At Two Chairs, our mission is to build a world in which we all have access to exceptional mental healthcare. We’re a brick and mortar based business, but we leverage our in-house engineering team to help our clinical team work effectively and efficiently — that’s how we deliver higher quality care at scale.

When our founder was starting Two Chairs, he often pondered the potential of putting world class clinicians and engineers together in the same room. We live and breathe this vision every day: HQ is a five minute walk from our San Francisco clinics, and we regularly spend time with clinicians discussing product plans, mockups, and sample apps. This co-design process is part of the Two Chairs DNA and means our product + eng teams have a direct impact on the care our clients receive.

Software has been a force multiplier across so many industries, and we are building that same force multiplier for clinicians and clients to transform mental health. As a Product Manager at Two Chairs, I work with our engineering team to build the platforms and tools that power our everyday clinical interactions, ensure we’re measuring and improving quality of care, and help us run a complex business. Below are just a few ways we’re using tech to rebuild the mental health system.

Matching

When a client begins care at Two Chairs, they go through a matching process to find them the best possible clinician. The process collects some data about the client, including demographic and symptom information. We supplement this profile with an in-person, deeper conversation around the client’s needs and wishes for therapy. We maintain similar profiles for our clinicians.

We use these detailed client and clinician profiles to propose several candidate matches for a client. These matches involve comparing over 100 client preferences to our diverse pool of clinicians. We have specially trained clinicians who conduct the matching process, continually iterating between machine-generated suggestions and the clinician’s professional opinion for who can deliver the best care.

We also measure the strength of the alliance between client and clinician — research shows that the therapeutic alliance between a client and their therapist is the best predictor of successful treatment outcome. We use the alliance metric to validate and improve our match suggestions.

Fed by match quality data, our matching process constantly gets better at suggesting the best clinician for a client. At scale, a lot of this learning and adjustment will occur in real time, especially as we discover the best ways to generate matches between client and clinician. With great matches, we can ensure we’re delivering exceptional care at scale.

Utilization

We’re a tech-enabled brick and mortar business with several locations and we directly employ our therapists. To best apply our resources, we help our clinicians ensure that they are seeing a diverse set of clients at an appropriate cadence.

We call this problem utilization: are we able to align everyone’s scheduling incentives well? For example, scheduling too many clients can lead to clinician burnout, and scheduling too few can lead to disengagement.

This problem as similar to how airlines ensure their flights have enough seats filled to break even, while reserving some seats for late purchasers or frequent fliers. However, unlike airplane seats, we have to guarantee ongoing availability for our clients, and manage the inevitable cancellation or reschedule.

In therapy, optimizing utilization is very multi-dimensional. We need to ensure our clinicians are happy and fulfilled and that our system always has capacity for current and prospective clients. Balancing these factors requires intelligent systems that constantly monitor and adjust our utilization, and building great tools that empower our clinicians to proactively manage their panels.

Lots of mental health providers struggle to provide care at scale: we’ve heard stories of 9 month wait times for a clinician, and just ⅓ of in-network clinicians can accept new clients at any given time. That’s why utilization is so important: when we do a good job maintaining and optimizing utilization, we can make sure that new clients to Two Chairs can always be matched to the right clinician for them.

Clinicians as Customers

We believe there’s a huge opportunity to improve quality of care in mental health by building great tools alongside our clinicians. We hear horror stories from our clinicians about how software has gotten in the way before (Atul Gawande’s Why Doctors Hate Their Computers highlights these stories well). We believe great tools can dramatically increase the quality of care, and should augment clinicians — not interrupt or impede them.

A key metric for improving quality of care is administrative time. There are two key levers for reducing admin time: automating processes that needn’t be manual, and providing tools that make clinical decision-making easier and faster.

We are constantly working to better integrate the variety of homegrown and third party software that powers Two Chairs so that every quarter, clinicians have to worry about One Less Thing. This requires building abstractions across a variety of data, and ensuring our tools work in harmony and always display the same picture of the world to our clinicians.

We also work closely with clinicians to create new tools that assist in clinical decision making. This doesn’t mean a fancy AI that crunches millions of data points to help clinicians ask the right question in session — rather, it can be as simple as helping clinicians manage large panels of clients, or facilitating conversations about affordability and insurance. The barriers to quality care are myriad for clients, and we’re dedicated to empowering our clinicians with tools that break these barriers down.

Conclusion

Matching, utilization, and the clinician tooling are just some of the ways we’re rebuilding the mental health system to increase access to exceptional care. We have a lot of work to do so if you’re interested in helping out, email [email protected].

To learn more about product at Two Chairs, read our blog about integrated client experiences.