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Alma is a platform that improves access to quality, affordable mental health care by giving providers the tools they need to build thriving in-network private practices. In this episode, Ross sits down with Alma CEO Dr. Harry Ritter to discuss the importance of a robust management structure, a focus on responsible growth, and having values that align with your business partners. The two also discuss their own mental health journeys, and how investing in people’s mental wellbeing and your own might now be more important than ever.


January 4, 2024





Ross Devor:

It just, it, it clicked very easily for me on just the importance of what you were building and having lived a small fraction of it, but just thinking about folks who need care and how widespread that need is and all of the different benefits that your platform brings. So thank you for improving this, I can say personally (laughing) from experience in the space.

Harry Ritter:


Thank you for helping us. We've been very lucky to have great partners across the life of the company and perhaps none more so than you. Thank you for helping us build it.


This podcast is for informational purposes This podcast is for informational purposes only and does not constitute an advertisement. Views expressed are those of the individuals and not necessarily the views of Thoma Bravo or its affiliates. Thoma Bravo funds generally hold interest in the companies discussed. This podcast should not be construed as an offer to solicit the purchase of any interest in any Thoma Bravo fund.

Orlando Bravo:

Welcome to Thoma Bravo's behind the deal. I'm Thoma Bravo founder and managing partner, Orlando Bravo, and that was Thoma Bravo partner, Ross Devor, speaking with Dr. Harry Ritter, founder and CEO of Alma. Alma is on a mission to simplify access to quality affordable mental healthcare for all by giving providers the tools they need to build their thriving in network private practices.

In this episode, you'll hear how Thoma Bravo is partnering with Alma to improve the company's technology roadmap and help bring the platform to therapists across all 50 states. The Alma deal is a case study of one of Thoma Bravo's core principles. Finding talented management teams and supporting them to help drive strong outcomes.

What we really valued in this investment is the partnership that we have with the CEO, Dr. Harry Ritter, and our alignment on how to build a company that doesn't just grow but that grows profitably. At Thoma Bravo, we've invested in close to 500 technology companies and have a playbook of operational best practices around driving efficient, long-term growth. It's one thing to invest in a company when the world is all up and to the right and quite another to step up as we did in this case when many players in the investing world are on the sidelines.

When we invested in Alma's Series D in 2022, it was clear to us that Alma's value prop had a differentiated potential for profitable growth and the ability to outlast tech corrections. And so, we leaned in during a challenging market. The Alma case study highlights two important aspects of the Thoma Bravo model.

First, it shows our model of working closely with companies to develop profitable growth plans. Second, it highlights our philosophy of investing in growth companies regardless of the macro environment, because what matters to us is the future value of the business and how we can drive it even further in partnership with management.

So today, you'll hear everything that went on behind the deal from Ross Devor, the deal lead and partner at Thoma Bravo followed by his conversation with Alma founder and CEO, Dr. Harry Ritter.

Ross Devor:

Hi, I'm Ross Devor. I'm a partner at Thoma Bravo and co-head of our growth fund, which is a dedicated fund to supporting and investing in high growth software and technology companies. Today we're here to talk about Alma. And Alma is many different things, but essentially Alma is on a mission to simplify access to high quality affordable mental healthcare, and they do this by giving providers the tools they need to build in-network private practices.

And when providers join Alma, they gain access to insurance and billing support, teletherapy, client referrals, and it really is a community of clinicians that come together and support each other through education and training and events. For us, at Thoma Bravo, we've been investing in the digital health space for a while and there are a number of exciting avenues in that sector and we've invested in a few, but behavioral health, the category behavioral health was particularly interesting for us because we really saw just an incredible opportunity for increased technology adoption in the category.

Looking back on the pandemic, the pandemic did a really good job at highlighting the need for and the benefit of behavioral health. But the need existed long before and it's continues to this day. Getting help and getting the support is being destigmatized, which is great, and it's being destigmatized really as the awareness of the benefits continue to grow.

And at the same time here in America as a country, we're spending over 200 billion annually on mental healthcare, but for all that money and all that spending only 40% of people are able to get the care they need, and along with that most practitioners are not managing their business and the clinical process with digital tools. Really this have been a pen and paper industry for a long time. The reimbursement billing process has just been so challenging and it's really been a real significant barrier to operational success for a lot of therapists.

And so, they really lack the ability to efficiently find new patients, interact with them, and used the tools, tools to increase the efficacy of sessions. And then, of course on the back end, dealing with insurance companies and the reimbursement and billing process is particularly painful.

