Integrated mental health care with Arpan Parikh of Sol Mental Health

Dan King: [0:00] Hello, everyone. Dan King back with you with another, I am hoping, I'm putting a lot of pressure on our guest today, thoughtful interview with Dan King: [0:08] Arpan Parikh. He's the Chief Medical Officer at Sol. Arpan, welcome. It's good to see you. Arpan Parikh: [0:13] Thanks for having me. I'm really excited to do this. Dan King: [0:15] So there's a whole bunch of things that we can dig into, but maybe let's start Dan King: [0:19] a little bit with your upbringing. You told me when we first met that psychiatry is the family business. Tell me a bit about that. Arpan Parikh: [0:26] Yeah, family business is the right way to put it. So I grew up in Akron, Ohio, a small city outside of Cleveland. My dad is a psychiatrist, so he was a first generation immigrant to this country. And after a couple of stops, landed in Cleveland where he did his psychiatry training at the Cleveland Clinic. Growing up, I saw the joy, happiness, and excitement he had for the work that he did. And while I went to medical school with an open mind and actually to some degree saying I'm not going to fall in the footsteps and fall into psychiatry, after I did my psychiatry rotation, which in Columbus, Ohio was at a state hospital, you know, which takes care of some of the sickest, most complex patients who have, you know, severe psychiatric illnesses. I just fell in love with it and it was fate. So I decided to pursue that as my career. And here we are a few years or more than a decade later. And funny enough, it truly has become a family business. I have a middle brother who also has become a psychiatrist. And our youngest brother actually strayed from the path and became an eye surgeon, but he married a psychiatrist, so he redeemed himself. Dan King: [1:33] From where did that idea that I don't want to follow in the family footsteps and do psychiatry, where did that idea come from? Arpan Parikh: [1:39] I mean, it came from the idea of any teenager, rebellious teenager, right? Of I don't want to do what others around me or my elders have done just because I want to be different. And there was also some piece of, you know, I want to create a name and reputation for myself and not necessarily do it on the back of my family. It turns out that was really poor thinking and poor logic because, you know, having that setup and having that legacy actually, I think is part of a big part of my career and the way it's unfolded. And I owe much of my success today to that reputation and to that legacy and to that from an early age kind of installation of values. Dan King: [2:23] That's awesome. I'm going to guess, though, that you still were able to build in some difference, even though you're following in some put stats. Arpan Parikh: [2:28] Of course. We are different. Dan King: [2:30] How are you different? Arpan Parikh: [2:32] Yeah, I mean, I think the biggest difference is five years ago, I made a really intentional decision to step away from full-time clinical practice. I took a break and went back to graduate school to get an MBA. And since finishing that, I have shifted my career away from, you know, seeing patients eight to five. And spending my time since then building businesses that deliver mental health care, bringing the perspective of a physician and a clinician and a psychiatrist, but spending my time actually putting together the fundamental blocks of, you know, a practice or a business that takes care of patients. Dan King: [3:09] We're trying to solve complex problems in the behavioral health world. And I always think when the problem is complex, it is so valuable to wear multiple hats because it gives you empathy, right? So you have a sense of where a business person is coming from now that you wouldn't have had had you not developed that kind of training. And so I remember years ago, I read Range by David Epstein. It's one of those books that I would come back to. Did you happen to know that book? Arpan Parikh: [3:33] Yeah, it's a great book. Dan King: [3:34] Yeah, I think it's great for those of us, maybe it took us a little while to find our place, and especially those of us that wear a number of different hats. And yet that perspective of wearing those different hats, I think it's crucial for building any kind of team that is going to achieve success here because things are just getting more complex by the day. Arpan Parikh: [3:52] Yeah, well said. Dan King: [3:54] So, all right, so we've got that business skill set. And what do you do after you get that MBA? What do you do next? Arpan Parikh: [4:00] Yeah, you know, so I've spent my career in a variety of care delivery organizations that have plotted the path that ultimately landed me today at Seoul Mental Health. I spent my first two to two and a half years out of business school, cutting my teeth with some of the legends of value based primary care, actually, which is a really formative time in my development. So I was at CareMore, which I would consider to be one of the OG risk-bearing primary care groups, and had the pleasure