[JOE SANOK] You can spend lots of time going on YouTube, reading people’s blogs, even listening to podcasts like this, but if you can find someone you trust and you understand what they’re teaching, they can save you time if you just follow them, if you dive into what they’re looking at teaching you. That’s why we put together pillarsofpractice.com, a totally free e-course to help you, whether you’re a solo practitioner or a group practitioner, to get the basic checklists and trainings that you need to rock out your private practice. Head on over to pillarsofpractice.com to get access to this free e-course. Again, that’s pillarsofpractice.com. This is the Practice of the Practice Podcast with Joe Sanok, session number 883. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. I hope you are doing amazing today. It being the 22nd of June this time of year always has some memories for me. On the summer solstice when I was in 10th grade, going into 10th grade I was in New Mexico hiking with the Boy Scouts and we climbed this mountain called Mount Baldy and when I was up there was actually a pastor that came and told my dad and I, that my grandpa had passed away. It was this whole thing to get out of the wilderness and to get on a plane. This was pre-2001, and so my dad had actually forgot his ID and like we had to figure out how to get it on an airplane. Every year on the 21st of June, which was actually my grandfather’s favorite day of the year, because he could garden late into the day, which he did that day, I always, for probably like five or 10 years did something big and noteworthy on that day as a high schooler, an early college. So it’s the kickoff for summer, but it’s also one of those things that, we all have those special memories of whether it’s grandparents or people that we’ve lost, that looking at today’s date makes me think about that. And having that why of why we do therapy, of figuring out how we do care of having more time with our clients is really a big thing that we’re talking about today. I’m really excited because Danny Freed is going to offer us some amazing advice in discussion around measurement-based care and how to have more time with our clients and not as much time doing progress notes. Danny Freed is the founder and CEO at Blueprint, which is a software-as-a-service platform for behavioral health organizations to easily measure, demonstrate, and improve quality of care at scale. Prior to Blueprint, Danny led product and design at Trunk Club, which was acquired by Nordstrom and I was a customer of Trunk Club. That’s crazy. His marketing worked on me and I did some Trunker Club fashion stuff. And co-founded Companion, which is an award-winning personal safety security app used by millions of people worldwide. It’s been featured on CNN, Today’s Show, Business Insider and More. [JOE] Danny, you are a powerhouse. Welcome to the Practice of the Practice Podcast. [DANNY FREED] Thank you. Appreciate that awesome intro. It’s great to be here. [JOE] Yeah, it was funny. I don’t, I know I interviewed you a couple years ago, but I don’t know if Trunk Club just wasn’t in your bio, but I just was like, what? Look at that. [DANNY] Great years at Trunk was, it was really fun. Fun fact, I actually, so I was doing product and design there for a few years and I would try and dog food the product, so I would actually be a stylist secretly and actually found out how to sell clothes, which was a fun experience. [JOE] Well, like, before we dive into all the therapy stuff, what from Trunk Club and being a product and design person in that world, what do you apply from that in your world now or when you’re working with mental health professionals? [DANNY] Well, I think there’s a bunch of things. I mean, the whole reason I got into this space it’s personal. I can tell that story, but I think what’s been interesting about my journey over the last 10 years, spending time designing software experiences for millions and millions of people and building products and having started a company before this, the little details really matter. Design really, really matters no matter what you’re doing, but it especially matters to have really thoughtful design when you’re building a technology product for clinicians who are treating clients really ultimately in a really vulnerable moment oftentimes, and you’re dealing with clients between sessions where they may be at their most vulnerable. So good design always matters, but it matters, especially I think, in mental health care. So from day one, we’ve thought for hours and hours about every little detail that goes into the experience with Blueprint from both the clinician side and the client side and there’s always more work to do. But I think that stuff adds up over time and really makes a big difference. [JOE] Yeah, I feel like design is one of those things that when it’s done well, you don’t notice it. It just kind of, things flow. You’re like, yeah, that’s how it should be. Like, of course, why doesn’t everything just flow like that? And once in a while there’ll be something that has such good design, you’re like, dang, that’s good design. But then when design is done bad or poorly, it stands out like a sore thumb where you’re just like, oh my word, this is so unnecessarily frustrating. [DANNY] Hundred percent. I mean, we obsess over the details at Blueprint. So we’re often, even though I think