Larry and Sergey. Jobs and Wozniak. Bill and Dave. Startup lore is riddled with stories of co-founder duos, always with at least one being the techie.
Much less common are founders like Dr. Harry Ritter — non-technical folks tackling the startup journey as a solo founder.
His company, Alma, is a membership-based network that helps independent mental health care providers grow their private practices and makes therapy more accessible. In August 2022, Alma raised $130 million in Series D funding after tripling its provider network to 8,000 therapists in 50 states.
But the product looks very different today than at launch in 2018. As so often happens for early-stage companies, Alma’s path to product-market fit was paved with obstacles—and one major pandemic-driven pivot. To understand Alma’s transformation, we must first understand Ritter’s, beginning with his introduction to the importance of mental health.
DIAGNOSING THE PROBLEM
It all began in 2011. As a newly minted M.D., Ritter was going through his residency at a primary care program in Internal Medicine at Massachusetts General Hospital in Boston, where he and his colleagues treated ailments like broken bones and asthma flare-ups. “And yet we were very, very uncomfortable with mental health,” he recalls. “It wasn't something that we really learned about or approached.”
It was around this time that Ritter also became the sole caregiver for his father. “Dealing with such a challenging and traumatic moment in my life, of being a solo caregiver for someone, that was when I started to see how mental health could really have this huge impact on me personally,” he says.
To process the loneliness and anxiety of caring for an ailing loved one, Ritter went to therapy. “It had this really transformative impact on my life. That was what opened my mind to this space. That’s when I thought, ‘This is a huge problem I want to solve.’”
Mental health is something that we don't talk enough about in conventional healthcare. I knew that if we could figure out solutions for people like me, we could do something powerful for other people too.
The seed for this future startup idea was planted, but it wouldn’t bear fruit for a few more years. It was now 2013, and Ritter had moved on to health insurance company Oscar, where he worked as a medical director at an integrated primary care and mental health clinic, the Oscar Center. In many ways, this job served as an incubator where his vague startup idea began to take shape.
“I was spending time in the community, and I was in the room with these providers and trying to make referrals out to mental health care specialists,” he says. “That was where I evolved from the broad idea of ‘I want to do something in mental health,’ to distilling down to a unique approach to the space that I thought could be impactful. I wanted to start a company that focused on the providers, the provider needs and the unique provider challenges that existed in the industry.”
The biggest challenge Ritter identified in the mental health industry? Therapists lacked access to the tools and community they needed to build thriving businesses. Unlike his med school peers who went on to work for large health systems with plentiful resources, mental health care providers, Ritter soon noticed, had a very different path.
“Whenever I called a therapist’s office to make a referral, it wasn't some big brand or big company with lots of resources. It was just one provider as a solopreneur, and they were trying to figure out all the administrative tasks and all the things that come with running a business. That was when I realized that we have these incredible humans who don't have the business skills, the support or the technology they need to meet this surge in demand for mental health services,” says Ritter.
So, he spotted an opportunity to create a product that relieved the burden so therapists could focus less on the administrative tasks, and more on providing high-quality care to clients.
VALIDATING THE IDEA
In his work as an M.D., Ritter had been both a referrer and, in his personal life, a client of mental health services, and these dual experiences sparked the idea of creating a solution for independent providers. But before he could build a solution, he needed to validate that initial hunch by gathering perspectives from the providers themselves.
Here are his two tips for getting the most out of these early conversations.
1. Standardize your customer interviews to prevent bias.
While at Oscar, Ritter started tapping his network to get introduced to some therapists for initial conversations. But he didn’t just wing it—he created interview guides that standardized the conversation with the same ten questions across the board. By standardizing the interview guide, Ritter aimed to avoid swaying his questions to confirm his own bias about the solution he wanted to build. At the end of each conversation (Ritter spoke to around 50 therapists total), he asked to be connected with three more therapists.
Ritter approached these initial customer interviews with all the precision of a physician attempting to diagnose a patient. “Those guides were built on some of the interviewing skills that I had from medical school. When you're trying to diagnose someone, you're supposed to combine both narrow questions and open-ended questions.”
