Lessons from Karan Singh, Headspace Health, reinventing new GTMs and business models in mental health
Karan Singh, COO and Co-Founder of Headspace Health, a leading provider of mental health and wellbeing solutions, touching the lives of over 100 million people in 190 countries.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a healthcare business from 0 to 1.
This week, we’re super excited to have Karan Singh, COO and Co-Founder of Headspace Health, a leading provider of mental health and wellbeing solutions, touching the lives of over 100 million people in 190 countries.
As Co-Founder & Chief Operating Officer, Karan drives clinical strategy, business development, research, and oversees daily operations for Ginger. He has worked across the healthcare ecosystem, from consulting with leading bio-pharma clients at ZS Associates to commercializing a health data analytics solution at Humedica. Karan holds his MBA from MIT Sloan and graduated with his Bachelors from UC Berkeley.
Founded in 2011, Ginger provides personalized mental health support from behavioral health coaching, therapy, psychiatry, and self-care resources, all from the privacy of a smartphone.
Last year, Headspace and Ginger merged to form Headspace Health, which is valued at $3B. Before Ginger was acquired, Ginger had raised $220M+ in funding. Now Headspace Health combines Ginger’s therapy, psychiatry and coaching offerings together with Headspace’s mindfulness and meditation services. Mindfulness by Headspace, human-to-human support by Ginger. Through their flagship Headspace brand, they have touched the lives of over 100 million people in 190 countries through mindfulness tools for managing stress, sleep, and focus. Headspace for Work and Ginger is distributed through over 3,500 enterprises today.
In this episode, we talk about what it was like founding Ginger, and establishing new business models (one of the first digital health companies that sold to employers at scale), and the incredible journey a decade later touching over 100m lives globally. Karan is extremely humble and grounded and I think we can learn a lot from his leadership style and his perspectives and philosophy on founder work-life balance.
Ginger’s founding story as one of the first digital mental health startups
In 2011, there wasn’t the ecosystem of digital health companies or care products that exists today. Ginger was inspired by Karan’s personal experiences with mental health after a loved one tried to take their own life. Many founders in mental health have in some way or form been affected personally through family, friends and loved ones, which drives them to tackle a difficult and challenging but meaningful space.
“I was surprised, and I didn’t see it coming. For many people, especially a lot of communities of color, mental health is a topic that very few people talk about. I wanted to do something about it.”
Karan went back to graduate school at Harvard Medical School / MIT Health, Science & Technology (HST) program interested in the intersection of healthcare, data, and technology, where he met a large portion of Ginger’s core founding team at the MIT Media Lab. Karan’s entrepreneurial path was not a straight path, he didn’t know if starting a company was the right approach but the more he dug in, the more conviction he had on starting Ginger. Ginger was launched in 2011 and started out working with or selling into provider groups, eventually becoming a provider group themselves.
“I wanted to be in this space in some way, but I wasn’t sure if entrepreneurship or starting a company was necessarily the right path for that. But, the deeper I dug, the more I realized that this was such an incredible and large problem and very few people were tackling it in a meaningful way.”
The genesis of Ginger was all about prevention— finding ways to support people in advance before they even know they need it and unlock access to care.
Supply of providers is one of the biggest challenges in mental health access and digital health, which is why Ginger expanded the supply base with coaches
Virtual mental health care’s efficacy has been proven in the last few decades, whether it’s cognitive behavioral therapy, motivational interviewing, etc. The challenge was these treatments hadn’t scaled because there weren’t enough providers, workforce, or labor in the market.
Karan shares that in the last few years, they’ve been pushing for an expanded definition of mental health care— people may not necessarily need a therapist or psychiatrist, but a coach.
In the beginning, Karan shares that coaching wasn’t present in the care stack. Early on health plans had not reimbursed coaches, but over time Ginger worked with health plans to get coaching reimbursed.
“We approach this from a clinical or scientific lens and say, ‘What is the evidence out there? What has been proven to work? Can we translate that or leverage technology to do that more effectively?”
Knowing what you’re good at is just as important as knowing what you’re not good at, what your boundaries - it gives you so much freedom in the product development process.
As a virtual provider, Ginger helps folks dealing with acute symptoms get easy access to care, then refers them to further resources when necessary.
“Knowing what you’re good at and just as importantly, what you’re not good at, what your boundaries are… that gives so much freedom in the product development process, but also allows you to then be really clear to your customers and members when you might be sending people to other resources.”
Headspace Health’s goal is to keep patients safe, so they do not prescribe controlled substances.
Karan shares that there have been many changes during COVID to prescription regulations, allowing for certain weaknesses in medicine prescriptions but also implementations of legislation that exists to keep members safe. To prevent any sort of prescription abuse, Headspace Health is focused on having their own psychiatrists on staff and currently don’t prescribe controlled substances. Karan shares that their team felt that at this stage of the company, in-person care providers are better equipped to determine if a patient needs medication. As the mental health space evolves, Karan says the conversation will continue on partnering with in person treatment resources or developing further programs themselves.
Today’s mental health landscape has been facing some controversy around lax prescription of controlled substances especially around well funded Cerebral. In mid May of 2022, Cerebral said they would halt prescriptions of controlled substances.
“All of this is really about risk trade-offs. We would rather be more conservative on things like patient safety, so that we can actually ensure that members are getting better…
For me, the lesson is this is ultimately all a team sport. You're going to be a part of a broader ecosystem and you have to understand what you do well, and what others might do well, and so you can work together on that.”