if you talk to folks who use our product, they would put us in the first category, most of the time when we think about things internally, all we talk about are the things that are frustrating the heck out of us because we know there’s these moments of friction and we can’t stop fixating over them until we fix them. I think it’s that counterbalance of focus on the little details, focus on the things that are going wrong and not working and have too much friction. That’s the only way to put it into the background and create these really amazing experiences. [JOE] Yeah, it’s actually really good to hear that you guys constantly have like things that you’re working on or improving or shaping because sometimes I feel like, oh man, I just want to arrive. But there always are those things and getting feedback from people and the market changes and expectations change. So it’s good to hear that you guys have that going on as well. Well, I want to dive into just measurement-based care. Before we started rolling, we were just talking about measurement-based care. How is measurement-based care typically done? Then maybe we can talk about new ways that it’s emerging now. [DANNY] Yeah, it’s interesting. So measurement-based care is this thing that’s been around for a few decades within mental health care. Early on it was really something that was only done in the research setting. It started to trickle into the day-to-day clinical practice, which is exciting, but I think the definition of measurement-based care is something along the lines of the routine administration of these clinical assessments and use of those assessments in a few different ways throughout the course of care. So not just at the start of care, not just at the end of care, but actually using these as a tool to inform decision making at the, before, during, after sessions session. What’s been I think interesting and a exciting thing that we’ve stumbled into is that there’s so much more value that we can deliver to clinicians beyond just a PHQ nine every two weeks, for example. So from day one, but also especially over the last 12 months, we’ve been thinking a lot about how do we expand this definition of measurement-based care? How do we maybe even rebrand what measurement-based care means so that it’s not just collecting data for data sake because I think that’s the connotation that most folks have when they think about or hear measurement-based care and actually making this a thing that’s really valuable in really actionable ways for a therapist at the point of care and for their client throughout the course of care. [JOE] Yeah, I mean, that idea of data for data’s sake, I remember when I worked at Community Mental Health or Catholic Family Services, all these places where they’d have their monthly audits and then their quarterly audits. It was because every three or five years they had some national audit and they wanted to make sure that they weren’t redoing files incorrectly. It was all for this auditing agency without any sort of meaning behind it that, oh, like this happened in the session and here’s the numbers and here’s how I’m going to then change my mode of care because of it. So what are you seeing happen with data equating more to action than just data for data’s sake? [DANNY] Yeah, so there’s really two things. I think early on maybe when we last talked, like there is some initial appetite in the market for data for data’s sake. Like there is value in having this data, but what I think we’ve realized is that most clinicians don’t care about data, but they do care about two things. Number one, they are motivated and driven to do their best work and I think that’s near and dear to everyone’s heart who is in this space and in the therapist’s seat and number two, they’re probably struggling with the amount of documentation and progress notes that they have to keep up with. It’s probably eating away into their free time, eating into the time they might spend with clients. So what we’ve done over the last 12 to 18 months is build Blueprint into this tool that can yes, capture data, but translate that data into guidance for clinicians to do their best work during a session and using that data to essentially write your first draft of your progress notes for you to save you anywhere from a couple hours to a dozen hours per month, depending on how you’re using it. [JOE] I want to dig into the progress notes in a minute, but before we move there, tell me a little bit more about what that looks like when it comes to measurement-based data informing the clinical session. Because I’m thinking about when I first got licensed, I worked in Michigan’s upper peninsula in this rural town called Escanaba and probably had 15,000 people, people would self-report something. I might even make something in word for them to tally mark how many times they were frustrated in a day. Like there weren’t many, I mean, I had a Palm Pilot at the time, so it’s not like there’s a lot of apps going on, but that was the extent. I might do an assessment here and there if we really decided we wanted it, but then the agency was like, we’re not going to pay for all these assessments. So then I’m, as a new clinician in the middle of nowhere with my treatment planning and going through all these different interventions we could do. Now granted that was Circa 2004, 2005, and I know we’ve come quite a long way