A Platform for People Who Help People
Marketplaces exist to bring creators and providers closer to customers and clients. Though generally equated with consumer goods, marketplaces connect humans in myriad forms. LinkedIn and Substack are both perfect examples of bringing together parties without convenient venues
Doug Wilson discovered a need for such a convening platform for mental health professionals. Let’s rewind a couple of decades to learn this entrepreneur’s journey.
Best Laid Plans Disrupted
Doug Wilson was living in Indiana and working for the behavioral health division of the pharmaceutical giant, Pfizer, in the mid 2000s, calling on clinics delivering psychiatric care. He would often hear clinics inquire if he knew of doctors seeking alternate opportunities. He’d make those connections when one was available, cementing not only a valuable relationship with the doctor but nearly guaranteeing a long-term relationship with the clinic served.
He enrolled in an MBA program in the late 2000s as he continued to think about a lifelong dream of running his own business. An assignment to develop a business plan led him to think about telemedicine and telehealth, services then in relative infancy due to the specialized hardware and connectivity required.
Although starting his own company wasn’t in his plans, fate intervened. Pfizer’s patents for the very pharmaceuticals he represented expired and the division was shuttered, displacing Doug in 2011 when the world was just recovering from the recent financial crisis. Entrepreneurship rises in times of economic uncertainty and Doug knew it was time.
He, like many others who’d been dreaming of entrepreneurship while being previously employed, decided to take the leap. Leveraging his family’s existing connections to Iowa, Doug and his wife moved from northwest Indiana to Iowa and Doug registered his new company, eVizzit, LLC in January 2012. The company later adopted the name Integrated Telehealth Partners (ITP) in 2017.
Funded by the severance check and supplemented by random gigs, Doug continued to diligently build his company while looking for funding to scale. He sought connections to entrepreneurial support organizations (ESOs) who could help him steer his business and fill the need for small office space. He found the West Des Moines Business Incubator, an effort of West Des Moines run by Clyde Evans and Jo Eckert, who facilitated several connections including to a future business partner, David Gion.
Equally valuable were connections who became mentors. Dr. Robert Caudill, a psychiatrist at the University of Louisville and one of the early leaders in telepsychiatry, generously volunteered his time to provide guidance from both a clinical and operational perspective in the earliest stages of the company. Similarly, Jonathan Neufeld helped him understand the changing trajectory of telehealth resource centers, regulation, and reimbursements.
Funding, however, remained elusive and Doug sensed an end of his dream, when he was encouraged by the West Des Moines business incubator to meet Mikki Stier. In his mind, that would be the one final meeting before he shuttered his dream.
The Spark
That pivotal meeting with Mikki Stier, then head of public and government relations at Broadlawns hospital led him to state representative Renee Schulte. Renee introduced Doug to Bob Lincoln. Bob was the CEO of the County Social Services Mental Health and Disability Services (CSS MHDS) region. Bob was helping the state transition from a county to regional system for behavioral health services and expanding their reach. He recognized the value telehealth could provide to far-flung rural regions despite the highly proprietary and expensive technology of the time (2012 was a different era for remote meetings).
A stumbling block remained. ITP was relatively tiny and large hospitals don’t just handover large-scale contracts to unproven small businesses. Recognizing ITP’s value, however, Bob introduced Doug to Chris Hoffman of Pathways Behavioral Health of Waterloo to the table and facilitated the funding for Pathways to partner with ITP and bring its solution to the regions. Bob, CEO of the first such region became a champion for the company.
The career that began with Pfizer in 2003, took him through the MBA at Kelley School of Business - Indiana University, and brought him to Iowa to launch ITP in 2012, had now delivered him the dream of running his business. ITP remained at the West Des Moines Incubator and began growing with servicing this new business model.
The Business
Behavioral health professionals, like in any other field, can have excess untapped capacity, especially when they live and work in remote areas themselves. ITP began building a network of providers willing to make their excess capacity available to hospital and clinics elsewhere. ITP built the technology to manage this ‘marketplace’ and hired the providers as 1099 contractors.
Nearly 60 county jails and 70+ hospitals across Iowa leveraged ITP’s providers, connecting the provider to someone seeking care. As such care needs often arrive unannounced to these facilities, ITP services became highly desirable and critical, especially in rural and remote areas that were mental health provider deserts and rarely had psychiatric services available from within their medical staff.
