Tales from the Trenches: Karan Singh, COO of Headspace

(00:11):
Hello everyone. Welcome to our signature Tales from the Trenches series, which we are delighted to produce together with VillageMD. Uh, I'm Steven Collens. I'm the CEO of Matter. We are a healthcare technology incubator and innovation hub with a mission to accelerate the pace of change of healthcare. And we do three things in service of our mission. First, we incubate startups. We launched about seven years ago. We've worked with more than 750 companies. They range from very early to growth stage and we've have services to help them at every stage. Along the way, they've raised an aggregate more than 4 billion to fuel their growth. We also work with large organizations, health systems and life sciences companies and payers to help them strengthen their innovation capacity. We help them find value in emerging technology solutions. We help them empower their internal innovators and we help them build a more human centered healthcare experience through large collaborations.

(01:19):
Third, we're a nexus for people who are passionate about healthcare innovation. We bring people together to be inspired and learn and connect with each other. And we produce a lot of programs like this one that are open to the public, that are large scale. We produce a lot of programs that are much more intimate and curated for our members or for particular groups as well. So Tales From the Trenches is our longest standing series at Matter, where we bring accomplished entrepreneurs who share their journeys about how they got started, what they've learned along the way, where they are now and where they're going. It's a series we produced together with VillageMD, which is it's a leading national provider of value-based primary care services. Somewhat recently has received 6 billion in investment from Walgreens to really scale nationally. Today we're joined by Karan Singh is the chief operating officer of Headspace Health.

(02:21):
He co-founded the Mental healthcare company, ginger in 2011. He was the COO until the acquisition by Headspace. And it's been an amazing journey thus far for Karan and the team that built Ginger and really one of the pioneers in digital health and in mental health care, specifically who Karan, thanks so much for joining us. We're looking forward to hearing more about your journey. Leading the conversation with Karan will be Dr. Satan Jane, who's National Medical Director at VillageMD. Uh, Dr. Jane serves as the clinical lead for Village Medical Markets in the northeast and he leads company-wide efforts on transitional care management, behavioral health integration, and Covid response. It's Karan Satin. I invite both of you to join us and really looking forward to this conversation.

Speaker 2 (03:14):
Thanks Steven. All right. Well Karan, it's such a pleasure to be able to spend this hour with you and pick your brain about your experiences starting Ginger and how that's evolved with your merger with Headspace. So we'll dive right in. I feel like there's never been a more perfect time to talk about behavioral health with everything that's happened with Covid and just surges of people needing to access more behavioral healthcare. Although one might argue that we should be, we should have been talking about behavioral health even way before Covid, and certainly you were love to hear more about just Ginger in terms of the company that you originally founded way back when. That sounds good section. Well, hey, thank you again for having me and to Steven and the matter team for hosting this. I got a chance to listen to a few of the sessions before this and some just great stories from the trenches.

(04:13):
So hopefully we'll get into the trenches today. My story and really the story at Ginger started over a decade ago now, mental health in many ways is in vogue and frankly was long overdue to be so. And unfortunately during Covid, I think the need is just more pronounced. We've got over a billion people worldwide now who our need of mental healthcare services and that was true for a family member of mine that had tried to take their own life. I was at the end of a phone call when I was surprised, to be frank, I always thought I was a good read on people, a good judge on character, and I got this phone call after they had tried to do so one Thanksgiving about 14 years ago now, and that really set me on this path, on this journey. My family originally is from India and grew up in the United, grew up the states, but mental health is a no-go zone.

(05:13):
It's a topic everyone didn't talk about, especially a lot of communities of colors. That was really true and it's true in our family for sure. So it got me started on this journey and I started to dig into how mental health care was accessed and delivered and the deeper I dug, just the more I realized how broken it was at every step of the process from just an incredible stigma to challenges with access to care because of the supply and demand and balance and the space that just not enough providers to actually seeing a provider and that provider not necessarily practicing evidence based medicine and then walking outta that provider's vir door virtual or otherwise, and having to often pay full price a hundred dollars, a couple hundred dollars a session because most were outta network. And so we started really Ginger coming out of graduate school at the time I was at MIT and Harvard studying this intersection of healthcare and technology looking to try to make a dent in the space. Originally the vision for Ginger was a technology provider selling into other mental healthcare providers and ultimately realized that the only way we're gonna solve this challenge was to become one ourselves.