in 20 years, but like, what does it look like for a new clinician now if they’re using measurement-based data to like, help them in the actual sessions? [DANNY] Well, I think it can still be lonely and I think especially with a lot of the move to telehealth, it can be even harder to get guidance support and training even if you’re in the heart of New York City or Chicago and you still might be delivering care on a remote environment and in some ways on your own. So there’s a couple of things that have I think enabled this type of approach to really take shape and move into the mainstream. You mentioned Palm Pilot. Now almost everyone is carrying around this smartphone, which represents this opportunity to capture data in real world settings throughout the week, which makes up 99.9% of an individual’s time outside of that session. So the first thing we do is we capture all this different data. So it’s clinical assessments, think PHQ 9, GAD 7, we have hundreds of those. We make it really easy. We make them smart so that you can actually interpret how those scores look. Number two we actually can administer homework through Blueprint. So you can go in and you can assign DBT diary cards or CBT thought records or even daily journals depending on what your approach to care is. Then number three, you can also capture things like exercise, sleep and other, what we called passive behavioral signals in the background which you can then incorporate into treatment planning. in addition to that self-report data. So these three things serve as the inputs for then what we do, which is generate what we call a blueprint. So we’re taking all this data that we’re capturing throughout the course of the week between sessions, and we generate this blueprint for the clinician, which they pull up typically at the start of a session or a couple minutes before a session and we essentially translate this data to try and mimic a therapist’s typical workflow. So it starts with presenting the data and really easy to understand ways around checking in and reviewing what was done last session, reviewing homework. Then you get to the section around actually delivering interventions and depending on what has transpired that we’ve captured over that last week, blueprint might surface up specific interventions that that may be relevant. So for example, let’s say client reported suicidal ideation through the PHQ 9 throughout the course of the week, we might present you if you’re a DBT therapist with a number of different DBT interventions that might be relevant at that point in time based on the data that we have. Then at the end, you can assign homework, you can plan for next session, and then you can complete that session and we’ll generate that progress note for you at the end of the session based on all of that data that we’ve captured between session from the client, as well as during session from you as you’ve used Blueprint to run that session. [JOE] So then, take your typical therapist that you know is first, second year out of grad school what sort of things, if they’re dealing with depression and anxiety, things like that, walk us through with that framework you just shared like what would their experience be that someone’s showing up and then what types of blueprints would be given to them as examples to get them going? [DANNY] Yeah, so the first thing the Blueprint does is it’ll call out any critical events that have been identified and identified how that, identify how that client is progressing towards their treatment goals. So this is a combination of things like mood and energy and sleep scores and social connectedness on a self-report basis, as well as these clinical assessments. These clinical assessments, I think sometimes get a bad rap. They’re often pretty clunky and cumbersome to use, s we’ve tried to distill them down to just the most important things and make them frictionless for therapists. For example, if I’m administering a PHQ 9 for a client who has depression or one of the other depression related assessments, Blueprint will actually tell you what the percentage change was since the last assessment, if that’s significant, how that maps to the clinical guidelines around that assessment. So we are not going to just say, hey, it was a 17 on the PHQ 9, good luck. Then based on that result, we may surface up different homework assignments that might be relevant. We may surface up different interventions that might be relevant. All of this is going to be personalized down to you as the individual client as well as the clinician and whatever your treatment modality is. We have a wide range of different homework assignments, a wide range of different interventions, and even if we’re not surfacing those up we have this library of interventions that has all this guidance baked in. So let’s say, let’s go back to the earlier example. Maybe there’s indication of suicidal ideation that I uncovered during the session. Well, Blueprint has a safety plan intervention that I can use and put together in collaboration with my client during a session. I can send it to them afterwards. That safety plan intervention is going to come with prompts and guidance and guidelines according to best practices out there that are going to help me as maybe an earlier clinician actually put together that safety plan and figure out the best ways to do it. So the alternative is