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Saul Marquez:
Hey everybody! Saul Marquez with the HLTH Matters podcast. Welcome back to today’s episode. If you have not had a chance to subscribe, hit the subscribe button because we have so many amazing health leaders that we’re interviewing straight from the HLTH conference in Las Vegas this year. Today I have the privilege of hosting Dale Cook. He’s the co-founder and chief executive officer at Learn to Live, a digital mental health company dedicated to helping people learn to live better lives. Founded in 2012, Learn to Live is transforming traditional care delivery models to address the mental health crisis at scale and make it easy for people to access care via on-demand, digital delivery of high-quality services. Learn to Live’s solution, based on the clinically proven strategies of cognitive behavioral therapy, combines self-directed digital programs with in-house, master’s level clinician coaches and innovative engagement tools like teammates and mindfulness moments, text messages to overcome barriers to care and expand access to the 100 million plus Americans who could benefit from support from the most common mental health problems: social anxiety, depression, stress, anxiety, worry, insomnia, panic, substance use, and resilience. By partnering with health plans, employers, colleges, and universities, Learn to Live services are available to more than 33 million Americans at no cost. Prior to founding Learn to Live, Dale served in various leadership roles at Deloitte Consulting and several technology companies, while managing over 30 million in e-learning and web-based learning delivery businesses. Just a pleasure to have Dale on the podcast today and chat about how they’re transforming mental health. All right, and with that introduction, Dale, I want to welcome you to the podcast. Thanks for being with me today.
Dale Cook:
Well, thanks so much for having me. It’s great to be here today.
Saul Marquez:
Yeah, hey, listen, so, you know, we’re covering so many things, health equity, we’re covering digitization, the cloud, and we’re also covering mental health. So I’m really glad that you’re here to chat with us about that. Before we dive into the topic of mental health and wellness. Talk to us about you. What is it that inspires your work in healthcare, Dale?
Dale Cook:
Well, I think this is a limited-time podcast, right? So I’ll keep my answers sort of brief because this could be a long answer, but I think a couple of things for me. One is very personal, so during my time in college many, many years ago, I struggled with some anxiety. I was really involved in school and that anxiety was driving insomnia for me, and I didn’t understand what was happening, but unlike many people, I actually had access to really great on-campus therapists. And so I went for a couple of sessions and they delivered something called cognitive behavioral therapy, and it was like a light bulb just turned on for me and it was fantastic and it addressed my issue. So if I take that experience and fast forward to today, even now, though, have family members, friends, who really struggle, most of us, those listening, for those of you who are listening, probably each of you can single out either your own personal experience with stress or anxiety or depression, or you have a family member or a coworker who’s really having a tough time. So the problem’s immense and we all know that, and so I think the second half of kind of the motivation, the inspiration for me was when my co-founder, Dr. Ross Morford, approached me on this about nine years ago. I thought, wow, this is an amazing business that we could really grow to reach a lot of people and really most importantly, help people with their suffering because we know it’s a huge problem and we know it takes a lot of different kinds of solutions, a lot of different types of approaches to solve it. So it’s a very personal but also very mission-driven reason for me to do this.
Saul Marquez:
Thank you for sharing that. And it presents itself in so many different ways, right? It could be insomia.
Dale Cook:
It does.
Saul Marquez:
It could be depression, I mean, you never know. And half the time you don’t know.
Dale Cook:
That’s right.
Saul Marquez:
It’ll be interesting to chat about that with you. Like, how do you even know that you have a problem or how do you figure that out?
Dale Cook:
Well, it’s one of the billion-dollar questions, actually trillion-dollar questions globally if we’re talking about lost productivity every year due to mental health problems. But I think it’s a really great question because for most of us, mental health can be a day-to-day thing. For some, they will always struggle with clinical depression, for example, and it will always be in their life in some really deep clinical way. For many of others, myself included, it can be a day-to-day thing, right? We can have really high stress or we can be really anxious and knowing how to manage that and learning the tools to do that is just like physical health. You know, as I get into my fifties now, understanding what it is to be in a calorie deficit and work out every day, right, to stay in shape.
Saul Marquez:
Yeah.
Dale Cook:
It’s exercises, it’s very practical things that I just need to know about to manage my physical health. And so I think part of it is almost a little less whether each person needs to know if they have a clinical level of suffering or not and more, what are the tools that can help me with me feeling sad today? And certainly, that’s not to take away from those who are clinically diagnosed because that’s, unfortunately, a large population in the United States as well, but there’s a range there, and I think companies like ours, other companies who really try to get the word out and make those tools really accessible is part of the unlock for kind of helping the day-to-day management of what we might call our mental health.
Saul Marquez:
Yeah, thank you for that, Dale. So on Learn to Live, your company, talk to us about how you guys are adding value to the healthcare ecosystem.
