Ch 1 – EVOLUTION: From the Idea to the Business, and How to Turn the Ship Around (2011

PIVOTS, a 3-part series

Mental health and virtual care are having an incredible moment during COVID-19. As co-founder of Ginger, an on-demand mental health provider delivering access to care around the clock and across the globe, we have been fortunate to be in the right place at an incredibly trying time. And with fresh capital from our Series D financing, there is no doubt this is our moment, too. 

But we’ve all heard *that* story about a company that goes from nothing to success, seemingly overnight. The reality is *this* story has come with many twists and turns. It is a story of near failures and many battle scars. Over the next few weeks, I’ll share what I learned from our Business Model Pivot (Ch 1), our Team Pivot (Ch 2), and my “Me” Pivot (Ch 3). Losing years on the “wrong” business model to being within inches of selling the company. Transitioning our entire leadership team to managing a CEO change. Being weeks from cash out to our hyper-growth of today. And ultimately, how over the past decade we evolved as a company and I evolved as a leader.

I don’t profess to have any singular insight or knowledge of the “right” path. My hope is that by exposing the adversity we went through, I can help other entrepreneurs succeed by being authentic versions of themselves. To challenge the stereotype of the “always-on” and “always right” founder. To be willing to ask for and receive help. Even with those you aren’t “supposed to” show vulnerability with, and especially when it’s hard to hear. 

Find passion, discover the burning need 

Ten years ago, I came together with a team from across MIT to apply new technologies, and data, to healthcare. I was shaken and fiercely motivated from personal experience when a loved one who had struggled with depression tried to take their own life. The deeper I dug, the more I realized just how the current mental healthcare system failed them and so many others.

There wasn’t (and still isn’t) a blood test for your depression. No easy way to measure your level of stress. We knew there had to be a better way.

We set out to bring objectivity and rigor to a field that historically lacked formal measurement. We leveraged Honest Signals or changes in behavior to develop algorithms that detected a symptom flare. Our earliest product offering used passive data from smartphones to predict when patients living with chronic diseases might need mental health support. 

We built a population health platform for care managers and specialists and launched dozens of research studies. We worked with a cross-section of providers from UCSF and Partners Healthcare to Kaiser Permanente and Federally Qualified Health Centers in rural parts of the country. And, by all accounts, the technology we built “worked” as we were achieving the Triple Aim: improved experience, better quality and lower cost.

And yet, we struggled to gain commercial traction with most partnerships stuck in “pilot-itis”. As we stepped back, we began to realize our approach to the market was misguided, and technology alone wasn’t enough. The fundamental challenge in mental health wasn’t measurement of outcomes — it was the massive imbalance of provider supply and demand for services. There were (and still are) far too few mental health providers to serve the tens of millions of people who needed them. While we offered the tools to identify the need for care, there was no easy way for most patients to access that care.

If you’ve ever tried getting an appointment with a therapist, you know what this is like. It can take hours of research and weeks if not months to land an open appointment. A majority of the time, the care you receive isn’t evidence-based and since most providers don’t take insurance, it can get expensive. And remember, this was 2014 when most people weren’t as open to admitting they needed help as they are today.

Experiment in the name of survival 

The friction within our business model at the time forced us to experiment in areas outside of our day-to-day work. We realized the traditional system was inadequate, but we didn’t quite know what it should become. We began hiring for and investing in small, entrepreneurial tiger teams, each with an independent charter to connect with members i.e. consumers directly.

We launched three experiments: 

MoodMatters, a fully virtual clinical study, helped us understand the gravity and depth of the access challenges. Over 500,000 people who needed help sought us out online. Eventually, we built one of the largest mental health datasets in the field.

Listener, a product connecting a non-traditional workforce with individuals in need taught us the power of personal connection and empathy on-demand. We learned behavioral health coaches in a collaborative care model, armed with the right training, tools, workflows, and incentives could achieve superhuman outcomes and scale.

Digital self-care, a collection of bite-sized resources and skills-building curated by care providers and optimized for a mobile experience. Our partnerships with dozens of academic medical centers and research institutes taught us the value of digitizing these activities into evidence-based protocols that had clinical impact.  

