Private Equity in Behavioral Health: Compliance Champions or Cost-Cutting Villains?

Health insurance plans may have the worst reputation in health care. Number two might be private equity.

Private equity is often criticized for cost-cutting and layoffs, and those critiques are unlikely to change any time soon, according to Steven Gold, executive partner at Lindsay Goldberg and F3 Partners and former CEO of Refresh Mental Health.

However, these negative commentators may be forgetting some of private equity’s positive impacts on behavioral health, Gold said.

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Small mom-and-pop providers may struggle to stay in compliance with regulations. Private equity, Gold argued, keeps regulations top-of-mind to avoid negative publicity. Investor involvement also promises bigger paydays for mom-and-pop operators looking to sell their businesses.

To learn about the implications of private equity’s involvement in behavioral health and other industry-defining issues, Behavioral Health Business sat down with Gold for our latest episode of BHB+ TALKS. During the conversation, Gold spoke about the difficult road ahead for value-based care, the potential impact of the Trump-Vance administration and the behavioral health deal-making landscape in 2025.

A replay of that TALKS episode for BHB+ members is below. A transcript from BHB’s conversation with Gold is also below. The transcript is lightly edited for style, length and clarity.

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Larson: I am Chris Larson, a reporter for Behavioral Health Business. I have been covering the industry since October of 2021, and I’ve been covering health care generally since December of 2016. Let me talk a little bit more about BHB Talks. If you’re in the Zoom, you can probably see the number of participants is relatively low, and that’s intentional. These BHB Talks are exclusive to our BHB+ members, and they are meant to be our most intimate, most informal offerings for our readers.

We welcome, we invite, and to be completely frank, we’re going to rely a little bit on the questions and answers that y’all can send in to us. We’ll incorporate those in real-time. Of course, we have questions that Steven and I will be going over, but if there’s anything that you want out of this, that you’re expecting out of this, if there’s a need that we can help you fill, now is your opportunity to at least get some insights and some thoughts on whatever that is.

Let me go ahead and actually get us started by handing the mic over to Steven Gold. Steven, can you introduce yourself a little bit more? Give people a better idea of your background and where you’re coming from.

Gold: Sure. Thanks for including me in this talk, Chris.

Larson: Love to have you.

Gold: You introduced me as an executive at Lindsay Goldberg and F3 Partners. Those are both private equity funds based in New York, and they do invest in healthcare. How I got introduced to them was a role where I was a founder and CEO of Refresh Mental Health, and Lindsay Goldberg was our first financial owner and sponsor in that consolidation strategy. Later, we went and sold to Kelso Capital, and then ultimately we were bought by Optum.

I stayed on with Optum for a couple of years, working on the integration with Refresh, but also working on integrating Refresh into various primary care practices within Optum. Then, also I worked as basically a business development officer within Optum Behavioral Health, looking at other businesses that could be complementary to Refresh in that universe. That’s really the last 10 years of my career.

Prior to that, I was a lawyer by training and worked as a lawyer for many years. I also have a master’s degree in public health as well as in bioethics. Refresh was really my second or third company that I had started, all in behavioral health. I come from a family of clinicians. Notably, my father’s a psychiatrist, and my sister is a psychiatrist. I have always been interested in behavioral health, and I enjoy working in fields where I feel like we can make a difference, and that mantra of do good and improve the access to care, improve the benefits of the workers that work for you, the clinicians. Those are always things that we wanted to do with our companies.

Larson: Good to know. You just had to go and break with the family tradition, be an attorney, be a businessman. Hey, if you hadn’t made those decisions, you wouldn’t be here with us today. I’m grateful for those life decisions. Let’s start the conversation with this question. What were your top learnings from 2024?

Gold: I think, for me, first and foremost, was just patience. I’m used to moving quickly. I like moving quickly, and it’s fun. I think when you look at Refresh, growing from really basically a single clinic to over 400 locations, we had over 3,000 clinicians, over 300 locations in 30-some states by the end. We did that all within 10 years.

