Two Chairs, a San Francisco-based company offering hybrid behavioral health care, announced the close of a $72 million Series C funding round on Tuesday. The financing round, led by Amplo and Fifth Down Capital, brings Two Chairs’ total funding amount to $130 million.
The startup was founded in 2017 to expand access to high quality mental health care. It provides both virtual and in-person psychotherapy for adults with a wide range of mental health issues across the acuity spectrum.
“We know there’s a widespread need for mental health care in this country, but solving the mental health crisis is about more than just access to care — it’s about access to the right, high-quality care,” CEO Alex Katz said in an interview. “I saw this clearly more than eight years ago, when my partner ended up in therapy with a clinician who wasn’t a good match, and it did her more harm than good.”
As some of the stigma associated with mental health care fades away culturally, more people than ever are seeking out these services, he pointed out. But the providers people end up finding often don’t deliver measurement-based mental health care, nor do they “have accountability around quality,” Katz explained.
He declared that from day one, Two Chairs has been focused on improving the quality of mental health care by prioritizing the experiences of both patients and therapists — starting with the right match.
The name Two Chairs is a reference to the patient-therapist relationship, sometimes known as the therapeutic alliance, Katz noted.
“Research shows that therapeutic alliance is the best predictor of strong outcomes in therapy, which is why matching is at the heart of our clinical model,” he stated.
When a patient begins their care journey on Two Chairs — often after they were referred by their doctor — the first step is to book a matching appointment, Katz explained. The startup’s matching process combines clinical insight with a proprietary algorithm that pairs patients and therapists based on factors that are likely to lead to a tight-knit therapeutic bond, he said.
Two Chairs is typically able to get patients a matching appointment within two days, Katz added. He described the appointment as a 45-minute video session with a licensed therapist who is trained in matching patients with the right therapist for them. During this session, the matching expert learns about the patient’s needs and preferences, answers their questions and educates them about how therapy works.
“Using their clinical judgment, the matching expert will then translate and prioritize the patient’s expressed preferences, unspoken needs and nuanced feelings into data we feed into our algorithm to match the patient with the best therapist for them,” Katz explained.
He highlighted this matching process as something that differentiates Two Chairs from other mental health care providers, such as Headspace Health, BetterHelp and Grow Therapy. He noted that 90% of Two Chairs patients make it to at least the fourth session with their therapist — compared to an industry average of just 36%.
Two Chairs’ focus on measurement-based care also helps it stand out, Katz said.
Every morning that a patient has a Two Chairs therapy session, they complete a digital check-in that takes no more than five minutes. The check-in includes questions from the PHQ-9 and GAD-7, two clinically validated assessments of anxiety and depression. Once a patient completes this check-in, Two Chairs tabulates results in a standardized clinical dashboard where therapists can view any changes to patients’ PHQ-9 and GAD-7 scores.
Then patients receive a snapshot of their progress in areas such as self-esteem, mood, sleep, restlessness and eating. Patients also receive reflection prompts and insights from their clinicians, which aid them in developing a better understanding of their mental health progress. For example, a prompt may ask a patients why they think their sleep patterns have changed or why they’re becoming more irritable lately.
These snapshots inspire patients to take a more involved role in their care and openly talk with their therapists about how the treatment is going, Katz remarked. In his view, measurement-based care is crucial because it’s proven to help patients achieve better outcomes from therapy. Research shows a nearly 75% improvement in remission rates among patients whose behavioral health providers use measurement-based care compared to those whose providers don’t, he pointed out.
“At Two Chairs, 100% of our therapists use measurement-based care, which helps give us clear insights into the clinical outcomes our care is achieving. Meanwhile, fewer than 20% of behavioral health practitioners have integrated measurement-based care into their practices, and few, if any, use a system that can consistently surface indicators to both therapists and their patients concurrently,” Katz stated.
Two Chairs’ dedication to measuring outcomes and care quality assurance are two key factors that have contributed to the startup’s success, he noted. Katz said that the company has grown eightfold over the past three years. It now serves more than 20 million covered lives through a national partnership with Aetna and partnerships with Kaiser Permanente in Northern California and Washington.
The startup employs a team of more than 500 full-time and part-time therapists. Nearly half of these therapists identify as Black or Indigenous people of color, 24% identify as LGBTQ, and 16% are multilingual, Katz said.
Photo: Alisa Zahoruiko, Getty Images
