Hello and welcome to Healthcare Horizons, a production of MATTER. I'm your host Steven Collens, the CEO of MATTER. At MATTER, our mission is to accelerate the pace of change of healthcare, and one of the ways we do that is by giving a voice to extraordinary individuals who are on the forefront of improving health and healthcare. This season of Healthcare Horizons is all about how artificial intelligence is changing mental health treatment. Last episode I spoke with Sarah Pierce, co-founder and chief clinical officer of Joystick Life, a powerful and efficient mind body training tool that helps to regulate the nervous system. This episode I'm speaking with Hafeezah Muhammed, founder and CEO of Backpack Healthcare, a platform that provides inclusive, accessible and comprehensive mental healthcare to children, young adults and their families. Hafeezah, thank you so much for joining us. Really looking forward to this conversation. 


Yeah, I'm so happy to be a part of this conversation and thank you for inviting me to your podcast. 

Yeah, so the data on the mental health of kids in this country, but even broader than that, but certainly in this country is really quite terrible and very, for those most who are parents, very troubling. Why is that? What is going on? What is the problem that is clearly creating such challenges and issues for children and youths in our country? 

Yeah, I definitely understand the challenges and I'm going to take a step back as to why I started my company and you can see the lens of where I see that challenge from. In October of 2020, my son who was six, came to me and told me that he wanted to kill himself. My heart broke. I didn't see it come in and I didn't know what to do next. As a mom, I struggle to find care for my son. I struggle to find support and I struggle to find answers. And I think the same answers that we're looking for comes on to a few things, and most people don't know this statistic. Mental health challenges has always been there for children. As a result, more than 50% of all mental illnesses start by the time a child is 14 years old. What we've seen is that during the pandemic, there's been a lot of reduced stigma in regards to mental health where people are acknowledging and seeing the issues as they happen so that we are able to understand the drivers of those issues and how we can help support our families within those issues. 


So being able to pinpoint a direct cause of it, I feel that it's been around for a long time. It just hasn't been enough attention on the crisis. I'm grateful my son is doing well right now and a lot of parents are still struggling. And I think addition to that too is that from a mental health perspective, parents are struggling as well, and when parents struggle, the kids could struggle and I think we have to look holistically at the parents as the kids so we can really understand what's happening with the crisis in the states and internationally. 


So as a parent of a six-year-old boy, your story of what your son says to you kind of makes me feel sick to my stomach. Glad that he is doing well, and kudos for you for turning that feeling and turning it into a company. So how did you go from what I imagine was that horrible moment when you had that conversation with your son into really changing your career and starting a company to do something about it? 


From a parent perspective, I was an executive for a mental health company. And so with that I had the foundational knowledge about what it takes to run a mental health company, the end-to-end, and I wanted to combine about how do we find self-care solutions, self-care feature so that we can help support children. And I think that knowing that I was struggling so much, I started thinking about the parents out there who are like me that can't find access for their kids. And I felt it was an obligation to make a difference for those families to be able to build resources. For example, I look for self-care solutions. Where do I Google? Is there an app? Because you're embarrassed about something that's happening to your child, you feel guilty, you're like, where did I go wrong? We already know kids don't come with a handbook. And I feel that knowing that this was the right timing, it was something I was experiencing and I had the experience is why I left and I said, this is the right time for me to do something. 

And what does the company do? 

So we're Backpack Healthcare, we provide therapy and psychiatry to caregivers as well as the kids. So we focus on kids on their caregivers, but we also have a self-care app that allows parents and children to have support in between sessions. And that support is critical because one hour a week with a therapist is not enough because their kids, there's things that's happening seven days a week, 24 hours a day, or let's say 16 hours a day depending on how much sleepover kids are getting. So how do we help support families in between sessions? And we wanted to ensure we had the end-to-end solution of self-care plus individual therapy. 

How does it work and how did you go about, for entrepreneurs who are listening to this, how did you go about this realization that there was something wrong, that there was a space in the market? Obviously you'd been in the mental health space for a few years. Tell me a little bit about that journey of discovering what exactly your company is going to focus on. 

