Select Page

Can data, software and devices enable better care?

andrew rosenthal
Moderator

principal
@ajr consulting

ian tong, md

chief medical officer
@doctor on demand

oren frank

ceo
@Talkspace

dan gebremedhin

principal
@flare capital

seth feuerstein, md, jd

asst clin professor of psychiatry
@yale university center

Andrew R.:
What a remarkable presentation to be following. Everyone take a a deep breath. We’re gonna go from kinda problem to hopefully some solutions or at least some things to be thinking about during solutions. My name’s Andrew Rosenthal. I’m a consultant which is in Silicon Valley generally means somebody’s unemployed. I’m a serial entrepreneur. I’ve done a number of different companies. Happier dot com was one of them. I, then did a food tracking company we sold to a larger firm called JawBone and I was there for about four years where I led our efforts working with employers. Both around physical health and some interesting things around behavioral health and around sleep. Which, was underrated at the time.

What I’d like to do is get the other panelists to introduce themselves but, before I do that. Just to help us understand. I’d love to get a sense of exactly who’s here. What kinds of people. So, I’m gonna take some guesses as to categories. I’m sure I’ll miss some people. But, if you are a Talk Space therapist, if you could just raise your hand to give us a sense. Thank you guys for the work you do. If you are here on behalf of an employer either cause you select or manage benefits or you advise employers on managing benefits especially around behavioral health, can you just let us know, raise your hand. Great. If you are student, let us know. Great. I’m sure I missed some other categories. Yell it out, if we missed what you are. Just understand where people are coming from. EAP. Think of that as an employer bucket but, good point. Vendor. Health Tech Company.

Great, this is helpful context for us. We’re gonna do intros. We’re gonna have time at the end for Q & A. We will get to the questions. So, think of good ones during it. Let’s just start to my immediate left. If you could give us some background on why you’re here today and kind of what you’ve been up to recently. That would be helpful.

Owen F.:
Thank you, Andrew. Good to see you again. I think last time was South by SouthWest right?

Andrew R.:
Yes, breakfast burritos in Austin.

Owen F.:
Yeah, we’re doing a tour together. Tickets are sold separately. As I mentioned before, my name is Owen Frank. I’m the co-founder CEO of Talk Space. Thank you again for coming. You know, I think …

Andrew R.:
Yeah, that sounds great.

Seth F.:
My name is Seth Fuerstien. Maybe I should just show a video. I wanted to … I wear multiple hats. I’m on the clinical faculty of the Yale University School of Medicine the department of psychiatry. I’m an entrepreneur who started the digital therapy company that was acquired by McGellan Health. Where I’m the Chief Innovation Officer at McGellan Healthcare and I oversee the reshaping of behavioral healthcare in the work place and other places generally leveraging technology collaboratively and with projects we build internally.

Ian T.:
My name is Ian Tong. Chief Medical Officer at Doctor On Demand. I’ve been a doctor on demand for four years now. Doctor on Demand is a digital health company. We are a nationwide medical practice that provides video visits to a patient on demand and by appointment in mental health. I’m on the faculty at Stanford as a Clinical Assistant Professor, taught medical school there for the last 11 years and I’ve reduced my role to pick this journey. Really happy to be here and thank you all for inviting us.

Dan G.:
Hi, everybody, Dan Gebbermetint, I’m a Principal at Flair Capital Partners. We have a two hundred million dollar venture investment firm. We invest only in healthcare technology and services. It looks like since I went to the dark side of investing, I lost my medical credentials.

Andrew R.:
I was gonna ask about that …

Dan G.:
I’m also a practicing physician at The Mass General Hospital. Before I was at Flair, I was a medical director of population health analytics in general strategy at the Harvard Pilgrim Health Plant.

Andrew R.:
Great, thank you. Our goal for this panel is to really talk to what’s happening with technology. If not solutions, then pointing towards solutions specifically of interest to behavioral health in the work place. So, you’ll hear me really try to shape the discussion toward that. There’s a lot of other things to talk to especially with the depth of expertise we have up here. But, that’s kinda what we want to touch on.

Dan, if we can start with you. You’re an investor. So you’ve seen entire landscape of people coming out of great academic backgrounds or grodges in Silicon Valley with amazing ideas. They are telling you and I’ve been across the table pitching you. They’re telling you, I have this thing and it is going to help people get better and it is going to save money and employers are gonna pay for it. What do you do when you hear that?