of working with some of the finest physician executives in the country who have gone on to become mentors and friends and helped to build and scale the co-located, tightly integrated behavioral health care delivery model for a complex population of Medicare, Medicaid, and duals patients. And mind you, in a world in which we were fully at risk for total cost of care. So really being able to innovate on the edges of traditional fee-for-service outpatient mental health care and do things and invest in services that, you know, in a fee-for-service world just aren't even in the realm of possibility. So that was a very, very interesting and formative time for me. And I bring that vision of value-based care in behavioral health along with me, you know, since that time. Dan King: [5:13] Well, now that you raised it, we weren't planning to get into it, but now that you've raised it, you know, there's so many different directions we can go in. But this is a fascinating one that's worth a little bit of exploration. Tell me a high level how you see this transition to value-based caring and behavioral health. Arpan Parikh: [5:27] Yeah, great question. So my hot take here is the industry isn't really ready for this or prepared for. And when I say the industry, I mean both on the care delivery side, businesses, practices that take care of patients and on the payer and employer side, right? Who are the folks paying for the care being delivered? So I think in 2025, a few unique examples, like take Eleanor Health as one of the big exceptions here. Payers are looking to the care delivery world to actually understand what are the outcomes we should be interested in and focused on, right? I think up until now, payers have been primarily focused on access. How quickly do you get our members in? Are they engaged in care? Do they come back and, you know, after an intake for a second appointment, which are all great initial metrics, but we know those aren't necessarily tightly predictive of outcomes in care. I think the burden is actually on us as the care delivery side of things to help our payer partners and employer partners understand what is value in outpatient mental health. And then how do we get to share in the value that we're delivering? And ultimately, the value is in helping patients live their best life, right? And how do you assign monetary value or dollar value to that. Dan King: [6:42] What forms has that taken for you up to this point? Is it lobbying and advocacy? Dan King: [6:46] Tell me about how you've been sending that message. Arpan Parikh: [6:49] Good question. It's been somewhat piecemeal. I would say it's a lot of writing. So trying to get thoughts out there, right, and help folks understand my perspective and my point of view. It has been conversations with payer partners and employer partners and helping them kind of understand how we see the world here, how I see the world here and where we see things going. And then it's honestly been working with some entities or organizations that I think are better prepared to do some of these innovative things and take a care more, for example, right? So if a payer isn't quite ready to engage in this conversation, a risk-bearing primary care group might be, right? Because they actually are transferring the risk from the payer to themselves. And typically primary care groups that are risk bearing are willing to do innovative things. So it's also been a little bit of let's go downstream to the folks who might be more willing to have this conversation and then try some interesting things with them. Dan King: [7:42] One of the things I think about to a degree, it isn't top of mind at the moment, but we think about it is primary care integration and behavioral health. So Dr. Michael Goldberg, our head clinician at Fireside, really pioneered that in the Northeast. I think there's a ton of potential. And it'd be interesting to see how the value-based care journey unfolds, especially if we are able to get more primary care integration in behavioral health. Arpan Parikh: [8:06] Totally, totally. Dan King: [8:07] Any kind of initial thoughts on how those might dovetail? Arpan Parikh: [8:09] Yeah, I've seen it work both ways, which is really interesting, right? At Caremore, the experience was a primary care delivery vehicle that then has co-located integrated mental health services. When I was at Mount Sinai training as a resident, we actually did the reverse. And this is in the mid-20 teens or early 20 teens, which I would say is a bit ahead of its time. We actually had a comprehensive mental health clinic at the hospital that took care of everyone who walked through the front door, kids to elderly folks, folks with anxiety, trauma, depression, psychosis, substance use disorder. And we actually had full-time primary care clinicians on our team in our clinic. So if I had a patient who I was treating for schizophrenia, who was being prescribed a second-generation antipsychotic medication, which put them at risk for and worse than their diabetes, I could send them upstairs to see my colleague primary care clinician who