As some providers hailed from outside Iowa and occasionally required licensure and insurance themselves, ITP facilitated their ability to become certified and provide the requisite services. The marketplace, thus, took care of both sides of the market, cementing its value in the eyes of both entities.
Over time, as the company grew, so did the complexities of managing flexible and varied availability schedules. Many of the 1099 arrangements have transitioned to full-time employees of the company. A growth in services required by children and adolescents, immediate and residual effects of the pandemic’s impacts, and societal isolation has also led to expanded need for ITP and similar providers’ services.
Funding
ITP raised a round of angel investments in 2017 and, in full disclosure, members of Plains Angels including myself, were minority investors in the round alongside executive members of the company. The company used the funds for growth, both in operational and medical staff. David Gion, a serial entrepreneur in the Des Moines area joined the company’s executive team after exiting his own construction software company, Canvis.
A period of quiet execution followed, with little heard from the firm in the central Iowa startup circles during the following two years. Although schools could’ve been a growth area, the bureaucracy of long sales cycles posed a risk the company chose to avoid, focusing instead on rural clinics, hospitals and jails expanding to over 200 facilities within the state.
The company continued to innovate from within. Nathan Vorm was the company’s first non-physician hire and became a multi-talented resource. He recognized the complexities inherent in proprietary hardware to deliver telehealth and built ITP’s own custom cart, an admirable yet complex solution. Recognizing their own small size and complexities of building hardware, they ultimately didn’t commercialize the cart (presciently, as web-based telehealth was just around the corner). Nathan delivered information technology support, identified new business opportunities, managed billing, accounting and customer support.
By 2019, ITP had reached the level of maturity that attracts strategic buyers and merger partners. Having exited their relationship with Pathways Behavioral Health, they were now a profitable and independent business.
Transition
Psychiatric Medical Care (PMC) based in Nashville, TN was a private-equity backed entity, formed to provide intensive outpatient group therapy program for older adults. Their product, Senior Life Solutions, was accretive to ITP’s telehealth services and envisioned as a complement to their service model. ITP brought a critical element to PMC-the psychiatric and medical professionals employed by the organization greatly appealed to PMC who had relied upon contracted services only until 2019.
PMC acquired ITP in 2019, providing liquidity not just to the ITP executive team but also to angel investors who in-turn reinvest returns from such exits into other startups.
The subsequent pandemic was an accelerant to adoption of telehealth. As the world became accustomed to mobile and desktop video conferencing for work, family, and play, medical professionals found themselves serving a larger number of patients in ever larger geographic areas.
Doug, like many ‘exited founders' (yes, this is a formal term for those who successfully exit a startup) could’ve simply cashed the checks and retired to warmer climates. Driven by his passion for behavioral health services, he chose, instead to stay with PMC and grow the business. PMC continues to grow, now with a recent second PE firm led recapitalization that helps facilitate organic growth as well as inorganic M&A.
What’s next
State regulations differ across borders for licensure, insurance, prescriptions, and service delivery. As behavioral health delivery may involve family intervention, patient self-check-in at hospitals, law enforcement and even involuntary commitment when self-harm may be suspected, the myriad regulations must be evaluated prior to connecting a medical professional to a potential patient. Doug and team remain in their West Des Moines office (albeit now in a hybrid mode paralleling their own product) to expand the ways in which their technology performs its work.
What Doug’s business plan at Kelley had envisioned nearly 15 years ago has come to pass in his care yet much work lies ahead. Behavioral health interventions cannot way a multiple week wait common when seeking professional health. Similarly, these services are expensive, cash-payment at service, even as many patients rely deeply upon Medicaid.
Despite the many changes influenced by the pandemic, challenges and vestiges of the past remain. Potential requirements for patients to be seen in-person at pre-set frequencies is often impeded by distance. Prescribing medications under the Drug Enforcement Agency’s potential supervision is another impediment to timely delivery of care.
As I left Doug’s office amidst light flurries and thoughts circling around telemedicine, behavioral health care, affordability and entrepreneurship, I was glad for Doug’s layoff from Pfizer. His story reaffirmed my long-held belief - entrepreneurship rises when economy falters. He thrived, experienced a double-whammy - layoff during a financial crisis.
Perhaps that is what inspires his grit and commitment to patient care.
I am a proud member of the Iowa Writers Collaborative, a cohort of writers, and artists who contribute their creativity to a global audience.
Fascinating.
Perhaps for your next story, check out Flowstate Health building out of Gravitate: https://www.flowstate.health
Seems like they might be where ITP passes the baton to next...