you’re looking through workbooks or you’re going from memory, or you have a one pager, a resource guide, something like that that probably lives in a file cabinet or a bookmark folder, a tab open on your browser and we try and take the best of the best information that’s out there. We have a whole clinical team that curates all that information and put it at your fingertips when you need it and really try and make this as simple and frictionless as possible. [ALMA] Going in network with insurance can be tough. I know when I took insurance there were long wait times and it was so confusing. Filing all the right paperwork is time consuming and tedious. And even after you’re done, it can take months to get credentialed and start seeing clients. That’s why Alma makes it easy and financially rewarding to accept insurance. When you join their insurance program you can get credentialed within 45 days and access enhanced reimbursement rates with major payers. They also handle all of the paperwork from eligibility checks to claim submissions in guarantee payment within two weeks of each appointment. Once you’ve joined Alma’s Insurance Program, you can see clients in your state of licensure regardless of where you’re working from. It’s amazing to know that you can be fully online. Learn more about building a thriving practice with alma at helloalma.com/joe. That’s helloalma.com/joe to get started. [JOE SANOK] Yeah, I even think about a lot of our group practice bosses that have a handful of clinicians all the way up to 40 or 50 and how often they’re like, we don’t really even know what’s going on behind closed doors. We don’t know how that’s working. To think about knowing that using a system like Blueprint or other systems to make sure that like we’re reducing our liability as a practice, making sure we’re offering good quality care, doing it on data how are you seeing practice owners, whether they’re solo practices, group practices, how are you seeing them utilize the tool? [DANNY] Well, I think first and foremost, this is a tool that not only can improve the clinical efficacy and quality of care, but can also grow revenue. We do that through a number of different ways, but just think about the time savings on progress notes and what that can lead to, not just more time to invest in yourself as a therapist or a group of therapists, but also potential to take on another client or spend more time with clients. So there’s a number of ways to produce revenue that way. But the other use cases for a practice owner that are really interesting are, and we’re seeing examples of this across our entire base using this as a tool to help with case management and supervision, that quality assurance, not from a report card standpoint, but from a, using data to identify cohorts of clinicians or cohorts of their caseloads, which maybe are below our normal benchmark and using that to then dig in and apply more training, apply more resources, and without data you that might go uncovered. So blending those two use cases together can be really powerful. And I think the other thing that we hear a lot from practice owners is there, they’re looking for ways to differentiate their practice, whether that be to prospective clients, whether that be to prospective clinicians or current clinicians that they’re really thinking a lot about retaining or whether that be to payers. When you use Blueprint, you’re not only empowering your staff to do their best work in less time, you’re also building up this really, really valuable and robust outcomes data set, which you can then use to differentiate your yourselves as a practice and not just say how effective you are, but actually show off with real objective data how effective you are to prospective clients, to prospective clinicians, to those payers and use in various ways. So that’s certainly something that’s an interesting byproduct once you start using the platform that you get on top of all the other benefits. [JOE] So awesome. Well talk a little bit about the progress notes and how that works because I don’t hear any therapists that say, I wish I was doing more progress notes and paperwork. So even just that pain being reduced is like, so awesome. So how does that work? What’s it look like? Do people, can they customize it after the suggestion? Yeah, walk us through some of that. [DANNY] It’s funny, I’ve met with thousands of therapists and practice owners at this point, and I have not yet met someone who enjoys doing their progress notes. I don’t think I ever will. Everyone recognizes this is something we have to do. It is important. Everyone recognizes the importance, but almost everyone I talk to is struggling to keep up or their staff are struggling to keep up, which has all sorts of other implications in some cases in terms of cashflow and documentation and whatnot. So the way that it works is we essentially take all of the data that we’ve captured for an individual clinician and client, so that’s assessments that were completed throughout the course of the week, that’s homework assignments that were completed, that’s maybe critical events that we’ve identified as well as any data that was shared with us during a session. So that might be the metadata around, hey, I delivered X, Y, Z intervention, hey, I assigned X, Y, Z homework. We’re not listening into, you know we’re doing any session recordings, but we have all of