Lessons from Tina Beilinson Keshani, Co-Founder of Seven Starling, on Designing a Mental Healthcare Model for Every Phase of Motherhood
Tina Beilinson Keshani, Co-Founder of Seven Starling, a modern mental health care company that supports individuals through every stage of motherhood
Subscribe to our substack for updates and listen on Apple Podcasts or Spotify. Connect with Andrew or Lipsa if you find this post insightful and want to learn more.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.
Today, we're excited to get to know Tina Beilinson Keshani. She's the co-founder and CEO of Seven Starling, a Pear VC backed company and a digital clinic making high quality mental health care more accessible for expecting and new mothers. Before Seven Starling, Tina spent six years at Warby Parker in strategy and helped them launch their first optometric telemedicine service in 2015. She worked alongside Warby Parker CEOs, Neil and Dave, learning firsthand how to build and scale a company that also does good in the world. Her experience lies not only in scaling, high growth startups, but also building patient centric digital care experiences.
In this episode, we talked about Tina’s journey towards entrepreneurship, her time with Warby Parker, how she and her co-founders built Seven Starling, the success of her maternal mental healthcare company, and advice she has for founders.
If you prefer listening, here’s the link to the podcast!
Upbringing and Entrepreneurship
Tina's family originally hails from Kazakhstan, but their journey took a significant turn when they immigrated to the United States when Tina was just six years old. They were granted asylum, driven by the hope and dream that this new country would offer a better life for Tina and her brother.
In their pursuit of the American Dream, both of Tina's parents embarked on entrepreneurial endeavors. Her mother, a gifted tennis player, ventured into coaching, offering lessons to students. Meanwhile, her father established himself as a small business owner in Cleveland, providing employment opportunities for fellow recent immigrants.
Witnessing her parents' tenacity in building businesses from the ground up, experiencing the creative process, and observing the profound impact they had on their community served as a powerful motivator for Tina. These experiences sowed the initial seeds of her entrepreneurial spirit.
Insights From Warby Parker
“At Warby Parker, I got inspired about the possibility of building a for-profit company that also does a lot of good in the world, creating a vast impact that touches the lives of thousands, if not millions of people in a way that could impact society in really meaningful ways.”
Tina spent nearly six years at Warby Parker, joining the company around the time of its Series A funding round when it was still a relatively small team. Over the years, she witnessed the remarkable growth, scaling all the way to its Series E round with thousands of employees.
Her journey at Warby Parker was dynamic as she transitioned across various roles, departments, and responsibilities as the company expanded. She began in the online experience team, transitioned to the retail team as they ventured into physical stores, and later found herself in strategy. These transitions exposed her to diverse aspects of the business and provided invaluable lessons on effective strategies and practices.
Warby Parker's success story was not a stroke of luck but a result of deliberate actions, and Tina learned several key principles along the way.
Testing and Learning: Tina and her team at Warby Parker emphasized the importance of testing and learning on a small scale before scaling up. This approach allowed them to refine their strategies and products incrementally, reducing the risk of large-scale failures. It's a lesson that Tina and her team are actively applying at Seven Starling.
Maintaining Focus: Another crucial lesson from Warby Parker was the significance of maintaining unwavering focus. Despite the temptations and opportunities for expansion, the company's success was rooted in a relentless commitment to its core offering. This involved making the core product more accessible and impactful, which contributed significantly to their growth.
Building a Strong Culture: Tina observed that cultivating a remarkable corporate culture played a pivotal role in Warby Parker's success. A strong culture supported broader success and evolved as the company grew. It emphasized the importance of core values in guiding day-to-day decision-making. This lesson highlights the essential role of a positive and aligned culture in fostering a thriving organization.
The Name: Seven Starling
Seven Starling’s name was inspired by the Starling, a bird celebrated for orchestrating captivating murmurations in the skies.
A murmuration is a breathtaking phenomenon where thousands of birds come together to craft intricate shapes and formations across the sky.
The magic of this murmuration comes from the influence of the Starling’s seven closest companions, a captivating rule in nature known as the "power of seven."
This concept pays tribute to the notions of community and a purpose greater than oneself, both of which are fundamental to the Seven Starling approach.
Assembling the Seven Starling Team
Tina met her co-founders, Julia and Sophia, at Harvard Business School (HBS). Each of them arrived at HBS with a shared goal of establishing a women's health company and making a meaningful impact in the field.
