Teladoc Health, Inc. (TDOC) Earnings Call Transcript & Summary

All right. Good morning, everyone. Thank you for joining Teladoc Health's 2021 Investor Day. I'm Patrick Feeley, Head of Investor Relations. It's really great to be back with all of you again. It's been a little while. Before we begin, I want to remind everyone that this presentation may contain forward-looking statements. So the safe harbor and risk factors apply. Please refer to the latest SEC filings, including our 10-Ks and 10-Qs for more information. We have a great program for you today. You're going to hear from leaders across the business who will provide insight into our approach to whole-person care, walk you through our multiple levers for growth. You can find bios of today's presenters in the agenda, in the back of the presentation deck, both of which you can find posted on the website. The morning session will wrap up just before noon with the first Q&A session, at which point we'll take a short break so you can grab lunch. We will then come back for the final session of the day, followed by a Q&A with all of today's presenters. We expect to be wrapped up around 1:30. So with that, very pleased to turn it over to our CEO, Jason Gorevic.

Thank you, Patrick. Welcome, everyone. Thanks for being here. We appreciate those of you who are here in person. It's nice to see you again. For those of you who are tuning in on the web, we appreciate you taking the time. I feel like there's some bizarre like Rumpelstiltskin event where we were here 20 months ago in this very room and somehow blacked out and had a crazy dream about the world turning upside down. And now here we are back in the very same room. Unfortunately, I don't think that's actually true, and we have -- we're going to talk a little bit about the impact of the last 20 months. What I will say though is that I have never been so confident about the future of Teladoc Health. And what I hope to do over the course of the next 3.5 hours is demonstrate the reason for that confidence and share with you a little bit about where we're going. But before I do that, I want to start in a way that we start all of our town hall meeting. When we do global town halls with our 5,000-plus employees virtually now all around the world, we always start with why we do what we do. And so we always start with a member story that helps to bring it to life for us. So I want to do that myself for all of you. And so rather than hearing from me at the outset, we're going to hear from Jameson. [Presentation]

So hopefully, you can see why we start all of our town hall meetings with a member story. We always find them inspirational and galvanizing and remind us why we do what we do. What you hear from Jameson there is about how the breadth of Teladoc Health solutions can impact the consumer in a way that more narrow solutions just can't. And hopefully, you can get a view into how the breadth of our solutions and our ability to bring those solutions to life for the consumer can also fuel our growth because as we bring more solutions to bear for the consumer, they achieve more value from it, we are able to capture a larger share of the health care dollar. So I want to start with a little rundown as we usually do of the investment highlights. Hopefully, these aren't new to you. What I also hope is that you'll sort of walk away at the end, having said we've proven these. We have true industry leadership. There is no question that we are the leading brand operating at unmatched scale. The breadth and depth of our digital and professional assets are truly unmatched. It's a complex ecosystem, and we deliver a seamless experience. Our data-driven approach to care delivery, and it really fuels our stepped care model. That stepped care model that takes advantage of digital assets and human capabilities and professional intervention in a way that you just saw brought to life with Jameson's story. Our integrated strategy and suite of solutions really delivers on the promise of whole-person virtual care. And we'll spend a lot more time diving into what we mean by that over the course of the day. Our distribution channels are diverse. We're a leader in every one of our distribution channels ranging from direct-to-consumer to B2B and all of the parts of the health care system, we believe that's a true competitive advantage. And lastly, as we've proven over the last 6 years as a public company, we have a strong financial model with high visibility, high recurring revenue, and that has enabled us to meet or exceed our guidance on revenue, 25 out of 26 quarters as a public company. So the video we shared a minute ago really helps to ground us in our mission, right? We're a very mission-driven team. If you talk to any of the members of our leadership team, they will tell you that the reason they're here is because of our mission. And the mission really hasn't changed over the course of our -- I've been here now 12.5 years or something like that which makes me just feel old. But our mission really hasn't changed. It's been pretty similar. And we've always said our goal, our mission for being is to empower all people everywhere to live their healthiest lives by transforming the health care experience. That's a powerful mission. It's big, right? There's no question it's a bold mission. And as we've gone through our iterations as a company and we've evolved through the evolving health care landscape and our set of capabilities, we've expanded the vision to be able to achieve that mission, right? And today, we are absolutely, without a doubt, the global leader in whole person virtual care. We rely on technology to connect and human expertise as well as machine learning to be able to provide a brand and an experience that consumers trust and that improves the health of all of the people who have access to our services. So how does that manifest itself? Well, there are data points that I can point to, and these start to articulate the scale at which we operate. The size and scale, you'll hear a lot about, but that's only part of the story. And I think the data points here like we will deliver or enable 18 million virtual visits this year. That really lends itself to significant scale and almost a ubiquitous presence. I was talking to one of the analysts, I'll spare him the embarrassment who said, "Oh, yes, I was in the hospital with my 7-year-old son, and I saw one of your devices sitting there, right? The ubiquitous presence of Teladoc Health now in the health care system and in every part of the health care ecosystem is really kind of humbling and mind blowing for me, given where we started 12.5 years ago. But I think that's only part of the story, right? The fact that we now sit on a treasure trove of 2 billion data points that we can mine to deliver better care and a better experience starts to bring it to life in terms of the impact that we have on consumers and their health care. And so what I'm really proud about are things like our Net Promoter Scores and the J.D. Power recognition because that's consumers saying that we are the best at what we do. And yet, we always say and our 5,000 people always say, it's still not good enough. There's more that we can do. We're just scratching the surface. So I talked a little bit about the Rumpelstiltskin moment and I unfortunately have to acknowledge that it was real, not a dream. But -- and it would probably be not fair to go through too much of the presentation without acknowledging the impact of COVID on our business and on the role of virtual care in the health care system. So you can see some of the changes in the data and the dynamics in the market laid out here. You've probably also heard me say that really, even in just the first 6 months of the pandemic, the market for virtual care and the role of virtual care accelerated 3 to 5 years. I think we're probably on the upper end of that 20 months into this. But what I can say is not only are people accepting it more and using it more, but equally important, their expectations, both among consumers, among planned sponsors, among providers, the expectation for the role of virtual care and the possibility has also changed along with that. So people are now expecting the same seamless, integrated, holistic experience that they get with all other parts of their lives delivered in a digital fashion. On their terms, bringing the best capabilities of data, digital assets and human expertise, all brought together in a holistic manner to deliver a better experience and better health for them. Well, that acceleration happened really fast. But we've been planning for that, maybe not quite in the step function that it happened, but we've been planning for that for years, right? As you look at this, I joke with my team, they keep asking me to retire this slide and I won't do it. But if you look back to the origin of 2015, and of course, we were here a long time before our IPO, you can see how we've been building out capabilities, market presence, breadth of service, breadth of clinical impact consistently with the goal of delivering whole person health care and delivering on what now is a market expectation. Now I consider ourselves fortunate to have been on this path for many, many years because you can't build this overnight. It's really complicated. And you're going to hear about how complicated it is to deliver on this and all of the assets and capabilities it takes in order to achieve this goal. We've been at it for a long time, and we took some big steps, fairly bold steps, I will admit, over the course of 2020 when everybody was shuttered at home, we saw where we thought the market was shifting and we took some big steps. And we're starting now to see the real benefits of that. All right. So I have a complicated model here that I'm going to try to bring to life in a story. So I've become -- when I took this job 12.5 years ago, I got a lot of condolence e-mails like, I'm sorry, I thought things were going well. If it doesn't work out, let me know. Now I get to talk to a lot of CEOs across the health care industry about virtual care and where it's going. And I got a call from a CEO of a large health system -- a large academic medical center that also owns primary care practices, has a health plan and a very, very impressive tertiary care facility. And the CEO said to me, I figured that the CEO was calling me to say, "hey, we're interested in your hospital solutions, the platform to virtualize care so that we can deliver care virtually to our patients. What ended up happening was a discussion that said, "We want you to bring your whole senior team in to talk to us about how we can stand up virtual primary care and maybe we want you to be our virtual primary care front door to our health system. And we want to talk to you about how we can bring chronic care solutions to our health plan members so that we can better manage risk in our chronically ill patient population. And we're struggling with mental health care capacity. So we'd like you to bring in your digital assets so that we can stand up a stepped care model like you've talked about, such that we can bring digital mental health solutions along with our professional capacity. We're interested in trying to expand the scope and reach of our specialty network and we'd like to be -- we'd like to help you by bringing our incredibly advanced specialists to bear on a virtual basis for your populations, Jason. And oh, by the way, we'd also like to talk about that health system platform that you talk about so that we can virtualize care across our system. So first of all, that conversation would never have happened 21 months ago, right? It just -- nobody was thinking about the vast expansive role of virtual care in the health care system like that, the way that, that conversation shook out. The second thing is nobody else in the market can actually have that conversation, right? And so if you look at the various dimensions of this model, we're delivering on the evolution of our products, our technology, our business model. And on the right side of this, really importantly, we've moved from being a vendor to being a strategic partner whether you're talking about a hospital system, a health plan, a large employer, domestically, internationally, and that puts us alone in the market, right? What everyone else is stuck here in the lower left with relatively narrow point solutions, trying to solve a single problem. While based on that previous slide, we've spent the last several years, let's call it 6 or so moving up in to the right, right? And doing it right, much less moving it up and to the right is really hard, right? It takes an incredibly deep set of leading capabilities to be able to do that. It's not a foregone conclusion. So if you're starting now to try to build that, no matter how much funding you get as an early start-up company, it's really, really hard to do that and move all the way up that curve because, look, a small company has to be super focused and focus on one thing at a time. And so our approach has been setting us up for a whole person virtual care for years. So let's dig deeper into what we mean by whole person virtual care. Our north star is that someone comes to us regardless of what their health care need is and we provide for them a front door that understands that there's a connection between all the dimensions of their health care, right? So you have a lot of different individual needs here on this slide. But they're actually all connected, right? Someone's blood pressure and their weight and their mental state are all deeply intertwined. And treating only one of those is insufficient at best and really could be detrimental at worst. So we believe deeply that treating the whole person from their mental health care to their physical health care from their acute episodic needs to their chronic needs and being there for their complex needs and also integrating with the physical delivery system where necessary is the full credit answer. And anything short of that actually doesn't enable you to get up in to the right of that sort of strategic box. Now it means that we have to rely on data science, and we have to rely on a stepped care model to do that at scale, right? And we talked about some of the scale that we've achieved, but we have much greater ambitions. And so in order to do that efficiently, you have to rely deeply on technology to do that. And so over the next couple of hours, you're going to hear from a bunch of my colleagues. You're going to hear about how we make whole person care a reality. And for a consumer there are multiple on-ramps onto -- into that system, right? That whole person virtual care system. So these are meant to illustrate that there are different on-ramps that someone could take because they're presenting with a different first initial need. What we find is that people who visit us first for a mental health care need are much more likely to have a general medical visit because they've already established trust and a relationship and a digital interface and we're helping them on one dimension, so they want to turn to us for a different dimension. And we can connect the dots, right? So that the physician who's treating them for a physical illness knows that they may be suffering from anxiety or depression or they're going through grief counseling and that could have something to do with exacerbating their physical illness. So what you see here is a number of on-ramps into whole person virtual care. So you're going to hear from some of my colleagues; Donna for example, is going to talk about the digital front door or the homepage of how you get into whole person care and what the consumer experience is? So our job and Donna's job in particular, but also our whole clinical team who delivers the care is to make it seamless and easy and intuitive, right? That's what whole person virtual care has to be. It has to be easy to walk through that front door and then be navigated to the right solution. Well, Claus gets the enviable task of explaining all the stuff that has to happen behind the scenes in order to bring that to life because it's hard to make health care seamless and easy and intuitive. Every point along this continuum has to be a leading capability, a core capability in order to deliver a seamless consumer experience and really deliver best-in-class whole-person care. And so you'll hear about various parts of this. People ask me all the time, and they've asked me since I got to the company and was raising my first round of venture capital, what's your secret sauce, right? What's your moat? And I've said, look, there are low barriers to entry and high barriers to scale and success. And it is a complex system of leading capabilities that creates a true moat in what we do. And so every one of these points has to be a leading capability in order to really take advantage of the opportunity in front of us. And I believe very strongly that our capabilities on every one of these dimensions leads the market. And that results in what I would argue is an unmatched competitive advantage, and a moat that is virtually impossible for an upstart to cross, right, and sets us up for the future of virtual care, not the past of virtual care. And for a broad set of whole-person care solutions, not a point solution. So if our competitive advantage sets us up for a leading place in the marketplace, then how do we build the blocks to give a growth outlook, right? to give the building blocks for where the growth is going to come from. So I want to transition from what has been, I would say, a strategic overview to more of a view into, okay, where is the growth going to come from? And how are we going to deliver on it? And you're going to hear from some of our colleagues Kelly, Alon, Dan, about the products, the go-to-market strategies and our approach to how we get there. And then you're going to hear from Stephany talk about how we engage consumers to build long-lasting relationships. All right. So let's start with the overall market. My favorite subject, the TAM. Okay. So I would start by saying, look, we are just scratching the surface, right? At $2 billion of revenue, I'm proud of what we've achieved, and we are just scratching the surface. McKinsey says that today, virtual care represents about $5.5 billion of revenue. That is constrained only by what has been done so far, right? I think the opportunity there is to massively expand that $5.5 billion, and we expect to get more than our fair share of that expansion. Why is that? Well, we've talked about our $121 billion that we talked about at the Livongo transaction close relative to the TAM, as we expand into virtual primary care, that gets significantly larger. And so we are a tiny fraction of the $260-plus billion opportunity in front of us, and we think we're best positioned to be able to capture that. And we have multiple levers for growth. One of the things I've always loved about our business is that we have multiple levers for growth. There are a lot of different ways that we can get to hitting our numbers. And we take keeping our promises really seriously. You've heard me say it before. It is one of our key seven values is keeping our promises. And we get to focus on a lot of those different levers. So at the highest level, we can add new members, and we can increase our revenue per member. We can add new members through new clients as well as by increasing the population within our existing clients who have access to our services because especially when you talk about health plans, you talk about various parts -- certain market segments have it and certain market segments don't. Certain geographies have purchased those services, others haven't. So there's significant opportunity at that. And then on the increased revenue per member, we have the opportunity for more product penetration. So our land and expand strategy is sort of the two of those, right? More covered lives once we get our foot in the door and more products into the client once we're there with a single or two or three products. And then, of course, we have the opportunity for greater engagement, more visits, more longitudinal relationships, more people enrolling in our chronic care programs. So let's start with the membership part. You've heard us talk about the 76 million people that have access to our platform. That's the U.S. paid membership and the visit fee-only population. What you haven't heard us talk as much about is the 16 million people who have access to our chronic care programs, right? Those are clients who have bought in for a population to our products and services we have the opportunity to do what I described in terms of upselling the population with other products. So we would say the full entirety of the sort of people who have access to our products and services is about 92 million people. Well, there's another 63 million people who are members of the population, if you will, who are of clients who have bought our products and services. So without adding another new logo, we could expand by another 63 million members. And then there are about 140 million people who are outside of the clients who we have sold, right? Now that was break down into commercial lives, and/or managed Medicaid or Medicare Advantage lives and then the 51 million people who are in fee-for-service populations. So you can see that the opportunity for us to continue to expand our membership is significant, and we will continue to grow along the membership continuum where we'll get more growth from a financial perspective, at least for the next several years is out of per member per month or revenue per member, okay? So buckle in, there's a lot on this slide. I'm going to take the time to walk through it because I think it's really important. What we've done here is broken down our product portfolio, looking at the entirety of the 92 million people who have access to at least one of our products and looked at the opportunity for each one of those sort of lines of products. So what does that really mean? Well, for CCM, chronic care, we've looked at prevalence data. So what's the real opportunity within the 92 million for us to penetrate that population with our chronic care? What can we capture in terms of total membership with our chronic care solutions based on prevalence data? So that ends up being about 47 million people. Primary360, for example, we've tried to exclude the population who has strong primary care relationships saying look, we may get some of those people, but let's not put that in the sort of primary market who is likely to opt in for our services for Primary360. Then at the bottom here, we've tried to give you a range of revenue per member about what that could contribute to our overall revenue. And then at the very bottom of the slide, we've laid out, well, what does that mean in the aggregate on a revenue per member basis and then on a total revenue basis. So what you see is a sort of upper range of $68 to $123 of revenue per member spread across our entire 92 million people which translates to somewhere between $75 billion and $137 billion without adding another new member. So we've gotten a lot of questions because Mala and I have been speaking a lot over the course of the last year about the expansion of our revenue per member. Mala is going to translate that to, well, what kind of contribution do we get for every chunk of additional population we add on each one of these products. And the question we've frequently gotten is, well, how big could it be, right? What is the opportunity? And so hopefully, we've laid out at least a framework for how to think about this. And that translates to, like I said, multiple levers for long-term growth. So while we think about whole-person virtual care, we understand that you need to get a little bit more granular in order to be able to model that. And so what are the components of growth? We've broken it down into virtual medical care, which includes some of our enabling technologies that enable the delivery of care for hospitals and health systems as well as Primary360, our general medical, dermatology, nutrition, like all of those things bundled in. Our mental health care, both on the B2B and direct-to-consumer side put together because we think of mental health care sort of horizontally, if you will. And then our chronic care solutions and we've given you a range of a growth outlook for the next 3 years. Now some of those, we think, will be kind of stable-ish growth over time. With the introduction of Primary360, for example, I think that's going to be an accelerating growth in our virtual medical care over the next several years as that takes hold and has a bigger contribution. But all of that translates to our outlook for the next 3 years of a 25% to 30% CAGR over the next 3 years. And if you translate that from what we've said is an outlook of about $2.6 billion in revenue next year, that yields a 2024 revenue target of over $4 billion of revenue. So over the course of the day, what I hope to convey and I hope our team will convey is that we have the opportunity to transform how consumers experience health care and that brings along with it a significant financial opportunity. We have the vision to fully address this opportunity like no one else in the market. We have the whole person strategy to bring the vision to life, and we have the core capabilities to deliver on that strategy. Each of our leaders today will work to prove these elements. And what I'd like to say and challenge you is if we fail to really prove the points on any of these dimensions, please challenge us, right? We have two Q&A sessions, and we want to hear if we're falling short because we want to be able to address any gaps that are left sort of unproven, and we want you to walk away with the same level of confidence that we have about our growth outlook. So to get us started on the rest of the day, since I know you want to hear more from the rest of the team than you do for me. I'm happy to introduce Kelly Bliss, our President of U.S. Group Health, who's going to walk you through some of our commercial opportunities and how we deliver on some of those growth opportunities. Kelly?

