The barrier you can't quite see

Most people outside the field assume healthcare and behavioral health are limited by clinical knowledge: that we simply haven't figured out how to treat people well. That hasn't been our experience. The limiting factor is rarely the clinical work. It's everything built around it: the incentive structures, the ownership layers, and the quiet pressure to run a practice like a portfolio company rather than a place where people get better.

We call this the glass barrier. It's rarely visible from the outside: the website still looks warm, the intake process still runs, the sessions still happen. But underneath, a clinician's autonomy gets thinner every year: caseloads climb, documentation multiplies, and the room to actually practice the way they were trained shrinks. Clients feel the same barrier from the other side, in the form of rising costs, shorter sessions, and care that increasingly optimizes for billing over healing.

The barrier is glass because it's structural, not personal. No one villain built it. It's the predictable output of an ownership model that answers to something other than clinicians and clients.

Private equity and venture capital are the clearest version of this force in healthcare and behavioral health right now, and we don't think that's controversial to say plainly: capital raised on a return timeline needs a return, and the fastest paths to one (larger caseloads, thinner staffing, standardized and often lower-cost care) are frequently the paths that erode what made a practice worth investing in to begin with. Profit-driven insurance administration adds a second layer of the same pressure from a different direction. Even well-intentioned independent practices, without outside capital pushing them, often can't out-negotiate these forces alone.

What makes that pressure so effective is the shortage of alternatives. An owner who feels the squeeze is usually shown two doors. The first is to sell to someone with capital and a return timeline, which trades ownership for relief and hands the incentive structure to a party whose interests will not stay aligned with the room forever. The second is to hire ahead of demand and hope volume closes the gap, which trades margin, culture, and often clinical quality for the same relief, and arrives precisely when the owner is least equipped to manage a larger organization. Neither choice is a failure of nerve. For most owners, they are simply the only two doors anyone has ever shown them.

Where this comes from

Three things put us here, and they are worth naming plainly.

We still practice. Both of us see clients. Everything in this paper was written by people who will be in session next week, not by operators describing an industry from the outside. When something in this model does not work, we feel it in our own caseloads first.

We see what our communities actually need. The gap between the care people need and the care they can reach is not abstract to us. It shows up as the waitlist we cannot clear, the client who cannot afford a third session, and the excellent clinician who leaves the field because the business around them became untenable. Building practices that stay open, stay good, and stay reachable for the people around them is the whole point of this.

We build with organizational psychology. Alongside clinical training, our leadership brings graduate training and consulting experience in industrial-organizational psychology: change management, organizational development, and organizational design. That is the discipline that turns good intentions about how a practice should treat its people into a compensation structure, a staffing model, and a set of workflows that actually hold under growth. Most of what limits a practice is not clinical. It is structural, and structure is something you can design.

What we believe actually works

Three convictions shape everything we build, and none of them are clinical.

Clinician ownership is the control variable. A practice reflects whoever it ultimately answers to. When that is a clinician who still sits in the room, the hard calls get made with the client in view, because the person making them will be looking at that client on Tuesday. Ownership is not a sentiment for us, it is the mechanism. Nearly everything else we do exists to keep ownership where it already belongs and to make holding onto it sustainable.

Care is regional before it is anything else. Referral patterns, payer mix, licensure, waitlists, wage expectations, and the way a community talks about mental health are all local. A practice in Chicago's West Loop and a practice in the Hudson Valley are not the same business with different zip codes, and treating them that way is how national platforms end up with practices that technically function and locally mean nothing. We build region by region so that the people making decisions know the ground they are standing on, and so that a practice's reputation compounds in the place it was earned.

Niche focus, wherever the market will carry it. A practice that is genuinely excellent at something specific, whether that is OCD and exposure work, perinatal care, first responders, adolescents, or couples, consistently outperforms a practice that is adequate at everything. Specialization tightens clinical outcomes, shortens the path from referral to the right clinician, makes marketing honest and cheap, and gives a practice real standing with payers and referrers. Not every market supports a niche, and we do not force one where the volume isn't there. Where it is supportable, it is almost always the stronger position for the clinicians and the better experience for the client.

Clinician-owned, regionally rooted, and specific about what it does well. That is the practice we would want to work in, and the one we would send our own families to.

Our role in the solution, not the whole solution

Midsommer Health is our attempt to be part of the answer to that barrier, not a claim that we've solved it outright. We don't think one company reshapes an entire industry's incentive structure. What we can do is build a working alternative, prove it inside our own practices, and make it easy for other clinician-led practices to adopt the same structure.

That only works under one condition, and it's the one we hold ourselves to above everything else: Midsommer only succeeds if our clinical directors and partner practices are genuinely, structurally better off for having partnered with us. Not "better off on average," and not "better off net of our fee." Better off in the day-to-day experience of running and practicing in their own practice. If that stops being true for a partner, the model has failed regardless of what our own financials say.

A third door: keep the practice, change the structure

The practical form our alternative takes is a third option for practices that already exist. An owner should not have to choose between selling the thing they built and overhiring their way into a business they never wanted to run. There is a version where the practice stays clinician-owned and clinician-led, and the strategy, operations, and management underneath it are carried by people whose entire job is to carry them.