Across the category, basically on all sides of this marketplace there's a need to use technology to help drive more and better outcomes. It was category we spend a lot of time in and, you know, Alma really stood out in the category because of their provider first approach to the space and the technology they're using to solve this challenge, and it also didn't hurt that they were really growing rapidly (laughs) on the back of some of these great tailwinds in the category and the fundamental need for more support and care in space. But more than the numbers, what really stood out to us from an investment standpoint was that Alma's marketplace fundamentally allowed all three sides of the marketplace to benefit.

If you think about it, some marketplaces is really a transfer of value from one side to the other, and sure, it could be a very efficient transfer. But here the therapist, the patients, and the payers all benefit. If you think about it, the benefit to patients and therapists is pretty clear, more and better care, but from the insurance companies, and this is important, the insurance companies also benefit because they recognize the importance of and the economic benefit of their populations finding access to this care and benefiting from the great effects of behavioral healthcare.

I's really rare to find a value prop where all the constituents (laughs) of this value chain into the marketplace all benefit and that's just a really exciting value prop to get behind as an investor and help support.

So, you know, thinking back on how the deal came together, any company that's doing really well, it's competitive process to show up and try to invest in the business. This was no different. A number of firms were interested in investing in Alma. And of course, we had to move quickly and, and with conduction working on a plan with Harry on the next chapter of the company's growth and where we could be a great partner to support that growth. But at the same time what made this deal really unique was the timing.

And this was in the summer of 2022, and really right in the teeth of, you know, the fastest interest rate rises in history. And the fed was really changing the economic paradigm of valuations and really bringing about consequential unraveling (laughing) of some of the high growth technology market which continues to this day, as we were working, you're watching days where the stock market is falling by a significant amount and everybody is retreating to the sidelines.

For us, though it was clear that Alma's value prop would be able to grow through and outlast any tech correction. And so, that part I think was the easier part for us, but what made the deal get over the line for us was really an alignment with Harry around a responsible growth plan going forward and a plan that really highlighted durable, efficient and responsible growth and that's exactly the, the growth plan that we like to invest behind and gave us the confidence to, uh, step up and write the check really in the midst of a market meltdown.

The deal making process and growth is fundamentally different than the deal making process for our buyout funds, because we're not investing to control the company. (laughs) And so, that you can imagine if you don't own the company, it really highlights the need of working collaboratively. Here, there's not governing docks that say whatever we say goes. (laughs) And of course it's not the approach we take in, in any event but it particularly is a dynamic in the growth market, in the minority investing market where you have to be invited in by management to add value and support these companies.

We've invested in over 400 technology companies and through that have built battle tested operational practices that really, really help highlight and drive efficient long-term growth, but at the end of the day, you still have to work through the process of building alignment and support with the management team and other shareholders in a way that you don't have to when you're bidding for the entirety of a business.

You know, looking back to some of the conversations with Harry and getting that invitation to say, "Look, we think you could be a great partner here. We'd like to invite you to make an offer for the business and think about being part of the team." We are always particularly careful with our capital, but certainly, again, wanted to invest behind folks who are thinking about, "How do I not just grow but build a long-term profit growth engine that really leads to significant equity value creation?" And we think the best and highest valuations out there for companies and that alignment existed.

And then, from Harry's side, it's, "Well, what are you gonna do to help me as a partner?" And that speaks to the credibility we have, you know, with the platform and with the history and invested in so many companies at so many different stages of growth. There's probably not a pain point of a growth story. We haven't seen, lived, and helped (laughs) solve with our portfolio companies before. And so, I think that was a, uh, a big difference compared to more traditional early stage firms or other investors out there just given kind of the breadth and, and history that we have working with management teams and, and helping them grow businesses.

Today, Alma is really thriving and it's great to be able to say that given what's happened more broadly from a macro standpoint over the last 12 to 18 months, but Alma is doing really well and continues to be the premier platform serving the behavioral healthcare space and we have reached our goal of extending service across all 50 states. And the scale here is also not just from a product standpoint, but the value in the scale that they are building is really important because when it comes to driving outcomes, improvement at scale, they're really doing it in a way that the category has never seen before.

And so, it's one thing to help on an individual basis and it all starts there, but it's a whole different thing to build a platform and, you know, a mousetrap, so to speak, that can deliver impact to outcomes at scale measured in the millions. And that's a really exciting piece here as you think about what is the growth (laughs) for us and growth is always exciting but growth here comes with helping millions and millions of people and that's just a tremendous story to be a part of and help support and just given the times that we're in, I think it's also worth mentioning that underneath all of this phenomenal growth, the company has already crossed the path to profitability and really shows, again, how Harry and team have just done an amazing job building not just great products and great value prop, but an amazingly strong business underneath it which we all can be really proud of.

Huge reason, right at the top of the list of the reason to invest in Alma is Harry and I'm, I'm lucky to call him a friend and a colleague in this partnership and I just think he's an amazing leader and he brings a bit of a different background as well to being a tech executive, (laughs) which he is, but he's also so someone that has a medical degree and has experience practicing medicine.