Dale Cook:
Well, we really do three things. We offer what we call self-directed digital cognitive behavioral therapy programs, a little bit of a mouthful, but CBT as a treatment protocol is very, very effective in face-to-face settings. It’s actually been around for over half a century and digitally delivered CBT has actually now been studied for over two decades, and so there’s gold standard research showing that if done appropriately, digital CBT can be as effective as face-to-face CBT. So that’s number one, is really comprehensive digital CBT programs for panic, substance use, insomnia, depression, a whole range of mental health problems. The second thing we offer is live clinician coaching. So we have mental health clinicians on staff. They all have clinical backgrounds, clinical experience available 24/7 to our members, unlimited, text, phone, email, and so we have clinicians on staff. And then the third thing we do is we do all the gold standard, what we call psychometric assessments throughout someone’s experience in our programs. And so you might go into primary care these days for, say, an annual physical and you might be fortunate if you get, say, a PHQ-9, which is the nine-question measure for depression, it’s a gold standard time-tested measure. We have those measures in our programs both at the beginning and then at each of the eight lessons to measure progress. The last thing I would mention, and this is maybe a longer answer than you were looking for.
Saul Marquez:
No, this is great.
Dale Cook:
Maybe by now all the listeners have tuned out, but in terms of our place in the ecosystem, I would kind of zoom back from what we offer and focus on the big problem, which is almost half of the people in the United States will suffer from a mental health problem at one point in their lives. Unfortunately, only one in four of those will seek what we call traditional care, which is face-to-face therapy or teletherapy. So even with the big spike in teletherapy during COVID, and that’s waned a little bit, but still has high usage, even with all of that, that only addresses the one in four. And so those three out of four who aren’t engaging in traditional care are prevented from doing that, either because of stigma, which is still very real access, or cost issues. And so that’s where Learn to Live plays, is really focusing on that three out of four, and the way we collaborate with clients and the way we offer our services really addresses those three barriers.
Saul Marquez:
Got it, and so are people finding you guys through a sponsor, like an employer, or how do people engage with your company?
Dale Cook:
They do it in two ways. Primarily now it’s through a sponsor. So we, our reach is about almost 33 million Americans now. And that’s, thank you, you know, it’s, we have an amazing team. We’ve been working a long time at this, and so we’re really excited to have that kind of impact. And our sponsors are primarily health plans, so large health plans, small health plans who help us get the word out to their members, whether we do it directly or they do it. We work with many, many employers, so that’s a big part of our business. We work with higher education institutions, so colleges and universities to serve their students. And then we work with a range of other partners, so pharmacy benefit managers, employee assistance programs. We’re now actually moving into the teen space, so we do a lot of work with teens.
Saul Marquez:
Huge need there.
Dale Cook:
Huge need, and it’s been a big theme this week for those listening, if you’ve been to almost any mental health session, teen mental health is kind of at the top of the list, and so we really focus on that as well. I would mention we also have a channel open that’s direct to consumer because that’s part of our mission. So if somebody who maybe doesn’t happen to have a health plan that is partnered with us, can still engage with us directly for a really modest kind of monthly fee and have the same suite of services if they need.
Saul Marquez:
Love it, that’s fantastic. Thank you, Dale. You guys are doing meaningful work. You know, I had a chance to work with a friend and he actually jumped off the San Francisco bridge and survived. So his name is Kevin Hines. His mission is to prevent suicide, and I’ve learned a lot from him about mental health and the things that we could do. And I’ll tell you just through him and what I’ve seen him do and the things that he teaches, I know that the work that you and your team are doing, Dale, is incredibly just impactful. So thank you for what you do.
Dale Cook:
Well, you’re welcome, and thank you for sharing that. You know, I think I actually know, you said Kevin, right? I think I know who he is because I followed some of his things. I think he has t-shirts and he has a whole program, and I will tell you that big shout out to Kevin. I don’t know, Kevin, but the most powerful thing that we see at Learn to Live is what we call our members, our users, reaching out to each other and speaking out about how they’ve learned to manage their mental health. It is the single most powerful way to help other people change their lives. And so that’s a big part of what we do to encourage community. So I appreciate you sharing that. That’s really the core of what we do, that’s a very poignant example and that’s great, that Kevin is turning that into something so powerful.
Saul Marquez:
He has, and so companies like yours help prevent the preventable.
