A Data-Driven Approach to Treatment Resistant Mental Health Conditions - Jimmy Qian, Co-Founder and President of Osmind

Shiv Gaglani: Hi, I'm Shiv Gaglani Today on Raise the Line, we're going to introduce you to a relatively new company in the digital health space focused on treatment-resistant mental health patients, which constitute about 30% of people in the US with a mental health diagnosis. My guest is Jimmy Qian, co-founder and president of Osmind, a public benefit corporation whose software product does three important things: it helps providers chart the care they are delivering; it gives patients the opportunity to provide real-time information on how they're doing between visits; and it creates a data set that can be mined to develop new interventions. 

Jimmy has founded, led, or scaled multiple non-profit organizations spanning life sciences, research, community healthcare and health tech. He's also a published researcher in digital health, mental health and health policy. And I should note that we have two interesting things in common: he's also been named to theForbes 30 Under 30 List; and he took a leave from medical school at Stanford to start the company. 

So, Jimmy, it's great to have you on. Thanks for taking the time.

Jimmy Qian: Thanks for having me on.

Shiv: You know, I think we got connected because of another MD-turned-entrepreneur, or medical student at least, John Wang, who's a great guy and has a really interesting company, but for those who don't know you or Osmind, maybe you can walk us through your background. What got you interested first in science and medicine, and then ultimately mental health?

Jimmy: Yeah, so I'll start with what got me interested in science and medicine is I got very lucky and fell into this space. So when I was growing up, I would see my mom working really hard. She worked in technology as a software engineer, sat in front of a computer all day and so as a little kid, I told her, “I don't want to be like you, sitting in front of a computer all day,” so I randomly chose medicine as a path that would help me not do that. Ironically, of course, these days, physicians tend to sit in front of a computer all day and look at their EHR more than looking at patients. So basically I lucked into healthcare life sciences, but over the years, as I took a bunch of classes and really just went on this pre-medical path, I realized I made a very good decision. I truly fell in love with the space and being able to just have a large impact and help the world. 

But through high school and college, I saw a lot of difficulties around mental health for a lot of people that were around me and I realized that this was a big crisis that we had in the world and in the United States as well. I became very passionate about the space, and so that's how eventually the idea of Osmind came to be.

Shiv: Awesome. So yeah, let's walk through maybe the actual founding story of Osmind. How did it come together? And then what are some of the things you guys are focused on right now?

Jimmy: Yeah, so I was in medical school at Stanford and that's where I met my co-founder, Lucia. She was an MBA student and we were taking a class together that was cross-listed in the medical school and the business school. It was on health IT and strategy, taught by an MBA professor, Kevin Shulman, and so we randomly met and paired up in a group project and through that just became friends. 

Then after the course, we realized we were both very passionate about mental health and we really wanted to make a dent in the crisis. But when we looked at what solutions existed, there was something we kept going back to, which was that there are a number of people who are not being helped by existing solutions. There are obviously a lot of problems around reimbursement and parity when it comes to insurance. Obviously a lot of issues around access to care both domestically and globally. But for us, we decided to focus on another problem, which was that there are people who have access to care who just do not get better with existing treatments and these are the people who have very refractory conditions,

very severe treatment resistance, and so we realized that part of the problem is we just don't really know how mental health works. We don't have enough of an understanding of the neuroscience behind it. 

But when I talked to a number of faculty members in the med school, they all said the same thing, which was, this is changing. We have so many new technologies coming out and specifically people were very excited about psychedelics and we realized, well, the only way for all of these innovations to reach patients is if number one, we have technology that makes it easy to provide these innovative treatments, but also number two, it's really a data problem. We can't understand the biology of neuropsychiatry unless we get more and more multimodal data and work together as a scientific community to really understand how mental health even works. And that requires rethinking diagnosis and treatments from the ground up using data.

Shiv: Yeah, no, definitely and we've had folks like Arif Nathoo, who's the CEO and founder of Komodo Health on the podcast, so definitely understand the importance of high-quality data when it comes to diagnosis and treatment. One thing that's gotten me excited about Osmind is you're at this intersection of this burgeoning space of psychedelic assisted therapy with ketamine clinics and other really promising therapies that we've been focused on for people who have treatment resistant mental health challenges. 

