Speaker 1:
Welcome back to the podcast. We are honored to have Erik Osland today, who's one of the co-founders of EvolvedMD. Erik, welcome to the podcast.
Erik Osland:
Thanks for having me. I'm excited to tell our story, and a little bit about the work that we're doing here in Phoenix.
Speaker 1:
Well, we want to hear the story of Evolve, but let's hear about you first. Tell us a little bit about yourself, and maybe something that we wouldn't find on your bio.
Erik Osland:
Man, I'm an open book, so that's a tough ask. So, this is unique because Phoenician is such a... we're a melting pot in a lot of ways from folks coming throughout the country, and the world. But I was born, and raised here in town. Born in Mesa. Spent the first couple years of my life there, and then moved out to Gilbert where my mother was a elementary school principal. She worked out there for 30 years, and I grew up in a place, and time with Gilbert, where on one side of my house was a dairy, and on the other side was a cotton farm. And so Gilbert was a much different place back then. I can recall when the 60 only went to country club, and maybe that ages me a bit, but I had an awesome experience growing up in the East Valley after I graduated from high school, went down south to Tucson, so got half your viewers that are going to love that, and the other half that aren't, but really blessed to have grown up in the place in time that I did.
I'm very proud of my Arizona roots. I'm very excited to see where this community's gone. And now as a business owner, and a founder, I'm excited to see how I can make an impact personally on the community. So, I know that kind of skirted your question as to something that people don't know, but gosh, I'm a big golf nerd outside of founding EvolvedMD back in 2017. I also founded a non-for-profit golf organization. Today we have 550 members throughout the US, and we raise money for a couple charities, predominantly veteran, and military based charities to support folks coming back from service, and supporting their integration back into the community.
Speaker 1:
Well, and that's a great mission for that nonprofit. What's your favorite course in Phoenix? I mean, maybe you don't want to give this away, but.
Erik Osland:
Yeah. I mean, I love Quintero up in the West Valley. I love Estancia up in North Scottsdale. I play, my home course is at downtown Phoenix, and love the people there. But really, for me, it's not so much as the golf course, but the experience. I love being around people, and seeing how they can host you at their home place, and I just love to have a good time. So, the golf game's not quite as good as it used to be. Work's kind of gotten in the way, but fortunate for me, I've got an 11 year old boy now. His name is March, and he's quite the golfer, so he's beating upon me these days.
Speaker 1:
Excellent. Well, it's always a tough day when dad finally gets beat. I have a 19 year old, and I certainly understand that. So, you mentioned not having a lot of time, and I can understand why as a co-founder of EvolvedMD, tell us how did this all come about? How did you get here?
Erik Osland:
Yeah, so I think for a lot of us in the mental health space, you end up here, because you've had a personal experience. And so, for me, I spent the bulk of my early career in the medical healthcare industry working for some big names, fortune 500 companies. And in 2014, I really found myself in a place, and time where I knew I needed to make the leap. I wanted to go out on my own. And so I started my first venture, which was an anatomical pathology lab. Started here in Phoenix, built a nice little book of business, grew into Nevada, Utah, and then West Texas. And during that phase in my life, I had an experience with my own father that's very similar to many of the listeners, which is my father was aging, he was at the end of his life, he was chronically ill, and he had onset dementia.
And so, as a family, we were spending a lot of time shuffling my dad in between his oncologist, his neurologist, his pulmonologist, and his primary care physician. And at that phase, no one was really focused on coordinating his care. It certainly wasn't integrated. My dad was on 17 medications, and slept about 18 hours a day, and we just had this really in-depth conversation as a family, my sister, my mother around, is dad just a really sick guy, or is he a sick guy that's being compounded by the fact that he is all these meds? And so I was really blessed at the time I had a really talented pharmacist that worked with me. We got really interested in this notion of integrating a model called medication therapy management into primary care offices. So, my dad was the guinea pig. We took him from 17 meds down to two with this notion that my dad had dementia, his mind was leaving we weren't going to really focus on propping up his body when his mind was going, and so-
Speaker 1:
Excuse me. Was there some concern within the family? I mean obviously, you're making this decision, and other people in the family when you did that. Kind of a controversial decision, I'm assuming.