Narrow questions. These types of questions grant you a structured data set you can use to think about what comes next. For example, “What application are you using for finding new patients?”
Open-ended questions. These let you capture information you may not have thought to ask. One open-ended question Ritter asked was, “What are the biggest challenges that you face in your private practice today?”
If you want to get to the core of the customer’s pain point, be sure to start and end with an open-ended question.
And don’t be surprised if interview subjects tend to save the best for last. “In the beginning of an interview, the focus was much more on the superficial or the transactional. It was only after they'd had enough time to really reflect on what they actually needed that the key insights would emerge,” says Ritter.
2. Allow yourself to be surprised.
As Ritter continued his interviews with therapists, he started to gain a better idea of the solution he thought he should create: one that focused on a therapist’s business needs, such as making it easier to find customers, process insurance claims and make money. But when he reviewed the qualitative data set he’d gathered from their answers, he unearthed an unexpected insight.
“The one consistent theme that I hadn't thought about was loneliness as solo providers,” Ritter says. “These therapists were saying, ‘I'm out there every day with my patients, trying to help them get better. And yet I'm really lonely. Where's my community? Where's my support infrastructure?’ So that became really core to our business. Alma’s emphasis on community and connection really came out of that insight that I hadn’t expected going into those interviews.”
This surprising finding led to a key feature of the Alma product: In addition to fulfilling the practical needs of providers, it would provide the psychological component of community.
“Yes, therapists need to be there for their clients,” says Ritter, “but these providers also need someone to be there for them too. That’s why Alma brings in the community and tools to support providers on their career journey.”
TO BE (OR NOT TO BE) A SOLO FOUNDER
The startup world doesn’t always feel friendly to solo founders. Even Y Combinator’s FAQ page states, “Our advice remains that one-person startups are tough and you're more likely to succeed with a co-founder.” That doesn’t exactly inspire confidence.
So what advice does Ritter, who now sits at the helm of a company he founded alone, have to offer? Here are two questions to help you decide if you should find a co-founder or fly solo.
1. Is there an obvious potential co-founder with whom you deeply connect?
For Ritter, founding Alma on his own was not so much an active choice as something that just happened.
“There just wasn't someone obvious that I should start the business with,” he shares. “For many people who I've seen be successful as co-founders, they're just perfect for each other. They were designed to start this business together. They work well together, riff off of each other. There's a real, deep partnership that existed before the company was formed. And I just didn't have that going into the project. Instead of focusing on, ‘Who should I work with?’ I got to hone in on ‘What's the problem?’”
Start with a co-founder if there's someone that you simply can't imagine starting the business without.
2. What are your strengths, and what are the gaps that someone else will need to fill?
“The most important thing to understand is—regardless of whether it's founders, co-founders or early team members—you need to know who you are and what you can do well,” says Ritter. “And based on the business you're trying to build, list the key capabilities that you can't live without. Then build the team to do that.”
Even if you lack an essential skill, such as product and engineering, that does not necessarily mean you need a co-founder. Consider making that person a key hire later on.
As a physician, Ritter’s strength lay in building relationships and thinking about the systems of care Alma would need to build. What he didn’t have, however, was the technical expertise.
“I knew I needed to find a really strong product and engineering partner who could help me think about that side of the business.” So that was Alma’s first key hire: Chief Technology Officer Nick Thuesen, who still serves as the company’s CTO today. “We met at a coffee shop down in Flatiron,” recalls Ritter. “It was sort of love at first sight, and we knew it was the right fit.”
The second key hire was Head of Community & Operations Nina Roth, whom Ritter had known from his Oscar days. With his core team assembled, he was ready to build.
FINDING PRODUCT-MARKET FIT THE FIRST TIME
Drawing from the insights from his dozens of interviews with therapists, the first version of Alma’s product focused on becoming a business partner by helping providers build their practice. The biggest jobs to be done were creating a communal shared space and simple-to-use technology to find and manage their clients. To tackle these pain points, Alma focused on two key components:
To solve the loneliness problem, Alma provided a physical space in New York for providers to socialize with their community of fellow therapists and a place to host therapy sessions with clients. “Providers would have access to a physical space where they can provide care, but we wanted to also bring in a communal element so being a solo practitioner wouldn’t feel so isolating,” says Ritter.
