Geoffrey Grammer

Mental health awareness might be one of the most pressing concerns that our fast-evolving society is currently facing. Almost all mental health experts are fighting against stigmas to enable patients to get the best treatments and resources to feel better. Today’s medical challenges require new ideas and efficient implementation of solutions that defy traditional care models. One of the most ardent reformists advocating for better treatment is Dr. Geoffrey Grammer, Chief Medical Officer at Greenbrook TMS NeuroHealth. Dr. Grammer is working to reinvent neuropsychiatric care to overcome barriers to provider and patient awareness, fiscal viability, and geographic availability.

An Ardent Mental Health Expert Transforming Patient Care

Dr. Grammer attended medical school at the Uniformed Services University before completing residencies in internal medicine and psychiatry at Walter Reed Army Medical Center. He earned subspeciality certifications in geriatric psychiatry, as well as the United Counsel for Neurologic Subspecialties certifications in behavioral neurology and neuropsychiatry.

During his 25 years of service in the U.S. Army, Dr. Grammer led the U.S. military to adopt progressive, ground breaking mental health care to treat U.S. service members, many of whom had undergone multiple deployments. His roles included Chief of Inpatient Psychiatric Services at Walter Reed, Chief of Research at the National Intrepid Center of Excellence, and National Director for the Defense and Veterans Brain Injury Center. He was a first responder at the Pentagon after the 9/11 attacks, and he completed three deployments, two in Iraq and one in Afghanistan, retiring from the U.S. Army as a decorated colonel with numerous awards including the Bronze Star, Legion of Merit and Combat Action Badge.

Dr. Grammer joined Greenbrook TMS NeuroHealth as a Founding Member and Chief Medical Officer in 2011. He advises the Chief Executive Officer, Board of Directors and other corporate personnel on all relevant clinical matters. Further, he helps establish corporate strategies for ensuring the highest caliber of clinical excellence at nearly 200 treatment centers around the country as well as vetting clinical offerings to benefit patients who are suffering from treatment-resistant neuropsychiatric conditions. As one of the first clinical transcranial magnetic stimulation providers in the country and a nationally recognized expert in the field of TMS, Dr. Grammer provides subject matter expertise to other Greenbrook providers. He also devises training programs for new providers and contributes to the development of operational procedures, spanning all aspects of the organization.

Dr. Grammer has authored numerous publications and book chapters and has been invited as a guest to multiple media outlets throughout his career, including print, radio and television. At Greenbrook, he often focuses on media creation and is the host of a successful podcast that provides information on the latest developments in emerging behavioral health therapies.

A Paradigm Skillset Shift in Neuropsychiatric Care

After working across numerous health care platforms with many medical professionals, business leaders and military personnel, Dr. Grammer has garnered a broad skillset that extends well beyond his medical training.

The start of his medical career at the nationally renowned Walter Reed Army Medical Center provided him with a culture of medical acumen and academic pursuit. His deployments required translation of care to austere environments with high-risk consequences. This blend of clinical excellence and the need for novel solutions for complex operational considerations helped shape his approach to the corporate medical world.

Overcoming the Challenges in Scaling Tech-Based Solutions

“There is a fine line between being a medical pioneer and exceeding data-driven evidenced- based care,” said Dr. Grammer. “Creating new models for care using innovative technologies must constantly balance enthusiasm and conservative caution for the well-being of patients.”

There is often a considerable delay before new treatments are incorporated into routine clinical practice. While this can help ensure the vetting of those modalities beyond the initial clinical trials, it may leave patients without adequate relief.

One-third of patients with depression will not improve with medication management, no matter how many medications are tried. Dr. Grammer presumes that technology in neuroscience continues to pull back the curtain on the causes of neuropsychiatric symptoms, but the interpretation of this literature can be complex.

“Deciding when and how to deploy new treatments must weigh the risks and benefits of each, tempering altruistic enthusiasm with conservative skepticism to avoid futile or harmful initiatives,” he said. “This delicate balance can be one of the most difficult challenges to scaling new clinical modalities across the medical landscape.”

The Keys to Being a Good CMO

Though an exceptional foundation in clinical knowledge is required for a CMO, the ability to work with other key stakeholders to bring about the implementation of new programs and procedures is critical. A CMO should be able to speak the language of corporate medicine. This extends beyond just vocabulary and interpretation of complex medical topics but includes interpersonal competency that promotes buy-in from non-medical team members and investors alike.

“The best ideas can be lost if the translation of medical information to business leaders is degraded,” Dr. Grammer said. “A good CMO must not only know when to push for ideas but also when to reject initiatives.”

Dr. Grammer has seen that as a medical company grows, it becomes a beacon of interest for other interest groups and agencies that result in daily pitches for the adoption of new products or programs.

“The skill to avoid the harm-avoidant approach of universal rejection or the undiscerning optimism toward universal adoption is critical,” he said. “At the least, a company could miss nascent opportunities or invest time and resources into futile efforts. Often, these decision points lack precedent in the marketplace and thus rely upon the wisdom and acumen of the CMO.”

Dr. Grammer suggests that a CMO should have a clinical acumen that garners the respect of peers.

“The shift from clinical practice toward corporate duties can degrade the efficiency of leadership through a variety of mechanisms including ill-conceived medical advice, loss of confidence in organizational medical personnel, poor prioritization of efforts, and errors of commission and omission that have not kept pace with the clinical landscape,” he said.

