🧠 Finding Nirvana

The latest on the business of mental health and wellness

Welcome to On The Mind, a collection of stories, news, and analyses on the startups, investors, and thought leaders in mental health and wellness.

Join 550+ humans exploring the business of the mind:

Here’s what’s included in issue No. 13:

  • Building a simplified billing engine for mental healthcare

  • Understanding how caffeine ☕️ affects the brain

  • Enroll in a free course from Yale on “the science of wellbeing”

🎙️ Interview with Akshay Venkitasubramanian, Co-Founder and CEO of Nirvana Health

Conversations with founders, investors, and thought leaders in mental health and wellness.

Akshay Venkitasubramanian co-founded Nirvana Health in 2019 with Kelvin Chan (President & CPO) and Urvish Parikh (CTO). According to Akshay, Nirvana Health is “making high-quality mental health affordable and accessible by bringing the power of fintech to the administration of health insurance.”

In other words, we hear about the problem of accessibility in mental health quite a lot, and Nirvana is chipping away at one of the biggest contributors: the convoluted financials happening in the background. A lot of times the accessibility conversation focuses on the problem of not having enough providers to meet the demand for mental health services. While that’s true, Nirvana is focusing on one of the (several) drivers of that imbalance, creating an easy-to-use billing engine for mental healthcare that makes life easier for providers and offers more transparency to consumers.

Tell me a bit about your background. How did you decide to start Nirvana?

I basically grew up in the world of healthcare transformation. I started off consulting for Deloitte, where I was working with clients who were reorganzing for the changes of the Accountable Care Act. Following Deloitte, I moved to Remedy Partners, where I dove deeper into bundled payments. After that I found myself at Mt. Sinai, where I really started to immerse myself in Value-Based Care (VBC) payments. Not just learning the financial side, but also the clinical, operational, and patient experience components.

I noticed demand for mental healthcare was growing and looked into building a mental health network with my co-founders. We realized that the majority of therapists are not set up to work with insurance, and that they don’t want to work with insurance. Nirvana was born out of this - my co-founder was automating KYC systems and had the insight that the same philosophy could be applied to filing healthcare claims. Since starting Nirvana, we’ve been working to simplify the entire billing process with this in mind.

Do you consider yourself a fintech company or a mental health company? What problem is Nirvana really solving?

At our core we’re a healthcare company that’s powered by fintech innovations.

This feels like a good opportunity for a story from when I was growing up in India. My father started off in the lowest rungs of banking, as a clerk and manager in rural Indian banks. His job was to open up a branch, at a time with no WiFi and little electricity. Shopkeepers had credit card copy machines they would use to swipe cards, and they would come by the bank in the afternoons where my dad’s job was to check the credit cards to see which purchases were valid and which weren’t.

Technology has completely changed this outdated model - this job moved to companies like Square and Stripe. No longer are customers walking out of shops with items unless they have the balance to pay, and that’s all verified on the spot. Insurance processing needs the same upgrade. It hasn’t been digitized for far too long, and at Nirvana, we’re digitizing it end-to-end. This is solving problems across the board, for providers, consumers, and payers.

On the provider side, we stitch together payments, sending a clean monthly report of which sessions have been paid and which have not so that they can practice with peace of mind.

For consumers, we give them the same digital experience they’re used to receiving in any other industry. When they swipe out of a Nirvana session, they get charged almost exactly the right amount - we check their claim accumulator to see if they’ve hit their deductible, and check their co-payment if they didn’t. They know right then and there what they owe, at the point of service.

For payers, we help improve the satisfaction of the products that they offer. Consumers use their benefits with ease, and providers are happy because insurance is working smoother - the better transaction system leads to happier providers and more satisfied members, and that positive experience is attributed to the payer.

