How Calm App is Innovating Mental Wellness

Anxiety and depression in the US have surged, and consequently, poor sleep habits have increased as well.

According to Gallup, over 17% of Americans report depression, and the Sleep Health Foundation states that up to 40% of those individuals also suffer from insomnia.

Getting help is harder than ever, due to caregiver shortages, soaring costs, and persistent social stigma.

But what if an app could help?

While smartphones are often criticized for their negative impact on sleep and mental health, Calm is reshaping that narrative.

Originally conceptualized as a meditation app, Calm has swiftly expanded its offerings to address a spectrum of issues from insomnia to mental health, amassing over 160 million users.

In our latest episode, David E. Williams and John Driscoll are joined by David Ko, CEO of Calm, to explore how his company seamlessly integrates meditation, sleep, and mental health solutions directly into your smartphone.

TOPICS
(3:57) Applying gamification to healthcare engagement
(8:30) How do you even begin to tackle a problem as big as mental health?
(9:17) The importance of brands in healthcare
(11:21) What is Calm and how did it start?
(16:43) Is there a good rationale for an employer to be managing stress and reducing burnout?
(18:18) What role can Calm play in helping people reduce anxiety and depression?
(21:59) Key takeaways from Calm and Harvard Business Review’s joint study
(24:09) Has Mental Health Awareness Month been successful?

🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (Senior Advisor, Walgreens Health) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.

🎙️⚕️ABOUT DAVID KO
David is the CEO of Calm, a top app for sleep, meditation, and relaxation, where he also sits on the Board of Directors. Before joining Calm, David co-founded and served as CEO of Ripple Health Group, a health tech company acquired by Calm in 2022. Under his leadership, Calm launched Calm Health, a mental health care solution aimed at payers, providers, and self-insured employers, bridging the gap between mental and physical health care.

Prior to founding Ripple Health Group, David was a Board Member, President, and COO of Rally Health, a digital health company. Rally’s solutions serve nearly 55 million people through health plans, care providers, and over 200,000 employers. In 2017, Rally was acquired by UnitedHealth Group.

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Chapters

• 3:57 Applying gamification to healthcare engagement
• 8:30 How do you even begin to tackle a problem as big as mental health?
• 9:17 The importance of brands in healthcare
• 11:21 What is Calm and how did it start?
• 16:43 Is there a good rationale for an employer to be managing stress and reducing burnout?
• 18:18 What role can Calm play in helping people reduce anxiety and depression?
• 21:59 Key takeaways from Calm and Harvard Business Review’s joint study
• 24:09 Has Mental Health Awareness Month been successful?

