Talkspace, Inc. (TALK) Earnings Call Transcript & Summary

Hi good afternoon, and welcome back to the Barclays Global Healthcare Conference. My name is Andrew Mok. I'm the facilities and managed care analyst here at Barclays, and I'm pleased to be joined with my colleague, Anna Kruszenski here. And we're pleased to welcome Dr. Jon Cohen, CEO of Talkspace. Jon, welcome.

Thank you.

Maybe for those in the audience that may not be familiar with Talkspace, why don't you give a brief overview of the company and current state of affairs?

Sure. So Talkspace right now is, we think, the largest in-network telehealth mental health provider in the country, meaning we're approaching 200 million covered lives on the payer side. We have about 6,000 therapists in all 50 states. We provide every modality of virtual care, meaning texting, messaging, live video, calls, et cetera. We have a payer part of the business, which is reimbursable for those people in our network. And then we have a direct enterprise part of the business where we contract with cities, states, counties, employers to provide a direct-to-employer or direct student offering.

So you've successfully executed that shift to become a payer-focused company and now have access to those 200 million covered lives. What are the key strategies to activate those new lives? And how do you think about the potential active lives sitting within that membership base?

So it's a great question. So we have the commercial, we have all the major national payers. The majority of the Blues plans. We announced after 1.5 years journey and longer, we are now in Medicare. So we're in standard Medicare for the 33 million standard Medicare, and we're in network for about 30% of the Medicare Advantage lives, which is growing monthly. In addition, we're in TRICARE East and West. So we're covering close to the 10 million military lives and their dependence. That's the orbit of roughly the 200 million. But like you said, the real emphasis for us is to, we call unlock those 200 million. It's getting people to know that they're in network and they could get their behavioral health and mental health support through Talkspace as a covered service. So increasing awareness is a huge unlock for us. So getting people onto the platform. And the other, which we're spending a lot of time this year in is really keeping people on the platform, keeping them engaged between sessions to provide the best quality care that you can with defined outcomes and improvement in quality. So a lot of time being spent internally right now on how do we make that journey better. And there's hundreds of different things you could do to help people get on and actually make it easier for them to stay on.

Great. And we just heard from the CFO of the largest inpatient behavioral provider in this previous session, and he talked about that shift from inpatient to outpatient that he's even seeing in his business. What has been your experience with just overall outpatient behavioral utilization? And what sort of penetration rate do you think you can get to within that membership base?

So in terms of the moving from the acute care to outpatient, that's a focus for a lot of health systems. As you know, a lot of them are trying to figure out, struggling whatever, how do I get somebody an appointment, like how when they leave their behavioral health service as an inpatient, how do we get them appointment. So we are a solution for that. It's very early days, navigating through health systems as an outpatient and network provider is like all parts of health care, extremely difficult. But it is on our radar to both do post ER visits and post discharge visits. So the outpatient part of it is a significant potential for us. Like we are when we're in network, most people still don't know that they have a covered benefit. 99.9% of physicians have no idea, primary care docs, primary care, OB, family practice, that they could actually refer their patients to Talkspace, and it doesn't cost the patients anything or it's a $10 co-pay or something. So part of what we're also doing is trying to figure out how to educate the physician primary care networks that were in network.

Great. And you're in a few new markets. You've expanded recently into seniors, military, et cetera. What's the marketing strategy there? And how does that differ from the traditional commercially insured adult?

