While business is booming for behavioral health practitioners, it can be difficult for independent ones to juggle demand with the everyday tasks of running a business.
Often when practitioners render services, money is left on the table. In fact, it is estimated that less than 85% of what is owed to independent practitioners from commercial insurance is collected. The deficit is no small sum, considering that recent annual figures on mental health spending have it topping $225 billion.
Founded in 2018, New York-based Alma is on a mission to plug the gap. It works with practitioners to streamline business operations and grow their practices through in-person and virtual appointments.
More than 4,000 providers nationwide use Alma, which thus far has raised $90.5 million, according to Crunchbase. The company adds that 40% of its providers identify as Black, Latinx/Hispanic and Asian.
“Our first customer is the provider,” Alma founder and CEO Harry Ritter told Behavioral Health Business. “Our primary function is to help independent mental health clinicians build thriving in-network private practices.”
Among the areas of operations Alma helps practitioners with are appointment scheduling, training, billing, revenue cycle management and online meeting services. The company is in-network with a number of payers such as Aetna, United Healthcare and Cigna, and it works with practitioners to get them credentialed in under 45 days.
From Oscar Health to mental health
Ritter is a health care professional by training, coming from a different field as a physician.
He told BHB that he had much to learn about mental health prior to establishing Alma.
“It is embarrassing to say, but like most doctors, I didn’t know anything about mental health care,” he said.
The roots of Alma lie in Ritter’s own mental health journey, which began when he became the sole caregiver for his ailing father. Ritter assumed his dad’s caregiving duties while also balancing responsibilities of a career, being a husband and fatherhood.
“That was a really challenging moment in my life when I was going through that anticipatory grief, the anxiety and the loneliness,” said Ritter, whose father died in 2019. “Very thankfully, my now-wife suggested I seek out therapy.”
At the time, Ritter was a medical director for health insurance startup Oscar Health, where he helped to establish the company’s virtual and primary care offerings. Oscar’s tech-heavy model of matching insurers with individuals would make an impression on Ritter, who would leave the company in 2017 to found Alma.
Initially launched with a B2C focus of in-person and telehealth services, Ritter said he immediately got a taste of how high the demand for mental health assistance actually was through the first practitioner he hired.
“Within 24 or 48 hours, she was booked out for three months,” he recalled. “There’s so much demand for someone who would see a patient with insurance in an easy and technology-supported way, and we couldn’t find anyone to refer to.”
Ritter would discover a potential B2B market after consulting with a number of independent practitioners who admitted to having trouble keeping up with both service demand and operational responsibilities – particularly when it came to dealing with payers.
“[About] 90%-plus of clinicians out there in practice are independent,” he said. “They’re one-person businesses, and they just don’t have the support that they need to deal with insurance to implement technology in their practice. The question that we wanted to solve was, ‘Can we really work for them and help them build more efficient practices?’”
Alma’s value proposition to clinicians
Practitioners interested in teaming with Alma start off by applying to become part of the platform. After going through an onboarding process, Alma builds out a practitioner’s virtual presence on the platform, allowing them to control the number of patients seen, fees charged and therapeutic modalities used.
“The value prop for them is they get the support of a group practice, but the entrepreneurship and autonomy of their own independent practice,” Ritter said.
Practitioners pay $125 for a month-to-month membership and keep all fees generated from patient visits. Alma also charges practitioners a fee, which varies based on the visit, for processing reimbursement claims.
Ritter believes the company’s business model is economically advantageous for providers, especially as a number of other telemental health platforms have been criticized for employing or contracting therapists at low rates.
“That ends up creating a downstream benefit,” he said. “It creates a better care environment for the patient. It creates higher quality and a more sustainable model. We work for the clinicians; they don’t work for us.”
Alma’s platform allows patients to search for providers, with the company claiming that 90% are capable of being matched within a week. The company declined to give a number of how many users the platform currently serves, but noted that the number of in-network visits has jumped 60-fold since the pandemic.
For providers, Alma asserts that its platform saves providers 30 hours a month in administrative work, which includes scheduling, billing and claims management, as well as electronic health record (EHR) upkeep. Alma also provides practitioners with a proprietary EHR software program for patient tracking.
“We’re trying to do this in a way that helps the clinician deliver better care – not just deliver a spreadsheet that allows them to be graded – but really creates insights and data that can help their clinical practice and push them forward,” Ritter said about the company’s EHR tools.
Alma claims that it is able to get providers reimbursed in two weeks, whereas it might otherwise take months.
“That is going to make a big difference in terms of helping us to attract – and ultimately keep – as part of the Alma community the best clinicians,” he said.
Alma has also witnessed the trend within behavioral health of more providers moving to telehealth during the pandemic, as it says that 95% of its practitioners before Covid had been practicing in-person. Since then, 90% of visits have gone virtual, with over 75% in New York state alone solely operating via telehealth.
Alma’s practitioners currently offer in-person services in 16 states plus Washington, D.C., with telehealth options available in every state.
“From a consumer perspective, if you’re a client looking for care, you want to come to a place that’s going to have a choice immediately,” Ritter said. “I think virtual care has been a really valuable tool to help solve that.”
Alma on telehealth, funding plans and value-based care
Even as the virtual component dominates Alma’s service delivery, the company is not doing away with in-person care. The company is looking to grow its platform to 10 more states in the second quarter of 2022 where practitioners can offer in-person services.
Ritter said that more demand for in-person services is coming from patients requiring what he describes as niche care, such as children.
“An example might be pediatric patients, where play therapy is more difficult to do virtually,” he said. “For the bread-and-butter [services], we’re continuing to see really high satisfaction and resilience of virtual as the dominant modality.”
Alma’s most recent funding round came last August, when it raised $50 million in a Series C round that put its valuation at $500 million, according to an article from Forbes. Ritter said that the company is looking to raise more down the road.
“There’s a lot more work left to be done,” he said. “If we can supercharge our ability to move quickly and make that investment, we want to do it.”
Business activity within the telehealth space has been at a fever pitch since the pandemic, with digital mental health companies raking in $5.1 billion in funding last year. The number of exit deals overall among digital providers in 2021 almost doubled on a monthly basis from the prior year, but Ritter maintains that Alma is not looking to get involved in any mergers and acquisitions.
“We don’t have any specific M&A plans as a company,” he said. “There’s a lot of work for us left to do as an independent business that we’re excited about.”
Ritter said that Alma does not have data on the impact of services provided by practitioners, which is frequently done through assessments like the PHQ-9 or GAD-7. However, he said that Alma is developing new tools to streamline assessments on its platform and enable the review of analytics to measure practitioner impact.
Ritter also is keeping watch on the move throughout behavioral health towards value-based care. He said that like a number of providers, the company is looking at how to integrate value-based reimbursement arrangements into the platform, describing the process as being in the “early innings.”
“Twenty-four months ago, most clinicians were operating on pencil and paper,” Ritter asserted. “Just the mere fact that we now have a unified digital record for care suddenly starts to give us an opportunity to set baselines, and start to evaluate metrics and pay-for-performance opportunities. We are actively working on that across every dimension of our space right now.”
While Alma looks to its future with a dual focus on serving clients and practitioners, Ritter said the company’s model will continue to lean significantly on the practitioner side.
“It is a great time to be a mental health clinician, because there are more opportunities than ever before,” he said. “The big question that mental health clinicians need to think about is, ‘Who do I want to be affiliated with, because it’s ultimately my brand and reputation that I’m connecting to these organizations.’ That’s why for us, it’s really important to be focused on this provider-first approach to our market.”