Last year was not the year to do that, or to try to do anything like that. I think interest rates spiking, valuations still are relatively high compared to where they would need to be to make sense from a deal perspective. With the presidential election coming up, there’s a lot of uncertainty. I think it wasn’t really the year to be aggressive, and try to do something. I think this next year coming up, hopefully, it will be a different story.

Yes, I think the main thing for me last year was patience. I wanted to do deals, I’d like to be busy, I like to be active, but it just wasn’t really in the cards for last year.

Larson: Yes. That’s one thing that Behavioral Health Business has been hearing: that the deal-making landscape was one that was not terribly favorable, but it’s also one that people who had more sober views described as necessary and realistic. Over the last couple of years, especially during the pandemic, I talked about how it overnight evolved meeting culture. Because of the profound, hopefully once-in-a-century nature of the pandemic, so much more was changed and altered, including deal-making, especially in the behavioral health industry.

One of the things that comes with the spotlight being placed on something, and in this case, investment in behavioral health, comes also a magnifying glass or a microscope. Whenever you have a bunch of money coming into a space, by the nature of that action, there’s going to be a lot more people thinking very critically about the space. Just like you were talking about, Steven, how did that manifest? That showed up in a lot of valuation rationalization. People are more skittish and have it taking a lot longer to do deals.

That’s actually something that we’ve talked about multiple times with multiple people. At some of our events, we’ve heard from folks like Braff Group, who do presentations, because they sponsor our events. Who, in their experience, are describing that just the process of doing deals where there are willing deal-makers are taking longer because people are very, very interested in making sure that the money that they’re putting behind these investments is going to be worth it, and they have some level of confidence based on the quality of their investigation of a lot of these companies.

Gold: Yes. The Braff Group, we bought a couple of businesses from Braff when we were doing Refresh. They’re well-known in the space. Every time, I think Dexter does the opening talk at the INVEST conferences that I’ve gone to.

I think even going to that conference this year, which was the first time I went in a couple of years, I think there’s an itching. People want, whether it’s the deal makers themselves, or whether it’s the attorneys and the CPAs, or other professionals that support that deal-making process, everyone wants to get back to business as usual. I think, hopefully, this next year will feel better. We did. We had a huge interest in our field, partially because of COVID. COVID drove interest from clients, but also from investment professionals, and even venture capital.

Venture capital had really never been interested in our field. Private equity was, but venture capital never was. Now we have legacy venture capital businesses that are out there. I think some of them are doing fine, but many of them are struggling. I think it’d be interesting to see what happens to the venture capitalists out in California. Do they continue to invest in these money-losing enterprises that they started during COVID and coming out of COVID? Some of them have even started merging, but it’ll be interesting to see what happens to some of those companies.

Larson: Yes, absolutely going to be a really interesting year, especially for those VC companies. We just had INNOVATE, in D.C., that was a maiden voyage into an event that’s focused on early-stage behavioral health entities. For a long time in our very brief history as a publication, we’ve only been around for about four years, in earnest, so we, even as a publication, we’re still trying to fine tune exactly what our perfect offerings are. In the process of doing so, you get the chance to meet a lot of amazing people who have great insights.

At INNOVATE, just a couple of weeks ago, we heard from people who are in the space, both venture capitalists and the entrepreneurs who are trying to run this stuff. A lot of them said at that event, this grand reconciliation between what venture capitalists are looking for versus what the market’s actually giving them is actually happening right now.

We don’t see it maybe as specifically and acutely in behavioral health, because even though behavioral health got a ton of attention, a ton of investment relative to the rest of what venture is putting money behind in healthcare, it’s still relatively small.

That’s one of the really interesting things that we can look forward to in 2025. Then in reflecting something that also that I learned from INVEST and other conversations, yes, the people that do the deals, the bankers, the lawyers, of course they want to be busy, and they probably have a bias to tell us like, “Oh, yes, deal-making is going to pick up.” They’ve been telling me that for the last two years. Every time I talked to them, I’m like, “Okay, guys, when for real? Were you lying to me then? Are you lying to me now?”