And so, he comes to this category and his customers with just a really great understanding of what medical practitioners believe in, live day in day out and are looking for when it comes to tools and other things that can help them provide care. And I think most folks who provide medical care, I think come and have built in, to some degree, just really great empathy and ability to put themselves in the patient shoes or in our case, the customer shoes.

So Harry has just a unique blend of empathy and experience, which makes him uniquely suited to serve this market, and what's been really great to see and to live with Harry in the trenches here, so to speak, is watching him be such a pragmatist around critical business decision-making and showing a lot of creativity and flexibility around learning new things as the business scales and being really collaborative around soliciting feedback, not just from us but from other folks as well. But really having just an incredible focus on finding the best solution and the best answer to the problem even if it's not already in his head, so to speak.

So I think this is a really great case study of building a great partnership with management and having that partnership lead to really strong growth but really strong economic growth underneath that. And I think that's really a testament to how not only Harry is building the company, but some of the learnings that we can bring as a partner who is seen around the curve as you cross 50, 100, 500 million of revenue about what you might have to do before it actually is on your doorstep to grow your business and to build something that is really strong economic engine underneath all the goodness you're delivering to customers. Here's my talk with Dr. Harry Ritter, founder and CEO of Alma.

Harry Ritter:

Ross Devor, how are you, sir?

Ross Devor:

Good man, how are you doing?

Harry Ritter:

Now that I see you're the podcast host, I'm better than ever.

Ross Devor:

I didn't know I had to get better headphones. You're showing me up a little bit. This is my first podcast, so clearly I need to up my game. 

Harry Ritter:

You can't have the dangles. That's JB.

Ross Devor:

That's right. There's always room for improvement. That's what we say here at TB. 

Welcome to the podcast, Dr. Harry Ritter. Great to call him a friend and a colleague here in our partnership with Alma. Harry is the founder and CEO of Alma and has been a great partner in this growth journey that Alma is on and continues to thrive. 

Harry Ritter:

Thank you for having me. It's awesome to always spend time with you, Ross, and I'm excited to have this conversation with you and spend this time together.

Ross Devor:

Harry, give us a quick background on yourself and some of your history as a medical professional, and then your focus on the behavioral healthcare space, how you founded Alma? Start us from the beginning, so to speak.

Harry Ritter:

Yeah. Well, it's been a journey that's for sure. I started out with a plan to be a doctor. I went to medical school. I was doing residency. I loved the idea that you could commit your life to helping people, the idea that your life mission could be about enabling healthier, happier lives was deeply resonant for me. It meant a lot that that could be my life mission, but I hadn't found what I wanted to do in clinical medicine. I was young. I've gone through school relatively quickly and I was trying to find that path that was right for me.

And I remember very clearly having this conversation with the program director of the internal medicine program where I was at, Mass General Hospital in Boston. And I was very nervous, I went to talk to him about, you know, what I would do next and I tell him. I said, "I, I haven't found that, that spot in clinical medicine and I don't really know what I'm doing." And he was this very special leader and mentor, I describe him as the human incarnation of Yoda from, uh, Star Wars.

Ross Devor:


Harry Ritter:

And he said, "Uh, we're in the business of building leaders in healthcare and it doesn't matter if in research, in academics, in clinical medicine, in business, as long as you're committed to leadership in healthcare and advancing the field, you have our blessing to figure out what you want to do." So that was what kind of gave me the courage to leave clinical medicine. I worked in Mackenzie for a few years. I found my way to Oscar Health where I was an early medical director, and got to really see that business grow from sub 30, 40 employees to well over 900 by the time I left.

And it was really on that journey that two things happened. One, I was caring from my father. I was a solo caregiver to my dad, who was at the last stage of his life going through that last few years of life where we knew he was on a difficult path, but that was the situation we were in. And then, I was at Oscar where I was seeing a business trying to really reinvent healthcare and simplify the experience, really be much more consumer focused. And I started going on my own mental health journey. I found my own therapist, dealing with the anticipatory grief and anxiety and loneliness that came with being a solo caregiver.

And then, at Oscar, I started to see it from the industry side that mental health was this massive need that nobody wanted to talk about. And so, when we started to build out some of our care delivery business at Oscar, which I was part of doing and we started to create resources for folks who needed mental health, those resources were gobbled up faster than anything else. And that really got me thinking and realizing that as a primary care doctor that's what I'd come out of, you had to start with mental health. Mental well-being, psychological health, that's really where primary care started and there was just this very obvious need to build something in this space that would help people access this care.

And so, that was really the kind of genesis of my interest in mental health as an industry. And obviously, we talk more about how we got to Alma's business model in particular.

