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How can we measure and manage the quality of Behavioral Care?

matt wallaert
Moderator

behavioral scientist

kathryn salisbury, phd

executive vp
@nha-nyc

linda sacco, phd

vp behavioral health services
@Talkspace

lenard lesser, md, mshs

provider
@onemedical

Matthew Amsden

ceo
@ProofPilot

Matt Wallaert:
Hey everybody. I know we’re all that stands between you and cocktails so we’re going to try and keep this as short as humanly possibly. Backstage, they’re like we’re running late. When the clock starts blinking, it’s you. Don’t take any questions. Just get off stage.

So my name is Matt Wallaert. We’re going to spend as much time as we can focusing on the issues today, but I want you to … I’m going to have the panelists very briefly introduce themselves as we go along just so you know who’s talking.

Linda Sacco:
Thank you, I’m Linda Sacco. I’m the Vice President for Behavioral Health Services at Talkspace. I was very happy to be told to talk quickly because usually I’m told to talk slowly. I’ve been in behavioral health for about 32 years, mostly in traditional mental health. and I’ve been with Talkspace just about a year.

Lenny Lessor:
Hi, I’m Lenny Lesser. I’m a family physician at One Medical here in San Francisco. I also work on our quality and value team, where our major initiatives are around mental health and muscle skeletal care. My background is in research so we try to evaluate what we do and make sure that things are done well, and evaluate why they don’t work when they don’t work.

Kathryn Salisbury:
Hi, I’m Kathryn Salisbury. I’m Executive Vice President of the Mental Health Association of New York City and oversee our Crisis and Behavioral Health Technologies Division. We’re a relatively large non-profit organization that has a three part mission of service, advocacy, and education. And part of what we’re really committed to is expanding access to care, when, how, and where people want it.

Matthew Amsden:
I’m Matthew Amsden, CEO and founder of ProofPilots. ProofPilot is a tool that’s, online tool, that’s democratizing the same techniques that have been used for decades in the academic and pharmaceutical industry, the randomized control trial, the longitudinal outcomes study, so that all of us, whether we’re smaller organizations or big institutions, can test what works and what doesn’t to improve the human condition. And at the same time, what we’re doing is actually making participation in those studies actually something fun and turning them into an entertainment activity.

Matt Wallaert:
Awesome, thanks guys. So look, I want to start with the elephant in the room, which is always the moment you say outcomes, everybody rolls their eyes, right? I want to talk, Lenny I want to start with you actually cause you and I got to talk a little bit ahead of time about the duel role that you’re playing and the back and forth nature of that. Can you talk a little bit about wearing two hats, one that’s evaluation focused and one that’s just trying to be practitioner and how you blend those, where they fit, where they don’t fit?

Lenny Lessor:
First of all, when you say outcomes, I actually open my eyes. I don’t roll them. Everything excites me when you say outcomes.

Matt Wallaert:
I know everybody on the panel has bought in. It’s everyone else we’re trying to convert.

Matthew Amsden:
I think we can all say here that outcomes can be sexy, and I think that that’s perhaps one of our goals here on this panel.

Matt Wallaert:
We’re going to try.

Lenny Lessor:
So, I mean I have to look at outcomes in two different ways. So with my patients at One Medical, it’s an individual type thing. Are you getting better? I take what patients tell me. Are you getting better? What’s your life like? Are you improving? And then in my other role, I try to use more objective criteria to try to take what I’m taking from the clinical field, but meld that with the research a little bit to use scales and tools and things like that to really assess what’s going on. And so often is the case, some things may work on a one-on-one basis, but not overall and vice versa. So when I try to bridge the role between providers and an evaluative research role, to help providers understand what works and doesn’t work for mental health and other conditions.

Matt Wallaert:
That makes sense. So Linda, you and I were also talking about this a little bit and the sweet gig that is not having to worry about outcomes and what happens when you bring outcomes to this space. Can you talk a little bit

Linda Sacco:
Sure.