Our audience, as you know, is primarily current or future healthcare professionals. Maybe walk us through the actual traction and use cases of Osmind so far because I know you had some exciting results that you published leading up to that psychedelic science conference in Denver, around suicide, as well as kind of the size and scope of the company and where you guys are at.

Jimmy: Yeah, sure. So we started in 2020 since then, we've raised around sixty million from venture capitalists, and our team is around sixty-five or so people. But in terms of our product, we're in hundreds of clinics in forty-eight states, growing very quickly.  The product itself is a one-stop shop for everything a mental health clinician needs to run their community practice. It's really anchored by the electronic health record, but also includes practice management, advanced analytics, patient engagement, clinician community. I would say the thing for us to really focus on is the fact that we really are tailored to the clinical workflow. So we work with a lot of clinicians who are treating these difficult to treat patients. This could be using ketamine infusions, it could be using TMS, (transcranial magnetic stimulation), it could be using traditional medication management, and for us, it's how do we make the software really tailored to that specific workflow? If you need to log something, if you need to go through a particular protocol, how is it on your screen with as many data fields pre-filled as possible, so that you don't even need to think, you can breeze through it, focus on the patient, and by the way, the compliance side, anything administrative is ideally automated as well. 

I think secondly, really focusing on measurement. For a lot of these patients, how do we know if they're getting better? If it's a serial treatment, like let's say ketamine infusions, the induction protocol is, let's say four to eight infusions over a two-to-four-week period. How do we know if it's working? How do we know when they need to come back after that? And how do we follow up at the right time to prevent relapse, instead of responding after relapse already exists? The only way to do that is to actually collect outcomes over time and be able to flag leading indicators that someone might need to come back in for treatment, so that's what we've really focused on. 

And just because you alluded to it, we try to do good with the data that we collect through the product. This is really one of the tenets for our company, which is there's a lot of work we all need to do together because mental health is such a big problem. If we can use the data for good, which means that no one suffers in vain, that would be a win for everyone. So our approach to do that is to work with academics and scientists to publish analyses based on the data that we collect to hopefully help move the needle, whether it's a scientific understanding of these conditions or just talking to payers to try to get better reimbursement for everyone.

Shiv: Yeah, absolutely and I know there's that Stanford study you guys published. It was the largest ever real-world analysis of ketamine as a treatment of depression. For our audience, do you mind just going through any of the results you can share related to that?

Jimmy: Sure, so we've published two papers with colleagues at Stanford. The first one in 2022, as you mentioned, at the time it was the largest real-world analysis of ketamine outcomes. I think just to focus on the real-world part because clinical trials and RCTs have shown that ketamine is very effective for acute mental health conditions but the protocols that are followed in these clinical trials are very different from what happens in the community and I think because of a very unique regulatory landscape, ketamine clinics do have quite a bit of freedom to treat patients the way that they deem fit, right? So for us, it's how do we actually look at what's happening in the real world and whether or not patients are getting better. 

So in our first paper in 2022, we analyzed a core sample of around 537 patients. We saw a 54% response rate in depression, 29% remission rate, and very excitingly for us, it was 80% sustained response at four weeks, 60% sustained response at eight weeks, even without maintenance infusions. So after the induction at four weeks, 80% of people still have responded. I think that was one of the things that I'm personally most excited about because you don't get that information from clinical trials. And I think one of the big concerns

around ketamine infusions is, do people need to be on this forever? I think our data shows some promise that, well, maybe we can space out a little more. Maybe we can start to understand that you don't have to go in every week for infusions going forward.

Shiv: Yeah, that's absolutely important. And I love how you guys are treating the data. I know there are phase four clinical trials, which is once it's in the real world, is it effective? Are there side effects that pop up? But obviously with the data you guys are collecting in a very exciting space, I think you'll be able to do things hopefully faster than or with more data than maybe pharma companies have been able to do so far. 

One theme that's been coming up in these conversations we've been having with folks like Manish Agarwal who runs Sunstone Therapies -- which does a lot of clinical trials for psilocybin and MDMA, but also is looking at ketamine because that's already been approved -- is the fact that maybe the ketamine clinics are a harbinger for how the delivery of regulated substances like psilocybin or MDMA could work because they are both expected to be FDA approved in the next two to three years. 

