Mental Health Access and Innovation: Meeting Employees Where They Are

Michael Mendenhall: Welcome back. Fun morning. We have a great afternoon. It is now my pleasure to introduce you and welcome back TriNet's President and CEO Burton Goldfield.

Burton M. Goldfield: Good afternoon and welcome back. We have another amazing guest for you this afternoon. Dr. Jon R. Cohen is CEO of Talkspace, a behavioral health company. Talkspace uses texts with licensed mental health therapists. Jon began his career as a vascular surgeon and then became chief medical officer at Northwell Health. He was the chief policy advisor to New York Governor, David Patterson, and he's a respected CEO using Talkspace in a very innovative way. So let's bring our hands together and welcome Jon to the stage. Welcome Jon.

Jon R. Cohen, MD: Thanks.

Burton: So before we get started, for those online, there's a little box on the screen and you can submit questions, which we will try to get to at the end of this discussion. So, Jon, I want to start with the state of our society. The environment seems to be polarized. It is blurring into the workspace. I can certainly see it. How do you think this is affecting mental health, both within the workspace and the leadership that's trying to build companies today?

Jon: Well, first of all, thanks for the invitation and for all that TriNet's done. It's an amazing conference. So congratulations.

Burton: Thank you so much. We love having you here.

Jon: So, I was trying to figure out how to introduce the topic of mental health, mental health therapy relative to what's going on. And actually this morning I went on Google. I said, what's the number one issue, for HR executives and CEOs, what's trending in 2013? And the number one issue is mental health for employees. And there's enormous amount of statistics out there. 70% of people say they want their employer to be engaged and figure out how to navigate through mental health. You know, over 70, 80% of employees say, you know, if my employer would help me through this, it would be an amazing fact to keep me on board.

So no matter what statistic you look at, the retention rate, the productivity rate, the cost is lower and people's absenteeism. All of the data indicates that if there's a vigorous mental health support program, employees are happier, they do better, and the company actually does much better. And I like to make this personal. So I tell people all the time, when you walk in the room, whoever you are, if you're an HR executive or whatever senior leader you are, or the CEO of the company, you walk in the room every day, hopefully, and you have a meeting with a bunch of people, and you should never forget that every single person in that room, many of them, oh, my kid's having trouble in school, I had an argument with my spouse today, my parents aren't doing well.

And those are the things that they're thinking about when you're trying to do a strategic meeting or you're doing a business meeting and you should never forget the fact that people bring all of this to the table and the question is how do you navigate through that? How do you help people navigate so that they're better at their job? You and I talked about the pre-meeting the other day is, if you're not happy with your work, if you're not happy what you do every day, nothing else matters.

Burton: That is certainly fair. So why did this become such an issue? Because I dare to say 10 years ago, nobody discussed mental health in the workplace. Is this a change from a societal standpoint or finally a recognition that this impedes productivity, the ability to build great businesses?

Jon: It's a huge change in understanding and perception. And I like to say that the time as a physician, the time for mental health has come. I went to medical school 150 years ago. And I will tell you honestly, I had one week of psychiatry, four years of medical school that has dramatically changed, right? Like I wouldn't say nobody cared, but it just wasn't a big deal. And what I like to point to in terms of some of the proof points, for those who remember when Damar Hamlin actually had a cardiac arrest on the field of the NFL, remember that was a huge deal. They stopped the game. That was the first time they didn't complete a game, and you look at all the players around and everybody was just blown away, like, this guy has gotten resuscitated on the field. Is he going to make it? Is he going to be alive?

And the next day on CNN, I will never forget, the representative from the NFL union. It was up there on the panel, big guy, you know, six foot six. And he basically said, listen, guys, there is no way you're going to psychologically get through the mental health of watching this guy rest on the field and get resuscitated. And basically he said, "You guys need to man up. It's about time that we recognize that mental health and therapy is just an unbelievable asset, so, you know, basically stop screwing around and go get help because you're never going to get through it without it." And that to me, is emblematic of where we've come. Five years ago, the NFL never would have talked about this.

Burton: So the good news is they're talking about it and, with all due respect, what is a surgeon talking about mental health for?

Jon: Yeah, that's a very good question. I tell people vascular surgery, psychiatry, mental health, there is no universe, no place in the universe where that Venn diagram overlaps, okay? It just doesn't happen. So I've been very fortunate, you know, in fact very lucky in my life to have had multiple different opportunities to do different things and run a bunch of different, you know, companies and it's been an amazing personal experience.