Transcript

0:00

Depression and anxiety rates are soaring in the United States and finding help is harder than ever, thanks to caregiver shortages, high costs, and social stigma. Smartphones often get a bad rap when it comes to mental health, but what if apps could actually help? Our guest today is David Koh, CEO of Calm, whose mental health program promises to relax your mind and let you wake up as the person you want to be. Welcome to Care Talk, America's home for incisive debate about healthcare business and policy. I'm David Williams, president of Health Business Group. And I'm John Driscoll, senior advisor at Walgreens Health. Come join us on the fast growing Care Talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access Care Talk content, and interact with the hosts and some of the guests. And please be sure to leave us a rating on Apple or Spotify while you're at it. David, welcome, my old friend. It's great to see you. It's great to see you, John, and thank you and David for having me on today. You've got enormous success with Com, but maybe you could tell us kind of the road that got you to this particular company, because logically, based on your background, you should be chasing some other great technology venture. But how did you originally get into technology? Maybe you could tell us a little bit about the road that brought you to Com. Yeah, you know, I think everyone's roads a little bit different. You know, for my, for me, I actually started off in more of a financial background. After I graduated, I was in accounting first and then investment banking. And I had done investment banking for a number of years at Solomon Brothers, which got bought by Smith Barney and then was bought again by Citibank. So it became Citigroup. During that time, I was privileged to meet to founders which were taking a company on a road show. I was more of the junior analyst there at the time of DoubleClick with Kevin O'Brien and Kevin O 'Connor. And I recognized early at that front that they weren't all, they weren't all, they were doing their job, they were loving what they were doing, and they really felt they could effectuate big change. I became enamored with that. And then in 99, at the end of 99, I applied to pretty much every Silicon Valley company I could out West. And I got accepted to join Yahoo at the beginning of 2000, which I joined. But that was a rocket ship. I mean, double click. I mean, in many ways that was kind of Kevin Ryan, as I recall, started as the CFO. He's an old friend and our kids grew up together. It's a, but he also came from Wall Street and that was really when. things started to really click, as it were, for the internet, you get to Yahoo and then you rise as a tech executive and you end up like helping run. The logical path for sort of tech executives is not necessarily to get into healthcare and meditation. Like what got you to this interesting place? And maybe you could talk a little bit about what it is and what drew you to Comm before we get into kind of what you're up to now. Absolutely. And isn't it funny, David, how I mentioned a name from almost 30 years ago. And of course, John knows that individual. So it's not surprising that John knows everybody on the Internet. I'll just start. Hardly. It's just as David, as you recall, you could get everybody around a large family table initially at the time when when when DoubleClick and other companies were starting to emerge AOL Yahoo, there weren't there there weren't there weren't that many of us, particularly in New York. That's true. That's true. But John, the main thing was to how many snacks you could fit snacks for everybody in the subzero refrigerator. That's that's that's absolute hot pockets, dude. They last. But David, tell us what is common? How did you get there from sort of a storied career in game social media? I mean, you could have gone any number of different directions in tech. What is common? How'd you get there? Yeah. And I'll walk you through calm. When I, when I first went to Zynga, actually my healthcare career really started from there. Interestingly enough, I went to Zynga and it was what it was a fabulous learning experience. worked with a great founder in Mark Pincus really focused on data. He really wanted to have the world play games together and really kind of just, just for those who don't, who didn't grow up in this little micro world of, of, of, of, of related companies. Zynga really, you know, you were the game, the first big public success of a game of a game gamification company at a time when the field was emerging. I mean, it was it's quite quite an amazing company. Yeah. And during that time, I met an individual that would actually change my life for many years to come. This individual was Jack Rowe. I was introduced to him by John Scully. So John was John Scully was the former CEO of Apple. Jack Rowe was the former CEO of Aetna. He asked me a question we met when I was at Zynga. He was like, how many people play games every day? And he liked playing games. So I thought it was an interesting question. And I told him 100 million people play games for five minutes a day on the Zynga network. We had that every day. And his question to me in 2010 at the time was, if you just got about 100 ,000 people, to engage in their health, you could actually help to change healthcare. And the numbers were vastly different and he encouraged me to think through some of the mechanics that we were building in gaming and bring that over to healthcare. I didn't act on that for a few years. You kind of take certain ideas, but they never kind of leave you or certain conversations. And then a couple of years later when I was leaving Zynga, I reached back out to him and he was on a board of a company called Audex. And I was fortunate enough to join that board. Really started thinking through how I could bring some of the gaming aspects around engagement to healthcare. There weren't a lot of Silicon Valley companies at that time focused in that space. And we focused on really simple things. We focused on how do you simplify experiences? And our first thing that we worked on was your health risk assessment form, your HRA. And