Interview with Joon CEO Emily Pesce

0:00:10 - David Williams
Teens and young adults are facing a mental health crisis, with record numbers recording clinical anxiety and depression that's been made even worse by the pandemic. Today's guest, Emily Pesce, is CEO of Joon, which provides world-class, outcomes-driven mental health support for teens and adults. Emily is driven by her personal experience and her professional roles at Amazon and elsewhere. Hi everyone, I'm David Williams, president of Strategy Consulting from Health Business Group and host of the Health Biz Podcast, a weekly show where I interview top healthcare leaders about their lives and careers. Please leave a comment, subscribe or leave a rating. 


Emily welcome to the Health Biz Podcast. 

0:00:49 - Emily Pesce
Thank you so much. It's wonderful to be here, David. I'm so excited to be part of today's discussion. Outstanding. 

0:00:56 - David Williams
Well, we're going to talk a lot about what you're doing now, but let's actually wind the clock back, if you don't mind. I always like to ask people about their background, their upbringing, partly because a lot of the people that listen to this podcast, you know they're interested in becoming CEOs. And I speak with CEOs and it's like, well, that's great, they're a CEO now, but how did they actually get there? So, you know, any childhood influences have sort of stuck with you throughout your career. 

0:01:23 - Emily Pesce
Unfortunately, we're winding the. We're having to wind the clock back further and further these days as I get older, but I think, as it relates to childhood influences, one that's unmistakable and something I had great privilege being around and seeing was my dad was CEO of a company. This was more in my teens, and so I was able to see him well before he was CEO, but then as well when he was, when he was leading our organization, and what it meant to him and how it affected him, often in wonderful ways, but also often in ways that show up for you know everyone CEOs included including stress and anxiety and those sorts of things. But most of all, the thing that that I noticed from him and my mom as well, in in what she did in her career, which was she was a teacher who worked mostly with special needs students was the joy they brought home from interacting with others. And there's a thing I remember most clearly about my dad's work was when I you know, when you're a kid you don't really understand what business is or what work is or what mom or dad are going off to do. You just know they go off to do something. But the thing I did remember was? I don't. He wasn't talking about the business, he was always talking about the people. Like we had towels, towels and chairs and things like that that were branded his company, but the logo was the place to be. It was where the where he wanted the employees to be the thing he was most proud of was being voted one of the best places to work. I remember that stuff so clearly and that I guess it's in my DNA too. It just rubbed off of me in my career. I'm sure we'll talk a little bit more about that. 

The things I remember most clearly are those I've worked with and those that have invested in me and lifted me, and then those that I've had some impact on, and I think at a point you kind of get addicted to that and you want to do it at greater and greater scale, and a good place to do that is as a leader, and so you don't have to be a CEO to be a leader. You can be a leader without a title, of course, but when you're leading a company in the way of Frank Sinatra, you sort of get to do it your way and you get to really set and build a culture, and one of the startups are hard in many ways, but one of the really exciting and interesting things about being part of a startup is you do get to set a culture. You don't inherit one. Cultures are very difficult to change once they're set in place, and so it's been. 

I think, part of that childhood influence and what I saw and the values I was taught when I was growing up, which were certainly influenced by what my parents were doing professionally of course rubbed off and have sort of led to the path that I've walked down here professionally, so hopefully that was helpful, but those are the things that come to mind right away, yeah. 

Sounds good and what? 

0:04:13 - David Williams
did you do in terms of school after high school? What was your focus? 

0:04:17 - Emily Pesce
So I traveled down to North Carolina to go to Duke. 

0:04:21 - David Williams
Yeah, why not? Why not, you know? 

0:04:24 - Emily Pesce
I was so excited I mean, you do the college tour as a kid and who knows what you're looking for but for some reason I showed up on that campus and it was magical and I had to go there. I applied early and I got deferred, I remember which was just such deep disappointment, had to do like 12 more applications, which is not fun. But I wrote them a note every week. I was like this happened this week, here's what I did, here's what I accomplished. And they eventually I probably annoyed them enough where they let me in and it was a wonderful experience. 

I studied a weird cross -section of things there. I've studied public policy, genetics and then computer science as a minor and the thought there was just to create as much option value as possible. I'm like well, public policy is you could kind of go into business or maybe even law and genetics. Like there was enough pre-med stuff there. If I decided I wanted to go into med school I could do it. But computer science was always what I could fall back on. Like I knew how to write code, I knew how to. Back then just having a computer was sort of a cool thing. So it was a wonderful place to be. 

We won basketball national championship while I was there and it was a taught me a lot, that's speaking of people taught me a lot about community. 