So I would say that let me talk about military first. So military, as I said, is about $10 million. The military for us, it seems easier in terms of the go-to-market strategy because it's very defined. We know who they are. We know where all the bases are. We know what they read. We know how to communicate them. We know who the decider and the family frequently at the spouse. So for military, it seems like it's easier to focus on that group of 10 million people. Medicare is very different. I mean Medicare is just basically is everywhere, right? That it took us 1.5 years, almost 2 years to get in network. We had to do it state by state. You have to be licensed in every single state to deliver Medicare and get the therapist credentials to deliver care. So we have a very defined strategy for Medicare, and it is different for Medicare Advantage versus standard. And what I mean by that is we know that they actually read their direct mail. We know that they're on Meta on Facebook. We know that they're very big in their communities. We know that they like to go to events. So we've done a fair amount of research fairly in depth in terms of how to get to Medicare patients. For us, that journey has just begun, quite honestly. We literally just got out of the gate because it took us quite some time to get in network. It also took us time. We had to change what we call our patient journey, meaning when you first sign on to Talkspace, you have to do an intake and you have to answer a bunch of questions. We found very quickly, which we have to revisit that our traditional our typical journey was in no way applicable to a Medicare patient. So for instance, you can't ask during your intake, a Medicare patient, tell us what drugs are on in your doses. And that will take them usually 3 days, like figure that out, like, okay, they're on a lot of drugs. So what you want to do is you want to make it incredibly easy which is what we've now done to get them on to the platform. Then once they're on the platform is how do we again keep them on the platform. So I make this it's a little bit of an analogous to or we may talk about teens. So we have over 500,000 teens in the U.S. that now have access to Talkspace free through their county, city, government, et cetera. But it took us some time when we did those contracts to figure out how to get to teenagers. They, of course, over 90% of our teens, we deliver therapies through texting and messaging. No surprise. If you want to meet a teenager, you got to meet them on their phone, right? And so it turns out it took us time to figure that out. And then once we figured that out, like how do you get to them? Social media, whether it's TikTok or other, how do you identify them and what attracts a teenager. So the reason I talk about that is we're going to do the same thing with Medicare. We have to figure out what it is that's going to draw a Medicare patient onto the Talkspace platform and how do we make it unbelievably easy for them. We have quite honestly, it's no secret. We have people on the ground, right? You go to retirement communities and other places and get on to events. So it is definitely a work in progress.

What are the key milestones you're looking for as you start that journey? And what's embedded in kind of near-term 2025 expectations around these populations?

So we're not dependent on either to meet our guidance. But it's built into the budget. We're being very conservative right now because we just haven't done it. So our expectation is we will continue to see it ramp through the year. We've had very positive results in the military, and we just launched. Medicare, as I said, we're just getting out of the gate. And what's interesting and what has been anecdotally interesting is even though we've done almost no advertising and no marketing, but a couple of press releases on Medicare, we still have a lot of people visiting us. What we'll try to do is wait, which we did do to where we were in a network in all 50 states. The reason is we don't want Medicare patients to come to the site and they realize that we weren't in their state or realize that we weren't in their Medicare Advantage plan. So we want them to do everything and then launch.

Shifting a bit to the direct enterprise side of the house. What do you guys see as the biggest areas of opportunity in that business?

So we still do a fairly substantial business on what I'll call mid-level employers who are looking for a solution for their employees that is in addition to their standard EAP program. Larger employers, it's a very different set of circumstances really. So the mid-market employers, we're talking to and winning a bunch of those contracts. And it is a better offering, I mean your EAP solution is usually 4, 5, 6 sessions. Our solution on a direct enterprise is much higher, plus we're fully engaged with the employer to make it work as opposed to someone who's an employee and looking at their EAP program. So that's on the employer's side. We also have a lot of associations, which are large groups of typical associations to think of that are looking to add on a mental health benefit for their members. We just announced Rowing, we announced the U.S. Teen Association. There's a bunch of those, a bunch of teachers that those groups are looking for a solution. The third big one, of course, is the teens. So we've leaned in, in a very big way. You've probably seen it. We have 465,000 teenagers in New York City have access to Talkspace between the age of 13 and 17. We've had over 20,000 teenagers come on to the platform in the last year. The results have been remarkable, 20% to 70% improvement. And we're reaching teens, as I said earlier, where they are. What's really interesting is we're reaching into communities that are traditionally incredibly difficult to get to. So we do a ZIP code analysis, ZIP code overlay and you could see that we're getting to communities that are really very difficult to reach. The reason is the teens are using their phones. It doesn't matter where they live, right? They're traditionally texting messaging after school turns out and on weekends and nights. And as I said, over 90% are actually utilizing texting and messaging as their way to get to their therapists. We're in Baltimore. We just announced Seattle, another 55,000, it's a larger, actually, age group in Seattle. We have a whole slew of other private schools and smaller districts and quite honestly, a bunch more to come. So as I said, right now, we have over 500,000 kids who have access to the platform. So we have a substantial pipeline. So we're hoping sometime soon, we'll make many more announcements about other cities, county states that are coming on. We've seen a lot of interest to apply a mental health solution to teen populations for not just the, say, the typical reasons, which, by the way, you would think are anxiety, depression, eating disorders, but it turns out the #1 issue right now is being a better self, is being more aware. Family relationships are very high. Family/relationships are very high in terms of what we're seeing in the kids. So that's a huge work in progress, but a lot more to come. It looks like.