All right. Thank you so much. Good morning, everyone. As Jason had said, my name is Kelly Bliss. I'm the President of our U.S. Group Health business. I'm going to be speaking today around about our commercial strategy. We'll talk about what's happening in the marketplace, and we're actually going to hear from some of our clients. Let me just start by reorienting everyone around our commercial construct. As most of you know, today, in the U.S., we primarily sell into health plans, the government, employers of all sizes and into health systems. Globally, our clients and partners span U.S. employers with a multinational footprint, global insurers, financial services firms and governments of countries with nationalized health care systems. We have the leading DTC mental health solution in the country which you'll hear from BetterHelp, you'll hear from Alon later on. And we've scaled this distribution and our client relationships to deliver product -- our product portfolio across these channels. And today, as Jason had mentioned, we cover over 30% of the insured U.S. population, and we have a footprint of about 130 countries globally. Not only do we believe this omnichannel distribution strategy positions us to win, but our depth of knowledge in an industry that we created, combined with our product and our operational sophistication creates a competitive distance that's really hard to close. Most importantly, we have multiple levers to capture this growth. Our mix of markets, channels, solutions equip us to capture share across the global health ecosystem, creating diversified revenue streams. Now let's talk a little bit about what's happening in virtual health today. As Jason spoke to, virtual care today, formerly known as telehealth, had origins in adjacent or supplementary or ancillary benefits programs. Largely progressive employers and plans would augment and layer in additional conveniences and savings for their populations. Times have really changed. As consumer expectations on the experience increase, our clients are seeing the need to think really differently about virtual care, and they're demanding broader, more seamless, more coordinated virtual care solutions powered by data, and our expertise, and they want scale, scale on a national and a global scale, which, of course, we've been building for many, many years now. Virtual care is not only here to stay, but unlike the days of maybe narrow use cases, virtual care is spanning an array of services from primary care to chronic to mental health and many others. Our 2021 client survey revealed that the majority of clients believe that virtual care will have a significant impact on care delivery in the future. What's most important is 99% of our clients are interested in maintaining or increasing their levels of investment in virtual care. And I'm still working on that 1%. We're also pleased to learn that 80% of our clients see us as a strategic partner. And with only 20% of those saying that their virtual care strategy is well established, we see tremendous opportunity to help shape our clients' offerings. Our health system clients revealed that their emergency need to stand up solutions like Zoom during the peak of COVID-19, is not scalable and is severely gapped as it relates to their integrated provider tools and workflows. So they're increasingly coming to us looking for our enterprise-grade health care platform to enable the delivery of their virtual care strategies. The net-net, virtual care is permanent, and it's growing. As I mentioned previously, only 20% of our clients believe that they have a well-defined virtual care strategy. Yet almost all of them believe that their investments in these capabilities need to remain or increase over time. That matters, yes, because, of course, they -- our clients appreciate our years of experience, our thinking and building and executing and they feel that, that does differentiate us. But more than a tailwind, our clients appreciate the fact that during what we might call a telehealth final exam, a pandemic where the majority of care was most appropriately delivered virtually, we not only showed up, but we delivered and we shined. Our clients expect us and asked us to come to the table and co-author their strategies for the future. As we enter 2021, we focused many of our commercial resources on engaging our clients in their effort to inventory, benchmark and plan for the future. Clients and nonclients alike have reached out to us, asked us as the industry expert what's next in virtual care. These forward-looking conversations continue today and have inspired our clients to capture the consumer and market momentum and to think bigger about what virtual care is to them. To do this at scale, we're rolling out a peer-reviewed virtual care maturity model to engage our C-suite relationships and thinking about how to take health care one of their largest financial spends and make it more accessible, more scalable, equitable and efficient in the future. This process has been quite swift. We have had clients across all of our unique markets at various stages within this maturity model, trying to advance to the next stage quickly. Most clients, 80% have self-identified at Stage 2 or below, not having a well-defined virtual care strategy but a desire to build one. Some of our clients are moving towards Stage 3 in early stages of developing a comprehensive virtual health care strategy, that is aligned with quality and cost outcomes. A few, largely, the health plans and integrated health systems are at Stage 4. They're starting to think virtual as the entry point of the delivery mechanism for many types of health care needs while also serving as the seamless connector to hybrid care. Building the engine and the platform for Stage 5 is where our R&D team is currently focused, which Claus will speak a lot to more later. This is really our north star Vision of the health care delivery model. In Stage 5, health care interactions are personalized, pricing models are value aligned to drive outcomes. Experiences are tailored and optimized for virtual first in the same way that e-commerce is today or fintech. While many of our competitors can deliver against Stage 1 and Stage 2, perhaps even Stage 3, nobody else has the infrastructure, the commercial scale and the proven track record to get to 4 and 5. And this omnichannel strategy and meeting clients where they are, understanding their level of maturity and helping them move forward and realize their virtual care goals is working. With over 2,200 related transactions this year, from bringing new clients on, to new product penetration, to new lines of business or adding new populations, our clients really value the scale and expertise and depth of innovation that we lead in this market. Said differently, the breadth and depth of category leadership across the digital health ecosystem uniquely positions Teladoc Health to meet our clients where they are in that journey while building and leading them to a new version of virtual care. So what are our clients saying? Most of the conversations that I have with CEOs and industry leaders of Fortune 500 employers, large health plans and health systems fall into 1 of 3 categories. First, clients migrating from point solutions towards more strategic partnerships who can serve their entire basket of virtual care needs. HCSC is a great example of an account where we've been serving them for many, many years. And early results of that partnership opened up many new commercial opportunities for growth on several dimensions. And this is a model we see repeating itself within our health plan book of business. You may have just seen that we just announced a virtual first health plan with Ambetter, Centene's marketplace business. These are clients that really want to think more broadly about their own investments in virtual care and what outcomes that can yield. Second, when the merger with Livongo was announced last summer, we spoke about our cross-sell opportunity, which have limited overlap. And just one year later, our cross-sell thesis is proving itself on multiple dimensions. Tyson Foods and Blue Shield North Carolina are just 2 examples of clients who quickly adopted the new integrated virtual care vision. I'm excited about the market leadership we're displaying around developing new clinical use cases. As health systems start to take on risk for new populations, they're looking for proven digital products that they can use to enable their physicians to keep track of those patients when they're not co-located, 99% of the time. Baptist, Jacksonville, a leading health facility system in Florida is using our CCM tools as a remote patient monitoring solution. We've also just launched chronic and mental care health products internationally, and we continue to do that over the course of the next 2022. Finally, we're expanding the frontier of what virtual care delivery can look like via market-defining partnerships with technology and consumer brands globally. Our partnership with Microsoft enables providers to integrate solo plus teams to deliver care to their members. And in association with Telefonica and Vivo, we're providing virtual care directly to the consumers in several markets such as Brazil and Spain. I want to double-click and illustrate what I mentioned earlier about having multiple levers of growth within a single account. You heard Jason mention this as well. Shown here is a health plan that we've had a relationship with since 2017. There are 3 main dimensions of opportunities for us to achieve deeper penetration with this plan. First, we can add lines of business. And in this example, we started with their commercial ASO lines of business. And once we demonstrated positive client and member NPS and proven outcomes, we've been able to expand to their commercial fully insured business and their Medicare Advantage business. Second, we can see additional products within each lines of business. For example, here, we started with our Gen Med and Expert Medical Opinion products, and then we grew into mental health. We began offering the chronic condition management services via our diabetes management product. And finally, we've just launched P360 with them. These offerings enable -- are available in their consumer -- commercial ASO business, and we intend on that same trajectory to be -- penetrate the rest of the lines of business. Third, enrollment and engagement mechanisms leveraging our market-leading data science assets. This is enabling us to perform personalized and targeted outreach to enable the consumers to best-in-class utilization, which is contributing greater revenue per member. So let's flip this view on its head a bit and look at one of our new products; Primary360, affectionately known as P360. Dan is going to talk a lot more about all of our products today, and actually Donna is going to dive into an actual demo of P360. But I thought it was important that I would illustrate exactly how Primary360 models have been deployed in their respective markets. Health plan carriers want P360 available to their self-funded employers to further their distribution and differentiation. In fully insured populations, P360 is about furthering access and enabling seamless handoffs to health plans contracted provider networks when required. And, of course, in fully insured to manage costs. For benefits consultants, our partnership is to enable innovation and differentiation within a very noisy employer purchasing market. And for our employer clients, virtual first primary care is about access, convenience and staying competitive and innovative with benefit offerings to retain their employees and lower their cost of their health care spend. What's interesting is different clients want to sign up for P360 in different ways. On one hand, some clients want a contract based on a PMPM across their entire book of business, their entire population regardless of how many people enroll in the program. So for example, in a population of 100,000, we would be paid on the full 100,000. But that pricing, of course, would be reflective of an expected utilization rate in P360. On the other hand, some clients want to contract on a per participant basis. So we get paid on a PPPM a per member per month basis, based on the number of individuals who elect to participate in P360. For example, our virtual-first plan design. The point is, regardless of the model, today, the economics are very similar. You're going to hear a lot over the course of the day about how we believe that rather than point solutions caring for the totality of the needs of the consumer via integrated whole-person products is the wave of the future. And nothing demonstrates this better than taking a look at an employer client, a top 20 national retailer, whom we have sold all of our products over the course of 3 years. We've launched the partnership with them in 2019 via the Livongo's Diabetes solution. They very quickly saw the employee adoption rates were exceptional and demonstrated ROI, which led them to add on hypertension and diabetes prevention products. Post merger, they were one of the first buyers of the entire telehealth suite, and we're thrilled to be taking them live on Primary360 effective 1/1. We're covering over 46,000 consumers with this one client, and we look forward to continued growth with them. What's important about the adoption of our products is that as our clients start to realize the value of whole-person care, we realize an efficiency in revenue growth. For similar level of sales motion in a same-size population given the prevalence of comorbid conditions across physical, chronic and mental health, and higher price points for product packaging, we're able to realize 4x as much revenue. Notably, 40% of our pipeline is multiproduct, and we expect that to grow. In addition to consumer and product capabilities, many C-suite executives increasing -- are increasingly interested in value aligned pricing in virtual care. As Jason had mentioned, we have a track record of skating to where the puck is, and this is no different. We've built a critical set of foundational capabilities to deliver scale on pricing models that align fees to outcomes that we realize for our members and for our clients. First, we have the largest breadth of integrated whole-person products and services in the virtual care industry and that we can align value to outcome. Second, our diversified portfolio across 12,000-plus clients, combined with our strong financial foundation, uniquely positions us to enter into outcome-focused contracts responsibly. Third, our clients are turning to us because of our track record of demonstrated results. It's table stakes in the health plan that you have to prove you can drive outcomes and lower cost and improve NPS. Finally, having the greatest depth of clinical outcomes plus financial claims data plus our deep data science analytics capabilities equals knowledge where our programs could be more effective. This allows us to focus on where we can have the biggest impact on any given population. All our capabilities and results at scale have positioned us to expand both market share and share of wallet as this market continues to shift towards value-based care. Historically, we go to market 2 ways: both traditional fee-for-service and pay for performance. Today, we're also beginning to enter into partial capitation models in key markets for diabetes management and virtual primary care. We're able to do this because of our strong results in diabetes management, and we're leading the market evolution towards virtual primary care. As we demonstrate success in partial capitation and expand our suite of solutions across the care continuum, we're building capabilities to contract for full capitated and virtual primary care, chronic services and mental health. Moving along this value-based care continuum enables us to unlock new channels, specifically commercial, fully insured Medicaid and Medicare Advantage. We'll be additionally able to grow membership numbers and drive more whole-person solution in these markets, which is allowing us to increase revenue per member. But enough for me, I'd like you to hear from a few of our clients and understand how they perceive the shift in the market and they perceive Teladoc. [Presentation]

So let me just wrap by saying I want to really drive home why we win. You just heard from our clients. The executives you saw on the screen are not just purchasers of -- for their populations, but they're also members too. So our commercial success and the commercial success that we have seen is because of our organizational competencies working in concert to support the needs of both our clients and our members. Before I hand the mic over to Dan to get specific about products, let me wrap by saying we're really living in this historic maturation of the global virtual health market spurred on by the pandemic, and it's remarkable to be a part of it. It's even more remarkable to be shaping it. Our mission has always been to improve access to high-quality care and help people live their healthiest lives. We ensure that happens by executing against a well-defined plan that includes the things that you see listed here. Our ability to perform in value-based contract arrangements, our scale, our diversification of solutions, our broad omnichannel levers are all important to our clients and, of course, to our growth, which is just one way that we're really trying to drive change in virtual care. So with that, I'm going to hand it off to Dan. Here you go.

