B.J. Miller, Sonya Dolan Found Palliative Care Company Mettle Health

Artist and hospice manager Sonya Dolan and palliative care physician B.J. Miller have established a for-profit company, Mettle Health, designed to provide a unique model of palliative care. Mettle offers counseling by interdisciplinary palliative care clinicians for patients experiencing serious illness and their caregivers. 

Mettle describes its services as praxistential care, helping patients and families navigate practical, emotional and existential concerns. Miller and Dolan jointly own the business and capitalized the startup using personal funds as well as a loan from a social venture foundation. The company plans to begin seeking investors in the near future.

“We’re entirely staffed by palliative care clinicians. We are coming from that world and know it well. We can catch folks and understand the context of their toils, but we’re not applying the medical skill per se. In part that’s to sidestep the medical industry’s gummed-up works, and avoid [electronic health records] and regulatory hurdles,” Miller told Hospice News. “It’s also born of a sense over the years that the medical piece is pretty good. The psychosocial and spiritual and cultural dimensions of care are, for our money, much more interesting and also underdeveloped. It allows us to focus on these other pieces of the puzzle that don’t get as much attention, while also allowing us to definitely navigate around the medical industry. We exist to complement existing structures and systems and to help them work better rather than to supplant them.”

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Miller left his clinical practice the University of California Helen Diller Family Comprehensive Cancer Center to launch Mettle Health with Dolan, though he maintains a teaching role at that institution. Miller speaks nationally about end-of-life care, including the benefits of hospice and palliative care. He was featured in the Netflix documentary short film End Game, and is the author of A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, with Shoshana Berger. He was among the 2020 class of Hospice News’ Changemakers.

Mettle co-founder Dolan trained as an artist and a business designer with experience in large-scale event planning. She was inspired to enter the field by the hospice care her mother received, and went to work for a San Francisco-area nonprofit hospice, managing the administrative staff.

“Because I came from an outside world, not from health care, I could take these solutions that I had learned from event planning, and from branding and marketing and apply them in a different way, and it led to a lot of successes, as far as the hospice’s regulatory burden,” Dolan said. “I love hospice very much, and I still miss doing that. But [Mettle Health] is an opportunity to really change the way people think about illness and the end-of-life and death.”

Sonya Dolan, co-founder of Mettle Health. Photo courtesy of Mettle Health.

Medicare does not cover Mettle’s services, and the company does not accept private insurance. The clients pay directly. Mettle markets itself directly to the consumer, though it does receive some referrals. Mettle is building relationships with organizations that provide related services to facilitate mutual referrals, such as advance care planning companies, other health care providers and others that address the needs of the seriously ill population.

The company’s services include advance care planning, bereavement counseling, caregiver counseling and education, assistance with medical decision making, education regarding hospice care, as well as spiritual and emotional care, among others.

“We’re building the plane while we fly it. While seeing clients and figuring out the model, we are also digging in with our friends and consultants to flesh out the business plan,” Miller said.

Todd Hido
B.J. Miller, M.D., co-founder of Mettle Health. Photo courtesy of Mettle Health.

Like many health care services during the COVID-19 pandemic, Mettle Health is relying on telehealth for connecting with its clients. While many of the company’s clients are local to its home base in the Bay Area, the flexibility of telehealth offers the potential for a national and international reach as Mettle Health grows.

“We would love to be a national organization.We’re starting here in the Bay Area as the first focus, but absolutely, we want to be able to connect with someone in Kentucky or Michigan and talk to them in the same way,” Dolan told Hospice News. “This also goes back to the mission of wanting to provide palliative care to anyone who needs it. This is such a big need. Therefore, we want to scale to fit that need and don’t want to be a small boutique practice that can only be accessible to a few.”

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