(06:21):
Well, it's a fascinating journey and what really drove you to enter healthcare in the first place? Looking back, it all makes sense at the time, it certainly didn't I, to be honest, I stumbled into healthcare. I was at uc, Berkeley as an undergrad, wanted to do something with purpose that had impact, didn't quite know what that felt or looked like, and stumbled into consulting, working with a lot of actually large biotechnology companies like Genentech and Amgen and Gilead launching sometimes life saving medications and therapies and had a great experience in that. But also realized that so much of mental healthcare was broken, that there was just so much investment that was going towards solutions or interventions that frankly often didn't move the needle. And that if you took a step back, providing a medication at the end of a series of broken touchpoints actually wasn't gonna resolve the issue that you actually had to rewire the whole machine and think about of fundamental care system redesign.

(07:36):
You all have done clearly at VillageMD and I think that's sort of what inspired me to get into this space. And you eventually went back to graduate school and got a scholarship and part of the deal with the scholarship was I was gonna start a company that had global social impact. And so for me, healthcare felt like a really great place to do that. And I obviously had this personal connection with mental health that gave me a sense of purpose and focus in that story. And that sounds like an enormous charge to start something with global impact and social impact, but you clearly pave the way and have done quite well. When I talk to a lot of folks who are thinking about careers and management or entrepreneurship, a very common question I get is, do I need to get an MBA to do that? And so what sort of drove your decision to get an MBA and how do you advise others? I'm sure you get similar questions often. For sure, and my caveat to all my answers is it largely depends.

(08:42):
It was the right decision for me looking back, no question. And in large part, I needed to create space to go deep and discover this space, this and you graduate school just more broadly helped me do that. But certainly my uh, mba particularly because I had this sort of dual degree or focused effort at the intersection of healthcare, I got a chance to really apply it to a specific use case and that made that experience far more valuable. It was kind of taking these lessons around sales or negotiations or change management or influence and then applying it to a specific setting, which is you. We had started the company while I was in graduate school at the time. So it gave me a laboratory almost to really be able to test out what I was learning.

(09:34):
I would say though that that's not true for everyone. It's not a requirement in order to get into entrepreneurship by any means. And the reality is this is hard. And so your MBA doesn't necessarily give you the resilience training that you need to be an entrepreneur. That's actually what I would focus on. I'd focus on how do you actually focus on found mental health and mindset and resilience because the journey to build a startup more broadly, but certainly any sort of innovation in healthcare is really hard. Takes time, takes years, if not decade plus. And there's a lot of lessons I think you can learn along the way, some of which you can learn in graduate school, but many of which you can learn through prior job experiences. Yeah, that's such a great perspective. And so I think that echoes what I tell people is it's gotta be right for you and it's gotta be at the right time.

(10:30):
So I love to hear a little bit more about your experience at gender and I, I'm sure a lot of folks are really interested and hearing more about the merger, we'll get to that in a second. But you were really able to successfully scale Ginger in a relatively short amount of time and I'm sure there were different challenges at the beginning and then even as you were scaling and probably found that the team that helped that you worked with and collaborated with to get Ginger outta the gate was probably a different team that helped it really scale to a very large and successful business. Can you tell us a little bit about that process of scale? Because I think it's probably a good problem to have that, to have the opportunity to scale and to have the investment, but what are some of the challenges and some of the lessons learned that you can share with the group?

(11:27):
A whole bunch of battle scars I'd say. So certainly some tales from the trenches I, I've kind of bucketed it into three pivots that we had over the course of our story, I'd say prior to Headspace. And then the Headspace stories is part of a pivot or an evolution if you will. But the first pivot was a business model pivot. The second was my team pivot. So you were describing kind of changing leadership in the DNA as we continue to scale. And then the third pivot was my own pivot as an entrepreneur, kind of my own mindset and how did I manage through that On the business model pivot, I think to be frank, when we started again, we were selling this technology solution that was really basically leveraging data you can collect off of a smartphone to predict when someone might have a depression flare or an anxiety flare.