for those of you know, it's kind of like, it's a standard form today, but a very 10 years ago, it looked like an SAT form. And what we tried to do is make it a little bit more user friendly, a little bit more Apple -like. And that was our first kind of focus area that we did. And then it kind of moved to a number of different services over time. Just for background, Jack Grow was the famed geriatrician. at Mount Sinai who wrote really the book on geriatrics and then became the chairman and I don't know if he's the CEO, but with Ron Williams, really saved Aetna and turned it into a health insurance managed care machine. But he definitely saved the company, but he had a deep background as a clinician on geriatrics. And incredibly, incredibly insightful. And how interesting that that's what... Although I will say that most his health risk assessments still look and act like something worse than an SAT form. David, how'd you do on your SATs, David Williams? You know what? I kicked ass on my SATs, John, even before they changed the curve. And I think it did it to make my kids feel better. But I don't know what it predicted exactly. But yeah, I did well enough, John. But I guess I should have focused on something else since that didn't seem to be, you know. So helpful. Well, but I think the simplification thing is really a major problem in health care in general. You know, David, you want what you want you dig into common. Let's see how the how the David's multiple backgrounds have played into his current gig. Well, you got multiple David's and, you know, multiple multiple questions. I'm actually reading a book now. So many Steve's have you heard that about Steve Martin? But we won't be as funny, but maybe we'll be as consequential. So one of the things that strikes me, you know, I started at the top of the show talking about anxiety and depression, and there's just been just so much of a explosion in that. And also, although there's still stigma, there's a reduction. All those things I think lead to this just impossible to fulfill demand. And in some ways you say, well, I sort of got to use technology, but on the other hand, maybe that isn't the best. But I mean, how do you start with such a big problem and try to actually go at it? Yeah, I think the problems today that we see in healthcare, you know, especially around your mental health and when you take big problems, you know, the way we the way I look at it today is brands will absolutely matter in terms of where healthcare is going. And so when I formed my when I left United after they purchased Rally, which was Audex renamed from Audex in 2017, 2019. Sorry. And when I left there, I started another company. It was called Ripple Health Group around the aging population. And so it was a platform for caregiving for that would supplement and support payer provider care management teams. Eventually we ended up selling to calm because at one point we realized that where we saw healthcare going was that brands were absolutely going to matter going forward. So how do you merge great brands that are trusted with people who have expertise in healthcare? And then how do we start to look at that? problem and tackle that together. And so one of the things with calm that really kind of drew me to the company was that the company turned today as over 160 million people have downloaded the product. It has over 400 million people who have touched the product to build a brand that people trust and will come and use. It's people underestimate how hard that is today with the sea of apps that are out there in the app store. There's over 2 .7 million apps in the app store today. So how do you discern one app from the other? So brands truly do matter when you get to a certain scale. And it even matters more today with the younger generation. Would you consider Com to be more of a B2B brand or a B2C? It started off as direct to consumer. And because we've been listening to our consumers, we've been developing new product lines. We built a new product line around our B2B business where we sell directly to employers. Cause our consumers said one of the benefits that we want to do is could we have this through our employer group? Could it be paid for by them? And so we started offering it to employers a few years ago and now we have almost 4,000 employers that have signed up for our products to be offered through them. It's different than our direct to consumer product. And then we've now taken that product even a step further and we're offering it to plans as well. Before you go there, David, maybe you could just step back because we'd love we have a bunch of questions about com, its effectiveness, consumer and enterprise. But what is com? I mean, and how did it start? And like a little bit of the above, but what it is and and and the and the path to get to where it is right now. Sure. It started 10 years ago by Michael Acta, Smith and Alex to. And the phone and the company initially was focused on their own mental health journeys. And they started the company around meditation. So most people first got acclimated to the company around meditation. Where the company started to really hit its stride though, was around 2017. And that's when we started with sleep stories. And what people started to resonate was that most people actually have trouble sleeping. If you talk to most adults, or most folks, they'll tell you, hey, I know I need to get at least seven hours of sleep. And it's not just the quantity of sleep, it's the quality of sleep. But actually only, it's about two thirds of the population will say that. But only one third of the population will tell you that they actually get that amount of sleep. And so often, you know, when we think about that, that's where the product first emerged. And then once they announced sleep stories and integrated sleep stories into the product, that's where folks will, like Matthew McConaughey, for example, or Harry Styles will kind of talk to you through a sleep story. It just really was bedtime stories and it really helped the company from a sleep perspective. And then we have stuff during the day for meditation, panic attacks, or in the moment. And