This is Bloomberg Business Wait inside from the reporters and editors who bring you America's most trusted business magazine, plus gloom War, Business finance, and tech news. The Bloomberg Business Week Podcast with Carol Messer and Tim Stenebeck from Bloomberg Radio.
You know, one of the components of Milkin. It's a lot about finance and capital flows and where the money is going, but it's also about wellness and health. And with that in mind, I want to welcome our next guest. Dale Cook is co founder and CEO of the digital behavioral health therapy platform. It's called Learn to Live. He participated in a panel. There's an app for that, hyper Health, So we have a lot to get to Welcome. Welcome, Nice to have you here.
Thanks so much for having me.
Carol.
Let's go to the I mean I said to you before we got going, I love meditation. I think these apps have really helped people access things like that. But I also think in terms of I've heard a lot of folks finally getting a chance to talk and have some therapy online and things that they either couldn't do in the past. Tell us about the panel and some of the things that came up there is a lot of applications out there.
Well, for sure, there's a lot of opportunity. As we know, mental health has not only been a large problem for many people globally and in the United States, it's getting even more and more challenging, both in terms of people suffering and those needing to find different ways to access care. So, for example, in the United States, only half of the counties in the country have at least one mental health
care practitioner. So you mentioned talk therapy, and it's great, it can be great for any people, but the supply of therapists for those who need it is it's very inequitable.
So we talk about food deserts, yes, like therapist desert exactly.
That's a great phrase for it. On top of that, we also recognize that three out of four people in America with a mental health problem do not want to seek out traditional therapy, an in person therapist, or use teletherapy because of stigma concerns. While it's gotten better, it's still an ongoing issue. Access concerns. We just talked about that, or cost concerns, and so in the panel, I think one of the really great topics was what roles do digital health apps play and how do we assess their
effectiveness their efficacy? And I think that was a key component because we talked about, for example, in the mental health space, two ways. We look at that as subjective measures. So we were talking about meditation before the session, whether or not the app you use is clinically validated. It may or may not be, but it works for you.
So that's a subjective measure that's critically important. For example, the work that Never Lived does, but in our space, it's critically important for us and for our clients because they're paying for the service to show the clinical efficacy. And so there's a whole body of work that's been done really over three decades for many digital apps, even the early ones, to show clinical effectiveness, and even more important in the mental health.
Space, dig a little deeper into that. So how do you show that. I do think that's really important. And I do also do think that there's a situation where you're going to understand that there's something more that's needed here, right, that's right to be able to identify that that's right.
And from the time we started nine years ago, my co founder's PhD in psychology we recognize that in as much as we want to reach people in the most efficient and friendly way possible, we needed to show really meaningful clinical results. So one of the ways we do that is we measure our users, we call them members, our members progress with what we call gold standard psychometric assessment. So if you've been in for an annual physical, you may have taken the PHQ nine for depression as part
of your annual physical. That's a gold standard, widely accepted assessment tool. And so if you're in a depression program with Learned to Live, you take that PHG nine at the beginning and then at the beginning of each of the eight subsequent lessons in the program, and as that score drops, we can show improvement. Interesting, but it doesn't stop there. So we take that data, we make it public, it's reviewed, it's peer reviewed, and then it's published in
research journals. So that's step two, because it needs to really be what we would call unassailable data, unassailable clinical effectiveness data that our payer clients, our employer clients, our university clients say this is the gold standard, that it's been used for decades, and this digital health app can be tied to that, and so we're comfortable that the improvements we're seeing. The subjective part is important, but the actual data, the raw data that we're seeing is really,
like I said, unassailable. And then in turn, it's driving meaningful cost reduction for our clients. So we can attach those two together where they say, Okay, it's not just a nice to look at app and it's not just really high engagement, which we're fortunate to get in the communities that use our application. It really works.
I love the use of data, right, and just really tracking it and it's not just kind of casual at all.
Right, And I think one of the nuances, and we talked about this in the session yesterday here not was it needs to be very user focused, right, So the consumer needs to be able to kind of choose their journey. It needs to be very friendly, very easy to navigate. But underneath that has to be a very structured clinical protocols that really drive the progress.
So dip Joe or Jane comes in and they want to use the platforms, How does it work? What's it cost? Give us an idea of logistically how it all work.