Dale Cook:
That’s exactly right. Yeah, and I would say one of the things that we do really well because of the way we deliver our programs is our programs are very clinically based, and so we can handle people who are, say, on the clinically diagnosed end of depression. Generally, we don’t get into high-complexity issues, and so our clinician coaches will hand off, right, to providers for, say, inpatient therapy or other kinds of pharmacy needs, right, medication needs, but we also work really far upstream. So to your point, preventing the preventable, I love that phrase, I’m going to steal that from you by the way, you’ve been duly warned. That’s a big part of what we do, and so when we work with employers, for example, one of our biggest opportunities is to help them engage. Sometimes it’s 40 or 50% of their employees and family members, which compared to their traditional models, which is face-to-face care, where they’re in the 1 to 2%, and this is a really large percentage. It’s exciting on the one hand, because we’re doing some great work with our clients. It’s a little scary, on the other hand, because they see, these employers, our clients have a front-row seat to actually the suffering because we don’t identify, the personally identifiable information of the users back to the employer, and so that’s one of the ways we get around the stigma to do that. But what we find is about half of our users are kind of upstream, so they’re in that place where if they engage early enough, they don’t move downstream into, say, a depression diagnosis, which also means it’s helping with the supply problem of therapists on the back, in which I’m sure you’re probably familiar with. Most people know how hard it is to find a therapist. Over half the counties in the US don’t have a single mental healthcare practitioner.
Saul Marquez:
It’s insane.
Dale Cook:
Long answer to your question, but I’ll stop there.
Saul Marquez:
Listen, this is great and I’m glad we’re really getting granular with some of these topics because it affects all of us, our kids, it affects us, our spouses, friends, and so it’s critical that we touch this well, so thank you for doing that, Dale. Tell us about really this massive unaddressed need for mental health services. Why does this gap exist and what can we do to address it?
Dale Cook:
Well, I think the first thing I would go to is back to kind of these three big barriers: stigma, access, and cost. And so, number one, and as much as we’re using words like stress or anxiety or depression, we’re talking a whole lot more about it than we ever have, especially this week, right, that’s a great example, stigma and in the workplace, fear of discrimination is still the most powerful barrier there is. And we all know people who maybe are struggling that have struggled for years, and maybe we just find out and we’re family. And so Learn to Live offers its programs and services in a completely confidential and private way, and so, for you as an employee of company A, you can engage with us as much as you want, Company A will never know your identity. So we do a lot of reporting in the aggregate and we can do age demographics and psychometric outcomes and all of the important results and clinical outcomes that our clients need to know that we’re doing a great job for them, but people can approach us in that confidence, in that privacy. So that’s number one. Number two, access. So our services are available 24/7, clinicians are available 24/7. We met with one of our senior executive, one of our largest clients last week, just an annual check-in, and she said, here I am, an executive at one of the largest health plans in the country. My daughter is suffering from anxiety and I could not find my way through our own network to find her a therapist. So she’s doing your program right now as we speak, as the first line of defense. That’s an access issue, right? So when we talk about teletherapy, which is being talked about a lot this week, teletherapy is great, but it’s still tapping into the same limited supply, it’s just a little tricky. And then the last thing is cost, and so we strive to do two things. One is set up a modest cost structure for our clients to make it affordable and provide them with substantial ROI, and then of course, it’s free to their community. So employees, family members, health plan members, Medicaid, Medicare members, it’s no cost.
Saul Marquez:
Nice.
Dale Cook:
So those are the three kind of big barriers and we can do it at scale, right? So we’ve scaled out now to almost 33 million. I don’t think we plan to stop anytime soon. And we figured out how to do that and also maintain really high engagement, maintain robust reporting for our clients, and really collaborate with each client. I think our team has a tremendous ability to be high-touch but high scale, which is a tricky thing to do, but that’s what we’ve been perfecting over the past nine years.
Saul Marquez:
Very cool, thank you for that. You know, and on the access topic, Dale, we’ve had some awesome conversations around health equity, and one of the interesting points that one of our guests made was around putting things in different languages so people can access it. Is your service available in other languages for different communities?
Dale Cook:
It is, so it’s fully available in Spanish, and we launched that I think about a year ago.
Saul Marquez:
Congrats on that.
Dale Cook:
Thank you, no, we were very excited to do that. And I would make a note as someone who actually grew up in Latin America.
Saul Marquez:
Oh, you did?
Dale Cook:
In Colombia and then also in Costa Rica.
Saul Marquez:
I love Costa Rica.
Dale Cook:
It’s amazing.
Saul Marquez:
Yeah, we got married, my wife and I got married there.
Dale Cook:
Wow, that’s fantastic. Destination wedding, you can’t beat it, you can’t beat it. Yeah, well, and so as sort of, in my formative years, having grown up in South America, it’s very important that it’s, as you know, it’s not just a matter of translating the language, language is culture, and so you have to translate the cultural nuances of the animations or the scenarios, right? So it’s a much deeper issue than simply Google translating, if you will, the text or the narrative. And so Spanish is fully available, and then we have other languages that we’re set to roll out over the next couple of years. We have our eye on sort of moving into spaces outside the US, which is kind of part of the next frontier for us because the suffering is worldwide.
Saul Marquez:
It is.