Thank you, Kelly. So I'm Dan Trencher. I lead strategy for Teladoc. And I'm going to dig much more deeply into our whole-person strategy. Before I do, let me make 2 observations. So first, my next few sections are sort of divided up, but don't think of virtual medical care and mental health care and chronic care as three separate things or three separate strategies or even product families. Think of them as complementary components of our whole-person strategy that all fit together, and I'll illustrate that as I go along. Second observation is that within the virtual medical care bucket, there's a wide range of services and experiences represented there. So general medical, dermatology, our virtual primary care offering, which I'll spend a lot more time on, expert medical services, even the platforms and products and services we sell into our hospital and health systems. Just examples. Today, I'm going to focus more on P360 because it's new and because we see a great deal of opportunity into the future in growth there. Just don't forget the other pieces are there, and you'll see how they come through in the story. So to focus first on the primary care market. I could have many, many slides that go through all the different ways that the current primary care market isn't performing for consumers and providers. You might call it broken; let's say, diplomatically, it's underperforming. The end result of that is that consumers are not engaging with primary care as they once did. 1 out of 4 adults do not have a PCP and 4 out of 5 adults say they don't have a strong relationship with a PCP. And that creates challenges. And in the end, it translates into an inefficient system. So the stat there on the bottom estimates a 20% to 25% savings if everyone had a strong primary care relationship. And so this is the problem we're trying to solve. Numerically, we started, as we've talked about the TAM, with the total primary care spending in the U.S. at about $250 billion. We then discounted that by two factors. So one is what percentage of that care could be virtualized. And the second factor is taking off those people who, as Jason said, already have strong primary care relationship that we're not trying to replace that. I mean so if you reduce that down, that gets you to the $160 billion, which is in the middle. We also want to recognize to be conservative that we have had, as part of our TAM, our general medical services. We had estimated that at $20 billion. And so to be fair, we want to make sure we don't double count so we net that out. And so that gets you to the $140 billion that Jason talked about on his slide. So let's get into the product a little bit more itself. And as we got started in this area, Jason threw down the gauntlet that the goal here is not to take -- add virtual visits to the existing primary care experience, but to fully reimagine it. So that's what the team has been focused on doing. And the heart of it is the integrated data that we have and the data science we apply to it to -- in order to create a different experience and different outcomes. So data points from the programs themselves, from the devices, from claims, from information from health plans, from information from community providers as we bring that back in. That's all powerful, and you'll see how it comes through as we walk through the entire experience here. It does start. I'll start on the bottom left of the slide, having a unified whole-person experience. So that's having not just one product behind the virtual front door, but our full range of products and experiences that cover the full clinical gamut, brings people in the first time and coming back for more as they go through. And this is also a great example of how we're applying data. So we bring into that front page and Donna is going to show it, we call next best actions. So those are recommendations that are generated from all the different data and analysis that we're doing behind the scenes to prompt for a consumer what programs might be beneficial them, reminders about taking their meds or other sorts of things like that. Lots of very personalized in-the-moment recommendations that can help the consumer take full experience -- advantage of the experience. Second, a dedicated care team. So certainly, every consumer who joins and uses our virtual primary care offering P360 will have an assigned or excuse me, a chosen but ongoing primary care physician that they'll work with. They will also have a care team. So it's not just the physician, of nurses and other types of clinicians to support that relationship. But importantly, it's powered by technology, which makes all of those relationships more efficient, and it really amplifies what those humans can do in taking care of that patient. So we've talked before about sort of a one-to-many model, and here's where we can increase the efficiency of primary care through the use of technology. One of the key, let's call it, outputs of that team working with the patient, is a longitudinal care plan. So this is not an episodic experience. This is very much a longitudinal experience and it's personalized for each individual and it helps provide a guide as to how they can help themselves. They keep track of results. And certainly, the care team has access to that so they can work on it together. That leads to the continuous guidance and support. And this is a component that consumers are really latching on to having 24/7 access to their care team through messaging and other means, really keeps them engaged. The next is around navigation and coordination. We know that there will be occasions certainly where a consumer could benefit from one of our other products that there might be a referral or coordination into that. And sometimes, they're going to need to have a service in the community, maybe for a specialty consult or other sorts of therapies, for instance. And so we're making personalized, high-quality referrals to those community physicians using importantly, health plan data because we know we want those referrals to be in network. We want to take advantage of COEs or tier networks or other sorts of components of health plans design and network strategy. So we make the most efficient use for that consumer of that access. The last piece there is last mile. So we got a slide on that specifically to click down. So when we talk about last mile, we know we virtualized a very large part of the health care journey. But there are still parts at the end that you can't quite virtualize right? So when you get to needing a lab when you talk about a prescription. Unfortunately, I know people still -- you can have a great virtual experience and then you still have to go to the pharmacy to pick up your drug or you still need to go to a PHC center to get your lab draw taken. So that's what we want to change and to make it as convenient as possible and cost effective for that consumer. So this just lists out some of the examples of the last mile services. And we certainly see the home as the next frontier for where care is going to take place as much as possible. So it's about bringing as much of that as close to the consumer as possible. Sometimes that will be a human, like phlebotomist, who might come to the home. Sometimes that will be mail based, so you can think of lab kits that could get sent in the mail to the consumer, they get the sample, it goes off to the lab and the results come back in. There'll be multiple different modalities, but the real focus is on making it as convenient as possible. And certainly, this is an area we're going to build out through partnerships and through having a flexible platform so that we'll be able to work with multiple different partners, different devices for vitals to both be flexible for the consumer and for our clients who want to have customized solutions. We've talked and used the term on-ramp, I think, a couple of times today. So this provides some data behind what we mean. So if you take a population of consumers who might engage with primary care, we looked and you can see 80% of them based on claims could benefit from one of the services that we currently offer, right? So almost 60% for general medical, 24% for nutrition, 30% for dermatology. And so as you go through that, you can see the power of this model. And you can also see it in a Primary360 environment where we do have a long-term relationship with that patient. It's perfectly set up for making these sorts of referrals which, of course, translates into what we would call multiproduct utilization financially, but really impactful for the consumer as well. So I was also here 20 months ago through that, that looking glass moment looking back. And I was actually talking a little bit, we were just about starting our virtual primary care pilots. So here to talk a little bit about some of the results, and we're very pleased with how they've turned out. So one of the value process is around access. So we've seen that we've been able to connect a patient -- let's call it, new patient with a PCP in under a week. And if you look at the data, it's 30 days or more in most communities around the country. We have succeeded in pulling through and having consumers engage, more than half of engage with another service. We're also finding an uncovering, let's call it, new diagnoses. So we're not just picking up that the patient already knew about and already in the records or almost 25% or around 25% of diabetes and hypertension diagnoses were new. So you can think of the power of catching those and the downstream care that we're going to be able to provide. And of course, it comes down to consumer satisfaction as well. That's what's going to keep people coming back and utilizing the service, and we're over 95%. So we're super excited about the results so far. Jason talked a little bit about the competition. I won't focus on it here too much other than to say, let's call it, virtual primary care as an industry is a fairly immature, right? So it's new. And so there are a lot of different types of companies calling what they do virtual primary care. There are lightweight text-based offerings. There are the traditional telemedicine pure-play players who are really focused on virtual visits. There are hybrid players that are really anchored around physical clinics and adding some virtual to that. I won't go into all the details on how we line up. But where I'd focus you is none of these players and models have the clinical depth, the clinical breadth and the ability to scale, all powered by data and data science that we do. And we think that those are the capabilities that are really going to drive success in the market. And we also think that this gives us the ability or the opportunity to define what virtual primary care is in the market, and I think we're well on our way to doing that with the commercial success that we've had. So I'm going to switch gears a little bit and now talk about mental health. And I couldn't do that without recognizing this is an area that has probably been more impacted than anything else in health care and more impact than any with any other part of virtual care as well by COVID, right? So clearly, adoption of virtual within this space has taken off dramatically from a consumer and a provider perspective. And we've seen an increase in need, right? More people need help because of stress and because of shelter in place and all the other factors that we know about. None of this data reflects that, right? So this is all pre-pandemic data, let's call it. So we see the opportunity is only bigger than what's reflected here. Starting on the left, in our previous TAM calculations, let's call it, we had estimated about a $15 billion TAM for mental health services. And think of that as really a replacement, right, taking existing outpatient mental health visits and virtualizing a share of them. Unfortunately, the dynamic in the U.S. and around the world really is that more than half of people who have a mental health need aren't actually accessing care 55%. And so yes, that sort of creates a bigger market, but it also creates a bigger challenge for engaging those consumers to get the help they need. And this is actually an area Alon when he talks about our BetterHelp model will show some statistics around, how we're actually engaging a lot of people who almost half of his members or our members that haven't sought mental health care before. So it really is a powerful combination, our mental health services. In the middle there, solving mental health problems obviously has a huge impact on consumers, and it's a good thing. It also has an impact beyond mental health because mental health is so often tied in, let's call it, comorbid with chronic conditions, such as diabetes and hypertension and others. And there's a real amplifying effect when the mental health condition isn't managed well to the total cost of that consumer to that patient in that episode. So really important to have all those things together and manage well together. And then, of course, it's not all just direct medical costs, this is a space where productivity and disability are really a huge factor, and employers get this and why there's been such an interest in mental health solutions accelerating in the last 18-20 months. So let's talk about our model. Our flagship offering in mental health is what we call, myStrength Complete. And it's built upon two basic pillars, right? So the first is having intelligent personalization that allows us to assess the patient, assess the consumer and direct them up to the optimal way to access care or the type of care, and that includes purely digital that can include coaching, that includes therapy in psychiatry and we'll get more into that model and really using data to help do that. The second part of it is having that full spectrum solution, right? So it is having the purely digital, the coaching and all the other elements I just described and having breadth in terms of the clinical specialties, so for a wide range of different types of mental health needs and that translates into different types of content and different types of providers in the network. So the combination of those makes a really powerful mental health service. But then the topper and what's really important is that it's connected to the rest of our whole-person system around chronic care and around virtual medical care. And that's what really drives result as consumers prefer single unified experience for their mental and physical health. And so that's what [ coverage want ] and that's what they're reacting positively to is bringing it all together there. This dives a little more deeply into that myStrength model, and we've used the term stepped care a couple of times. So I want to clarify for folks. That doesn't mean you have to start at the bottom and like walk your way up as a patient. Part of what I was trying to describe in sort of the beauty of the model is as a consumer comes in and maybe they were referred in from another program, maybe they fed through because of our marketing or various different ways they could wind up at that front door. They then can take an assessment that helps figure out and help understand what's going on and then can guide them to the right component of this -- the stack here that meets their needs. And it can be fluid, right? So they might start with engaging in digital content, sort of purely digital content and self-managing. But often, that might be used actually in between therapy visits as an example. So it could be complementary. And then a coach is always checking in on them and seeing how they're going throughout the course of their treatment or their engagement with us. And if something goes wrong and there's a crisis of the moment, we can actually take care of that as well and connect them with resources that can help them in the moment. And that all delivers a very wide range, as you can see in the right of different types of client value, which is really important in mental health. So let me bridge then to the last topic that I'll talk about around chronic care. So similar to the story I was just telling around mental health, chronic care also the different conditions don't happen in isolation, right? So many people who have diabetes also have hypertension, and it translates into, again, this amplification of costs and, therefore, potential impact if you can treat all of -- and handle all these different conditions at once. Unfortunately, as you can see the stats on the bottom, 60% of Americans have a least 1 chronic condition, but 40% have more than 1, right? And so that's what we're really talking about here and really being able to impact those costs because that's where the [ big basket ] in the system are. How do we do that? One of the things I think is really interesting is that we've sort of migrated ourselves in the market away from thinking about individual conditions as I was talking about, like helping somebody who has diabetes with just their diabetes. But also then moving towards helping them with their hypes on the left, their hypertension, their dyslipidemia, so think of that as around cholesterol and other lipid challenges, weight management, mental health. And so we're selling these chronic condition solutions like a diabetes solution or prediabetes solution that contain all of these different services that each individual consumer can -- will use which ones make sense for them and which ones will provide value. But it's really tailored around, again, whole person, right, treating the whole person, not just the condition. And of course, financially, this does translate similar to what Kelly showed in one of her examples into higher revenue per member, you can think about order of magnitude compared to just a diabetes solution -- excuse me, just diabetes-only product going to a diabetes solution might be 25%, 50% higher sort of revenue that we can generate. So obviously, impact there as well. I'd be remiss if I didn't sort of point out, we do -- we think what powers all this, of course, why we win is that we've got a differentiated offering that is driven by the very easy and sort of seamless way consumers can interact with the product in terms of gathering -- collecting the data through the device or enrolling right out of the box. How we utilize that data to generate personalized health signals that can ultimately drive behavior change, which is really the key in many [ crime ] and condition management situations. And then that it is human-centered, right? So it's not just digital. And it's not just coaching. It really is the combination of those. And as I'll talk about in the next page, bringing in sort of medical physician services as well. And then finally, it's all anchored on a long history of proven outcomes and ROI, right? We have years and years studies and studies that show that it works. And it's the combination of all these things, but particularly that last part that allows us to talk about and turning into value-based arrangements with our clients and having confidence that they'll turn out positively. So we've talked about before the stepped care models that applied to mental health. So here, we're -- what we're saying is we're now bringing that into that same sort of model into the Chronic Care Space. What we're calling chronic care complete. And in lieu of walking through each individual piece, I'll just provide an example because that may be easier to sort of think through. So we would have a patient who maybe has diabetes and so they're engaged with the blood sugar reader, and they've signed up and they're using that and the data is flowing through. And they're periodically engaging with their coach. They're getting nudges and they have developed action plans to help manage their blood sugar and help manage other conditions that they might have. And so then maybe one of those or two of those readings start going way out of whack and actually it was similar to the story in the video, if you heard that earlier, where within a few seconds, the patient got a call from their coach, what's about what's going on. And so that's the acute outreach, right? And so we can handle it in a moment. But then the coach and the patient may talk and realize, we need a higher level of supporting care and maybe there's something else going on. So this is where we could bring in a physician, right, one of our Teladoc physicians who could have an A1c test ordered right? And that test goes to the home, it's mail based, let's say, it goes off to the lab, comes back, the results come back. And then that physician working with that coach and the patient can make an adjustment to their medication perhaps, and that can make all the difference. So it's really the combination of all these different components and bringing together what you may have thought of as old sort of Livongo components, Teladoc components. That isn't really the point at this point. It's bringing all of these different capabilities together in a single experience to create greater impact. So lastly, we're not resting on our laurels. We're continuing to innovate in this space as well. The 3 themes I would use here, 1 is increasing the clinical impact, the depth of our clinical impact, the breadth of what we're doing clinically and then bring solutions into new markets and use cases. So on the depth side, I talked a lot about the chronic care complete model. So that's a great example of it, further expanding our integration with continuous glucose monitoring, being able to order labs, new and different types of devices, the close and record gaps in care, continuous RPM. Those are all examples of how we can get deeper on the conditions that we're serving and covering. And then second column, we touch people every day with heart failure and CKD and MSK and all these other conditions. But what we're here really focusing on is focused programs around these conditions. And so we're pretty excited about the early results of our partnerships and products on the CKD, the kidney disease side and pilots on the heart failure side as well. And those really help us round out our cardiometabolic sort of syndrome series of services. And then, of course, we're looking at new spaces as well. MSK, so musculoskeletal, respiratory and cancer are all areas that we're looking at for getting deeper in some of the other big key drivers of cost and outcomes for our clients. And then on the third column, taking some of the solutions, all the solutions that I've just talked about and bring those into international markets as Kelly talked about, bringing CCM management into the hospital health system market, so that providers can manage their own patients, utilizing our tools and technologies. And even new use cases such as at least new use cases for us and focusing, for instance, on a post acute, right, transitions and care model to help prevent readmissions. And we're just scratching the surface how we can use our assets and capabilities to tackle some of those important use cases. So with that, I'm going to transition in a second, but to wrap up, I hope you've taken from this that while we do have we believe 3 market-leading differentiated series of solutions and strategies around virtual medical care, including primary care, mental health and chronic care. It's all those together that helps us address the large markets, but also make a bigger impact and drive greater ROI for our clients because medical conditions don't occur in isolation. We're taking a very people-focused approach. So with that, we've talked a lot about our experience. You're going to get to see it, which is going to be really great. I'm looking around for Donna over there. So she's going to come up and give you a quick demo. So thank you.