The initial connection began through the Startup Bootcamp program at HBS. Engaging actively in various entrepreneurial clubs and activities on campus, they discovered a close-knit community of like-minded individuals genuinely committed to turning their business ideas into reality.
Continuously crossing paths in these entrepreneurial environments, they eventually joined forces during the summer between their two years at HBS to pursue a shared idea. Their second year was dedicated to testing, learning, and laying the foundation for their company, officially incorporating it in January 2020
Since the company's inception, the team has assembled a talented leadership group, including Dr. Amy Roskin as the Chief Medical Officer.
Dr. Roskin, boasting over 20 years of experience as an OBGYN, previously served as the Chief Medical Officer at The Pill Club, contributing significantly to their expansion from operating in a few states to a national scale.
Her journey with the team began as an advisor, and she quickly forged a strong working relationship with the founder, given her expertise and passion for the mission.
Earlier this year, Ceili Cascarano joined as the Senior Vice President of Growth.
Previously, she held the position of Vice President of Growth at Mindstrong, a Series C mental health company. Her extensive experience encompassed leadership in various facets of growth and go-to-market strategies. Ceili has a track record of collaborating with major payers and forging partnerships across diverse business segments
“ In the early stages, I think it's all about the hustle—initiating conversations with exceptional individuals, while having a compelling mission and vision that truly excites people. It's about inspiring them to take that leap of faith and join you on the journey.”
In line with Seven Starling's commitment to specialized care, the organization's mission plays a pivotal role in attracting providers to the team. Seven Starling stands out as one of the few maternal mental health providers that specialize in the maternal health population, establishing itself as a unique and essential player in the growing field of behavioral health.
Many providers choose to work with Seven Starling because of their passion for serving this specific patient population. In contrast to other mental health platforms where providers often deal with a broad range of patients, Seven Starling's focused approach enables them to offer highly specialized and thoughtful care. The organization's deep commitment to this area serves as a powerful source of inspiration for providers considering joining Tina's team.
Seven Starling’s Commitment to Women’s Mental Health
Shockingly, 94% of women do not seek help due to feelings of shame and guilt, highlighting the urgency of this issue. Perinatal mood and anxiety disorders affect one in five women during the motherhood journey, but only 20% get screened for mental health issues, with 75% of them not receiving treatment. Seven Starling believes the prevalence of mental health issues during motherhood is much higher given the lack of screening and high social stigma.
Seven Starling is dedicated to addressing the unique mental healthcare needs of women. The mission is to support individuals throughout the entire motherhood journey, from fertility and pregnancy to postpartum and early parenthood.
The focus is on providing specialized care for those dealing with anxiety, depression, or trauma related to childbirth and postpartum experiences. Seven Starling's overarching goal is to improve access to essential support while working to reduce the stigma associated with these conditions.
This commitment is realized through a specialized care model that addresses these core objectives. The model comprises three main components:
Specialized Therapy: Seven Starling collaborates with perinatal mental health experts who comprehend the unique challenges faced during this phase of a woman's life, characterized by significant hormonal changes and heightened stressors.
Community and Peer Support: Alongside specialized therapy, Seven Starling offers both individual and group appointments.
Individual sessions cater to personalized attention, while group appointments enable women to connect with peers experiencing similar challenges, fostering a sense of community and support.
Therapy sessions are flexible, accommodating various preferences and therapist styles, whether structured or open-ended. This adaptability ensures that each session is tailored to the individual's needs.
Seven Starling's group therapy adheres to a trauma-informed care philosophy, creating a safe environment for transparent and active group discussions. The goal is to provide tangible takeaways from each session, enhancing a sense of community and shared experiences, particularly beneficial for individuals dealing with perinatal mental health challenges.
Medication Management: Approximately 30% of women experiencing these conditions can benefit from medication, yet it remains stigmatized and misunderstood. Seven Starling provides evidence-based medication management, along with knowledgeable providers who can guide and support women in their treatment journey.
Seven Starling delivers all its services virtually for the utmost convenience of its members.
Furthermore, the user-friendly app boasts a rich array of resources, encompassing guided meditations, journaling prompts, and exercises, meticulously crafted to address diverse facets of the motherhood journey.
This customized approach guarantees a meaningful and personalized treatment experience for each and every woman.
Seven Starling's approach has evolved iteratively, much like the successful strategies employed at Warby.