(12:22):
And then based on their location and communication patterns, you could actually infer when they were feeling symptomatic, when they were gonna have about a depression or a flare up of anxiety. And we could use that to drive in effect more population health. And what we discovered is that while many providers talked about wanting those sorts of solutions, and this is well before value-based care and other sort of models have even started to take meaningful shape, when push came to shove and you looked at the incentives, the reality was most like no one actually invested in them. They'd be willing to do the pilot, they'd be willing to test it out, they'd see the results. And we proved in spades that it worked. But when you actually moved from pilot to let's scale this, let's invest a multi multimillion dollar kind of contract to actually support a large population.

(13:16):
Providers were in a fee for service environment. They had patients waiting out the door weeks, months if not longer, and there was no incentive to actually bring more people in because they already had more than enough demand. And so I think one of the biggest lessons and frankly kind of mistakes that we made in those early days was we weren't tackling the fundamental problem in the space. And that problem was and largely still is, around access to care that people just couldn't get through the front door. And so that's really what prompted I think our evolution from selling to providers to then standing up a virtual clinic and becoming one. And I think we use that as a chance to really not just take an offline visit and put it online. Teletherapy has existed for decades now, not as seamless and as easy, but largely you could have a session with a therapist and there's proven efficacy in many clinical studies that showed that it worked and worked equivalently to an in-person session.

(14:19):
But we actually thought about, well what would it take to actually fundamentally rewire this whole system? And not to give everyone necessarily a therapist per se or a clinical provider, but actually start to think about other kinds of providers like coaches Akin do of physician's assistant or an NP or an NP that can actually give our license providers more scale. And so we started to think about creating a different kind of virtual clinic model that actually allowed us to tackle that supply and demand imbalance and unlock access to care. And so that was a big part of that kind of, I'd say six to seven year journey in the early days until we really found the kind of core go to market to solve the fundamental challenge in the space. And it sounds like one of those opportunities was really building out the team, having everyone work to the top of their license and allowing you to really do more and serve more patients and extend that access. So that's a really great perspective. I'm really interested to hear a little bit more about the virtual component now It's like we're all on Zoom and it's commonplace and most companies, but probably 10 years ago, even though there had been a paradigm of virtual behavioral healthcare, probably more telephonically, what was the thinking behind that and was it a popular idea? What were some of the things that you heard when you told people you were gonna scale a virtual behavioral health model?

(15:59):
I remember vividly this conversation we had with a leading law firm and headline was It's the wild West. It's not allowed or not okay. But when you peel back the layers and you look at a lot of the regulations and otherwise you realize there actually is a model that puts the patient or the member at the center that protects their privacy and confidentiality but then still allows for the access of care and high quality care. And so it was scary. I mean, to be real, I remember that those conversations at the board meetings with our leadership team with many people throughout the organization to kind of move from really a technology platform, if you will, to actually becoming a provider of care, it took different kind of dna and especially since there wasn't precedent for it, particularly in behavioral health or rather, there wasn't a lot of examples of it being done well or done in a scaled way.

(17:04):
There was a leap of faith in some of this. And so it was tough at times because as I think we all know healthcare doesn't happen or innovation healthcare doesn't happen overnight unless there's a global pandemic and it forces the situation. But that wasn't true in 20 15, 20 16 as you were making that decision. And so I think it was challenging. I think we had a lot of late night conversations and heated board discussions to really think about, well what is the right scalable model here? And is this something that fundamentally is gonna solve the core challenge and deliver value to the end user, to the member? And I think that was what's right way to describe it. That gave us confidence that if you do but right by me the member, you can actually build a big business. And that there've been too many kind of folks in the value chain that were extracting their rent.

(18:03):
But if you cut that away and you really focused on, well, at the end of the day you have millions and millions of people who need access to care aren't getting it through the traditional system, the traditional system hasn't innovated to support that population, can we create something that is at least equivalent if not better, to give them that value? And that gave us the confidence to say, let's continue to try this. Let's continue to gather data, let's continue to first prove to ourselves and improve to the world that this model can actually work and be scalable. So not easy and some tough challenges along the way for sure. But looking back, it was the right decision. Yeah, I love that. And it's innovative and also it makes a lot of sense at the end of the day that you're trying to meet the patient or the member kind of where they're at.