Good morning. I'm Donna Boyer, I'm our Chief Product Officer. And as Dan said, in this next section, I'll be bringing to life the consumer experience. really showcasing the integration and as Jason said, the intertwining of primary care, mental health care and chronic conditions through the eyes of the member. I'm going to be demoing this through a magical AV setup that brings together my phone on the screen and the screen in that screen with a [ skull ] of Bluetooth and WiFi. So give me a moment to make that magic happen. Okay. We're going to get started with our first example of Judy, who is a fictional member, but a very common persona for us. Judy is -- she does not have a primary care regular relationship. It's one of the 80% of people who fall into that category. She has a prior diabetes announced diagnosis, and she has not really been proactively managing her health. She's looking to turn over a new leaf and really start a new relationship getting her diabetes under control. She starts this by jumping into primary care from her digital front door, which allows her to see all of the care options that are available to her. Through her access to primary care, she has an option of 24/7 access for opportunities like allergy shots, sinus infections, flu. But for today, she's really looking to establish that relationship, so she goes ahead and she selects starting with a primary care doctor. Judy can choose from a collection and a selection, a curated list of primary care physicians. She has an opportunity to filter by specialty, by language, by gender. She can see an in-depth portfolio. She goes ahead and decides to select Dr. Meyers. We know, particularly for primary care that this ability to handpick from a curated list to understand who the providers are, give her an opportunity to establish rapport in relationship and comfort even before that first visit. Understanding what to expect really lowers, as we know this from our user research, the anxiety and the trepidation of really jumping particularly for people who have not had established health care into a health care relationship. Before her first visit, she has an opportunity to schedule from a number of dates, times and selections. As Dan mentioned, we have all of our -- on average, our visits are within a week, which is very different than the national average of over 30 days to schedule a first visit with a primary care physician. She goes ahead and schedules that for the next Monday. And prior to her visit, she answers a brief set of questions covering her mental and physical health as well as her lifestyle factors and health goals. We've optimized this first visit assessment to really bring out the most important information for physicians to understand while also acknowledging that members often are concerned about sharing their health information, and they also have a short attention spend. I bring this up because it is a great sample of us not just replicating the clipboard waiting room experience but rather bringing together our collective expertise in consumer technology experience, behavioral science, clinical operations, to reimagine the whole experience starting with that initial intake. In addition to her standard physical health, she also goes through a mental health care assessment. This is really important. Up to 70% of mental health needs are missed by primary care physicians in their first assessment. So we do a combination of both physical care and mental care using adaptive personalization to understand the most relevant information answering and adapting our questions in our surveys based on the answers that people have given in their prior answers. This allows us to get the maximum amount of information to the physicians in the shortest amount of time for the members. After she completes that assessment, her doctor on the other side, Dr. Meyers has an opportunity to review it before they meet. Fast forward those 6 days, and she -- Judy and Dr. Meyers have an opportunity to meet together to discuss Judy's diabetes, her mental health needs that have surfaced and their health care goals. Being able to address all of these concerns in that first visit, really speaks to the heart of what Jason and Dan and Kelly talked to earlier, the intersection of these all in one place and the importance of that in terms of being able to manage outcomes. 33% of people with a chronic condition have an undiagnosed mental health need. Being able to address those all in one place not only helps the mental health aspects, but the intertwining of those addresses the 2 to 3x additional cost in counter care management by not managing those underlying mental health needs. Following up from Judy's visit, receives an integrated personalized care plan in her app. That care plan covers everything from her diabetes management all the way through to mental health in a comprehensive way in one easy place for her to follow through in each of the recommendations. In her case, Dr. Meyers has encouraged her to enroll in our diabetes management program, regularly checking her blood sugar but also going forward with lifestyle coaching and nutritional coaching to help her take control of our diabetes management. Additionally, you'll see that she's ordered her a lab test, an A1C test sent to her home, right? By being able to send this kit directly to her home, it lowers the barrier for Judy to actually complete and return the test. Another really crucial factor is making sure that she schedules her annual eye exam. Through this, we are making sure that we're covering the gaps in care related to the programs in her referred physical health that she has put off over not having a primary care relationship for years. Last but certainly not least, a seamless integration into our mental health programs. This ability to incorporate this into an integrated care plan is really crucial. Less than 10% of referrals for primary care physicians to mental health actually get followed through because of that -- the disparate nature of these. By integrating these, we're just scratching the surface, just getting started, and we're already seeing a 2x improvement in those referral rates -- in those completion rates. In Judy's app when she goes to her care plan, she starts on her recommendation first to get an eye visit. For these eye visits, we're working with, as Jason mentioned earlier, integrating seamlessly with physical delivery. We take her health plans network data, generate a curated list of options on the best-rated network-preferred ophthalmologists within -- close to her home, within 30 minutes of her home. So once she selects an eye doctor, her care team provides her health records electronically, and so there's a seamless integration as she goes to see that eye doctor both -- and the results seamless to get back into her app experience and to her care team. She goes ahead and schedules that. Sees her doctor and we'll fast-forward. When she returns to the app, what you'll see there on the top is an example of what Dan talked about earlier is the next best action. It's a tongue twister. These are personalized recommendations based on data science, clinical science and behavioral science to recommend the single most important next thing that our members need to do. We know that it is really overwhelming for people to receive a large to-do list. So we send personalized targeted next-best recommendations to nudge people along that health-care journey. In Judy's case, her single most important action is to get started with her diabetes program. When she does, though, she sees the results of that A1c test that she took at home seamlessly integrated in her app. She's happy to see it there, but less happy to see that the results are not what she anticipated them being over her lapse in managing her care. The [ ease ] and simplicity of this encourages her to get started. And so she's able to get started in the app directly going through and learning how to do a check with her connected blood glucose meter. But beyond just measuring her blood glucose regularly, we know that there's lifestyle and nutrition and diet changes that go along with managing her blood sugar. And those changes can be really overwhelming. What you'll see down here is an example of a personalized action plan that helps with that behavioral change. She decides to get started. Action plans are another example of how we're using data science in conjunction with behavioral science and clinical recommendations to drive behavior change that drive outcomes. What you'll see here is an opportunity for her to select from a variety of activities, personalized and adaptively recommended to her based on where she is in her health-care journey and recommended based on her likelihood to complete the activity. She chooses dinner pairings and gets started on our action plan. This is really important. We know that members who are able to take part in choosing their care and have control over their activities have a higher completion rate. And those higher completion rates lead to better outcomes. Members who actively engage in their action plans see statistically significant benefits across lowering their blood sugar levels as well as their blood pressure and their weight loss. All 3 of these lead to better outcomes and lower complications. Again, fast-forward. Next time Judy comes back to her app, she sees a different next-best action. We know that she is participating and doing her blood sugar checks regularly. And her blood sugar readings are under control. With that, we're able to make a next clinically appropriate recommendation for her to get started on our mental health-care options, again, integrating this into her digital front door, into her home page, all in one place, meets members' expectations of simplicity and drives their outcomes by more likelihood of following up on referrals. She decides to get started with the mental health program. One thing that we know is that when people are starting mental health, they don't know where to start. And not knowing where to start is a significant barrier to getting started. So we start with a very easy approachable intake assessment that helps us uncover what our needs are. So we take the burden off of our members and use our decision science and our clinical recommendations to put her in the right place based on her needs. She goes through an in-depth assessment. That in-depth assessment covers a variety of clinical standard questionnaires as well as, again, adaptive personalization for us to get to the heart of what her underlying mental health needs are and at what acuity level. These are foundational for us in developing personalized health plans. What you'll see next is the personalized health plan that's recommended to Judy based on these assessments. What we've uncovered is the important things for her to work on is getting started with managing her depression. And second to that, processing grief and handling stress. This takes it from having her to have to self-diagnose to us giving her some easily approachable recommendations so that she's able to action. Dan talked earlier about step care. This is a great example of step-care. What we're recommending to her is teletherapy. This is based on our assessment of her acuity and what she needs next. She will also have access to self-guided content in a variety of tools, but her next best step in our step-care model is getting started directly with a teletherapist. She can go ahead and schedule this very similarly to how she did her primary care. So it's a familiar interface, which again lowers the friction and increases the likelihood of her going ahead and following through with this referral. Similarly to primary care, our average times for scheduling mental health visit are within a week, again, very different to the weeks and months that we're seeing increasingly as mental health needs continue to escalate. But even in advance of that week, we want her to be able to get started with our digital content to begin taking control of her mental health journey on our own. Based on her needs, there's an assortment of recommendations. She decides to get started with mindfulness in grief. Our digital health -- digital mental health firms use adaptive learning algorithms to get people started in the right place and then personalize the content for them based on their needs and their level of engagement. We're going to get her started with a very simple easy exercise. This is just a simple 7-minute early success. We're not going to go through 7 minutes of breathing. But I wanted to point this one out because it's a really good example of giving people early wins to start feeling the success of something that might be overwhelming. This is a really important recommendation from a clinical perspective but also is very rooted in behavioral science, kind of like, in Super Mario, getting those first coins really important, but this is way more significant, right? So we're getting get started early and often. And we're choosing the most important content from her from over a bank of 1,000 pieces of content that we're using our recommendation engines to put forth to her, her first step on this journey based on our history, her clinical significance and what she wants to get going. These easy steps really help overcome the barrier of her feeling like a win and feeling like she's getting started on her journey even before her first appointment. But less than a week later, she does have that first appointment with a licensed therapists for the first time. Very successful visit, and she and Dr. Adler decide to continue with therapy on an ongoing basis. They determine the date and time for their next appointment, and that again shows up seamlessly in our app. Following up from this visit, she receives a message of push notification from our care team, again important because those push notifications are a reminder and a prompt to bring her back into the app on a regular basis, so she can continue her exercises and continue to engage. This particular message is the message from Dr. Meyers, her primary care physician, noting that she's received the results of her eye exam, her blood sugar levels are looking good and that she's looking at her engagement in the metal health program that's further driving her blood sugar levels down. This really matters to our members. This longitudinal relationship and this acknowledgment that what she's doing is taking steps creates just a cycle of continuing to engage and continuing to commit to changes over time. So what we've seen in this example is bringing together primary care as a way of integrating in mental health and different aspects of chronic care engagement all very intertwined in one place really seamlessly creating a longitudinal relationship with a primary care doctor. Let's switch gears and do another example. In this example, we're going to do meet our member, Umar. Umar has been a longstanding member of our diabetes program. Recently, however, he's seen increases in his blood sugar level. So Umar receives, in this case, a mail notification that he has something to pay attention to in his app. Going into the app, you'll see a slightly different version, an alert version of our next best action noting that he's had a few high blood sugar readings recently and asking if he wants to see a physician. This is an example of step-care applied to chronic conditions. So in Judy's case, we saw step-care applied to mental health, seamless access from digital care to all the way up to seeing a physician. In this case, this is an example of Umar being able to access a physician directly. These next-step actions are highly effective. These are targeted based on clinical predictive analytics in advance of something happening. Being able to reach out to a member and pull them in to take more proactive control is a very, very -- both effective method of managing chronic conditions, but a very effective way of engaging people. We see upwards of 60% of our members engaging in these alerts. Umar's going to be one of those 60% and chooses to schedule an appointment right there within the app with a provider who can help them manage blood sugar. So again, similar interface, similar simplicity of going through and just being able to schedule directly in the app interface itself. Before meeting with a provider, the doctor has full access to his blood sugar readings, notes from his coach, trends over time, so that when he is meeting Umar for the first time, he has a complete view of his clinical diabetes history introductory. Umar has a meeting with doctor -- an appointment with Dr. Hansen. And in that, they make a decision to increase his medication dosage. Similar to Judy, these next steps are seamlessly incorporated automatically into his care plan available both to him as a member but also to his full care team. In this case, he receives another e-mail follow-up from his care team. And this one is from his coach who he worked with regularly on his diabetes program, noting that he's had the increase in the medication and checking in with him to see how that's going. So this is an example, again, of step-care going from remote care to license physicians to the care team taking a holistic integrated view of the step-care model applied to chronic conditions. Both of these examples are from key takeaways. An example of us being able to bring together our virtual mental health care and chronic care in one easy integrated consumer experience. Throughout this experience, Umar and Judy's example show how we're interweaving data science, behavioral science and clinical science, integrated and interwoven throughout the experience to create a truly adaptive personalized experience, which then in turn drives relevancy, trust and ongoing engagement, creating an upward cycle of care management. Within this whole person experience, step-care matches the members to the right intervention at the right time whether that's digital coaching, digital content, remote monitoring or integrated seamlessly licensed care. I'm going to hand this over to Claus then to show how that happens behind the scenes, what is happening under that member experience to make this all possible.