Duke basketball is Duke basketball to a lot of people, but to that community it is the foundation of a thing that very rarely happens, so rare that you get undergrads and grads and people from different backgrounds socioeconomic backgrounds or ethnic backgrounds, people studying different things all rowing in the same direction about a single thing, a commonality, where everybody's high fiving each other, whether they know them or not. 

There's no frats and sororities or nerds or cool people, it's just everybody is pulling in the same direction and that's what coach K meant to Duke and its culture in that campus. And those are magical moments where everything else melts away and you sort of share a human experience from a place of commonality and it's a true gift that Duke has that. And to win a national championship and feel sort of the pinnacle of that was an incredible experience. But the things I studied gave me a really unique sort of background across a bunch of different disciplines and some have carried through well in my professional career and others I certainly took a test about some things related to biology. Today I'm sure I would not do particularly well. 

0:06:37 - David Williams
That's okay. Well, we give you a chance to study. We don't ask any pop quiz type questions like that. Thank you On the Healthis podcast. Now, when I looked at your career before Joon, there were three main companies. I saw one of which I know well and two which I hadn't heard of. So I saw CGI, amazon and Nerdy. So what was your earlier career like? 

0:06:57 - Emily Pesce
Well, I packed my bags up from Duke and went to DC, and right outside of DC, in Fairfax, virginia, was a company called American Management Systems, or AMS, which was bought by CGI shortly after I arrived and they had a healthcare practice, and so I think there was enough about what I had done in sort of economics and public policy plus this genetics and computer science thing that they saw my background would work well with the practice they were building. It was a consultancy, an IT consultancy, and what they were doing at the time was helping large hospital systems implement medical record and building systems that were sort of migrating away from paper and to the time there was no cloud infrastructure on premise sort of server architecture, and so for a few years I helped build that transition some of the largest healthcare systems to digital medical records and digital building systems. It was a way to learn a little bit about healthcare, and certainly there's a bunch about healthcare that's idiosyncratic and unique and challenging. I remember one of the things that was super clear there was how the you know, the rock star physicians in those hospitals really dictated a lot about what the hospitals did, and they often did not like switching to changing their notes to a digital system instead of scribbling on a piece of paper, and there was a lot of work we had to do to get them on board, but that was a relatively short lived thing. I stayed there for about three years and then went to business school. 

I went to business school up in New York City and went to Stern, which was a wonderful experience, and the thing I would just highlight there was when I was leaving. It was during the 2007 financial crisis and all my friends were going to investment banks and at the time, a lot of people from NYU going to Bear Stearns and I had offers from a few of those banks and then I really I did that because they were on campus and it felt like the cool thing to do and everybody was doing it. But I really wanted to go build and I had the foresight to go fly out to Seattle a place I'd never been and interview with Amazon and get an offer from them. So I was weighing should I go to this bank as an eye banker and do the three to five year thing and get all the experience, or go out to Seattle, far away? Everybody in New York said you're crazy. At the time, amazon was not a sexy company. They were shipping textbooks and I chose that, which is good, because two of the three offers I had in banks ceased to be banks within like the next several months and Amazon turned out to be an incredibly formative experience. 

So I joined Amazon to help build Amazon Fresh, which was their first foray into grocery beyond sort of shipping dry goods from a normal warehouse, and so we started in Seattle and built that from the ground up. So we were, you know, wearers of all hats. I joined in a product capacity but you know, wrote code, picked and packed in the fulfillment center, drove trucks. We ran out of driver capacity. You know, was involved in pitching to Bezos and other leadership there and just really saw what it took to build. And that was an incredibly, it was an amazing experience. 

It was not easy but, wow, I looked back on that so fondly. Kindle started to take off and so there was kind of an internal draft to get resources to Kindle because of the rate at which it was growing, and so I was pulled off fresh onto Kindle, worked there that led to Jeff's kids started playing more video games and there was a belief that AWS, which was pretty new at the time could offer a lot of connected type services to mobile and game developers, so I started doing work in AWS around meeting those audiences needs a little bit better. I could spend several hours talking to you about Amazon, and I'd love to, but I will pause there and give you the opportunity to ask the next question, or else I will take several hours, but that's a formative experience. 

0:10:39 - David Williams
Well, the only one I saw nerdy was that yeah so I'm sorry. 

0:10:45 - Emily Pesce
The story of nerdy begins with my parents successfully begging me to be closer to them on the East Coast. So I moved back to East Coast to be closer to them. That's tough to me, going from a family I love them tremendously and I had done New York. So I moved back to DC and what I did was when I joined Amazon, the stack was like 30 bucks and I had made this. Another good decision I made in retrospect was I lived off my salary, not the RSU that Amazon granted me, and so you know, a few years ago, before the split, amazon was $3,600, was like a massive venture, like return for a public company. So I started taking that money and doing some early stage sort of angel type investing in the DC area, and that started to go well. So for a few years I was basically function as an investor, started a fund called Working Lab Capital with a partner who I knew from NYU. We did a lot of investments around the DC area. I still sit on several of those boards. I have had some of them exit. One of them, at the beginning of this year, exited to Instacart, which is super cool, and so that was great. 