You've talked on recent earnings calls about making improvements in the tech platform to keep members on for longer. So can you share some examples of ways you've helped with retention and maybe talk about what's on the product road map in this regard?

Sure. So the [indiscernible] and one of our cool things is we announced at the beginning of January at JPM. We announced, we call it Talkcast. It's a personalized podcast. So that's an example of utilizing technology between sessions. So what it is, is it's AI generated. And what it does is it looks at the conversation that you've had with your therapist, it looks at the major theme or themes. It then accesses our database. We have a database of 10 billion words, which is millions of conversations. So it matches what you said in your therapy session to what our experience has been in the past, and it generates basically a 3-minute to 5-minute personalized podcast just for you. So it's incredibly interesting. So we give it to the therapist. They have to approve it. They read through the script. They said, okay, you could send it to the patient, to the member. And you listen to it, and it says, "Hey, Sarah, we know that you're having trouble with your parents and your relationship. These are the things you need to consider that we talked about. These are the things that other people have done. We know that this is a success, and I want you to try". So it's actually personalized exactly to what you said you needed help with in your podcast. So we did that. We just launched it. And that's just an example of things we're doing between sessions to fully engage people to stay on the platform. And there's a bunch of others we're looking at. I would tell you, anecdotally, so fun when I did it, I told the therapists for the session to generate my own personal podcast that when I'm on the golf course and putting, I get incredibly anxious, right? And when I'm standing over the ball, and I literally do, and I said, and it turns out you can't believe the sophistication of the podcast that came back. It told me things I should be doing differently, how I should be lining up, all the famous golfers that have had the same problem and what are the things I need to practice along the way. And it's all AI generated, which to me is unbelievable anyway, it's just one of the tools we have.

Is there any early color you can share on like utilization of Talkcast?

Not yet. We literally I would say we were testing it. I think we went live 10 days ago. Like live, live, right? So I don't have any early data yet. And then we're making a whole bunch of other changes to the platform to continually engage people in a better way.

Sticking with that topic, what role will AI play in improving the member experience?

So sort of the question of the day. So there's really 4 major areas. And by the way, we've been working with large language models for years. We have internal resources and engineers that are doing AI. So I'll put them in the buckets of, one, we are using for some improvement in business operations. We talked about a couple of months ago, we call SmartNotes. And what it is, is we now do an intake summary, AI generated. So you answer all these questions and then there's a summary generated that gives it to the therapist. So when you see them, there's an intake summary. Then what it does is after the session, it summarizes the notes, and it may be a week of texting. It may be a live video. And it summarizes it. It gives it to the therapist so they could sign off on it. And that becomes their note. So what's happened early on, we saved 4 hours a week on therapy administrative. So that's a huge issue because that means there's 4 more hours that they could be delivering therapy. So that's the other one of the other buckets. The third bucket is we have reported on back in 2019, a proprietary algorithm in this case to predict suicide. So what that does is the engine, which is running every 30 minutes, looks at the conversation and it actually will tell the therapist based on the conversation that you're having on the Talkspace platform, you need to be aware, Mr. or Ms. therapist, that this patient is at risk for suicide. So it's an alerting mechanism. It's what I'll call flashing light. It doesn't tell them what to do. It doesn't tell them how to do therapy, but it says you need to be aware that this patient is at risk. It's 86% accurate. And it's dialed up purposely to have high number of false positives because what you want to do is have a higher number of false positives, so you don't miss anything. We reported that back in 2019. We've had, I think, 40,000 alerts now that comes. We've had a significant number of alerts on the Teen Space platform for teenagers, as you can imagine. So the AI-generated risk algorithm for suicide has been in place. We are quite honestly, we are generating other risk algorithms for other entities, which will help the therapists be better at their job. So it's not just the administrative side, but we're trying to really improve the quality of what the therapists deliver by making them better at their job. I would say the last category is sort of the example we did with podcast is how do we use AI to help us keep people on the platform.