Gold: I think next year’s the year.

Larson: Next year is the year.

Gold: I’m not getting paid. Interest rates just got cut again a quarter point today. It does matter for, if you’re going to borrow money, what can you afford to pay for someone’s business? The owner doesn’t want to sell if it’s not at the right price, because these are profitable businesses that they’re making money on today. So they’ll just wait.

Larson: Yes. Let me actually ask you that. Of course, rate cuts are of themselves a substantive thing. One thing that I think I’ve learned, and I want to hear your thoughts on this, is that the greater impact of these rate cuts is more about the vibes, the mood of the market. Is that something that fits with your conception, or how else do you think about these rate cuts and their impact?

Gold: I think both. The rule, don’t fight the Fed is real when you’re investing or thinking about starting a business or growing a business. Right now the Fed is on the business side, on the investor side. They feel like they have inflation under control, and the monetary policy is now picking up. I do think when you’re modeling out your deal, and you’re getting term sheets from the debt providers, it is real when you’re trying to figure out what you can pay for a business, and every little bit matters on what debt you’re getting. Of course, if it’s a very small business and you’re not getting a loan, then that’s different.

I’ve been talking to a couple of executives who are just buying businesses themselves using SBA loans. Even SBA loans today are right around 10%. That’s not cheap money, but it’s still, it’s better than alternatives, and that’s the road they’re taking. I think it does matter, and whether it’s a small deal or a big deal, these kinds of things are helpful. Bringing up rates like they did had the effect that they wanted, which was to cool inflation and to cool deal-making. To cool the economy. It did do that.

Larson: I’m going to practice what I preach, and let’s actually tackle that first Q&A question. Wes, thank you so much for sending that in. Let me just read this verbatim to the rest of the chat and to you, Steven. What’s your opinion on whether or not value-based care will ever materially actualize in the behavioral space? Great question. Let me shamelessly plug. We got a whole event about this, Wes. If you want to tackle these questions, network with people who are thinking the same thing, come hang out with us in New Orleans on March 20th and 21st.

Gold: I think it’s a great question. I don’t have the answer, except for that I can tell you based on experience, we did do value-based contracts, but they were not like true risk-based value-based contracts that they have in primary care. They’re more, if you do these 10 things, we’ll give you a rate increase that’s higher than the typical inflationary increase year to year. We would do those things, and we would get those kinds of increases. When we ultimately were purchased by Optum, and we got to work with Optum on primary care integration, using our behavioral clinicians within their primary care practices, and their primary practices were true at-risk practices for value-based care, even there, where you have the primary care owned by Optum, you have behavioral health, now Refresh Optum, and you have insurance company in line, they still all have their different sets of P&Ls. It’s not one common P&L.

There was never really a great way of, how do you divvy up the pie, because primary care wants the value-based contract. They still want to pay the behavioral a fee for providing the service, hourly or so forth. I don’t know, even in that system, it wasn’t so easy to figure out. I’m not so sure, how do we do it as a global system?

Then the other feedback I’ve heard tangentially from payers is that everyone wants value-based care because they think that that’s going to mean that they’re going to get paid more, but that’s not necessarily what happens on the primary care side. I’m not so sure. I think it’s a great question. I don’t think we can probably do it like it is being done on the primary care side. It’s just not that easy in behavioral. Then frankly, some people benefit from once-a-week therapy for years and years and years, and that’s okay, in my book. I don’t think we should try to stop that. Probably, in some of these value-based, true risk-based situations, you would probably want to stop the maintenance dose. Again, at least in my experience, I don’t think we as mental health advocates, clinicians, business owners necessarily want to stop that.

Larson: Yes, definitely hear you loud and clear on that last point. Especially where I start trying to figure out whether or not we’re going to see value-based care come to reality in any meaningful ways that we have to toss out the public health definition of what value-based care is, the triple aim or the quadruple aim or whatever, and realize that this is now the industry’s catch-all term for anything that’s just not straight up, straight down fee-for-service. If you take that definition, that loosey-goosey definition, you can actually make the case that in some cases, we’re in an environment where something that makes attempts at aligning towards value is reality. It is at least possible.

