7 ms·

Lifestance: A mental health rollup headed for a breakdown

46 points by jlund-molfese 3y ago

NickC25 3y ago
If the overall sentiment behind the bullet points are true, WOW. From what I can tell - this is a digital pill-mill targeting some of the most vulnerable members of modern society. Pardon my french here, but how the fuck was this able to IPO? And more than that, what firms actually bought into this? EDIT: not every facet of the Health/Wellness/Medical industry needs to be subject to Wall Street's rules. Why don't people understand that by now?
- 15457345234 3y ago
  Let me guess, this is one of those online-only adderall-pushers that grew enormously during the pandemic, right?
  - gs17 3y ago
    They pushed more than just Adderall, of course: > • LifeStance deals in controlled substances and medications like Xanax and Adderall that have huge potential for abuse, with prescription volume growth rivaling opiate prescriptions at their peak, according to health professionals. > • Despite the potentially addictive nature of some of these medications, former LifeStance employees claim that medication prescribers have been advised to cut consultation times to maximize revenue, with some former clinicians having seen “30 patients a day”. Others described it as akin to “war medicine.” > • LifeStance also rewarded its “highest-performing” medication prescribers with stock grants, according to the company’s CFO. A former practice owner told us the grants were tied to number of sessions a clinician conducts, an incentive that can encourage quantity over quality of care. > • In December 2023, we signed up for an appointment with a LifeStance psychiatrist to better understand the company’s patient onboarding process. We were given a questionnaire developed by Pfizer and were asked if we were open to medication 13 minutes into our first session. > • Despite reporting to the psychiatrist that we had been in a good mood since Christmas, 32 minutes into our first session we were offered Pfizer’s Zoloft for treating depression and anxiety. By the end of a 15-minute follow up session we were prescribed Zoloft.
- fragmede 3y ago
  Thing is, how else do you want health care to work under capitalism? Health care is operating in Wall Street's world, and is thus subject to Wall Street's rules. If we had a different system where it wasn't subject to Wall Street then sure, but it is, so that's what we have. Not to be defeatist, but for better or worse, this is the system we have. If they're getting medication to people that genuinely need it, more power to them. How they treated their employees is broken as fuck, so good riddance, but in the bigger picture, there are patients that need treatment and this is how they're able to get it.
  - NickC25 3y ago
    Capitalism is not just what Wall Street wants. Plenty of firms in a wide variety of industries don't have a shareholder mandate to increase profits every quarter. They have to respond to the needs of Main Street, not Wall Street. They still operate under capitalism. How else is health care supposed to work? How about government subsidies? How about price controls? "Public healthcare is such a complex beast that only 32 of the 33 most advanced economies in the world have made it work"
    - fragmede 3y ago
      I mean, I'd love those things in greater quantities than we have now, so I agree with you, but until that happens, we gotta do the best we can in the system we got.
- hotsauceror 3y ago
  Why wouldn't they be able to IPO? Making money off of pushing addictive chemicals to vulnerable people is a very attractive proposition. We know this because people will do it despite its being illegal. If you can make money, legally, doing something that hurts people, people will do it. Ask the Sacklers. Ask health insurers that deny coverage. It would be fashionable to say "the cruelty is the point" but it's not - the cruelty is just icing. Whether it is 'cruel' or 'moral' never even enters into the picture. People invest in companies that make torture devices, sell addictive chemicals, develop nerve toxins, and slaughter animals wholesale, without a second thought, because there is money to be made.
simple10 3y ago
From the claims, it appears Lifestance charged therapists to be part of the network but were treated as employees, resulting in some therapists owing more than they made. Ouch! I wonder why they didn't operate as a lead gen agency to avoid the employment issues. Maybe this is how they were able to IPO. It made it seem like they had real assets with a network of on staff therapists and nurses.
- simple10 3y ago
  From the doc: LifeStance provides advances to clinicians who expect to eventually reach the company’s lofty compensation promises. This often results in burdensome debt when expectations fall short. One former LifeStance manager described the situation as “a crappy thing, to owe your employer money.”
  - derbOac 3y ago
