for you. We recognize that we have to go beyond faster access to faster recovery, and that is only possible through precision and through personalization. We founded the company off of this idea that we should eliminate guessing in care.”

9:23–21:05: On the evolution of Spring Health to a full-stack mental healthcare service

• On selling to clinicians: April and her co-founder initially envisioned Spring Health as a clinical decision support tool for primary care providers since these providers represented 80% of the U.S. market for mental health recommendations. To create an offering for this customer, Spring Health’s first MVP was a digital software solution for provider systems. However, April soon realized the product-market fit was not strong given the lack of incentives for providers to invest in predictive mental healthcare offerings and the long-term health outcomes of patients.
• On building a full-stack solution: In addition to the limited product-market fit with providers, Spring Health required a lot of quality data to improve the accuracy of its algorithms. To achieve this, Spring Health built a full-stack mental healthcare solution that included care delivery and a provider network. Spring Health collected the data from patients and providers that used their platform to understand the patients’ end-to-end care journey.
• On the pivot to employers: During a routine sales meeting with a health system, one of the clinicians in attendance mentioned the offering April and Dr. Chekroud were pitching could help alleviate burnout amongst physicians and nurses. The pair were referred to the HR department of the health system, and this led to Spring Health’s pivot into selling directly to employers.
• On what Spring Health excels at: Spring Health focuses on excelling in two main areas: precision mental healthcare, and outpatient services. To deliver precision care, Spring Health leverages its data collection methodology and predictive algorithms to create personalized care programs including mindfulness exercises, coaching, medication, and network referrals. The accuracy of the predictive model leads to more effective care programs for patients relative to other forms of mental health. To provide superior outpatient services, Spring Health developed a proprietary provider network operated centrally. This structure gives Spring Health the ability to shape the quality and delivery of care through their providers.

“Our focus is on two things. The first is in precision, meaning matching each person to what will work for them from meditation or mindfulness and coaching all the way down to medication and network referrals. The second thing that we do really well is outpatient care, meaning therapy and psychiatry.”

• On the various use cases for data: Spring Health emphasizes its scientific foundation, which relies on the collection of patient and provider data. Spring Health utilizes the data it collects to continuously improve its precision mental healthcare capabilities. Beyond improving its internal algorithms, the data is also used to provide more clarity for employers to understand their employees’ mental health. In addition, data is also used to enhance the member experience and ensure patient needs are addressed. Spring Health’s goal is to create an offering that truly understands individual patients’ needs and generates solutions that dynamically fit any changes in these needs.
• On value-based payment models: Spring Health is uniquely positioned to shift towards a value-based payment scheme because it has created the first pay-for-performance outpatient network. In the pay-for-performance model, providers in the Spring Health network are compensated based on the healthcare outcomes of their patients and how efficiently they are providing quality care. Providers can be stack ranked in real time, and top performing providers are rewarded every quarter. The data-driven operations of Spring Health is what enables its deep understanding of provider performance.
• On creating a differentiated experience for providers: Spring Health’s data-centric approach has benefited not only patients, but also the providers in their network. Providers learn from the data Spring Health provides on the efficacy of their services. Spring Health also provides formalized coaching programs for providers that structures opportunities for providers to learn. Spring Health has found that their providers really appreciate this service, and Spring Health leverages these services to attract top practitioners.

“Our mission is to eliminate every barrier to mental health and it’s not lost on us that the financial barrier to mental health is one of the biggest barriers to mental health today.”

21:05 to 27:51: Upcoming plans for this unicorn company

Spring Health recently raised $190 million in additional funding to close out their Series C round. This means that to date, Spring Health has raised $300 million in total funding. That puts Spring Health at a valuation of $2 billion dollars, and positions April as the youngest female to run a unicorn company.

• On what’s ahead: With the support of the latest funding round, Spring Health is focused on three priorities: global expansion, family care, and a mentally healthy workplace.

1. Global expansion: Spring Health’s current US-based customers have asked for an extension of its services to their multinational locations. Spring Health is currently building out its platform and translating its services to support international expansion.
2. Family care: Spring Health is also responding to its customers’ request for providing care to the families of the users they support. With teenage suicide rates at an all-time high, mental healthcare services aimed at caring for the family is top-of-mind for Spring Health.
3. Mentally healthy workplace: Spring Health strives to marry mental health and high performance amongst its own workforce. By harmonizing these two dimensions, Spring Health seeks to better support their employees and translate their learnings to improve their customers’ experience. To do this, April is applying Spring Health’s emphasis on data and academic research to combine existing knowledge with its own scientific discoveries to lead the industry on optimizing employee work / life balance and performance.