“We did one thing at a time, nailed that, and then sort of continued to layer things on. “
The initial launch of services in September included a combination of individual and group therapy, with a strong emphasis on community support.
“In the last few months have layered on medication management, because it's a critical part of the treatment experience”
Success of Seven Starling
Seven Starling has witnessed remarkable levels of patient retention and engagement
“As one of the founders of the company, it's incredible to see patients not only use our product but love it and stay with us way longer than we could have ever expected in these early days.”
Seven Starling's success can be attributed to their deep understanding of their patients' needs and experiences, as well as their ability to connect them with specialized providers.
These providers possess the expertise to engage in meaningful conversations without the need for patients to explain their unique situations repeatedly, such as the experience of having a newborn or the emotions surrounding miscarriage..
Additionally, their specialization allows them to provide practical insights and that patients can apply in their daily lives between sessions. This approach has proven to be remarkably effective. Seven Starling doesn't treat every patient the same way; they recognize that each individual is undergoing a challenging and unique transition phase. This personalized and empathetic approach is a crucial factor in ensuring that patients feel truly understood and supported when they engage with the platform.
Seven Starling employs a two-pronged approach to patient access.
First, the care model incorporates group therapy, fostering meaningful connections and facilitating efficient resource scaling.
Unlike conventional one-on-one therapy, this model has resulted in a significant increase in capacity, effectively eliminating supply challenges.
Second, Seven Starling has a distinctive go-to-market strategy, with over 90% of patients getting referred by their OBGYN (the remainder hear about Seven Starling from friends or family).
Seven Starling has cultivated a vast network of over 1000 providers. These providers, including OBGYNs who play a pivotal role in patients' pregnancy and postpartum journeys, refer patients to Seven Starling.
This is crucial because OBGYNs are recommended by the American College of Obstetricians and Gynecologists (ACOG) to screen for mental health issues during the perinatal period, yet they often struggle to find suitable resources for their patients or where to send them. Seven Starling effectively bridges this gap.
“If the provider has a positive screen for a patient and they do not have a place or resources for that patient, they’re liable for that patient. It is a tricky situation for many providers and luckily it is a problem we are solving here at Seven Starling.”
Seven Starling also tracks a variety of mental health outcomes over the course of a patient's treatment. Seven Starling conducts a live screening at the very first session, serving as a baseline for the patient's condition.
Research has shown that a live screening conversation, conducted in person rather than through a survey, yields better results, as patients tend to be more honest. It also allows for a deeper conversation to clarify the meaning of certain questions, which can be unintuitive or problematic.
Subsequently, Seven Starling repeats these live screenings on a monthly basis to track the patient's progress.
Various other essential metrics, such as engagement, retention rates, and attendance, are considered to gauge patient satisfaction and the extent to which they continue to participate actively. These metrics play a crucial role in assessing the program's success.
Furthermore, overall patient satisfaction is assessed by directly soliciting their feedback on the service experience.
Finally, Seven Starling measures overall patient satisfaction by directly asking them about their service experience. Efforts are also underway to explore novel metrics related to the therapeutic alliance, aiming to evaluate how effectively patients feel supported and matched with their therapists.
Seven Starling initially launched in DC in September 2022, and since has expanded into Maryland, Virginia, Texas, and New York.
Creating Partnerships with Seven Starling
Part of Seven Starling’s success comes from partnership with providers, but getting buy-in from providers in the beginning is difficult. Providers naturally approach partnerships with skepticism and selectivity, seeking genuine solutions to pressing problems.
In the domain of women's behavioral health, traditional options often fall short, characterized by lengthy waitlists and limited insurance acceptance. Seven Starling offers a swift, specialized solution that providers can trust.
The ongoing relationship with providers includes regular progress reports, instilling confidence in continuing patient referrals to Seven Starling. Recognizing that OBGYNs lack the time, training, and resources for mental health, Seven Starling emerges as an ideal solution.
"Typically, OBGYNs refer patients to a local provider, who may or may not accept insurance. If they do, there is often a waitlist of six months or more. Consequently, when there is a need for swift patient access to care, providers have limited options. That's where we come in as an excellent solution. We can get patients into care within a week, with no waitlist, and we accept insurance—a crucial aspect of access in our model."
Seven Starling also incorporates the pivotal practice of sharing patient information with providers to enhance trust.
Typically, providers initiate referrals by sending a few patients to Seven Starling, evaluating their satisfaction and reviewing progress reports.