Sure, so one of the ways we think about it, So we are very direct, consumer focused in terms of how we deliver the app and make sure that you're having a great experience on the app and that you're progressing with your mental health improvement. But we have organizations who are our clients. So, for example, a large Blue Cross Blue Shield plan we serve almost thirty three million Americans,
is what we cover now with our services. And so let's say you're a health plan client and you're made aware through a communication from a Blue Cross Blue Shield plan. When you come onto our site, there's a code that you enter. It's very easy and essentially you're what I call behind the curtain. There's no cost to you, and right away you're presented with an assessment that's optional for you to take, and it's a comprehensive assessment. So when
you take it takes about five minutes. You can see how you score clinically across social anxiety and soomnia, substitute depression and so on, and the results of that also help guide you into the program that we think may be best for you. Right but you can override that. So if you say I don't want to do that, I really am feeling anxious. I just want to go
into the anxiety program. You have full rain into that and then immediately if you want, you can engage with one of our clinician coaches that we have on staff twenty four to seven. So you don't just need to do the app on yourself, on your own and a self directed way. You can engage with a clinician anytime if you want to do.
Because I do think that there's nuances right when it cots to wellness in a mental wellness, if you will a mental well being, what is it cost? So it sounds like there's a lot of coverage an acceptance that's.
Right, So to the individual users, zero cost, right because the organization that you're with, your employer, your health plan is paying for it.
But what acceptance has there been in general Corporate America or health some of the major health.
Insurers significant acceptance. So we fifty per you know, it's hard to say what the overall penetration is. I can tell you that, you know, we've grown to covering over thirty three million Americans in a pretty short timeframe, and that's a really interesting mix of payers, large scale payers. You know, some payers we cover you know, twenty million of their you know, membership and then we're fortunate to see you know, twenty to thirty to forty percent engagement
of that population just with learn to Live. And so if you consider traditional behavior health, which is one to two percent a year for population, and we're doing twenty or thirty percent, it gets very exciting for organizations.
How sticky is it in terms of people who come up on the platform and then stay with it?
It's incredibly sticky. I would say, you know, if we're speaking in sort of digital health app terms, roughly thirty percent of you So wrong to say, but it's important, right, I mean, when we think about reframing mental health into a daily mental fitness routine or it needs to be sticky and we need to stick with it. And so it's been very, very very sticky, very popular. About thirty percent of our users who begin with us are still interacting with us a year later.
Your client retention rate is that very high.
Very high? And certainly we like to think that we have an amazing team that learned to Live, but part of it is that there's tremendous need.
Yeah, what's the demographics? Is there a typical demographic or is it all over all over the place?
You know it's changed over the past nine years, but I would say currently there's a few different kind of
bumps in the Bell curves, if you will. We have a really interesting use in sort of the nineteen to twenty two age Raine, so we offer our programs thirteen and up, and then we have another kind of tip of the curve in the early thirties, about late fifties, and then interestingly in the seventies and so we've moved into Medicare in addition to Medicaid, and we have tremendous use among seniors.
I'm not surprised. I mean, having had elderly parents and depression is often you know, you see it and just talking with friends that that's pretty common. Privacy issues an excellent question.
So this is where different organizations are highly differentiating in the space. And as we know, especially with COVID, there's been a proliferation of time health apps, right, and so organizations have become much more sophisticated and discerning.
It's stressful just trying to figure out how to do it.
It is and it's a highly personal journey, right. So for you as a user, you care what happens to the data that you're using in an app, it's a really big deal. And so for example, learn to Live, there's very strict protocols we follow. There's something called High Trust Certification, which is kind of a gold standard for health plants that you need to meet, Soft two compliance, Hippo compliance. All of these are standards that we've met years ago.
But even though the data, as you said, goes to research journals and stuff like, all of that is just kind of like it's.
Just that's all masked very yes, and that's with permission, So we don't ever publish. We never personally identify any of our users, even to our clients. So if you had access via a Blue Cross plan, that plan would never see your personal idelfiable data.
Just last question, what are your plans for the future.
Well, we're going to continue to grow and expand you know, there's a massive need for mental health program so that's one area we're going to keep adding new programs, and two we're continue to find really big ways to integrate into other points of the mental health care ecosystem.
Well, really fascinating, And I feel like I'm a little stress because we got to talk a little bit about banks. So I'm going to have to shift gears, but stay in touch and let me know how things are going.