Good morning. It's still morning. I'm Claus Jensen, the Chief Innovation Officer. And I'm going to try to give you a view of what I believe is a uniquely valuable way of putting the pieces together through our integrated product and platform strategy. You've seen we're solving a new problem. We're creating a whole new market. We're delivering this next normal whole person care model. I call it we're solving a paradox. It's a paradox that people want the sophistication of modern health care. But at the same time, they also want the closeness, the intimacy, the historical understanding, all the things you just saw Donna demonstrate is we know you. We recognize you. We are with you for the duration. That's hard to put together because solving that paradox requires actually 2 paradigm shifts. The first paradigm shift is removing the tight cobbling between bricks and mortar and care and acknowledging that some care components are done as well or I would say, in some cases, better, especially with regular interaction as it is in bricks-and-mortar setting. We've done that, but there's a second paradigm shift. The second paradigm shift is much harder. It's choosing to not just focus on one piece but to amplify all of health care. And through a unique combination of clinical and technology that is helping people make better holistic care decisions. Think about that. The actual outcome of care is based on decisions. We talk a lot about the decisions made by physicians, by the care team. Donna just demonstrated that the decisions you make as an individual had at least as much impact on that. So we're not just replacing parts of the system with new care components that remain disconnected. We're not just sticking the pieces together. What we have done is drive transformation through innovation and integration. Being that strategic partner that Jason talked about earlier for all parts of health care. So that second paradigm shift, as I said, is a much harder problem to address. And it embodies the full multi-hundred-billion-dollar opportunity we talked about. That problem requires the fusion of 4 sciences to actually solve. They're on this slide. If you think about it, it has to be based in clinical science, combined with technology, otherwise, you can't get to the reach and scale that's necessary to solve this for our country, let alone the world. But that's not enough. You also need the logistics to be able to execute at scale, and I'll walk you through each of these 4 sciences. And you need the behavioral science that Donna talked about because, if you can't activate the self-care component of let's say a chronic condition management care plan, you're not going to get the outcome you're looking for. So before I talk about each of these 4 in more detail, there is a fifth data science that underpins all of the other 4, that delivers the intelligence that powers our integrated platform. And by the way, just for reference, we have more data scientists than most organizations have R&D people. Delivering care with integrity, with quality and with compassion requires a situational and emotional understanding at every single point of interaction. You can't miss one because then the trust is gone. You have to connect all the pieces all the time. The entire R&D team is totally passionate about that, about the mission. And we're pretty much relentless in making sure that everybody in health care, be that clinicians, be it health consumers, have the right experience. It's totally unacceptable that you have to wait a month or more for an appointment. It's equally unacceptable that, when it's not necessary, you have to drive somewhere, wait for an hour or 2 or 3 in an office to get done with a component of an integrated care plan. That's just not acceptable. So having built the right whole-person care platform, we've actually done something about both but it's by embracing our role to augment and amplify the rest of the health-care ecosystem, so we have a much better -- much greater positive impact on health care as a whole. It's the very relationship with our clients that actually maximizes the value of the assets we can bring together, and the integrated platform we've built. So our job is not to replace everybody else in health care. It's not to be a [ conjurist ] that helps navigate. That's not enough. We have to break down the barriers, disaggregate the isolated solutions and then put the pieces back together. That's a complex problem that requires a lot of sophistication in the 5 sciences you're seeing on the slide. So how have we done that? How have we actually practically driven transformation through integration because that's the pivotal problem to solve in health care. We began with creating not just a data record but what I would call a clinically curated personal trusted truth about your health. It's not actually about the data but what the data means. This is in a data-rich environment, an order of magnitude more difficult than managing an EMR, and I worked for a hospital for a couple years. That's hard. It's not just about the EMRs, but all these other data points that live in this data-rich environment that we have created. It spans all kinds of data points from visits to screening surveys, to device interactions, to the measurements that Donna talked about, to third-party interactions. If you look at that little circle, there's a lot of different data points that are coming together from lots of different sources. Some of these interaction points are through a telehealth clinician. Some are client clinician. Some are through a device. Some might be through your employer. There are lots of different ways of engage with the health-care system. And every single interaction has to be connected. As I said earlier, you can't miss one. So to construct that because this is a hard problem, but we actually solved it, to construct it, to construct that lifetime personal clinical truth, the very first thing we did was to build a notion of global identity. That sounds boring. It's not because of the difference between feeling connected and recognized every single time we need you and not. So think about this, we get an eligibility file from a health insurance company from a payer. And all we get is the name, some address information and maybe a few other demographic pieces. Now we have to be able to recognize this is a person we've seen before, though not through that insurance company. That was the first problem we saw because now we can recognize people at every single point of interaction. The next thing we did was to step up as your health data partner for life, not for a relationship that happens for some short period of time, not for a single interaction, but pretty much for as long as you want to work with us. Managing diabetes, let's just take that example, is a lifelong exercise. You can't stop. And something has to connect the ports. That's us. We built a unified data fabric for whole-person health. That wasn't easy either. And that has the ability to remember and combine the data points from all these different interaction points I talked about. It's a pretty sophisticated data and technology platform. Consumers in general, look, you've all seen the newspaper articles. Everybody talks about how I will have an app on my phone that will manage my medical record. It's not going to work. For most people, having an app on their phone that collects all this data doesn't actually make it meaningful to them, and it certainly doesn't make it meaningful to the physician. So we need a different model where somebody helps you remember, manage, combine the complexity, integration and the sharing of data, and that help has to be consistent and persistent over time. It has to be part of just managing your health, not something that happens on the side. We've done that. That was a choice. People can make different choices. We choose to help you manage your personal clinical truth for as long as you want to work with us. Finally, none of this matters if not based on robust clinical science. It's great. Okay, I get it, Claus, you built the data fabric. You got all the data points. It's put together the data to integrate it. What does it mean? It's the very combination of data science, clinical science and technology science that allows us to understand and interpret because we're doing sophisticated filtering and separating clinically meaningful data points from noise. Donna showed it to you. She didn't show you all the moving parts underneath. There are lots of them. That combination of clinical science and technology science is totally fundamental to delivering whole-person health at scale. You can't do it without the combination I talked about. So that is in our DNA as a hybrid health care and technology company. So that was the first one, the whole notion about clinical science. Okay, let's talk about behavioral science. So now we have the unified data relevant to care. Enter behavioral science combined with data science. Think about it. Step-care begins with self-care. Donna showed it. Kelly and Dan talked about it. Self-care begins with the right motivation. The right motivation is always deeply personalized. People have different motivations. If you don't understand the motivation of something, you can't actually get them to take action on their self-care. Matching the right provider includes sell factors, the ability for people to choose based on what's important to them. And culturally competent care, let's not forget, requires culture understanding. Understanding the context, that's also deeply personal. This intelligent engagement platform only stays intelligent if it receives high-quality feedback on what works and what doesn't. Donna used the word adaptive personalization. Everybody talks about personalization. Personalization that isn't adaptive is not going to work in the long run. You need to have the intelligence, the behavioral science, the data science, the analytics underneath to adapt as somebody moves to a journey of, hopefully, a relatively healthy life. And to derive actionable insight is not just for the health consumer. It's also for the clinicians. They very much want that as well. And finally, don't forget that more data and more holistic data requires and leads to faster learning and better decisions. So as Jason has been saying for years and as Teladoc Health has been doing for years, the notion of intelligent actions and referrals matter. Whether it stays inside our ecosystem was referral to the outside. So think about the notion of an applied health signal. What is an applied health signal? Well, it's actually in the name. That's the heart of combining clinical science and data science. It codifies an important next-best health action to take. These applied health actions are the difference between a care model that looks good in theory and one that actually works in practice, and that's scale. I think the 22 million nudges and 1 million clinical signals speak for themselves as do the outcome they've helped generating. And we're only accelerating from here. We're just getting started. Technology Science is the third science. I could probably talk about this slide for a couple of hours. I'm not going to. Having a sophisticated and adaptable technology platform is crucially important when not just digitizing brick-and-mortar model. That is not going to solve the paradox that start what I was talking about. We have integrated whole-person care in a way of those in because we chose to take a different approach to technology. I'm not talking about the future. We've already done this. The underpinning technology looks very, very different now than it did 2 years ago. That's a current state statement. Historically, health-care solutions have been designed as solution towers aimed at solving a particular problem. This is not a bad thing because that's how you drive the frontier of science. But what is a bad thing is that forces, patients and clinicians to navigate this very, very complex system on their own. And down to this -- to fixing this was not establishing a parallel system. It was doing things differently by the disaggregation and recombination of the parts in a totally orchestrated ecosystem of our creation. This next normal better health-care model in that next normal model is not actually about the what. It's about the who. It's about the experience and the outcome for the people that exist in the health-care ecosystem. The right questions are not what's your diabetes solution, or what is your telemedicine solution? Those are building blocks. The right questions are what is the right whole health experience for a patient member health consumer? Or what is it a clinician needs in total to understand what's going on with an individual to give them the best possible care. Those are the right questions, and it's totally aligned to the mission of the company. So getting people to engage in care across all those things. We've talked about primary care. We've talked about chronic condition management. We've talked about mental health. There are 3 foundational on-ramps to a whole-person care model. We've integrated all of them, hundreds of moving parts underneath the cover coming together the right way, powered by a single unified technology platform that keeps patients and providers in touch the right way, not just at a visit but in between. That's the hardest problem in health care. How do you stay in touch in between. Our front door to health is so much more than just a UI overlay. It's deeply connected to all of your care needs and all the resources that you need to take care of yourself and for people to take care of you. This relentless focus on low-friction experiences is what -- and that's what drives the adoption. It's what improves health equity because, even when people sort of want to engage in their own care, it's hard, and you have to make it easy for them, especially in an environment where digital presence means much more frequent interactions. If that becomes hard, people are not going to do it. So a small, simple example. Donna talked about our chronic condition management programs and the devices. Okay, I'll give you one tiny technology tidbit of how those devices work. They are cellularly enabled. They're not actually tethered to your smartphone in terms of how to send data points. Why? Because that reduces friction. And in the example that you saw in one of the videos, as soon as somebody takes a measurement with one of our devices, we know what that data point is. We can reach out, if that's what's appropriate and necessary. That's low friction. And it's quite simply why we're integrating and delivering the way that I don't think other people can easily match, if at all. On the client side, it's not just about the clinicians, and it's not just about health consumers. On the client side, Kelly mentioned large comprehensive deal opportunities. I'm telling you they're going to be based on white labeling and deep integration because health plans are making strategies and plans for how to take better care of their populations as well. And they don't want something that's not connected. They want something that fits into their plans and strategies. We deliver on that without sacrificing the cohesion and integration and niceness of the experience for the people that we serve. So anytime somebody interacts with our technology platform, it always happens in the context of everything that went before. These successful care models actually have to sell three times. The first time is to the client. They want to buy what they want to buy, and it has to fit into their overall environment. The second time is to the clinicians, what the integrated care teams need. Care teams have opinions, too. And if they don't think that it fits what they need, they're not going to use it. And finally, you have to sell what consumers want to use when they want it, all of which we're doing at a massive scale, enter logistics. That's another hard problem. We've built a powerful ecosystem platform that deals with an incredibly complex logistical challenge. That's the center of gravity for a digital/hybrid whole-person health economy. And you can think about other industries. By the way, they're simpler, Uber, Airbnb. Those are logistical powerhouses, but they're in a relatively straightforward direct-to-consumer model. Health care is not that simple. There is no successful platform play in health care today. That's about to change. I put 9 examples of the complexity and logistics in health care on this slide, and I'm just going to highlight one overarching thought, which is think about how hard it is to match thousands of clinical resources, clinicians and members/patients that want help every single day across the complexity of what cues do we have for who wants what, what's the credentialing, licensing, which providers are able to practice in what state? I can go on about that for a long time. We have already solved that problem. Every single 1 of these 9 things we already solved. And it was not easy. We do it not just once we do it differently for every single client because the different clients have different integration needs, again, every single day. So that's a problem that I would pose to you nobody else is really positioned to solve. So I'll give you some examples. Be that a health system that uses our technology to power up their virtual visits, but maybe also handle overflow, but they know enough clinicians that's actually at duty at 2 a.m. in the morning, or it could be a client taking on population risk, but they want to contract chronic condition management with us, or it could be a health plan that uses our white-labeled clinical programs and products to engage members and lower medical costs. So this is not huge to state. We are already uniquely delivering and amplifying health care. And I want you to remember that word amplification. It's a funny word, but it talked about adding value so that 2 plus 2 becomes more than 4, and that's actually what we do with our clients. This is how we become strategic partners for our clients and not just somebody that delivers a point solution. We set a pretty high bar for what integrated products and experiences look like, much higher than what most organizations contemplate. And we continue to invest in the heavy lifting, building the right foundation, solving the hard problems and then accelerating the differentiated value. We've clearly delivered on that in the context of whole-person care. So it's all about changing consumer behavior, laying the foundation for better decisions, stronger self-care. It's all about managing clinical resources at scale, avoiding putting that burden on the clinicians of the world. There they've got resources. And it's all about integrating the last mile, which Dan and Kelly and Donna all talked about, which is getting their interface right between clicks and bricks and integrating devices, sensors, referrals, labs, medication, which by the way, has to be technology-based to work at scale. If it sounds like I'm passionate about this, you would be right. We're not standing still. So I'll just talk for 1 minute about some of our current R&D focus areas. We're actively adapting our programs and products to new channels. I'll give you 2 examples. By the way, this requires significant time and effort for localization. I talked about that. Context is everything. So one example is, recently, we went live in Canada with our mental health product, myStrength. Canada is like, okay, English speaking, but it's still a different culture. It's a different context. It's different integration. It required work. And we have a couple of recent examples where we took the chronic condition management programs and took 2 hospitals, not employees, but patient population. Again, required adaption. Our ability to continue to adapt our products to new settings is what will unlock this massively expanded addressable market that we've talked about. And to increase penetration, the integrated platforms is what we continue to invest in. For example, I talked about Unified Data Fabric that's already giving us new insight. Donna mentioned a couple of examples. And the integrated experience you saw is the essence of what it means to put the pieces back together better, especially for high-touch areas like chronic condition management. Kelly talked about the Primary360 product. That breaks new ground to virtual first care. We'll continue to expand those capabilities, and we're continuing to do new last-mile integrations. There's a lot of things you can integrate out there. And lastly, we're accelerating our investment in value-based whole-person care, not only by expanding the clinical product differentiation, that's important, but also, as importantly, by expanding our provider network capabilities so that our clients can put their providers on our ecosystem platform seamlessly integrated with our provider resources when appropriate. You could say that we lead growth and share of wallet for whole-person health. That's what the headline says. But I think more importantly -- this is certainly true, but more importantly, we have a proven track record of continuous innovation, but innovation from the top of the market rather than innovating one part sitting over here in a corner. You can say that we're a multidisciplinary example of what it means to operate at the top of your license. That's, by the way, what you will hear health-care professionals say their ambition is to operate at the top of their license and [indiscernible] nurse. So is ours, and we've shown it. We led the market as virtual visits became normal. We clearly demonstrated our ability to scale that model as the virtual and hybrid care transition accelerates, as it moves from visits to meaningfully connected journeys, we created the foundation of this personal and compassionate health journey that we've talked about all morning. myStrength complete, the step-care model, that's the first of a kind example of a fully integrated step-care model. That didn't exist before. A step-care approach to everything Dan talked about is our strategic foundation. Mental health was simply the first place we did it. As always, we invest in a foundation. We learn what works. And we accelerate the deployment at scale. If you go all the way to the right, we continue to create and lead the market, innovating on top of everything that came before, including our existing stuff. The next frontier is a new category for whole-person care. The full last-mile integration, a complete and holistic step-care model to chronic conditions and mental health. And that new category is absolutely based on the fusion of all the 5 sciences I've talked about, all of them. You cannot do it without integrating all of them. So all in all, clear line of sight to full platform integration; clear line of sight to fully integrate the whole-person capabilities, a first in health care; delivering a new category, solving for that inherent complexity, solving a really hard, complex problem through sophisticated technology and the integrated application of 5 different kinds of science on top of that. Pretty sure you're uniquely positioned to deliver. We have all the right ingredients. We have the right team. We have the right vision, and we're going to be the ones that define and power the next normal in health care, which is why when Jason asked me to join Teladoc Health, that was an easy decision. I think it's time to move on to Q&A.

That is correct. So if I could have the morning speakers come up, I'll do a little bit of curating of the Q&A. I'm sure we have a bunch of questions. We have a couple of microphones that will go around the room, so we'll take hands. I see Sean is eager at the front.

Okay. Sean Dodge, RBC. Maybe on Primary360, Jason, when you've piloted those programs in the past, what's uptake been then of the members that have had it made available to them? How -- I guess, how eager are consumers to self-select into a virtual primary care program?

So early pilots are really promising. I'm not going to give expected enrollment rates because that might set expectations before we have an adequate sample size. So I want to be cautious about doing that. In many of the populations that we've served in early pilots, uptake in enrollment has been higher than our expectations. And as you saw from the slides on Dan's introduction to Primary360, the engagement of those consumers in terms of interactions with the care team, identification of chronic conditions, mental health conditions has been even stronger than we expected. So we're excited about the impact it will make and just sort of generally looking at what our health plan clients are modeling. They're modeling savings of anywhere from 10% to 20% from a virtual primary care -- primary first product rather than the sort of traditional delivery system. Next question?

It's Jess from Piper. I guess, can you tell me...

You need to speak into the mic, otherwise nobody on the webcast would hear it.

Sorry. Jess Tassan from Piper. Can you just talk a little bit about how you employ and compensate providers across all of the businesses, better health, advanced medical, the virtual primary care. And then just does the virtual primary care solution change at all the way that you're thinking about employing primary care docs?

Yes. So historically, we've always compensated providers essentially for the value that they provide. So there -- as they perform visits for us. They have generally been 1099s. We reimburse them as for us a variable cost, for them, based on their productivity. We will begin to move into more employed providers who are paid on sort of a hybrid model with a base plus of productivity and value basis. And that is certainly to create a more longitudinal relationship and aligns relative to value-based reimbursement that you heard Kelly talk about. And I think that aligns us with those providers. But we will always be a hybrid that includes a substantial portion of independent contractor providers.

Jailendra Singh, Credit Suisse. Following up on your discussion around the incremental revenue potential discussions specifically related to partial capitation and capitated whole-person care models. What are your views on the time line around transition to adoption of these models? What could be the key hurdles there? And are you assuming any significant adoption within your 25% to 30% revenue CAGR there?

Yes, so the question is about new payment models. I'll start and then maybe, Kelly, you can give us some insight into what the clients are asking for. So we've taken very modest expectations into our modeling relative to our outlook for additional contribution from new payment structures. I will tell you that, today, we're having discussions with clients that range from guarantee of savings all the way through Primary360 discussions that have a set capitation with downside risk and upside benefit as we get to share in the savings that we generate. So we are already having some of those discussions. You could call that a partial cap or a sort of a cap with corridors. And those are evolving now. I think over time, as we integrate all of the Chronic Care and Primary360 and whole-person care capabilities, you'll see us more move to a larger, more traditional capitation because we can make a bigger impact on the overall health-care dollar. Kelly, you want to give some insight into the client conversations.

Yes. I think what I would add to that, Jason, is that what we're seeing is, as I talked about, the maturity model across our entire portfolio of clients. I think each one of those clients sort of arrives to a decision around whether or not they're ready for a value-based care arrangement. As Jason said, they all sit along that spectrum somewhere. And so a lot of our conversations are let us understand what you're after. What is the solutions you're looking to incorporate into your populations? What are you trying to achieve? And that leads us to the next level of conversation, which is are you able to actually adopt a program of partial or even consider full capitation. And many times, again, their sophistication levels along their maturity of virtual care aren't there yet. Some are. And so I think it is a little bit of an N equals 1 conversation with each one of our clients.

Let's go to this side. Maybe Lisa?

Lisa Gill with JPMorgan. It's so nice to see everyone in person again and kind of set the stage for JPMorgan, 2022. Anyway, I just really wanted to go back all the excitement around virtual Primary360, and you made a lot of comments today. But when I look at the targeted growth rate of 10% to 20%, what am I missing in that expectation? Is it just going to be a longer ramp for people to implement this? Is it that some of the things we saw today around, for example, chronic care having a much higher PMPM dollar amount that impacts that revenue? How do I think about that opportunity?

Well, so remember that the virtual medical care encompasses a lot more than Primary360. It's working off of a very small base admittedly, right? It's brand new in the market. And so we're modeling a very modest contribution, really not material contribution in '22. So when we talk about a 3-year CAGR in terms of our growth rate, and I mentioned that, that one specifically accelerating over the course of those 3 years, it's really because we expect that to be a meaningful contributor to '23 and '24 and really not much of a material financial contributor to '22. What we expect to do is set the stage with a lot of phenomenal clients and proofs of concept for that in '22 that will play out in terms of growth in '23 and '24.

So does that [indiscernible] business is growing much lower than it has historically? Like I mean, I just look at that different bucketed growth rate that you were talking about [indiscernible] understand how to think about that?

Well, I think we've -- I think it's been clear, and as we've talked about it, sort of the general medical business, which is the bulk of that, is not the explosive growth rate that we had seen in the past, and it's shifting to more whole-person care. Lisa, one of the challenges, honestly, that we've had internally is decomposing the parts because we see it as really whole-person care being the pulling together of all of those parts, and that's more and more how we're selling it. George?

Jason, mental health and behavioral has been a huge home run for you guys, and it's expected to be the fastest-growing part of the business over the next couple years, will be about half the business according to your 2024 targets. I guess I would just -- I would imagine there's been a huge pull-forward as it relates to COVID. I'd love for you to talk about what you've seen, and what gives you the visibility in that sustained very strong growth for the next handful of years, assuming that COVID ramps down at some point. And we don't all stay crazy.

Yes, so maybe Dan can take the B2B side of that, but I would ask you to hold that question for the afternoon. We're going to hear from Alon, who's going to talk about our direct-to-consumer BetterHelp offering and a lot of why we feel very confident in the sustained growth of that. Do you want to talk about the B2B side?

Yes. So from a B2B side, it is dramatically underpenetrated even today after, you might say 18 months of crazy growth because of all the dynamics we talked about. That's both from a percentage of the book that has the service, and we'll get into more of that later, but then usage of the service within that population continues to grow, and we continue to see that those patients are having more visits, and more patients are getting involved. And then, of course, as I was talking about, the story is a lot bigger than telemedicine, right, sort of what Teladoc would have been talking about 20 months ago. Because of the step-care multimodal model that is myStrength Complete, that is almost a new sort of category, right, that we see tremendous opportunity to bring into our client base. And we're seeing that interest in sort of, I might call it, upgrading right to that more full solution that can very efficiently take care of a broader part of that population and drive outcomes. So I think there's sort of additional phases that we're entering into that are more than what you might have sort of thought of as traditional telemedicine.