Dan G.:
You know, it’s a good point. I think that there’s a real need for solutions in the market, right? So, everyone is familiar. We spend over two hundred and thirty billion dollars on mental health care, behavioral healthcare in the United States. You have kinda that perfect trilemma for opportunity for entrepreneurs. Where you have high costs, low quality outcomes, and low satisfaction.

We did an overall analysis of The BH tech landscape. There’s over two hundred companies in this space. In 2016 alone, you had two hundred million of venture capital invested into roughly 18 or 19 BH Tech Companies. There’s been a lot of activity in this space. There’s been a lot of new entrance. I think historically, the customers have been pairs and providers. I think, pharma med devices are starting to play a role.

But, you start to see employers really kinda coming to the forefront as being really interested stake holders who ultimately are the end user of a lot of these products. I think at a high level where we have seen mismatched cause you haven’t seen a whole lot of quote, unquote, traction in this space. There’s this general conflation of behavioral health as one thing. I think what you see sometimes, you see both in entrepreneurs and customers. Confusion between sub clinical behavioral health so things that would fall into a wellness, mindfulness, resilience category. With serious mental illness things like mood disorders, substance abuse conditions.

Where you have tech, generally designed for some of these sub clinical conditions trying to identify new mental health conditions. Trying to treat some of these sub clinical conditions and trying to position it and pin point towards a more serious use for it. There’s just not gonna be a lot of product market fit. You’re not gonna get the outcomes. You’re not gonna get the efficacy that you would like. So, that’s high level something that we’ve seen.

But, I think there’s a lot of people here on this panel that are pioneering new approaches to attacking these problems with more educated solutions.

Andrew R.:
So, I’m gonna come back to you a little bit later around how you evaluate if a company is getting traction. Cause that means a lot here in San Francisco but, it also involves employers and employees a lot when people are selling to employers. I’ll come back to you there.

Ian, if you could kinda touch on what you see happening with the employer landscape around behavioral health either trends, major obstacles, given that this is a lot of where your working day to day.

Ian T.:
Yeah, sure and maybe I should just give a little bit. I forgot to just say, that I’m an intern. I don’t think I said that. So, my background is not particularly in mental health. However, I spent the first eight years of my career in my clinical work at the VA Palo Alto. There my program was to do outreach to homeless veterans and rural veterans. You can imagine I saw a fair amount of mental health there. Even in my general medicine clinic which would be … you think is a sort of a better approximation as sort of a cross section of the general population. Lots of mental health there as well.

So, five years into my career. I’m slow on the uptake. It took me that long to realize that mental health is really important to interns and it’s really important to overall health and having a mind-body approach is extremely important if you care about your patients overall outcome. So, just take that back drop and I’ll take a little bit about enterprise because I think employers want to think and maybe approach it very similar as a sort of more global truth telling experiment.

So, it starts internally I think saying, what is it that I want to provide for my population? How do I want to approach addressing mental health problems for my employees? I think Laurie was talking about the investment that they are. I could not agree more every single individual person that is working in your company. You’ve spent a lot of money, let’s just put it that way. You spent a lot of money, resources, and energy in bringing that person on, training them, and making sure that they can perform their duties. So, to take care of that investment you should ask yourself first, how far are you willing to go to make sure that you’re protecting it?

So, one thing that I think you want to do as you answer those questions are you trying to just identify who the population is? And do you have tools for that? Cause there are certainly tools that can aid you in identifying your populations that you should be targeting. Then you might want to find a solution for that. But, you may not want to go that far. Maybe, it’s just finding out who they are. Identifying them and you have a program like an EAP that you have kind of said, well I’m just gonna take that next step and make sure I point them to some subject matter experts and that’s where I’m gonna stop. That’s fine.

I think if you know that your population has specific exposures and you want to really customize the treatment programs and you want to have some say in that. That’s another level of depth I would say and responsibility, that you’re gonna take for your employees. That starts to dictate maybe a little higher level of investment in terms of scrutinizing who you engage with. But, should be well worth it depending on how you reveal your employee population.

Andrew R.:
So, Owen what is the cutting edge of what employers are doing around behavioral health? We’ve heard about EAP’s. Which most everybody has. We’ve heard about this idea of having a place for people to go where there’s a problem. Network referrals, covering some of these. But, what is that next step that Ian was saying employers are doing?