Now, is it possible for your organization specifically? That’s an open question, because you have to do these deals knowing that you’re going into them with very little leverage. There’s very little reason for any one, even at state level, just say like a Blue Cross entity, to take any one provider in behavioral health very seriously, with maybe some exceptions of some of the highly concentrated, maybe autism providers.

I know of a handful of providers in the South that absolutely dominate these states. I can’t really think of very many behavioral health providers that would be able to have a reasonably high level of confidence going into a negotiation on an innovative agreement with a payer.

That said, we can’t stop. The industry can’t stop. You have to do something that better aligns providers in the industry, and do so in a way that rewards the providers that do really well, and frankly, pushes out the providers that are not doing well, and not doing right by the patient. How do you do that? Something other than just straight up, straight down fee-for-service. That’s a distillation of a couple of learnings I’ve had over the last couple of years. Steven, am I wrong on anything? Is there anything that you would attack differently when it comes to thinking about value-based care and whether or not we’re going to see it become reality?

Gold: No. I think, again, it’s going to be a primary care mental health practice. I think that would successfully work with the payer. I think it’s hard just in mental health, or even like you’d mentioned, in autism. Then you have to have the size and scale, one, to have the influence to even talk to them at that level to get that kind of contract, but also there’s going to be ups and downs to the business, and you’re going to have to be able to weather that. It’s not going to be like, again, a straight fee-for-service where you can know you’re going to be paid.

There’s a lot of risk involved in whatever entity that would try to crack the code. I think there will be variations. It just is not going to be the standard, what we’re used to seeing, that’s rolled out throughout primary care.

Larson: Yes. Real quick follow-up question to that. I want to make sure I’m understanding this. This is also one of the quirks of lingo and language that I’ve picked up on in the industry, is that whenever people are talking about, well, there’s risk, that usually means, hey, you got to have a bunch of cash to do anything that’s risky. Is that what you’re saying? If you’re going to do this, you have to have a balance sheet that can sustain it.

Gold: I’m thinking you’re going to have to have a bunch of cash and supportive partners, to be like, “I’m doing something innovative.” That could even be from the venture side. You’re willing to give $30, $40, $50 million on the balance sheet.

You could try something like that, and know that you’re going to be losing money for

some period of time, but the goal is to make it a better system overall. Yes, the typical mom-and-pop practices, or the nonprofits in our world, they’re not going to be able to afford to take that kind of a risk. It’s going to have to be some heavily funded entity.

Larson: Yes. There’s some indications to think that venture is actually down for those kinds of risks. A very micro case study to look at is the startup Amae Health. We wrote about them recently having this partnership with Cedars-Sinai. What Amae Health does is they focus exclusively on serving people with SMIs, including behavioral health, social supports, but also primary care as well. All this is done on an outpatient basis. They have a bunch of venture capital backers who look at the case that they’re making about this population that needs help.

Amae is very shy, actually, about explaining to us what the business case is here, other than to unite a very fragmented industry. From a lot of the social impact part of venture investing, about making a better world, that kind of investment makes a lot of sense and appeals to a lot of those people. It remains to be seen if this less than two-year-old startup is going to air quotes “make it” and become a commercially viable company, but that’s just an example of exactly what you’re talking about, Steven, and illustrating the concept of innovative things maybe actually getting a hand from venture capital.

Gold: I think the social impact investing, which is a newer concept, does benefit our field greatly. Even the social determinants of health and things like food as medicine. Some of the things we were talking about before, Chris, I think these sorts of things are new, and they could really be game changers, ultimately in the future of our field.

Larson: Yes, that’s putting it mildly, putting it briefly. Could probably spend another hour talking about what the impact of different types of capital are on different issues, but I don’t think we have time to get into that.

Gold: Serious SMI, like you mentioned, too. Serious mental illness is just another area that it’s kind of overlooked.