Before even officially launching, Alma started hosting bi-monthly dinners in the location so providers could start connecting with one another before the space officially opened.
In the first several months, the Alma staff actually moved their offices into the space so team members could share meals and connect with the very customers they were serving. Even when they eventually moved out, they transferred to a floor below to remain in close proximity to their members.
To help therapists grow their practice, as well as make therapy more accessible to the public, Alma also had a provider directory and client matching service to help find and manage clients.
Alma also had early billing tools to help therapists accept cash-pay clients. But the ultimate goal? Make it easy for providers to process insurance claims so patients could receive therapy at a reduced rate, which would rely on Alma signing contracts with insurance providers further down the line. (Alma does not take a cut of therapists’ cash-pay fees; instead, it charges a monthly membership fee for access to its tools and support.)
On October 10, 2018, Alma opened the doors to its Midtown Manhattan co-practicing space, complete with a waiting area, 16 therapy rooms, a lounge for providers and meditation pods for patients.
“Launch day for any new product is terrifying because you've spent all this time and energy building this thing, and you have no idea what people are going to say,” Ritter shares. “It's a very nerve-wracking experience. I remember telling the team that if all Alma ever ended up accomplishing was helping that first group of people have a really great therapy experience—that would be worth everything.”
As he watched providers and patients file into the space, some filling their mugs with a hot beverage from the tea bar, Ritter witnessed everything he had worked for in the past several years click into place. “Okay,” he thought. “This thing is going to work.”
FINDING PRODUCT-MARKET FIT A SECOND TIME
After that initial launch, Alma started to grow steadily by word-of-mouth and its Midtown space was packed to the brim. So in the Fall of 2019, the company opened up its second community space in downtown Brooklyn, which was quickly gaining traction. The company also signed its first insurance contract, on the path toward making therapy more accessible to all sorts of folks. But just a couple of months later, COVID-19 would crater the company’s in-person, communal focus — and necessitate a huge pivot.
Losing 70% Of Revenue In One Weekend
“I remember so clearly walking into the community space in our Midtown location. That day in February 2020 felt like any other day: Providers were there, they were seeing patients, no one wore masks back then—it wasn't even a concept. I was standing in the lounge listening to some of the providers talking, and all of a sudden, I picked up on everybody talking about the same thing, which was, ‘Tomorrow is our last day. We're not coming in anymore.’”
No, Alma wasn’t closing its doors, and the government hadn’t yet issued stay-at-home orders. The providers, sensing that the spread of Covid was going to get worse, had decided among themselves to stop coming into the co-practicing space.
“Sure enough,” recalls Ritter, “Monday morning, everybody was gone.”
And just like that, 70% of Alma’s revenue disappeared in one weekend. In the year and a half after launching, Alma had found its market, but the market had changed almost overnight. With its main source of revenue gone, Alma had to pivot—and fast.
In the darkness of those early days of the pandemic, Ritter saw a glimmer of opportunity: “If we're all about to go into lockdown, and we're about to experience all of the challenges that are about to come with this emerging pandemic, mental health is only going to matter more. And moreover, these small business owners who struggled to figure out how to run a business during normal times—how much more are they going to need us to show up for them now that things are getting even harder?”
Alma Product V2
Alma’s mission was now more important than ever; how it was carried out would just need to look different. For V2, the company focused on two key components:
Prior to this, only 5% of Alma members had been offering virtual care. Now, because of the pandemic, 100% had to. To help providers bring their practices online, Alma focused on providing tools such as HIPAA-compliant conferencing for teletherapy sessions.
Insurance can be a huge hurdle to therapy. While therapists may want to accept insurance, doing so is often such a headache that they only accept cash payment. At the end of 2019, Alma started acquiring its first insurance partnerships, so the silver lining of 2020 was that the company was finally ready to launch its insurance program.