“Companies are starting to realize that they need to harmonize [employees’ mental health and high performance], and really prioritize both of those things. And so I want Spring Health as an employer to build the strongest culture not only so that we can change our employees’ lives, but also to take those learnings and share them with our customers.”

• On scaling precision care globally: Spring Health is investing to develop the capabilities to provide localized services that are culturally competent as they look to expand their services abroad. This expansion encompasses the full spectrum of Spring Health’s services, from customized member care to the support they offer to providers.

27:51 to End: Learnings from April’s entrepreneurial journey

• On what to look for in investors: The first dimension April looks for in a potential investor is mission and value alignment. For Spring Health, this means finding investors who share their long-term goal orientation instead of investors who are looking for a fast-tracked exit or IPO. The second is deep healthcare expertise. Healthcare-knowledgeable investors can not only provide expertise in understanding the broad healthcare landscape, but also provide a diverse network for Spring Health to access and help accelerate their growth. Spring Health also looks for investors who truly value diversity and see this commitment to diversity reflected in the way the firm invests. Spring Health found these factors converge in Kinnevik, the investor who led their Series C round.
• On the importance of diversity: As a female woman of color, April strongly highlights the importance of diversity at Spring Health. Currently, 43% of Spring Health is composed of people of color (15% African American). 60% of the employees at Spring Health identify as female. April seeks to reflect this diversity in Spring Health’s leadership team and board of directors.
• On growing aggressively but sustainably: Spring Health is focused on winning in the mental healthcare market in a way that supports their long-term vision. Spring Health’s investor base shares Spring Health’s vision and does not push for reckless growth. Spring Health’s growth plans have been further boosted by COVID-19 and the emphasis it has brought on mental health.

“We want investors who are long term oriented and really buy into this idea that Spring Health will be the next mental health giant of the future.”

• On founding a company as a young female woman of color: April founded Spring Health at the age of twenty-four. Healthcare is an industry that has historically defaulted to those who have medical degrees and more years of experience in the industry. The ageism and male-dominated culture made it more difficult for April to establish credibility at the beginning. In addition, April’s Korean cultural heritage emphasized deference to elders. This idea normalized hierarchies built around age and further rationalized the ageism she experienced.
• On turning youth and inexperience into a strength: Being young and having less experience in healthcare helps April embrace “clean slate thinking.” This entails examining the fundamentals of the U.S. healthcare system and questioning why things operate the way they do in the status quo. Bringing in this outside thinking helped April and Spring Health disrupt the traditional mental healthcare space by reducing unnecessary complexity.
• On leveraging her co-founder: After starting her first company with some classmates, April learned firsthand the importance of the working dynamic between co-founders for the success of a young company. When April initially met Dr. Adam Chekroud (PhD), her Spring Health co-founder, the pair tackled a series of smaller projects to test their working relationship before committing to starting Spring Health. The two shared many complementary skill sets, and Dr. Chekroud’s extensive scientific background lent credibility to the company from its early days.

“[My experience starting a company] has taught me that co-founders are everything. The dynamic among co-founders is the most important thing to get right in startups.”

• On cultivating a winning culture: Spring Health prioritizes six values, and hires talent within this framework. The six values are:

1. Members come first: genuine interest in mental healthcare and creating solutions that improve the user experience
2. Move fast to change lives: importance of working with a level of speed, urgency, and intention
3. Taking ownership: “radical owners” take responsibility for mistakes and are self aware
4. Diversity: intentionally building teams that reflect diverse perspectives and backgrounds
5. Candor with care: facilitating healthcare with honesty and transparency, and empathy
6. Science will win: adopting a data-driven approach to evaluating decisions

• On managing work / life balance: Striking the optimal balance between high performance and personal health is critical for April, and is also why Spring Health is dedicating resources to figuring out the right formula starting with its own employees. For April, burnout at work is a reality. To combat burnout, April models recovering between sprints at work by taking true vacation days to fully unplug.
• On general advice: Start a company if you sincerely care about the mission or goal and know when to quit: reflect on your criteria for quitting and don’t quit until you get there.

“We can be so passionate about what we do, but still burn out. Recovery is imperative to ultimately going faster. I think about it as a series of sprints: athletes who are sprinting have to rest after sprinting in order to sprint faster and continually improve.”

If you are interested in job opportunities at Spring Health, please refer to their job postings here.