    This is so messed up. It shouldn't happen. If a company thinks some compensation is warranted, it should be given as pay, period. Sometimes I'm amazed at what contemporary society thinks is reasonable in terms of compensation norms. This is obviously extreme if true but it's like the US has been collectively brainwashed in terms of merit, pay, and compensation practices.
    - simple10 3y ago
      I've been seeing this model popup a lot in the lead gen space. Practitioners pay a fee to be part of a network with the promise of getting a steady stream of clients. Lifestance took it to a new level with practitioners being employees and then not delivering on the promise.
  - NickC25 3y ago
    And this is the type of shit that should have been snuffed out during the IPO vetting process, and something VC firms with any brains at all would have taken a huge objection to before investing. "So, your whole business model is effectively a digital pill mill for ADHD stimulants and antidepressants, and the mechanism for service delivery involves putting your service providers into debt so they can cut corner after corner to get more and more people taking this medication faster than if a customer went through the traditional evaluation-and-prescription model with a real doctor?" Yeah, that's fucking dumb. I'd nope out of that so quickly. ADHD pills are over prescribed (often to the wrong people), and that's super dangerous. I have pretty severe ADHD and even I don't think these pills should proliferate as much as they have society-wide.
fishyjoe 3y ago
Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid. Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with. My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.
- rideontime 3y ago
  That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."
  - jeffreyrogers 3y ago
    Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
    - ImPostingOnHN 3y ago
      >Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. Correct on the important points here: - They are trained as a medical doctor - They went though an additional 4 years of training during residency as a medical doctor. - Due to that additional training beyond PhDs, they are granted prescription privileges. >You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. You can, but: - You usually won't, if we were to pick an example at random from "therapists". - That isn't the sort of therapist we're discussing here, as the article points out. - A PhD can be in anything, not just psychiatric disorders. - A PhD requires significantly less training in treating patients than an MD. >I don't really see any reason why a psychiatrist would be any better than a therapist For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go. Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
jgoldshlag 3y ago
Lifestance bought up the practice I was going to a couple years ago, and I have continued to see the same people. Haven't heard any complaints from them, will have to ask at my next appointment I guess
alangibson 3y ago
Looks like a trash business but I'm not so sure it's a good short. Extractive, value negative businesses can go on a long time eating up profits from like locusts from real businesses.
- 15457345234 3y ago
  Their IPO was Jun 9 2021
mattgreenrocks 3y ago
I'm just baffled at how they messed this up. They provide infrastructure for therapists and psychiatrists to source patients. Mental health needs have only accelerated since the pandemic. Laughable is the claim that therapy doesn't "scale." Of course it doesn't! The thing that makes it not scale is exactly the thing that people are there for.
- NickC25 3y ago
  Not every business or service can "scale", and even fewer can do so in the way Wall Street wants. That doesn't mean it isn't a viable business or service; or isn't one that provides a valuable resource to society. And Wall Street / VC firms need to accept that. A person's individual needs for medication is not something VCs or Wall Street should be getting in the middle of, no matter how enticing the returns have the potential to be. You get it wrong, you could affect someone's life permanently in a very dangerous way.
latentcall 3y ago
This company bought out my local psychiatry group and ran it into the ground. What once was a fairly personal experience grew into cold, emotionless online pill pushing. I could literally ask for anything I wanted and would get it. It didn’t feel right at all. I no longer do business with them but am warning people to stay away.
recursivecaveat 3y ago
> “They’re not able to collect, and then they don’t pay you because they would have paid you based on the appointment that you conducted. Right? But because they were not able to collect because they were so inefficient, you end up not getting paid.” I wonder if this is legally wage theft? Based on my layman's quick reading I think yes in California, but no federally unless it brings you below minimum wage. Imagine if you're a factory worker, and the warehouse storing all the widgets burns down. So they tell you that they're retroactively not paying you for last month's labor because they lost the product of it, independent of anything you did.