“We were pivoting out of in-person and into virtual and at the same time, we were introducing what would ultimately become a transformative part of the business: a new way to make care affordable for the end client,” says Ritter.
PANDEMIC TRACTION AND SERIES B FUNDING
Even so, Ritter still had to face shaken stakeholders in a series of board meetings every two weeks for a six-week period. “The first two were the worst board meetings I've ever had in my career as a CEO because we were trying to figure out what to do, and I wasn't so sure.”
By Ritter’s own admission, from an outside perspective, things looked bad. “You've got a company that has millions of dollars of real estate in New York City, the most deeply impacted city, maybe in the world at the time, from Covid.”
What was he supposed to tell investors?
Thanks to his CTO’s early suggestion of investing in infrastructure and visualization tools, Ritter had his answer. He drilled down into segments from data analytics platform Looker to prove to investors that Alma still had a fighting chance.
If you looked beyond the decreased revenue, there were signs of hope: a spike in providers joining Alma to access its virtual support services and insurance program, plus promising early metrics around growth velocity, retention, close rates, time to sale, utilization and customer satisfaction. These early insights were gleaned from a fraction of Alma’s previous customer numbers (maybe 20 providers in that segment), but it told a compelling story: Customers were quickly seeing the value prop of Alma’s product, and once they signed up, they were immediately using those tools to scale up their practices.
It was enough to convince investors at the third board meeting. “That was the change moment where everybody in the room said, ‘All right. If you believe in it, you're willing to do it, and you've got this data that seems to make sense, let's see what’s going to happen.’”
As the pandemic wore on, Alma started to see another promising piece of data: website traffic from people looking for therapy was skyrocketing. The company was now successfully facilitating providers’ shift to virtual care, partnering with insurance companies to reimburse teletherapy sessions and meeting a surge in demand for mental health services. Alma had, once again, found product-market fit.
(RE)BUILDING THE TEAM
Faced with looming lease obligations, an unstable economy and a world in disarray, Ritter had to make some tough calls. The company underwent a reduction in force, but as the business bounced back, Ritter needed to rebuild his team. He focused on hiring in sales and marketing to grow the provider and client base, and product and engineering to continue building the technology.
While Alma had always been based in New York City, Ritter realized, “There's no way we can grow this quickly without becoming remote first.” So the company started accepting applications from all over the country. Today, Alma has over 450 team members in 30 states.
THE PATH FORWARD
After the challenges of early 2020, Alma rallied through spring and summer. In February 2021, the company came back stronger than ever, closing a Series B of $28 million, eventually followed by C and D rounds—bringing Alma's total funding to $220.5 million. Today, Alma’s providers are licensed to practice in all 50 states, up from 1 state in February 2020.
So, what’s next?
It really goes back to the same question we asked at the very beginning: What job does our customer need us to do to help them achieve their goals?
Three main charters come to Ritter’s mind:
1. Continue to grow the community. While Alma’s physical spaces no longer exist, its community is constantly growing with virtual events, such as a discussion session for providers with disabilities and a town hall where members can chat with Ritter. Going forward, there will be a focus on reviving local, in-person experiences as well.
2. Improving quality and access. “How can we use new technology and the power of community to improve quality and access to behavioral treatment?” asks Ritter.
3. Add in advocacy. Coming from a primary care background, Ritter points out that advocating for mental health care providers is critical for Alma: “There's just so much more that we must do to support these clinicians to make sure that behavioral health can have all the impact it deserves.”
Entrepreneurs often build a business that solves a problem near to their heart. For Ritter, his life-changing experience in therapy is an obvious throughline to the purpose Alma serves today. But look more closely, and there’s another thread: This solo founder whose first therapy session stemmed from loneliness as his father’s sole caregiver, ended up creating a company that tackles loneliness for independent mental health professionals by providing the support and community they crave.
It’s a story that gives hope to anyone starting a venture on their own. From validating his idea by interviewing therapists at the Oscar Center, to moving into a shared office space with Alma’s first members—Ritter has shown time and again that, even as a solo founder, you’re never truly alone if you keep your community close, and your customers closer.