Matt Wallaert:
About what you guys have been up to?

Linda Sacco:
Every time I say outcome measures, I hear 1,000 therapists sigh. As Oren said this morning, it’s something we’re late to the table with this. And I don’t think it’s because we don’t want to provide the very best quality of service. I think behavioral health hasn’t had all the tools. We’ve never had a platform to collect data. I remember collecting data back in the day on statistic sheets. One hospitalization, one arrest, one overdose, and then giving those to a secretary who had to input them into a system and then count them. So I think we were late with getting on board, partly because of that. In terms of benchmarking, I think we haven’t had access to transparent data. What are we benchmarking against? Nobody talks about it. You can find some data in the industry but the high performing organizations don’t share. We don’t share data and say well the best retention rate we think we can strive for is this and this is how we got there. So we haven’t had that.

Matt Wallaert:
So the data collection feels like a tax a lot of the time, and then it feels like well I collected this data. What’s my return on it?

Linda Sacco:
Right.

Matt Wallaert:
If nobody’s sharing it,

Linda Sacco:
Right.

Matt Wallaert:
Then it doesn’t sort of-

Linda Sacco:
How can we benchmark externally? So we’ve done a lot of work benchmarking internally lately with our therapists, looking at some of the outcomes. If a therapist has a 95% retention rate, we dig deep and find out what is she or he doing right, so that we can benchmark everybody against that therapist.

Matt Wallaert:
Got it.

Linda Sacco:
It’ll be a couple years probably before we become somebody’s benchmark.

Matt Wallaert:
Well, and that’s an interesting-

Linda Sacco:
And in online therapy, there’s no benchmark for us.

Matt Wallaert:
To your interesting point, is retention even the right thing

Linda Sacco:
Right.

Matt Wallaert:
To measure, right? Like in an environment like mental health where a lot of what we’re trying to do is help people grow to not need us anymore. We’re trying to work ourselves out of a job. How do you know when is the right moment to, right? When is retention no longer the right variable? We talked a little bit about tools and platforms, like Matthew, this seems like a … Talk to us a little bit man, like how did you enter this space? Why and where do you see it going?

Matthew Amsden:
Well it’s kind of a long story, but I’ll make it relatively short here. I was working in HIV prevention and in large cases, these efforts were government sponsored and so there was an evaluation component or some kind of RCT involved. And I’m not a researcher by background. My role there was marketing, and I don’t think I’m being overdramatic when I say this, but in every single one of the research studies that we were involved in, it was a complete and utter disaster. It took years to actually launch the study. Once the study was launched, the participants didn’t want to engage because they felt like a cow that they were being jabbed with treatments and then milked for data. They were all kinds of disconnected systems. So I was reliving the pain with every single deal that we were doing of what it meant to be part of a research study, as someone who was participating as well as someone who was managing these studies.

So we developed a tool that made it easy for organizations that wouldn’t necessarily do research studies in the past, and created efficiencies for those organizations that were quite large. So what we’ve been doing at this particular point is really exploring what it means to be part of a research study and what organizations and what questions can be asked. When we talk about a randomized control trial today, the immediate thing that goes into your head is a pharmaceutical trial. But the same kinds of techniques that have been used in the pharmaceutical industry since the 1940’s can be used in behavioral health. It’s just that the studies are much more complicated, but at the same time, a lot more interesting. When we look at a pharmaceutical trial, we’re essentially looking at a person in some kind of test tube and you can’t keep a person in a test tube, particularly not for months or years.

But the work that’s being done now in research and in outcomes in the behavioral world, that’s actually out in the real world. We’re actually living our lives and we’re actually looking at outcomes, whether it be online or whether it be in person or whether it be via something like Talkspace or more traditional interactions or a combination of all these things. That to me is where the real interest is. And coming back to your point about therapists and some of their concerns about being tracked or measured. This is an opportunity for all of us to actually learn what’s working and what’s not.