Do you want to comment at all about maybe those modalities and if you guys are building kind of those workflows into Osmind?

Jimmy: Yeah, I think maybe it's more of an analogy with Spravato, which is nasal esketamine. It's FDA approved and it's a drug by Janssen because ketamine is used off-label

for mental health treatment so it is not subject to the same controls and compliance workflows that Spravato is. Spravato has a risk evaluation and mitigation strategy, REMS, that's required after the FDA approval. That just means extra reporting for clinicians every single time they give treatment. It's also subject to a number of difficult insurance barriers such as prior authorization and this just only adds burden to patients and clinicians, and sometimes patients don't even get treatment when they need it.  There are very serious adverse ramifications for a lot of patients who are suffering very acutely so we try to help with that as much as we can and part of what we do is to automate the REMS reporting for clinicians. 

Traditionally, every time a clinician gave Spravato treatment, they'd have to do whatever they need in their EHR and then document again so that REMS is taken care of. There's no reason anyone should have to double document. That just makes it harder for clinicians. And so all we've done is to say, well, we'll just automate the second reporting for you. You only need to lock things once and you're done. 

I think we're taking that same approach for everything, whether it comes to prior authorizations, whether it comes to registering the patient into the registry that's required for these treatments to be provided. I would say everything that's gone on with the real-world launch of Spravato will likely apply for MDMA therapy and psilocybin and all the psychedelics that are in the pipeline that we're both very excited about. These will all be subject to REMS from the FDA. I think the barrier on the insurance side is going to be very challenging because like is United going to come out tomorrow and say, well, we're actually going to reimburse psilocybin? I would imagine they're going to throw a lot of difficult challenges to clinicians and patients before anyone gets reimbursed for that.

Shiv: Yeah, and that's why what we've been seeing is it's more cash-based practice like in Oregon. There's psilocybin clinics, but it's mostly cash-based, or it's pharma-sponsored clinical trial type work -- that’s at least what I've been seeing. I don't know what solutions there are that you're seeing around this for scaling out these kinds of therapies to make it more equitable, because right now, again, a lot of these trials or these studies really are not that equitable because of how much they cost and kind of the people who are most likely to be enrolled in those trials.

Jimmy: Yeah, I'm curious for your take, just because you brought up Oregon, on the whole medical approach versus the decriminalization and how the whole field moves forward to just help people. That's the end goal. Everyone believes in the same end goal, but they're different approaches. Do you have any thoughts on that?

Shiv: Yeah, I think obviously what I've been hearing from talking to folks like Rick Doblin at MAPS and Manish and a bunch of other folks is the cost curve has to go down to make it equitable, to bring it to the masses and there's various ways of doing that. The medicines themselves aren't that expensive to manufacture, and many of them are generics. At this point, they've been around for a long time, but it's really the wraparounds. You need two therapists per session and multiple sessions, so that's very expensive human capital. The question is, how do we train people at scale? And that's obviously something Osmosis thinks a lot about. Can we start incorporating automation in certain things? 

I'm very excited about AI. We'll talk about that a bit. Maybe instead of two therapists,

maybe one therapist with an AI coach listening in and offering guidance and advice. And then the funding is gonna be a major issue. I mean, one innovative approach is group sessions I've been hearing about, right? So it isn't necessarily one patient at a time, but you can get maybe five or ten patients into the same kind of therapeutic environment and maybe scale it out that way. But no, you're right. I think it's gonna be a long while and one of the main themes from Psychedelic Science was how there's significant hurdles to scale it out and make it equitable and improve the access to care.

Jimmy: Yeah, I totally agree. I think we continue to see a lot of the clinics we serve, they face so many barriers to just do what they want, which is to help patients and so many administrative hurdles and compliance hurdles and I think scaling these really promising breakthrough treatments into the real world is tough. If we can all do a little bit to just make it a little easier for the end users, the practitioners and the patients, that's all we can hope to do.