46 points by jlund-molfese 3y ago

If the overall sentiment behind the bullet points are true, WOW. From what I can tell - this is a digital pill-mill targeting some of the most vulnerable members of modern society. Pardon my french here, but how the fuck was this able to IPO? And more than that, what firms actually bought into this? EDIT: not every facet of the Health/Wellness/Medical industry needs to be subject to Wall Street's rules. Why don't people understand that by now?

15457345234 3y ago
Let me guess, this is one of those online-only adderall-pushers that grew enormously during the pandemic, right?
- gs17 3y ago
  They pushed more than just Adderall, of course: > • LifeStance deals in controlled substances and medications like Xanax and Adderall that have huge potential for abuse, with prescription volume growth rivaling opiate prescriptions at their peak, according to health professionals. > • Despite the potentially addictive nature of some of these medications, former LifeStance employees claim that medication prescribers have been advised to cut consultation times to maximize revenue, with some former clinicians having seen “30 patients a day”. Others described it as akin to “war medicine.” > • LifeStance also rewarded its “highest-performing” medication prescribers with stock grants, according to the company’s CFO. A former practice owner told us the grants were tied to number of sessions a clinician conducts, an incentive that can encourage quantity over quality of care. > • In December 2023, we signed up for an appointment with a LifeStance psychiatrist to better understand the company’s patient onboarding process. We were given a questionnaire developed by Pfizer and were asked if we were open to medication 13 minutes into our first session. > • Despite reporting to the psychiatrist that we had been in a good mood since Christmas, 32 minutes into our first session we were offered Pfizer’s Zoloft for treating depression and anxiety. By the end of a 15-minute follow up session we were prescribed Zoloft.
fragmede 3y ago
Thing is, how else do you want health care to work under capitalism? Health care is operating in Wall Street's world, and is thus subject to Wall Street's rules. If we had a different system where it wasn't subject to Wall Street then sure, but it is, so that's what we have. Not to be defeatist, but for better or worse, this is the system we have. If they're getting medication to people that genuinely need it, more power to them. How they treated their employees is broken as fuck, so good riddance, but in the bigger picture, there are patients that need treatment and this is how they're able to get it.
- NickC25 3y ago
  Capitalism is not just what Wall Street wants. Plenty of firms in a wide variety of industries don't have a shareholder mandate to increase profits every quarter. They have to respond to the needs of Main Street, not Wall Street. They still operate under capitalism. How else is health care supposed to work? How about government subsidies? How about price controls? "Public healthcare is such a complex beast that only 32 of the 33 most advanced economies in the world have made it work"
  - fragmede 3y ago
    I mean, I'd love those things in greater quantities than we have now, so I agree with you, but until that happens, we gotta do the best we can in the system we got.
hotsauceror 3y ago
Why wouldn't they be able to IPO? Making money off of pushing addictive chemicals to vulnerable people is a very attractive proposition. We know this because people will do it despite its being illegal. If you can make money, legally, doing something that hurts people, people will do it. Ask the Sacklers. Ask health insurers that deny coverage. It would be fashionable to say "the cruelty is the point" but it's not - the cruelty is just icing. Whether it is 'cruel' or 'moral' never even enters into the picture. People invest in companies that make torture devices, sell addictive chemicals, develop nerve toxins, and slaughter animals wholesale, without a second thought, because there is money to be made.

simple10 3y ago

From the claims, it appears Lifestance charged therapists to be part of the network but were treated as employees, resulting in some therapists owing more than they made. Ouch! I wonder why they didn't operate as a lead gen agency to avoid the employment issues. Maybe this is how they were able to IPO. It made it seem like they had real assets with a network of on staff therapists and nurses.