As the pandemic picked up and I was sort of beginning to feel the operator itch like. It's hard to get the Amazon out of you. You resonate there. I got a call from some friends who had worked with me on Amazon Fresh and they were helping to lead a big part of this company called Varsity Tutors. That was traditionally a marketplace that helped put tutors in people's homes and part of their longterm plan was to virtualize a big part of their experience so they could extend the access to high quality supplementary educational support to those who don't live near tutors. That would help make, for example, really high quality tutoring in any subject for any age available to somebody who lives in a rural area or make more affordable tutoring available to somebody who lives in New York City, where tutors are incredibly expensive. 

And then COVID hit and their five year plan became like a five day plan and so I got a call hey, can you help? And I basically showed up that Monday. No title, didn't really know what amount of money I was going to make or anything, but I trusted the people, like going back to where I started with my childhood, like they were great humans. They had invested me back in the Amazon days. I knew who they were culturally, how they like to build, and it felt like a really interesting moment because there was so much, so many dynamic things happening because of COVID and they were right in the middle of it. And so we built a learning, a virtual learning marketplace with supply on one side tutors and demand on the other kids. 

And as schools shut down and varsity tutors at the time had some trust in a brand as they'd been operating for a while and had a brand built around it, a lot of demand flowed to us and we worked really hard to create the world's best learning environment and to extend its capabilities more broadly and make it effectively as efficacious as we could. And it was a wonderful, wonderful journey. And company got taken public as nerdy. There was sort of a recognition that the brand varsity tutors was somewhat limiting as it related to many of our ambitions beyond sort of a core tutoring product and to maybe older populations or younger populations, and so we took it public as nerdy. But the varsity tutor sub-brand is still pretty active and pretty much the main sub-brand that they're operating out of. 

And that is like I'll lead a little bit here and then pause so that you ask any questions about the work experiences, but that, being part of a marketplace, it's applying to man Again, and a virtual thing in the center turned out to be one of the reasons I ended up at Joon, which is in some ways very reflective of what the Joon environment looks like for therapy, and I can talk about how I got connected to Joon and how we sort of lean into it. But that was the time at nerdy and, yeah, those are the three probably meaningful professional experiences if you sprinkle in a little bit of sitting on the investor seat that have led to where I am today. 

0:14:31 - David Williams
Well, that's good. It would rise to hold onto those RSUs at Amazon. Some would say, well, you're already over-weighted in that sector, but if it's going to do really well, it's great. I've seen the opposite happen. Well, of course, sometimes they don't end up being worth anything. But I saw something with a biotech company here in Boston where somebody had sold a little bit earlier and they said be careful sitting on that couch because it cost me a million dollars, because they probably sold their stock at the wrong time and it went zooming up from there. 

0:14:59 - Emily Pesce
That's so true, and I mean it's not. When you join a company, you're not like this thing's going to be worth a thousand X or a hundred X more Like maybe you're like maybe two or three X would be great. So the thing that I always held in my head for Amazon and maybe a piece of advice I would give to those who are asking that question was there was one metric I could not let go of, and that was this may be dimensionally true, but it was definitively true. About 10 years ago, maybe even five years ago, e-commerce was still a single digit percentage of total commerce, and Amazon was clearly a market segment share leader, and I had been around the leadership of that company around Bezos and Jassy and Wilkie and Harrington and there was no doubt in my mind they would out execute. That's just who they were, and so it was very hard for me to think what is the downside here? 

Is E-commerce going to be a single digit percentage of overall commerce forever? 

I know there's categories that don't translate well cars, houses, whatever but there's a lot of headroom here and they've got a platform like a legit platform to expand upon and they are relentless about that, and so it just felt like remaining leaned in there made sense, and there's a lot of lessons about big markets and companies that have cultures built around earning the right into adjacencies and things in those big markets, and that was what Amazon was exceptional at. 

And so if you combine sort of conviction about size and stage with execution and mentality around and ambitiously attacking things, you end up with a deep conviction that things will trend in the right direction. You don't know how. You don't have to actually be a particularly great forecaster of the details, you just have to believe what I described, and that turned out to work really well for me at Amazon, and that pattern gets matched in a bunch of different places, and so that was a little bit of the magic of the place at the time, and I think that's where they accrued tremendous value in the equity. So I mean, careers are a lot about timing and I was very lucky to join Amazon when I did and I feel thankful and grateful that I did. 