could start them on metformin and monitor their A1C every couple of weeks or every month. So I think there's actually interesting angles to this. And in many ways, an American's primary contact with the healthcare system may actually be their therapist or their psychiatrist. Versus their primary care doctor or their cardiologist. So I think there's interesting opportunities for the mental health clinician to actually be the point of entry. And then primary care is actually a consultative or collaborating specialty with us versus the other way around. Dan King: [9:34] Mental health is the greatest source of disease burden on planet earth. And in America, two thirds of mental health patients are seen by outpatient group practices, right? Yeah, yeah. And so I think you're absolutely bang on that that is so often it's also regular contact. It's one of those mental health is one of the sort of chronic types of conditions, right, that our health care system actually takes seriously. Arpan Parikh: [9:57] That's right. Dan King: [9:57] You're bang on. Arpan Parikh: [9:59] Yep. Dan King: [9:59] So turning back to you, though. Okay, so we've we've developed this deep interest in in all different aspects of value based care and walk me through the journey of getting to getting to soul and tell the audience a little bit about soul. Arpan Parikh: [10:12] Sure. So after Caremore, I took up one other career step, which actually is also very formative in the work I do at Seoul. So I spent a little bit over a year at a company called Roe, which many folks may know as Roman, which is, you know, the direct-to-consumer digital health company that started in the men's sexual health space and has expanded to include a number of different clinical service lines. I went to Rowe to help launch and scale their direct-to-consumer mental health product, which was a med-management platform for depression and anxiety. So very different experience from working in, you know, a tertiary academic hospital in Manhattan or a risk-bearing primary care group. We were doing direct-to-consumer, all digital, lots of async, and just psychiatry for folks paying with a monthly membership. That included their care and also their medication shipped directly to their front door by our Roe Pharmacy. So that gave me a completely different perspective on mental health and healthcare delivery in general, and specifically two concepts. One was Arpan Parikh: [11:13] It is the job of the healthcare delivery business to make the life of the clinician delightful. And that's one of the ethos at Rowe that resonates very strongly with me. And the second was, it's also the job of the healthcare delivery platform to meet their patients where they are. And Rowe does, in my opinion, a phenomenal job of understanding the pain points that patients are trying to solve for and accessing the services it provides and building a clinical care delivery platform that matches that need. So that was an immensely valuable learning experience for me and saw some of the best in the game in building direct-to-consumer, high-touch, asynchronous care delivery models. So my journey to Seoul in many ways is a culmination of this idea at CareMore, the ethos was deliver incredibly rigorous care to complex populations in a high-touch brick and mortar model. And the ethos at Roe was create a very delightful experience for the clinician from a technology and operational perspective, understand your patient's needs and build a care model that meets them where they are and do it in a way that is enabled by technology. And if, you know, if I look at Sol and the way we've evolved over the last three to three and a half years since I've been here, you know, I can proudly say in many ways, our model brings both of those together. So in a nutshell, the care model at Soul Mental Health is based on Arpan Parikh: [12:38] A couple of core tenants. Number one, it's an integrated or multi-specialty care model. So we believe strongly that delivering psychiatry and therapy together in the same care centers leads to the best outcomes for patients because we know the data says most Americans who have a therapist and psychiatrist, the therapist and psychiatrists rarely actually talk to one another, right? Which is a mind-blowing statistic. So number one, we offer both those service lines together in the same clinic. Number two is the fact that we have clinics, right? So our thesis is more and more Americans want in-person care. And by the way, so do clinicians. They want to work in a organization that creates a sense of community and in which they can see their patients face to face. So we build and operate our own care centers in our markets. Number three is a highly clinically rigorous model of care. And that's why I was brought on and I joined the team to make sure So we're building a best-in-class clinical model that includes very rigorous clinical supervision, both for our therapists and our psychiatric clinicians, and helps us deliver a value proposition that is really, really strong to both our patients and our partners. And then number four