Erik Osland:
Yeah, I mean, I think it's a unique conversation that each family needs to have, and it needs to be thoughtful. And if your loved one, and specifically my dad, if he's capable of being involved, you want to engage them, and kind of understand how they want their care managed. And so I think, for us, from an outsider, it might seem controversial for us, it was the right decision to make. My dad had been ill at that point in time for over five years. And the good news is when we went through this process with my dad, he didn't get any worse. He didn't get any better, but he lived for another three years. For my mother who was the main caregiver, he was easier to manage because he went from 17 meds down to two, they saved $900 a month. And for the most part, again, I think his quality of life, and that's what we were focused on, it didn't diminish, and maybe it didn't get better, but we were really focused on quality of life, not quantity.
Speaker 1:
Which is such an important part of the process that sometimes gets lost, I think.
Erik Osland:
Yeah. And I think at the time, and I'll be honest, we didn't really think a lot about my dad's mental health. We knew it was there. We'd make comments to his primary care physician around him being depressed. But the reality for my dad is when he went to the doctor's office, that was his outing. He was as engaged as he was at any given time. And so it kind of got pushed under the rug. But through that experience with my dad, we ended up going to the Arizona State Physicians Association, I think it was back in 2015, and said, "Hey, we think that there's a big opportunity to focus on medication management, i.e. bringing a pharmacist, clinical pharmacist, into a primary care practice where they would focus on complex chronically ill patients, and do nothing more than manage their medications. So, think about going to your doctor, you've got 12 or 15 minutes with that PCP, and during that time, if you're a complex patient, they don't have time to go through all those medications.
And so the idea is we'd bring a pharmacist in to work with a PCP, and they would do nothing more than focus on the meds. Polypharmacy is a big deal, dosing optimization. Can we take patients, and move them from a name brand med to a generic, all of these things that they have a ton of utility but are complex to pull off [inaudible 00:06:48].
Speaker 1:
...a pharmaceutical quarterback?
Erik Osland:
Yes. Yeah, I mean, that's a really good way to think of it. And so we did just that. We hired another pharmacist, we put them into a primary care location out in the West Valley, and we ran that program for six months. My wife, and I actually did intake. So, we'd sit there in scrubs, we'd bring the patients in, and it's called brown bagging. They'd bring all of their meds in a brown bag, and you would basically dictate all of those meds into the EMR, or the medical record, and prepare that patient to be seen by the pharmacist. And so we ran that project for six months. We managed 400 patients. It was a really cool experience, I think. But we ran into what many entrepreneurs run into, which is we had a difficult time paying for the program. We had a difficult time really scaling the program, and we made the hard decision that we were going to have to put that on the shelf.
But as we were putting that program on the shelf, we started to analyze the data. And one of the things that we had done is we had screened every patient on our panel using an instrument called PHQ9, which screens for depression. And of the 400 patients we managed 80% of them, 80%, screened positive for depression, and none of those patients had ever had a behavioral health resource. And so started to reflect on my time with my dad. I called Steve Biljan, who's now my business partner, and I said, "Hey, there is this huge unmet need of patients with underlying mental health issues. Depression has a higher prevalence rate than diabetes, and I think the market's ready to shift. I think we're really going to start tackling this for the first time as a society. I think we should take a look at this."
And so Steve joined the team in 2016. Very quickly, he identified the model we use today, which is called Psychiatric Collaborative Care, and we went back to the well, and did the exact same thing. Hired a behavioral health therapist. Our first therapist was Sarah Hanchett, she's now our VP of clinical services. And we ran that site for a full year, just making sure that we could give the patients a great experience, we could get good outcomes, and that the model would be financially sustainable. And so that was, gosh, almost six years ago now. And fast forward to today, I think we've got 75 sites spread between Arizona, and Utah, and I've got a lot of growth ahead of us as we expand integrated mental health services.
Speaker 1:
One incredible story, and I think really based on personal experience, I think makes it much more real as well. I guess one question would be is as far as traditional physicians are concerned, obviously, they understand depression. Why is that not part of a diagnosis in a treatment plan? Why do you believe that, that hadn't been happening before?
