Podcast with Mariam Malik (WG ’16) | Genoa Healthcare Telepsychiatry

The hot take: Telepsychiatry has stormed onto the field in caring for the most complex behavioral health (BH) populations. 1DocWay has had a successful journey from Wharton start-up to its most recent acquisition as Genoa Healthcare Telepsychiatry by OptumRx, a UnitedHealth Group company. Mariam Malik (WG ’16) has been a part of the team since interning there during her MBA as a Product Manager, and is now Senior Director of Physician Partnerships. In this episode, we explore the deeply personal experiences that motivated her interest in behavioral health, how she has led a team prioritizing both treatment center needs and clinician experience, and Genoa Healthcare Telepsychiatry’s need for MBA talent as it continues to scale.

Editor’s note #1: Telepsychiatry — the adaptation of telemedicine to treat patients with psychiatric illnesses — has existed for decades. However, it is especially in the last 5–10 years that shifting regulatory and reimbursement landscapes, evolutions in public perception, and advancements in technology have made telemedicine an attractive and effective modality of treatment to address behavioral health needs.

New Podcast Host (Start-1:30):

• Arpan Parikh, MD is a rising 2nd year MBA student in the Healthcare Management Program at Wharton and a currently practicing physician specializing in psychiatry and addiction medicine. Before coming to Wharton he was the Medical Director of the Addiction Institute at Mount Sinai-St. Luke’s, an outpatient addiction psychiatry clinic on the Upper West Side of Manhattan

Mariam’s career path to Genoa (2:00–4:30):

• Our guest today is Mariam Malik — Senior Director of Physician Partnerships for Genoa Healthcare Telepsychiatry
• Interested in the life sciences and healthcare early on; after college at UC Berkley worked at L.E.K. Consulting in SF office, in the Healthcare Services practice (primarily focused on payers, providers, and healthcare technology)
• Made the transition to Wharton’s MBA program, where she majored in Healthcare Management Program and met Samir Malik, the founder of 1DocWay
• Interned at 1DocWay in 2015 and after graduation joined Genoa Healthcare in a full-time role building and running the Physician Partnerships team

Brief Overview of Genoa Healthcare Telepsychiatry (5:00–7:40):

• Genoa Healthcare is the largest pharmacy provider for community mental health centers, with medication management and telepsychiatry services focused primarily on underserved Medicaid populations
• There is a tremendous need for a company like Genoa Healthcare in caring for this complex population which faces significant access challenges
• Telemedicine for psychiatry looks different from telemedicine for other specialities; it requires building not only a technology platform but also a clinical care system
• Some folks are skeptical about telemedicine and telepsychiatry; it can been difficult to shift their mindsets to be accepting of delivering psychiatric care virtually

Behavioral Health Megatrends for Telepsychiatry (7:40–9:25):

• Medicaid is leading the charge on reimbursing for telemedicine visits; in almost all states Medicaid will cover the cost (and sometimes pay a bonus) to incentivize the delivery of care via telemedicine
• A significant headwind in this space has been the state-by-state regulatory burden; Genoa Healthcare Telepsychiatry has been active in lobbying for change (for example, efforts to standardize and allow the e-prescribing of controlled substances in Indiana)

How Do We Define Behavioral Health? (9:45–14:55):

• Behavioral health encompasses mental health needs (e.g. anxiety, mood disorders) as well as substance use disorder needs
• Psychiatry and therapy are tools used by clinicians to address patients’ care needs
• Stigma in behavioral health is driven by either a lack of understanding or a lack of willingness when thinking about where to start in addressing the behavioral needs of a population

Direct-to-Consumer in Behavioral Health (15:00–18:00):

• The growing trend of direct-to-consumer (D2C) reflects people wanting to take a larger role in their own behavioral health (BH) needs or the BH needs of loved ones
• Making it ok for people to address their BH needs and have a path forwards in treatment helps lessen stigma, and D2C platforms can provide that capability
• D2C products will resonate most with the fairly low acuity and healthy populations; for populations like those that Genoa Healthcare addresses (who face significant barriers in accessing care and have complex clinical needs), the D2C model is not as compelling alone
• There is evidence that telepsychiatry functions well in treating this clinical patient population, and this data is compelling to payers (see here and here for two studies exploring this further)

Editor’s note #2: The proliferation of D2C healthcare companies as of late mirrors this trend — the vast majority are aimed at treating relatively low-acuity and chronic diseases in otherwise health populations. It remains to be seen if the same D2C model can be effectively expanded to care for more clinically complex and potentially life-threatening disease states, behavioral health included.