As your Carol, Thanks good luck.
Dale Cookie's co founder and CEO of Learned to Live here at Milkin.
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Things are getting done, the world is moving forward, and that is true when it comes to aviation and clean technology, which is something that's come up a lot here at Milkin. So we want to talk about that with our next guest. Delighted to bring in about Miftakoff. He's founder and CEO of Zerio Avia. They have backing for Bill Gates, break Through Energy Ventures and Jeff Bezos Climate Pledge Fund.
Welcome, Welcome, thank you, thank you. Great to be here.
I love talking clean technologies, I said to you, and I love talking what's going on with aviation. Tell us about your company first of all.
Yeah, so we started a company five years ago, a lill more than five years. We have built a technology in house. We're flying multiple prototypes already the largest one flying in the UK. The company is between West Coast US and the UK twenty seedars and we just announced with Alaska, one of our launch partners and airline investor, a large aircraft development, seventy six seat aircraft. That's serious that we're looking to start running on our powertrain later this year and flight next year.
So tell me about your powertrain.
Yeah, So it's hydrogen electric to hydrogen board the aircraft and then converting that to electricity using the fuel cells and Electrica Iron's motors.
All the critical.
Technology we have in the house, which is important because you cannot really use automotive technology. It's very hard to certify, so you need to develop everything from scratch your build to the whole days.
So that's what we've done before that.
Before zero, I did the electric car company and charging systems already in sustainable transport, so this was natural.
I'm sold that.
I sold that started to think about what's next.
I'm a pilot myself, so flying helicopters airplanes is personally connected to the industry and didn't really started seeing you know, people talking about, you know, maybe we should stop flying and maybe we should all sit at home, and I really didn't like that.
So so is what we're doing the focus on evs in their current state, not the future. In terms of alternative fuel, is it hydrogen that really makes the difference? And you think that ultimately is what takes over?
I know it depends on that your book, It depends on the type of but you know, we like to think that we are unbiased. We're first principles based. Yeah, and my previous company was all about batteries.
I know, is that the answer because that has problems too, and you need power to fuel those batteries.
That's right, that's right.
But so the secret source from my previous company was exactly around that. And I did apparently yesterday on the future of mobility and all that. We had a little bit of discussion around it, and the key was, yes.
It requires a lot of new power. But those cars typically sit.
In the parking lot, either at your work or at your house for ninety five percent of the time, and if they keep kept plugged in, then you can use that battery capacity to store all that renewable power. So renewable power problem is, you know, sun shines, you have power. Sun doesn't shine, you don't have power, right, and everybody
quotes that as a problem. But if you have storage connected batteries connected all the time in these electric vehicles, then you can store that power use it later, right, So that's why I think will happen in the automotive space.
So batteries work there.
The bigger problem there is recycling off all these materials, right, because right now you know single digit percentage penetration. You know,
we have enough materials is not a huge problem. But when you have you know, fifty seventy percent of all cars being electric as a lot of chart for aviation, this is a complete non starter because you know what's worked for your Tesla, right, or for my wife's Desla, because I don't have a car anymore, which is you know, a thousand cycles on the on the battery, that's three hundred thousand miles. You ver will drive three hundred thousand
miles in your car. But in a commercial aircraft you go through that battery in six.
Months, right, like what kind of size the mattery?
Right, and then your replace, replace, replace, So material problem is huge, and even before that it wasths too much.
It doesn't work.
Hydrogen is the only way to do large commercial aircraft over long distances.
But what about some of the concerns and problems with hydrogen.
Yeah, so the main problem actually from the technology standpoints, the main problem is hydrogen takes more volume, yeah, to store. So what we are doing and we're going after the existing aircraft, existing fleets, and then existing types of aircraft, maybe new aircraft, but existing types. So what we do is we retrofit those aircraft and line fit and we're able to achieve about.
Half the range. Right.
So an example I mentioned in Alaska, they have thirty of those aircraft propel large propeller aircraft, seventy six seed aircraft on fleet. Those aircraft on fossil fuel, they can fly for one five hundred miles six hours in the air. Nobody flies those things for six hours. So we are coming in and we're saying we can't deliver half the range seven hundred miles, and all the operators say, well, that's fine because we fly them today three hundred miles
four hundred miles max. Right, Because when they were designed back in the day, they were designed for long missions, not anymore.