We have a question from the web. From -- Daniel Grosslight at Citi asks, can you talk about how data is shared between different providers within the Teladoc network? For example, if a consumer is utilizing primary care and mental health care, how is data shared between those 2 providers? And when referrals are made out to in-person care, how is the data shared with the in-person providers and then back to Teladoc?

Yes. So I think just to maybe frame the question, we've gotten a lot of questions about, well, can a Teladoc physician see the chronic care results, right? Can they see the blood sugars? Can they see the blood pressure readings? And I think there are some misconceptions out there. So the answer to that question is yes. We've executed on that part of the integration. And then, Claus, maybe you want to talk about how we make sure that the data is ubiquitous across all providers, whether they're part of our network or part of the delivery system.

Sure. It really comes down to the unified data fabric that I talked about. I mean it's labeled unified data fabric because that's what it is and what it does. So using our global identity capability, every time we have a data point that comes in, we will immediately connect the dots and say that belongs to this particular individual that we're tracking over time. Donna showed an example of how the primary care physician has access to the report, the readout from the management of your diabetes. So that's one example of how it comes together.

I think we have time for maybe just one more question before lunch. We'll have another Q&A session at the end of the day with the full management team.

Stephanie?

I have one for -- probably best for Kelly. You talked a lot about how you're seeing a lot of traction in the cross-sell thesis playing out for Livongo and Teladoc. You mentioned Tyson Foods and Blue Cross Blue Shield North Carolina. Could you give us a little bit more color from the ground of what you're seeing in these conversations, why it is happening? And maybe the level of penetration of these conversations you had with your client base given the breadth of it.

Sure. A couple of things on that. I'd say, first, it's the ground game. I sort of had -- I had mentioned what we launched into 2021 with the close, and the thesis around our cross-sell was in Q4 of last year. And so we sort of hit the ground running early in '21 with really sort of aggressive notions to get in front of our clients and really start to tell the story and, as I mentioned, sort of inventory where they're at. And those conversations have been really fruitful because not only do they give us an insight, they give us an opportunity to sort of benchmark where that client is and further the conversations about expansion. We moved quickly into -- in Q1 of '21 to make sure that we were in the field, having the conversations. And so those conversations have continued to grow over the course of the year. I would say that it then tees up an opportunity to talk about Primary360, for example, sort of what is their more holistic strategy and what are they after in that? And what I'm seeing in the U.S. group health markets is that -- what we typically have seen is sort of nascent products would evolve in the D2C in the employer space first, and they would sort of gain some traction and adoption and really, start to prove themselves out. And then slowly, they'd migrate over to the health plans, which would take notice for differentiation reasons, cost reasons, et cetera. And one phenomenon that we're seeing on P360 is that those -- that product is being adopted concurrently in all markets. It's really been sort of fascinating to watch because I think what we've seen is that early, the health plans and integrated health systems and employers are all seeing the value sort of day 1. And so we're really excited about that momentum, and we're really sort of trying to harness it and move into '22 with even more sort of ground game and focus.

And a quick follow-up on that one. So if I can sneak that in. This is probably more for Mala. So let me know if this is something I should not be asking. But just given that color, is there any way to track it against the original Livongo revenue synergies?

So Mala is going to talk about our financial outlook toward the end of the day, and we'll talk about sort of where we are relative to synergies. The short answer on that is that we're on track this year relative to our expectations for the cross-sell synergies and feel very good about where we are.

All right. Thanks, everyone. We're going to take a quick 15 minutes for lunch. I know that's quick, but we wanted to get back and we'll be -- thanks.

Thank you.

Thank you. [Break]

Okay. We're going to get started again. It's my pleasure to introduce Alon Matas, President of BetterHelp.

Thank you. Good afternoon, everyone. My name is Alon Matas. I founded BetterHelp 9 years ago, and I joined Teladoc 6 years ago with BetterHelp's acquisition. Now Dan and Jason mentioned, we see mental health as a key growth area, and that is true for both B2B and DTC. And -- with BetterHelp, Teladoc extends its mission to provide care to any person who's looking for mental support. Now BetterHelp has been the clear leader in direct-to-consumer mental health for several years now. But this year was pivotal with tremendous growth that exceeded all our expectations. To put that growth in perspective, we had this year more live sessions than in all previous 8 years combined. As a result of this massive growth, BetterHelp will generate this year revenue of about $700 million. A key learning from this year is that COVID-19 was much more than a circumstantial temporary spike. It had permanent and lasting impact on the consumer's desire to get therapy online. In fact, from March to September 2021, we had more new members joining BetterHelp than between March to September of 2020 when much of the nation was under shelter in place. And despite traditional brick-and-mortar therapy being available pretty much everywhere available, again, consumers continue to prefer and appreciate the advantages of getting therapy online. On the other side of the equation, BetterHelp established itself as the #1 opportunity for any therapist who wants to work remotely. This year, over 20,000 therapists provided services on our platform, with more than 10,000 of them joining just in the last 10 months. Another thing we really got excited about this year is the increase in the case load size of therapists in our network. That happens because many therapists join us with the intention of doing it just as a side gig for a handful of clients. But then when they discover how compelling and rewarding this can be, they increased their share of work at BetterHelp, for some of them making it they're de facto full time. So we're not just increasing the number of therapists in our platform but we're also increasing the volume we get from each therapist. Our scale is helping us to provide quality of service that is superior to any competitor. And there's really no better way to demonstrate that than with the critical challenge of therapist matching, which studies have found to be a determining factor in the therapy success. Because in therapy, you're not just looking for a therapist, you're looking for your therapist. Now let's say that you live in Wisconsin, which means you'll need a Wisconsin-licensed therapist, but you also prefer a female therapist who is black and older and has specialty in grief counseling and expertise in parenting. With the very large size of our network, we not only have what you're looking for, but we probably have many, many therapists to choose from. And then by leveraging the massive data that we have and analyzing over 150 million interactions we've facilitated, we're able to pick and choose and match the therapist for you that is most likely to succeed in helping you. We continue to innovate and add functionality and value to the platform beyond the member therapist communication. Previous years, we added webinars and journal and guides and worksheets. This year, we started rolling out support groups where members can connect with each other and a dedicated therapist over a shared experience. We got extraordinary feedback and tons of enthusiasm around support groups for members. Now all these additions make the service more sticky, more valuable to members and also let us adjust our membership rates to higher price points. The merits of our product and service yield high engagement, high satisfaction and high retention. These 3 data points here show how quality translate into long-term value. First, 86% of our members continue after the first session to have more sessions. This is remarkably higher than the standard retention rate in traditional brick-and-mortar therapy. Second, while some people may use BetterHelp in a kind of a transactional way, maybe to get help with a temporary specific issue, the vast majority of our revenue is generated from people who use BetterHelp for at least 3 months. And third, our goal is definitely not to keep people in therapy forever, and we're actually happy when they reach their goals and move on. But what we constantly see is that when past members have new life challenges and they need help again, they come back and use us again as a trusted resource. This chart puts some of that in financial lens. What it shows is the trend in the average revenue we generate from a member in the first 12 months of their membership. And as you can see here, it keeps going up. So for example, the revenue we generate from a member who signs up today is almost double compared to the revenue we generate from a member who signed up 4 years ago. So what you can see here basically is how the engagement and satisfaction and retention and long-term value that I talked about in the previous metrics translate also to increased revenue and also increased profitability. It's no secret that part of our growth comes from increased investment in marketing and advertising. And this is where we leverage economies of scale. Our marketing becomes more efficient, more sophisticated and more effective as we keep accelerating. As you can see here, although we spend much more than we used to, our return on investment of every additional dollar is actually not diminishing. And if you take out the impact of shelter in place from last year, our marketing ROI keeps increasing over time. I'd also like to point out that the marketing has become very diversified with multiple channels, multiple sources and multiple strategies. And 2021 was the first year where we didn't have a single source that brings more than 25% of our new members. This is very important because unlike some of our competitors, which may rely just on a handful of sources, this diversity gives us scalability, but it also protects us from the volatility that sometimes happen in the media landscape. In fact, being able to shift budgets between different channels and different sources let us capitalize on opportunities that come out of this volatility. And I know there's a specific concern around the rising cost of social media advertising and even more specifically, Facebook. So it's important to note that over the last 2 quarters, less than 10% of our new members came from Facebook ads. Thanks to our scale, BetterHelp is also becoming a household name for online therapy. In a recent survey by Qualtrics, where consumers were asked to mention the first brand that comes in mind as it relates to online therapy, BetterHelp was mentioned more times than all other major competing brands combined. This brand awareness means 2 things: First, even people who don't use us know about our solution. And that means that when they come to a moment of need that they need help, they sign up to BetterHelp organically. And second, it's a massive accelerator to our direct response marketing because people are much more likely to respond to a message or an ad from a brand that they already know. And last but definitely not least, we're able to establish our sites and apps as the leading source of knowledge and expertise around mental health. And this year, over 20 million people visited them. That does not include any ad-based traffic. So we saw how our member lifetime value gets better with scale, thanks to data insights, ongoing innovation and the size of our provider network. We then saw how our advertising ROI gets better with scale because of economy of scale, increased efficiency and brand recognition. If you combine the 2, you get not only the rapid growth that I showed in the first slide, but also high profitability. BetterHelp has a consistently strong and improving margin profile, which is accretive to Teladoc's consolidated adjusted EBITDA margin. So where do we go from here? If there's something that 2021 taught us, it's that we're barely scratching the surface in a market that is almost untapped. And Dan has already covered the enormous TAM of mental health. So I don't want to repeat it. But I want to explain why direct-to-consumer, specifically, is such an exceptional opportunity in mental health. Well, mental health is an area where people, many people are relying on themselves to make decisions and take action. And these 3 data points here demonstrate why direct-to-consumer -- why mental health basically is such a consumerized market and why it's so ripe for DTC growth. First, 32% of people who have private health insurance go out of network for therapy. That's compared to just 8% in other medical specialties and just 3% in primary care. Second, this is also reflected in the provider side. A survey by the California Marriage and Family Therapist Board showed that 42% of therapists are not part of any managed care panel. And third, mental health is unique because it's not just a replacement for a traditional brick-and-mortar care, but it can actually expand the market dramatically. For nearly half of our members, BetterHelp is their first experience with therapy, although many of them have been struggling for years. And for many of them, if it wasn't for BetterHelp, they would continue to avoid getting any care at all. So we're not just operating in a market with a very large TAM, we're basically doubling the TAM. And not only that, all this additional TAM is exclusive to our type of offering. On top of that, we make intentional efforts to increase the market. And I want to give just 2 examples for that. The first example is the male population. It's known that the ratio between women to men in therapy is around 2:1. And that is true both online and offline. But we thought that by investing in marketing and messaging, we can help change that. We can break stigmas. We can raise awareness. So more men would be inclined to get help and get therapy. In a 2 years' time frame, we're able to more than quadruple the number of men getting a therapy through BetterHelp. And I want to show you now a male-targeted video that we produced. And that video got overwhelming response with close to 30 million views in just 1 month. [Presentation]

Yes. So like I said, these kind of efforts help us to penetrate in the populations that would not typically use therapy. So as I said, I'm going to give 2 examples. The second example for market expansion is international. BetterHelp is the only global therapy DTC provider. And although most of investments are focused in the U.S., we're already the market leader in many, many countries. This year, we served members from over 100 countries and provided therapy in 26 different languages. From a financial standpoint, out of the $700 million, we'll generate over $100 million from non-U.S. consumers. And after we've seen all these indications for massive growth potential, we will double down on the international opportunity. And before I finish, I want to take a minute to talk about something that we're extremely proud of beyond the great business performance. 1 of our 7 core values in Teladoc is that we're passionate about taking care of people. And by that, we mean all people. By being open to any person regardless of insurance, in employment status, BetterHelp is already a great equalizer for affordable access to mental health care. But as a market leader, we felt we have the responsibility to do more. And we took this responsibility very, very seriously. And we leaned in and harnessed the resources to tackle the mental health crisis. So this year, we provided worth $45 million in discounted sliding scale therapy to consumers who couldn't afford our regular rates due to financial hardship. We partnered with many impact organizations to provide free therapy where mental health resources are needed, such as victims of sexual assault, young athletes from the LGBTQ community and, most recently, refugees and people impacted by the humanitarian crisis in Afghanistan. We're helping the helpers, providing free therapy, again, to volunteers and front-liners in situations where mental health is a problem like with health care workers during the pandemic. And lastly, we support underrepresented communities that are particularly affected by mental health challenges. And this is not happening just on the consumer side, this is also happening on the provider side. A great example is our college scholarship program where we support black and Latino students, psychology students in their journey to become mental health clinicians. So to wrap up, we've seen this year very rapid growth with strong margins while reinforcing a leadership position. For next year and beyond, we see how our scale help us scale even faster in a massive market that keeps expanding. And we do all that while fostering equitable access to mental health care and creating real social impact. Thank you. And with that, I will hand it off to Stephany.

All right. Thank you, Alon. And for those who I've not met, I'm Stephany Verstraete, the Chief Marketing and Engagement Officer here at Teladoc Health. So I have been studying the adoption curve within -- for consumers within virtual care now for about 6 years, which I think isn't quite as long as Jason's, but it does give me a unique perspective on the trends we've seen emerge this year, right? First, there's no doubt that there has been -- and we've reached an inflection point in the adoption of episodic virtual urgent care, driven in large part by the massive awareness and openness that was brought on by the pandemic. Millennials are driving this. And we see within -- during the pandemic, we've seen multi -- sorry, multi-service and repeat usage really drive the growth of this demographic. We're also seeing the emergence of future power users through the adoption of mental health, right? On one end of the spectrum, it's Gen Z, which is probably fairly intuitive. But the other end of the spectrum is actually older populations. In fact, last quarter, with one of our largest Medicare populations, we saw mental health visits actually exceeding that of general medical. I say power users because those users that start with mental health. Mental health services, somewhat like nutrition services, they're gateway services. When you start with mental health, you're statistically more likely to use 2-plus services and become a multiservice user over time. Now as we think about the shifting and expanding the category into whole person care adoption, we are expanding the category, but, once again, it's still early innings. Why? I think actually that the travel category presents an interesting analogy for the point that we've reached now. So -- I joined Expedia actually just after the company went public. I held a variety of marketing leadership roles while I was there. And I think when I look today at the point that we've reached with that mainstream adoption of virtual urgent care, it's very similar to -- at Expedia when we reached the online -- the mainstream adoption of booking a hotel online, right? In both cases, that first phase was all about meeting an acute need. In the case of Expedia, it was meeting, right, the desire for a better discovery experience or better access to a hotel stay. It was an entirely different paradigm shift to go beyond hotel stays and make -- staying in someone else's home mainstream. For many consumers, it was absolutely not something that they could imagine. It was Airbnb's focus on making the stay an integral part of the overall destination experience that truly resonated with consumers' expectations for today, empowerment, seamless end-to-end experience of the journey and, in their case, better holiday outcomes. So similarly, for many people, the experience that we're building in Primary360 is actually not something that they can fully imagine, right? But we're seeing those early adopters of Primary360 really invested in being well. And that spans both their mental health all the way through to their physical health. What makes us confident in our ability to unlock the growth here is the proven track record that we have when it comes to driving sustained consumer behavior change, moving cohorts up that adoption curve. And we're already seeing very strong momentum in that multiservice usage. In fact, why don't we let Ray tell us. [ Ray ] is a member who has access to our full suite of chronic condition management programs.

I got this e-mail from my medical provider about Livongo explaining this service, particularly dealing with diabetes. And since I unfortunately had acquired type 2 diabetes, I was very interested in seeing what the service was all about. They provide materials. They provide support. And they also provide a way to record your readings every day. And that's something I found valuable, so valuable that when I got another e-mail from them talking about high blood pressure, I said, "Well, I got that, too. Let me try that." My doctor has always said he wanted me to record my glucose reading every day and record my high blood pressure so he could analyze how I'm doing, I never did it. I might do it once or twice a week. But with Livongo, I know there's a record being made. And then after the high blood pressure, I got another e-mail about weight control. And that's something that I wanted to do as well. I weigh myself every day. They gave me a nice scale. It automatically gets recorded. That's important for me to know that it's being recorded and it's available for my doctors to see. I've lost 12 pounds. I reached my initial goal of 220 -- get below 220. Now my next goal is 210. My heart doctor did reduce my high blood pressure medicine. One of the side effects of that medicine was sluggishness. And so I felt very tired all the time. And now because of that, I feel much better. And it's certainly better for my tennis game and my golf game. It's becoming a way of life for me, and I believe in it. I believe what it's done for me. Health care typically treats symptoms, treat it with drugs and so on. With this Livongo program, they're getting right at those symptoms and trying to eliminate them so I don't have to take the medicine and I don't have to be treated. And I think that's the great approach. So I will continue it for as long as I can.