(18:54):
And those are things that even on the primary care side, we're trying to figure out on a daily basis in terms of absolutely how do we improve that access? How do we make this more patient centered? And it sounds like you guys really figure that out and we're able to meet people where they're at in a way that made sense and that you were able to scale. So moving into Headspace. So really excited to hear a little bit more about the thinking around that. So my understanding is that that was something that evolved Rev relatively quickly and also happened right in the middle of the pandemic. So what was some of the thinking in terms of where you saw opportunity with Headspace or maybe some of the other organizations that you were considering as you were thinking about that merger, what were some of the decision points that you felt like could really complement the work that you're already doing at Ginger to help you really grow in an even more comprehensive business?

(20:02):
I think first and foremost, it started with the people. I think most of these things for them to really work out, it always starts with vision, values, culture alignment. And I think we had that in spades with the Headspace team. I'd say when I rewind back to the decision of becoming a provider, we often talked about the three Cs coaching, clinical and content. Pick two outta three was kind of the on a napkin back in the day when we made that decision. And the idea being like, you can't do all the things, let's focus on a few that we think we can do really well. And for us at Ginger had largely been building coaching and clinical services, introducing this preventative layer of care, making sure we could connect them to clinical care as needed and build this collaborative model or team based model. We had some level of content that we had built out, but the more we dug there, the more we realized that building scaled, engaging, stigma free content was a company in and of itself.

(21:19):
And when we looked at the market, there was really one company that clearly stood out and that was Headspace. And for the better part of a decade as well, they started roughly around the same time. Andy and Rich and the team over the years have built really an incredible product that allowed access in over 190 countries and hundreds of millions and millions of users who were looking for mindfulness and meditation and other self care resources to help them live a happier and healthier life. And for us, that was married so well with the genesis for gender, which if I take a detour for a second, it helps connect the story here. We name the company Ginger because my mom used to me feed me ginger and honey whenever I got sick. And a lot of Asian cultures and a lot of in India and beyond gender as a preventative connotation.

(22:24):
And she in many ways knew me better than I knew myself. And so prevention was at the core of what we did is how do we move upstream and catch things early? And the Headspace product and experience had done that in spades. And so it's been hard and fun to bring these teams and these experiences together. But we've now, I think coming out of this and built an incredibly, I think affordable, accessible and really comprehensive mental health and wellbeing solution that spans everything from mindfulness meditation, all the way to coaching therapy and psychiatry services. So medication management for our members. Great. And congratulations on that merger. So one of the things is you think about bringing two companies together, let alone two departments or two individuals. There's obviously cultural differences and I think as individual companies we're all trying to figure out how to deliver the optimal culture.

(23:24):
And so I'm curious how you have two kind of big companies that have different services that you're offering. How do you marry the cultures beyond the logistics and all the things that are happening behind the scenes around rev cycle, et cetera. But I think that that's such an important thing that I think we're trying to work on at Diligent and many other places. You seem all seem to have done a good job of it too. I I'd say no magic bullet here, I think it's been messy at times as a always is with people, right? You've gotta work through the specifics. There's a variety of different tribes that were in many ways all kind of coming together. We saw that when we first made the evolution of being a technology company and eventually then becoming a provider was bringing our tech technology teams alongside our provider teams.

(24:23):
And then we saw that again as we started to merge with the Headspace team where they have this incredible group of creators, content producers that have created Emmy award winning shows on Netflix that have been seen by tens of millions if not hundreds of millions of people. It's a very different skill set. It's certainly not something that's widely seen in healthcare creating a compelling experience or psychoeducation that people wanna consume. Most of what's produced is not very good. And so I think one of the things that's really helped is having that shared mission and vision values and really being able to bring the best of what both teams have to offer. And there's differences. So it's not just taking the two and melding them together, it's creating something new together. And it's this mutual respect across all of these different departments having to come together to build that.

(25:28):
But I think it's united by the fact that the need hasn't changed. It's only gotten more pronounced. The Headspace and the team had actually been doing an incredible amount of research prior to the merger and they'd found that so many of their members actually wanted more than meditation and mindfulness, that they needed more, that actually many of them have been acute and required some sort of clinical or other person based care. And on the flip side, we continue to find that so many of our members actually could have been supported in an earlier setting, could have been graduated after they finished their course of treatment with their coach or clinician and could actually gone to see a, could have actually gone through self care that they could have prevented maybe potential relapse. And so we've been working through how do we continue to meld those stories together. And I'd say it's been a journey where 14 plus months now in and I think we've come a long way really excited about a unified experience that we're launching basically in the next few months here and we're gonna continue to iterate around. And that having that unified goal has really made the integration experiences easier but not perfect.