How big can you go in terms of like the jumbo plane that I'm going to take home from Lax back to New York. Is this ultimately what you can do?
Yeah, it's cossiles.
So within ten years we're hoping to get to what's called single aisle, so Boying seven thirty seven or Airbus A three twenty.
And what's holding you back from doing it?
Today?
We need to scale the technology, the fuel cells most importantly to these large power levels, high power levels, right, So today we have the technology that power is already twenty seed aircraft and this flying, and we're submitting that engine for certification later this year, launching twenty twenty five, so two years out you'll be able to buy tickets yeah, for that aircraft. The next size is the seventy six
seed aircraft. That will take us about five years to get to commercial, but you know, within ten years we'll be able to get to to get you.
To New York.
What's the safety Yeah, frequently asked question to the point that at some point I had, you know, second page on my presentations, Hindenberg, you know, just showing safe then and then you know the message there is technology has moved on right in eighty plus years, Yeah, so we have one hundred week meaning you know, society, right, Yeah, worldwide, we have over one hundred thousand ground vehicles operated on hydrogen by unqualified personal You can you know, anybody can
walk into Toyota dealership today and buy a hydrogen car, drive off, go into the fueling station and fuel up with hydrogen, buy herself himself, you know, without any training.
Yeah, and no incidents.
But I don't see that anywhere, Yeah.
Because you know, a hundred thousand is not a huge number with respect to you know, billions of vehicles worldwide, but they're there.
California actually has like a third of them.
But where are we then doing more of that versus the eb batteries?
Yeah, the vehicles, the hydrogen fuel cell technology is expensive now relative to the combustion cars.
Relative to battery is much more expensive.
So Toyota I think still loses money on every vehicle, and those are not cheap vehicles.
I think the is it double the cost of combustion it's probably ten x ten.
Times, probably ten What about evy batter.
Part of that is volume game as well, right, so you know you don't you don't have a long going but in aviation, everything is expensive, right, So your performance you're not based on cost, you based on performance and safety, so you have a lot more room on the cost basis, and that allows us to deploy these technologies in aviation.
And coupled with the fact that you know batteries will not work sustainable aviation fuels are really fundamentally much more expensive than hydrogen than hydrogen electric, that gives us an opportunity.
You have airlines lending up to order.
Absolutely, we have pre orders for about ten billion dollars of worth of future revenues. Might have American Airlines, United Airlines.
For bigger, for the bigger actually for.
Regional planes to start with.
So in the next seven years we're looking to do, you know, fulfill those orders, start fulfilling those orders. We are now taking deposits, booking productions laws, very exciting time.
Unbelievable now, it's fascinating. So you think in ten years from now it will be all over, well.
Not quite all over the big tween isle planes.
It will take more time, right, so these are what you would take you know, from Lax to London, for example, right, So that will take some time, but I think technology will be available for all aircraft within twenty years. Yeah, and then it's a you know, how how quickly will replace. And that depends on how committed the governments are, how committed the you know, the operators are and everybody else.
We'll come back and let us know how things are going.
Of course, love this space.
Val Michtakoff, he's founder and CEO of Zero Avia, joining us here at Milk and you're listening and watching Bloomberg Business Week, and this is Bloomberg Radio.
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Well, it has been a special edition of Bloomberg Business Week Radio. We have been live from the Milk and Institute Global Conference in Beverly Hills, and that's where we find our next guest, Rich Lesser, is with us. He is the global chair of BCG. Rich thanks for being with us. Charlie was just talking there about the FED today and the assertion on the part of the chairman that maybe we get a recession and if we do,
it will be mild. Now, you run a rather large consultancy, and I'm wondering whether or not you share the same view here. What are businesses telling you right now?
Those are two separate questions. It's a pleasure to be with you, don the first. On the first question, I'm personally leaning to the more optimistic side of that. I think we're seeing inflation pressures decreasing relatively quickly, and I think that that will continue, and my hope is that that will allow the Fed to not have to go higher on rates. I have no sense of when they
might start cutting. I think they're going to be cautious on bringing them down again, but I'm hopeful that we'll see a plateauing of where we are now, and I think there's a real chance that will avoid a recession. And I thought his words that better than a fifty percent chance we avoid a recession, and most likely if we have one, it will be mild. As for me,
would calibrate with what we're seeing and hearing. There's a second thing about how CEOs are feeling right now, and I would say the starting point is a high level of uncertainty. There's just so many factors macroeconomic geopolitical and various pressures that they're feeling, and I think as a result, there's a conservativism in the CEO community in response to an uncertain environment in terms of focusing very heavily on resilience.