Well, I was actually on the board of Talkspace, and we'll talk about the company hopefully in a couple of minutes and the people on the board had asked me and the chairman had said, "Listen, you know, would you consider coming off the board to be CEO of the company?" And the reason I did it is as follows. One, mental health time has come. Second, there is actually enormous amount of funding for the first time being put into supporting mental health. Third, if you look at what we call the TAM, which is, you know, what's the addressable market. Yeah. I could tell you it's a $30 billion market and I could tell you it's a $250 billion market. Nobody knows because it is so pervasive, so many people want it. You don't have to steal market share, basically, you just have to build the market.

Burton: Right.

Jon: On top of it, you're doing amazingly good things for people. And I thought, okay, this is a really cool thing to do, and it's an amazing opportunity. So I said, sure, I would do it. And we can talk about what that is, but that was the major decision. That was the major reason. Those were the major reasons why I made the decision to go ahead.

Burton: So you took on a completely new and exciting challenge.

Jon: Yes.

Burton: And it wasn't a matter, a lot of people said to me, "You know, you've run a billion seven on the P&L side, why are you going to $140 million company?" And I said, "it doesn't matter, I want to get up every day and go to work and be happy with what I'm doing and see if I can make a difference." So let's talk a little bit about Talkspace. Who are your customers and what is that unique approach that you're taking?

Jon: Sure. So Talkspace has been around 12, 13 years. Our brand ambassador, for those of you who were here yesterday, is actually Michael Phelps. He has been our guy up in front. He's had an amazing story and has been using Talkspace for as long as we can think. So Talkspace pioneered all the work originally, which was also amazing to me, where you can text people or message people to deliver therapy. So think about that. On your cell phone, it turns out your therapist is available almost 24/7, you have a constant conversation. So the conversations and texting was all the pioneer working, all the research, all the publications, which was originally done by Talkspace. We've then moved in addition into video, live video and of course for phone and conversations. So we offer all three modalities. But still a majority of our business, of our interactions with our therapists is through texting. So we're in all 50 states. We have 4,400 plus therapists. And I think the biggest marquee item for Talkspace is we are the largest in network provider of telehealth mental health in the country.

So what I mean by that is we cover 112 million lives of the 330 Americans. That is going to grow substantially in the next six months to a year. So the difference for us is if you need therapy, we ask you, we'll determine your eligibility, pretty good chance you could either get it for free or you could have a $20 copay. That is a massive change for us, because when you find therapy online and you find Talkspace, we say, "Listen, you could pay it for as a consumer, it's about $200, $250 a month."

Burton: Right.

Jon: It's very expensive or let us determine eligibility. So the result of that is we have had enormous growth, as you can imagine, as people have moved to the platform because they don't have to pay for it. So, it's texting, voice and video. That's what we provide. And then we provide it for people who have benefits. We provide it as part of an EAP program and we can talk about when we get to it, we also have a direct to enterprise, which is really important for this audience relative to HR executives and what we do for employers.

Burton: So tell me a little bit more about virtual therapy.

Jon: Sure. So it turns out Covid accelerated telehealth in general by at least 10 years. It literally accelerated telehealth. What was interesting, about 20% of primary care visits, right during COVID, about 20% occurred as telehealth visits and telehealth mental health was a big part of that. Post-COVID, it's fallen off some, but what's happened now is, if you look at all the telehealth visits in the country, 65% of them are mental health. And the reason is, it's unbelievably convenient and it's unbelievably accessible. So you don't have to take time off from work, travel a half hour, 45 minutes, go to your therapist, sit in the waiting room, have your session, leave and go back to wherever you're going, nights, weekends, whatever. Our platform, you're available 24/7. So you actually can take your hour off for lunch, go outside or whatever you're doing, speak to your therapist, and text them back and forth. So it's available, accessible and obviously very affordable.

Burton: Now, there seems to be a lot of demand. Is there a supply of therapists out there to match the demand based on these stunning numbers you just gave of 112 million people?

Jon: So the majority of our workforce, we have about 200 full-time nurse practitioners, physicians, therapists who work for us. And then the rest of it are, I guess we refer to them as 1099, as part-time. So it turns out over 4,000 of our therapists work for us as a 1099. Now, the advantage for that is they come and they take sessions, they, you know, they sign up. Most people stay with their therapist, 80% stay with the therapist that they're matched for. And what's nice is the therapist can add sessions, do weekends, do nights. The workforce, turns out, is very flexible for us. So we have no issue right now in terms of availability and capacity.