So you think about the quantifiable self movement. These are a group of individuals that are really excited about what actually is not only solving problems, but actually increasing our possibilities of what health is. And for those of you who might be a little bit like oh these outcomes. I just don’t want to deal with this. Think about that sports celebrity or that Olympic athlete. They’re using outcomes on a daily basis to improve their performance, and that’s a lot of what we try to do with our work to actually change what it means to do a research study and to create outcomes.

Matt Wallaert:
Yeah and I think that’s an interesting, like the sports analogy’s an interesting one. Like Andy Walsh runs a group at Red Bull where they look at maximizing human potential in part because of their work with extreme athletes,

Matthew Amsden:
Yeah.

Matt Wallaert:
Right. And they have some very compelling work around … They take these extreme athletes who do what you would think of as relatively germane mental health, trying to emote in front of another person. These other sorts of exercises that you would find common place, and these athletes will say this is the scariest thing I’ve ever done. And then you’ll see a clip of what they do and you’re like, and this is the scariest thing you’ve ever done? Like crying in front of someone else is the scariest thing you’ve ever done as you jump off this 100 foot cliff with no parachute.

So I want to bring it back to … The New York mental health folks are really, I mean as a mental health community, one of the more mature communities in the country, right. Lots of practitioners. Good involvement from the government. Good non-profits. What are you guys seeing in terms of evaluating and sharing data more importantly? As you guys evaluate technologies, are you encouraging your partners to share data with each other to create common benchmarks or …?

Kathryn Salisbury:
Absolutely and as an organization, the Mental Health Association is very committed not only to improving access, but to improving outcomes. So as Seth said earlier today, therapists by and large have been given a pass. We don’t know what is working and what isn’t working as a whole. And there have been recent studies where clinicians, if they’re asked, when they were asked which of their patients were deteriorating, only 20% of them could accurately identify who was deteriorating.

And moving into the online and digital space as Lynn was saying, we have an opportunity in the backend to really look at how people are progressing through their treatment and to use that data to improve our practice. It’s understandable that people in traditional office space practice might be a little reluctant to be looked at because it makes them anxious. It may require behavior change so we’re very committed to looking at outcomes because we strongly believe that it’s going to improve both engagement and activation and the ultimate outcome for the patient.

Matt Wallaert:
So I want to drill in a little deeper on, actually on that, the barriers to people up-taking outcome measures. I think from all of us, we were having a conversation ahead of time. There was a quote earlier. Someone was essentially saying that the notion of adding how this affects the bottom line of a business to the conversation was a travesty. Right, that that devalued the importance of mental health. I think both of the two of you hit on the data collection is a tax, right. It’s a tax I have to pay whether I want this grant or if I’m participating in a system that says it. How do we get people enthusiastic about sharing and collecting data? Like why do you, where do you think that fits? And again Lenny, I want to go back to you because you’re playing this hybrid role. When you put on your evaluative role, how do you think about getting other practitioners as excited as you are? As you pointed out, you’re not the eye roller. Your pupils dilate. How do you think we get practitioner’s pupils to dilate around data collection and intervention?

Lenny Lessor:
Well people will evaluate things and use things if they’re useful for them and their patients. So when I see patients in my office, for instance, depressed patients, I will classically use something called a PHQ-9, which measures their relative … how bad their depression is, right. And I use that from visit to visit to see what their score is and how they’re doing, and I have the time to do that and scan it into our electronic health record, and I can use that with the patient and then I can say, oh we started this medicine. You’re a little bit better. You went to a therapist. You’re a little bit better. I can work with the patient and that’s useful for the patient and it’s feedback to me. Am I doing my job? It’s kind of like if I give you blood pressure medicine, does your blood pressure go down. Like I might not just give you blood pressure and then never check your blood pressure again.

So I use that and then we try to get other providers to use that. And so we’re standardized that throughout our system so that it’s useful for all of our providers and all of our patients. Meanwhile we’re collecting these outcomes because they’re useful to the patients and the providers that are actually using them. So if it’s useful to the people in the process, they will be collected and then you have people like me that can get things from the backend and evaluate what’s going on.