There's an underlying recognition the rate of change in the world also continues to rise, AI being the focus of the moment, so I don't want to minimize that, but i'd say uncertainty and resilience are the top of mind words for CEOs.
Before we take a closer look at the kind of the global perspective, I want to get your reaction to what's been happening among some of these regional banks. We're just getting indications now that another PacWest Bank Orp. Which is headquartered right in the same city where you are right now, Beverly Hills, California, it's weighing a number of strategic options, one of which may be an outright sale, although that's really unclear at this point who might buy
the bank. When you look at the contraction that we have seen within the number of lenders, We've only been talking about four or five overall, but the footprint clearly is shrinking and their ability to influence credit in the broader US economy may bee dwindling right now? Is that concerning to you at all?
I think that there's an underlying negative pressure that comes from what's going on in banking right now. Negative in two senses. One is the large banks really face strict rules on lending, so to the degree that large banks are gaining share because they receive greater scrutiny, they may have less expanse of lending policies. And second that the regional banks themselves, facing all the pressures that we're seeing,
are likely to be more conservative. I think it's part of the reason we're most likely to see a leveling off of FED rate increases versus what we might have expected two or three months ago, because they realized there's these downward pressures coming from the credit challenges in the US economy. I think the question is how that stabilizes
in the medium term. I think there's been relatively good intervention so far to prevent a crisis from spreading that we see even in this afternoon's data, the continued pressures there, so we're not out of the woods yet, even if so far it's been navigated pretty well.
Wonder get your views on the global situation, particularly US China. We had a story earlier today on the Bloomberg Terminal indicating that the senior advisors to the White House said that the American economy is vulnerable to China's law on critical mineral processing. That just is one example. We know the semiconductor story you mentioned Ai. I'm sure that when you get into some of these advanced semiconductors, that represents
a real concern here. How do you view the US China relationship right now?
It is probably the highest level of concern for the business community. And I would say for me as well. I mean not that I don't I don't want to minimize all these near term economic pressures we just discussed, but I'm really quite optimistic we'll navigate through that period. The underlying geopolitical tension between the US and China is a different animal. It's a wild card for the business leaders to predict where it's going to go. I think
no one can predict. It's certainly not the business community, and it's extremely challenging. And you discussed the challenges of the US dependency on China for critical elements, but it goes the other way too. China relies on chips that are manufactured in Taiwan that use technology that comes from the US, from Europe, from elsewhere, so they're feeling uncertainty and risk as well. And when both sides are feeling uncertainty and you have a rapid deterioration in trust, you
have a level of unpredictability which is very high. And we're observing that it continues to seem tougher and tougher. We're seeing a loss of trust almost week by week, and we hope that the political leaders on both sides can do some things to rebuild some of that trust because the downside scenarios on all sides are very high.
What level of confidence do you have right now in the current administration to navigate that terrain.
I am optimistic we will avoid the worst case scenarios, and I think that it is really tough right now. But I think both China and the US leadership realize that why the price that gets paid if we let things really fall off a cliff here, and I think they'll be able to avoid it. The challenge is not what the intent is. That sometimes wild cards can come that no one can predict, and when neither side is talking to the other, they put their own interpretations on it,
so it's not the intent on either side. I don't think either side wants this to fall off a cliff. There's too much interdependency. It's that some of the elements that build trust and the mechanisms that allow for clear communication are not as strong as they should be right now, and we need both sides to work on rebuilding some of that.
Rich, last question, I'll give you thirty seconds talking about optimism here. Are you optimistic that we're going to get a resolution to this debt sealing issue here in the US?
Yes, but not without a whole lot of pain. I mean, it seems that we can't just move to things that seem basic in running a country or an economy. It seems we can only do it with extraordinary stress and down to the minute deadlines, and it's frustrating. It's frustrating for business leaders. They want predictability. But we'll get there. It will be really painful.
Rich, thanks so much for taking time to chat with us. Rich Lesser is the Global Chair of VCG. Live from the Milk and Institute Global Conference from Beverly Hills here on Bloomberg BusinessWeek, and this is Bloomberg.
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