Larson: Kind of is putting it generously. It’s very much overlooked. It’s even overlooked by a lot of primary care.

Gold: Payers are aware, because it’s a big drag, as far as cost spending on not a huge number of people. That’s the same with autism. Autism is obviously growing, but the spend per capita or spend per autism client is really, really out of line when you look at spend per mental health client.

Larson: Yes, and it’s definitely something that needs to be looked at, needs to be assessed, and there needs to be greater conversation in the provider space about that. Just specifically in the autism space, just to touch on before we move on to our next question. We’re seeing action by the payers on this. We followed up on a story by the investigative news outlet, ProPublica, that was able to get their hands on documents from Optum, that detailed what they’re trying to do to get some control over spending on autism-related therapies.

Now, I’ve heard for years now, through my contacts in the autism industry, that they’re hearing from their contacts at payer organizations that the actuaries and, I use this term kindly, the money nerds, that these payers are freaking out a little bit, because even though behavioral health generally and autism itself is a microscopic part of their overall budgets, the rate of increase has exploded over the last several years. Part of that’s obviously driven by state coverage mandates, and that can be accounted for, but there’s a lot of something else out there that’s driving that.

When you’re an insurance plan, what else can you do? Does that make it right? That’s a different debate. There are all kinds of questions that one can get into around the philosophy of it all. The practical effects of payers seeing huge spending is to use financial tools to bring it more in line with what they’re trying to do.

Gold: Yes, you don’t ever want to have the attention of a payer, on either cost or overuse or whatever it is. I think autism has gotten that attention, over the last couple of years. It’s a field I don’t know terribly well. We had a couple autism providers within our network at Refresh, but yes, it’s undeniably growing, and it’s part of the mental health universe, but it also has the attention of the payers. Because, I think if you look at the per capita spend, I think it’s around, maybe it’s around $100,000 a year per client, something like that, or at least $50,000. It’s a very expensive private school education per year per client. Of course, that’s going to get the attention of the payer.

I think the clinicians would say that it’s very much hands-on. You have a lot of clinicians there working with the client, but again, I don’t know the field well enough to espouse on like, is this the best treatment for the dollar that we could be providing? I just don’t know. It’s newer, right? Autism’s been around for a long time. Actually, my mother has a public health degree from Yale, and she worked in the– they had an autism center back in the ’70s there, that she worked there in the Yale Child Center. We’re learning. ABA therapy is one option, but I think people are trying to develop alternative models as well.

Larson: Yes, indeed. We’re seeing some of those could start to come to the fore and get the validation of investors as well. Everybody, keep the Q&As rolling through. We had a great conversation inspired by the question-and-answer section. If you have anything else that you guys want to talk about, go ahead and drop it there.

In the meantime, Steven, let’s shift our gears to looking at the year to come. 2025 is right around the corner. What is top of mind for you when it comes to the year that’s on its way?

Gold: I think no matter your political preference, it was an election year, and I think there’s going to be changes. I think, as an investor, or an operator like myself, you have to be aware of that change. Usually, the first couple of years of any party coming to office, there’s going to be change and enthusiasm, and it’s probably a good time for businesses. I think that kind of energy, hopefully, will come forward in the new year.

I think you also have to look at some of the administration’s positions and views. Some of these are very different, especially if you look at Kennedy’s platform and so forth, and his being head of a huge, huge department that matters a lot to a lot of what we’re all talking about here. I do think there are some key areas, such as the food. You can’t charge for obesity counseling. I think there may be something there, and certainly, food as medicine, which some of these states have already started to pay for, like California. There may be some legs on creating food programs that could be a component of a mental health clinic, even.

I think there are some themes that could come, which would be completely new

businesses, completely new business models, out of the change of administration. Then, of course, I think what we talked about earlier, with rates and so forth, it just makes it more of a friendly business climate to be investing in the new year.