Kathryn Salisbury:
I’m a little more cynical about that and I think it’s really going to be value-based payment that drives the adoption of practitioners being motivated to look at outcomes because that’s what’s going to drive their income in the future. And I think for employers, it’s extremely important for us to do a lot of education because all programs are not equal. And you’re going to get much more value if you choose wisely based on outcomes, not just doing the same thing over and over.

Linda Sacco:
And consumers are already doing that. In this value-based world, marketplace comparisons are really driving where consumers go. So we have to be able to show that we are effective, that we have good data, because they’re going to pick somebody else.

Matthew Amsden:
And let me take the more optimistic view here. I’m one of these tech CEO’s, New York not San Francisco, but same difference, and I really do believe that some of the best ideas to solve some of the issues that we’re talking about across the entire health care industry actually come from individuals. And if we can empower those individuals, like One Medical is doing, to actually create their own data and actually use that data for their own purposes, we give them the leverage to actually say this works. And with that leverage, they can actually go to pairs in a value-based care environment. They can go to government grantees and say I’ve got pilot data here that suggests my program works. Let’s scale this. These smaller entities and individuals, I really do think with some of that empowerment, we can solve some of the issues that our larger bureaucratic organizations can’t necessarily.

Matt Wallaert:
But so how do you address the files are a problem, right, though everybody wants to talk about an intervention that works. Nobody wants to say I took a multimillion dollar bet on an intervention and it didn’t work. How do you get out the negative findings? To your point, we look at people with higher retention rates. How do we look at the people with low retention rates? What do you do around actually improving care for people who may not be delivering it in the best way?

Linda Sacco:
I think it’s the flip side of the same thing. We’re going to look at people that are showing not such great outcomes and find out what they’re doing. What are they missing, and we can compare them to the high performers and look at there’s something off about the way you’re engaging people. Something’s not quite right. Let’s compare and disseminate some best practices out to the folks that are lower performing.

Matt Wallaert:
Matthew, do you see a world in which like the results of RCT’s are public comparable to a marketplace?

Matthew Amsden:
There’s somewhat of a change in thinking that we need to take here. Typically today an RCT is so expensive that if you are an organization that conducts one, you’re going to get one chance.

Matt Wallaert:
Right.

Matthew Amsden:
And if that one chance fails, you’re done, but technology has democratized lodging and transportation. Why can’t it democratize the RCT? At least that’s what I’m betting my money on, obviously. So if we can change that process so as opposed to just doing one RCT that costs a couple million dollars, and turn it into more of a continuous process improvement model, the bad data actually becomes an opportunity to improve as opposed to a death sentence, which is in many cases what it is now.

Matt Wallaert:
Right so you’re saying essentially if you look at the fail fast model that startups, right. The idea is you run a fast and light experiment, and then we use that to build the next generation.

Matthew Amsden:
Exactly. Exactly. That’s what we do in every other sector. It’s time to start carefully, obviously in the health care sector, doing the same thing here and not be so afraid of failure.

Matt Wallaert:
To your point Linda, there’s certainly an opportunity to look at people with low rates and say like here are things that we can bring them into that fold

Linda Sacco:
Right.

Matt Wallaert:
Essentially. I want to shift gears for a second because a lot of what we’ve been talking around is around the idea of disordered mental health, right. Things that fit a diagnosis. But when we talk about benchmarks, and particularly when we talk about the workplace, 80% of Americans are disintigation. They’re in their job, lending to your earlier point in our conversation, like people that are … there’s the false dichotomy between happiness and work, right. How do we start to go address that, and I know Kathryn has thoughts on this because you guys have done a great job of broadening the conversation around mental health to be more than just like it fits diagnosis.