Ginger merging with Headspace to become Headspace Health
Karan shares that it comes down to people, vision, values, and culture. Ginger and Headspace shared the same mission of helping people be kind to their minds, and that the solution to the mental health crisis is prevention.
“When we first made the pivot to becoming a provider, we often talked about the three C’s: coaching, clinical, and content. Pick two, meaning you can’t do it all. We at Ginger largely focused on coaching and clinical services, really standing up the people side of the house and making those care providers really effective and efficient.”
When thinking about the third pillar of content, Headspace was the natural partner. They now serve the full spectrum of care from prevention to meditation and support members throughout their care journey.
The companies are still merging in phases: Headspace Health is the umbrella entity with Headspace for Work and Ginger beneath.
If an employer has purchased the full spectrum of care, members have access to Headspace app meditations in addition to access to care to talk to a coach/therapist/psychiatrist paid through the health plan. Care providers are able to engage with the meditation content as part of the treatment plan and vice versa for Headspace users to get connected to a care team quickly.
Ginger: building mental health product offering from 0 to 1
In the early days, find 1) great people, and 2) the right problem.
Karan believes the key is to find great teammates who complement your skills, bring something unique to the table, and allow you to experiment, test, iterate, and pivot if needed.
Their team’s early insight was to use data, such as from a smartphone, to gain insights on mental health, such as being able to predict when you might have a flareup of depression or stress or anxiety. They sold that core product into providers, large academic medical centers, hospitals, etc. After a while, they realized their core challenge in this space was patients’ access to care in the first place, not just quality of care.
Pioneering the employer GTM approach
Their goal before selling to third party payers was to measure and demonstrate that their customers were getting better. They had already tested going direct to consumer, and discovered that interest had mainly been coming from employers looking to support their teams. After testing with a few pilot employers, they realized an employer need not addressed by existing health plans
Mental health space is moving towards a more specific, distributed ecosystem creating more targeted experiences for different populations.
Karan believes the mental health space is moving towards a more specific, distributed ecosystem creating more targeted experiences for different populations.
“Try to be focused, especially in the early days and the 0 to 1… It certainly tripped us up trying to do all the things at the same time. So much of this is finding a key segment, deciding in what stage/in what order what kind of hypotheses or data you're looking to prove out or test, and then deliver on that.”
After these initial steps, widen the scope and demonstrate the efficacy there. The mental health space is an underserved market: if you can get something to work, there’s a lot of value to be captured.
Don’t get too far ahead of yourself— keep the patient and providers at the core, and let those insights and the data guide your business.
“So much of the challenge has been figuring out what works for whom, when and how, because the data in this space doesn't exist, or historically, it hasn't existed, right? We didn't have alignment on even what you use to measure progress, like a PHQ or a GAD, let alone kind of alignment and payment for impact against those measures.”
Karan is bullish on tracking progress so that you can think strategically and thoughtfully about building your business. Keep the patient and your providers (if you have your own care network) at the core— treating them right will allow you to build a big business.
On scaling globally across different markets:
For early-stage founders, it’s important to start in a specific geo. It’s hard to choose a state within the country to start building in, let alone global markets.
“While there are very clear differences in which different communities talk about mental health, at the core, oftentimes, they're the same issues. Workplace stress relationships, sleep, parents, caregivers, loss of a loved one… these sort of core concepts are just really like life triggers, if you will, that we all share. It's just part of the human experience. That makes it in some ways easier to really deliver a somewhat of a consistent experience in each of these different countries.”
When expanding geos, think about making approachable jumps . Ginger rolled out support for Spanish last year. It required high effort to convert the whole experience, but has also created the infrastructure to recreate this for other countries.
Think carefully about when you do this and if you can do it well, because it creates more complexity over your whole operating system. It can be well worth it— Karan shares that many employer customers are interested in supporting worldwide employees as we see companies become increasingly global, and consumer demand is worldwide.
Karan’s been an executive leader for 11 years. His advice on maintaining the right mindset as a founder and prioritizing mental health as a founder.
Karan believes so much of founder success has to do with founder mental health and mindset. You need resilience in order to bounce back from challenges.
“One of the things I wish I had known early on was just how critical resilience was going to be to being successful as an entrepreneur… All you hear is no, all you hear every day is another massive challenge.”
Karan shares that protecting his mental health helped him not just respond, but react.
Build resources around you to be more successful, which for Karan was a tribe of other entrepreneurs that he could regularly lean on to talk through things.
Grind culture doesn’t make you more productive, it makes you less healthy. For Karan, spending time with his daughter is non negotiable.
“As a founder, you are not your company. They're two different things, and you can conflate your identity… [but] it's not who you are. Those two things make it really hard at times to if you need to step away or to bring in the leadership or to go in a different direction. But sometimes, it can also mean that, you know, gives you energy and purpose for a decade and maybe another decade.”
Future of Headspace Health is focused on addressable access and affordability
A major challenge in the mental health services in the US is affordability and access. One of Headspace Health’s primary value props is combatting this. From the providers’ perspectives, the reimbursement rates for mental healthcare can be low, which is why a lot of providers stay out of network (today over 60% of providers are still out of network). Headspace Health is focused on reducing friction by pulling costs out of the system and going in network. Receiving coaching or clinical resources can be far more economical for patients and make working with plan purchasers easier.
This is Karan’s big vision for digital health: finding ways to make healthcare more affordable, beyond a wealthier and healthier population.