Group practice insurance negotiation with Maya Topitzer (Breksey)

Dan King: [0:00] It is a pleasure to do another interview for you. And today I'm joined by Maya Topitzer. She's the CEO and founder of Breksey. Maya, welcome. I'd love for you to tell the audience what's new and exciting in your world and the basics of what you do. Maya Topitzer: [0:14] Thanks, Dan. Great to be here. So I am building Breksey. As you mentioned, Breksey is totally focused on supporting clinician-owned businesses, private practices, and group practices. My whole career has been in mental health, largely on the tech side. So building software for big, big mental health businesses. And now I wanted to bring that same quality of software and operational and business rigor to group practices. So that's broadly how we think about what we do. And then we try to plug in where people need us most. And so where we have seen that is on the marketing side. We help folks bring in new clients, make sure you have a steady stream of referrals. Super key, especially as you're growing your practice and hiring clinicians. Can you get those people in the door and match them to a clinician, which is core to great outcomes? And can we have a clean revenue cycle? So are we collecting good data upfront, which means you'll have a much higher chance of getting reimbursed on the back end. Maya Topitzer: [1:17] So that's high level how we think about what we do. And it's been a fun ride and continues to be. Dan King: [1:22] Well, that is awesome. And that is much needed. I would love to hear first digging into this steady stream of referrals piece, because a lot of practice owners struggle with that. What are the two or three most common mistakes? Or you could take it as one of the two or three low hanging fruit that most independent practice owners can relatively easily pick? Maya Topitzer: [1:40] Definitely. Yeah. So mistakes and then some easy practical tips. I think by way of a quick zoom out, we're at this strange place in mental health where there's still a big national conversation about how there is so much more demand than supply. And then almost any clinician I talk to is looking for more referrals. So there's a fundamental matching problem happening out there in the world. And that's one of the things that we're trying to solve. Mistakes that I see are spending tons of money, thousands and thousands of dollars a month on Google Ads, especially when you don't understand Google Ads and you have somebody else running them for you. Ads can be great, but you have to understand what you're doing and you want to be experimenting and paying attention. And the second mistake, this is more on the earlier practice side, but I see folks who probably have heard that national conversation, like there's so much more demand than supply. So I'll just start a private practice and then people will show up. You still have to market yourself. You are still running a business. You have to get your name out there, make sure that you are available to your Maya Topitzer: [2:44] potential clients and also know who your clients are. Maya Topitzer: [2:47] So that leads us into practical tips, things you can do. The first one is understanding really, really clearly who your client is. If you are a group practice, are you aiming for higher income and doing something that feels a little bit more concierge? And if so, does your website and all of your marketing material reflect that and feel a little bit higher touch, a little bit higher end? If you are solo or a small group, I really recommend and I see more success usually when people have a focus. So a group of people who are focusing on intense trauma it will probably be more successful because that's memorable and people are looking for that can find you rather than getting three people together and saying we're going to try to meet everybody's needs and we're going to have like one person who does anxiety and one person does depression and one person does this other thing as you grow and grow i think you can earn the right to do that and do more for more people But as you're getting started, you want to really nail down that marketing and have a consistent stream of inbound clients. And that is much, much easier to do when you know exactly who you're trying to help. Dan King: [3:55] I think that the helper's instinct to want to serve as many people as possible is very powerful, especially in this space. Maya Topitzer: [4:02] Yes, absolutely. And I feel it with what we do also. I'm like, I want to build everything and do everything, but we have to rein Maya Topitzer: [4:08] it in and focus on what we can do really well. Dan King: [4:11] Agreed. Talk to me a little bit more about, I really love the way that you've articulated, this challenge of there is a ton of demand and yet so many independent practice owners are seeking referrals. Is there something about the mental health industry or this moment in the mental health industry that creates that disconnect? Maya Topitzer: [4:26] There are so many things happening. I think it's a really interesting and layered question. We have made huge advances in reducing stigma and general awareness over the past 10, 15, 20 years. More and more people are recognizing Interesting. The need for mental health support, openness to seek it out. And now we're really faced with this access and quality issue. So now that we've had people start to seek out therapy, try therapy, Maya Topitzer: [4:55] You have a group of people who have tried it and had bad experiences and get turned off. And so that group shows up in this big national data that says all these people need therapy because they're not doing well, but they also may not be actively seeking care yet. We have a lot going on nationally with health insurance. So both private and public health insurance is really complicated right now. People are scared of losing benefits if you're on Medicaid, Medicare. On the clinician side, on the business side, folks are scared or uncertain about whether their rates are going to be cut and so whether they want to continue working with those payers. And businesses that have historically been private pay, I see starting to dabble in health insurance because now that so overall, like there's