is bringing all of that together in a way that creates a delightful experience for the clinician. So all of our clinicians are W-2 employed by us, by our practice. And it's my job and it's our job to make sure we're providing the support, the technology, the supervision, and the professional development opportunity Arpan Parikh: [14:02] that makes this an amazing experience from an employment perspective for a clinical team. Dan King: [14:07] Why is it, let's start with the first piece. So why is it that psychiatrists and therapists often aren't talking to each other? And for our audience of practice owners, what do they need to know about integrating those two? Arpan Parikh: [14:20] Yeah, it's a great question. Yeah. My perspective on why this gap exists is that, generally speaking, you know, the outpatient behavioral health ecosystem is a relatively fragmented one with many smaller or small to medium-sized groups or practices, right? And that makes coordination of care hard. We are also a specialty that hasn't been the fastest adopter or embracer of technology, right, which can also help make coordination or collaboration more seamless. You probably won't find a specialty that has more clinics or clinicians who are still writing notes on paper for example than outpatient mental health right yeah yeah so in that fragmentation plus the relative lack of technology penetration in my opinion means typically for a therapist to collaborate with a psychiatrist it's picking up a phone and dialing and what are the odds you're going to be able to catch someone right and they're going to pick up the phone very very low And that also takes time out of the day. And if you're a solo practice therapist, that's 30 minutes you could have spent taking care of a patient, right? So there are many barriers to coordinating care when it's folks who work in separate practices that don't have shared technology and when there are not asynchronous modalities of communication or sharing information. Dan King: [15:39] That's interesting. And I guess the training is also very different, even in a sense that you could tell me if I'm barking up the wrong tree here, but if I'm a nurse, I have access to some of the training that an MD does, right? Sure. In other specialties. But here, the training that a licensed professional counselor gets or a licensed mental health counselor gets is going to be fundamentally different than the training that a nurse or even a general practice doctor would get. Arpan Parikh: [16:06] Sure. I think that's part of it. And I think that works in both directions, right? I think from my experience, I've seen many times, and I see this in our own practice at Seoul, right? We have some patients who will come to Seoul for therapy and maybe they have a psychiatrist they see in the community. I'll see my therapist calling the psychiatrist weekly and the psychiatrist doesn't answer, doesn't pick up the phone. So I think it works in both directions and it is a training and it's a kind of adherence to best practices, honestly, conversation. Like this is a best practice. It's honestly in many situations malpractice to not coordinate care with a patient's other behavioral health clinician. And that would be front and center from a plaintiff's lawyer if something goes wrong. So this is not just a good experience and good care thing. It's actually a liability and protect yourself kind of thing too. Dan King: [16:56] So much of our healthcare system is incented towards greater and greater degrees of specialization, right? Yeah. So I think there's all kinds of incentives not to think about healthcare in general in a holistic way and seeing that play out within specialties, right? It's got to be very consequential. Arpan Parikh: [17:11] Yeah, absolutely. Dan King: [17:13] Interesting. Okay. So I can understand then why, I mean, there's a few different directions we can go from here, but we were speaking before hitting record about technology and its value for improving quality of care. Can technology be a very useful tool for helping both practices, efficiency in general, but also bringing together psychiatrists and therapists? Arpan Parikh: [17:36] Yes, without a doubt. In 2025, the explosion of technology platforms that we're seeing in the market today that can literally intervene or be part of every step of a patient's journey in care are, in my opinion, truly astounding. We see technology today that from the very beginning of a patient's engagement in care, for example, platforms that can record a 60-second audio clip with a patient from an outbound phone call. And from a 60-second clip of audio, develop a clinical triage of the patient is likely suffering from an anxiety disorder, the level of risk for the patient is moderate, you should see them within 72 hours, right? To matching technology that can help match patients to the right clinician based on patient and clinician attributes, to clinician co-pilots that help take notes, that help develop treatment plans, Arpan Parikh: [18:33] To documentation and coding platforms that make sure the documentation that is