Ross Devor:

Sure. So why don't we turn right there, the origin of Alma. Walk us through how you transitioned to starting a business yourself and how you opened thinking about where to start and how to set your company up for growth.

Harry Ritter:

Yeah. So it starts back really when I was at Oscar. I had the opportunity there working with Mario, was an incredible CEO, was an incredible mentor to me, to start thinking about the future of care delivery. We were a health insurance business. We had customers who needed access to care and we started to think about how did we fully facilitate that. And so, I had the opportunity to launch the Oscar Center, which was an integrated primary care and behavioral health clinic, an integrated care model, and our virtual primary care program.

And I saw right there that, first, validated the thesis that there was huge demand. The behavior health provider that we had in that clinic booked out instantaneously when we opened our doors. Uh, the other part that I saw was that the provider landscape was insanely fragmented, unlike medicine where I had come out of where everybody goes and becomes part of a one medical group or a big health system, behavioral was totally different. It was mostly solo practitioners, most of the market was independent, single providers who are some of the most tremendous human beings on the face of this Earth, but don't necessarily get the training or have the infrastructure and support to build a business.

And so, that was the initial problem statement. We thought this is interesting. This is a really big, amazing, thoughtful, caring, compassionate group of, of providers who lack the support they need to succeed in the modern healthcare system. And so, how can we start to do that? And that really was the genesis of the business was trying to build this provider enablement platform that said, "How do we help these clinicians succeed in the modern era?"

We started doing that work, we built, uh, in our initial iteration this membership model that offered practice growth, helping them find patients through our directory. We offered practice management software to manage billing, things like that. Uh, we also offered in our first iteration space, which is an interesting part of our story, but we were sort of a we work for mental healthcare so we had two beautiful facilities in New York where folks could come and find access to space.

And then, we started working on insurance, which we knew was going to be really the big unlock for our business. In fact, I, I remember the day after we opened our doors in midtown Manhattan, we had a meeting with our first insurance payer and started that process of thinking about how can we empower this community that we're building to become part of the insurance system, which is ultimately the critical unlock to think about real access and affordability over time.

Ross Devor:

And tell me more about the nuance there which is important of building in-network care and the importance of working with the insurance providers. I'd love to hear just you explain a little bit about how important that is.

Harry Ritter:

Yeah. It's foundational. If you think about the barriers to access, people often time talk about stigma as a critical barrier. And it is. It's unequivocally a major barrier. It's a particularly big barrier in certain communities that have historically been marginalized. And so, it is a very important barrier, but the true primary barrier is affordability. The ability to pay for care and to have a system to reimburse for care is really the primary limiting factor for most people.

They simply can't afford 150, 200 bucks a week or even for if it's short duration of care, that just becomes an astronomical sum of money for most people. And so, we knew early on that if we really wanted to create system-wide change, we would really have to figure out a way of partnering with payers. And it's really a partnership model. I think it's very important our, our view at Alma is that the payers are critical partners who really have to be engaged from a place of collaboration, of partnership, of win-win mentality to start to solve some of these systemic issues of access in the system.

And that was really exciting to us from the get-go. I think there was always a question how would we get there? And it took some time for us to get there and get those first contracts and, and build the program we've built, but that was always very foundational to, to the mission of simplifying access to affordable care for everybody.

Ross Devor:

And you mentioned this kind of sentiment of win-win, right? And as I think about it, it's not just win-win, it's win-win-win, (laughs) because the patients, the therapists, and the payers all benefit here as I think about it. And importantly, as we think about, well, the money's got to come from somewhere. And you talked about how important it is to find funding for behavioral healthcare. Why do the payers think about this as a win for them and what do you do to help them believe in this kind of value prop and support with their economics, (laughs) this ecosystem and this care?

Harry Ritter:

Yeah. It's a great question. First, just as a starting statement. I think when you think about businesses that really have the opportunity to be resilient and industry changing businesses, they have to be value creating, not value destroying. And I think that's a, a really important, I think, foundational principle, at least that we feel really strongly about at Alma. If you view these transactions or experiences as zero-sum, "I win therefore you lose."

I think it limits your opportunity to truly transform. You have to find that space where you're actually unlocking value that was hidden beneath the surface beforehand. Payers look at the world, and first of all, they have a mission. They have a, a responsibility to their customer to ensure that there's adequate access. That's implicit in the reasons that these businesses exist and I know in interacting with the leaders we work with at these payers that they take that mission very seriously.

They want to ensure that the product they're offering the world is achieving the higher aims of access for the services people need to live healthier, better lives. And so, there is a real sort of moral and mission imperative to improving access. It's also a business imperative. We know that employers, we know that customers of these insurance plans are expecting that these plans will deliver on that access for the members who use those services and that's a critical part of their revenue model.