Owen F.:
I think I go back to Laurie’s description of her thinking process which didn’t even include for a second the option of getting help by her organization. Fox News at the time. I think that’s a perfect example and captivation of the problem. I don’t think it’s about not nearly only about the specific options that organizations offer. It’s about the bond, or the relationship, or the agreement of organizations with their employees. Which is currently completely reversed towards the employers and it’s extremely driven by tradition, by the way we used to do things, by what worked and didn’t work in the past.

It doesn’t address the stigma. We can probably agree that the more larger an organization is the more slow it is. The more risk of it there is and therefore it’s not gonna accommodate or welcome any new approaches and at the end of the day you have a series of people that are responsible for getting things done that are living within a very closed system without being … because of stigma, because of the typical stories such as Laurie described. I’m not really exposed to the real cause and the real size of the issue. Therefore, everyone is blissfully blind and continuing forward.

I think that’s the current situation. The fact that I can tell you that I think the cutting edge is what we’re offering because we can triple penetration in civilization which is a major problem but, that is almost a technical discussion I think it misses the cultural aspect. Which is what really is needed in the discussion with large employers specifically.

Andrew R.:
And to say, do you have this in the cost is critical. The numbers Laurie cited were huge but, if you are tasked for solving the problem for your employer. You’re not seeing that hundred and fifty billion dollars in cost across employers. You’re seeing the amount of money spent on reimbursable visits and medication. You’re not … no one sees the missed productivity. No one sees the missed day of work. A big part of the cultural challenge is really scoping the size of the problem.

Owen F.:
To be honest, let me quote a very old sentence from a previous life. Which is, no one gets fired for hiring IBM. Which is, let’s choose again and again and again the good all solutions because I’m not gonna get fired. Next quarter is my event Horizons. So, let’s continue

Andrew R.:
Give us some hope guys.

Ian T.:
Well, maybe what Owen said about the relationship. I think if you’re in enterprise and you’re looking for a vendor. I would push you a little further and say look for a partner because they’re out there. There are certainly companies and medical practices that see your population as valuable. So, you want to find one that talks about themselves. That has a vision and really it’s about quality of care. Not just having some features that kinda solve this problem. But, really that they have the team and the technology and they’ve integrated those well enough that you don’t have to be laser focused on exactly what you’re population might need cause I think we don’t always have the sophisticated tools to know what those exact laser focused things are.

So, do they have the right population of provider types for you? Do they have the technology? Have they cared about that enough to make sure that your population will use it? I think that there’s a lot of evidence hopefully, we’ll get to it. That shows that there is traction I think when you integrate those things well, patients will engage it. They’ll give you a high net promoter score. They’ll give you five star ratings. That’s all information now that we have that we didn’t use to be able to see into a medical practice. You used to have to trust primary care provider to provide with their distault or their feeling of who’s good and who’s not. Now, there’s additional data out there I think that we can already use which is great.

Dan G.:
I think that there’s a big push generally from a society. We need to integrate medical and mental health. I think when we start to talk about costs, we actually start to do a de service to mental health. I think the goal isn’t necessarily to save money. I think if you do attribute resources to mental health in the back end you will save money long term but, I think we should really focus on investing in mental health because it’s the right thing to do, right?

I think, we’ve looked at a lot of the different youth cases for tack and behavioral health. I think, it’s like five things. It’s screening and identification, care coordination and disease management, ethicacy, cost effectiveness is a component. But, I think it’s a minor one. The last thing is kinda, monitoring and tracking and access and convenience.

So, cost is important but I think people really have to focus on the adequacy of their overall platform for treating mental health. Someone mentioned that they were from EAP. I think whenever we do diligence on companies and we talk to potential customers. We always get kinda triage to the EAP person. I think what that tells us is that EAP is extremely important but, it shouldn’t be mental health, as an employer thinks about it, shouldn’t be side loaded EAP. It should be thought of, taken a broad perspective to their mental health strategy because you’re paying fifty cents PE, PM. Your health plan to run your EAP. But, at the same time you’re paying mental health care costs broadly across your population so you’re almost kinda paying twice without a concerted integrated strategy.

Andrew R.:
Seth, what do you see happening with employers in behavioral health?