being written meets the requirements at a payer level for reimbursement of the chosen CPT code, to agentic call center agents that can help improve time to pick up phone calls that are inbound from patients that can in real time do outbound outreach and engagement of referrals or patients to RCM platforms that on the very back end of the patient journey, help practices make sure they're collecting what they're owed from payer partners is amazing, right? So it's literally every step in the care journey and every step of running a Be Ever Health business. There is today a technology platform or a technology solution that just turbocharges the capabilities and honestly helps a practice drive operational leverage. Dan King: [19:25] Is there one tool that integrates all of this? Or at this point, are we adding multiple tools into the mix to get it all done? Arpan Parikh: [19:31] Yeah, it's a really good question. So the integration and the consolidation has begun, but it's still in the early innings. So today, there are some platforms that are, for example, combining note-taking or scribing and coding, right? There are some platforms that are combining clinical triage and agentic AI call. There are some platforms that are combining coding audit and RCM claim analysis, but we haven't seen anyone yet try to go further upstream and combine platforms. So it's a burden as a practice owner or an executive at a practice, right, to assess the landscape and understand where in the business we want to plug a solution in. But this is an activity or an exercise that I think has a massive ROI for anyone who's running an outpatient mental health group or practice. Dan King: [20:20] I'm curious specifically to dig in a little bit more to the triage piece. So is this triage solution one in which there isn't a human picking up the phone when a potential pit went at all? Arpan Parikh: [20:32] That's right. So, you know, there are a couple of platforms that have been on the market for a few years that were able to take an audio clip wherever the audio clip came from. Right. And then assess the tone, the cadence and the rhythm of speech, as well as the content of the speech and then develop a clinical triage. What's really cool in 2025, though, is now you also have agentic AI call agents, right, that can do the inbound and outbound calling. So you can think of the natural combination here of an outbound agentic AI call solution that calls a patient who scheduled an appointment, walks them through a clinical triage or screening script. And then as the patients respond on the back end, the platform is taking the audio that the patient responds with and then feeding it to the platform that analyzes the content of the conversation and then spits out its assessments. It's actually beautiful in some ways how these platforms can now integrate and in many ways do a lot of this work in a really automated and seamless fashion. Dan King: [21:33] I think there's a journey for a lot of clinical leadership to get behind this, right? So it's interesting to hear about the sort of concrete benefits. And clinicians have been doing what they've been doing for a long time, right? And we're almost speaking a different language here. And it can be tricky to bring people alongside. Arpan Parikh: [21:48] Yeah, absolutely. I mean, take this ambient scribes as another example. That's been an interesting journey. And there's a lot of change management that's involved in, for example, as a practice executive, buying a solution and then rolling it out to a team. What I've seen and experienced myself as a clinician is these scribes are actually life changing, right? In the way a clinician allocates time during the day. So to some degree, particularly for clinician facing tools, it's a matter of try it once, try it two times, try it five times and like understand the ROI. It's hard to actually internalize how this is going to impact my life as a clinician until I use it. And I feel confident now saying, you know, by the end of this year, by the end of 2025, like an ambient scribe is table stakes, right? So by the end of this year, in my opinion, if you're a care delivery organization in mental health or any other specialty, and there isn't an ambient scribe solution that is being provided to the clinical team, like that is going to be a big negative in the pro con column when a clinician is thinking about where they want to get a job or take an employment opportunity. Dan King: [22:59] You know, clinician retention is going to be super important to any practice owner listening to this, right? It's one of the... Dan King: [23:05] Questions group practice owners are confronted with. So I think that's definitely one argument in favor of exploring this trajectory. Do you think adoption is easier in a context where we're speaking about organizations purely with clinical leadership or organizations where you've got clinical and non-clinical leadership? Arpan Parikh: [23:23] It's a great question too. So I'm a really big believer in the concept of dyadic leadership in healthcare. And this comes from my time