While at times this created confusion within our already small team, it also accelerated how quickly we learned. These experiments provided us tremendous amounts of data and the insight that there might be other ways to achieve our mission. Instead of convincing other providers to rewire their operating system, we could reinvent it. Instead of selling to providers, we could become one, too. Ultimately, the only way to stay true to our vision was to evolve. 

Having this data was one thing, but actually making the decision to pivot wasn’t easy.

Lean on your board at crossroads

We had to face the facts: our vision wasn’t our reality. I remember one fateful board meeting in late 2014. Our leadership team had prepped for this meeting for months, gathering data on the virtues and risks of different strategic paths. We knew we needed to “go direct” to consumers, but debated whether to sell to enterprises.

Khosla Ventures challenged us to think beyond traditional telemedicine, i.e., taking an offline visit and putting it online. Automation and the “robot-doctor” was the path forward. Kaiser Permanente Ventures encouraged us to focus on supporting clinicians and easing the complexities of running a hospital system and integrated delivery network. True Ventures reminded us to stay close to our mission and “member first” value, and to focus first and foremost on building an experience that people loved.

This seemingly contradictory advice spurred heated debate, and led to gut-wrenching, late-night discussions amongst our leadership team in the subsequent weeks. After all, we’d spent years building and iterating on our product, only to realize that to be viable, we’d need to hit reset. On our business model, our customers, and our team. I remember vividly some brave teammates offering to “fire themselves” to enable a change. It was incredibly daunting and deflating.

Yet, this time also came with one of the most critical learnings in my journey at Ginger. Good entrepreneurship isn’t about making everyone happy or building the perfect product. It’s about openly seeking counsel, then making the best decision you can with the hopes of being “mostly right.” As a first-time founder, I began to appreciate how our board and our investors could provide more than just financial assistance. They could also help us to see past our internal and emotional biases at
critical inflection points.

When a reset necessitates reinvention

Rather than trying to patch the holes of a flawed healthcare system, we decided to reinvent one ourselves. We wanted to reduce friction for our members at every step of the process and cut out the inefficiencies. We needed to deliver mental health care directly.

And so Ginger’s on-demand mental health system was born.

The idea of building an entire virtual-first clinic from the ground up was terrifying and also incredibly freeing. There was no blueprint for this, nor anyone we could turn to with prior expertise. While most were quick to point out the reasons it wouldn’t work, it meant we had a chance to rethink everything. We set up a medical group practice in 2015. We got to hire the right people, train and incentivize them appropriately, create the right feedback loops between clinical and data science, and implement all the workflows we ever dreamed of.

We built an entirely new model of care, fundamentally oriented around our members. We found a happy medium between the use of technology and a human touch that we’re always optimizing. We met members where they were, in-the-moment. We stepped them up for clinical care, and down when evidence-based protocols justified it. We built content and acquired digital therapies from Lantern and Live Better to support that scale.

Today, we deliver mental healthcare across all 50 U.S. States and in 40+ countries around the world. We’ve established partnerships with leading health plans and other market leaders. And, in the last 12 months, consumer preferences and the healthcare industry have created tailwinds for our business larger than we could have ever predicted. We just wrapped our best ever quarter, closing more revenue than we had combined over our first 8 years. Hundreds of enterprise customers and millions of new people now have access to on-demand mental healthcare.

We reinvented Ginger after having raised over $28M 4 years in. We experienced the pain that can come with pivoting. The pain of moving on from legacy customers, losing investors and parting ways with early employees. We even dropped the “.io” from our name (check us out at Yet as painful as each of those decisions were, each one helped us to focus our attention on building a technology and service offering that’s both essential to those who needed mental health support – and a viable business. 

I used to hate the word pivot. I thought it was a euphemism for failure, for giving up. I have finally come to own it. I now understand it’s a natural part of evolving, of getting better. Ginger’s reinvention was painful, and it was scary – but it was a bet that paid off.

Stay tuned for “Chapter 2 – BRAVE CONVERSATIONS: Leadership Changes, Venture Assistance, and The Obstacle is the Way” coming next week.

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