this tide of a better coverage in health insurance, that means people want to use their health insurance when they can. And so they might be more careful and choosier looking for clinicians who are accepting insurance. So there's kind of this this perfect storm of a lot of change happening at the same time. Maya Topitzer: [5:58] And the one other thing I would throw in there is we are coming out of this big telehealth boom and people are wanting in-person care again. So we also saw a lot of businesses who were just totally thrived during the pandemic and were able to show up and offer care and like be in five, 10 states all of a sudden and have a ton of demand. And now people are wanting in person again. And if you don't have a physical presence, number one, you may have a hard time Maya Topitzer: [6:26] keeping your health insurance contracts if that's part of your book of business. And number two, you may have a hard time bringing people in the front door because people do want that in-person touch. Dan King: [6:36] Curious if you have any data on the extent to which demand for in-person has increased. I agree. I see it as well in the practices that we work with. Very often, the higher quality practices have a pretty strong in-person element. But I'm curious about the extent of that shift. Do you have any data on that? Maya Topitzer: [6:52] Yeah. Like you, I had an anecdotal sense of it. And then there was a report released, I want to say two or three weeks ago, that verified that, that showed overall with healthcare, we're seeing more demand for in-person and that Delta is outpacing primary physical health or mental health. People really want to get back and be in-person again. Dan King: [7:14] Super interesting. And it's interesting from a business perspective to think about, I almost in my head often will split the outpatient industry into the purely virtual and all the other practices because the better helps of the world are playing a very different business game as well as a very different client's game than your typical independent group practice that's rooted in a community. They have different business challenges, different opportunities. Maya Topitzer: [7:38] Yeah, yeah, absolutely. And then, you know, I know on your side, you think a lot about the financial aspect, which practice owners do too. So if you're now looking at bringing your practice in person or making sure you have that brick and mortar space, you have to figure out how to balance that additional overhead. And you may have a lot of people who want the first session in person, but then the follow-ons are going to be virtual. So how are you scheduling rooms with your clinicians? Like these are all interesting challenges that I see practices figuring out. Dan King: [8:08] Does Breksey have the ability to support practices on that logistical journey of figuring out how to allocate space and offices? Maya Topitzer: [8:15] We do not do that today. We are working on a scheduling feature, which will include something like that. So thinking about how you use both virtual and physical space when you are maximizing folks' schedules. Maya Topitzer: [8:29] And that light bulb came from seeing people deal with this exact challenge. Dan King: [8:34] Definitely something to look out for. So maybe taking a step back, we've been distinguishing between in-person and virtual practices. We should also distinguish between your typical clinician-owned independent practice versus headway and alma. What do you think is most important for a practice to think about deciding whether or not to work with a headway or an alma? Maya Topitzer: [8:56] It's super important to understand what you are agreeing to when you work with a platform like that and to think about it as a lever for your business. So Headway and Alma essentially put clinicians under their own group practices and then they mark it as you can have a private practice with us. But you never own that insurance contract yourself. This can be a great lever to get started because they have preferential rates. They can make billing easier. and what i've seen is a lot of younger solo practitioners who want to get into practice end up on like five different platforms and they're trying to juggle that with their own time and their clients and that can get pretty spidery really quickly so like anything like it's a business lever think through like what it means long term and also where you want your business to be long term if you want to hire if you want to grow it's probably worth investing in your own relationships with the insurance companies, because you'll negotiate those up over time, you'll keep that upside. If you want to do something solo, maybe more part time, and really keep your overhead as low as possible. I think these platforms are great. In some ways, they're very counter to what we're doing at Breksey. But I also appreciate that they can make care more accessible. It's just really important to understand how they actually function and what that means for you as a business owner. Maya Topitzer: [10:21] And unfortunately, I see a lot of clinicians kind of land with us asking about working with insurance, how can we help? And they're really confused about what has been done so far and what they actually own and don't own. So they'll say, oh, yes, I have my contract with Kaiser and Caroline and Blue Cross Blue Shield, but something isn't working and clients are not getting the care that they need. They're getting kicked back and I don't know why. And then you dig in and realize they don't have any of those contracts. Headway has the contracts. Headway won't do secondary tertiary billing. They're working on supervisory billing, I hear, but it's pretty hard to have that supported through the platform. Again, if you want to grow, I recommend getting your own contract that's part of your book of business and that really adds value. And then on the really kind of extreme side, I've also heard a clinician who went and tried to sell his business and the sale ended up falling through because he didn't have the contracts under the business itself. And so that was like part of the value that was being acquired and it turned Maya Topitzer: [11:23] out the value wasn't there. Dan King: [11:25] Can