Erik Osland:
Yeah, I mean, we built a system in healthcare that was siloed. You had physical health, and you had mental health, and there wasn't a lot of interaction between the two groups. In fact, if a patient would go into a primary care office in the past, and they were there for a mental health issue, in a lot of ways the physicians were required to kind of work through the system strategically, because if that depression was the primary diagnosis, the insurance companies would deny that claim. And so we had built a system that was fundamentally not intended to serve both mental, and physical health. And so although the physicians were seeing it historically, there were barriers in place that mitigated their ability to do that. And so what I'm happy to say now is we now understand that that's a bad philosophy. We need to move away from that.
And so you're now seeing both physical, and mental health brought together, and you're seeing that both at the delivery side, the things that we're doing in the clinics each day, but you're seeing the health systems push this forward, the payers push this forward. The federal government CMS just released their final rule for 2024. And a big part of Medicare coverage going forward is these payers, these insurers, have to support access to mental health services. And a big strategy for that is the integration of behavioral health.
Speaker 1:
Well, and you mentioned your partner, clearly entrepreneur, and the medical space, but not a lot of experience, or obviously no specialty, in terms of behavioral health. How did that either help, or hinder you? And it sounds like part of the solution was hiring the right people.
Erik Osland:
Yeah, I mean, we always make the joke when folks come in that the biggest advantage that Steve, and I had when we found it EvolvedMD, is that we didn't have experience in the mental health space. We came from it from individual personal experiences with the system. We had our own frustrations with getting access, and I think we looked at it through the lens of the patient. How can we better address these needs, reduce barriers, reduce stigma, and finally provide better access to high quality affordable services? And so we didn't go out to the market, and say, "All right, who's doing behavioral health really well?" We really looked at it as the old system was broken, we get to just take a different view of this, and we get to build this company like we would want to build as patients. And so we did just that.
I think very quickly as we went into that process, we also identified that there was a secondary issue we had to solve for, which is, yes, we can look at this through the lens of what a patient needs, but we also need to look at this through the lens of the workforce. Traditionally, folks in social services, and behavioral health, they are the most wonderful, caring, compassionate people you'll ever run across. And what does the system do? We bring them in, we give them very little support, we give them massive caseloads with really complex high acuity patients. We burn them out, and they turn over. And so from a very early stage at Evolved, we knew that potentially the main issue was we had to go out, and identify great clinicians. We had to bring them into the organization, focus on developing them both personally, and professionally because they're intertwined.
And if we did that, we would be able to retain good people, and go out, and recruit. And so I think I'm very pleased we've built the reputation in town as being a good place to work in behavioral health. And it's because we knew from a very early stage that the employees were the center of our success. And so we've really focused on that.
Speaker 1:
Well, and I think probably a lot of industries, this is one of the key features. I don't want to come back to that, but you talked about being from Mesa, and Gilbert, and growing up here, and I think you're probably well aware that in terms of rankings nationally, Arizona has a pretty significant rate of mental health issues as well as lack of care. Maybe speak to that a little bit, and how you were able to address that.
Erik Osland:
Yeah, so I believe, and I haven't looked at this year's rankings, but I believe Arizona's 49th out of 50th in the country or somewhere very, very low. The reason for that, it's a multitude of issues. One, as a state, we have underinvested in mental health resources, and that's across the board. That's from workforce development to delivery to all of these things that are really important. So, one, as a state, we need to start investing in a lot. In some ways that's already occurring. Two, we've also built a system that really wasn't servicing the needs of either patients, or employees. And so in some ways, I look at EvolvedMD as being disruptive. We're giving folks, and clinicians, and the workforce a different option. And I think that that option is going to compel others to look at what we're doing, and to duplicate it.
So, I think in some ways how we're changing, or moving the needle is that we're creating a different dynamic for clinicians, and it's forcing other employers in the state to recognize it, and move on. But broader than that, I think what I'm most excited about is the way that we move the needle is we look at our job as being one, we need to expand access to mental health services. We need to do that in a care setting that patients are comfortable in already, which is primary care. And then we need to break down the barriers of cost, which is mental health right now, if you can get it can tend to be very expensive. It can be out of pocket. Well, guess what? If we integrate it inside primary care, patients can typically access it very easily. We reduce all of the barriers around stigma, because they're going to a care setting that they're comfortable in.