Seth F.:
It depends on the employer. They have different paying points. Sometimes, it can be driven by personal experience of senior management. It can be driven by their previous experience with either behavioral health for their employees or EAP. Sometimes, a lot of the innovative companies are large technology companies so they have a certain ethos around how they feel it should be tackled.

Most large employers recognize it’s a problem. Some of them are cost driven around the benefits today. I think what you tend to see is people will choose which solutions to use at an employer based on what they think they can actually get done and what people are complaining about and that can vary tremendously. There’s no question employers are skeptical about legacy solutions like traditional EAP.

for instance, your utilization is low and when you think about stigma. Which has come up a couple of times today so think about this. I’m a clinician by background and it never really occurred to me until I became sort of an accidental software salesman in my last company. That when you start to meet with people and talk to them about what you’re doing. It’s all fine and dandy to say, well it’s confidential you can do whatever you want through HR, no ones gonna know. For the vast majority of employees and honestly, since if you’re here today you’re not the vast majority of employees.

Most employees if they go to their boss and they say, I’d really like every Thursday afternoon off for the next eight weeks but I can’t tell you what for. I mean, you’re either gonna lose your job. You’re certainly gonna lose a lot of money because you probably have to take economic impact for that. So, you’re essentially admitting without admitting what it is that’s going on. Separate from the sort of traditional stigma it is this, there really isn’t confidentiality around traditional delivery mechanisms.

So, novel delivery mechanisms are really interesting to employers. There are basically a couple ways to think about that. One is, if I have someone in the current triage pathway for care. I now have new options so it might have been office visits. Then it’s taking traditional office visits and delivering them using a platform like Telehealth. But, then it’s an entirely new style of office visit like texting with an employee and that leads to interesting questions around, okay, am I willing to start to measure something like texting in a way that’s quantifiable that fits into the economics of how I design my benefits?

Andrew R.:
Right.

Seth F.:
Those are interesting questions and they require creative thinking by leaders who want to try to accomplish something. So, did that answer your question?

Andrew R.:
I think that’s a lot of the question people here have is. Tech is happening, there’s all this innovation. Where does it actually start getting implemented and it sounds like part of it is triggered by senior leadership having some personal connection saying this needs to be better.

Seth F.:
Yeah, part of the problem in healthcare is unlike most industries. So, I’ll say a few things that are biased that I’m repeating what others said cause they clearly couldn’t be me. I would never have a biased opinion. So, when you come out west, it’s all about consumerism and what can we do to empower the consumer? That’s great if you’re Grub Hub or if you’re delivering books or food or whatever.

But, the healthcare ecosystem is different because you have a delivery system where reimbursement is designed around very specific pathways and ways to quantify those pathways. When you’re changing the way those things happen it’s much easier with traditional Telehealth where you’re beaming somebody in. Cause it’s like okay, 45 minute visit, we can pay for that. When you start to do things that truly change what’s happening it’s really hard for people to get their head around how do you quantify that and measure it.

So, on the other hand once you break in … so, you’ve got that same initial get your foot in the door. Which consumer product companies have but, then once your foot is in the door how do you not just be a product but be a solution. So that you’re not just something that people try for a little bit of time and then it kinda works. But, you never really expand your footprint and really become a significant contributor.

Then, data is huge. Employers, health plans, others. They want to see what you’re doing. There’s a lot of sizzle out there across every part of what’s going on in use of technology. But, having real data. Actionable data. Then sort of being permanently irritative is increasingly important to the people you collaborate with. To get traction with employers and with other places.

Andrew R.:
So, we talk a lot about employers. Just to give the perspective of the operators or the vendors or the entrepreneurs depending on what you call them. Earlier we heard David Kim on the panel talk about following the money. It was great comment and the natural follow onto that was reimbursement or follow the money to providers. Think a lot of people are following the money right to the door steps of the employer thinking there’s too much legacy in a carrier.

At least with an employer I can sit down with someone and show them why this new category of data ought to matter. If it’s text sent or penetration into the workforce which never mattered in a carrier.

Seth F.:
I don’t want to monopolize. But, one thing I’ll say is what’s interesting about employers is that when you go to a health plan they’re often an intermediary to employers or to medicaid or medicare. Employers are interesting because often there is one person at that employer. The head of the Human Resources who can make specific decisions about, now they may have people reporting them about this area, that makes it a unique entry point to get things done. Then, employers can actually work with their payers to design benefits around using certain solutions. Honestly, there are experts in the audience who know more about the employer space than I do.