that became something that more and more people were just using all over the world. It's a global product today. And I said 160 million downloads. And that's been something that people use a lot. I don't suppose we should dig into the one third of the people who are lying about how good their sleep hygiene is. But but okay, I I'm a buyer. I believe that Matthew McGonaghey could make a lot of particularly female friends of mine probably go to sleep. But why? What do you think it's what is it? What is it about the sleep stories that grabbed people or that works? What's the what's the secret sauce there? Is it? I can't imagine it's just the celebrities, although perhaps it is. No, I mean, it's we started with celebrities. We don't have as much of them anymore. And so what I would tell you today is we 44 % of our narrators are are people of color or different types of backgrounds and ethnicity. So we try to really meet you where you are. What I'd also tell you is that. you know, our sleep stories vary across all different topics. So some people actually will want to go to sleep to sometimes, you know, if you're trying to go to sleep to a topic that interests you, it may cause the opposite effect and keep you up because you want to hear the rest of it. So it just really depends. I think what you'll find is that in this day and age today with the complexities of everything around the world, whether it's the, you know, politics, whether it's how we're thinking about technology, Whether it's how we use technology before we go to bed at night, things are just keeping us up later and later. And so, you know, there's all this talk about leave your phone in the room, but the reality is you have your phone with you pretty much all day. So it's really hard to leave your phone somewhere else. And so we've just figured out a way to use your phone in terms of like helping you as an aid to get to sleep faster. And we're embracing that technology, not telling you to put it in a drawer. But but is it I guess I still want to know what is it about the stories that you think works? You find something for everyone. So meaning the following, you know, some you may come and say, I want one of our most popular sleep stories are are almost like high school dictations. They're they're they're they're areas that you may bring you back to college or other places. And you may be like, that's a topic that I am. That's going to make me go to sleep because that reminds me of when I was in school. It's like we have. Listening to David Williams drone on about a healthcare topic. I'll tell you, John, I was thinking back to high school, my 11th grade European history class. And I did used to say, I'd like this textbook because if I had trouble falling asleep, I would, I would use it. I guess I was a generation ahead of my time. He should have founded a company. So, so David, you're basically creating a menu of. sleep aids. That's correct. Through talk. And it works? Well, how do you know it works? Our average user uses the product for about 300 minutes a month. So that's one indicator. Another, it's about five. Five minutes a day. So about half of them today use the product for sleep. And then the other half use it during the day. So you mentioned that, you know, the B2C users, the direct consumers have asked that their employers pay the bill. But is there a good rationale for an employer to be managing stress and reducing burnout? Is that something that should be on their high on their agenda? Absolutely. I mean, thank you for asking that, David. I mean, there's two things. One, today when employees, you know, have a sea of things to choose from, whether it's around your employee assistance, choice of menus of benefits from employers today, it's really hard to discern one thing from the other, you know, the way it's presented to you, right? With the app icon and things like that. And so, you know, a lot of times these benefit managers come to us and we start to talk to them about our product and they're all users of our product. So one that definitely helps in the process when we talk to them. The second is they just want their employees to use the services that they offer. so that they find not only is the engagement and the activation really high with us, so they know actually if they offer us as a service, people will actually use it as a benefit. So often, these benefit managers talk to us and say, we have all these benefits, but nobody will use them in the company. So we could tout them, but unless we have the CEO message them or others, they won't use these products. And so many of these benefit managers say mental health is important for us, but we don't know what types of services we should be offering. And so we try to check all these different boxes for them today. And, you know, that's one of the reasons why we also renew at such a high rate with so many of our employers today. In this time of an epidemic of disconnection and anxiety and depression, to David's point earlier about, you know, we've got a disconnect and perhaps not enough clinicians. And certainly, even if there are enough clinicians as there appear to be in the state of Massachusetts where David is where there's more clinicians per potentially covered member, but you can't get an appointment for like six months. What kind of role can Complay to help people kind of deal with their anxiety and depression? Maybe you take them separately because they're really kind of different situations and then talk about how people can get at those services because it's critical. Yeah, I mean, I think part of it is just we can help you in the self -directed route. So many times, as you know, you know, 10 people may raise their hand, but not all 10 people need to go see a therapist or need to go see or go to the doctor, for example, and ask for help. And so, you know, there is a part where we do when we actually go and do surveys or some of our own screenings, we may say based on your feedback, you're in the green. And if you're in the green. You can just use Calm the app and that actually helps our overall healthcare system as a whole. If you come back and you're yellow, we may direct you and