(26:46):
And you're totally right. Having that shared mission and purpose is so important across the company and you have to be very intentional about laying the right bricks so that people are on the same page and feel passionate about those same things. And it sounds like you've already begun the legwork around that. So that sounds great. Both someone who's leading behavioral health integration for a large and growing primary care organization and also as an infectious disease doctor by training c o has been very illuminating in a lot of ways and has obviously exacerbated a lot of behavioral health disease. We've also seen people kind of come out of the woodworks and access behavioral health that maybe had existing behavioral health issues that now they felt more comfortable accessing. We've seen a lot of investment in this space for a lot of companies that are consumer focused or employer focused.

(27:48):
What are some of the things that you feel that this merger does differently from some of the other folks in the behavioral health space right now such? And I wish I could ask you a few questions about some of what you're doing cuz I know y'all have been doing some really great work in this space too. I, I'd say that the headline is we've under invested in behavioral health for so long that the last few years has really represented a catch up factor of trying to catch up to the lack of innovation that's happened here. And we know that one company alone isn't gonna solve this problem. And so that's something that's just helped me personally as there's been this influx of energy and entrepreneurship and creativity in this space. It's like there are so many challenges to solve for here. It's having one primary care company, clearly there's just unfortunately too much to go around.

(28:47):
So that's the headline for me when it comes to how we think about it and where we differentiate, I think it's a lot of what we've been talking about, the supply and demand imbalance in this space is so pronounced that there are just not enough providers, not enough therapists and certainly not enough psychiatrists to meet the need and that's going in the wrong direction. And so we need to rewire the whole system to solve for this. We need to figure out ways to pull costs out and to drive supply side innovation. It isn't about playing therapy visits online, that's one component of it, but it's actually systems level innovation. And so that's really the charter that we've taken is to say, okay, well what's the combination of resources from preventative self care tools, mindfulness meditation to people based support through highly trained coaches to eventually therapists and psychiatrists.

(29:43):
And then very importantly to a whole host of other things that are happening outside of the Headspace Health kind of product experience that we need to connect to, we might need to refer into in person or virtual primary care or I O P or variety of other resources when a member might be too cute or need to coordinate or comorbid conditions because so much of mental health is comorbid with other chronic diseases. And so I think that's our focus. And I'd say our differentiation too in the long run is that continuing to build out that compelling stigma free experience that pulls costs out of the system where also and very importantly the unit economics work, when you look at a lot of, I think the innovation of the space, it's actually been driving the price up, not necessarily down, which is me, which means that you're not gonna unlock affordable access to the communities and populations that are probably most in need that most likely can't afford it.

(30:39):
And so that's what we're excited about is figuring out ways to actually continue to innovate there and use technology and better processes and payment model innovation to create access to communities whether it's new languages or new levels of care. We introduced a few years ago access to teens and adolescents where the needs for mental health services is really continue to grow. Yeah, absolutely. And it also sounds like some other things that I think about are just the size of your organization and the ability to impact people in across really diverse geographies and also provide a diverse suite of services that, you know have this a carte option of whether you need more mindfulness or more clinical. And so you kind of have all of that available, which is really cool. And I don't know if everyone's kind of there yet, but I was talking to someone at another behavioral company a couple weeks ago and I said, listen, I'm kind of rooting for all of you because there's so much need right now and it's not even being met yet, right?

(31:54):
Yeah. So I think to your point, there's so much to go around, there's so much primary care to go around too and I think it's really gonna require a collaborative effort and also partnership between organizations like yours and ours and different ways. And so really excited about how all of those different pieces of healthcare are gonna start stitching together as these services become more available and such. If we just double down that just for a second, cause I think it's so important cuz it often gets lost, especially for entrepreneurs, is you think of your competition as others in your space when you know look at this sector and it represents less than 1% of the total spend. So most of the healthcare is happening in a very different setting. And so like you said, I think this is a team sport and this is a team effort and it's gonna require collaboration across primary care, it's gonna require collaboration across other early or late stage companies who all still want the same thing, which is to rewire the system to get access to care and frankly to break up sometimes a very inefficient system. Yeah, absolutely. So as we think about the Ginger and Headspace being clinical oriented companies and technology companies, how do you excel at both of those areas? Because I think some companies really dedicate themselves to being expert at the clinical aspect and you have to be very intentional about being good at the technology piece. So what's your kind of secret sauce for developing those seemingly unrelated parts of the business but so important?

