Finding product-market fit twice — Alma’s Harry Ritter on pivots and staying close to customers

it's amazing how far Alma has come over the last five years. And I know just a few weeks ago, you announced your series D funding round 130 million round. I believe after onboarding over 8,000 therapists onto your platform. And now in all 50 states. So incredible progress for Alma.

 But this episode, as you know, is largely about how you unlocked product market fit at the very beginning of your journey. And so I'm excited to go really deep into the early days. So let's rewind back to 2017. How did you come up with the original idea for Alma?

 I think like many founders. The original idea for Alma was really born out of personal experience. I was a resident. I was training to do primary care at an amazing program up in Boston and learning all about how you take care of people in some of the most acute settings in the world.

And yet in my primary care clinic, Very very uncomfortable with mental health. It wasn't something that we really learned about or, or approached. But around that time started, uh, taking care of my father as a solo caregiver and going through that process of dealing with what was, you know, really challenging and traumatic moment in my life of, uh, being a solo caregiver for someone.

And, and that was really this aha moment when I, I started to see, wow, how mental health could really have this huge impact on my life. I found my way to therapist. It had this just really transformative impact on my life. And so that really was what opened my mind to this space and said, This is a huge problem.

Mental health is something that, you know, we, we don't talk enough about in primary care. We don't talk enough about in conventional healthcare. And if we can fix this, if we can figure out solutions for people like me, we can do something really, really powerful. So that was really the initial starting place for me.

 And so, and of course, mental health, you know, such a big problem, such a big area and growing area. The specific idea for, for Alma. Did you sort of have that in mind very early on? Or how did you go from the inspiration to the idea?

 So I knew that I wanted to do something in the mental health space. I knew that as an industry, it was this massive opportunity I thought, I think, and I continue to believe that it was the single most impactful thing you could do to transform, not just healthcare, but society at RIT large, but it's always a question when you're starting a company, you know, what's gonna be your entry point.

What's gonna be your angle. Unique contribution. Can you make, uh, for me, I was a clinician, so it felt very natural for me to go to my people, which were the providers in the space and spend time with them and getting to know their issues. And at the time I was working at Oscar health where I had an opportunity to open up the Oscar center.

It was an integrated primary care and mental health clinic. And so I was really like in the room with these providers and trying to make referrals out to these providers and spending time in the community. And so that was really where. From the broad idea of, I wanna do something in mental health. I started to kind of distill out a, a unique approach to the space that I thought could be impactful.

Where as a company, we could really focus on the providers, the provider needs the unique provider challenges that existed in the industry.

 And what were some of those challenges that you had identified early on with providers?

 Well, the big thing with providers in mental health, which is so interesting and so different from the rest of healthcare is that it's primarily an industry of independent. So practitioners. So if you look at, you know, my colleagues from medical school, almost every one of them went to go work at a big large health system or a large employed private practice, like a one medical group or things like that.

Behavioral health. You know, we were in the clinic and we were trying to make these referrals to clinicians of the community. You'd call these providers up and it wasn't, you know, some big brand or some big company. It was that person as a solo prep printer, uh, a single business, a small business owner, and they were trying to figure out.

How they made all of this come together in a business, out of, out of their profession. And so that was really the big kind of aha moment. When I realized here you have these incredible humans who don't have the business skill, the support, the technology they need to, uh, really meet this surgeon demand for, for mental health services.

 And so, you know, speaking of solo entrepreneurs, I, I know that you were a solo founder, right? And so you had the idea for Alma. Um, it was sometimes what we see is, you know, a couple of founders who start together. And sort of come up with the idea together, yours, you know, you were solo, but you had the idea.

 I think the main reason wasn't that there's just, wasn't someone obvious that I had to start the business with. I think that for many people who I've seen really be successful as co-founders. They're just perfect for each other. Right? they were designed to start this business together.

They work well together, riff off of each other. There's a real deep partnership that preexisted the company. And I just didn't have that going into, into the project. So had I found someone along the way, I think, uh, that might have been different, but for me, I was much more interested in what was the problem that I could solve.

And then. Understanding that the problem you choose to solve might also impact who the right people are that you need to bring to the table. So I just, that was my kind of experience there just wasn't that person at the beginning. And I, I got to start from the other side of it, which was what's the problem.