We've added actually 1,400 therapists in the last eight months. People really like the platform. They like working for us. They like coming on and doing their job. And by the way, therapists, in general, they like to earn a living, but we don't compete on salaries. What we do is compete on the environment in which they work. It's our product. Happy, communicate with them, talk to them a lot, make their lives better, and now we just added on the ability for them to also pick who they actually match with, in terms of giving therapy. Because some therapists, they wanna do divorce, they wanna do family issues, they wanna do kids who are doing bullying. There's a whole set of choices for them to match for who they wanna take care of.

Burton: So I didn't realize that much of the telehealth is actually going to the mental health space. That's fascinating to me. Do you see that continuing to grow over time and therapists that may not want to travel to an office coming back online based on that demand?

Jon: Yeah, so we give you another effect. So 50% of our users for Talkspace, telehealth, mental health in the last six months are new. They've never had therapy before. So, the market, like I said, the TAM, the total addressable market is growing incredible. Then there are some very important subsegments of the population who unfortunately have not had that much access before. And again, we'll talk about employees, maybe in a couple of minutes. Yep. But colleges, universities, public schools, particularly teens, and then of course, you know, employers and eventually the Medicare population. So, I'm sure all of you have seen, you know, suicide is the second highest cause of death in teenagers.

The Surgeon General's report you've seen, the crisis in teenage mental health is probably the greatest crisis since cigarette smoking, in terms of the impact on teenagers. That just came out, of course, then there's the whole social media addiction part. But mental health in teenagers, mental health in colleges and universities is also the number one issue. The overwhelming majority of kids who leave universities and colleges leave because of mental health issues. So those markets continue to expand dramatically. And that's not talking about employee, like employers, employees. That's just those segments of the population.

Burton: So how do you measure success? As a CEO, I want to measure success of each interaction. Is that possible in this space?

Jon: So it is. So we do three week post therapy in continuing three week sessions, we actually validate and survey the patients. How are you doing? Are you doing better? There's very defined metrics to define anxiety levels, to define depression levels, so there's a whole set of objective questions that we go through, and then we evaluate them, and there's a scoring. So we actually know how we're doing. So we do, so for instance we did a really interesting study in health care workers right during COVID 800-plus workers. And we look to see, they were desperate for help, quite honestly. And when I say desperate for help, what I'm meaning is the majority of people who want therapy, particularly kids, they'll tell you they want one thing: "I want somebody to talk to. I want to be able to text or get on the phone and talk to somebody, talk me off the ledge. I have a problem. I'm really feeling bad. I want to be able to pick up the phone and call somebody." So we did this thing with 800 health care workers. 57% of them improved for four weeks of therapy. It was a dramatic improvement, just to give you an idea. So we know it works.

Burton: And is that against the standard? Is that better than you expected about what you expected?

Jon: Better than we expected. In a shorter period of time. Most people are on the platform for much longer than that, but that's a pretty, it's a pretty dramatic response. Now that is a very significant subpopulation that was under enormous stress. The overall majority of the COVID workers were expressing huge amounts of anxiety, not as much depression. And again, they're seeing people dying. They're seeing people really sick, people intubated in ICUs. And again, they wanted an outlet. They wanted somebody to talk to. I'm not surprised at the impact that we had.

Burton: And I'm not surprised at the results. I have family members who are in the nursing profession and during COVID, it was more difficult than any other time in the history of their careers. And again, as you said, it was hard to relate to what they were going through. So having a professional to talk to would be a really important thing to do.

Jon: I mean, everybody was anxious. I remember, beginning of COVID when I was coming in and taking off my clothes in the garage and washing all the vegetables and like everybody's doing.

Burton: Mail with the curb and a box.

Jon: Yes, exactly. So it was a very anxiety provoking time to say the least, if not more so.

Burton: I understand the enormity of the problem. You're talking to entrepreneurs and business owners. Talk about how this bleeds into their businesses and how you can give access to larger populations or very specific populations within their culture and their companies.

