Where will innovation come from?

One of the best parts of participating in the What If? Fellowship was hearing from MindStrong CEO Tom Insel. He was one of our first speakers, and after he signed off for the evening I thought to myself, “Well, that was worth the cost of the entire program.”

He had a slide in his presentation that addressed the differences between what is effective as a public health strategy vs. what is exciting for investors. It was… Well, “depressing as hell” is probably the right way to describe it.

The slide looked something like this…

It blew my sweet, naive, summer-child mind that the left side of the slide and the right portion weren’t overlapped. It wasn’t even a Venn diagram with a sliver in the middle!

He went on in his presentation to discuss — in a more nuanced way — the difficulty in merging these concepts. It was incredibly valuable.

He was kind enough to reply to my email asking about this phenomenon, which led to a sleepless night spent thinking about whether or not YourPath should pursue venture funding. If all the VCs were looking for was empty, shiny things sexy enough for a large valuation and returns driven by what is essentially an informal pyramid scheme, count us out.

As much as I would love to see a text-based, home-delivery, gamified, ketamine and psilocybin telehealth venture that revolves around psychedelic avatars wandering through a haptic-feedback inclusive metaverse… I just don’t think that’s us.

Our team will never win that game.

But, if we were able to make a compelling business case for a set of replicable, hyper-scalable services with bulletproof outcomes that prove our potential to change the trajectory of the lives of individuals, families and communities across the country? That, I think we'll take a crack at.

And, that goal is terrifying. It would be much easier to pretend.

Innovation as performance art

Performance innovation often looks like offering a vision that is far enough away to be divorced from urgency or accountability and close enough to remove any risk that comes when one actually places a bet on creating the future.

Mix up the sexiest, widely-palatable fad with a heap of the prevailing wisdom, cover it in some language pulled from a pay-to-play trade media group, polish it up nice for consumption by laypeople, and voila!

Safe, instant “innovation.”

I get it and am likely guilty of it. It’s tempting sometimes, especially when you know the stupidly-simple, counterintuitive truth sounds so pedestrian that it’s easier to gloss over it or phone it in.

Basically, what it comes down to I think is that everyone wants to do the innovative and outrageous, and nobody wants to fail, especially when the stakes are as high as they are in healthcare.

In Scott Shreeve, MD’s recent piece on “The Allure and the Illusion of Care,” he takes aim at the idea that we can take shortcuts to effective care. Go read it. Seriously. Just stop reading this and go.

“What I see from the current industry narrative is the allure of care—“Hey, we can do this virtually only,” or “Hey, my chatbot will intervene at the right point,” or “Hey, my AI magic unicorn thingamabob will bolt onto your cerebral cortex and send you the signal,” and other related alternative realities. But, I believe this thinking leads to an illusion of care that the industry should be wide-eyed about, including patients who should be asking questions, pushing back and demanding real care on their terms which leads to optimal health. More fragmentation by more tech, further distance and displacement of real relationships, and more noise and nonsense without addressing the actual delivery of care by actual providers is a problem that I think should be put front and center of the conversation.”

- Scott Shreeve, MD

Private Equity/VC vs. NGOs/grants/philanthropy

I happen to agree with Dr. Shreeve that the best place to start is with the provider team. But, what’s the best way to make these efforts reality?

I have seen a lot of conversation lately around the “best” way to innovate and where the financing “should” come from. Much of the thinking I have come across has been from people with little experience on both sides of the VC-PE/nonprofit-philanthropy fence. Lots of posts from academics and leaders from large, staid institutions warn of the corrosive effect of venture capital and private equity. Members of the world of startups and disruption have fired back with some hot takes of their own. They’re both right. Or, as Doc Shreeve sees it, they’re all wrong.

Having worked in a large organization that was attempting to cultivate innovation and having raised VC funding, I can say that the limitations are very, very similar. The idea that VC or PE funding can be corrosive to a mission-driven organization is widely-accepted, but what is less obvious is the way that the same short-sighted, hubris-driven thinking is pervasive in every system. In my experience it is uniquely difficult in nonprofit service organizations because the prevailing attitude is one that denies the very existence of these compromises.

The market forces one meets while pitching institutional investors are mirrored within most large organizations. What you see as patterns in the market, especially in the investor market, is what you see play out in organizational leadership. What is a vested interest in protecting an investment in adjacent verticals in a VC portfolio isn’t terribly different from an executive posturing to own a piece of the org that threatens them personally or professionally. The human ability to identify and gravitate toward that which is familiar and non-threatening while anointing it something new and bold is consistent across both settings.

The truth is we need all of it — preferably at the same time. We need the heft of academia and the moral weight of trusted institutions. We need the urgency and magnetism for raw aptitude of the best VC-funded companies. We need the grassroots credibility of neighborhood nonprofits and the global reach of world-class technology and technologists. And, we need them together.

Success in behavioral health is not unique to either setting, but rather offers us lessons in what makes fertile ground for innovation — real, honest innovation proven by the success of the individuals we serve.