0:17:18 - David Williams
Good. So I'm going to ask you the question about how you got interested in Jun and how you got there. But one step back from that and just say when Jun was established, what was the need for that and how did the company get started before you were there? 

0:17:33 - Emily Pesce
Yeah, so I'm not one of the co-founders of Jun. So Jun was founded by Dr Amy Missoules and Josh Hearst, and Josh was. He had two kids, I think two, maybe three their boys and they were getting close to being teens or were just becoming teens, and I think any parent of that age group is at least adjacently aware of what's going on with mental health. And Josh's observation was I'm not sure we're doing the best we can, like it feels like we can do better, especially for this audience. And so Josh is a guy who has deep intellectual curiosity, and so he started poking around and a lot of his intuition turned out to be right, like there wasn't really a lot of great solutions that took advantage of, for example, technology that was targeted at teen and young adults. And so, as a curious person would do, he started to connect in his network to look for experts, and he was connected to Dr Amy Mozulis, who has spent her entire career around adolescent mental health. She's written scores of research papers on it and her research has been funded by the NIH. She has graduated many master's level and PhD level clinicians into the field that do research and do clinical care. And so when they got connected and really started talking about. Was there an opportunity to do something different? They felt there was, and so they sat down and started to build a set of ideas and products around making just a better path for achieving really healthy well-being, mental health amongst teens and young adults. And it began as sort of like the internal name was uplift navigator how do I navigate? A complex set of things related to uplifting myself, my own perception, my well-being, my mental health and, as obviously translated to Joon, which I think is a much better brand, of course, but that's where it got started and I think they were spot on. And, of course, as COVID hit, it was a pretty good like to lean again maybe a little bit forward in the conversation. 

You talk a lot about healthcare on this podcast. One of the things that's true is healthcare is a little bit stubborn and how frequently it changes and adjusts and adapts and embraces things that are new. But what COVID forced in healthcare was a pretty rapid adoption of telehealth and one that probably would have taken decades otherwise, and that was a foothold for Joon, which is fundamentally a teletherapy business. There's a lot more to it which I'm happy to talk about to thrive, and so, as again, in all things business, timing is important, and that was like a really, really wonderful. All the terrible things that COVID was. One of the really nice things is it advanced this acceptance of teletherapy, and the reason it's nice and I'm happy to explain in more detail is teletherapy actually ends up being the most effective modality for working with teens. If there were no COVID and you had the opportunity to sit down in person, teletherapy's still better, and what it also does is it extends access, and that's critically important for all, especially to groups that don't traditionally have access to mental health care. And it is at an amazing moment, because COVID is not what has caused the major in growing mental health crisis amongst teen young adults. 

It started in 2011. And it's effectively started with two things the ubiquity of mobile phones and the software running on them, namely social networks, but also with the growth of, sadly, adolescent homicide and gun violence. Most other predictors of poor mental health amongst teen and young adults, things like abuse, bullying, parental substance abuse, socioeconomic status those are all flat or declining on a rape basis. The only two things that are deeply correlated with this decline in mental health are time spent online and guns and gun violence, and we've effectively dramatically increased the number of stressors on teens and young adults really serious stressors. Being worried about getting killed at school is not an easy thing to handle. Scrolling through social media and making a sense of like my body is, I hate my body, I'm dumb, I'm not welcome, I'm not that is really hard to deal with, and if you're a teen, as your brain is literally developing and you don't sort of have the mechanisms in place, what that tends to do is spiral into hopelessness and all kinds of other presenting symptoms that we work with. 

And so for us to be able to offer this virtual platform for therapy, as enabled by COVID, was really in some ways fortuitous. And so that's where it got started, and I'm super thankful to Josh and Amy for their hard work in getting it off the ground. Josh is very much get it started, get it to a product and then move on to the next thing, like his curiosity is so intense. So Josh and I started talking through an introduction made by one of the initial investors in Joon Pioneer Square Labs here in the Seattle area, and Greg Goddusman and Julie Sandler, who are founding partners there we got introduced, and when I heard what Joon was doing and we could talk a little bit about my personal experience. It came very important for me to understand whether I'd be the right fit, and obviously we all felt that that was the case. And here I am. 

0:23:14 - David Williams
Great. Well, that is a great explanation. When you look at and I do look at the youth mental health crisis, it's really staggering the percentages that you see of people that have a clinical level of. There's always the angst and everything as a teenager. But when you go beyond that to really impacting someone's function and being clinically depressed or with anxiety, it's just really quite something. And then even more so if you look at particular subpopulations and I think in particular, as well documented in the LGBTQ plus community, the numbers are even higher, for even beyond and I wonder, can you explain that beyond the, maybe the gun violence and the social media? 

maybe they tie in there too. 