Jon: Sure. So as I said, we have HR benefits. We also have, we call direct to enterprise. So we have a large number of employers, both large and small, who put Talkspace on as an added benefit. So just to move back for a second for the HR execs or small businesses who are listening in, you can usually access Talkspace through your EAP program. It turns out EAP programs for therapy are okay, but they're limited. They're usually four or five sessions before you have to kick off into another way of getting covered. When we sell an addition direct to enterprise, what happens is a full spectrum of services. You can get one or two videos a month, if not more.

We also back it up with much more utilization data. We have a much stronger relationship with the employer, relative to how do we get their employees engaged. We have other content. We have classes that are available. People can sign on to a huge amount of content. We have 150 different classes, from bullying, to parenting, to whatever. But all of that is part of a direct enterprise relationship with us. So we have a huge number of employers and employees. It also turns out it's really inexpensive. Right? It's really not that expensive to put a DTE direct enterprise program in place. And whether you have 50 employees or you have 5,000 employees, it's really, you know, relatively easy to do and it's really beneficial as you can imagine.

Burton: And what would a CEO think about the adoption of that? What would be successful in your mind of a percentage of a population that either accesses sessions or accesses the content?

Jon: So like any of these programs, we talk about this all the time, the program is only as good as the HR executive or whoever the executives of the company is engaged in the program. I mean, we could sell somebody a direct enterprise program and they could put it on, but if their employees don't utilize it, it's not good for them. It's not good for us, right? The last thing I want is someone to come back, oh, I'm paying, you know, per employee, per month fee. We did it for a year, nobody's using it, and that's the end of the relationship. That's not good for anybody. So it has to be a bilateral engagement. That's really important if you're going to put it on.

So then the question is what's the utilization should be? And we know that a good utilization is somewhere between five and 10% of the employee population. That's back of the envelope. And we've had, that some people don't use it at all, which is terrible, right? And now, on colleges, universities and schools, it's probably higher.

Burton: Right.

Jon: Because it's such a big issue. And we look at it and we report it back and we partner with the employers and the HR executives to get it done. As I said, a lot of people say, "How do you measure success?" Right? Like you said you'd have to survey your employees. Like it's really something you use. You really feel better. I don't want to be too glib. My view is if I could save one person from committing suicide, it's been a successful program.

Burton: Right. And I want to get to that in a minute. Do you help companies in the adoption so mental health is no longer in the shadows? We can both agree with that. I think most of our audience can agree, but rolling it out in a culture seems somewhat daunting.

Jon: Yeah. So we have an entire program in place to roll it out to help you bring it on board. We go in, we talk to the employees, we talk to the HR execs we do on-site programs. As I said, we have a huge amount of curated content. Part of our job is to make it successful. Last thing I need is for an employer to come back and say, "This is terrible, nobody used it." That's no good for you, not good for him and it's certainly not good for his employees. So we have an entire program to roll it out for the employers, and whether, again, whether it's small or large.

Burton: So there was another part of your career we didn't talk about where you were racing to come up with testing for COVID during the COVID crisis. Does this feel similar to that in terms of the urgency and the scale or are they different in your mind?

Jon: What you're referring to, I had the opportunity, I was the CEO and executive chairman for basically the third largest commercial laboratory in the country during the COVID crisis. I'd been there a year when COVID hit. We had an extraordinary experiences and relative to what we did with COVID. So we ended up doing the most surveillance than anybody else. And then we had the largest number of significant specific contracts in the country. What I mean by that is we ended up doing all the testing for the NFL, NBA. We brought the cruise lines back on board, Royal Caribbean, and we were testing. We tested New York city, which is largest public school system in the country.

So we had all these large contracts. What happened with COVID, reference what you're saying, is it was a huge imperative and it was just an unbelievable crisis that continued to change every day. Mental health is very similar in terms of crisis. What we had to do with the COVID testing is we had to figure out how to scale. In that sense, we had to scale really quickly. You know, March 7th, 2020, nobody knew what COVID was. Nobody had to know what was going to happen. And we were just beginning to begin testing and we were proud about what we were doing, 5,000 tests a day. We eventually scaled to 100,000 tests a day in an industry and in a test that had never before performed for you before.

So the scaling is similar. The crisis is similar. I think the issue in terms of the imperative is similar because mental health has come up and COVID came up. So there are definite similarities. I think the COVID experience was more daunting, because the clock was ticking. Right? In other words and we had no idea where it was going. One of the first quote of my book is, you know, "COVID is where intuition goes to die." Because every single day people ask me what's going to happen next. And I would say, "I had no idea, like literally." So crisis management for COVID was very different than anything.