I think …

Andrew R.:
You’re mic’d up so you can say …

Seth F.:
That’s sort of the …

Andrew R.:
Go with it.

Seth F.:
But, it’s a unique situation to work through employers because of that.

Andrew R.:
So, in terms of leveraging technology specifically. I just want to cut and go down the line. Dan, we’ll start with you. When you are talking to an employer on behalf of one of your portfolio companies or on behalf of your company. What is that dream checklist of questions you want that employer, buyer to be asking? Which helps signal hey, here’s a chance to bring this technology, to let software do what software does so well, to bring it in for mental health, behavioral health.

Dan G.:
Yeah, I think it’s a great question. Ultimately, the things that we look for are activation of the population so, it’s one thing to say as a purchaser of services for an end user population that I can’t directly control. I know what my employees want. I know what they need. I’m going to purchase services on their behalf. So, that’s not enough for us as investors. We actually want to look at the data. Once you sign this year long PE, PM contract that you’re paying fifty cents PE, PM for some form of technology. What’s the actual usage of the technology? Because that becomes important when you think about recurring contracts and long term value.

Andrew R.:
By usage you mean the old reports we used to get the 4 percent of the population signed in with the portal over the last two years? That’s what you mean by usage.

Dan G.:
Yeah, I mean I think it’s something that you’ve seen. It’s been a systematic issue with a lot of digital health that has been purchased by enterprises. You have these decision makers whether it be benefit managers, whether it be CFO’s, whether it be Chief medical officers of organizations who will purchase tech on behalf of their population then no one uses it. Right?

You’ve seen this across the board. You see single digits or low double digits activation and usage of this technology. I think that has to do with product market fit. I think also on the entrepreneur side I think it’s a lack of understanding. I actually market a solution to create awareness in the population.

Andrew R.:
So moving beyond downloads or signups that actually see completion or progress after several weeks, usage over time.

Dan G.:
Yeah, we like to see organic growth of that pattern.

Ian T.:
Right, so you want to see the company that has built the technology or the flow so that it is engaging for the patient. Companies, that and this is really Dan, maybe to comment on. If the company is geared towards or built to be direct to patient or direct to consumer. Then, they would live or die by their ability to be able to engage the cross section of the population that they’re targeting.

Andrew R.:
So, if you’re talking to an employer though. What’s another thing where it’s just it’s on your list that you hope he or she asks about?

Ian T.:
I would think that, ask about the business model. If it is a PE, PM then I agree. There’s no guarantee that they are built for a value based outcome. They’re getting paid whether people use it or not. I would encourage them to asking what is the business model? How are we aligned? Are your incentives aligned with mine? They may end with getting great patient care then that’s a question you must ask. I would also add. Does your partner, the healthcare partner who’s that’s providing the services for your employees, do they employ their providers because I have found by accident, I admit.

We didn’t go out prospectively we’re gonna employ our providers. We ended up having to do because of the way we were using them but, it has turned out to be very valuable insight that I can now do things with my physician population because they’re employed. I can actually develop programs that are customized to that employer for their population, what they need. The better they know their population, the better I can tailor the program to them. That’s really powerful I think. So, that’s I think another important question.

Andrew R.:
Thank. Seth, what are you seeing or hoping that employers start asking about?

Seth F.:
Well, I’m in a legacy large company so I hope they don’t ask any questions. No, I think when I work with employers, I try really hard to sort of … they’re really busy with lots of complex problems. This is just one of them. So, helping them identify as much in a granular way as they can. Let’s understand what you want to solve for then let’s figure out how to have, not just a six month or twelve month relationship around it. Let’s figure out what are the metrics that are important initially. It may only be one percent penetration because they may be interested in something that simply worked better.

Do you want to layer something on top of or replace what you’re doing and making sure that expectations from design in the beginning create metrics that the person will look at with a realistic lens as a building point for and a spring board for expanding what’s going on. But, this idea of … so, for instance, completion rates or you know, getting fifty percent of the population to engage with something. People will often come in, I was at a large technology company yesterday. They said, we want sixty percent utilization in year one.

Andrew R.:
Got it.

Seth F.:
Which is sort of like unheard of. They happened to have hit it in that case believe it or not. But, they have a lot of power with their employees. I think if you set those expectations reasonably and you have a map in front of them that they can remember in a year to go back to and look at. That’s the most important thing. Going forward because there’s just so much noise.