(33:46):
I wish I had the magic pull on this one because I think it's definitely been hard to get right. There's no doubt about it because I mean these are disciplines that have historically not interacted right with each other. In a traditional hospital system you might work with it for your emr, but beyond that there wasn't a whole lot of process and workflow and other innovations that were really happening in a meaningful way that made your lives easier, more sustainable. And so I think that's actually been a unifying forces a, making sure that in the product development process the we're our product is in effect a combination of a set of technologies or what we often think of as products like mobile applications and backend dashboards and EMRs, et cetera. A set of people that are using the tools and a set of processes or workflows that are all kind of baked around that.

(34:45):
And that combined set of efforts to three P's is the experience. And so I think that's actually been a really helpful framework is to say, hey, we need people or stakeholders from every one of those departments to be coming together as we co-create these solutions and we need providers to have not just a voice but to help develop 'em, develop those solutions. But we also need great product managers, designers, data scientists and others who are really looking at these problems in a unique way because we know the traditional medical establishment didn't develop a solution that's scaled. We also know that you've got a lot of good intentions but a lot of big tech or otherwise that has historically not appreciated all the complexity that goes into healthcare. And the fact that medicine is just complicated and it's as much as it is science, it's also some level of art.

(35:39):
And especially when it comes to the mind and the brain, there's just so much we don't know. And so I think it just starts with getting those groups in together, working together and co-creating those solutions. And then having an experimental and feedback loop that allows us, while still protecting member safety and privacy allows us to learn and iterate. We've all got ideas but let's put it out there and see what works and then keep running with that. And so I think if people feel like they have a voice in that process and they feel like they have agency to actually influence it, that's helped. If any one of those is like defacto the automatic how things get solved, it doesn't work. It needs combination coming together. Yeah, for sure. So I think a lot of people are wondering where the future of behavioral health is gonna go. And I'm sure that you've been thinking a lot about this over the next five years, 10 years. Where do you see Gingered Headspace where that collaboration and what you've now built and grown, where do you see behavioral health growing going more broadly and where do you see gender and head kind of fitting into that future direction of behavioral health?

(37:11):
I'd say the headline is, I'm excited probably have to be if I've been doing this for as long as I have. And I think a lot of that excitement comes from the fact that there's a lot of really great people that have jumped in to try to solve this problem. Whether it's like from your vantage point from primary care, whether it's within behavioral health, whether it's kinda other sectors that are all thinking about different aspects of this solution, we're really bullish on the model that we've created. And in large part that's because while there are a lot of interesting point solutions that are solving kind of component pieces, there are very few that are actually connecting those threads in an integrated experience and you know aren't just one of those, you ebb and flow based on life's changes, new baby or get through the early years death in the family, get through the trauma post.

(38:17):
That experience that every one of these life triggers is an issue that can sometimes either exacerbate an existing chronic condition or can flip you into having an acute need that requires extra care. And when you're in those moments, it's hard to get help. And so our thesis is how do you remove friction from that process? How do you actually engage people really early in that so they don't feel like they have to have depression in order to get access to care? But when they do, how do you get them in it just as quickly as possible and then step them down to those other resources. So that's like our vision is that how do we work with large to small employers? How do we work with commercial plans and eventu increasingly government payers, how do we also unlock access in a consumer setting to affordable care that we know works that allows people to not, again, not just get a therapist because the default, what I'm really excited about is that therapy has become mainstream.

(39:24):
What I'm concerned about is that everyone thinks that therapy is the solution and the reality is it is for some and it's incredibly effective, important and we believe it and we have got an incredible team of therapists and it's not for everyone. Some members self care resources are actually appropriate or some kind of cognitive digital C B T or other sort of program that a member can go through, but for others they might need far more care medication management or beyond that. And I think being able to navigate through that is so hard and our belief is that combining those experiences are gonna be really powerful. If I take my Headspace Health hat off for a second and look more broadly, there's a long tail now of interventions that are being developed, everything from virtual reality therapy to new forms of medication management that are being studied right now in a variety of different settings that we just haven't really don't know enough about.