That is the work. We take the business layer off the owner's desk without taking the practice out of their hands: revenue cycle and billing, insurance verification and credentialing, intake and client experience, marketing, SEO and content, bookkeeping, CPA coordination and fractional CFO support, hiring, compensation design and HR, and the day-to-day practice management and technology that quietly consumes an owner's week. Practices come in through a scoped consulting arrangement, a full MSO partnership, or a single service bought on its own, and they can move between those as their needs change.

Underneath all of it sits the discipline that makes the rest hold: organizational psychology. Change management, organizational development, organizational design, and performance improvement are not adjacent interests for us, they are the toolkit. A compensation model is a behavior model. A staffing plan is a culture plan. A workflow decides what a clinician has attention left for at four in the afternoon. Most of what limits a practice is not clinical and not even financial, it is structural, and structure is something you can actually design. That is the consulting we sell to outside organizations, and it is included for every clinical director in the network rather than billed as a line item.

The Midsommer Method

The organizational framework we use to hold up that condition is what we call the Midsommer Method: small, self-managing pods of roughly 10–12 clinicians, organized by geography or specialization, given the infrastructure of a much larger organization without the bureaucracy that usually comes attached to one.

• Pod structure. Clinicians organize into small teams designed to govern themselves once established, not permanently managed from the center.
• Collaborative decision-making. Pods make their own calls on client care, resourcing, and practice management, informed by organizational psychology rather than top-down directive.
• Shared knowledge across pods. What one pod learns doesn't stay siloed. Clinical and operational insight moves across the network deliberately.
• Supportive infrastructure. Billing, compliance, technology, and continuing education are handled centrally so pods can stay focused on care.

This isn't a philosophy we describe after the fact. It's applied organizational design theory, built the same way we'd build it for an outside consulting client, and then held to the same standard inside our own practices first.

The flywheel: why serving partners is the growth strategy

We think of growth less as a sales function and more as a byproduct of a structure working as intended. When a pod or partner practice succeeds under this model, two things happen at once: the clinicians and clients inside that practice are better served, and Midsommer's own capability (capital, infrastructure, expertise, track record) grows a little more. That added capability is what lets us take on the next partner, and support them better than we could have supported the first one.

Success compounds outward, not just upward. Every partner we genuinely serve well increases our capacity to serve the next one. That's the entire growth model.

Our intent is to keep populating this ecosystem deliberately: bringing in new pods and new partner practices not to maximize our own footprint, but because each well-supported addition feeds the capacity of the whole network to help the next practice, and the clients behind it. Organic growth and strategic partnerships are simply the two channels through which we do that; the underlying mechanism is the same either way.

A community model, not a diluted one

The usual assumption about networks is that breadth costs depth: that the more practices you take on, the thinner the expertise gets, until what you have is a brand and a billing department. We think that only happens when the network is built to average its practices rather than to concentrate them. Ours is built the other way. Each pod and partner practice is regional and, where the market allows, specialized, which means depth is the unit we are replicating. What the network adds is not sameness, it is access: shared clinical and operational knowledge, a back office none of these practices could afford alone, continuing education, referral flow, and leadership support that an independent practice usually goes without entirely.

We are also deliberately long-horizon about it. Optimizing for the short term is easy to do in this field and almost always shows up in the same three places: caseloads that climb, sessions that shorten, and clinicians who leave. We would rather build practices that are still good, still open, and still reachable in twenty years, and we are willing to grow more slowly to get there.

Ethics and performance are not a trade

The fair question to ask a model this constrained is whether it can perform. Our answer, and we hold it plainly, is that the constraints are a large part of why it performs. The practices we manage see outsized results, and they see them because of the ethical, human-centered work rather than in spite of it. Clinicians who are paid well, trusted with their own decisions, and not asked to sell anything tend to stay, and turnover is the single most expensive and least tracked line in a behavioral health practice. Clients who feel genuinely cared for complete treatment, refer their friends, and come back years later when something else comes up. Practices with a clear specialty and a real regional reputation do not have to buy their growth. None of that is charity. It is simply what good operations look like when the incentives point the same direction as the clinical work.

We do not trade ethics for performance. We have found we never had to. The innovation is in the structure, not in what we are willing to give up.

Where we do push hard is on design. We are aggressive about workflow, compensation architecture, payer strategy, technology, and organizational structure, because those are the levers that let a practice pay its people better and still hold healthy margin. Each practice is optimized for its own clinicians, its own clients, and its own region first. Midsommer benefits second, and only through the same mechanism: every practice that does well makes us more capable of helping the next one, which makes the whole network stronger than the sum of the practices inside it. That is the only kind of growth we are interested in.

What we won't do

Midsommer is self-funded and structured to never accept venture capital or private equity investment. We think that's the only credible way to hold the line described above: an outside capital structure with its own return timeline would eventually put us in the exact position we're trying to build an alternative to. Growth here is organic and partnership-based, on a timeline that answers to clinicians and clients rather than investors.

An invitation

We don't think Midsommer is the only path to a more humane model of healthcare and behavioral health, and we'd genuinely like to see this structure, or something like it, replicated well beyond our own portfolio. If you're a clinician, practice owner, or organization who sees the same glass barrier we do and wants to build against it rather than around it, we'd welcome the conversation. And if you are an owner currently weighing the two doors, a sale you don't really want or a hiring spree you can't really afford, we would ask you to at least look at the third one before you decide.

Spencer R. Potesta & Taylor Newendorp

Founders, Midsommer Health