Dale Cook:
It’s not exclusive to the United States.
Saul Marquez:
What does the international footprint look like? I mean, the needs got to be enormous.
Dale Cook:
It’s enormous, and I think I maybe mentioned this earlier, but just for employers globally, over $1 trillion, 17 billion with a B, billion working days, lost productivity every year just with employers globally, right? So the need is universal in that respect. It’s not, you know, in mental health, the need to manage your mental health is universal. It’s a human issue, right? It’s not an American issue. Are there unique things happening, I think, in this country that can contribute? Sure, just as there are unique things in each country. So the need is global, we intend to serve the needs globally. We just haven’t quite gotten there yet, but we will.
Saul Marquez:
Awesome, and I applaud you for, and your team, for the efforts, the execution that you’ve made on the equity side of things. Spanish is available, folks, English, and more to come. So I want to remind everybody listening that in the show notes you’ll find links to resources we’ve discussed, the website for Learn to Live, HLTH, and everything that we’re talking about here. So make sure you take action on the things that you learn and the things that Dale is sharing with us, because one thing is to listen, the next thing is to act, and that’s what we’re looking for you to do. So one more question for you, how do you evaluate efficacy for digital mental health programs?
Dale Cook:
Well, I’m glad you asked, because outcomes are critical, right? So we can meet with, say, an employer and we can forecast together that they’ll have 30% or 40% of their community engage with us, which is quite high, and that’s wonderful, but if someone isn’t staying with us long enough through the lessons of the program, through the clinical protocol, if you will, it’s kind of math, they won’t see the outcomes typically that they need to see. And so the biggest way we can measure efficacy and outcomes for their experience with us is through these psychometric assessments. And so if you think of the PHQ-9 is a commonly known one for depression and the GAD-7 for anxiety, a social phobia inventory, it’s called the SPIN for social anxiety, and so we use these measures both at the beginning to get a baseline and that at each of the eight lessons, each lesson is about an hour long, our users do homework and activities in between the lessons to apply what they’re learning online to their day-to-day lives, but those psychometric assessments is really the most important clinical measure. The second measure we have is our coaches, because they’re clinicians, they’re able to assess in a different way, it’s a more subjective way, but they’re able to assess progress. And then, number three, very practical outcomes are measured too, such as … in a program. How far has he progressed in the goals that he set interacting with us in lesson one, how is he rating himself against his goals in lesson two, in lesson three, in lesson four? And so the percentage of people that reach their goals is measured, the percentage of people that as a digital company, right, we measure net promoter score, we measure all of the other really important user experience outcomes that we need to measure because digital is different than in-person, and so if someone is not having an amazing, engaging experience with us, that can impact clinical outcomes. I don’t know if that was too long. That answered your question, maybe we lost all our listeners again.
Saul Marquez:
Negative, negative, everybody’s tuned in. And you know, this topic of user experience is a common theme at the conference. I’m hearing it from a lot of the leaders on the podcast is, A, satisfaction and satisfaction experience, the consumer experience.
Dale Cook:
That’s right.
Saul Marquez:
Being able to be satisfied and have a great experience is what differentiates, it’s what helps health plans and health systems retain the people that they’re taking care of. So yeah, man, I’m glad you hit that note. Listen, Dale, this has been so much fun. Thank you for all the insights you’ve shared. What’s a closing thought you’d like to leave our listeners with?
Dale Cook:
Well, first of all, thanks Saul, it’s been a pleasure to be on with you today and to speak to the millions and billions of listeners that we have today, I’m sure, right? I think my closing thought would be literally to speak to those listening to say, if you’re suffering, you’re not alone. Most people around you are having challenges with their mental health and you just don’t know it, and you’re not alone. Whether it’s Learn to Live or whether it’s other companies, you can access what you need if you need to directly, immediately from a digital point of view. And if you don’t want to do that, there are other resources. And so I think I would just close with that encouragement to people to take that step, take that first baby step, talk to somebody about it, talk to a friend about it. Certainly, we have a lot of information on our site that you don’t have to enroll, if you don’t want to, that can help you start to learn how to just manage your own mental health day to day. That’s what I would encourage people to do.
Saul Marquez:
Dale, I appreciate that so much. And folks, take what Dale said to heart. You’re not alone and there’s options. And on that, let’s share the option Dale has for you. What’s the place where people can learn more about you and your company?
Dale Cook:
It’s www.LearnToLive.com. Check us out, we’d love to have you.
Saul Marquez:
Love it, and folks, all of those links are in the show notes of today’s podcast. If you haven’t already, make sure you subscribe to this series because you’re not going to want to miss amazing leaders like Dale sharing some of the best practices, in this case, mental health, but in health as a whole. Dale, really appreciate you.
Dale Cook:
Thanks, Saul, pleasure. Thank you.
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