So having a personal connection to the problem and knowing that I struggle to find resources, I always feel that from an entrepreneurship perspective, having lived experiences is really key. If you've lived an experience and you've tried everything you can to solve a problem and you haven't been able to solve that problem based on what technology or solutions are available, that that's a key to be able to start a company and say, you know what, if it's not there for me, there are a lot of people like me. I can be able to create something and first identifying that this is a lived experience that I had. And then second, taking a look at the broader market, how many kids are being impacted, how many kids from who are on Medicaid, which is our focus point, are getting care and identifying those issues. Identifying the market size to see how large of a market this is, was one of the key initiatives that I had to decide that this is the company that I can build and be able to be sustainable enough but also create impact for the world and for the states. 

And is it primarily a services company or is it primarily a technology company or a tech enabled services? How do you think about the type of company that you're building? 

Yeah, we are definitely a tech enabled services. So we are definitely at the true intersection between technology and services because there's work that you can do independently and there's also the opportunity to upgrade to one-on-one therapy, and that's what makes us unique. We're truly that true intersection between tech enabled the technology and services. 

So how's it going? You started the company, you've raised money, you've been through some prestigious accelerators. How's it going so far?

As any startup or any company, you have your up moments, you have your dung moments, entrepreneurship is definitely not linear and it's definitely not the most easiest thing that you can do is actually the most challenging thing I've ever done in my life. Even more challenging than the C-sections I've had. I would tell you that and c-sections are very brutal, but for right now, what I am very proud of is that we are expanding our reach. A prime example, we started in Maryland, right now we provide care in DC, Michigan, Virginia. So knowing that we're able to reach families and we're starting to expunge state by state, it's very exciting to see our growth. But also growth does come with challenges. How do you ensure you don't grow too quickly, but how to ensure that you grow fast enough to ensure that you can meet the demand and meet the kids and their families wherever they're at? 

Congratulations, that is no small feat going. It's hard enough to open in one market and then now it sounds like you're in three or four, congratulations. As you grow, how do you ensure the quality of the services that you're providing? One of the things that we've explored on this podcast is the variability of the quality of mental health services. And it's not like, I mean it's hard enough to find a therapist in many cases, but finding one who you're going to resonate with, who you're going to have that important connection with, whose kind of style and methodology is appropriate for the particular patient's needs is not always easy. So as you grow, how are you ensuring that the services that you're delivering and that your clinicians are delivering are really doing the trick for the people who are counting on you to improve their wellbeing? 

That's a very great point. And you're right. As you scale, how do you maintain quality? So there's some different things that we do as an organization. So first is that we do have a two year training program for any new graduates come into the field. They go through what's called our residency program where they get the hour. So that's one thing that we do to ensure consistency in training, but also we are focused on outcomes. Is there a reduction in GA seven? Is there a reduction in PHQ nine? What is the average sessions per patient? Is there a first session dropoff rate? So looking at the data to identify early issues, another thing that we look at is that after every session we get feedback from the patient, how was your session? How's your therapist doing? So at that time, we're able to fine tune and find issues immediately versus waiting for them to linger because it's easier to curse correct when you're really data-driven. 

And lastly, we always track our NPS, our patients doing, okay, is that feedback we need to give? Are they churn in? Are they not happy with billing? So we also have NPS, so we gather their NPS scores and we make real time improvement based on their feedback. We are fortunate that right now our NPS is 84%, which is definitely significantly high. That's high for our healthcare field or even from a mental health perspective, but that been rooted in the data that we've been driving and gathering after every session. And when therapists know that you're focused on the voice of the patient listening to the patient, getting their feedback for how to improve, it makes the training that they're learning even more exciting for them because they know we put this training together for a reason and they're going to execute because the patients have a voice. And I recommend that any entrepreneur that's building anything for their patients, that we find a way to give our patients a voice regularly as much as we can, especially in a mental health field, so that we can get better. No one is perfect, no therapist is perfect, no organization is perfect, but we do have to get that feedback so we can make changes and make improvement. 

Talk to me a little bit about artificial intelligence and how it is that you're doing that to how is it that you're using ai? 