Why Behavioral Health? (19:00–21:00):

• Deeply personal experience with a close family member who struggled with psychiatric symptoms
• Accessing the behavioral health system for a family growing up in the Bay Area with one parent as a physician was difficult; saw endless problems to solve in making the patient journey a better one

The Rollercoaster Ride of OneDocWay to Genoa (21:00–22:45):

• In November 2015, 1DocWay was acquired by Genoa Healthcare, forming Genoa Helathcare Telepsychiatry
• In October 2018, OptumRx of UnitedHealth Group acquired Genoa Healthcare, including the telepsychiatry group
• 1DocWay targeted the Medicaid population, and the acquisition by Genoa Healthcare was synergistic in being able to provide both the pharmacy management and clinical treatment to psychiatric clinics

Mariam’s Role Leading Physician Partnerships (23:00–26:00):

• The role was primarily business development, with the goal of building a team to attract physicians and nurse practitioners to Genoa Healthcare Telepsychiatry
• Key step has been to identify the primary gap for psychiatrists and nurse practitioners in delivering care via telemedicine, and making the role attractive to clinicians
• In addition to engaging patients on the platform, she wanted to find a way to bring clinicians happiness in their daily work and build value in their own careers

Key Challenges in Managing Physician Partnerships (26:00–28:30)

• Clinicians have varying degrees of telepsychiatry understanding, technological competency, and career goals; the Physician Partnerships team looks to close gaps in understanding and create longevity in the relationship
• Creating longevity in the patient-physician relationship improves clinical outcomes and improves clinician satisfaction in using the platform
• It’s a two-way relationship: Genoa Healthcare Telepsychiatry learns from physician feedback, while clinicians grow professionally; this differentiates Genoa Healthcare Telepsychiatry from other consumer-oriented gig economy businesses

Editor’s note #3: Based on my clinical experience, this is spot-on. Physicians (particularly psychiatrists) deliver the highest quality care when they care for a consistent patient panel and have a consistent team (therapists, social workers, front-office). This consistency also drives physician satisfaction, and in today’s increasingly competitive clinician job market, is an essential component of the business plan.

Adapting to Shifting Macro Trends (29:00–31:00):

• Genoa Healthcare Telepsychiatry has created a core competency in matching the right clinician with the right opportunity at the right time
• Finding clinicians who can meet the specific needs of a population as identified by their clinic partners is critical (whether based on age, language, or treatment subspecialty)
• Genoa Healthcare Telepsychiatry has also begun to invest in the clinicians they work with, and provide additional training and support to ensure they are best suited to care for the populations based on shifting trends (e.g. rise in substance use disorder incidence and an aging population)

Hiring MBAs (31:30–33:00):

• Genoa Healthcare hires MBA, and has hired MBAs since the OptumRx acquisition
• They are looking for MBAs with a variety of skills, and are particularly interested in MBAs looking to join the team of a business that is still scaling
• Mariam finds she often uses skills developed during her Wharton MBA in her role at Genoa Healthcare Telepsychiatry
• Contact hiring@genoatelepsychiatry.com if interested

MD/MBAs Making the Decision of Residency or Not (34:00–36:00):

• There is value in learning about the broader context of medicine — finding a way to absorb that knowledge is particularly important given the shifting practice environment whether that means getting an MBA, industry experience, or seeking out experts in the field

Advice for MBAs (36:00–37:30):

• Don’t be afraid to lead with personal stories, particularly in the healthcare space; leading with authenticity and showing vulnerability is powerfully inspiring