They have to make sure that their customers feel that they're delivering on the service promise that they have and there's now a governmental imperative as well, right? We've seen through the ACA, the Biden administration now reinforcing some of these laws around mental health parity that as a society, as a country, we expect that people should access these services. So there is an access imperative and what we're saying at Alma is, "Great. We'll help you do that. We'll mobilize these clinicians. We'll bring them together through one technology platform that can expose scheduling APIs, that can make it extremely easy to get fast access to care across a very diverse range of clinicians and will help you solve that access problem."

That's part one. I think there's a second part to it, which is around quality and about ensuring that we're actually moving the industry forward. I think payers rightfully wanna ensure that what they're paying for has impact. It's delivering on outcomes. It's delivering on results. And I think there, again, we offer the payer a really unique opportunity to work with an organization that is partnership focused and can really help to support clinicians in engaging in this future of healthcare in a way that is provider first, that protects the provider, that ensures the provider's interests and needs are met and does that in a way that can actually enable some of the system-wide change we need in the industry.

Ross Devor:

That's really fascinating and in some ways to stand up and deliver on all this need and imperative that you talk about, we're only as good as our therapists, right? And so, talk to me about how you built this community and remain committed to diversity and depth and have driven this provider first approach that kind of resonates throughout Alma.

Harry Ritter:

Yeah. It's a great question. I think one of the early insights for me thinking about mental health and contrasting mental health with other areas of healthcare is that the provider-patient relationship is just so important, right? You're gonna come in as I did, I remember coming in for my first session for therapy and here I am talking about a dying parent and the challenge of he lived in LA, I lived in New York. I was jumping on a plane, flying back and forth, just gotten married, thinking about my obligations to work, to family, to all these pieces of my life.

I couldn't have cared less about the business that sat behind this person in the room. I cared about the person in the room who I needed to build trust with so that I could get into and talk about some of those really deep and intimate and challenging things and make the change I needed to in my life to be the human being that I wanted to be. So that was a really big insight for us early on, right?

The provider is really what matters. They're the one who are doing the hard work and they may be supported by the most beautiful office and the greatest technology and everything else, but if they're not centered, everything falls apart. And so, that was really foundational to our model.

I also think, frankly, in healthcare, we often times race to talk about the consumer or the payer or the employer, all of whom are critical stakeholders, but we oftentimes have a tendency to forget the provider and forget that the provider is ultimately the essential ingredient to making things better.

And so, that's been our focus at all is really saying, "How can we help providers believing that when providers have the support they need, the system gets better for everybody?" 10x more than it would if you start someplace else.

Ross Devor:

That's really helpful. I can only add to the personal background here thinking through a couple times that I've interacted with therapists and one that I don't mind talking about is for the therapy, before you walk down the aisle to get married, took us three times for my wife and I to find the right therapists and each time, we were calling and leaving voicemails. Are you available? And tell me again about your specialty and your background.

And of course, every session was pen and paper and it was hard to draw the line between the dots on, hey, what were we talking about last time? And what one of the themes that we needed to fixed (laughs) here so I just remember... Oh, and by the way, this was in some basement of a Lower East Side single practitioner facility, which God bless her, was what she had to do in New York City to provide care, but just all of those things around providing digital tools and expanding access and meeting you and hearing you talk about the value prop and the platform and the tools, it just, it, it clicked very easily for me on just the importance of what you were building and having lived a small fraction of it, but just thinking about folks who need care and how widespread that need is and all of the different benefits that your platform brings. Thank you for improving this. I can say personally-

Harry Ritter:

Thank you for helping us. (laughs)

Ross Devor:

... from experience in the space. (laughs)

Harry Ritter:

Thank you for helping us. (laughs) We've been very lucky to have great partners across the life of the company, and perhaps none more so than you. Thank you for helping us build it.

Ross Devor:

Harry, let's go back to the early days of trying to make this investment happen and why don't you talk through from your perspective of meeting me and Thoma Bravo Growth and beginnings of working together.

Harry Ritter:

Yeah. That's interesting. I often times joke about this, Ross. You're actually one of the investors that I've spent the least amount of time with in-person and you have been more instrumental in the funding of this business than perhaps anyone else and that's frankly a byproduct of COVID, of the pandemic, right?

I, I remember the earliest days of us getting to know each other back before Thoma Bravo, right? When we were starting to get to know each other at Insight, and those were COVID days. Those were days when I actually remember our first meeting was at my CFO's house, Chris Davis, out in Long Island.

Ross Devor:

That's right.

Harry Ritter:

And it was in the backyard.

Ross Devor:

COVID safe.

Harry Ritter:

COVID safe. (laughs)

Ross Devor:

Six feet or more apart.

