Ideas come from life experiences. If you make a conscious effort to engage life, then ideas will come.
Serial angel investor, entrepreneur and philanthropist, meet Ara Chackerian. Ara is the Managing Partner of ASC Capital Holdings, LLC which is focused on investing in early-stage healthcare companies. He is also a co-founder and board member of TMS Health Solutions, a treatment provider of transcranial magnetic stimulation for those currently suffering from treatment resistant depression.
Prior to his involvement with TMS Health Solutions, Ara’s professional career has always revolved around entrepreneurship and investing. He is largely interested in the health-tech and services field and has more than two decades of experience in building healthcare companies: BMC Diagnostics, Embion/Provider Links, PipelineRx and now TMS Health Solutions, to name a few. He serves as a dedicated board member for several early stage healthcare companies in the San Francisco bay area including but not limited to PipelineRX, Mint Medical Education and TMS Health Solutions. He also is deeply committed to the environmental causes with his investment in Limonapa, SA – a sustainable reforestation Teak plantation in Nicaragua and a number of youth development non-profits including JUMA Ventures, CREA Nicaragua and Nor Luyce.
Where did the idea for TMS Health Solutions come from?
My long time business partner and I wanted to extend our experience in building out-patient diagnostic radiology centers to another area of healthcare. We spent over a decade building a network of centers in Northern California. One of our long-time provider partners suggested that we take a look at the outpatient psychiatry space, particularly, a new device based treatment for depression called transcranial magnetic stimulation. Our research into the technology and treatment lead us to the realization that TMS had the potential to become a third pillar of psychiatric care, along with medication and talk therapy. The efficacy of the treatment, particularly for patients suffering from major depressive disorder was startling. This lead us to ask the question – why is there so little awareness and access to the treatment?
In a serendipitous meeting with one of the preeminent TMS thought leaders, Dr. Richard Bermudas, we began to understand the structural impediment to access. Rich had been utilizing TMS in his Sacramento practice since its FDA approval in 2008. He learned the hard way about limited insurance coverage policies, the difficulties of hiring and retaining quality technicians, and the realities of trying to run a group practice while still being a clinician. In many respects, it’s hard for doctors to be doctors in our system. This is where Brad Hummel and I believed we could make a real difference. Rich’s passion and fundamental belief that TMS had the potential to help thousands of people suffering from medication resistant depression was infectious. He wanted to expand access and we believed that together with our experience in building outpatient facilities, we had the potential to create something special.
As we studied the existing out-patient psychiatrist model, we quickly realized that the current care delivery model was not designed to support device based treatments. The typical psychiatrist worked as a solo practitioner or small group in a 200 square ft shared office performing medication management consults. Most didn’t accept insurance because the demand for their services was insatiable and the market allowed them to prosper without dealing with headaches of being contracted with insurance companies.
Our vision was to design a care delivery model that both enabled the patient and physician to achieve their desired outcome in a way that incorporated a ‘patient first’ methodology, both in terms of experience and treatment.
Since we formed our partnership just over two years ago, we’ve built seven new facilities serving the broader San Francisco Bay Area and Sacramento. Our typical facility is 3,000 square ft with both consult and TMS treatment rooms. Our prototype facility was designed by Josh Heitler, the renowned New York Architect of end-user focused businesses such as Drybar and Rent The Runway. We wanted patients to feel as though they were not going to the doctor’s office but rather to a place of serenity and relaxation which is particularly important for patients with psychiatric disorders. Each detail around the patient experience was carefully crafted to ensure we could maximize positive patient outcomes and create raving fans of our brand. We loosely describe our facilities as anti-healthcare facilities.
What does your typical day look like and how do you make it productive?
I don’t really have a typical day. My wife often describes me as the most whimsical man alive. I’m really bad at calendar planning and details. I tend to immerse myself in areas that involve vision, strategy and coaching which drives my daily schedule. Balancing my entrepreneurial desires with our philanthropic efforts is of utmost importance to me. I’m smart enough to know that much of my good fortune has little to do with me, but rather the lottery of life. Making sure that I don’t forget that fact is a centerpiece of my existence.
How do you bring ideas to life?
Ideas come from life experiences. If you make a conscious effort to engage life, then ideas will come. It’s a pretty simple formula. My parents encouraged this behavior when I was young, so once again, my ability to come up with ideas is nothing more then being fortunate enough to have been raised in an environment that encouraged thinking hard about life.
What’s one trend that really excites you?