 Yeah. And you mentioned your background a little, it it's a super interesting background, not only as a physician, but also law school. You know, I know you're an alum of Oscar health, you know, as you were thinking about who should I bring onto this team to work with me, or what are the areas that I need to learn, that it will be new for me?

 I think the first thing, and I've seen this talked about a lot more recently than maybe it has in the past, but, you know, I think the most important thing you can do, if you wanna start a company to try to understand what you have as your ability and what you need is to work at a company first. And to have that experience, I think being at Oscar was such a huge part of how I developed as a leader and also what gave me.

Enough of an understanding of all those other parts of the business that you have to bring together to be successful and to make the business work well, I knew for me, my core, my strength was, you know, really came from what I was, which was a clinician understanding how to build relationships, think about the systems of care that we needed to build.

I needed to find a really strong. Product and engineering co-partner, who could really help me think about that side of the business. And so, you know, that was really our first key hire was our CTO was still our CTO today. Nick Thon, we met at a coffee shop down in flat iron. It was sort of love at first sight and we knew it was the right fit.

Um, but I knew from what I had seen at Oscar, that that was the piece that I, I simply couldn't build myself. I had to have a really strong leader to, to do that with me. And, and, and that was really what helped me find that, that first.

 Makes sense. What advice would you have for founders who are considering going kind of the solo founder route versus the co-founder.

 I think that 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, what you can do well. And based upon the business, you're trying to build what those key capabilities will be, that you can't live without and build the team to do that.

Um, if you're starting with a co-founder, because there's someone that you simply can't imagine starting the business without. That's a different story, but if you have an idea for what you wanna build and you start to understand the shape of that idea and you understand you're well enough, hopefully through experience that you've had as an operator in some capacity, um, you gotta kind of think about what are those key things.

I think product and engineering, if you wanna build anything, a venture is gonna be one of those things. So it's either you or the other person. Um, but outside of that, it really depends on the business and, and what those kind of key things are that you're gonna, you're gonna wanna bring to the table.

 Cool. Okay. So let's get to customer discovery, customer validation. This is an area that I'm always curious about, about how founders validated the initial idea. How did you think about taking the idea that you had and getting feedback on it and, and validating it with, with your customer?

 The way that I approached it. Was really, uh, in as quantitative a way as possible. So, you know, I think you, you really have to get close to your customer in the beginning and really spend time with them and then make sure that you are collecting feedback from that customer in a way that you can really step back and analyze apps in your own bias on the subject.

So I'll give you an example. You know, what, what I did at the beginning was we went to The therapist that was working in our, in our Oscar center that I had known, well, I went back to her and said, Hey, can you introduce me to three therapists? And I wanna have a conversation with those therapists about their practice, because I knew this was the space I wanted to build.

And what I tried to do in of those conversations was really create a, an interview guide. And it was a Google sheet interview guide, where I had a certain set of questions for 10 key questions that I would ask every single person that I spoke to. And at the end of each of those conversations, ask them for three more introductions to new therapists that I could speak to.

And what was really valuable about that. Obviously the conversation would go in many directions beyond those 10 questions, but by having, uh, a sort of consistent data set, you were able to then come back to that and reread it and identify insights or correlations or ideas that maybe you wouldn't have had because you would've come at the questions with too much of your own internal bias around the idea that you're trying to validate and build a business around.

So that was really, my focus was meet as many customers as you can get as close to them as you can, and then try to create. Structured mechanism to collect that data so that you have the ability to challenge your own biases around some of the information that you might be getting back.

 Do you remember Harry, what some of those initial 10 questions were, were like, were they very general or were they very specific?

 The the, the way that I built those guides was really built on some of the interviewing skills that I had had from medical school. So when you're trying to diagnose someone, right, you're supposed to start with, your narrow questions and your open-ended questions, right?

And you're, open-end ended questions are really important because they let you capture information that you might have not even thought to ask. Your narrower questions are important because You get a little bit more of a structured data set out of that, that you can then use to think about what comes next.

So, there was a combination, there were questions that were really focused on. What are the biggest challenges that you face in your private practice today? If there's one thing that, you know, you would be looking for to help you build the practice of your dreams, what would that be?