Yes, we offer a fintech solution, but we very purposefully chose mental health as our first specialty to launch with, specifically individual adult psychotherapy. Mental health is probably the space where billing systems are hardest to use and most antiquated. It’s a space where bills add up quickly, and providers and consumers alike are acutely aware of the painpoints. And consumers are actively involved in the mental health care model, which means we’ll get access to great feedback in the product development process.

What have you figured out about your customers, and how has that informed how you build the business?

Since our launch, a big revelation for us has been that billing and insurance operations is a problem not just for small providers, but large enterprises and groups. We expected to focus primarily on small providers who wanted to incorporate our technology solution to reduce repetitive tasks, but we’re seeing a huge amount of traction with larger players as well dealing with the same billing problems but on a magnified scale.

This has shifted how we think about developing our product a bit. Many large provider groups are building their own electronic medical records (EMRs), which has led us to focus on creating an API-based service that enables these providers to plug Nirvana’s billing capabilities directly into their workflows.

There has also been a lot of good investment in mental health-focused EMRs in more recent years - therapy notes are getting a good challenge from companies like Osmind and SonderMind. One of these new mental health EMRs will dominate the space eventually if they’re built with the right intentions and provide support for psychiatry in a structured way. We consider EMRs to be partners - everybody needs to interact with insurance, and unless you’re 100% focused on it, you won’t build the best service.

Who do you consider your main competition? What do you think about companies like Headway?

We basically consider Square to be our biggest competitor. They power most of the interfaces for payments we receive, and we’ve been going up and replacing them.

We expect to see more billing companies (such as Kareo and Trizetto) become competitors as we scale to payers and digital health companies.

Headway is a virtual care network builder that we see more as a partner. They’re building good mental healthcare networks, and we see ourselves as being able to help them service those networks. We have providers onboarded with Nirvana who also use Headway.

How do you expect mental healthcare to change in the next 5-10 years? How will Nirvana play a role in that?

Mental health is moving from something akin to a gym membership (something you have to pay out of pocket for), to something an employer considers essential and will pay for.

I think this will have some good effects on the overall payer landscape - better medical coverage and more reimbursements for mental healthcare.

I think we’ll also see much better care coordination across medical and pharmaceutical needs for mental health. I’m personally very passionate about addiction care and how that evolves. C3 HealthcareRx is a great example of this - I love the way they’ve reinvented medication-assisted therapy by bringing it closer to the consumer at the point of service with their PCP.

Our aspiration is to make the transaction system around the consumer as seamless as possible for any healthcare service they get, which means expanding beyond mental health eventually. For Nirvana, this means we’ll be scaling our platform, both for the larger enterprises and to support solo or small group providers.

Can you walk through your latest raise and how you plan to allocate the funds? What’s your biggest challenge now that your Series Seed is closed?

Absolutely. We raised about $4.2M led by Eniac Ventures and Arc Ventures. There’s so much money out there - it was really important to us to find the right partners. We liked that both Eniac and Arc have made early bets in disruptive markets in the past, and that they have access to really strong fintech communities.

When it comes to allocating our funds, half is going straight to engineering talent. We have a lot of demand for plugging into large groups’ existing workflows and we need engineers to deliver on this. We’re also putting a good amount toward other aspects of the product design and management.

The biggest challenge for us now is the radical prioritization of the features we build. We’ve got some customers of 1 and some customers of 1000, and different customers request different features. We’ve got limited resources and time, so I’ve been spending a lot of energy on prioritizing our product roadmap to show we are constantly enabling the maximum value. We prioritize by having monthly discussions with different customer segments, workshopping our product roadmap, collecting feedback, and making the necessary tweaks as we go.

🩺 Clinical Coverage

Discussion of clinical concepts, studies, or perspectives on mental health and wellbeing.

Michael Pollan came out with a new book last month, This Is Your Mind on Plants, and while I haven’t yet read it, I’ve listened to a couple of his podcast appearances where he gets into some of the details.

He covers a variety of ways that humans have used plants to change their consciousness, but his overview of caffeine specifically caught my attention since I admittedly and shamelessly have a deep addiction.