0:24:02 - Emily Pesce
Yeah, I mean social media certainly does. It exasperates bad things to often levels that are far greater than they deserve to be. But yeah, so like I realized I was trans pretty late in life I was 38 and it was both a clarifying moment it helped me understand myself in a way that I hadn't before and an incredibly terrifying moment. I thought in that literally in the middle of second, the light bulb went on. Oh God, like you know, I have a wife. There's a kid on the way. You know, I'm gonna lose them, I'm gonna lose my family, I'm gonna lose my friends, I'm gonna lose my job. That's, sadly, a reality for trans people. And so I engaged in therapy and it was very helpful for me, but that's not the primary motivation I had when I eventually had transitioned and come out. I hadn't lost my family and I hadn't lost my friends and I still had a job, and sadly, that was enough to put me on the extreme end of privilege in the trans community. Like it's like terrible that that's the reality, but sadly it is. And so I was like I gotta get back. And so I started participating, engaging with learning with great organizations like the Trevor Project and others that are working with these populations and once you spend any time there, you realize how bad the situation is for youth. Greater than one out of four trans youth will try to commit suicide in the next year or have in the last year. Overall, one in four LGBTQ plus youth will try to commit suicide. One in four girls will seriously consider attempting suicide and three in five girls feel persistent feelings of hopelessness. There's no clarify, there's no qualifier there, except for girls. Yeah, it is rampant amongst all populations and it is unacceptable. 

Back to my dad and company culture from the beginning of the conversation, he's a big human culture investment. Like that's what he's about, and one of the things I've heard him say in the past that really lit up in me when I started hearing this is like a good way to judge society is how we treat our most vulnerable, and kids are vulnerable. Teens are vulnerable. Their brains are literally still developing for their mental health to be where it is and for some of the metrics I just said, which are terribly sad to be true. Just, we cannot allow it to continue, and so there's a little bit of a feeling of helplessness. How do I help? What am I gonna do? Like this is a big problem, and so when Joon became an option for me to go spend my time at, it was really a path for me to let that energy and that need and desire flow into something really productive. But you're right If I mean, I can speak from a lived experience. I now know a little bit more as an adult. 

But if you're a trans kid and the government around you, your community, your church, your family sadly, your friends all basically say you don't exist, you're weird, like it's, you're broken, you're sick, you know worse, you're gonna mutilate your body Like what do you start to think about yourself as a kid? And one of the really one of the things that Trevor Project will point to it from their studies is it takes one person in a kid's life to use the pronouns that they want One for them to feel enough hope to make it to a place where they can get away from the negativity. One person and who is that person? Often teacher. It's the person furthest away from those who should but won't honor that their families, their communities. And what have now we started to do? We started to legislate teachers away from being able to do that. So what it does is it effectively creates a hopeless situation. 

When you hang around with psychologists, enough, you start to hear studies, and one of the things, one of the studies, that really stuck with me was they did an experiment with mice where they put them in this vat of water. That was not escapable and generally they gave up in about 15 minutes and drowned. Then, as the control, they reran it. But before that 15 minute hurdle they pulled the mice out, dried them off, fed them, put them in like mouse wonderland, whatever that would be like, and then they put them back in and in the second stint the mice lasted 78 hours. So they went from 15 minutes to 78 hours and the difference was my interpretation, the power of hope. That second group knew somebody might come save me. 

It's worth keeping going and I think we as humans dramatically undervalue how much hope matters and how little we have to do to create it. 

We can be dispensers of hope by doing not that much and it's a very empowering feeling. 

And so for trans youth again an audience I know a little bit more we're not providing enough of that, and social media makes it worse. I mean, it's not even social media. I simply go on CNN and I hear the way politicians are talking about me. It's just deeply discouraging, and what it leads to is my life's not worth living, and so, anyway, it's a very, very, very critical and important problem, and it's certainly prevalent amongst communities like the LGBT plus community. But, like one of the things that one of the populations we're beginning to work with at Joon now which we're so grateful to be able to do so with a partner, a company called Valorant, as Care Navigation Company is work with Native American populations. That's another group where there's a tremendous need for mental health support, and so we need to find these groups and help empower them, give them hope, give them agency over their lives, help them understand they deserve to invest in themselves, they deserve to be happy, and that feels like incredibly satisfying work, david. 

0:30:02 - David Williams
So, emily, it's a great concept, a great background and so on. What are some of the specific things that you do from the offerings that Joon actually has? Like, how do you go beyond identifying the situation, which is certainly very important, having empathy and so on but then how can you make a practical impact? 