So those being kind of the more open-ended question, and then there was always the more specific, you know, what application are you using technology? Are you using for taking notes or what application or technology are you using for. Um, finding new patients.

 That's great. was there anything that you learned, like the responses that you were getting. That really surprised you or kind of eye opening for you?

 Absolutely. The. The thing that was mind blowing to me that I didn't expect going in, uh, was this insight that started to emerge around community and the importance of community and connection for providers. So, you know, you go into starting a business and You're thinking about it from a business point of view, you know, what are the business needs?

You need customers, you need to make money. You need to make things easier or simpler to use. But you don't oftentimes think about the emotional, psychological components of being a business owner. And what was amazing to me in that interview guide was when I went back and started looking at the questions around what are the, you know, challenges that you experienced in your practice?

The one consistent theme that I hadn't thought about was loneliness. So providers over and over again were saying, yeah, exactly. It was, it was it wasn't I, you didn't expect it right. They were saying. I'm out there every day with my patient, trying to help them get better. And yet I'm really lonely where's my community, where's my support infrastructure.

I don't really know what I'm doing and that's scary. And having that sense of connection and community is really something that I, I feel like I'm missing. And so that became really core to our business. Right. We thought about our provider centricity. Our emphasis on community on connection really came out of that insight that I didn't expect going in.

 Wow. So that was, you know, when you think about creating the product, designing the product and jobs to be. Was solving loneliness, like one of the top jobs to be done for, for Alma early.

 I think it absolutely was, uh, there was this idea that in addition to the practical needs of a provider to build a business, there was also a very, very important, at least equally important psychological and sort of communal need. To feel that you had your people and there was someone there to have your back.

It wasn't just about you being there for your clients. It was about you having colleagues and, and others to help support you in your own career journey.

 And did those sentiments come pretty naturally from customers, you know, from the providers during your discovery? Or did it seems to me like a question that you sort of have to tease out, right? No. One's gonna tell you, oh, I'm lonely every day. What, what was, what was sort of the questions that you asked to get to that?

 Yeah, it's interesting. I, I think, especially for caregiving professionals who are so primed to be receivers of other people's needs, it actually does take a lot for them to sort of stop and say, well, actually, what do I. and it was interesting because I would ask always an open-ended question at the beginning and an open ended question at the end.

And it was always at the end that you would really see this insight starting to emerge that in the beginning, the focus was much more on sort of the superficial or the transactional. And only after they'd had enough time to really reflect on and be in the sort of mindset of like, yeah, what do I actually need that this, this insight would start to emerge.

So I do think that's. Uh, it does take coming back sometimes to the same kind of question at different moments in getting to know someone where deeper insights might emerge.

 Yeah, I totally agree with that. I feel like in the last two to three minutes of these customer calls, like that's when a lot of the magic happens. If you ask 'em an open-ended question after they've had time to kind of think through everything and you get that's when they open up. Um, that's amazing. So.

How about in terms of developing a routine around customer discovery? Like I know you were, you did a bunch of these initial conversations. Did you then develop kind of a habit or a way that you talked to customers in an ongoing way?

 So in the early days of Alma's, uh, story, we had a really strong physical space component to our business. So, you know, the platform initially was about helping providers build private practices. The most important product we had was these beautiful spaces that we built, which were built as not just office spaces, but community hubs.

Right? Really off this insight of, you know, the need for providers to have this sense of connection before the spaces opened, uh, we would do events. So we would do recurring events, actually hosted by you by the first round team, uh, at the first round offices down in flat iron. And, uh, we would have these really fun.

Uh, catered dinners, uh, that we really ripped off of first round. So first round I remember in my early days, you'd come into the first round office and you'd have these amazing dinners with other CEOs. And it was this really amazing communal experience. So I decided to copy from first round and build this sort of dinner experience for providers.

And we would do that on a, a monthly or bimonthly basis before we open our doors. Then when we opened our doors, we had this amazing. Opportunity because our customers were literally in this space every single day. And so we actually moved our offices into the space. So we were having breakfast and lunch and dinner and, and, and every other kind of imaginable meal and interaction with these providers because we were getting

 your team actually worked in the same physical space as your customers.