And guess what? It's also a very low cost alternative. Patients will typically pay the same out of pocket for our services in the mental health space as they would to see their PCP. And so how are we moving the needle? I think that our job is to expand access to high quality, affordable mental health services in care settings where the patients are comfortable, which is primary care. And I think if you look at the metrics on it, every full-time equivalent we place, it's a behavioralist inside of a primary care setting.
It expands care to roughly 10,000 patients in our community, right? Because each PCP office that we serve is that's roughly their patient panel size. And so if you look at where we've come over the last couple of years, we've gone from one site to almost 50 here in town that will most likely double, or triple over the next three years. And so you're starting to look at our impact in the community, and it's expanding to a lot of patients that, one, typically wouldn't have access to it. And two, now that they do have access, this is going to be their first interaction with behavioral health, and we want it to be a high quality one.
Speaker 1:
Well, it's interesting the model that you're talked about, or that you've developed, this idea that you embedded into our primary care physician sites, and looking back, hindsight's always 2020 like, oh, of course that makes complete sense. But it was something that hadn't been done, and it makes that revolutionary. When we're talking about business, and obviously this is a podcast that focuses on the business community. What's the business case for mental healthcare?
Erik Osland:
Yeah, I mean, fortunately, it's simple. Today in the United States, and I believe the National Institute of Mental Health has a good statistic on this, but the number one cause of absenteeism in the US today is depression. And when you think about depression, and its impact on your employees, it's not just about that patient taking a day off, because they're having a mental health day or they don't feel well, but it's how they view themselves in the world. It's how they view themselves, and the control over their job. It's about their ability for that patient to be in a good position to put out a good work product. And so I think the math is something like 200 billion plus a year as the financial impact, or the strain caused by underlying mental health issues. And so as an employer, I think if you simplify this down, it's like I have a employee with cancer, that employee shows up, and what do we do as an employee?
We try to wrap our arms around that employee. We try to give them the supports that we can, their coworkers come, and they provide support, but when this happens from a mental health perspective, it's taboo. We don't talk about it. We don't wrap our arms around it. And so I just think that as we've moved forward with this conversation around mental health, we need to destigmatize it not only for the patient or the employee that's impacted, but for the employer as well. And I know that we have to be very cautious about how we do that with our employees. But I think encouraging them to have good habits around self-care, encouraging them to do the things that are important for their mental health, like eating well, exercising, being able to create good boundaries around work, and then beyond that, when a patient is, or when a patient, or an employee is in need, give them the tools they need to go out, and garner those resources in the community, whether that's through an integrated site, like an EvolvedMD practice, whether that's through an EAP.
And we've got a lot of improvements to be done on the EAP side, [inaudible 00:18:00] that's for traditional services in the community. And so I think, as an employer, we play a role in all of that. We've got to create the groundwork so that we support people when they're in need. We encourage them to have good habits, and then when they need supports, they can get them. I mean, we are paying for them right now as part of our benefits package. Dang it, our employees better have access to them. I think that's part of what we need to push as leaders.
Speaker 1:
Well, it sounds like part of the solution, then, is having a workplace culture that talks about these things, and that recognizes that there's a holistic side to this that includes things like you talked about self-care, exercise, eating right, and when there is a challenge talking about it.
Erik Osland:
Yeah, I mean, they're not sophisticated, and there's plenty of tools out there to encourage these things. If you're not having a conversation with your employees today about their mental health, again, reach out to us. We can help provide supports. But the reality of it is, I think 41% of US adults over the last 12 months have had some adverse mental health symptom. That could mean that it was just a one off. It was acute, or it could be something that's more ongoing, but it's impacting folks in your office today. So, let's start to address it, because it'll lead to healthier employees that are more productive, and that are happier with their workplace.
Speaker 1:
Well, I want to delve into this a little bit since there's clearly a business case. What are some of the misconceptions about people with mental health type of issues? And then how do we start to change the dynamics in terms of the stigma that you referenced?
Erik Osland:
I think in this area, we've made some good progress over the last couple years. I think COVID blew the doors off of how we view mental health, because it forced us all to look on words. I mean, I think one, if you haven't experienced some anxiety, or some feelings over the last couple years, I'll speak for myself, I have. This has been a challenging few years as a business leader, as a husband, as a father. I mean, there are anxieties in life. We all feel them. And if you haven't had them personally, you certainly have friends, or family members that have. And so the reality is, is that your life at work, and the people you interact with are no different than yourself, or folks in your family. And so I think how do we start to knock down these barriers?