0:30:21 - Emily Pesce
Right. So and you mentioned this a little bit earlier and you're spot on, but like the biggest input to. So, if you're in a medium or high acuity level of mental health need where therapy is the inappropriate thing for you, and so and you're a teen like one of the greatest in 80, 20 problems, right, one of the greatest inputs to a good output in that case is showing up at all Therapy at all. And getting a teen to show up to therapy in the first place is hard. Getting them to show up to anything is difficult, but then getting them to show up, like on a weekly basis, to something is like okay, well, what are you asking me to do as a parent? Like this is like literally impossible. And so what we have to acknowledge, and one of the reasons why the virtual modality is so effective with teens, is if we can make it easier for them to show up. Guess what? They show up more often, and there's like a chasm worth of difference between saying, hey, kid, it's time for you to get in the car with me, to drive to the office, to the human adult that, like you don't know, in a place you've never been, to sit in a room with me outside. You don't know how thick the walls are to talk to somebody that you've never met and we have to do that every week. Versus, hey, log into your phone in your room surrounded by the things you know, you love and you trust, where at least you know how thick the walls are, and then start being vulnerable, like so it's. If you just put yourself in those shoes for a second, you realize, well, hey, this virtual thing has a much greater shot at doing the biggest input to the whole thing getting somebody reliably in therapy at all. And then the other side of that is like okay, great, like virtual is cool, like I can imagine it'd be easier to get my teen in therapy if they're using their phone, which obviously paradoxically, is part of the problem, but at least they're familiar with it and they'll do it Is the phone also then extends the audience of clinicians that could potentially meet the needs of your teen or yourself if you are a teen. So no longer am I now bound by the clinicians that are available within a 15 mile radius that I can drive to or my parents can drive me to, but now anybody in the state or anybody who has license to work in the state who may be in another state, becomes a population that I can work with. And if I want somebody, so if I'm in the BIPOC community and I want a therapist that looks like me and has a lived experience like me, now all of a sudden, not only is it easier for me to show up to therapy, it's actually easier for me to connect to somebody who I want to connect with when I'm showing up to therapy. 

So one of the things that Joon offers is that and we should not underestimate in all businesses, 80% of the problem is like kind of obvious and straightforward, and what Amazon taught me is you just gotta put your head down and execute relentlessly to do the best version of that 80%, but like, don't overcomplicate the thing, do that well and you're gonna drive great results. And then what that has earned us is an opportunity to then take the technology and begin to influence the experience in ways that you couldn't in a brick and mortar or physical space which is between therapy sessions, live therapy sessions on device, on the client side. So for a teen or young adult, we've got a bunch of sort of digital therapeutics which you interact with asynchronously, things like surveying and mood tracking. You can do. You can discover yourself or have skills assigned to you by your therapist, skills like how to build resiliency or how to calm or how to cope. You can practice those skills and that interaction and engagement with therapy in between session supercharges the 80% results. So now we're like migrating to the 20% solution, but by staying engaged. 

Basically what you're doing is you're it's the transference of agency. You're beginning to gain a foothold over your mental health. You're happening to it instead of it happening to you, because you're now being given tools that you can invest in and you can feel those tools start to give you that agency to have an impact on what could have felt like crippling anxiety or depression or self-harm or an eating disorder. And then, when you show up to therapy the next time, it's not like a cold start, like I haven't thought about this in a week. It's like, oh, I've been, I've been mood tracking or I've been surveying or I've been practicing. And then you and your therapist get straight in and on the therapist side, it's not a mobile experience, it's on desktop. 

And that's by intention, because, in addition to the audio and video that they see, we surround that session with the best of evidence-based, clinically supported approaches to that particular client's needs. So we're bringing to the clinicians foreground the best of what research has said to help that particular situation, plus all the information about what that particular client has been doing between sessions and, of course, the session history. So it supercharges and empowers the clinician to do a great job. And of course, in mental health we know one of the big eventual constraints is how many clinicians are there out there, fewer than the overall demand. So if we can take so we want more clinicians. A new clinician has a fundamentally sort of smaller ledger of work experience than one that's been around for a long time. So if we can help supercharge their like experience and work by bringing to them what they need in that session we're now taking brand new clinicians or maybe bottom quartile performing clinicians and getting them to median or top quartile performance. 

And if you compare it to what used to be a room with a door that closed, that was intentionally private and it was a teen therapy sort of situation, how is the teens supposed to know if the therapist is doing a good job? 

How's the therapist supposed to know if they're doing a good job? 

Like it's a black box and so what the technology has not only made access possible, not only made better matches possible, not only helped teens with comorbidities and acutes that fluctuate and them being teens engaged in therapy, but it's also supercharged it and created a little bit more transparency and grading awesome outcomes. 