this data where we actually understand which interventions were delivered, what those outcomes are looking like, what the specific homework assignments were, and we can use that to essentially generate a first draft progress note. So the way we do that today is we give you a bunch of different progress notes, snippets that you can then compile into a soap note, into adapt note, you copy and paste those into your EHR so it’s super simple, one click copy paste and then you can edit and adjust as you go. It’s a new feature for us. We launched this in, I think January, February of this year to our full base of clinician users and the response has been overwhelmingly positive and exciting. So we’re going to continue to improve this feature, add more functionality, more templates, more data inputs to really try and make this progress, this process of progress note writing and documentation, not only a lot more efficient, but also a lot more effective and really allowing practice owners to configure these templates according to their best practice guidelines for their specific markets and their specific payers. So there’s a lot more to go here, but even today that copy paste feature is going to save the average clinician about 10 hours per month on progress notes if they’re using blueprint across their full caseload. That should only improve. [JOE] Dang. I mean, you figure 10 hours a month, even at a hundred bucks a session like that’s a thousand dollars in extra revenue or time that you could be doing other stuff that’s amazing. The last little bit here, since we have the time, I would love to hear your thoughts on like the intersection of technology and mental health. Because it seems like people fall in a couple different camps. There’s people that are really into technology, they feel like it can enhance things tremendously. It’s a huge time saver the creation of apps, all of that. There’s people in the middle that maybe are thinking yeah, this is great. It can be a good addition to it. Then there’s people that are very against most technology interventions. I’m not talking like EHRs or resources, but when we talk AI in a lot of our membership communities there’s some benefits to it for sure of helping people come up with blog post ideas, coming up with all sorts of ways of using AI, but then there’s also a big worry that I’m seeing more and more in the mental health space of people saying no one’s ever going to replace a human. Nothing can ever replace that relationship. Even though that’s true there’s also a lot of new apps coming out using AI to support people at 3:00 AM when they’re feeling upset and want to talk to an AI bot that just helps them get through until they can see their therapist. So there’s a lot, not necessarily, I don’t necessarily have a, here’s the question, but more of just raising the topic of the intersection of technology and mental health, like, how do you think through that and what conversations are you hearing from, from therapists that are in the tech and mental health spaces? [DANNY] Yeah, I think it’s a really good question. I think it’s a little all over the board right now. I think people are excited and nervous and scared, and I think that’s all good and healthy. I think the debate around this is all really important. My personal opinion here is that, first of all, I think AI is here and it’s only going to grow and get better over time, but it’s here. But the way I think about AI is, I personally don’t think this is something that’s replacing a human or replacing a therapist, at least not anytime soon. The way I think about these tools are how are they going to enhance and augment humans to be more productive, more effective, more efficient in various ways and how do we leverage them to help us as humans do our best work hopefully in less time and what does that look like across any type of profession? So you mentioned the use cases of like copywriting and marketing and whatnot, and I think the same will trickle into healthcare. I think it already is trickling into healthcare and into mental healthcare. I think the progress notes aspect is a really exciting early use case where there’s still a bunch of questions around privacy and data that are really, really important to answer, but no one likes doing their progress notes. I think most people would be willing to hire an AI tool or program or platform to help with those. Then you start to think about okay, well, what’s the next evolution of this? I think what we’re thinking a lot about at Blueprint is how do we continue to generate these insights from all the different data sources that we’ve captured from an individual and use that to help therapists through their best work. How do we enable the intern or the one or two years out of school, out of their graduate program to be as effective as possible? How do we turn them into super therapists by leveraging data and technology and AI? So that’s where my head’s at and thinking about how we might do that and there’s so many different ideas and paths and lots of exciting dialogue happening right now. I think at the end of the day, there’s two things that we’ve tried to be really focused on at Blueprint since we got started, number one being really problem focused versus technology focused. So we always start with the problem. We always think about the problem. We don’t really talk about the technology much