And I'd been in a couple of the crisis management situations before. It was very different because everything changed every day or every week. We thought we'd figure something else and then Delta would hit. Something would happen, Omicron would hit. Surveillance testing and point of care, being able to measure COVID on-site changed. All of a sudden, we needed retail outlets. So people knew where to go to test. It was just remarkable how every time we thought we knew it was going to happen, something else happened. That was very different than mental health, because it's not the imperative that COVID was, in terms of the time, right? That's the biggest issue.

Burton: But you mentioned the statistic around suicides, and in fact, the news this morning was about the suicide rate between 11 and 16 being the second largest cause of death in 11- to 16-year-olds. I had no idea. Yeah. So, there's a little bit of an urgency in my mind because, as you say, addressing that issue and helping people in their time of need could prevent a death.

Jon: If I could turn on all the public school students in the country tomorrow…

Burton: That would drop.

Jon: It would drop, yes. It would drop significantly again. We did announce, so I guess we'll get to AI at some point, but yesterday we announced that we believe the only ones that have an AI large language model generated suicide risk assessment tool. And what that means is that if you're texting your therapist on the Talkspace platform, we run that through the AI engine and basically real time, we will tell the therapist, “Something is going on. You need to be aware that this person may be at risk."

Burton: Right.

Jon: Which is a really big deal. Now, it doesn't mean that the therapist has to do something different, we're not telling them how to treat the patient, we're just alerting them that based on the conversations, based on the words and based on the phrases, which is how we generated the model, you really ought to know that this patient may be at risk. So we just actually announced that yesterday because it turns out September is Suicide Awareness Month.

Burton: And that was going to be my question about AI, and we've been talking all week about AI, and the idea that you're using AI to analyze this text conversation back and forth is phenomenal, just absolutely phenomenal. Do you see other applications for AI?

Jon: So we think there's going to be other ways of assisting the therapists, right, which is coming fast and furious. We are using AI now to help us on the business side.

Burton: Good.

Jon: Right. The other really big one is we're using it to generate a comprehensive summary note because we are a full-fledged healthcare provider. So we can get referrals from physicians, we need to send the note back. We have our own electronic medical record. We are audited by the payers. So, when we give a week's worth of texting to the AI engine, the engine will generate an amazing, I'm telling you an amazing summary note that the therapist doesn't have to spend the time to do because that takes a lot of time out of what they need to do. And I will tell you, when you look at these notes, there's no way you could write a better note than this. It's phenomenal. So that's a business application for us. That's very important.

Burton: That is phenomenal. I remember a few years ago, they started using Google glasses during my annual physical and they said, you mind if we record the conversation? I'm like, fine. I went back after that a couple of times, and said, "Doc, what'd you ever do with that?" They said, "Oh, we never got time to transcribe all the recordings." So it really didn't work out. So Google Glass has left the examining room.

Jon: That whole workflow is coming back now because of AI, right?

Burton: Because of AI. So there you add technology, but we couldn't go the last mile of distilling it down into that's being able to do what needs to be done.

Jon: That's what the engines will do now. It's amazing, actually.

Burton: That is really interesting.

Jon: Thank you. Yeah.

Burton: So let me switch to, I also understand, under circumstances you'll prescribe drugs and pharmacological.

Jon: So we have 200-plus physicians, nurse practitioners, who can do prescription management. And what that is mostly actually anti-anxiety and anti-depression. We do not do controlled substances. We also will not prescribe for anybody under the age of 18. So it's a growing business for us, because so many people are on anti-anxiety, anti-depression, and need their medications. So that is a growing part of the business, but we will not do controlled substances. So we will not, you know, we won't treat, for instance autism, we won't treat, you know, attention deficit disorder. There are certain substances that we will not prescribe. And by the way, we're not in the business of owning the drugs, distributing the drugs or any of that kind of stuff.

Burton: Got it.

Jon: We're purely, we will prescribe and patients then get their prescription filled.

Burton: So in your opinion, are they on those drugs because of the ads or because they need them?

Jon: The anti-anxiety, anti-depression, I'm sure they need them, you know, with what's going on in the world.

Burton: So what do you think is going to go on in the world? Do you think this anxiety that we're all feeling will abate over time and become the new normal or do you think that this is a point in time that's pretty unique? Certainly it's unique in my lifetime.