So well, potentially hearing someone wax poetic about our e-mails might be an anomaly. Ray's story, James' story at the beginning, these are not needle in a haystack testimonials, right? With the millions of people who have access to more than one service through Teladoc, it creates an unmatched foundation for that -- driving that growth of whole-person care. The challenge, however, is that unlocking that full potential requires taking one consumer, making them aware -- fully aware of that full breadth of services that individually they have and then driving the relevant adoption around that, right, and the relevant engagement around that. This cannot be done at scale without sophisticated, robust assets and capabilities, which Teladoc's powerful surround-sound engagement engine has been built and refined over a decade specifically to do. Now if we were to look under the proverbial hood of the engagement engine, over the course of this year, we've significantly deepened our capabilities as we brought together and integrated the legacy Livongo and Teladoc marketing data and tech stacks, right? In doing so, we've created -- we've equipped ourselves to be able to deliver highly relevant, scalable, but one-to-one engagement life cycle management, which drives those stickier relationships and which sort of allows us to reach any given member with any given service configuration. Okay. So what does this look like in practice? All right. So Ray -- one of the e-mails -- the e-mails that Ray talked about is one of the components within there. And so here, what we can see is Ray had a good week, right? His stats are up. And the data shows us that, that is the right time to introduce a secondary service. In this case, it's hypertension. Now unfortunately, for Jameson, she didn't have such a good week. And what we know is when people get bad news, they have their personalized stats, they can become discouraged and drop out of programs. So this is the moment where we need to seamlessly be able to dynamically present her with help through the mental health service. Now Chris happens to be a member of Primary360, right? Same, you can see how this engagement engine and that ability to put them through this life cycle management enables us to use an interaction that they're having with the chronic condition program of ours and really use that as a lead-in for driving engagement with his care team. So if marketing is our tech stack that effectively -- sorry, if the marketing tech stack really is effectively driving the delivery of those personalized experiences, it's data science is the supercharged brain that powers that world-class engagement engine, right? Compared to premerger, we've massively expanded the role that data science plays in creating unprecedented insights for consumer motivators and truly shaping new capabilities. Some examples on the right. First, our audience intelligence models enable us to reach very specific populations with or without claims data, which is a competitive advantage as we think about value-based care arrangements. Additionally, data science actually helps us deliver a better experience. So by combining 2 distinct data science models, we were able to drive a 24% increase amongst an at-risk population. All of this is repeatable, it's extensible, and it's having an impact on our business now, right? Not only are our campaigns better, but we're able to deliver cost efficiencies, and we're doing so in one of our most important marketing channels, which is direct mail. So historically, we focused on visits being the primary measure of our engagement with consumers. But today, as our business increasingly moves into whole person care, the breadth of interactions that take place between members and Teladoc assets, whether that's digital or human has expanded well beyond that of our traditional visit. In fact, the 590 million total interactions that have taken place over the past year is a much more relevant reflection of the breadth and scale of the engagement that we're having with consumers today. Now in the blue circle, you can see that a subset of these total interactions are actually health interactions. Health interactions occur specifically during the process of a member requesting and receiving care with a Teladoc asset or through a Teladoc asset. Health interactions include things like someone completing a wellness survey within myStrength. It could be someone responding to a nudge who's enrolled in a chronic -- one of our chronic care programs. It could be a care referral by a provider, an internal referral, or it could be a session with a BetterHelp therapist. And of course, it includes our visits. In contrast, members registering, logging in or engaging with marketing materials is really what comprises the majority of the interactions in the gray bar -- the gray area. It's really these total interactions that are the reflection of us deepening our relationships with consumers, right? Building on a very strong 2020, we're continuing to see our ability to drive growth. We've activated the -- sorry, we've increased the Teladoc activated base by 44%, growing Livongo consumer app sessions by 78%. And lastly, as more and more of our members have access to multiple services through 1 experience, we're seeing the volume of referrals, internal referrals that are made by providers grow by 86%. So to make that paradigm shift that we talked about earlier and really unlock the potential of whole person care, our consumer research shows that there is still work to be done when it comes to driving awareness and resolution confidence in virtual care beyond sort of those routine needs, right? A key barrier to overcoming this is trust in the effectiveness of the experience that they're going to receive from a care perspective. Access -- secondly, access to Teladoc's full suite of care services is a key differentiator when it comes to driving adoption. In fact, we're already seeing this with early P360 users who, with one of our early clients, almost 20% of the users had at least 1 mental health visit. And then lastly, no brand currently owns this space in consumers' minds, and Teladoc is well positioned when it comes to trust. Teladoc brand is the leader across awareness, usage and satisfaction. And Teladoc is well positioned to be the brand that people turn to first. Research across a broad audience shows that we're well associated with a broad set of care needs, and that Teladoc users -- as you can see from the stats in the middle, Teladoc users overwhelmingly see us as the provider that not only can treat a broad set of needs but actually can help resolve them. With this -- what this positions us to do is actually be the brand that extends into that white space. So as we continue to drive towards mainstream adoption of whole person care, we will continue to extend the Teladoc brand across our full portfolio of B2B2C solutions. So in summary, we're well on our way to driving the adoption of whole person care. We're deepening the relationships that we have with consumers. And we're uniquely positioned to win going forward with consumers given the unmatched experience we provide, our differentiated capabilities, the trusted brand and, obviously, our proven track record. Thank you. With that, I will turn over to Mala.

Thank you, Stephany. Good afternoon, everyone. I'm Mala Murthy. I'm the CFO for Teladoc Health. I hope what you take away from this at this morning is not Rumpelstiltskin that Jason talked about, apparently Through the Looking Glass that Dan talked about. I hope what you have taken away is the depth and breadth of what we do, our strategic differentiated assets and capabilities and how we are thinking about the business and the growth of our business going forward. And what I'll do in the next several minutes is essentially bring it all together from a financial perspective, okay? So before I look forward, just indulge me one moment, let me look back very briefly. So if you look at our revenue growth, that's on the top left. Our revenue growth over the past 3 years has been 69% on a CAGR basis. That's over 40% on an organic basis. Our business has quintupled in size over the last 3 years. From a profit perspective, we turned positive adjusted EBITDA back in 2018, as you can see. We are expecting to deliver over $260 million in adjusted EBITDA this year. That's over 700 basis points of adjusted EBITDA margin expansion over the past 2 years. That's well ahead of what we said and expected to do when we stood before you all March of 2020. And importantly, the profit is generating operating cash flow. Over $100 million of operating cash flow delivered through Q3 year-to-date. And that's important as we think about the investments that we are making and we will continue to make. Claus talked about it, Donna talked about it, and I'll go into a little bit more detail on it, so that we can continue to fuel our top line growth and momentum. So speaking about sustainable top line growth and momentum. I talked about the 69% CAGR, 3-year CAGR over the past few years. We talked a couple of weeks ago that we expect to deliver between $2.015 billion to $2.025 billion in 2021. That is a 45% pro forma revenue growth -- pro forma for the Livongo merger. We also talked about the $2.6 billion of preliminary outlook in revenue for 2022. That is approximately 30% in revenue growth for 2022. If you put that all together, importantly, we are expecting to deliver between 30% and 40% revenue growth through 2023, as we said last summer. If we look over the next 3 years, we are expecting to deliver 25% to 30% revenue growth through '24, putting us on track to be over $4 billion in revenue by 2024. So how do we think about the building blocks and the drivers for this revenue growth? Jason talked about it upfront. I'll double-click on it a little bit more. So you can see it's 3 strategic areas of focus: virtual medical care, mental health care and chronic care. So let's start with virtual medical care which is about 1/3 of our business today. That includes our gen med business. It includes international. It also includes, importantly, Primary360, okay? Dan talked very eloquently about Primary360, the product, how we are thinking about it. And what I would say is while we expect the revenue contribution of -- from Primary360 for this piece of the business to be small in 2022, we are just rolling it out with some of our important relationships that Kelly talked about, like Aetna, Centene, et cetera. We do expect the contribution from that to steadily ramp up and be an important contributor to our revenue growth by 2024, right? Now why is that? Because if you think about it, Jason talked to the fact that we have access to 92 million lives right across our clients. If you think about the fact that most of them today have a gen med solution, which they do, think about the opportunity for us to move them up to a value -- higher-value offering, such as Primary360. That's going to take time and we will ramp very steadily through 2024. We expect this piece of the business to be between 10% to 20%, accelerating, as I said, over the next 3 years. Now let's talk about mental health care. Both Alon and Dan have talked about mental health care, right, the vast opportunity for growth. It's about 40% of our business today. We expect it to grow between 30% and 40% over the next 3 years. And what's important is people ask us all the time, is it a COVID phenomenon? I hope what you took away from what Alon and Dan both said is no, it's not. While COVID has merely heightened the need, the unmet need for mental health care, we've been seeing this for a while. And these are sustained tailwinds that will fuel this growth. Chronic care, we talked about it a couple of weeks ago on our earnings call. It's about 25% of our business. We expect it to grow between 25% and 35%, both from more enrollees and enrollees accessing multiple programs, right? So that's how it all adds up to how we are thinking about our 25% to 30% revenue growth over the next 3 years. So why do we have confidence in this 25% to 30% growth? In our view, it boils down to a few important factors. Number one, what we affectionately call the membership donut on the left. You can see 92 million lives with access to a Teladoc product. That is an unmatched, unique, rich asset base that we have. And number two, think about the opportunity for us to penetrate that base deeper with higher-value products and services, such as Primary360, such as chronic care, such as myStrength Complete, right? So that is how we think about expanding our share of the health wallet. Okay. So I talked about product penetration. What is the opportunity for product penetration? Let's look on the right. So it's true that if you think about the urgent care telehealth solution, it's very heavily penetrated, over 80%. But look down on the right, unsurprisingly, things such as Primary360 and myStrength Complete are very nascent. Obviously, we've just launched them. But just look at even something like diabetes, only a 20% penetration, right? Look at our mental health telehealth solution. It's about 35%. The legacy myStrength digital product, 22%. The point being, If you take the fact that we have access to these 92 million lives, combined with the opportunity for us to penetrate further into that base, a base we already have with products that we already have, and these are our higher-value products and services, that is what is fueling our confidence in expanding our revenue per member, as Jason talked about earlier. Now it doesn't mean that we won't go after additional members. We will. You can see, again, on the left side, there is scope for us to go after additional members, whether it be the 63 million members and our own client -- within our own clients or 92 million outside of that. This is where the land-and-expand strategy that Kelly talked about is important, right? So we are increasingly having C-suite conversations and getting a toehold into additional populations with our clients with higher value offerings, conversations around 360, conversations on chronic care. And once we land, we will expand with this full suite of our products and services, including, by the way, in those products and services, the basic telehealth solutions which will unseat our competitors. That is how we think about expanding our membership over what I will remind you is already a very, very rich base. So let me now answer the question that we've been asked many times over the past year. What does this all mean in terms of the growth algorithm? We've talked about the 25% to 30%. So what it comes down to is we expect our revenue per member over the next 3 years to grow about 25%. Most of our growth, a lot of our growth will come from expanding revenue per member for all of the reasons that I just talked about. Now if you want to think about how can you translate that into, say, a PMPM metric that we report, that you're all very familiar with. So think about it this way. Every 100,000 new participating, actively participating members in, say, something like Primary360 will add $0.07 to PMPM. Every 100,000 in myStrength Complete at $0.04, and every 100,000 in chronic care will add $0.15. Think about the value accretion to our PMPM. And last but not least, an additional 5 percentage points of better health revenue growth at $0.06 to our PMPM. Membership growth will add between 1 to 5 percentage points in revenue growth over the next 3 years. So I've talked about product penetration into the member base, the base of lives we have. The point is we know how to do it. We have done it. Why do I say that? We've talked in the last several quarters about multiproduct sales. right, over 70% of our bookings is multiple products. What is that translating in? You can see what it's translating into on the left. Back in 2017, less than 10% of our members had access and use one or more solutions. Today, that number is over 40%. And in fact, over 25% of our members now use 3 or more solutions. Same phenomenon on the right. If you look at chronic care, back in 2019, less than 3% participated in multiple programs. Today, that's over 20%. So again, to wrap it all together, we have access to a large base of lives, the 92 million. There is an opportunity for us with our products to penetrate deeper into that, and we know how to do it. That is, again, fueling how we think and our confidence in expanding our revenue per member. So I've talked a lot about revenue growth. Let's talk about profit. So I talked a few minutes ago about the fact that we are expecting to deliver greater than $260 million this year in adjusted EBITDA, the over 700 basis points of adjusted EBITDA margin expansion over the last 2 years. We are driving adjusted EBITDA margin expansion and growth through both revenue scaling and disciplined operating expense leverage. And I do expect that to continue, especially on the SG&A side. Now in the next 3 years, we do expect adjusted EBITDA margins to expand by between 100 and 150 basis points. Importantly, that will include the R&D investments that we will make, and I'll go into more detail in that in a minute. And just as a quick reminder, we will not get the benefit that we got this year of approximately 75 basis points of margin expansion because of the purchase price accounting adjustments from Livongo. So what are we going to invest in from a P&L capacity standpoint? 3 areas. First, product enhancements and integration. Donna talked about how an integrated user experience is critical to serve as a digital front door to our consumer health care needs. Claus talked at length about our data, our data platform and our integrated data platform. Dan talked about how myStrength Complete is serving as a blueprint for Chronic Care Complete, right, which we will launch. So those are the things, those are the kinds of things that we will invest as it relates to product enhancements and integration. Second, market expansion, whether that is marketing dollars for Alon as he grows his business, engagement and enrollment investments to support launches of new products, whether that be chronic care expansion into international markets, something that we have talked about as we talked about synergies in relation to the Livongo transaction or new chronic care programs. Dan talked about heart failure and chronic kidney disease. That is what we'll invest in. And last but not least, Kelly talked about making the journey into value-based arrangements. We need to invest in analytical capabilities. We need to invest in data for that. We need to invest in predictive modeling, and we will invest in that. So I hope that gives you a sense for how we will use our P&L capacity to make the right investments. We will never compromise on our return measures and our need for attractive ROI. But we do believe that these are important investments that we need to make to sustain our revenue growth. And last but not least, I talked about how we are using our P&L capacity. We also have a strong balance sheet. We have over $800 million of cash through the end of Q3. And as I said, we are generating over $100 million of operating cash flow. And as we have in the past, we will use it to make inorganic growth investments. Now our filters, our criteria for assessing inorganic investments remain the same as before, right? We've talked about how it needs to enhance our vision, our strategy. It needs to be a strong culture fit. It needs to have attractive financials. And I would be remiss in saying if I didn't say, and we will incorporate the learnings of the integrations that we have gone through over the last 18 months and are still going through, right, as we assess these investments. So I hope what you have taken away from the last few minutes is the following: First, we have a demonstrated track record of meeting or beating our financial targets. Second, what I hope you've heard all morning is the fact that we have a comprehensive virtual care product portfolio and scale that creates a compelling financial model. Third, our growth over the next 3 years, as we see it, is going to be driven by expanding our revenue per member for all of the reasons that I talked about. And last, our profit expansion, our margin expansion and cash flow generation will fund continued investment in our business, so that we continue to grow sustainably. Before I turn it over to Jason for concluding remarks, I wanted to thank you for coming, for participating either in person or virtually. And I hope what you have taken away is, again, the breadth and depth of what we do, our vision, our mission, our strategy and our building blocks for success. With that, let me turn it over to Jason.

And before I wrap it up, I have an important correction to make. While you all were having lunch, I was getting brutally made fun of by my team for mixing up Rumpelstiltskin and Rip Van Winkle, So I just want to set the record clear. It was Rip Van Winkle who fell asleep, not Rumpelstiltskin. My kids always made fun of me saying I was terrible at fairytales. The good news is that I don't have to be good at fairytales to make this a reality, right? So the -- I swear that wasn't on purpose. What I started with was the opportunity in front of us is massive to make a huge impact on the health care that people get on their lives and on the health care system at large. And there's a big financial opportunity that goes with it. We have the vision to go take advantage of that opportunity. We have the strategy to execute on that vision. And we have the underlying capabilities that nobody else has. So we are uniquely positioned to take advantage of this massive opportunity in front of us. Now it really comes down to execution. And I can say with confidence that we have a track record of executing, right? We came out 6 years ago and said, here's what we're going to do and here's where we're going to go. And here's how the market is going to evolve, and we have taken meaningful steps along the way and tried to give the investor community, and quite frankly, more importantly, our clients and members, a road map for where we think things are going and how we can help make their care better and take cost out of the system and improve the health care of our communities so that we can achieve our mission of helping our members to live their healthiest lives. So I want to reiterate the thanks that Mala just said and challenge you one more time that if we have failed to demonstrate any of these, we're going to bring the whole team up for a final Q&A section, and we really welcome your questions, and please challenge us if you think that we've omitted any part of this progression. So thanks again. We'll have the team come up. Linda, I think we have a question at the front corner. So let's -- right here.