Shiv: Totally, totally. And that's why I'm excited about the work you guys do at Osmind. So I was gonna ask you, just curious, I love the name Osmind, it reminds me of Osmosis. What is the name? Where did it come from? I’d love the origin story of that.

Jimmy: Yeah, so I love this question. The credit goes to Lucia for coming up with the name Osmind. There are two reasons. Number one, it was named after Humphrey Osmond, who was a leading psychedelics researcher. He was a psychiatrist, did a lot of work on alcohol use disorder and how psychedelics could help with that. He was the original inspiration for the name Osmind, but also the spelling of Osmind is O-S-mind and it's really “operating system for the mind.” We like the idea of an operating system, a one-stop shop software, as well as a surrounding platform that just makes it possible for us to help people and help improve the health of the mind.

Shiv: That's awesome, I love that. And yeah, I think Osmond, if my history is correct, he helped coin the term psychedelic, right, manifestation of the psyche, I think in a letter to Hoffman or something like that? There's some history around that, which is kind of cool.

Jimmy: Was it a letter to Huxley?

Shiv: Maybe it was Huxley, yeah. One guy we had on the podcast, two actually, we had Jim Fadiman, who's the father of microdosing, and Bill Richards, and both these guys are amazing. They're probably in their seventies, maybe even eighties and they knew people like Timothy Leary and that whole first cohort of people who were pushing psychedelic therapy. Unfortunately, a bit too much, and that led to some of the backlash that we saw. 

Going back to the AI question, although I don't know if Osmind was doing anything in AI.

We had a previous conversation where we talked about the cool stuff Carbon Health was doing with AI in terms of automating clinical workflows and documentation. We had Erin Bali on the podcast I think now a year or two ago, the CEO of Carbon Health. Can you just comment on anything Osmind is thinking about with AI, or more generally, because you're a med student, entrepreneur in tech, things that you're excited about with AI?

Jimmy: For us, we're really focused on how AI can automate workflows for clinicians. I think that's just the theme we keep going back to. Clinicians are so busy, whether it's AI or not, anything that would allow us to just do things automatically, handle the administrative things

they don't really care about, even some of the clinical workflows, we're always interested in that. And I think charting is obviously something we think a lot about because we're an EHR company, and everyone complains about how long it takes to chart. So there's obviously a lot of potential for large language models to automate parts of that, so we're looking into all of these, 

I think, especially for mental health treatment, we need to be very careful. Obviously, there are privacy concerns and making sure data stays safe, and there's no data leakage to any of the AI solutions out there, but also accuracy and we need to ensure if there are clinical notes, they don't just have clinical ramifications, but also legal, medical-legal compliance related concerns that anything that's put there is subject to very high degrees of accuracy. So, we're being very careful around that as well.

Shiv: Yeah, no, you've nailed a lot of the issues that we're hearing from folks like Adam Rodman, who we had on the podcast, or soon enough, we'll have a faculty member at Stanford, Neha Mishra, who you may know who has been pretty active in pushing the frontiers of AI in healthcare specifically.

I know our audience would be interested in your journey as a med student turned entrepreneur. I talked to a lot of students, and I know you do as well, people who maybe don't want to go to med school because they want to start something, or they're in med school, they take time off like you and I have done, or they're graduates and they're actual physicians practicing who want to do this.

How are you thinking about that whole journey? Was it hard leaving med school to focus on Osmind and do you want to go back and finish? And if so, can you predict what type of residency you'd be interested in, if any?

Jimmy: Yeah, this is a very interesting topic. I know that Shiv, you also have a lot of thoughts about the medical education system. So just briefly, for me personally, it was definitely hard to leave, but I was so excited about the unique opportunity to build something to just help people. I think the timing was very particular because Osmind is a COVID baby, and also I think the confluence of technologies coming out around mental health and neuroscience. So I just thought, look, it's now or never, like this needs to exist for people. So I was just drawn in to leave school to do that and to be honest, I don't think a return is going to be very likely. 

This really stems from the problems I have with the medical education system. I think it's fundamentally broken and I think if we just look at the barriers people have to go through to become an MD, and you look at the number of healthcare practitioners, specifically physicians that we have in the country in a shortage, I don't understand why it's so hard for us to get more doctors out there and to have different pathways of training for people, depending on what their goals are. Actually, I guess I know the reason why the incentives aren't always aligned with the trainees, but I'd love to pick your brain on this as well, because I think that's honestly the biggest problem I have, is the number of years and the things that people have to do just to get to the end goal.