I drink probably 3 cups of coffee a day on average, which with a little bit of quick maths equates to ~550 pounds of liquid that I’m putting in my body annually, without really understanding how it affects my mind.

And I’m not alone - “caffeine is the most widely consumed central-nervous-system stimulant.” To learn more I turned back to my trusted source for digestible clinical concepts, the 2-Minute Neuroscience YouTube channel.

In summary:

  • Caffeine belongs to a class of compounds called Methylxanthines

  • Caffeine is an antagonist at the adenosine receptor, and its primary mechanism of action which promotes wakefulness is attributed to interaction with the A2A receptor subtype

  • Typically, the adenosine receptor prompts GABA release (GABA was covered in the last issue of On The Mind here), which supports sleep, but the introduction of caffeine opposes this action, promoting arousal instead

For a deeper dive on caffeine’s effect on human behavior, check out this paper.

💰 Recent Investments, Acquisitions, and IPOs

Rundown of recent investment news in mental health and wellness companies.

📖 Interesting Reads

Sometimes mental health-related. Sometimes just things I find interesting.

  • Back to getting shamed for my coffee addiction, by Michael Pollan. The Guardian

  • The role of digital tools in employee mental health. McKinsey

  • Building an arctic vault of humanity’s most important music. Input Mag

  • “Speaking” after a decade of silence, thanks to neurotech. WSJ

  • Tech hubs outside of Silicon Valley (and the US). Rest of World

  • Interesting profile of the man behind mushroom company MycoWorks. Alta

  • Epic bird pics. Make sure to check out the hawk video. Audubon

  • More evidence that walking is good for your brain. NYTimes

  • I’m looking for a new cult to join if you have any recs. The New Yorker

  • Viewing the world through the lens of Olympic medals. NPR

  • Zuckerberg’s plans for the Metaverse. The Verge

  • The morally questionable hustle for the title of youngest grandmaster. NYTimes

  • Athletes and mental health. David Epstein

  • The FDA approves its first human study for brain chip implants. Input Mag

  • America’s mental health moment. Vox

  • If anything is going to make me sign-up for Paramount+, this is it (still won’t). Bloomberg

  • The pending infrastructure bill’s implications for crypto. TechCrunch

  • Travis Kalanick’s secretive dark kitchens. Sifted

  • A look at how Coronavirus changed how we spend our time. FlowingData

  • The impressive evolution of AI-generated art. Berkeley

🧠 Mindfulness Tip of the Week

Tips to improve your mental health and wellbeing.

Full disclosure - after a year of virtual MBA, I’m not personally in the market for another virtual class, so I haven’t tried this one personally. That said, a friend recommended Yale’s “The Science of Wellbeing,” which is one of the most popular Massive Open Online Courses (MOOCs) on Coursera.

With nearly 3.5 million learners and a 4.9 out of 5 stars from over 27,000 reviewers, they’re clearly on to something.

For those looking for a little bit more structure and guidance in their wellbeing practices, this free 10-week course seems like a good option. You can start it when it’s convenient for you and complete it at your own pace.

Here’s the syllabus:

  1. Introduction

  2. Misconceptions About Happiness

  3. Why Our Expectations are so Bad

  4. How Can We Overcome Our Biases

  5. Stuff that Really Makes Us Happy

  6. Putting Strategies into Practice

  7. Start Your Final Rewirement Challenge

  8. Continue Your Rewirement Challenge

  9. Continue Your Rewirement Challenge

  10. Submit Your Final Assignment

If you end up registering or have enrolled in the past, let me know what you think.

On Your Mind

Email me at tarockoff@berkeley.edu with any reactions to the newsletter.

If you’re working on something in mental health and wellness, let’s talk. You can book some time with me here.

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Written by Daniel Tarockoff, an MBA student at UC Berkeley and former healthcare strategy consultant exploring the future of mental health. Born in Michigan. Based in Berkeley, CA.

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