One thing we're proud of is being one of the leaders for AI in mental health. So we have a mental health large language model that we've developed over time with our technologists, and as part of that model, we build tools to help ensure that our therapists can have better capacity to reduce burnout and to help improve outcomes. An example of that is that we realized that our therapists were spending more than 45 minutes for a treatment plan, 45 minutes on a progress note after every session. And we took that information and we help automate it through artificial intelligence where they can generate a treatment plan within a few minutes and they can edit it the as well as progress notes. And those are two major examples of how we leverage artificial intelligence to reduce the burden of our therapists so that they can also improve and increase their capacity, but also that we are helping them reduce burnout so that they can continue to do the work they went to school to do. They went to school because they want to make impact, they want to help people. They didn't go to school because they want to be admins, they want to make a difference, and this is our role is to make sure we give them what they wanted and their why. 

I would imagine your therapists then love working with you if they don't have to spend anywhere near the amount of time that they would otherwise on getting ready for. And then summarizing their meetings. Do you also keep tabs of or survey how the sentiment of the therapists you're working with? 

Yeah, so we do survey them to get their feedback because we are a company that was built for clinicians, so it's clinician built company. And what we do is we understand, we look at attrition, what is our attrition rate? Are people leaving? And right now we've been a solid at around a 97% retention rate. So those are things that we look at, but we also empower clinicians to not only be able to deliver care, but to be owners of the business. So a clinical team, they have shares within the company, so they're building the company, they're helping out with marketing with blogs. So all of our blogs that you see written are reviewed by clinicians at times, written by clinicians. They're creating our TikTok videos because we want to make sure everything that we do is clinically verified, has been written overview by the clinician because they are the experts. So we make sure they have a holistic view of the business and how we do things, but also give them opportunities to support us in our growth and ensuring that they feel like they're part of the build. 

So just going back to the artificial intelligence, did you build your own LLM or did large language model or did you sort of train somebody else's with mental health data? And how did you ensure that the LLM that you're using is appropriate for specifically for mental healthcare? 

So we build it from our own data and the work that we've been doing because we wanted to ensure that as we build our laws language model, there was data from diverse data sets, different backgrounds and so forth, to ensure that we're able to provide that care and provide the right technology that's inclusive. And also we ensure that we have input, ensuring the things that's coming in is the right thing and the output, like we're tracking for hallucination risk models, giving things scores to help ensure that what we're producing out is accurate. And as a result, we are the only mental health company that's working with N to help shape policy and artificial intelligence for the country. So very excited about that, but it goes into ensuring that we're able to help manage risk, reduce hallucination, and also have a responsible AI framework in what we do every 

Wow. And how do you ensure that speaking of responsibility and standards and how do you ensure that it it's safe? Obviously you're dealing with data that is extremely personal and that most patients and families would consider quite sensitive. How do you ensure that the data is safe, that the system is trustworthy, that people can kind of have faith that nothing's going to go awry?

So we created our own responsible framework because we wanted to ensure that there are some things that we do. And what we do well is ensuring that everything that we do is de-identified. There's no patient information, there's a lot of misinterpretation of AI recommendations, data security and privacy is big, ensuring that we're high trust certified. So what we do is that we have input guardrails, so we check for prompt injections for data leakage, relevance, and then our framework where we have output guardrails. So anything that comes out, we look for bias, toxicity, relevance, accuracy. And with the monitoring for hallucination bias, reliability and toxicity scores, before that goes back out, we give it a score. If it doesn't pass a certain score and mark that information doesn't go back into our LLM or anything that we're working to train. And when we started this is that I said as a mom who's, I like to say paranoid about technology, I love technology, but I always can think about the harm I can do. I feel I said if there's one person or one company that can do it, it could be backpacked because I know we will do our best to do it right to ensure that people feel that there's a place that's responsible but has the same nervousness or concern that any ordinary parent would have and to ensure we build it away so people can feel comfortable and confident. 

You recently raised $14 million, I believe in what is the most challenging fundraising environment that we've seen in many, many years. We work with lots of companies that are really struggling to raise capital. Any advice for them? And how did you do it? How did you manage to close this round in this moment? What do you think was key to your success? 