 We did. Yeah, for the first, I think six or nine months, we took two of the therapy rooms. Uh, we had, I think about 16 therapy rooms. We took two of them. We put desks in them and we worked out of those therapy rooms. Uh, and that was great because also it meant that. If, you know, someone needed to run to the front to let a new client in or help a provider problem solve the internet.

Right. We were there and it was this very sort of intimate relationship. And then when we grew out of that, uh, space, we decided rather than moving down to flat iron, where most of the tech companies at the time would kind of naturally gravitate. Instead, we took an office, a floor below, which was this sort of very dingy looking office, but it preserved that proximity to the customer, which was, I think really ultimately ended up being, I think, a great decision for.

 when you think about advice, you'd give to founders on customer discovery. what are some of the mistakes that you think might be easy to make and, and things that you'd advise founders against?

 The biggest mistake I think founders can make is to think about their customer. As a class, as opposed to as individuals. So if you say something like providers need X or some stakeholder needs, Y uh, it's easy to forget that there's human beings behind it. Human beings are ultimately the users of products.

Companies are not the users of products. Human beings are the users of products. And I think instead, if you can get a little bit closer to the individuals that are there. So that was really the beautiful thing about our early experience at almo it wasn't. You know, providers as a whole would like to see this feature.

It was such and such provider who I bumped into yesterday in the lounge had this particular challenge and it became a lot more human and a lot more connected to the fundamental product need the fundamental used to be done, as opposed to this more abstract one. I think just staying away from abstractions and trying to get really down to the much more human level of customer need is really, really helpful.

And I think the more that you can stay close to the customer themselves to do that, it helps a lot.

 So how, how do founders do that? Cause I imagine. Alma, your whole team had this, you know, you could, you could be like, oh, I bumped into so and so provider in the lounge and everybody knew who that was. And so those individual stories were so present for people. I know you haven't had to do this, but have you thought about how other founders who don't have that direct connection might achieve something like that and keep the individual in mind?

 Well you're right for us in the beginning, it was a totally amazing, unfair advantage that we had. Um, and it was really true of, you know, I'm thinking about some of our engineering team members who. Might not have interacted with our customers firsthand. Were they not walking into the door with them at the same time and standing with them in the break room and having those interactions?

So I think that was really amazing. I think there are a lot of ways you can still do that. And as we've grown as a company, particularly after the pandemic, when we no longer were able to be. In the room with our providers, there's there's tools that you can do to do that. So, you know, one thing I think every pro every team and every company should be doing is finding ways to bring their customers into those, like all company moments, like all team events, to hear them speak to those experiences that they're having.

It's unbelievably motivating and powerful there's best practices. Obviously that product and design teams can, you know, implement around customer interviews and spending time with customers. Um, but getting the customer in front of not just the product managers and the design team. Everybody throughout the company I think is really important.

 So you think you took us through a good timeline there, Harry of, of 2018, which started with initial idea customer interviews, the dinners that you did at some point in 2018, you, you opened your first physical space where along this timeline for you were those moments that were confidence, inspiring, where you were like, wow.

You know, I actually think this could be a good idea that we're working.

 The the first moment that I really remember clearly was. I think it was the first or second day that we had opened our first space in Midtown. And I was at the front of the space, helping new customers, new clients that were coming into this space find their way in. And I just, I remember very clearly this one person who came into this space and they came in with a sort of shoulders hunched over, you know, you could tell that they were a little bit anxious about.

They were doing there, what this experience was gonna be like, and this space was really beautiful and they walked in and they, the elevator doors open and I saw them sort of just lift up. Like they, they, they kind of grew an extra inch or two. They suddenly just had this look of like, oh, wow. Like this is what therapy can feel like.

And look like if you really take a much more thoughtful approach to, to building this experience. And that was a really powerful moment. And then just seeing the interaction. Provider had when they had the support of Alma to deliver care to that person. The, the pride that they were able to speak to that was like one of those moments that was very powerful.

Um, just seeing how people reacted to creating good quality experiences and mental health and just the hunger for that level of experience was really great to see.

 what did, what did the V1 product of Alma actually look like? Because I know part of it was the physical space. Part of it was, was some software that you had built. What, what was that V1 product like?