[indiscernible] from Wells Fargo. I wanted to come back to virtual first health plan side of things. So was hoping you could talk a little bit about more for the employers that have adopted these services. How are they educating their employees and pushing their employees to consider these type of plans? And when you talk about the 10% to 20% lower cost that these plans could generate over time, is there a general way that you could help us think about whether the employees themselves that adopt these plans are seeing this savings? Or is that something that's being used to sort of subsidize broader health care cost for the company. I'm just trying to think about what the factors are that are going to push people to adopt or not at all these type of plans.

Yes. So I'll take the second part of your question first and then hand it to Kelly for employer and client experience and really commercialization of Primary360. What we're seeing is a lower employee contribution when it's in a self-insured plan for a virtual first plan design because they know that the actuarial value, the actuarial expectation for cost is lower, and they want to pass that on to their employee population. Certainly, we're going to see that reflected in the exchange plans and what the ultimate actuarial cost is, therefore, minus the subsidy, what it costs the consumer. And we're starting to see the plans talk about commercial fully insured plans in small group markets and even individual non-exchange plans that are based on that, that again, reflect the lower cost.

Yes, and I think what I would also add is that there's actually 2 deployments when you think about an employer. They could actually opt to offer a P360 program as an additive layer on top of whatever plan offerings that they're putting forth their populations or they -- and/or they can add to a virtual first Primary360 offering where they're actually affirmatively electing -- their population would affirmatively elect that plan over any other plan in the lineup. So there's actually 2 offerings. And what's fascinating about it is as we've been talking to employers about the offerings, many of them are sort of stage gating, where is my population going to actually see the most value? Where am I going to see the most value? And many of them are actually talking about deploying both of them simultaneously, one being sort of a stepping stone to another. We're opening up the access point with P360 as an overlay, meaning there's versions of how you might control cost on top of your health plan. And then the opt-in model is I'm going to deliberately choose this offering and actually the way that they're modeling it is basically like you would model a health plan design. So every employer can offer sort of contribution factors to that. But we're seeing a lot of momentum in how they're coming at it, looking at it actually in concert with one another.

And Kelly, we also as we, as your team and our teams come together in the contracting phase are talking about the difference between how are they going work towards driving engagement.

Yes, yes.

So, Charles?

Yes. Question for Mala. So you gave the revenue accretion on the PMPM for the different buckets for every 100,000 members. Maybe can you extrapolate that to margins as well? So think about EBITDA contribution for each 100,000, whether it's chronic care, myStrength or Primary360.

Yes. So I'm not going to give you product-specific margins, but I'll answer the question directly and more generally. On Primary360, it's candidly too soon. But as we are having the conversations and as we've talked about the rolling out of Primary360, we will learn what the gross margins and what the available contribution margins, candidly speaking, will settle out at. You know we have a strong history of managing our margins and frankly, managing both the gross margin and the operating expense such that we get to the adjusted EBITDA margins that we want. So the fact that we are putting out there a longer-term outlook on adjusted EBITDA margins hopefully gives you enough information that we've sort of thought through all of the puts and takes. If I think about myStrength Complete and the margins on that attractive margins. So I don't -- I don't want to dissect it product by product, but I think we've given you enough information on how we are thinking about the corridors of each of those 3 areas and in addition to the overall adjusted EBITDA margin expansion.

And I might just add just sort of echoing what Alon said that the Better Health business is accretive to our overall consolidated margins.

Yes.

I think you'll see an expansion of gross profit dollars per member as we go into higher value products, higher-priced products like Primary360, where we play a bigger role, and of course, dropping through higher dollar profit per gross profit per member on a controlled expansion in our OpEx gives us expansion and the confidence that Mala talked about. Jailendra gets the second bite of the apple.

Jailendra Singh, Credit Suisse. Just to make sure -- so you're saying that mental health care growth, faster growth is actually accretive to your margin overall?

It is.

Okay. That's an important clarification. And if I'm doing my math right, there's $100 million of non-BetterHelp and DTC business in 2021. Is that traditional B2B telebehavioral business, you're moving from core to mental health because that's important because I think people are getting confused with that 10% to 20% growth with historical core growth. Actually, you moved a very important piece of growth from core to that.

Yes. yes.

Can you [indiscernible]?

Yes. So to be crystal clear, what we have categorized in the mental health bucket includes the following components. It has better help. It has our historical Teladoc behavioral health solutions. It has the myStrength legacy digital solutions, and it has myStrength Complete, which has just launched. So all of those 4. So if you think about it, Jailendra, we've taken myStrength out of Chronic Care and put it into mental health. And to your point, we've taken legacy behavioral health out of Virtual Medical and put it into behavioral.

That's helpful clarification. And just one more quickly on the 10% to 20% growth you're targeting for your Virtual Medical Care business. Is that -- should we think about it as slower growth in '22 and then acceleration because of the Primary360? Is that the way to think about it?

Yes. Yes. And if you think about it from a CAGR standpoint, given what we have talked about, Primary360, really being a small contributor for growth in revenue for 2022, and we have talked about the accelerating growth within the 10% to 20% through 2024. I think you will be able to get a good sense for how much ramping we are expecting through '24.

Steve, did you have a question?

Yes. Steve Valiquette from Barclays. And I know you're not giving the '22 EBITDA guidance today, but with that target of the 100 and 150 bps of EBITDA margin expansion over the next 3 years, I mean is it possible you could still have that type of EBITDA margin expansion in '22 specifically despite the 75 bps? Or is the message that with that headwind, you will not achieve that in '22? Just want to clarify that.

I thought you started out by saying we will not give adjusted EBITDA guidance, so I will not give adjusted EBITDA guidance. We will give it in February, pretty soon.

Is there a question at the back of the room?

It's Elizabeth Anderson from Evercore. I was wondering you talked a lot about some of the investments that you're planning to make over the next few years in terms of [indiscernible]. It has been on things like that. I was wondering if you could help put some guardrails around sort of how you think about the spend there versus in other parts of the OpEx.

Yes. So here's how I would sort of generally think about it. And again, I won't go into specific year guidance. Generally, what we have said is think of A&M roughly in line with revenue growth. Now I will say, Alon talked about the revenue to CAC efficiencies that he is getting. One of the important factors fueling the strong margins that he's seeing in his business. He's also seeing higher LTV quite candidly, right? So all of those things are expanding his margins. But just coming back to our overall OpEx. So we have to think about it is think about marketing roughly in line with revenue growth. We have been getting good leverage on selling expense and G&A, right? I would expect R&D investments, as we have talked about, to increase a bit as we invest in the things that we need to that Claus talked about, that Donna talked about and put all of that together within the context of the $100 million to $150 million.

At the front of the room, Linda. Sorry. make you walk all the way around. We have 2 questions side by side so we can take them one after the other.

Jack Wallace, Guggenheim Securities. When you're talking with employers and talking about taking risk, how much of the PMPM is at risk? Is that bidirectional, and what type of metrics were being used?

Yes. So as Jason talked about, as we are going in, making the journey into value base, we haven't candidly, at this point in time, over the next 3 years, factor a ton of that already into our growth outlook. And I would also say we need to make the investments. We are going to do this thoughtfully, judiciously, and we'll sort of do it. We've always talked about this being a multiyear ramp. And I would say, I view it as a strong enabler to the things that we have talked about, such as Primary360, such as the chronic care programs, et cetera. So it's not as if that it's very explicitly factored into our math today.

So I would also just add, we're seeing more true sort of risk arrangements with the health plans than with the employers. It's also not new for us to be paid for performance, right? We've had for years situations where we're paid based on the value that we drive. Now historically, if you go back 4, 5 years, that was just how much utilization are you driving? Because we know for every additional incremental visit you drive, you're saving this much money. And so we've had an escalating PMPM that reflected the additional utilization and, therefore, the additional value. It was sort of an early crude form, quite frankly, of value-based reimbursement. We're now moving into more sophisticated models where we're starting to look, especially with the health plans that, okay, let's look at a population of people with diabetes and agree up-front on a methodology for what's the cost PMPM or the total cost for the year of those who engage with us versus those who don't. And therefore, we're willing to put a portion of our fees at risk to guarantee the savings that we're going to drive because we know exactly what that looks like. So it's just -- it's an evolutionary thing. I don't want you to think like all of a sudden, for the first time, we're going to be paid for performance because that's been at least 5 years old.

Dave Larsen with BTIG. Can you talk a little bit more about membership expectations for 2022? And then also on your Slide 107, you highlight there's 298 million total U.S. insured lives. Why aren't you talking more about the 7.8 billion lives that are on planet Earth? And like can you maybe talk about the growth potential in other countries? Is there a reason why there's not more emphasis there? Is it because they're socialized systems, they're harder to sell into. And I would think that they would actually be easier to sell into because if they're cost-constrained, that's the whole strategy and purpose and value that your enterprise brings to those nations and those could be sizable sales as well?

Yes.

You want to me to take the international part first and then you jump into the membership outlook?

Either or both.

Okay. We'll do that. Internationally, look, I think the answer is we expect to continue to get growth outside the U.S., relying -- forecasting based on sales to big nationalized health care systems is a recipe for missing a quarter or even a -- or longer because they're big and they're binary, right? And so we don't build in any assumptions about giant sales to nationalized health care systems. That does not mean that we're not going after them, right? And that we don't expect to be able to land some of them, especially with our chronic care solutions, which we're finding a tremendous amount of interest from those nationalized health care systems. We just have to be -- right, we always forecast based on what we know, not what we hope. And so we try not to build that into at least a short- to medium-term forecast, and we view those as being upsides to our overall outlook.

Yes. And I would also say on international, we've had -- Jason and I had active conversations with the Head of our International business, David, over the last 2 weeks, 3 weeks as we are building out our plan to next year. And suffice it to say, those are exactly the conversations we are having because as we think about our international growth, and I've always said this, you can go very quickly sideways if you splinter your investments across a vast swath of countries. I think international, it's really important that we stay focused on a few big bet countries, and that's exactly what we are doing. So if you take the Chronic Care programs, combined with exactly like you said, the national health systems, we are focusing it on a few big bet countries and we are methodically going to grow into those, whether it be through the national health systems or whether it be, say, something like Telefonica, where we are very pleased with the growth.

And then membership for '22.

So just like I said, I will not guide on adjusted EBITDA. We will absolutely guide on membership when it comes time in February. We will give you all the transparency that we typically do.

I'm sorry, just one more quick one. 21% penetration for CCM diabetes into 92 million Teladoc lives, I think about 20% of the population actually has diabetes. So is that 20% of the opportunity market within the 92 million lives?

Yes.

[ Cindy Moss ] from Goldman Sachs. Stephany, maybe for you, maybe, Kelly, can you talk a little bit more about how you market to providers, how you like raise the awareness there? And then also, just in the consumer channel, like if a consumer has a plan with Aetna, how they get awareness so that they can go in and see what's being offered?

Sure, I'll start probably with the easier one, which is the consumer or the near and dear to my heart is the consumer engine. When we talk about that sort of around engagement engine, it is really comprised of our ability to work with our clients, and that may be work with Aetna, maybe work with the employer through really the scalable infrastructure that we have. And so we know that, that is a very effective way to introduce the service. And then what we also know is that all of our direct touch points that we have with them, and that may be through digital media. It could be through the direct mail that we do. It could be through, frankly, the TV advertising that we do, really is what is bringing together that whole paying off the introduction that we find either the health plan or the employer does. Kelly, did you want to add anything on that?

Yes. I think Jason was going to talk a little bit more about the providers. But just to sort of jump on to, from an employer perspective, we've always sort of taken a position that making sure that the member is aware of the services that are available to them. We take a lot of pride in that. Stephany and her team do a fantastic job sort of owning that so that our clients don't. That's the value proposition that we bring to our clients. We feel like it's our responsibility. So there's many tentacles about as to how do we get at that end consumer, whether that is via the health plan and the partnerships that we've built there to ensure that the services are -- that they're made aware and that they're engaging in them or as a direct channel, we can work directly with those employers to ensure that we have complete surround sound around engaging them in whatever services are available. And of course, it's different based on whatever that client has purchased along the way.

And then with respect to marketing to providers, we actually are -- we're in the middle of an evolution, I would say, from what was historically the InTouch business of large devices in the hospital for high-acuity situations like telestroke and telepsych [indiscernible] moving to more of a software platform that's a ubiquitous platform. And you heard from the Geisinger team about how we bring a ubiquitous software platform so that everyone can communicate with all of their patients regardless of where they are. And now we're seeing the benefit of the chronic care solutions being brought to the provider market, quite frankly, with faster adoption than we had expected, especially for those provider organizations who are taking risk. We're finding that they're very interested in adopting those chronic care solutions to better manage down the cost of care, leveraging our technology and their physicians when there needs to be a physician intervention. George?

Second bite for me, too. I hope I don't embarrass myself doing math in public here. But if you disaggregate the 3 product categories of virtual care, mental and chronic and model out your projected growth rates through '24, you could wind up meaningfully above the $4 billion target that you guys have outlined for 2024 from a revenue perspective. I guess maybe could you just talk about the big puts and takes as you think about what could lead you to be substantively above or below that $4 billion number in 2024.

Yes. So I'll -- let me start and then Jason, please chime in. If I think about the puts and takes, George, I'd say the following. We've talked at length about both Primary360 for virtual medical care as well as myStrength Complete, the product that we just launched, for mental health, right? So what is embedded in our thinking about the ranges we gave you is the fact that these are very nascent, right? We've talked about all the reasons why we believe we are positioned to win. And I think we are being, as Jason talked about, responsible in terms of how we think about the growth trajectory over the next 3 years. So you're absolutely right, mathematically, we could be at the high end of the range and absolutely beat it. But we wanted to at least give you the range in terms of how we think about it. So that's one. The second is the point that David brought up that if you think about growth internationally, there is really attractive and sizable opportunities for us to partner with nationalized health care systems, but they're very lumpy. And so what we didn't want to do is to put out ranges there and then have to come back and say, well, we have factored those lumpy things into our forecast, and that's the reason for the miss. I would also say, if I think about mental health, we have talked about the fact that these are sustained, there are sustained growth opportunities there. And that is also something that I would say when we've talked about the 30% to 40% that as we've thought about the vast unmet need there is in terms of growth in that piece of the business.

The only other one I would add, I think you covered almost everything, is enrollment in the chronic care solutions. When we sell into a population, we sell into a health plan or a large employer, we make assumptions about the enrollment that we're going to get into the chronic care solutions from those populations. And we're continuing to refine how we do that. As Stephany talked about, putting the marketing tech stacks together and leveraging the best expertise and technology from both organizations. So to the degree that we outperform our expectations with respect to chronic care enrollment, that could provide meaningful upside. We are, I think, Patrick, are we running short on time or are we still good? Two more.

I have two questions then.

So all right, the rest of you can pack up. Just kidding.

So first on behavioral, curious what's the split of B2C versus B2B in the revenue mix? And what are the growth expectations for each?

So I think we have given you enough and more transparency in how we are thinking about it. I will not break it out further between B2B and B2C.

Okay. And I guess maybe then my second question. For chronic care, how much of the growth expectations are coming from cross-selling the existing client base?

Yes. So, It goes back to the question -- I think I'll answer that question and answer the question that came up in the morning on synergies because they're sort of related Stephany, to your question. So listen, we are -- we've talked about the robustness of the cross-sell pipeline. We've highlighted in our various earnings calls, the cross-sell wins we are having. So we feel really pleased with the progress that we are making on our cross-sell, and that's absolutely embedded into the growth ranges that we have provided for Chronic Care. The thing I will also say realistically is, if you think about how our business is evolving and the whole person approach that we are taking and the various on-ramps that we have talked about at length, I do think, over time, it is going to be increasingly difficult to parse out. I totally understand you need it from a modeling perspective. And by the way, that is exactly why we have laid it out in the way we did across the 3 tracks. I will be equally honest in saying, as we think about the business, as we think about managing it, the client conversations we are having, it's all becoming increasingly intertwined. Like if I give you -- one example would be you think about what Dan talked about for Primary360. The reason that, that will be successful is because of the Chronic Care and the Livongo capabilities we have. So is that a synergy? Is that not a synergy it's completely unclear. And so I do think, over time, this will all become sort of very, very intertwined and related.

All right. I think we're out of time. Thanks very much, everyone.

Thank you all for being here and for your long span of attention.