at Caremore, and Roe, and Sol. And in my opinion, it takes a diversity of opinion and diversity of skill set to lead a clinical care delivery organization, behavioral health or otherwise. So in the context of rolling out a new technology solution, let's say, I am a pretty firm believer that you need both sets of expertise at the table to number one, make a decision on is this a worthwhile investment. Number two, decide who you want to go with as the vendor or the platform. Number three, actually do the rollout and implementation and the change management. And then number four, do the assessment of is this effective in driving the outcomes and ROI that we thought it would. I haven't seen an example where a pure clinical leader or a pure non-clinical leader is able to execute that type of complicated, you know, buy and rollout of a solution. And it really takes a dyad that has deep expertise on each side that's working together in a really collaborative way to do it well. Dan King: [24:36] How should the two sides speak to each other? Because as a non-clinician, I'm sensitive to the fact that I'm in a space where people who have extensive training and care know so much I don't. And I'm cautious about deferring to them, especially in their areas of expertise. But how should we go about having this conversation? Arpan Parikh: [24:55] Yeah, it's a good question. So what I've seen in my career is it takes a true collaborative partnership and the dyad doesn't work if one side treats the other purely as a figurehead consultant. And I've seen it work in both directions, right? I've seen organizations where the owner, the CEO of the organization is a clinician, right? It's an LCSW, it's a psychiatrist, et cetera. And they see themselves as the king of the, queen of the organization. And at some point in the journey, let's say they bring on a CFO who helps them manage the finance and the operations. Arpan Parikh: [25:31] They really just delegate the CFO to making difficult decisions and they turn the CFO into the bad cop in any situation. That's a very common theme I've seen play out. On the flip side, I've also seen many examples of care delivery organizations started by or eventually run by someone who is not a clinician. And they bring on or have a legacy clinical leader who is there to be a clinical, for lack of a better word, figurehead. Right? Just to say there's a clinical leader, this person owns the professional corporation, they rubber-stamped the policies, but really, they're not a partner in the decision-making. Either of those examples, in my opinion, is never going to lead to a highly performing, excellent employment environment practice. So it takes an environment in which both the clinical and non-clinical leader see each other as complementary, take the time and effort to actually upskill each other in understanding and bridging some of the gaps in knowledge that might exist and ultimately partner in making decisions that are for the best of the business, the best of the clinicians, and the best of the patient. I don't think the outcome of the business and the outcome of the patient have to be at odds with one another. I think they can be lockstep together. Ultimately, taking good care of patients and taking good care of clinicians Arpan Parikh: [26:54] results in a great business. Dan King: [26:56] As we come towards the end of our time together, I always love to end on a human note. So when you're not building great care organizations, you're not thinking through this journey of how the dyad leadership can work best. What do you do for fun? Arpan Parikh: [27:09] So my wife and I live in Southern California. We have an almost two-year-old daughter, so we spend a lot of time with her. And for those of you who have kids or have kids in your lives, you'll know that this age is a fun one. So taking full enjoyment in her personality and having her in our lives. We also spend a lot of time in the outdoors and so we have the luxury of sunshine. And as someone who grew up in the gray Midwest and then spend most of my adult life on the cold East Coast, it's nice to have that ability to just step outside and get some sunshine and vitamin D. And then I think the third passion I have is actually teaching. So I, outside of professional work, have spent a bunch of time teaching medical students, teaching resident physicians and something I find super just personally fulfilling and enjoyable. Dan King: [27:56] Amazing. Well, Arpan, thank you so much for sharing your wisdom. And I think building this vision of what the future can look like technologically in terms of collaboration between all the different types of folks that need to work together here. So I think it's a beautifully aspirational conversation that I think will resonate with folks. So thanks so much for coming on. Arpan Parikh: [28:15] The future holds so much potential for us in this space. And I'm excited for what we can achieve together as an industry. A rising tide here is going to lift all boats and we can all share in the success and make sure we're taking amazing care of our patients.