(40:28):
But I think I'm very hopeful will actually be very effective for certain cohorts. So I think the future's gonna enlarge part be better segmentation to know what works for whom, when and how. Yeah, that's a great perspective. I think there's such kind of describing the continuum of people and patients who are depending on what's going on in their life at that moment may come in and out of behavioral health care. And as you were describing that, I was thinking that's just like primary care. There's so many parallels to that and for obvious reasons, I mean behavioral health and primary care are inextricably linked and I think we need to do a better job of merging those two. But I think there's definitely a lot of opportunity here to think about the proactive and reactive elements of behavioral healthcare and there's lots of exciting things in the pipeline. So excited to see what's coming next for behavioral health and specifically for Headspace. So I think it'll be a fun journey as it already has been.

(41:48):
So shifting gears a little bit to, would love to get your advice for some of the folks that are listening. We know that hindsight is 2020 and you've had extensive experience to reflect back upon. If you were to go back in time and go back to a place where if you could pinpoint either a decision or an action that you took that maybe you might have done differently if you were to turn back the clock, is there something that you can think back to that maybe you might have done differently with the experience that you currently have?

(42:31):
I have to decide which of the many decisions I might have done differently. I think maybe I could referenced my third pivot, if you will. My me pivot as I talk about, which is my own mindset. That's probably one of the biggest to be frank. I think in the early days, certainly when my first job coming out of school undergrad and even in the early days at Ginger, I had this belief that the only way to be successful here was working harder, was plowing through it. And I think I realized that less but better is actually just a more fulfilling and sustainable life mantra. And I think that I read this book Essentialism and the byline is the discipline pursuit of less but better. And I think as an entrepreneur there's just so much possibility in the early days and you think about all the things you could do.

(43:41):
And I remember beating myself up often about not having done all those things and when I look back I realize that's just crazy. And I remember my daughter's seven years old as of last week. So that's that kind of marks the turning point in my sort of life thinking and I see all the baby pictures over your right shoulder there too. So I don't know if you can relate to any of this, but that was a reorientation for me to say when she was born that there's a set of things that I want to achieve at work, but there's a equally important set of things that I need to do and create time for necessarily to achieve but just be there for outside of work. And I think that's been made me more effective at the work that I do and made me a better leader and manager because I actually have time for that.

(44:33):
And that's took the form of meditation and mindfulness and yoga and exercise and cooking and all these things that are in the early days I'd say I just didn't have the time for that. I can't do that. And turns out that was a terrible decision cause it was so bad for my mental health and it made doing this work so much harder when in fact now that I've learned that I've become better and more effective frankly. Yeah, thanks for that. And I feel like I'm taking notes right now and it's great to see you leading by example, running a large mental health company and then being able to model some of those behaviors around maintaining work life balance I think is so important but so hard for many folks to do who are very motivated and driven to be successful, yet at the same time struggle to find that time to carve out for themselves as they go through this journey.

(45:35):
And that journey can be very long and if you don't sustain yourself, you're gonna burn out. So I'm glad to hear that you've, you found a balance that works for yourself. A great, I have to give this plug now cause it's been actually really even helpful for me now. There's a great Headspace podcast I called the Long Time Academy. You can find it on Apple and Spotify and the rest. And it talks about taking the long view and the importance of taking the long view. I'd highly highly recommend it. It's just fascinating as a podcast. And again, it sort of reinforces a lot of these core concepts, which if you're in this space, do it for the long run and take that view. And if you take that view then it becomes about working with people that you care about on problems that matter, not beating yourself up that it has to happen overnight, but being focused on for the time that you are spending doing that really, really well and being effective for that. So for what it's worth, no, that's really valuable advice. We covered a lot of ground today in terms of some of your career trajectory leading up to founding Ginger and scaling Ginger to the merger with Headspace and also getting some lessons learned about what maybe all of us could be doing better professionally. What other areas or advice do you feel like folks who are entrepreneurs or rising entrepreneurs should know that maybe you can share from your experience that maybe we haven't covered today?