Digital healthcare is a trend that I’m following closely. Telemedicine and digital assisted healthcare apps have the potential to bring tremendous value to the healthcare system. For example, patients that are entering a phase of depression tend to change their communication patterns both in terms of speech pacing and frequency of communication. Algorithms have the ability to pick-up these behavior changes that can help patients and providers to assess deterioration and/or improvement in one’s behavioral health. It’s a remarkable exciting time on this front.
What is one habit of yours that makes you more productive as an entrepreneur?
I’m not sure I can identify a single habit that makes me a better entrepreneur, but a few come to mind. When I was younger, I don’t think I realized all of the unforeseen obstacles that entrepreneurs face when starting or running a business. I tend to see these obstacle better when I put myself in a state of calm, which for me is either surfing or trail running. I tend to see things better and more realistically when I’m surrounded by nature. I also routinely use my wife as a sounding board to validate ideas. She’s always been great at seeing things from a different and helpful perspective.
What advice would you give your younger self?
Be incredibly thoughtful in picking your partners. In my 25 years of business, I’ve had some amazing partners but I’ve also had a few train wrecks. On that note, make sure to appreciate the differences that people bring to the table. The best entrepreneurs recognize how to create a whole from many.
Tell us something that’s true that almost nobody agrees with you on.
I’m not a believer in the great man theory, which in our culture is not the typical view. I’ve spent a lot of time traveling in the third world and I’ve learned that opportunity and success is almost impossible unless life circumstances provide the basic opportunity. Unfortunately, from my perspective, too many in our country/media feel success is more driven by the individual’s innate capabilities. I understand that it sells, but it’s way off – from my perspective.
As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?
I could be super excited about an idea and feel like it’s going to be a winner. My natural tendency is to think about all the reasons why it’s a good idea (glass half full bias – which most entrepreneurs suffer from). This approach in thinking is fantastic for building excitement and idea creation, but it can lead to situational bias which can then lead to missing major holes in an idea. A helpful approach from my perspective is to follow the motto – seek the truth. This means asking the hard questions over and over until you feel as though the entire team including yourself is truly looking at an opportunity through a clear, unfiltered lens. We all bring situational bias to the table; what’s critical is to recognize this inherent flaw in much of our thinking and then design a framework that helps adjust for it.
What is one strategy that has helped you grow your business?
As a clinical practice of psychiatry, our clinical reputation is paramount. When we launched the business three years ago, we decided that physician education would be a centerpiece of our culture so we decided to form TMS Health Education. We kicked off this concept with a three-day educational symposium which focused on educating not only our physicians but physicians from around the country on the application of TMS therapy. We brought in academic thought leaders from some of the best research institutions in the world including Stanford, UCSF and Emory University to teach different aspect of TMS and discuss much of the research in the field. Many would ask, why are we educating potential competitors. We simply believe that driving awareness through education will empower physicians and ultimately, help more patients suffering from mental illness. We want our brand to always be associated clinical excellence, sharing knowledge and promoting awareness – no matter the short-term consequences. We recently hosted our third annual event which has become the premiere event of its kind on the West coast.
This commitment to education has paid dividend in helping us grow the business. It’s enabled us to recruit top notch physician talent because most physicians put a lot of weight on their clinical reputation. Having an employer that is committed to not only investing in their clinical education, but the broader clinical community, is highly valued.
What is one failure you had as an entrepreneur, and how did you overcome it?
I was an investor in a business where the CEO/Founder was a personal friend. The business was challenged for several years and I continued to support it even when there was clear evidence that it was time to let it go. The final outcome was very challenging because we didn’t face the reality many months/years earlier, when we should have. My lesson from this experience is the importance of recognizing how emotions can influence making difficult decisions. It’s very important to understand this risk prior to getting involved with any venture.
Today, I spend a lot more time thinking about the potential emotional repercussions from my involvement with each different venture. It’s a risk factor that I now include in my assessment of an opportunity.
What is one business idea that you’re willing to give away to our readers?
I think there is a huge opportunity to connect primary care providers with behavioral health providers. Eighty percent of depression treatment medications are prescribed by primary care physicians. In many cases they become the default behavioral health provider. This works fine for some patients, but others many need a higher-level of care. If we can build a truly collaborative care model, we will be able to identify those patients who do require the higher-level of care earlier, which will result in more effective treatment at a substantially lower cost to society. A true win/win.
What is the best $100 you recently spent? What and why?
My 15 year old daughter had her first real job this past summer. Since we were in Nicaragua where the average wage is about one dollar an hour, we decided to subsidize her compensation. It felt really good to pay her at the end of summer after watching her put the time in.
What software and web services do you use? What do you love about them?
What is the one book that you recommend our community should read and why?
The Worry Cure – it’s a fascinating read on why we worry and how we can worry less.