Kathryn Salisbury:
Sure. I think there’s on the mental health end, it’s you’re either looking at absence of illness or absence of symptoms. On the other end, you’re really looking at wellness and quality of life and I think that in any environment, it’s not mutually exclusive. They’re really synergistic. If you’ve got 20% of your population who’s experiencing a mental health challenge or behavioral health challenge at any one time, that’s going to affect the overall culture and productivity of the workforce and vice versa.

If you are able to create the kinds of conditions in a workplace that promote wellness and one of the most robust predictors of that is positive supportive relationships. There are many other things that you can look at about the environment, the work environment, but I think if you approach the issue from both sides, that you’re really going to help people wherever they are in the continuum. And I think a number of times today people have talked about choice, and people have varying levels of severity and subclinical conditions, and if you make a lot of different options available to people to take advantage of in the workplace, then I think that you’re really going to get the engagement all around and begin to shift the culture.

Matt Wallaert:
So Lenny and Linda, actually I feel like this is actually your germane to both of you, right, because you both are working in a two-tier system, right. You have patients, but you also have providers who themselves have their own mental health. Are either of you guys running programs that are looking at how do you go and enrich the work environment for providers so that they can be better providers of mental health care?

Lenny Lessor:
I mean part of One Medical’s whole philosophy is that when the providers are positive and have energy and aren’t bogged down in a lot of crap work, basically, they’re going to provide better care for the patients. So I know, for me from shifting from previous jobs where I saw a patient every 10 to 15 minutes to most of my visits are 30 minutes. So we focus a lot on mental health and retention of those good providers, and that’s why people want to work for us I think because we try to separate a lot of work into the right places so that we don’t have physicians trying to do referral paperwork type stuff.

And I really feel that our providers are just happier. When I talk to colleagues at other systems, they’re just scrambling one patient to the next, one patient to the next. They’re on this hamster wheel all day and then they’re dead at the end of the day. And it doesn’t lead to good patient care. It doesn’t allow you to talk to your patients about mental health because your mental health is doing the same thing. So that’s part of our whole philosophy. So we focus on that a lot, making providers feel like they have good space to deal with what they need to deal with.

Matt Wallaert:
And do you guys do passive data collection or active data collection or both, right? You mentioned some sort of passive data collection, retention, other kinds of things. Do you do active data collection? Are you actually asking folks how does … I mean is it qualitative? Is it quantitative, like what’s your [crosstalk 00:22:17] ?

Lenny Lessor:
Yeah. I mean so we have qualitative feedback. We do surveys of our providers as well to get a sense of how they’re doing and things like that.

Matt Wallaert:
And then also passive. What about you guys?

Linda Sacco:
One of the things that … Well, we have a very remote workforce, so we have a 1000 therapists all over the country. So it’s not as easy to do that, but I think for the employers, it’s important to open the conversation, and it’s been said 10 or 15 times today. As a clinician, I worked in a hospital where we had hundreds and hundreds of employees and I was told by HR you can’t ask a question. And I think Andy alluded to it before. You have to be really careful. So if I was to see a provider who was suffering, and I clearly could see the signs of either depression or substance abuse, I wasn’t allowed to ask because that steps on the legal toes. So employers I think have to be ready to have that conversation, be open and be willing to take whatever the legal ramifications might be if you were to open a discussion and say, “Listen it looks like you’re having a bit of a problem. Are you depressed?” Well no I’m not. Oh my goodness. Right to HR they go.

Matt Wallaert:
Right.

Linda Sacco:
So we have to be able to have a conversation and recognize when our employees or our providers are suffering because how could we ask them to do that with clients.

Kathryn Salisbury:
Yeah, we have a contact center, formerly called the call center, but now because it’s text and chat and many other things, it’s all forms of contact. It’s a very high stress environment. We do a lot of crisis services there, and there’s very high turnover. One of the quantitative instruments that we use when we do employee surveys is the professional quality of life survey which has a number of questions about compassion, fatigue, and other working conditions. And what’s crucial if you’re going to be surveying your staff is making sure that they, you publicize what the findings are and that you act on those findings and that you share those findings with people. And what we found each time we do the survey is that more and more people will respond to that and that we’re able to make changes that result in real improvements in the working environment for our counselors.