(47:26):
Another really influential book in my life was by Sidney Poitier. It was one of the first African American actors to win the Academy Award. It was called Measure of a Man of a Person. And it was really that it was all about the importance of measuring you against you, not others. And I think that's been so important for me personally. And especially if you're an entrepreneur, you're just constantly waking up to news about someone who's done something better than you, younger than you, whatever it might be. And you don't know their story, you don't know everything that kind of went behind that and maybe the struggle they're going through and you don't know if they're gonna be successful the next week, the next month, the next year. And so I've learned to focus on me first as in have my measure be my own barometer, not what others define.

(48:32):
And it's been freeing, it's been really helpful and it's been actually something that I wish I had known a long time ago. And you have this sort, especially with social media and the rest is just this constant of mirror against everything you're doing and you have to compare yourself against others. And I think I've learned over the years that just how harm that harmful that's been for my own mental health and how important it's actually been to just take the time and have the courage because you're gonna fall down, things aren't gonna work out. And building resilience or the bounce back muscle again might be the number one skill you need to learn as an entrepreneur. And I was trying to count, I got asked this, how many nos have I gotten over the course of the last decade and just, or how many heartbreaks or how many just critical pivots have I had to make that were challenging And reality is many, many thousands and thousands.

(49:37):
I don't actually quantify it, but the thing that's helped the most in the way that I've been able to get back up oftentimes is really having that, of having these resources, having this sort of practice. And it's come through a variety of different tools from meditation and mindfulness. I use the Headspace app every day as part of my morning routine and my morning walk and having these other resources just so that we can take care of our own mental health. I mean we talk about patients or members or others, but it's easy to focus on, lose focus on the fact that you need to do you first. Yeah. And that mindset of comparing yourself to others, you know, think that people will graduate high school and then that would just be a thing of the past. And then it's almost like the further you get deeper into your professional career, some of those symptoms start coming back. And so it's interesting to hear you talk about that.

(50:39):
There was one more question that came in the chat that I wanted to ask you about from one of the listeners was about the integration with social determinants of health. Certainly a very important area as we think about health equity and access to care. Is that something that you are working on? And if you could talk a little bit more about that probably deserves its own panel in and of itself, the intersection of health equity, social determinants of health and mental health. They're so intertwined and so complex. I'd say at the core, I think it's fundamental and foundational to what we do. And again, we know we can't do all the things. And so whether that's collaborating with primary care or other resources or building out our own referral coordination team to help support and connect people to not just mental health resources but a variety of other resources, we know that that's critical.

(51:46):
I, I'd say that we focused a lot on making sure that we not only we can a recruit a provider group of coaches and therapists and psychiatrists and support staff that are reflective of the population that we serve and make sure that they are diverse and can represent again, the different kinds of populations that we work with and have the level of cultural competency to really be able to stay in tune to the needs of those groups. And that's helped because that's also helped then inform the product development process and making sure that we're being mindful of not just the quality but really equity so that members can get the appropriate level of care. It's an area that we're continuing to invest in and we have an incredible leader on our team, Dr. W Powell, who has done a lot of research into this space and over the years has helped us in rolling out programs and resources as part of our purpose program, if you will, to deliver impact to different communities and different populations.

(52:53):
And I think in the long run as we continue to work with, eventually more and more government payers is gonna be just a critical part of making sure that we can achieve the outcomes that we want to achieve. So I'd say the short answer is it's very important and it's hard. We're definitely looking for partners and ideas and people who can continue to inform our approach here and it's something we're committed to continue to invest in to make sure we can get the outcomes and achieve access to those who most in need. That sounds great and wish you all the best and your journey and continued success. It was really great chatting with you today, but it was really nice chatting and thanks for your time. I'm sure a lot of our listeners got a great, learned a lot from our conversation. Thanks such, I appreciate the questions. Again, I wish I had time to ask you if you, y'all have done some great work here.

Steven Collens, CEO of MATTER (53:51):
Thank you so much. Thanks Satin for leading the conversation and Karan, of course for all your insights and everything. I mean I, I've sort of followed Ginger since it's early days. I mean again, it was really one of the pioneering companies in digital health and in mental health that we all hear about all the time now. And then of course I've followed head Headspace cuz Andy's voice is really the most, I just want his voice around me all the time cause it's amazing. But obviously it's much bigger than that now, but especially in the early days. So really looking forward to seeing what you and the whole company do this platform. And thank you so much for joining us. Hope you enjoy the rest of your day.

Speaker 2 (54:34):
Take care. Thanks everybody.