Democratizing Disruptive Technologies to Improve Patient Care

During the pandemic, Dr. Grammer has observed behavioral health care reaching a crisis inflection point as the rates of depression, substance abuse and anxiety have increased.

“The reality is that there are just not enough licensed behavioral health providers to meet the needs of the community,” he said. “Some companies have pursued models of care built around impersonal efficiency, leaving patients feeling misunderstood and invalidated and providers feeling stretched to the point of impacting their career satisfaction. This phenomenon has led to several providers from payor networks, creating less availability and a tiered system of care with disparate quality.

“While many automatic and technological solutions are available in the market, the best of corporate or technological engineering will be wasted if there is not a commercially viable model and a process for scaling these solutions across the network of care.”

At Greenbrook TMS, Dr. Grammer’s team continues to look for ways to provide patient- focused care with a high level of personal interaction and consideration that uses technology to maximize provider and patient collaboration. For them, technology should be augmented to provide patient care, not used as a replacement to maximize the amount of time and resources that providers might need for decision-making, enabling them to accommodate business requirements and improving the time in which patients and providers can work together to appreciate the scope of concerns and jointly reach consensus on best treatment options.

Greenbrook TMS utilizes electronic health records, digital data collection, automation of customer relations and revenue cycle options, and marketing initiatives that emphasize digital campaigns. They will continue to look at technology solutions for intake, care delivery and aftercare monitoring with plans to incorporate when it benefits the patient experience and not for the sake of the technology.

Advanced Treatments to Tackle Public Health Bottlenecks

According to Dr. Grammer, Greenbrook TMS prides itself on bringing complex treatments to patients. They establish treatment centers near residencies and workplaces and use insurance payors to improve fiscal feasibility, and their marketing programs inform current and potential patients about new treatment modalities. The team has advanced corporate and clinical talents to tackle broad public health challenges, starting at the local level.

For decades, behavioral health care has been centered around medications and talk therapy, yet for many patients these interventions have failed to result in adequate relief from symptoms. The complexity of care and the business backbone needed for implementation is out of reach for private practice providers, and Greenbrook TMS is committed to creating treatment centers that serve as a platform for uniting patients and providers for idealized care delivery. Using existing paradigms of care in the community will not be enough to meet public health needs. Around 80 percent of patients receive treatment for depression through their primary care provider without the benefit of a behavioral health professional. A common refrain is that behavioral health care is expensive, has long wait times, and can be unsatisfying due to short and infrequent appointment times. Furthermore, new treatment modalities and the latest best- practice initiatives can be missed by providers who are struggling to meet the needs of patients that eclipse provider availability.

As experts increase their understanding of neuropsychiatric illness and brain function, behavioral health care will need to adapt its approach to change with the times. Just as advancements in urgent care reinvented acute care delivery and ambulatory surgery centers decreased the labor intensity and risk of hospital-based procedures, Greenbrook TMS works toward creating new treatment programs and paradigms with impetus for better patient care without compromising efficiency or productivity.

Dr. Grammer envisions a future where Greenbrook TMS is the country’s largest provider of TMS and Spravato, a prescription nasal spray for patients with treatment-resistant depression. He looks forward to implimenting treatment solutions as their efficacy is proven, such as what might occur with psilocybin or other psychedelics. Greenbrook TMS is stepping into a future that incorporates the ease of online access with the comprehensive satisfaction of face-to-face care.

A Piece of Dr. Grammer’s Mind for Budding CMOs

Dr. Grammer believes these are the most ardent qualities that aspiring CMOs should possess:

Be a good clinician. This requires effort and attention to both training and continuing education. A good CMO must be considered a leader in the field; otherwise, they might lose the confidence of the care teams and business stakeholders.

Participate and be familiar with clinical research. Even if research isn’t a main initiative of the company, being familiar with good research designs and data interpretation is critically important for vetting new treatments and technologies. Avoiding errors of omission or commission can balance expenditures between critical resources and futile initiatives to help maintain corporate competitiveness.

Take leadership positions though your career. A good CMO must have a fundamental understanding of organizational leadership. They need to understand the feasibility limits and practical considerations that corporate operations must overcome to implement care models. Ideally, a CMO would serve as a point for the deployment of new programs and have practical experience with various positions of escalating responsibilities.

Be broad. A good CMO may be required to interact with people of distinct backgrounds and experiences. Medicine can be an insular environment, and a lack of proficiency to tackle others can degrade stakeholder confidence and diminish a CMO’s advocacy. Both interpersonal and recreational diversity can be a competitive advantage in accomplishing initiatives.

Pick your battles. Medical idealism must contend with corporate realities. Payroll must be met, facilities need upkeep and growth is expected from investors. Besides, blind rigidity to medical idealism that ignores the rest of the organization’s realities will stagnate progress and create liabilities to the organization that can threaten the entire enterprise. Judgment and wisdom must prevail to overcome the logistical considerations of corporate medicine.

Quote: “We continue to look at technology solutions for intake, care delivery, and aftercare monitoring with plans to incorporate when it benefits the patient experience and not for the sake of the technology itself.”

- Dr. Geoffrey Grammer, Chief Medical Officer, Greenbrook TMS NeuroHealth Management: Dr. Geoffrey Grammer, Chief Medical Officer, Greenbrook TMS NeuroHealth Website: https://www.greenbrooktms.com/