Jon: Personally, I think it's pretty unique. Yeah, I think I spend more time worrying now about the direction of probably the country than I personally have ever worried before, not to get into any politics. But I think it's a realism. I think everybody experiences it based on what's happened and what's happening now and what's happening in the world now. You probably go back historically and everybody will say, and my parents will say, or my grandparents, they would maybe say, yeah, it was a terrible time where they were growing up too, but for us, it just seems different.

Burton: Yeah. It does. It really does seem different. There is a few times in my life, the late 60s, and then Kent State, when our country shot at our citizens. And this stands out, similar in something doesn't quite feel right. So having help, like Talkspace, appears to be the right time for the right set of capabilities.

Jon: It's hard for some people to talk to people and the other part which I didn't mention is, there's a certain degree of confidence or comfortableness, believe it or not, when you're doing video or texting because it's uncomfortable for a lot of people to sit in a room with somebody like this and actually tell them what they really think. So some people feel the protection of being a little bit more anonymous when they're talking to their therapist, which is one of the reasons why it's so successful.

Burton: So let's talk about the generational differences. I ended up showing up at a physical doctor's appointment when I was supposed to be on a virtual doctor's appointment recently. I can't imagine texting with a therapist. Is there a difference generationally in people that are more accepting of this?

Jon: So we like to talk about that, it's texting and messaging is very common for people under the age of 35. Okay. Now, it's becoming more progressive for people over the age of 35 in terms of accepting that. But because, I mean, all of us live with our cell phones now, but that age group is sitting on their phones constantly. So for that group, it's really convenient for them and it's very easily for them to accept it. That's good and bad, because people on the, you know, I don't know if you know the data on social media, it's not getting to social media dependency, which is why it's such a big deal. The average teenager in this country, you ready for this one, spends eight hours a day on social media.

Burton: Eight hours a day on social media.

Jon: Eight hours a day. Which is why it's such a problem.

Burton: That is fascinating.

Jon: Yeah. It's unbelievably bad. No matter how you craft it. Eight hours a day.

Burton: So there's many questions coming in from the audience, if it's okay with you, I'll switch gears and give you a couple of them. Sure. So here's one that in a burned out, working world of doing more with less, whose responsibility is it to support workers with mental health issues? Is it the leadership? Is it the individuals? Is it society? How should we be approaching that?

Jon: So, it's probably all, but I think there is actually a big responsibility, I think, on part of the employer. You know, you spend whatever percentage of your life going to work, and it's not just because it's the employee, but it's the employer that wants his employee to be a better employer. So I think the employer has a big part. Obviously, parents have a huge part, so it's a little bit, it depends on the population, right? If you have older parents, then it's you, maybe who is then is responsible. So, the answer to the question is it depends on who it is we're talking about. You know, I can't over stress enough the role that parents need to play in interacting with their kids who are on both social media or having problems.

And the number is over 40% of parents will tell you that possibly the number one or two issue is their concern for their kids relative to their interactions with cell phones. And you know, the numbers for teenagers, particularly teenage girls, is devastating. 22% of teenage girls are so unhappy that they consider suicide. I mean, it's 56% of teenage girls will tell you that they're unbelievably sad or think that their life is hopeless. Right? 22% increase in the last year of emergency visits for teenage girls relative to mental health. The data is so overwhelming that you just don't think it exists. But if for any of you have been out there who have any idea, who have touched this, know how pervasive it is. The bullying that goes on, the body image stuff that goes on, that stuff on, I'm not going to criticize too much TikTok, but all of this is unbelievably bad.

Burton: So, perhaps you are the right person to do this job. Because you were challenged and energized by the enormity of going after the COVID testing. So, the board probably knew exactly what they were doing. So, here's another question from the audience about confidentiality. And it's about how do you protect employee privacy and the balance between managers supporting mental health, but also, not being involved in either the care or the issues associated with it.

Jon: So, mental health is like your regular health care, meaning, first off, we are totally HIPAA compliant. So we are a full-fledged health care provider. Totally HIPAA compliant, data is protected, we don't sell the data to anybody, we treat everybody as the same as you were being treated by your primary care physician or any other healthcare provider. It's all protected. Now, what we do feed back to the employer is the data de-identified on what the utilization is. So we'll say this, how many employees are doing it, so we'll give them data around the program, but we are ultimately protective of our patients and of their data. We have to be. We get audited by the payers, as I said, we send referral notes back to the doctors. It's all with permission. And by the way, for kids, it's also with permission, although there are some exclusions, that kids actually could have therapy without telling their parents with certain issues that they could bring up.