Matt Wallaert:
So I like that. In some ways I think it comes back to something Lenny was saying, about are people seeing the value from the data that they trade in, right, either as a patient or a provider. Do I see how when I collect data there’s a good feedback loop that that comes back to me? I think there’s actually several themes. We sort of heard the taxes theme, right. How hard is it to actually do this? And then this sort of rewards theme, and how easily do I get back notions about whether something’s valuable? I know you were looking a lot at engagement in actual RCT’s.

Matthew Amsden:
Yeah.

Matt Wallaert:
You talk a lot about how do you make it fun. How do you make it feel like a game?

Matthew Amsden:
Yeah.

Matt Wallaert:
And that feedback cycle is always important in games, right.

Matthew Amsden:
Yes.

Matt Wallaert:
How do you give something and get something?

Matthew Amsden:
It’s absolutely essential.

Matt Wallaert:
Can you talk a little bit about how you see that working for you, how you think people should be applying it in the workplaces more generally.

Matthew Amsden:
Well first off, what I always say when you start this conversation is that you’ve got to think about who your target audience is, and this is Marketing 101. So just taking it back to this particular conversation here within our own internal workforce, most of our technical staff is actually in Ukraine in Eastern Europe. And so what we’ve had to do as far as engaging with that group to make sure everything’s cool is recognize that half that staff is a refugee from war torn regions of the country. That means that what we’re doing to engage that particular group of individuals is very different than what we’re doing with our staff in New York City. It’s a dramatically different effort. So that’s issue number one.

When one of our customers is launching a study, they need to think about who is our customer and what is it that they are going to want as part of being, as being part of the study. So that might mean in the case of Planned Parenthood, for example, a typical Amazon gift card, eh, but a Sephora gift card because their primary target audience is all women, very effective. That being said, we can’t all afford a half million dollar gift card budget. So that means informational give backs. So how do I compare with other people that are like me? Based on my answers, what are some kind of fun scenarios.

To give you a very specific example, we did a CDC study recently. It was a 45 minute, three times a week effort in which they were looking at behavioral change within men who have sex with men. Not a super exciting effort to be involved in. No budget for incentives. So what we did instead is based on the individual’s answers, we said, “Based on your answers, you are like other guys in X city.” And then based on that particular city, they got a video that showed a day in the life of a typical guy in that city. That was so successful that the Family Research Council actually shut the study down just because it went viral, and the number of individuals involved actually raised the ire of some folks who might not have liked to see the government spending money on something like that.

So it doesn’t necessarily have to be something expensive. It can be an informational give back. It can be just seeing that the information that was provided is actually making change within the organization, but I’m going to come back to it. You’ve got to think about who it is that you’re targeting. And given that most of us have decentralized groups of employees, we are working across cultures, and us as individuals are all different. You’ve got to think about who is that market and what is it that they are going to be interested in. That’s going to keep them engaged.

Matt Wallaert:
Yeah I really like you specifically mentioned both the fun aspect, right, and it’s being useful, right.

Matthew Amsden:
Yeah.

Matt Wallaert:
So my data is being used. One of the places that often we fall down in the workplace, we collect data, but then it goes into a black box and we never say, “Well here’s what we did with it. Here’s what we changed because of it.” And I love this fun idea. People often forget that data can be generated to be very fun. One of the most successful data collection experiments obviously was OkCupid, right. They got people to answer hundreds and hundreds and hundreds of questions because it was about a topic they cared about, and it felt kind of fun, and it was in small bites and so they actually got massive quantities of data cause they did it a little sip at a time. So I love that you’re echoing those two points.

We are really limited on time today, but I do want to make sure since we do have amazing panelists that you guys have a chance to answer some questions as well. So what I’m going to do is we’re going to spend the last 15 minutes on Q & A and if you don’t come up with questions, I’m going to come up with questions cause there are things that I still want to know, but I don’t want to steal your time. So do you have any questions? If not, I’m going to keep talking. I warn you. Yes ma’am?