Owen F.:
I think a huge thing is utilization, penetration, a combination of both. I think that has to do with the work the technology solution is being thought of from or developed from. One of the things that we see that companies are selling software solution or technology based solutions through enterprises to employers of large companies are really not focused on that part. Which is, is the user actually willing and able to use your product and derive and extract some value from it? As opposed to, did I make the sale? Am I gonna renew the contract next year?

One of the reasons we started direct to consumer because I think that’s probably the most effective. The most difficult and the most effective way to achieve the product market fit that you are really sure that people are willing to use it because they are actually willing to pay for it. Which is one stage higher in our mashed up pyramid in a sense. I think, employers that are looking to do the right thing as Dan said, which is critically important and are aware of the problem and the size of the problem. Sometimes, it makes the need for this to be something that’s actually usable.

Technology today is an abundance not sure even if the word qualifies anymore. Talking about leveraging technology. Technology it’s fundamentally, it’s data. Your ability to solve a problem. I would say, land and capture enough data. But, what you’re doing in order to be able to learn and improve your solution all the time. That’s my current definition of technology. Usually, expressed by software. I thought it was a couple of very interesting phrases we heard before.

The first one was, prescribing software. Which is kinda two words that don’t really work together but they’re very indicative on what’s technology today. The second one, which is, I think Seth just said, Traditional Telehealth.

Seth F.:
Right.

Owen F.:
Which is even more interesting.

Andrew R.:
You heard it here first.

Seth F.:
The old guard going on providers.

Owen F.:
So I’m using this to say that technology is actually something so fluid and so changing and so surprising that we have to focus on the fundamentals. The fundamentals are, are they gonna use it? Which is absolutely critical. The second one, can you actually land and capture enough data to show this actually working? So, let’s simplify the entire discussion. I think that’s what employers should ask for.

Andrew R.:
Awesome. Thank you. I promised questions. We’ve got several minutes. So let’s take the first question if we can. Let us know if you’re an employer or coming from a different sector. Great, we’ve got you.

crowd member :
Hi, this is a fascinating panel for many reasons. One of which is, I am in this life currently a Talk Space therapy provider. But, in my previous career, I was general counsel for a multi-national here in the United States and the Human Resources department reported to me. So, I feel a little like I had split personality related to, okay this makes sense to me over here.

Owen F.:
There’s plenty of therapists in the crowd by the way too.

crowd member :
So, I guess I want to sort of share at least what I sort of relay to our Human Resources department about where our role is in relationship to our employees. That is, that we have right to manage an employees behavior and their performance. We do not have a right to manage their thoughts or their emotions. So, if I were in the position cause now I’m semi-retired as an attorney. But, if I was in the position of wanting to buy a product like this or a service. I would want to ask can you deliver a product that would help me measure performance, optimization, and providing those particular employees where our outcomes are basically it’s critical to their job in a way that could utilize the thoughts and emotions optimization for them. So, in other words, it’s a support mechanism for them to achieve optimal performance by helping them work through, work out, work with their emotions and their thoughts cause that’s obviously, as any CBT Practitioner would know is critical to positive outcomes.

So, that’s the thing I guess I wanted to ask you is that in this context I see that employers are aligned with providers. Where it’s outcome measures that are the same. In other words, that’s what we’re both wanting right?

Seth F.:
It’s really interesting you say that. Cause I wanted to interrupt Owen and say something related to that. So, that’s totally true cause you’re an expert I couldn’t disagree with you even if I did. But, I think what’s really interesting about what you said is and I think this is a huge challenge when people try to leverage technology. Which I think is working and increasingly working around the things that everyone here spoke about. Is that if you talk to an employer today about how they’re measuring that they often have little or no data. When you ask them what’s happening in the clinical continuum that they’re providing to their employees. They actually really have almost no data. Then when technology companies … I can keep going down the chain. You asked the providers, tell me the break down of your patients. They have no data. You ask them what percent get better. They have no data.

So, when you bring technology in and you have all of this data. It’s like saying to somebody, can you please look at this essay for me and give me your comments? They always give criticism and comments because that’s what you’re asking them to do. When you come in as a technology provider even if what you’re doing has real value. They have numbers in front of them to think about and they will always …