Brian Kinsella worked in two of the world’s most intense environments—as a soldier in Iraq, and later at Goldman Sachs—before hatching the idea for his mental health startup, Rappore.
Kinsella witnessed the ravages of mental illness firsthand. The 9/11 attacks that struck when Kinsella was a high school senior prompted him to enroll in the Army ROTC at Johns Hopkins University. In 2006, on his first assignment heading a platoon of 25 in Germany, one of his soldiers, an 18-year-old woman, attempted suicide. She fully recovered. But at Fort Knox, in Kentucky, following Kinsella’s combat deployment in central Baghdad, a fellow Iraq veteran put a bullet through his head. “He was one of best soldiers in the campaign and one of the most liked guys,” recalls Kinsella. “He was suffering from his wife’s leaving him and drinking heavily. To see this good person coming back from combat and be so distressed that he took his own life, and so many others did, too. I had to do something about it.”
In 2010, while an analyst at BNP Paribas in Manhattan, Kinsella cofounded alongside ROTC classmates Nick Black and Craig Gridelli the nonprofit Stop Soldier Suicide, which provides virtual counseling to troubled veterans. In the early years, Kinsella ran SSS day to day from Wall Street, including his five years covering oil and commodities at Goldman Sachs. “It’s a crisis,” says Kinsella. ”We’re losing 6,000 active military and veterans to suicide each year. At SSS, we try to get to the root of the problem, and that might mean helping veterans deal with PTSD, substance abuse, or financial and housing challenges.” Today, SSS—Kinsella now serves as chairman—ranks as one of the largest veteran mental health and suicide prevention nonprofits in the U.S., advising several thousand clients a year. By its own measure, SSS treatments lower suicide rates by 22%, and it’s on track to reach its goal of saving 7,500 lives in the 2020s.
On leaving Goldman in 2018, Kinsella started Rappore in partnership with a septuagenarian titan in psychiatry, Dr. Fred Kass of Columbia University. Kinsella recognized mainstream behavioral health as a hodgepodge of disconnected services that if melded, could be delivered in a structure that greatly lowered cost, improved service, and could document superior outcomes.
Rappore is pioneering a new, sorely needed model in what’s arguably the most fragmented and patient-unfriendly sector of the medical market. It features a wide variety of counselors, from psychiatrists to psychiatric nurse practitioners to social workers who treat a full spectrum of behavioral health illnesses in-house. The comprehensive approach means that folks suffering from substance abuse or eating disorders can receive both counseling and medication management in one place, instead of getting outsourced for the latter to a super-busy MD. “A big trend is to Uber-ize the field, where the practitioners are all independent contractors,” says Kinsella. “That sounds good in theory. But when it comes to the actual delivery of care, it results in less coordinated and effective outcomes. Sure, mental health is a hard place to innovate, but no field needs it more. We can’t address the exponential growth in needs by doing things the old way, in an industry that’s stuck 50 years in the past.”
So far, Rappore’s raised around $9 million, chiefly from family offices and Alan Quasha, chief of investment firm Quadrant Management. “We’re all virtual,” says Kinsella, “except for prescriptions for controlled substances such as Adderall, where we have to see patients in person. So we use WeWork-style offices.” Rappore operates mostly as direct to consumer: It attracts new patients through online searches and recommendations from those it’s treated. Unlike so much of the industry, it doesn’t depend on cash payers, but gets almost all of its revenue from its patients’ insurers, which include everyone from Optum to Humana to Aetna to Blue Cross Blue Shield of New York and New Jersey.
Rappore is still relatively small. Its staff comprises two psychiatrists and two psychiatric nurse practitioners (PNPs), and around 38 social workers, clinicians, and other counselors, all on salary. It currently treats approximately 2,500 patients in 50,000 sessions a year, and operates in five states: New York, New Jersey, Connecticut, Florida, and Texas. What makes Rappore special: steering patients to therapy tailored to their needs all within a single organization, and keeping them in its ecosystem until, and not beyond, the point when they show substantial improvement, as gauged by its sophisticated measurement tools.
The yardstick is what’s called the Mental Health Fingerprint, a system developed exclusively for Rappore by Dr. Kass and Dr. Michael First, who’s renowned as an architect of the DSM industry-standard protocols on psychiatric treatment. “At the start of the journey, every patient goes through a structured interview evaluation called the Intake, and fills out a detailed Fingerprint questionnaire, guided by a counselor,” says Kinsella. “Then we match the person with the right clinician right out of the gate for treating insomnia, ADHD, postpartum depression, excessive weight loss, personality disorders.” The Fingerprint establishes the baseline for where the patient begins. They keep responding to the Fingerprint’s evolving questions while in treatment, and their answers help the Rappore clinicians monitor their progress, generate more precise diagnoses, and focus objectives for treatment. The Fingerprint results are demonstrating a 65% success rate for depression, 47% for loneliness, and 43% for insomnia. “Many professionals don’t like churn, they tell patients they should keep coming even after they’ve shown lots of improvement,” says Kinsella. ”We like churn. It shows that people leave Rappore much better than when they entered.”
Still Kinsella’s exercise in mental health entrepreneurship convinces him that to be successful, any model, including Rappore’s, must be both comprehensive and big. “The problem is that psychiatrists have not been able to demonstrate that they are driving outcomes to insurers,” he explains. “The industry needs to show improved outcomes to go get higher rates. Right now, our average therapist receives from commercial insurers around $100 per hour. We need to get that up. We’re in many insurance networks, but I can see why at those rates so many clinicians avoid the networks and take cash. The average private-pay therapist can get double or triple that. And that gap is a major contributor to the current crisis.”
For Kinsella, the goal is deploying the Rappore model, but on a much bigger scale. To get there, he’s looking to roll up other practices, or even merge into a large primary care network. “Getting larger isn’t just about economies of scale, it’s about getting more leverage with insurers to negotiate higher rates,” he declares. “When you have 200 clinicians and can measure outcomes on that scale, at 10 times Rappore’s size, you can go to the insurers and get favorable national contracts. That’s part-and-parcel of the value-based care concept, where insurers pay based on well-documented outcomes.” The holy grail is showing that the prized Mental Health Fingerprint can really deliver the results worth the extra dollars providers need to democratize mental health care. Kinsella, the warrior turned health care reformer, believes he’s got the right model and a metric so powerful that they can impose their fingerprint on the wild, patchwork quilt of mental health care.