Audience:
So the question that’s forming in my mind is what happens when the outcome of the, when the outcomes indicate … Okay an organization like Talkspace is working for the HR division of a company. And so are you benchmarking outcomes in those conversations or tracking the data in a way in which the same dislocations socially that cause some of the mental health issues? When they’re duplicated in the workspace, are you getting that information? Are you tracking that information, and what kind of complexity in your relationship with your client, which is the company, where the social system within the company is duplicating the inequities at the intersections of race, class, culture, gender, are actually causing the mental illness? Where is that? I haven’t heard about that today and I was really coming with that set of questions.

Matt Wallaert:
So I’ll actually talk to it, not as moderator but just as a guy who’s worked on this a ton, right. So you actually sort of heard in my introduction that I’m a rabid feminist and I’ve done a bunch of other work in this area. I think, actually Lenny and I were talking about this earlier cause we both have backgrounds in nutrition, and I was talking about the obesogenic environment, right. The idea that much of obesity isn’t you having some disordered thought or you having some physiological problem, but the fact that we spend trillions of dollars advertising high calorie food to you, right. And that some people are differentially susceptible to this.

I do think it’s interesting when you’re working with an organization, like how do you have the tough conversation of like well you know a lot of this stuff is due to systematic stuff that you’re doing really, really wrong, and that can be a difficult conversation. In Kathryn’s, I’m going to hold you up as the pinnacle of cynicism here for a minute, like as Kathryn’s self-admitted cynicism, some of that’s going to get corrected by lawsuits and things, right. I think you see …

Matthew Amsden:
That takes the cynicism to a whole other level.

Matt Wallaert:
Well look, like there’s two versions of this, right. There’s two versions of workplace mental health, right. One version is the hey, this will make your workforce more productive. You’ll have better bottom lines, etc., and the other is the hey, you know what? If you don’t pay women fairly, we’re going to sue for it, right. If you don’t treat people in an ethical, responsible, compassionate way, we’re going to bring to bear the laws that protect people in the workplace. But you guys specifically have this … This is really hard for you because you have really three clients, right. You have the therapists. You have their clients, and then you have the workplaces that you’re working with. How do you balance those concerns?

Linda Sacco:
I think the important thing to your question too is collecting that data in real time so you can actually see what’s happening. We would want to know … I had a client one time who was an emergency room. And we were doing some consulting with them and they didn’t know or didn’t care to know that their emergency room docs and PA’s and nurses were suffering from vicarious traumatizations, some of them from PTSD, telling us stories of things they’ve seen and had to deal with and then go right on to the next patient.

So we had to have that difficult conversation with them about you’re not addressing the needs of your workforce, and they were able to come up with some systems that they put in place for debriefings and stuff like that to address that need. They never saw it until they brought in consulting clinicians to look at what’s going on here. Huge turnover rate. Huge absenteeism. Violence in the workplace. But I think a lot of that came out of that data was collected in real time, not at the end of every case, not at the end of every year. Data was collected every day.

Matt Wallaert:
Kathryn, go.

Kathryn Salisbury:
I have an example from on a systems level. We have a contract with a Fortune 500 company to provide online cognitive behavioral therapy with text, chat, and telephone supports. And when you look at the enrollment of people in the company, you would expect it to be, in terms of all the various programs, depression, anxiety, substance use, and insomnia, one would expect depression to be the most commonly enrolled in program. However, that’s not the case in this company. Anxiety was the number one program that everyone enrolled in, and it has to do with the culture of the company. So I think that when you have the kind of transparency in the data, you can provide very useful data points and feedback for people if they are interested in making the adjustments that would make a difference in their company. And I think it’s very ironic that I self-labeled myself a cynic because most people call me a cock-eyed optimist.