So there are a few things and I would tell you to any entrepreneur raising capital, never gave up, keep believe in, always understand ways that we can pivot. And I feel like what has been unique for us is that we were not fortunate to have raised capital in a time when a lot of companies were able to raise capital. So we had to focus on this that can generate revenue to get customer feedback. And as we continue to grow without raising capital in 2021, besides a few angel checks, we were able to build a business. But what happened was that maintained the relationships with investors along the way. So the investor to end up leading the round was someone that we've had a conversation at an early stage of where we were at with backpack and by then we were able to prove that we have traction, we have expansion, but then the development in our technology was something that was also thoughtful in how we built it. In order for us to raise capital, we still go through the same level of rejection, hundreds of conversations, hundreds of nos, but all you needed is that one, yes, to have that momentum to keep going. And I really hope that as interest rates are dropping, that there can be better opportunities for capital raise. But focus on when you get to profitability, how do you manage your cash burn and what is the ROI on the money that you're spending, what is the ROI your investors are getting on the capital that you're spending?

One of the things you just said I think is really important and something that we often talk with entrepreneurs around. I talk to lots of entrepreneurs who say, oh, I'm not ready to go talk to VCs. I don't want to talk to VCs yet until I'm ready to raise. And oftentimes what ends up happening is what you I think just described and I'm curious about it, is that the VC who ends up leading year round is somebody that you get to know over time and you meet before you necessarily fit that firm's investment thesis and they get to know you over time. They get to see how you operate, they get to see the kind of progress you're making, and then when you are ready to raise around and raise something that fits their thesis, it's a much easier conversation than if you're starting from scratch and trying to build that relationship and figure out, figure out if it's the right fit. Is that kind I interpreted a lot, maybe too much from one phrase of something that you said, but does that resonate? 

Yeah, that resonates. It's all about relationship building and you want to make sure you're able to have proof points that if you meet with them, let's say a year ago and you said you're going to accomplish A, B, C, and then you have a follow-up conversation in six months and you accomplish A, B, C, then you start to build trust and credibility that you're headed in the right direction and you always have to think about you start the conversations way ahead of time before you start raising so that you can let them know, Hey, this is what we're working towards, but ensure that you on the promise and over deliver, and then people will get to be able to build trust and knowing that you're heading in the right direction and they will love to support you to help you get to that next level. 

I think it's such an important point. Any other advice that you have for entrepreneurs? Particular those who are looking at the mental health crisis that we have, which by the way is an interesting perspective that you had in the beginning that maybe it's always been there and we're just talking about it more and better at diagnosing. But either way, we have what I think is objectively and sort of unacceptable state of mental health in the country, whether it's newly like this or been like this for a long time, especially for entrepreneurs who are looking at this space and thinking, I want to be part of a solution. I want to build a company. What other advice do you have for them? 

I always give this advice for anyone in the mental health field that wants to grow their business and it's focused on the Medicaid population. When you think about that population, it's something that's state by state, it's very challenging, but there's such a white space in that arena where if you're able to make it work, you can be successful, but it takes a lot of resilience, a lot of time for us to get to that point. But it's going to be one where I see as an opportunity as a market is the Medicaid market because Medicaid is the number one payer in the US and more than 50% of the kids are on Medicaid. So if you're able to capture that market, you're able to make a difference and make impact to lives of people who not have ordinary, been able to get access to care and it gives you an opportunity to learn, to play, to try new things, but just to never give up.

For those who are interested, where can they go to learn more about Backpack? 

If you're interested to learn more about Backpack, you can go to hellobackpack.com, follow us on LinkedIn. We'll love to have you follow us on LinkedIn and you can download our app from the app store. So those are different ways you can get in contact with Backpack and help support us on our journey. 

Well, AFIA, thank you for speaking with me, for sharing your insights. Congratulations on what you've been able to do in the last three or four years in again, what is really, for at least the last couple of years, one of the more challenging environments that we've seen for companies who are building and raising capital. You're really well on your way and it sounds like you're already making quite a difference and innovating in a space that really needs more innovation. So really appreciate what you're doing, appreciate you talking with me, and thank you so much. 

It's my pleasure. Thank you so much for having me and good luck to all their entrepreneurs out there. We're the future, we can make a difference. Never give up. You got this. 

Thank you all for joining. If you enjoyed this conversation, you can find the rest of this Healthcare Horizon season and all of MATTER’s programs on our podcast. Wherever you subscribe, healthcare Horizons is a MATTER production. Learn more about how MATTER is accelerating the pace of change of healthcare at matter.health. I'm Steven Collens. Thanks for listening.