Positive feedback and improved patient outcomes inspire them to refer more patients and advocate among their peers, resulting in a network effect that contributes significantly to Seven Starling's growth and reputation.
In addition to providers, Seven Starling has also partnered with health plans including Anthem, Aetna, Cigna, CareFirst, United Healthcare, and Blue Cross Blue Shield
Untreated maternal mental health conditions contribute to an additional $14 billion in annual healthcare costs. These conditions have a cascading effect, leading to adverse birth outcomes, a significant cost burden for health plans, especially during one of the most financially demanding periods in a patient's life. Complications such as C-sections and preterm births represent primary cost centers.
Research has shed light on the link between untreated maternal mental health conditions and the costs associated with infant development. Studies reveal that when mothers experience mental health issues, their engagement with their babies is compromised, leading to reduced eye contact and interaction. This has a profound impact on an infant's life and may even carry generational consequences.
Furthermore, untreated maternal mental health conditions affect women's ability to re-enter the workforce, leading to reduced engagement or non-return, presenting a substantial concern. Alarmingly, the CDC recently reported that untreated maternal mental health conditions are the leading cause of maternal mortality in the US, underscoring both financial and societal ramifications.
Discussions with payers have centered on the critical role of specialization in achieving the best outcomes, supported by data that clearly illustrates the significant benefits of Seven Starling’s approach. This has been a compelling aspect of Seven Starling’s narrative with payers.
Future Seven Starling Offering
Seven Starling is actively shaping its future by addressing the challenge of reducing friction in individuals' access to mental health care services.
Drawing from Tina’s experiences at Warby, where they focused on simplifying the process of obtaining eyeglasses, she is applying a similar philosophy to Seven Starling. Seven Starling is currently developing a screening and education product intended for use by their referring providers. This innovative solution aims to alleviate the burden on providers by handling tasks like screening and patient education, starting right from the early stages of pregnancy.
“Rather than waiting until the postpartum period, we are committed to educating patients about the prevalence of mental health conditions, what to expect, and how to prioritize their mental wellbeing early in pregnancy. Our plan includes regular screening at each trimester, aligning with the latest ACOG guideline. This approach not only allows us to monitor progress but also enables us to share valuable insights with providers and guide patients to appropriate care when needed. We are enthusiastic about this opportunity to strengthen our relationships with providers, enhance patient engagement, and further guide individuals on their behavioral health journey.”
In addition to this product, Seven Starling is also trying to foster a greater sense of community by creating smaller, specialized groups within their provider base.
These communities offer opportunities for professional growth, knowledge sharing, and collaborative learning. Providers can participate in peer circles, engage in group case studies, and seek answers to challenging questions from their colleagues.
Seven Starling believes that continuous learning and knowledge exchange are integral to their mission, as many providers join them to deepen their specialty and expertise in supporting this unique patient population.
Advice for Founders
Establish a robust support network: Early on in the entrepreneurial journey, it's crucial to realize that the road might be more challenging than expected, but also more rewarding. Building and maintaining a support network from the very beginning is critical. This network should ideally extend beyond co-founders and act as a source of balance and sanity. It should provide emotional support and be a source of joy outside the day-to-day grind of running a company.
Focus on the Problem, Not Just the Solution: While it's natural to become deeply attached to your solution as a founder, it's crucial to maintain a strong passion for the underlying problem you're addressing. You'll likely be dedicated to solving this problem for an extended period, and solutions may need to adapt and change. Remaining open-minded about evolving solutions is essential for your company's long-term success.
Keep Talking to Your Customers: Regularly schedule interviews and feedback sessions with your customers to deeply understand their experiences. This goes beyond surveys and involves actually spending a decent time with your customers to help you spot trends and opportunities for improvement.
Human-Centric Approach: In healthcare, it's crucial to consider the human aspect. Think about how you treat your employees and the patient's journey beyond just the numbers. Incorporating empathy into your approach, even in a remote setting, is challenging but essential for better outcomes.
Interested in Seven Starling? Learn more on their Website Twitter and LinkedIn
A note from our sponsor: PacWest
Looking for guidance, connections, resources, opportunity? Pacific Western Bank’s banking products and services are built to support your evolving needs as you navigate the challenges of growing a successful business. As you continue to scale, our team will be with you every step of the way. Ready to take your business to the next level? Learn more: pacwest.com