say, okay, here's a different path you may want to take. And that may mean more of our kind of HIPAA or high trust compliant product, which we call Calm Health. And if you're in the red, we may direct you actually someplace else. So the reality is you really want a product that says for the people who really need help, How do we get them to the care that they need at the time that they need it in a timely manner? And for the people who actually are more in the green, how do we offer them services like Calm? The direct to consumer piece that is. And what's different about Calm Health? Yeah, so that's something that we've worked with plans on working together. So that's more kind of directed with them. So they'll use some of our narrators, for example, in a product that's already HIPAA and high trust compliant, and they'll give us care pathways. and we'll make them go through a GAD -7 or PHQ -9 type of survey. And so what they're finding by using our products is saying... And just for those of you who have not been involved in mental health, those are the evaluations that sort of the conventional clinical evaluations that are often used to cue kind of what level of risk or difficulty an individual is suffering from that would be a conventional kind of psychosocial screen. That's right. And if you're asking someone around like, you know, what's your general anxiety and depression for, for in the survey, well, we end up trying to do there is trying to create a relationship with that patient, the plan and ourselves, because so often a plan may say, you need certain types of mental health services, but then you lose that relationship with the patient as they're going through their mental health journey. You know, we give you an opportunity to screen them. They go through a certain care pathway, and then they may actually, we may screen them again to see have they gotten better? Has some of the treatment worked? And so we tried to create more of a relationship with you in your journey, because we realize your mental health journey isn't kind of something that's one and done for most individuals. It's with you for many, for most, for many years that they're working through things. And so we want to be a part of that journey with you. There's a lot of important. stories and personal impressions that people have and anecdotes, but I know you've also done some more rigorous research. I know there was a paper published with Harvard Business Review. What was that about? What were some of the key takeaways from that? Yeah, we had, we had, we thank you for asking. We had a couple of things that we did with the Harvard Business Review. One of them was just a workplace kind of study. And we looked at organizations and said, how are you managing your stress levels? And 82 % of the response through our Harvard Business Review, review study said that workplace stress was one of their largest problems. And we started to dive into that number of the 82%. And we asked, what was the main cause of that workplace stress? 72 % said it was that the employees were overworked. So they were raising their hands and saying, we're overworked today. Well, what's leading to that? Part of that's communication. Part of that is not, you know, sometimes lots of activity doesn't mean productivity, for example. And in this new world today of many folks being hybrid or over Zoom, lots of times you're just adding more to the plate, but you're not taking away things. And so what we found was that some of the times lines of communication asking employees, are they working on the right things? Management, it wasn't always shared. So that communication line was really important. And so it could, because interestingly enough, after you asked about overworked employees at 72%, almost 30 % of those said, It's because of poor communication and collaboration. So those are just like some of the examples that were coming out of this Harvard Business Review. Well, I had, you know, I never had any crappy managers because John was my first manager, but it sounds like I made, I kept expectations low, but based on the need and the needs for collaboration communication, perhaps we should be using the app. Just tell me what to do, you know? And then, yeah, I guess Yahoo Messenger or whatever would be the way to go. That is one way. Yeah. All right, John, I got one here. So we're just coming toward the end of mental health awareness month in May, and that's been going on for a while. There's a lot of these, you know, it's a lot of other months. May also has, you know, this month and that month. Do these months, are they helpful? Has it been successful to have this mental health awareness month? You know, I absolutely think it's critical that we continue to shine a spotlight on this. I think it makes the conversation a lot more approachable. I often talk about this, whether it's Mental Health Awareness Month or the conversations that we're having right now. I believe the conversation around mental health is the most approachable it's ever been. The stigma is not as pronounced as it once was for so many individuals. And so we can actually have these conversations. I contrast that with where my parents live today in Korea. And if I were to go back to Korea, They are not having conversations around mental health the way we have conversations around mental health today. There is still much, there's still a very real stigma around saying, I need help. or let's talk about mental health services in the workforce today. So just the fact that we continue to highlight some of these things around mental health, health awareness month, I think are critical to continuing the dialogue going. Well, that's it for yet another episode of care talk. We've been speaking today with David Coe, CEO of calm and learning about all sorts of exciting. and calming approaches to mental health. I'm David Williams, president of Health Business Group. And I'm John Driscoll, senior advisor at Walgreens. If you like what you heard or you didn't, we'd love you to subscribe on your favorite service. And thank you, David, for joining and bringing us a little bit of calm. And David's my anxiety driven relationship.