Harry Ritter:

Yeah. And this was after we had done some work together and I looked, I was like, "Wow. Ross, you're taller than I thought you were gonna be." (laughing)

Ross Devor:

Right. (laughs)

Harry Ritter:

But I do think it speaks to an important element of the relationship building when you're a founder and you're thinking about who's gonna sit around the table with you as you grow the business. When we went to do our Series D, we had been in touch for a while before that had happened and I knew you and I trusted you. I knew that I wanted to do business with you and I remember we had that conversation where I said, "Hey, Ross, we're gonna raise and I'd love to do this again with you."

And that trust, just knowing who you're working with, the ethics, the, uh, alignment in terms of vision and values, really made it easy. And obviously, Thoma Bravo is an incredible firm, comes with an incredible reputation for really building excellent businesses and supporting those businesses in highly, thoughtful, and effective ways.

And so, the combination of getting to work with someone who I knew and trusted and new would be aligned to the values that we wanted to bring to the business, combined with the fact that it was coming out of a platform that was really best in class in terms of building businesses at the scale that we were now starting to achieve as a, as an organization I think was really a no-brainer for us.

Ross Devor:

So let's talk a little bit about the partnership so far. And, you know, look the partnership here started in the summer of '22. What a market? What a time to, to strike a deal? But since then, so much activity and growth and success for the company and for you, in particular, but also a new world to operate and to grow a growth company in.

And so, really interested for how you have thought about working together to grow the business, but also how you've thought about growing the business in this new world we're living in post the inflation and interest rate work that our fed has done and how young companies have dealt with that.

Harry Ritter:

It's definitely been an interesting few years to lead a venture-backed company. It's been definitely a tumultuous (laughs) set of years. But I think I credit you with a lot of this. I think our mentality at Alma has always been build a great business and the market's the market. The market will go up, the market will come down, obviously, there are moments when it matters a lot, because you have to raise capital or, or do a transaction.

And so, that can be a dispositive moment in time, but the purpose is to build a great business. And that means whether it's 2020 or 2023, finding the appropriate balance between growth, between profitability, never swinging the pendulum too far in any direction just because the market is a certain way, but really staying focused on underlying profitability, unit economics, quality of revenue, quality of experience for your customer.

And if you can keep delivering on that, the market will do what the market will do, but you're gonna build something that's really special and fundamentally rewarding for yourself, for your stakeholders, for your shareholders over time. So I think that's been our mentality. I think I credit you with that in large part. You've helped us stay focused on that, but we were very fortunate to be able to do that investment with you.

I think it helped us enter this period with the ability to really stay focused. We've been very fortunate because our industry where we are, we've been able to really execute on plan and continue to, to meet goal and exceed goal month over month, quarter over quarter. And I think that's been incredibly helpful to be able to know we have the balance sheet to do that, and to do that effectively and deliver for our customer.

And I think what we're doing now, and again, I think this is part of the value of Thoma Bravo is just thinking about what does it mean to be a mature business at this level of scale? How do we make sure that we are continuing to uplevel the experience for our providers, we're continuing to uplevel the quality of the product, and we're doing that while building the underlying foundations of just a fantastic business when it comes to how we build teams, build culture, uh, think about our financial health, and, and build towards that long-term profitability and, and, and sustainability of the enterprise. So I think that's been really the approach, it's stay focused on the core of just building a great business.

Ross Devor:

I just, I give you a lot of credit, because like you said this has been such a volatile time and to run a startup has been no easy feat in any times, but particularly one where the world's changing so fast and your embrace of we can do both. We can be entirely customer and provider focused and think about all of the things that we need to do to expand our value prop and to just expand the reach of the business while never losing sight of what are the underlying metrics and numbers that we all believe speak a language of business strength and remaining just a preeminent unit economic business while growing so fast, while also building great products, and delivering to so many patients out there in need has just really been an exceptional story to be part of in our small way here.

And I think has really just been really rewarding for me to work with somebody who, like us, wants to do both. (laughs) And, and that's really the hallmark here for us in Thoma Bravo Growth and Alma embodies that in so many ways.

Harry Ritter:

I appreciate you saying that. It's interesting to me, people oftentimes will ask this question about how do you think about profitability, growth, these various factors? And my common note is always that when you're building a business that is growing at the velocity that we are and trying to accomplish what we hope to accomplish as our ambition, you're driving a race car.

And so, what that means is small adjustments to the steering wheel can have a pretty big impact. And I, I found that a lot of what we've done and I think about, Ross, conversations you and I have had month over month, quarter over quarter, year over year thinking about budgets and plans is really those calibrations, right? Where you're not swinging the pendulum, because if you do, you can really drive that car right off the racetrack.

You're trying to find that balance. It's one of the hardest parts I think, frankly, of running a, a growth stage business is trying to find that balance, but when you have good alignment around the table and helpful advisors like all of you to help us with that, it makes a big difference.