Shiv: Yeah, no, you're speaking my language; time-based versus competency-based, and there's obviously the guild-like aspect of medicine. I think there was a recent report that the median or average salary for a US physician is $350,000. Partly that's justifiable because there's only so many spots, there's only so many neurosurgeons, there's only so many dermatologists. And so a lot of what I'm interested in, as I know you are, is how do we use technology to give power to physician extenders, right? Like social workers, mental health therapists, psychologists who can help hopefully reduce the cost to access mental health care. Very few psychiatrists are actually doing traditional kind of psychedelic-assisted therapy because they're so expensive per hour. So how do we help physician extenders? How do we use technology? Again, AI therapists and AI clinicians...I'm very excited about. 

It was obvious before, but now it's even more obvious with AI that clinical decision support tools are gonna get so good -- much better than the average clinician can be in terms of diagnostics -- that I think it's gonna be indefensible to take years to train a clinician, minus some very technical fields, I think, like trauma surgery or transplant surgery. Certainly those things I think will take a long time before AI can help augment or replace what they do. But radiology, I'm just not sure. I would not advise if you went back to med school and certainly myself, I'm not that interested in pursuing anything related to radiology. Well, maybe RadOnc or interventional, but probably not even that.

Jimmy: Yeah, I think one of the problems is, physicians have to jump through so many difficult hoops to become that MD that they are incentivized to keep those hoops for the next generation and it's a cycle that perpetuates, right? If someone had to go through so many years of training, so many different exams and residency was brutal for them from a work environment, they probably are going to look at younger people, next generation that are going through the process and say, “Well, if I went through it, I think they should as well. It's not fair otherwise,” right? And I think this also has a lot of ramifications around the compensation and why physicians are compensated highly because they went through so much garbage to get there...like it feels fair, right? But that obviously then has impact on the cost of healthcare and many other things. 

I think part of the other challenge is the world is getting so much more complicated and people have so much more to learn, right? Like even within a single specialty, science advances at such a pace where if people aren't just drinking from a fire hose throughout their entire careers, they're going to fall behind and so I think it's worth reflecting on like, what's the future of medical education? How do we actually train people in a limited amount of time if the amount they have to learn just continues to skyrocket from basic science and translational science to digital technology? And how do we handle that as an education system?

Shiv: Yeah, no, I think there need to be different types of pathways, right? We need the Stanfords that produce a lot of physician or med student entrepreneurs like yourself. We also need the Caribbean med schools. I know a lot of traditional MDs tend to snub their noses at those kinds of programs, but I think they're providing them and IMGs and DO programs and NPs provide such a valuable and important part of our healthcare system, at least with again, lowering costs and improving access that the hierarchy of medicine certainly has turned me off over the years. But my hope is we can kind of go in and fix it through again, technologies or companies like Osmosis and Osmind.

Jimmy: I think what I'm hearing from you, let me know if this is accurate is, you think there's a very key role for non-MDs to play and for the system to be much more creative and collaborative in embedding them into the delivery of care. But it sounds like you're focused more on that than rethinking the role of what it takes to become an MD in the first place. Is that accurate or is it you're interested in both?

Shiv: Definitely interested in both. Certainly, what makes a good MD is a very important question. One of my mentors over the years is Dr. Mark Triola at NYU and I think he has the right approach of what he calls “precision medical education” which is that ultimately the goal of an MD or a medical school is to train people who provide the best quality of care, best access to care too, and you can kind of optimize for that. He has pulled data from the CMS to see how these physicians who trained at NYU perform and just go back, back, back, back all the way to maybe who are we admitting? 

You know, what are the things that lead to a good pre-med or a good med student? And so kind of reverse engineering it where we don't put the cart before the horse. The horse is the patient outcomes. Like that's ultimately the North star. And I think a lot of medical education gets in its own way, forgetting that. So certainly, you know, finding people who are empathetic, keeping them empathetic, not letting them burn out. They may not be the best at organic chemistry, or the best test takers, but you and me both know that does not make the best clinician. 