Matthew Amsden:
We find that it’s also very interesting to actually give data behind an anecdote. Every corporate culture is slightly different, but when you are actually hitting up against an issue that might be a little uncomfortable, a lot of times that uncomfortable issue is an anecdote. It’s a whistle blower. It’s a bad story in the press and a lot of times in corporate culture, an individual can basically say, “Oh, that’s a one time deal.” To actually be able to show real time data, to actually show numbers, that sort of thing actually, it’s almost like a one-two punch. You’ve got the anecdote that’s got an emotional element to it and then you’ve got real numbers behind it. That often can take an uncomfortable conversation where there isn’t a lot of trust between two parties and very quickly turn it into a very different conversation.

Matt Wallaert:
So wrapping it all up, I think sounds like examples plus data and then I think coming with anytime it always helps to go into a conversation with some ideas about things that might be done. Here’s interventions that have helped elsewhere and that’s sort of the more system-wide transparency some of you have been talking about, right. How do we know what’s worked elsewhere? How do we gather those things that have worked in one place so that when we do find that okay, everybody’s enrolling in the anxiety program. What have other companies done that also had this problem? How do we go address that? You talk about transparency. It’s the levels of transparency, right. How to be transparent at every level of the system to find better answers.

Kathryn Salisbury:
And also the level of partnership because if you just farm it out for somebody to fix it outside, it really has to be a partnership where you’re working together.

Lenny Lessor:
We work with a lot of large employers, and the best relationships we have are where those employers are open to the feedback that we’re giving them. And we’re kind of, we can do our own investigative type research or evaluation of what’s going on in the company. And those companies that let’s say, “Like yeah, tell us what’s going on and let’s craft a way to fix it.” Those are the companies that I find are most responsive and lead to better outcomes.

Matt Wallaert:
So that actually brings up an interesting point because all of you are doing some different external work. I’ve done a bunch of work recently on talking about the need for Chief Behavioral Officers. Who are you talking to within a company? Lots of different concerned parties. What tends to be the easiest way to get in that is receptive to that change? Is it a business leader? Is it HR, like … ?

Linda Sacco:
I think it’s generally where the pain is coming from. So somebody recognized that there’s terrible retention. There’s violence among staff members on a unit. We have to bring somebody in here and see what’s going on, and I think then they become very receptive. It came from them. It wasn’t an external entity coming in and saying you have a problem. They come and say, “I have a problem. What can you do about it? Can you dig deeper, find out what’s going on and maybe set something up for us.”

Matt Wallaert:
And where do you typically find that entry point for One Medical? Is it usually like Chief People Officer or where does sort of … ?

Lenny Lessor:
I think it depends on the size and the construction of the company. Sometimes it’s within HR. But some companies are big enough to have their own medical director who we converse with directly. So it really depends on the structure. But most companies that are coming to us, especially large employers that are coming us that use One Medical as a benefit for their company, they want better health, better outcomes overall. So they’re already interested in that and then we can engage them further and say, “Hey, if you give us some of your data, we’ll blend it with some of our data and we’ll try to figure out what’s really going on and give you some feedback about that, and then craft programs specific for you.” A lot of employees, obviously there’s a lot of anxiety, so we can work with that data, figure out if there’s a lot of anxiety, and then craft anxiety specific programs for that employer.

Matt Wallaert:
You guys roughly feel the same thing? You guys are hearing it, depends on the size of the organization?

Kathryn Salisbury:
It could come from HR or anywhere. And people are looking for solutions and not products, as we heard earlier to day. And I think we just have to be very attentive to that. Listen and find the right, just like Talkspace finds the right match between the patient and the therapist, we need to really tailor the right interventions and solutions for people who are experiencing difficulties or for organizations.

Matt Wallaert:
Well, I probably have time for one more question, although I’m tempted to end it on that like incredibly eloquent point, right. Is there any burning questions? Alright. I’m going to end this just a few minutes early so that they’ll love me backstage. I know it’s been a long day. I want to thank you all for your attention. Can we get another round of applause for our great panelists?