Ross Devor:

It's great to hear. Why don't we turn to the future and give you the chance to talk about what has you excited about how the platform is growing, how Alma is growing, and how you will expand your value prop and services in the future?

Harry Ritter:

I think It ultimately roots back down to the mission. Our mission as an organization is simple access to affordable quality healthcare for everyone, and I think that's really where we wanna keep our ship pointed and focused over the course of the next few years. I think we've done incredible work in the last few years to dramatically expand access. We've been able to build a really robust community of providers available in all 50 states that are offering in-network services across a whole host of insurance plans and that's incredible and exciting.

There's work for us to be done I think in three main areas. One, continuing that access story. There are still far too many Americans today who are unable to find care that works for them, because either it's not covered by their insurance plan or the kind of provider they need is not available to them or the cost of that care is out of reach.

And so, that remains I think a very big focus for us as an organizations. How do we work with our payer partners, new and existing, to continue to expand the aperture of access for folks who need it? A second big focus for us is on quality. We are really at a foundational change moment in mental healthcare, where providers who historically were these islands totally disconnected from one another are now coming together and getting to access technology and support services that can really take us to the next level when we think about the role mental health ought to play in healthcare and health and wellness overall.

And so, we view it is our responsibility to really work with our providers and advocate for our providers in that journey and in ensuring that we are really bringing mental health out from the fringes to a, a seat at a table as we think about the future of quality. And then, I think the third part we think a lot about is our providers. What else and what, how else can we show up to support them? What are the other ways that we can make sure that they have the tools, the resources, the infrastructure they need to build financially rewarding practices while at the same time building a life for themselves and for their families that meets their own personal aspirations and goals?

And so, I think that's a third Focus area for us is just thinking about where else and how else can we show up for these clinicians who are doing this critical work at the front lines of what remains a massive challenge in our country around mental healthcare and mental health access?

Ross Devor:

Let's think about Alma in the future Harry, and think about three, five, 10 years down the road. What does Alma look like to you and what has changed and what has it become from where it is today?

Harry Ritter:

So I'll give you the answer that I give to this question, I do... Welcome to Alma for all of our new employees that join and folks will oftentimes ask me this question. So what's Alma gonna be like in five, 10 years? And I get, I think at this point the chance to say something that I love saying which is, "I don't know. You tell me to our team, right?" Because that's actually the beauty of I think where we are as an organization.

We, we know that what we will be doing in five to 10 years will be centered on our mission, on simplifying access to affordable quality mental healthcare. We know that in five to 10 years that means that we will be supporting more providers and more ways to achieve that mission. And from that level, our ambition at Alma is to ensure that Alma is the operating system for behavioral health across the country that every provider who is delivering quality services is part of the ecosystem that we've built in some fashion or form in a way that's helping them succeed in the work that they do. But what we will build, how we will do that, the specific products and services I think are really up to the team and I think that's actually why I hope folks are excited to come work at Alma.

This is an opportunity to not just execute on an action that is sent to you from above, but to really think proactively, originally, creatively about what and how we build the products and services that will enable clinicians in the future to have the level of impact on our healthcare system but I think more broadly on society that we, we wanna see happen.

So sometimes people want a specific, more specific, uh, detailed product, five year, 10 year product road map, but I, I think that, that's actually the, the fun part is getting to turn around back to the team and, and, and the organization and say, "Here's the mission, here's some of the things we know to be true around our commitment to our providers, you tell us how are we going to make that happen."

Ross Devor:

And I can't help but ask, this is the topic of the day for almost all technology companies, what does the rise of generative AI and AI tools mean for Alma and how you help drive care for your patients and the tools you provide your therapists?

Harry Ritter:

I think it's been fascinating to watch the conversation on generative AI in the last year. The interesting part about AI in my point of view is it's not new. We've been talking about machine learning and we've been talking about AI for well over a decade. The crazy thing that happened is it started talking to us and that's what's opened our eyes I think up, right? In a way that folks are putting a lot more attention on this area and, and rightfully so.

I think this does have the opportunity to transform how businesses work and how we serve customers. To me, it really falls into two broad buckets. The first is how can we harness the power of these tools to do our job for our customer, for our providers. What are the ways that these tools can make their lives easier, can make their work more impactful, and how can we as an organization harness the power and leverage of Alma to bring that to market to advance provides needs and client care, patient care in a way that's gonna make their lives and the work that they do better and more impactful?

I think the second big part, frankly, is thinking about how you run businesses. There's opportunities to think about how we think about our, our data, how we think about our internal processes, how we build great high functioning organizations that are inclusive, that are equitable using these tools. And so, I think that's the second major application is really looking inward at how organizations are built, designed, operate, and identifying not just efficiency gains, but really better ways of doing business. And I think that's a really exciting area that we're really focused on at Alma so that we can build...