And that's where, like I think you were very gracious in describing Joon in superlatives earlier and I'm thankful for it, I'm so thankful for the team. We deserve it and I'm confident we can say we deserve it because we're very transparent about our outcome data and that's what matters in this space. Like we have to be honest with ourselves and transparent in how we're measuring results, because, at the end of the day, our products, unlike in Amazon, is not delivering groceries where we forget your cereal. It's okay. We're dealing with high acuity needs amongst teens, who I just told you are often seriously considering or have attempted suicide. This product cannot fail them, and so we've been incredibly intentional on making sure it works and we're really, really proud of how the things I just described have come together to deliver what we think is the world's best therapy experience for teens and young adults at a moment where they really need and deserve it. 

0:36:57 - David Williams
So, emily, talk about this partnership that you have with the city of Seattle. I see that's been announced publicly. What's that about? Why is it good for them? Why is it good for Joon? 

0:37:07 - Emily Pesce
It's a great, it's a perfect question in this narrative, because the other impediment to access which is a theme we were sort of touching on it I'm not sure if I said the word access out loud is cost, and the reality of therapy is it costs a lot and it is a privilege for people. And it should, because, at the end of the day, the other side of therapy is a human and therapists are much like teachers. I learned a lot about teachers from my mom and from the work we did at Nerdy. They're heroes. I mean, imagine your job and your ability to earn income is linearly related to with time. It's an hour session and so if I want to make more money, I have to do more hour sessions. And what is an hour session for you? It's you interacting with a human who is a teacher. You're interacting with a human who is at a moment in their life that's so intense emotionally that they need a therapist. So you do more and more of those. I'm sorry it does not have zero emotional impact on you, so it's a very, very hard job. What do you wanna do in Joon? 

None of our strategies will ever be about removing COGS by paying therapists less. I want to pay therapists more and more and more, and so what we need to do is figure out how to make therapy a little less reliant. We need a supercharged therapist so instead of working with 20 people, they can work with 200 somehow, and we'll figure that we'll earn the right into those innovations. But it's expensive today. And so what the city of Seattle has done and I think the leadership in the city of Seattle are amazing and forward thinking on this is they've set aside money to subsidize the cost of therapy for populations within the city that otherwise would not have access to it, and so they've worked with us to provide that subsidy to us and then for us to connect to those populations and to begin to dispense our products to them. And so we're working with 22 agencies within the city who have relationships and daily interactions with folks who could use it, and they are referring those folks directly to us, either directly from the kid reaching out or them reaching out on their behalf, and we're getting them in this world-class model of care, and the team at Joon is very, very driven to provide access to all, and as a startup, we haven't earned that right yet from an economic perspective. We have to build a business that can sustain long enough so we can figure out how to both invent and economically support access for all. But what deals like the city of Seattle provide us are the opportunity to start doing it today, and we're super grateful for it. As a company, we learned a tremendous amount from it and how we build our product, because we now have populations that look like everyone, which is fantastic. We get to bring our clinician populations, which are particularly diverse, to those populations, which we're very proud of. 

But we also solve and I know this is the business of healthcare, we talk a lot about that it solves a really important business problem, which is in our world. We have a supply marketplace where people show up and in a supply marketplace, so in this case, clinicians, they principally care about. There's other things they care about, but if you don't have rate the rate at which I'm paid per hour and opportunity how much of that rate I can earn if I so desire the marketplace doesn't make sense and people disappear. And so when you bring them on, that's great, but you have to supply demands to them, and one of the really difficult challenges in mental health is, despite this tidal wave of need, connecting to demand is complicated, and it's complicated because of stigma and in the case of teens, there's generational and family stigma related because parents are almost always involved, whether it's for consent or helping to pay, and then they're deeply emotional moments. It's just a hard selling environment and so it becomes very and we as a society tend to, like all things healthcare, tend to treat things reactively, not proactively. So, basically, families defer, defer, defer, defer, bam, there's crisis, I need help now. Where does it show up? It shows up in a Google search Teen therapist, now teen therapist near me, therapist for my teen. So that auction gets bid to the moon. It's a deeply emotional moment, like, how, like it's very expensive and complicated to connect despite the demand, and that's one of the challenges of our business. 