Larson: Yes, definitely, there’s a tendency toward it. At least that’s the stereotype that we apply with GOP administrations. One of the things that I don’t have an answer for, but I’m using as a yardstick to help assess things as they come, is keeping in mind these diametrically opposed beliefs and approaches to governance that are going to be inherent in the Trump administration. Steven, you talked about RFK Jr. being there. To bring about a lot of the stuff that he envisions as policy, he would have to actually be enacting policy.

He’d have to be rolling out new rules, new regulations, but that is going to be at odds with the overall vibe of the Trump administration, which is going to be deregulation, and cutting red tape. How is someone who ostensibly is set up to be a reformer going to navigate a world where the mandate is going to be cut, cut, cut.

Then there’s no better example of this than who Trump is pulling in and surrounding himself with than Vivek Ramaswamy and Elon Musk, and their department of government efficiency, not officially a department, not created by Congress. Think of it more as like a commission, but there’s going to be pressures from the people that helped finance his campaign, that campaigned for him, that ultimately helped push him across the electoral finish line, to make good on what a lot of that political movement’s priorities are, and that is a weaker federal government, more power to corporations, and a tax environment that will hopefully enable greater and more investment.

RFK is tasked with ultimately adjudicating some vision of the future that will require new regulation. I just don’t know how that’s going to reconcile, and I don’t think we can predict it. It’s going to be one of those things that you just have to have in mind as we go forward.

Gold: It’s a great point, Chris, and a great question. When I went about building Refresh, we tried to build a commercial and network strategy. Now, we were still probably like 15% to 20% government pay mixed in, because frankly, I wanted, and our clinicians wanted to be able to do some of that work. You can control your own destiny a bit, at least when you’re doing commercial and network. It’s a business. You’re getting insured from your work, your place of employment. I think when you’re relying on government as your pay source, there’s always going to be more risk.

I think if I was flip-flopped, and I was the CEO of a company that was 80% government pay, 20% commercial, frankly, I’d be worried what might happen, because there is this new oversight of like, “Let’s cut government spending and eliminate departments.” Right? Does that mean Medicare, Medicaid get impacted, and mental health? I don’t– no one knows, but the only way you can avoid that is by trying not to have your business too heavily weighted towards government pay.

Gold: Yes, definitely a great case that you’re making when it comes to just diversifying a business’s revenue streams. Let me turn to the Q&A section again to get another question here. Where do you see the tension between “payers are the bogey person of US healthcare” versus private equity as the bogey person of healthcare,” playing out in the year ahead?

Listen, as Americans, we love having things to be afraid of, to some degree. There’s no shortage of places for bogeymen to exist. That’s my unhelpful glib attempt at humor answer. Steven, maybe you get at something more substantive while I collect myself.

Gold: Yes. I don’t think private equity has done a good job of promoting themselves as anything but. I think we really have done great things to a lot of the fields, professionalizing them, like compliance and regulation. When we did Refresh, we probably bought, let’s say we bought 80 different businesses along the way, and brought them in to integrate them as part of a network. There were probably another 100, 200 that we looked at, that we couldn’t buy. We didn’t want to buy, or we couldn’t come to terms, or we didn’t want to buy.

A lot of those had compliance problems. You never want to throw anyone under the bus. I never name names, but there are compliance problems throughout healthcare, not just mental health, right? For mom-and-pops trying to run their own businesses, sometimes they just don’t know the rules. I do think private equity does a pretty good job of compliance because the firms themselves are scared to death. They would never want to be part of an exposé or an article or whatever that is. We

institute very strict compliance regulatory programs that are atypical from the typical mom-and-pops out there, and probably the nonprofits that exist as well. We didn’t look at many nonprofits to buy.

I think that that part of private equity, like professionalizing businesses and eliminating fraud, is not really spoken of as much. What they concentrate on are probably the private equity groups that come in, and it’s cost-cutting and firing. That does happen as well.

Unfortunately, or fortunately, we have AI coming into existence, which would have done that probably anyway. This may get spun, at some point, where it’s like private equity using AI. You may see an article about that coming up. Like private equity using AI to eliminate roles, and administrative roles, and so forth, and call centers, and things like that.