simple10 3y ago
From the doc: LifeStance provides advances to clinicians who expect to eventually reach the company’s lofty compensation promises. This often results in burdensome debt when expectations fall short. One former LifeStance manager described the situation as “a crappy thing, to owe your employer money.”
- derbOac 3y ago
  This is so messed up. It shouldn't happen. If a company thinks some compensation is warranted, it should be given as pay, period. Sometimes I'm amazed at what contemporary society thinks is reasonable in terms of compensation norms. This is obviously extreme if true but it's like the US has been collectively brainwashed in terms of merit, pay, and compensation practices.
  - simple10 3y ago
    I've been seeing this model popup a lot in the lead gen space. Practitioners pay a fee to be part of a network with the promise of getting a steady stream of clients. Lifestance took it to a new level with practitioners being employees and then not delivering on the promise.
- NickC25 3y ago
  And this is the type of shit that should have been snuffed out during the IPO vetting process, and something VC firms with any brains at all would have taken a huge objection to before investing. "So, your whole business model is effectively a digital pill mill for ADHD stimulants and antidepressants, and the mechanism for service delivery involves putting your service providers into debt so they can cut corner after corner to get more and more people taking this medication faster than if a customer went through the traditional evaluation-and-prescription model with a real doctor?" Yeah, that's fucking dumb. I'd nope out of that so quickly. ADHD pills are over prescribed (often to the wrong people), and that's super dangerous. I have pretty severe ADHD and even I don't think these pills should proliferate as much as they have society-wide.

fishyjoe 3y ago

Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid. Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with. My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.

rideontime 3y ago
That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."
- jeffreyrogers 3y ago
  Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
  - ImPostingOnHN 3y ago
    >Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. Correct on the important points here: - They are trained as a medical doctor - They went though an additional 4 years of training during residency as a medical doctor. - Due to that additional training beyond PhDs, they are granted prescription privileges. >You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. You can, but: - You usually won't, if we were to pick an example at random from "therapists". - That isn't the sort of therapist we're discussing here, as the article points out. - A PhD can be in anything, not just psychiatric disorders. - A PhD requires significantly less training in treating patients than an MD. >I don't really see any reason why a psychiatrist would be any better than a therapist For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go. Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.

jgoldshlag 3y ago

Lifestance bought up the practice I was going to a couple years ago, and I have continued to see the same people. Haven't heard any complaints from them, will have to ask at my next appointment I guess

alangibson 3y ago

Looks like a trash business but I'm not so sure it's a good short. Extractive, value negative businesses can go on a long time eating up profits from like locusts from real businesses.

15457345234 3y ago
Their IPO was Jun 9 2021

mattgreenrocks 3y ago

I'm just baffled at how they messed this up. They provide infrastructure for therapists and psychiatrists to source patients. Mental health needs have only accelerated since the pandemic. Laughable is the claim that therapy doesn't "scale." Of course it doesn't! The thing that makes it not scale is exactly the thing that people are there for.

NickC25 3y ago
Not every business or service can "scale", and even fewer can do so in the way Wall Street wants. That doesn't mean it isn't a viable business or service; or isn't one that provides a valuable resource to society. And Wall Street / VC firms need to accept that. A person's individual needs for medication is not something VCs or Wall Street should be getting in the middle of, no matter how enticing the returns have the potential to be. You get it wrong, you could affect someone's life permanently in a very dangerous way.

latentcall 3y ago

This company bought out my local psychiatry group and ran it into the ground. What once was a fairly personal experience grew into cold, emotionless online pill pushing. I could literally ask for anything I wanted and would get it. It didn’t feel right at all. I no longer do business with them but am warning people to stay away.

recursivecaveat 3y ago

> “They’re not able to collect, and then they don’t pay you because they would have paid you based on the appointment that you conducted. Right? But because they were not able to collect because they were so inefficient, you end up not getting paid.” I wonder if this is legally wage theft? Based on my layman's quick reading I think yes in California, but no federally unless it brings you below minimum wage. Imagine if you're a factory worker, and the warehouse storing all the widgets burns down. So they tell you that they're retroactively not paying you for last month's labor because they lost the product of it, independent of anything you did.