unless it’s a means to an end. The other one is really leaning on our customers and on our clinician users and on their clients in some regard to help us figure out where to take this thing. We don’t claim to be grandmasters or geniuses in a back room, devising these whole plans. We like to think we’re pretty good listeners. We like to think we can ask the right questions to try and figure out the different dots and piece them together. So we really owe it to our clinician community in terms of helping us to figure out what to build next and how to evolve this platform and how to incorporate different technologies like AI into the platform over the long-term. So we’ll continue to do that and just listen to clinicians and let them show us the light. [JOE] So awesome. Well, the last question I always ask is if every private practitioner in the world were listening right now, what would you want them to know? [DANNY] I think, the thing I would say is something I heard on a podcast a couple of months ago that was not about therapy at all. It was actually interviewing the founders of Instagram. This takeaway I had, I think applies to anyone running their own business or managing their own caseload, which is trust your measurements. So I think the job of a therapist, the job of a practice owner can be incredibly lonely. I think the job of an entrepreneur can be incredibly lonely. You’re often fighting with your emotions, trying to stay level. Sometimes you have really good days, sometimes you have really bad days. Same goes for a therapist, same goes for really anyone. I think what their message was, and what I think really resonated with me is trust your measurements. The same way a pilot who’s flying through clouds trust their measurements, they don’t look out the window and make assumptions, they trust their measurements, and they really believe in those measurements. I think that applies to running a practice. I think that applies to managing a caseload and I think that applies to a lot of different things. But I think within therapy, one of the things that we have been focused on is how do we collect those measurements and make those measurements really useful? So I would just really encourage people to, if they have a connotation on measurement-based care or data or technology, it’s totally fair and valid. Step back and think about how you can make this technology work for you versus the other way around because I think there’s some exciting stuff going on and it’s going to be interesting over the next few years how all this stuff shakes out. [JOE] Hmm, that’s so awesome. Danny, if people want to connect with Blueprint, if they want to get started with it, where’s the best place to send them? [DANNY] Yeah, so our website is blueprint-health.com or blueprint-health.com. You can also reach out to me directly at [email protected] and myself or anyone on our team would be excited to chat and learn more. [JOE] Oh, Danny, thank you so much for being on the Practice of the Practice Podcast. [DANNY] Thanks so much, Joe. Appreciate it. [JOE] It’s amazing how often I meet with consulting clients, people in our membership communities, even folks that are just listening to the podcast and we talk numbers and really basic numbers that we all should know. Like, how many calls are we getting per month? How many of those are converting into doing actual sessions? What percentage are private pay versus assurance? What’s our lifetime value of a client? Those really basic financial numbers oftentimes we don’t know. Then what we measure is oftentimes what we work on. So even looking at the clinical side of how are we measuring the effectiveness of what we’re doing? I mean, just think if you had two therapists and one could say I know the average person comes 6.7 times and they say that they met their goals and they feel better, and here’s the measurements we have over the last five years, the last six months, or whatever. The other side, the art of therapy is great, and I don’t know really if people get better, but it’s artistic. Like sure, there’s a place for the art side and the non-measurement side of private practice, but there’s also a lot of value in what we measure. So I hope that you think through that lens that Danny gave us of yeah, let’s measure a little bit more. Let’s use resources like Blueprint to help us leverage that power of technology to do the work that we are doing, not to replace the work, but to do even better and more effective work and to not fricking do progress notes for like a whole day. 10 hours a month, that’s no joke. That is a lot of time savings. So again, if you’re looking to connect with Blueprint, that’s blueprint-health.com. Also, we couldn’t do this show without amazing sponsors. Our sponsor, Alma knows that going in-network with insurance can be really tough, filing all the right paperwork, it’s time consuming, tedious, and even after you’re done, it can take months to get credentialed. You can build a thriving practice through Alma over at helloalma.com/joe. That’s helloalma.com/joe to get started. You’ll see a little quote from me there on the same page as Esther Perel, which that’s a pretty big deal for me to be on the same page as Esther. Thank you so much for letting me into your ears and into your brain. Thanks a lot. Talk to you soon. Special thanks to the band, Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.