Great. Jon, maybe taking a step back on the broader competitive landscape, who do you view as your direct competitors? And what are the key differentiators for Talkspace that gives you the right to win in this business?

So competitively well, people like to ask BetterHelp. BetterHelp is a completely different business to us because they're a consumer-based model. And we do consumer, small part of the business, continues to decrease. So in that sense, we're not really a competitor with them. There are a couple of other regional players. There are some other mental health providers that have bricks-and-mortar psychiatry practices, have more psych than we do, have other entities, coaching, et cetera, that we don't do. So it's hard for me to make a direct comparison to Talkspace. The other is the market for behavioral health is so big that I don't view it as a competitive landscape. It's not like we're not a commoditized business where it's a zero-sum game, you have to steal market share. What you need to do is what we did at teens, what we're doing with Medicare is actually build the market that currently exists. 25% of Medicare patients have a diagnosable mental health condition. 23% of kids on the intake have suicide ideation. So the number of people out there that could benefit from our service is gigantic. So I don't view it as competitive. I view it as how do we build the market. By the way, your [indiscernible] points. I don't know, 50%, I think, is 50% of people coming to us are new to therapy. It gives you an idea of how much is out there. The TAM is essentially incalculable.

Right. And then on your last earnings call, you mentioned the quality of your provider network helps you to attract talent. One, can you maybe speak and elaborate on some of the recruiting trends you're seeing? And are there any geographies that you would point to as being more difficult, like characteristics of geographies that point to a more difficult or easier landscape to recruit?

So we have 4, 5 strategic initiatives that we talk about. One of them is improving the, I would say, quality and life of the therapists. So our therapists are a real community. There we educate them. We have continued education. We hold them accountable to a certain standard. It's not it's not a matching only. You're part of this community. You have to live by the quality standards that we set. So that whole guys relative to the therapist network is a really, really important issue. Remember, our product is therapy and the ability for us to be successful is based on having great therapists deliver great therapy. So that's a really important initiative for us. I would say in terms of your market question, California is always difficult, salaries, competitiveness in terms of the number of platforms out there. So in general, California is probably one of the more difficult regions if I had to pick across the country.

Maybe just last question here to finish up. There's been a lot of noise coming out of D.C. or just discussions coming out of D.C. with targeted cuts towards Medicaid exchanges. It seems like your business is relatively insulated from a lot of those risks. Is there anything you're monitoring from a regulatory standpoint that would be more meaningful or impactful to your business?

I would say, well, what just happened recently, which we knew would happen in a positive sense was the extension of the telehealth regs around Medicare population. So they extended it. It was going to expire, I guess, it was this month, sometime this month. They just extended it to September 1. I think all of us would predict that at some point, it will become permanent. I don't think anybody is going to take telehealth away from Medicare patients anytime soon. So that was a little bit of a flashing light for everybody, are they going to do it? Are they going to do? Are they going to do it? And I think most of us said, it's impossible for us to believe that they wouldn't. Medicaid, we're not in. So as you said, is not particularly worried about the Medicaid. I think on the regulatory side, in general, I would say it's relatively positive in this kind of administration in terms of less regulatory oversight than more. So I view that as a positive for the business.

Great. With that, we're out of time. Why don't we end it there? Jon, thank you so much for joining us here today, and please enjoy the rest of your conference.

Thank you very much. Thanks for the privilege. Thank you.