We are two products. We're a therapy product, but we are an acquisition product as well, and so one of the ways you can help there is to partner. You can partner with organizations that have relationships with people who run wait lists for therapy, and one of those really wonderful partners are, of course, payers or insurance companies, where they have the other combination of not only a wait list of people that they're members that might need care, but they're also subsidizing the cost of that care through their members relationship with them. That's the whole purpose of the insurer and the. But the challenge that presents in a marketplace model is when you have a commercial agreement with a payer, go live, it doesn't mean you have any clinicians credentialed in their network and of course the reason they're doing a commercial agreement with you is because they want to add supply to their overall network. So if you're just taking a bunch of people who are already in their network and bringing them under Joons umbrella, it's not as interesting to them and credentialing, sadly, can take three months or four months or five months. So you've got a problem now as a business where you want to bring supply so you can begin to submit the credentialing or a paneling process internally to these payers you're bringing on board. But you have to fill the demand of that supply for several months before they become credentialed and you can work with the subsidy. 

And so deals like the city of Seattle are fantastic because they allow that supply to start working with, by the way, populations that supply wants. The clinicians want to work with people in grants that are underrepresented and it helps us sort of step up and build the business. So from a business perspective, this is a very complicated, hard business and that has its challenges, especially as a startup with a thin balance sheet. But it has its advantages because if you can execute well, you start to build mode. It's like hard to go replicate these relationships and get this marketplace spun up. 

So that city of Seattle deal both helps us advance our moral imperative, which is access, but also the way we execute our business, and we're obviously grateful for our partners at the city. Since we've announced that deal, which is relatively recently, we've received outreach from two high schools in the area who have funds that they want. They've effectively asked us to go duplicate the deal or replicate the deal with them. And so there's a lot of need, david, and there's a lot of dollars. Governor Newsom down in California signed on nearly $5 billion bill targeted at teen and young adult mental health last year but it's about the anniversary of that. So a lot of dollars sitting around, a city and county and state level agencies that can work to help us create broader access, and so that's a model we're going to look to lean into. 

0:43:51 - David Williams
And my last question for you is whether you've had a chance to read any books, or you know, Kindle titles certainly count for that, and anything that you might recommend to our listeners. 

0:44:02 - Emily Pesce
Look, I'm not read, I've not completed a book. I guess I should say it sometime. I've been very busy. I always like hate this question because it makes me look like an idiot. But I will say I do get to listen to podcasts as I'm driving. We have a four year old and a two year old, so, like as we're trying to shuttle them between. And there was a podcast I listened to recently Am I going to? I think it's called the hidden brain. I'll check that out. 

But one of the things I really like is when we discover things about ourselves which, like overusing the word paradoxical, but like they're just surprising. And one of the podcasts was about how we, as humans, always underestimate the value of our kindness and overestimate people's criticism of things we do. And the example in this podcast was somebody had found out that a person that they had known from years ago like they hadn't talked to really a bunch in the last call 10 years had gone through a pretty nasty divorce and they cared about that person and they're like, oh you know, I hope she's doing all right. And they were driving through the town that they knew that person lived in and they were like I should just reach out and have coffee and give them a hug, but that person convinced himself not to do it because they're like that person's gonna be like are you stalking me on Facebook or Instagram or wherever I am? Like, how do you know I got divorced, like what? And so they didn't do it and they just did their trip and didn't stop or whatever. But had they, what would have happened is that person almost certainly would have deeply appreciated there was another human out there who cared about them, cared enough to stop on a road trip to say, let's get coffee, I'd like to give you a hug, I hope you're doing okay. And whatever degree of uncomfortableness they might have had, that somebody knew that they got divorced is vastly outperformed by the feeling that they get by knowing somebody wanted to be kind to them. 

And so I think about that a lot in the context of Joon and what we're doing overall, which is how can we build products around that like weird hurdle we have in our bodies, which is helping people understand the impact that they make when they do simple, kind things. And so I think about that particular podcast a lot and it is hidden brain. It's a wonderful podcast, just like yours, and if those are done, listening to your podcast at any given day, it's like it's a good one to listen to. But I think about that a lot and I, like you, know this may sound awfully capitalistic of me. But how do I productize kindness, how do I productize caring? And to me, what that sounds like is how do I fix the cold start problem? 

Because I think humans can get addicted to being kind. I think humans can get addicted to feeling the joy that they can bring to others, and I think it happens a little faster than when they're the opposite. And, and so I think that's one thing that I listened to recently that I try to bring in my own life, by the way, like now, since I've listened to that, there's been several occasions where I'm like, oh, I should just say hi, like, what am I doing? So I hope that I hope that qualifies for your question, but I'm doing a poor job. I've got this, this great book, right here, so now I need to read next. So I can't say it's good or not, but this is your brain on. Food is an important one as well to listen or to read, as it relates to mental health. 

0:47:18 - David Williams
Sounds good. Well, Emily Pesci, CEO of Joon. Thank you so much for joining me today on the Health Biz podcast. Thank you, David. You've been listening to the Health Biz podcast with me, David Williams, president of Health Business Group. I conduct in depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services and healthcare, check out our website healthbusinessgroupcom.