It's just having some open dialogue. It doesn't need to be targeted. As a leader, certainly, if you can be open, and talk about your experience, I think that helps to facilitate it. I mean, here at Evolved, we all talk about how we feel. We do personal, and professional check-ins every week with our direct reports, but it doesn't have to be that targeted. It could be more of like, "Hey, we have these resources. Let's encourage you to use them. Here's these tools. Here's how these things can feel. And then here's some ways that we can adapt to address those." So, skill building is another way we can go about it. So, if you don't want to take it head on, and you want to ease your way in, maybe focus on skill building, and the way that we, what do we drink? What do we eat, and how does that impact our overall mental health?
Speaker 1:
Sure. And then you think that that'll helps on the stigma side? I mean people are reluctant to talk about it. And to your point, we, and our family also had a family member that struggled. It was hard, and there is a stigma associated with it. Is this part of the process of making that go away, and the idea that we're talking about it?
Erik Osland:
Yeah, again, I think going back to the analogy of cancer, could you imagine if we had a stigmatic approach to cancer? I just don't think that would be healthy. And so to me, I can't remember what gen we're on now, is Gen Z the most recent?
Speaker 1:
I think so.
Erik Osland:
I'll give them a lot of cred. I mean, this is the first generation that's actively talking around their mental health, and starting to do the things that are important. And so let them take the lead, let them talk about it, because that generation is comfortable talking about it. And then for those folks that aren't quite there yet, create mechanisms where they can get resources either within the community, whether that's within HR, if we've got a confidential situation we can go to, whether it's EAP. And again, I would really impress upon employers that it's not good enough anymore to say, "I've got an insurance package, and it has a behavioral health element." Because guess what? When you start to look at utilization, it is really difficult for your employees to get access to care. And we have to start pushing back on the insurers to say, "Look, this is necessary. It's important", when an employee of mine needs a resource, they either need to get comprehensive services from an EAP, or the payer needs to step in, and provide a conduit to that service.
And it's not enough just to say, "Here's a list." Because guess what? When you've got a mental health issue, you typically are depressed, or you lack motivation. And I might try to reach out to a couple groups on that list, but it's so hard to get through to a live body in a lot of cases that these folks need more supports. And so that has to come from the employers. It has to come from the insurers. And not to beat up on the insurers a lot, because we've got a lot of great partners, but they all understand that they play a much bigger role in facilitating, and coordinating in these cares. And so pushback, you're paying for it now, let's make sure our employees can get access to it.
Speaker 1:
Well, it's not as black, and white as it might seem. And certainly when you looking to insurance, and the payer side of it, it's just a very complicated system that probably if we were to design it today, we wouldn't do it the same way. You mentioned Gen Z, a lot of reports out there about kids, COVID crisis, and the impact. Are you seeing that? Is that really a significant issue that we're hearing about?
Erik Osland:
Yeah, I mean the data right now is one in four, and I call them kids, because they're young, but one in four kids between the age of 18, and 24 have thought about harming themselves in the last month. That's an alarming statistic. If you look at suicidality, and self-harm, and all of the things related to that age bracket, it's really concerning. And I have a daughter who's 13, I have a son that's 11. We're starting to head into these things. And so as a parent, talk to your kids about it. And if you've got a workforce in that category, let's make sure we provide them supports, because they need these things. Those kids, they're willing to talk about it. But it's a real issue. I think a lot of it stems from the fact that we went through a couple of years where we just decided to disconnect from one another.
During COVID, we decided to go to a virtual only format. And I think what we missed in that is the younger workforce especially, they spent the last couple years of their college experience doing virtual classes. They then entered the workforce, and we put them into virtual roles. They didn't have the opportunity that we all had to go out, build relationships, learn from our coworkers that were older, that had different experiences. And so what I would say is outside of providing resources, start pulling these folks back together as a community, intermingle your tenured workforce with your younger workforce. That is the biggest benefit we can give them from a professional development perspective.
And guess what? It properly also helps from their mental health perspective. They want to be in, and around other people. And so, I know this opinion's not shared by all of my peers, but virtual work as a standalone to me doesn't work for all employees, which means that we've got to rethink this. It especially doesn't work for the younger folks who want that experience, who want that interactivity. And on top of that, I think it brings this community back where we can support one another.