 The product in its infancy really focused on three things. It focused on community. So how do we solve that loneliness challenge that we were talking about? What were the events and programming and connecting tools that we could build for providers to stay. Together with one another. The second was really around lead generation and helping, uh, prospective clients find providers in the Alma community.

So the directory service and our client matching service, which were really designed to help people find a good clinician for them. And then our early billing tools, which were really focused on, uh, cash pay support, because when we started the company, while we aspired to really crack the code on affordability through insurance, we didn't have those relationships in place.

And so the early tools that we built in the technology for billing were really focused on cash pay and supporting providers to make that, that process simpler and.

 Okay. Got it. So let's go back. You've mentioned the physical space a couple times, and I just remember Harry, like I was lucky enough to visit you in 2018 when the space was under construction, it was basically a hard hat zone at that point. And I was just so struck by your attention to detail.

Like, I still remember this. We were walking through the space. There'd be like a crack in the tile on the floor and you'd, you'd put a piece of blue tape down. So the construction crew would see it. And I just remember, imagining how that would translate to your attention to detail when, when you first opened the doors or, you know, launched the product.

Um, so what was that like that first day? Right? When, when, when your customers started coming into your space do you remember what launch day felt like?

 Launch day for any new product is terrifying, uh, because you've spent all this time and energy in invested in building this thing, and then you have just no idea what people are gonna say, right? And it's, it's a very nerve wracking experience to kind of. To feel that and to see what's that gonna be like?

I do remember saying to the team on that first day that if nothing else happened, but that day in, you know, all we ever ended up doing with Alma was helping that first group of people have a really, really great therapy experience. Because of what we had invested, that would be worth everything. Right.

That was enough to really feel like we had done something meaningful and positive in the world. So I think, you know, that that's one of the powerful things about being in a mission driven space, where if you feel like you're really adding good back into the world, you kind of have that. And you know, that that's a good starting place, but, um, That that was, I think really, you know, very scary.

And then as you see people coming in and starting to use the product, uh, and I think when they start to use the product in ways that you didn't quite imagine also, right. we had this, when you walked in this tea bar that would allow you, you could grab a, a cup of tea and seeing providers interacting with that, bringing it to their patients, like really all of a sudden, you start to realize like, oh, wow, like this is something that, that they're gonna take ownership of and make their own, which was you start to feel like, okay, this thing is gonna work.

 That's super cool when it starts to take on a life of its own. So you mentioned the team. What, what did the early team look like at this.

 In the early days, um, at the very beginning, our, our first two team members, uh, were Nick Thon who was our, uh, engineering leader, and really came into to build the product and, and build the engineering squad. And then Nina Roth, who I had known for years from Oscar, uh, who was really everything else. Right.

Nina did sales, community support, uh, operations. Uh, she was that sort of quintessential. Can do absolutely anything person, uh, on the team who really helped make all of that work. And then the team started growing from there, you know, hiring the early team members, uh, who would help run the space, uh, and hiring our first marketing hire, right?

The rest of the team started to come together from that core.

 And was there anything about that early set that you felt was just critical and you learned how important it was to hire people with a certain characteristic or attribute and, and maybe that's informed kind of how you think about people that you wanna join. Alman now.

 Yeah. I think one of the things that I really admire and look up to about our early team members and I think has been a consistent theme that they've imparted to the business and is true of really everyone that's come to Alma is this sense of. Humility and respect for not just one another, but the work that we do, you know, I always tell our team that in mental health, we're interacting with really intimate and personal details of people's lives.

And we have to do that with a huge sense of respect and, you know, a, a desire for innovation and change, but also a, a healthy appreciation that we don't know what we don't know. And we need to make sure that we're always listening to one another and really coming. Every issue with a sense of humility and curiosity.

And I think our early team members really embody that these were people who had incredibly high EQ, who were thoughtful, who were listeners first. And that's one of our company values today, right? To listen first, really came out of those people who I think were never fixated on being the smartest person in the room.

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Founder Harry Ritter dives into Alma’s journey to product-market fit, with advice on rallying through tough pivots and building as a solo founder.

Finding product-market fit twice — advice for pivots and customer discovery

Harry Ritter dives into Alma’s journey to PMF, with advice on rallying through tough pivots and building as a solo founder.