I change course if I'm a practice owner and I'm getting started and I want, I don't want to do the hard work at the very beginning, right? I want some revenue flowing in. I want the ability to be able to ensure clinicians I bring in get steady flow of referrals. Can I later transition? Can I start with Edway or Alma and then down the line, even while I'm with them, can I be negotiating my own contracts and then ultimately make a transition? Maya Topitzer: [11:48] Absolutely. And it's something that we see happen a lot and work with a number of folks who are in that moment of transition. I caution people to make sure that you are paying really close attention during the transition because you have multiple stakeholders with access to your CAQH at the portal that connects you as a clinician to the health insurance companies. And as you're balancing these shifting contracts, that also means that you need to balance your cash flow, right? So you don't want to like turn one all the way off while you wait for the second one to ramp up. You want to kind of ramp one down and ramp one up at the same time. So it can be done and it is like a delicate dance. Dan King: [12:31] It's a delicate dance, particularly because we see clinician retention being a big, big challenge with a lot of practices that we consider investing in. And it's a delicate dance for two reasons. One, I think, is that Headway or Alma can make it seem easier to get referrals than it may actually be. So you may have clinicians on board, and if you have Headway and Alma at the beginning of your practice journey, they may artificially speed off the process of bringing in customers. Presumably, clinicians can leave on their own group practice journey if they choose to work with a Headway or an Alma. But I think they can convey that impression that, hey, it's relatively easy to build your own practice. By the same token, though, because at this point, anyway, the price points tend to be relatively strong, they can be a powerful tool for attracting clinicians to your group practice. How do you see all of that? Maya Topitzer: [13:22] I'm glad you mentioned clinician retention because that's huge and that comes up for a lot of our folks. I think, and this is what I meant by think of it as a business lever. And also think of it from the lens of if your business is extremely reliant on any one third party, there's some inherent risk there. So if you are trying to build a full business and you have both referrals coming from one place and your billing is happening in one place and you don't have the insurance contracts, like that's a risk. You can be aware of the risk and say, this is the risk I want to take to get started. But what I see, unfortunately, is a lot of people not realizing how risky that is and then trying to back out of it as they grow. On the flip side, on the positive side, I've seen people do it in really smart Maya Topitzer: [14:09] ways and use it to actually grow quite big, quite quickly. But those are people who really understood what they were getting into at the beginning and had a plan for backing out of that, making sure that they have good stability and business continuity and they're not overly reliant on any one third party. Dan King: [14:26] How do you see the future of price points here? Do you envision that over time, Hedeway and Alma will be reducing reimbursement rates? Or do you envision them generally remaining steady? Maya Topitzer: [14:37] So these companies have taken investment from insurance companies. And what usually happens is they need to eventually repay that investment in some way, right? Investment is not debt, but it is a promise that we're going to grow and we're going to keep growing. And right now, I think there are too many players offering essentially the same thing. So we're going to see some type of shaking out. And what I expect that may look like is the insurance companies that invested will acquire the companies, they'll bring them under their wings, so to speak. So you'll have extremely preferential rates with that insurance, and the other ones will drop either quite low or potentially to zero, they may stop supporting them. So a bit of both. I think some of the high rates will continue, some of the low rates will get lower. We're already seeing some squeezing. We've helped a number of businesses get their own contracts and actually they've been able to go out and get higher rates in a number of times. Maya Topitzer: [15:35] Already it's not just like they're higher than everything and we could never attain that. Dan King: [15:39] This is a great transition to one of my absolute favorite subjects that we think about a lot. Can you talk through for practice owners who do want to go through this journey and maybe they either don't want to do headway or alma or they want to just focus as much effort as possible on getting their own pair of contracts? How can they handle those negotiations in as powerful a way as possible? Maya Topitzer: [15:58] Good question. And I'm also curious to hear your thoughts on it. With any negotiation, you want to get yourself in the space and the mind space of who you are negotiating with. We'll do the same like mistake and then practical tip. On the mistake side, I see people going to insurance and presenting themselves in the light that they believe is valuable. So clinicians are like, I run this holistic business and it's so wonderful and the clients love it. And like, that is probably all true, but the insurance company does not care. The insurance company cares if you have no wait lists, if you have multilingual staff, if you're seeing kids, they care about metrics that they can then go and sell. They're also a business. So they're going to say our network is great because we can provide all of these languages support and we have super fast access. And that then gives them leverage on their own business. So practical tip then is get yourself in their mind space. What are they looking for? And how can you show that you have what they're looking for? Clinical outcomes, of course, are also coming. So can you show you're making a dent on PHQ and GAD scores for reducing anxiety and depression? Like all of that is really, really valuable to them. Dan King: [17:12] Yeah, I would definitely echo all of that. And I would say I'd maybe add three quick things. One is each insurer is a little different. Some of them are state by state, some of them are regional or national. Dan King: [17:23] And I think there's a core set of criteria that matter to each of them, but then there may be specific issues that are more consequential to some payers rather than others. So it's good to build your own individual contacts, as well as even chat GPT can give you some distinctions between how Blue Cross and North Carolina thinks versus how, you know, Aetna and New York thinks. So there are definitely going to be differences. And even just a little bit of AI research can start to inform you as to what those differences are to better do what Maya suggests, which is. Empathize, right? Then I would add, adding services is a huge thing. So if you're able to offer services, could be med management, right? Could be psychological testing, services, often med management is a big one where there's just so much demand across the country that if you can even, if you happen to be able to get one nurse practitioner in a small group practice, that can give you negotiating leverage. If you're able to offer services that are just harder to find. It makes the network more valuable, right? And then I'll add one other thought for now, which is, especially if you're able to do those other two, and what Maya suggests, there comes a time where you may need to play hardball. And this is uncomfortable for a lot of clinician founders to do. But if you have a variety of pair relationships, and there's one in particular that you'd like to maneuver upwards, you can threaten to leave the network when the time is right, when you've done a little bit of work to position yourself to potentially have to follow through on that threat. Dan King: [18:52] Right? Which you probably won't have to. But look, any negotiation requires leverage, and sometimes you need to hold folks' feet to the fire. And so very few practice owners will ever threaten to lead the network, let alone have the conditions in place to make the threat credible. But if you do, it can really have an impact. Maya Topitzer: [19:09] Yeah, those are great. So basically, use the tools you have. Use AI to research, to draft also your communications. Do not send exactly what comes out, but use it for that first draft. Build relationships, bring in additional services, especially kind of higher and higher cost services and play hardball. And I would add to that last one, like you can also say no, you can leave networks. We don't necessarily want you to, right? The goal is to get a higher rate and stay with them. But I do see businesses with like a very small percent of their clients with one very low paying insurance company and they're still jumping through all these operational hoops just to service those few clients like that may be costing you more than it's worth. So look at all of this. Maya Topitzer: [19:53] This is your book of business and think about it strategically. Dan King: [19:56] Yeah. Look, Maya, I think this has been an excellent set of tools for independent practice owners to think through some strategic decisions. Is there anything else that Breksey is doing at the moment that you would want practice owners to think about that ways in which Breksey might add value? Maya Topitzer: [20:12] Definitely. So our core platform today is really focused on aggregating your inbound inquiries and getting them to the first appointment. And so we kind of opened this up talking about marketing and marketing mistakes. And one of the mistakes I see is people pouring money into marketing that's not working when you already have a pretty decent funnel and you would be much more efficient with your spend and better converting that. So people don't realize often that inquiries are falling through the cracks, like depending on how you and your admin team are tracking inbound, how quickly you're getting back to people. Like one day is too slow now, it needs to be like five minutes, which means you need an automated tool, right? You're not going to have a human answering the call, calling people back every five minutes. That's just not going to happen especially as you grow so that's a big thing that we support folks with is that immediate response high touch response it's not just like a templated form and then matching that inbound to the right clinician i also see these like massive spreadsheets of clinician preferences and abilities and da da da like we will consolidate all that data for you and just present the three best matches and that's been a huge unlock for front office teams yeah Dan King: [21:27] Especially with larger practices with so many clinicians to choose from, and it's hard to keep track of where they all are with their caseloads. So that sounds super useful to me. Maybe to wrap us up then, Dan King: [21:38] we always love to end on a human note. What do you do for fun when you're not building Breksey? What's entertaining, and how can people find you if they want to follow you? Maya Topitzer: [21:46] So find me on LinkedIn for fun. I have been really into The Sopranos lately. I'm watching it for the first time like the first time yes so late to the party no so late but it is so good it's just completely like different from what i'm doing day to day to live in this mob world although i grew up in new jersey very close to where it is set the Dan King: [22:10] Therapist you'd say is a pretty big role in the show and you're from new jersey. Maya Topitzer: [22:14] Exactly my husband and i were joking that And if somebody told me how important the therapist was, I would have watched it earlier. Like, she's in every episode. I had no idea. So that's been great. Dan King: [22:26] It is a classic. It is a classic. And TV is such a helpful escape. And when a story can be that compelling, it turns out to be a very powerful escape. Maya Topitzer: [22:36] Yes, definitely. Dan King: [22:37] Always a pleasure to connect, Maya. And folks can follow Maya and Brexy on LinkedIn if they want to learn more. And it is always enjoyable to chat. So wishing you the best. Maya Topitzer: [22:49] Thanks, Dan. Always great to chat with you. Thanks for having me.