Speaker 1:
Is it going to be interesting to watch how the sort of virtual option, hybrid option evolves over the next 24 months. And to your point, I think the assumption that people just want to stay home is maybe not necessarily where people necessarily want to be. And so how does that going to look in 24 Months?it'll interesting. It'll be telling. And it is true, when you have people together, things happen, and they're excited to see each other, and you have a different dynamic. Well for us to think about. I think one of the things that we hear a lot about is the practical side of this.
And I mentioned the family member. When I had to try, and find care, you need to go to, it was my mom. She had a bad knee, easy, all day long, no problem that when it came to mental healthcare, it was really hard. It was getting the internet, and going back to dial up, and trying to find things that didn't really work. So, I'm looking today for myself, or a family member. I'm out there. How do I access care under your model? How does it work?
Erik Osland:
Yeah, so if you think of what we do, so EvolvedMD is a behavioral health group that is solely focused on one thing, which is the integration of behavioral health services in primary care. And so we don't have any of our own clinics, but everybody on our team is a W2 employee of ours. And we work with standalone clinics to place our therapists, our counselors, our social workers, and our psychiatric consultants within a primary care practice. So, a great example here in metro Phoenix is Honor Health Medical Group. They have 27 primary care locations spread across Metro Phoenix. All 27 of those are now integrated with a therapist on site at least a couple of days a week. You go there, you see your primary care provider. If they identify that there's an underlying mental health need, they will say, "Hey, we've got Lana down the hall. We'd love for you to go meet with her. She can provide resources here on site."
And so for us, we are growing. I can't talk about it now, but there's two other large health systems that we're beginning to work on. And I would say within the next two years, we're going to have about 50% of the large primary care groups here in Arizona integrated. And if we haven't integrated them, a lot of these other groups are working on their own behalf. And so as a consumer, what I would say is start to have expectations of your primary care physician. And the example I'll give you is five years ago I refused to go to my primary care doc anymore if they couldn't do a blood draw on site, that was a convenience thing for me. It allowed me to do the blood work that I needed to do in a convenient factor.
Behavioral health is now the new blood work. When you go to your PCP, you should expect that if you have a mental health issue, that they can address it there on site. The mechanisms are in place. Here in Arizona, we have over 250 million that's available to primary care practices over the next five years to help support integration. And that's on top of 300 million that came in five years ago. As Arizonans, we should have huge expectations for our primary care groups because the funding is there, the infrastructure is there, we need to do it now. And so that's what I would say is, as a consumer, if your PCP doesn't have it, tell them that they need to help you find it. It's not enough to give you a list of referrals, because that doesn't work.
Speaker 1:
Well, let me get a little personal here. You mentioned the idea that this should be in every PCPs office, and that this kind of treatment is important. I've heard you've said, look, leaders, business leaders should have a career coach, and a life coach, and a therapist. Where are you on this? Where do you fall on this, and how do you talk to your team about this?
Erik Osland:
Yeah, I mean, obviously, we're in a different space, so this is part of the deal, and you have to talk about it, and what you do. And so I think for me, when this is, gosh, seven, eight years ago, I had my first experience ever. This was before EvolvedMD with a therapist. My daughter went through a pretty significant health scare, and my wife, and I went to a therapist to talk about it to make sure we had a good game plan, and that we were thinking about things correctly. And that was my first experience. And after we went through that phase in our life, I kind of graduated out, and I hadn't gone to therapy for a long time, and my team was encouraging me to do it. And I was one of those folks where I was like, I'm in a good head space.
I do have some ups, and some downs, but they're pretty level. What am I really going to sort out? There's no big thing for me. And my team pushed me, and then I went. And I found the experience really beneficial to me. It allowed me to view the things that were going on in my life, maybe from a third person. So, I was looking at it objectively. And for me, therapy is not something that I go to every week, or every month. I go in phases. So, it's about skill building for me, and thinking about how I manage my mental health in a different way. And so I'll go for six months, I'll feel like I'm in a good spot, and then I'll take six months, or four months off, and then I feel like I need a brush up, and I'll go back. And so to me, therapy is something that's ongoing that'll continue to be part of my life, but I look at it really as skill building, and working through really complex dynamics as it relates to my overall health, and my wellbeing.