I said this to the company the other day. I think building products is oftentimes easier than building great organizations, and great organizations over decades can create many great products. Think about a company like Apple, right? Started out building things that are look very different than the things they build today. The products can change but organizational excellence is really the foundation stone for future innovation. So that's a really big focus for us when we think about how these tools come to have an impact on Alma.

Ross Devor:

You mentioned something that I specifically wanted to touch on, which was not only are you getting bigger as a company, not only do you have great products, but you have an amazing culture at Alma. And you're consistently one of the top ranked places to work and I know just talking about when you have an open physician or an open executive search, (laughs) how many resumes and applications you get, it's just such an exciting culture that you've built and really unique. Touch on how you have grown rapidly, but also focused on culture and built a unique one at Alma.

Harry Ritter:

It's a great question. I, I have to be honest and say from a place of humility, sometimes I don't know. (laughs) It's really, it's something I look at with, with a great deal of gratitude, right? The way that the company has taken ownership of that culture. I can't promise that I know all the answers to how we've done this so well. What I will tell you is the way I've thought about it, at least, is early days in a company, culture is people driven.

You hire people who are values aligned. You don't necessarily have a checklist of what those values are, but you, there's kindred values that come together. And there are certain key ambassadors of those values. So if I look at our leadership team today and I point to the different members of our leadership group, those are the people who have been those champions and have really held on to those culture norms that have helped us in the early years, but then there comes this moment when you have to flip the switch and acknowledge that people can't scale, you have to scale to something else and that's really when, what, what we've tried to focus on is almost is a flip from people to a values driven culture.

And what we've tried to do there is really be very intentional about articulating our values and then living those values. As an example in our interview process when you join Alma, every candidate regardless of role goes through a values interview and we have a values' ambassador program where we train employees to conduct these interviews. The worst thing you can do is look at culture fit, right? Because that can ultimately, and oftentimes be frankly a, a way of actually creating a, a not inclusive or not diverse culture.

So if you really focus on values, that I think has been really critical to us. And I think having a strong values culture, and then just making sure that you're holding yourself at the leadership level accountable because ultimately setting the right example I think is critical, and hopefully, we've done a good job of that at all.

Ross Devor:

Yeah. And look, as much as you might not want to admit it, I think culture starts at the top, and your embrace of those values and the values first approach to building teams, building company culture, I think continues to be just super, super impressive. I know it's no easy feat. And so, continue to be awed by the company that Alma is and that you continue to build and very appreciative of our friendship and the ability to be on this journey with you.

We wanna thank, Dr. Harry Ritter for coming on Behind the Deal and being part of this. This was fun.

Harry Ritter:

Thank you for having me. This was fantastic. Always awesome to get time with you Ross and will echo what I said earlier, which is it takes a village and you have been one of our, (laughs) our most important villagers. So thank you for being part of this journey with us.

Ross Devor:

It was really fun to have Harry Ritter from Alma on this episode of Behind the Deal. And a big thanks to him for coming on and giving us such a great conversation. If you wanna learn more about Alma, visit helloalma.com. And if you like this episode, tune in to our new miniseries, Beyond the Deal. That video episode will have bonus content from me and Harry today that we didn't have time to share with you. You'll find it on this feed soon with full video of the interview available on YouTube now.

For more stories that go Behind the Deal, check out all of our episodes wherever you get your podcast and subscribe to Behind the Deal for all of our newest episodes. I'm Ross Devor, thanks for joining us.

Orlando Bravo:

Thoma Bravo's Behind the Deal is produced by Thoma Bravo, in partnership with Pod People. Stay tuned for more stories Behind the Deal. I'm Orlando Bravo. Thanks for listening.


Certain statements about Thoma Bravo made by portfolio company executives are intended to illustrate Thoma Bravo's business relationship with such persons rather than Thoma Bravo's capabilities or expertise with respect to investment advisory services. Portfolio company executives were not compensated in connection with their podcast participation, although they generally receive compensation and investment opportunities in connection with their portfolio company roles, and in certain cases are also owners of portfolio company securities and/or investors in Thoma Bravo funds. Such compensation and investments subject podcast participants to potential conflicts of interest.

Certain statements about Thoma Bravo made by portfolio company executives are intended to illustrate Thoma Bravo's business relationship with such persons rather than Thoma Bravo's capabilities or expertise with respect to investment advisory services. Portfolio company executives were not compensated in connection with their podcast participation, although they generally receive compensation and investment opportunities in connection with their portfolio company roles, and in certain cases are also owners of portfolio company securities and/or investors in Thoma Bravo funds. Such compensation and investments subject podcast participants to potential conflicts of interest.