But then the other piece that I'm most excited about is I've always said, there's never gonna be enough psychiatrists for all the people with treatment resistant depression. There won't be enough endocrinologists for people with diabetes. Much of healthcare moving forward is what Peter Attia has called medicine 3.0, which is not just preventative medicine, its proactive medicine, right? I'm sure you've seen his book Outlive -- a very interesting book -- and we've followed him for some years. 

Can we not have a binary approach -- like this person is now sick, they now have diabetes -- but rather zoom back way before they get diabetes.  Same thing for heart conditions or with cancer...there's all this more proactive healthcare that just is a little more costly and inaccessible right now, and doesn't necessarily align with the screening guidelines. But I think going direct to patients is the future and not just patients, but consumers before they become patients. My hope is we can have like a Luther type revolution in healthcare so that you don't need necessarily a priest to communicate to God, but you yourself can communicate to God because you understand the Bible now, you understand the importance of spirituality and whatever. 

So anyways, that's a long-winded answer to saying, I think both are really important. And I think the tertiary care systems that MD traditional allopathic schools train for will still play a role, but it won't be a scalable role that gets to hundreds of millions or billions of people in the way that we need it to.

Jimmy: So, when is Osmosis coming out with a medicine 3.0 module?

Shiv: That's what the podcast is. It's the leading indicator before we can then invest time and money into developing curricula. So actually that's a good question for you.  As you know, Osmosis is a teaching company. We like to fill in knowledge gaps. In your mind, if we could snap our fingers and have a video or a whole module or something related and train our audience on some topic, what would it be and why?

Jimmy: I honestly think some of Peter Attia's ideas and teaching the thinking around “health span” to trainees would be a really good idea. I also think the history of psychedelic medicine, what happened in the past, where we are now, I think that history is very important to understand as well because these are such different treatment modalities compared to what we traditionally have, and I think if people don't understand the full history over thousands of years -- how psychedelics have been used and then the political journey that psychedelics have gone through within the United States to where we are now and the specific Renaissance and science and also regulatory -- I think it will be dangerous if people don't understand that. I honestly think Osmosis is in such a good position to make these very interesting concepts accessible and scalable to audience members. Love the idea that you can bring this to people.

Shiv: Awesome, I appreciate that. And again, I think it doesn't matter at all unless we have good delivery systems and platforms like what you guys are building at Osmind. I want to be respectful of your time so I only have two other questions for you. The first is what advice would you give to our listeners about approaching their careers, knowing that you've also zigged and zagged a bit too?

Jimmy: I think keeping an open mind about the best way to solve big problems. I think being very honest about what someone wants and if it is to really help the patients and to make an impact on the world, what's the most efficient way to do that? I think for me, it took a lot of reflecting on what I feel is a treadmill of training, and I think being open-minded, but also not having the hubris that a lot of what I'll call healthcare tourists come into the space with.

A lot of people from tech have a certain hubris when they say, hey, here's an industry, medicine, healthcare they might not know a lot about. I think it's bridging the two, right? Being open-minded, but also not being arrogant. That's something that I've just really appreciated

talking to a lot of people that have zigged and zagged and that's really exciting.

Shiv: Totally, yeah, the humility is critical, but also the openness to experiences. That's one reason we've been so focused on psychedelics as a modality because it tends to repeatedly and predictably help people become more open-minded and change their perspectives on things, whether it's why they're addicted to alcohol or cigarettes or why they're judgmental about certain things or whatever. So my last question for you, Jimmy, is there anything else you want our audience to know about you, about Osmind, about mental health in general that you want to share today?

Jimmy: I think the only message is to, however you can, please help out with the mental health crisis. I think there are so many people suffering of all ages in all countries, whatever we can collectively do to help, I think that would be great.

Shiv: Totally, that's a great kind of call to action that we can end on. And so with that, Jimmy, thanks for taking the time to be with us on the Raise the Line podcast, and more importantly, for the work that you're doing to scale out and help improve mental health care across the US and hopefully soon enough more globally.

Jimmy: Thank you so much, Shiv.

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to raise the line and strengthen our healthcare system. We're all in this together. Take care.