Now, in addition to that, I've also got an exceptional coach. I don't know if I can say his name but I'll throw it out there. But Andy Shirk, he's the CEO of a large group here in town called ESI. And I've known Andy for a long time. And a couple years ago I approached Andy, and I said, "Hey, I'm going through a spot in my career where I've got a lot of development to do, and I need to surround myself with folks that have either gone through this, or can help support me." And so Andy, and I created a cadence. We get together once a month, we usually have happy hour, and we just talk about the things that are going on in our individual businesses.
And I learn a lot from him. He probably learns a couple things from me, but I think it's another way, it's almost like a soft therapy. You got two leaders coming together, having conversations about what they do. And in some ways being a leader of an organization can be a lonely place. And so whether you have a partner, or a co-founder, or a business coach, these are all ways for us to just get it out there, and talk through it, and reconcile, and make sure that we're in a good head space.
Speaker 1:
No, absolutely. It can be lonely, and sometimes it's really just validating what you're thinking before you take that step. But I think you're being modest in terms of the success of this company, and the way you're doing it. And of course the social benefit is incredible, but there's also an economic benefit. I would want to make sure I get this right. But you appeared in Inc 500's fastest growing private companies for the first time recently. Talk a little bit about that. That's a big deal for you, for Arizona as well.
Erik Osland:
Yeah, we are really proud of the work that we've done. We think that we're a very cool story in Arizona. And outside of the fact that we're making an economic impact, we think that we're making a really strong social impact as well. I see this, and I know Steve feels the same way as the rest of our leadership team. Like this is a legacy builder thing for us because if we are successful in growing this business, it is going to have a massive impact on our community. And to us, that's what we're looking for. Beyond that, I think from a national perspective, we've gained a lot of attention for what we're doing. In a time, and place where everybody a year ago wanted to be the hottest, latest technology intervention. We were actually doing the exact opposite. We were saying, "No, the best behavioral health care isn't a widget, or a virtual person or some sort of chatbot."
It was a human being sitting in front of a human being talking about their lives. And although that wasn't popular at the time, we really felt like that was what was going to allow us to be sticky, and allow us to have sustainable relationships with our customers. And fast forward to today, guess what? We are unique. We didn't go down that path. We were [inaudible 00:33:18] to it. Now the market looks at us as the most comprehensive provider. We don't lose customers because they understand the value we deliver, and we're growing. And I think when we look at growth, too, we look at it a little bit differently than we did a couple years ago. This is about high quality growth, both in the customers we work with. We want to make sure they're aligned with our philosophy, and our level of quality. And two, growth can can be good, and bad.
I mean, we're looking at high quality, high margin growth where we can generate revenue that we can dump back in. I mean, it's no secret to anybody we've been raising money over the last year, and we've been very successful in a tight capital market in that. But we also really focus on dilution, both for Steve, and I, and our employees. We've given a portion of the company back to our employees, and they are stakeholders, and our shareholders. And so the less money we can raise by having high quality growth, the less we have to dilute, and we basically have more value creation.
Speaker 1:
Well, and for those listening, take your model, and use that in your industry, for instance, those of you listening, it's high quality revenue, a high quality growth, it's taking care of your people. It's being mission focused, not looking at who's coming up behind you, but just staying true with your North star in it. That really is a tremendous recipe for success.
Erik Osland:
Yeah, and I think at the end of the day, we are a service provider. We have to provide services in order to make money, but we actually look at it as a, no, our main stakeholder, our main customer is our employee. We've got to be able to go out, and find great people, and keep them. We have to cultivate a great experience, and we have to make sure that they're as healthy, and happy as we can make them. And if we do that, then the product probably takes care of itself. There's certainly some guardrails, and some parameters, but I don't want to say that we're not focused on the patient care elements, because we are, it's what we do, but we're more focused on the experience for our employees because if they're not in a good spot, it's really difficult to provide high level of mental health services.
Speaker 1:
So, as we wrap up, looking at your history, you're clearly an entrepreneur. You are able to see things in the future that people don't necessarily see today. And you capitalize on that. Everyone's talking about AI today, and clearly AI not where it needs to be, but 10 years down the road, will AI have a place in mental healthcare?