Burton: So can you talk a little bit about your leadership style and approaching the enormity of the problems that you've approached throughout your life and maybe a couple of hints for the CEOs and entrepreneurs in the room?

Jon: Sure. So, very fortunate, I've had the ability to teach executive MBAs leadership. So I've done these programs where we talk about leadership, and the book that was just published, TriNet was nice enough to buy some of them to give out to the audiences, each chapter has a leadership part of the chapter.

Burton: Okay.

Jon: Okay. So I divide leadership up into two things. One is the questions I get are frequently is like, "How do I get there? So I'm an executive, I want to be a CEO, I want to be a leader." And then the second part of the question is, "Once I'm there is how do I stay there?" It's sort of two things. So, some of the real high-level issues about, you know, how do you get there? One, and I know this is going to, it's not really glib. I talk about this all the time. You need to be nice. And I know like that says, well, let's just do it. Let me tell you something, you need to be a nice person.

You are never going to know when the CEO or the senior executive says, "Hey, we need somebody to run this new program. We need to figure out something new. Who could we get?" And when all of us are sitting around the room and someone says, "Oh, let's ask Andrea." And someone in the room says, "She's a jerk." Right? I asked Tom, like, I can't stand that guy. You will never know who killed your career. So what I'm telling you, but nice makes a difference. I cannot tell you the number of times in my personal career that I've interacted with people from 20 years ago who said, "You were really nice to me."

Burton: Oh, that's interesting.

Jon: And what I'll tell you right now, what comes around goes around. Anyway, be nice. I think intellectual curiosity is a major thing. If you're not reading books and journals and newspapers and watching stuff and reading, if you're not up to date about what's going on, then honestly you should not be in a leadership position because I, again, cannot tell you the number of times that we found an idea or thought of something that was totally unrelated to our industry that someone else did and someone else read about, which we brought forward. So intellectual curiosity is a big deal.

Communications. You can learn it. I tell people you can learn how to be a good communicator, but if you can't get in a room and talk to your senior executives or talk to your cohorts or talk to people and communicate effectively, it's a non-starter. There's nothing worse for me when I walk in a room, we have a junior person who's coming in to pitch an idea and they put up a PowerPoint and they start reading their slides. And it's like, "Okay, I can read your slides, I don't need you to read your slides. Tell me what you want to tell me." So communication is a really big deal. Take risk, you know, fortune favors the brave, Virgil. You gotta be a risk taker. Two-minute message. How many times you meet somebody, you talk with them for five minutes, you still have no fricking idea who they are, what they're doing, right?

Like, you gotta be kidding me, right? So I tell my folks all the time, develop a two minute message, practice it, write it down, memorize it, because you have no idea when you're going to get in the elevator with Burt, and he's gonna say, "Hey, who are you? What do you do?" You got 60 seconds and he's gonna either remember you or he's never gonna remember being in that elevator with you. So you need a 60 second message. I believe in what I call relationship radar, which means I pretty much touch base, I have a very significant Rolodex, but I try and keep in touch with people every three to six months. How are you doing? What's new? You know what? You don't know when that person, "Hey, I remember him. I remember her. I remember what she did." So you've got to stay on people's radar.

Internet presence. You know what they say? What goes on in Vegas stays on the internet. Okay. If you haven't checked your internet presence, you better make sure you do because you have no idea what's up there and it's not going away. So you got to figure out what sense. And this to me is one of the more interesting, I usually ask the audience questions is—what's the most significant factor in your career promotion or development? And here's the answer. The answer is who you work for. Yeah. If you're working for a jerk, you better find yourself another job because that person is never going to promote you. It's never going to be good for your career. The people do all the things you need to do, but you need to work for somebody you want to work for, who's going to treat you well. So that's the, how do you get there thing.

Burton: I think that is an incredible list. I support every one of those items. I do about 50% of them, so I have a little bit more to go. I appreciate you, the company you're building, and the fact that you keep taking on successive challenges in your life.

Jon: Thank you.

Burton: I appreciate that you're a TriNet client, and we all appreciate you, and we're going to help you in any way we can.

Jon: No, I appreciate being here. My last point I will tell you is being in this environment, the customer is king. Don't ever forget customer is always right.

Burton: Absolutely. Right. Well, thank you Jon, and thank you to the audience.