That was going to happen anyway, because of technology and so forth. I think private equity is going to be a boogeyman. Payers have always been. I think one of the most difficult things for me was, how do I convince my 3,000, 4,000 clinicians that working for Optum is the future? I want to say they have 40,000 physicians that work for the company on a primary care basis. We were the first employees on the mental health side. Just a fraction of, compared to primary care.

Still, most clinicians have some sort of experience in their careers that would lead to an adversarial relationship with the payer, whether they don’t feel like they’re being paid enough, whether they’re denied services that they feel should have been covered, either personally or for a client.

I think that it’s a hard issue. I think, again, maybe there’s something with the administration here that really shakes things up in our country, because really, they are the middleman.

I saw an article, too, just today, on pharmacy benefit managers. All the insurers that have PBMs, their stocks just tanked, because in some regards, they are a middle person. I think there are ways where if there are these middle people that can be eliminated, and make the system work more seamlessly, and more affordable, maybe now is the time where we have some real change.

Ultimately, there continues to be a negative perception about both payers and private equity. Again, having worked from within those kinds of groups, they’re not bad people. They feel like they’re doing their job, just like the United CEO who was on the street, he’s doing his job.

I think we can collectively, hopefully, make some changes to the systems that would create better outcomes for clinicians and clients and so forth. It’s a massive, massive system, so the change is not going to be so fast. We need to look for small wins and incremental change.

Gold: Definitely. Just to very briefly add my two cents on that. I think your insights about just the historical nature about the place of payers not necessarily being the good guys of the story of healthcare. That’s just going to always be the primary narrative that’s going to echo through any frustrated discussions about healthcare, and about healthcare reform. Going into the year forward, private equity is going to probably continue to be under the limelight. If there’s going to be anything that an administration that’s motivated by some populist tendencies is going to pick up, it’s going to be those like antitrust, anti-big business – the few anti-big business policies that the Biden administration had started during their one term, and because of this also this other conflicting tendency towards looking out for the little guy, that the Trump administration rode to electoral victory on, is going to lead them to that direction, to some degree. Again, how they consolidate that with more traditional GOP approaches remains to be seen.

We actually need to get winding down here. It’s been a great conversation. Thank you so much, everybody, for being here. Steven, I want to have you have the last word. What are you looking out for in 2025?

Gold: Since joining Lindsay Goldberg, I have not had a deal, personally, and I actually still have my non-compete in outpatient through February with Optum. After February, I can start looking at the outpatient mental health field again. I encourage anyone listening, either live or on replay, that’s interested in talking to me, find me on LinkedIn. I’m going to be back in the business.

I think there’s still a big opportunity in outpatient. It’s still very much fragmented. I think you do need the consolidation to be able to get the ear of the payer. Whether that’s, like we mentioned, some form of value, or just these pilot programs that they do, where you’re working in their primary care locations and so forth. That opportunity still exists. That’s the good news. We’re not like dental, or some field that’s just been fully consolidated, and all corporate. There’s still a lot of room in our field. I think if you’re a clinician out there thinking about, what’s your legacy, or what you want to do with your practice, and you’re getting to the latter stages of your career, and so forth, I think the good news is there’s still an option.

Thankfully, for private equity, there is a financial sponsor behind being able to buy your practice, because otherwise, as everybody knows, back in the old times, your only option would be to probably either close it down, or you could sell it to a clinician within your practice. There’s the value you would get for that would be really de minimus compared to what the true value of the practice would be.

Larson: All right, Steven, thank you so much for sitting down with me to have this BHB+ Talks conversation. Thank you to everybody who has joined us, joined us in the Q&A, or otherwise just listened along. As Steven mentioned, this will be distributed to BHB+ members, on replay. If you missed our conversation, you get the chance to listen to it, and otherwise share it with any of your co-

workers who are interested in what we’re doing over here at BHB. I’m Chris Larson, reporter for Behavioral Health Business. We’ll catch you next time.

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