Erik Osland:
Oh [inaudible 00:35:44]
Speaker 1:
We're going to come back in 10 years, and check on your answer here, but what do you think? Is there a possibility? Is there something there?
Erik Osland:
Man, I'm going to hate what I'm going to say in 10 years, because I'm probably going to be totally wrong, and I actually hope that I'm right. But we got to take a pause as a society, and look at how technology... How we interact with technology, especially with these massive advances in AI. Let's take a step back, and look at the last 10 years, and how social media has impacted our mental health, and the mental health of our kids. And this is something that we really have to reconcile. It is not good for adolescent kids to be on these systems interacting in the way that we're doing. And so using that as a starting point, we thought technology was the solution. And guess what? It's been part of the problem. And before we race to say AI is part of the solution, maybe we pause, and say like, "All right, what are the ethical boundaries of technology? Where do they fit into our lives, and where is there a hard no-go situation?"
My problem with AI right now is it's the wild west. You can Google chatGPT mental health, and you'll find plenty of folks that are advocating that a chatbot can talk to a human being. And I don't think that there is any ethical, or professional guidance that, that should occur. And so do I think AI has some potential? Yes, mainly in non-human interactions. I don't think we should be building systems to pull out an emotional response from people. I think that's dangerous. That's where social media got us into a spot. And so I think we have to be very careful. I think AI can be great for things like intake, things that are rudimentary, and non-emotional. And I think that as we start to go into these kind of non-traditional interactions between humans, and machines, I think it's a very scary dynamic. And so as a parent, I'm concerned, I'd like to see someone step in, and say, "Here are the guardrails." Because right now it seems like the technologists are really dictating where this thing goes, and what's happened over the last 10 years gives me a little bit of pause.
Speaker 1:
It is interesting, and I think you bring up a lot of interesting points, and certainly some ethical questions, and we'll certainly want to come back, and look what happens with this. Before we finally wrap up, we're going to do a quick lightning round.
Erik Osland:
Okay.
Speaker 1:
First job.
Erik Osland:
I was a cart kid at Smitty's back in Mesa. If anybody knows where Smitty's is at, I was pushing carts the summer of my 15th year.
Speaker 1:
And what'd you learn?
Erik Osland:
That that's a really tough job, and that I need to work even harder so that I don't have to do that for the rest of my life.
Speaker 1:
When you see a cart kid out there, you give them a lot of respect when they're out that long?
Erik Osland:
I push my cart back to the cart area.
Speaker 1:
There you go.
Erik Osland:
It's one of my biggest pet peeves is people that leave their carts in the middle of the...
Speaker 1:
And I was going to ask you pet peeves. We're going to have to skip that one. All right. So, now clearly you love your job, you love your work, but we're going to go outside of that, and ask you dream job.
Erik Osland:
I think this is it. This is the last job that I want from a professional perspective. Doesn't mean that I won't do anything when this period of my life is over, but I think for me, this is checking all the boxes. It allows me to do something in my community that's bigger than me. It allows me to help the folks that work here to get to a spot, and time in their professional career. And ultimately, it should allow me to have the financial freedom, and confidence that I need for my family. And so this is my dream job, and I want it to be my last job in my professional career.
Speaker 1:
Excellent. And since we know you're pet peeve, and I agree with you a 100% along with people who park in handicap spots that...
Erik Osland:
And littering.
Speaker 1:
...shouldn't be there.
Erik Osland:
That's number three. I got three rules. Never park in handicap spots, don't litter, and make sure you push your carts back to the cart zone.
Speaker 1:
Those are... And make you a better person.
Erik Osland:
They do.
Speaker 1:
And then you're obviously well traveled. Favorite place to travel?
Erik Osland:
We mentioned this. Took my family to Columbia a few years ago. Love, love, love Columbia. The food, the people, just the whole environment. Big, big fan. So, I can't wait to get back.
Speaker 1:
Excellent. As a dual citizen, I love that, and appreciate it, and appreciate you spending so much time with us, and more importantly for the incredible work you're doing in Arizona, and nationally.
Erik Osland:
Awesome. Thank you for having me. Appreciate it.
Speaker 1:
Thank you.
Erik Osland:
Bye.