Jennifer Conrad (3:09)

And so how is your company different from some of the other offerings that are out there?

Ray Wolf (3:13)

It's the access. So we get everybody in within two days. So we have same hour appointments, we have same day and we have same week. On average it's two days. Second, it is licensed clinicians and evidence based medicine. And while it seems like it was pretty standard that you would go to someone who went to school and is licensed in behavioral health care, because of the access challenges, people are turning to all sorts of solutions. I mean, as you see in the news, people are turning towards chatbots, et cetera. The other one is that we accept insurance. So we have figured out how to create a viable company in an insurance based model where most behavioral health companies are cash pay only, which is a barrier in itself.

Jennifer Conrad (3:54)

And so as number 54, you've had phenomenal growth. And I'm curious what kind of metrics you're using to make sure that that growth is continuing and going where you want it to go.

Ray Wolf (4:03)

So my background, first 25 years of my career was in aerospace and then I was in high tech. My past company was in workflow automation. So we knew right off the bat is to start out with a real strong data and systems base. So we have over 500 metrics that measure everything clinically and operationally which we use to what do we do next? Where do we get efficiency? And if you think about being profitable in an insurance based model, the numerator is what big insurance payers provide to you. And truthfully, I don't have any control over that. And while we can try to convince them to pay us a little bit more because we have higher quality care, it's a challenge. So what we focus on is the denominator and we have unbelievable metrics to help us with the processes. And we're using AI to help us automate those low value tasks, taking away administrative burdens on the clinicians so we can prevent burnout. And we also kind of continue to attract quality clinicians.

Jennifer Conrad (5:00)

Can you talk a little bit more about how you're incorporating AI and what it's doing?

Ray Wolf (5:04)

We are using it to take steps out of the normal routine, day to day routine. So if you think about someone has to write a note, they're in session with a patient. So we use AI, ambient listening AI to help with that. So it actually crafts the note. Second, the ambient AI that we use actually helps guide the interview. So we make sure it's a very high quality interview. If you think about it, right now we have about 200 clinicians. How do you get 200 clinicians? Following a televaro protocol and model. So we use AI, a lot of that, writes the notes and then we also use the notes in care from checking and making sure there aren't other high risk situations that we need to pay attention to. So about 20% of our patients will take medication. So you have to check medication against their current medication that they're taking for physical situations. You also have to watch out, you know, based upon individuals. So for example, if women are of childbearing years, you can't use certain types of medication. So we're using AI to go check that. And then we're doing non sexy things like patient outreach. We use it for call routing, we're using it to help us with billing. It's ingrained inside the whole company and it's moved super fast.

Jennifer Conrad (6:17)

Where do you think some of the growth in AI usage is going to be in coming years?

Ray Wolf (6:22)

If we focus on getting the human or the individual to work at the top 30% of their skill range and just map out what's the other 70%? And let's just challenge ourselves as how do we obsolete that? How do we automate that? Let's get people not doing the admin and the busy work. Nobody wants to come to a job and just do the repetitive task time and time again. So I think that's the biggest thing. We're not going for a moonshot with AI. We're not at this time solving behavioral health with that. But it's really super enabling our clinicians to be elite clinicians. I like to think of like Tony Stark with the suit on. Well, we're starting to feed our clinicians. Hey, this is what happened in the last session. This is what you need to check in this session. Oh, by the way, you should follow up on these social determinants. Ask the person, how are things going with their new pet, the death in the family, the job change. So I think it's going to be ingrained and it's really not hard for people to adopt it that way. I think if you start to use it in unnatural ways and start to reach too far, I think that's where you might get a Little bit pushback and people are fearful for their jobs.

Jennifer Conrad (7:32)

And are you building your own tools or is it building on ChatGPT, Claude, things like that.

Ray Wolf (7:37)

So we do a combination. You know, we started out, we have a growth mindset that really says let's get started any way. Anyhow, there's a great book by Ryan Holiday called the Obstacle Is the Way, so we've kind of adopted that. So we dive right into these problems at first. We'll see if there's anything out on the market. There's a lot of great solutions and point solutions. So we'll start with a point solution, low cost experimentation, and let's see how it works for about 90 days. And then after we figure out, you know, what it does and what possibilities exist, then we'll look to bring it in house and we'll develop our own platform and improve upon that. And we've been doing that across the entire spectrum. So we've insourced everything from billing credentialing. There's nothing that we're outsourcing at this time.

Jennifer Conrad (8:24)

Using generative AI with health and mental health can be a very sensitive subject. First of all, I'm curious how you're ensuring that everything is safe and secure.

Ray Wolf (8:34)

So the first thing is every technology that we use is HIPAA compliant, so there's special agreements that you need to sign. And not everything is HIPAA compliant, so you need to pay attention. Some of the most popular tools out there that are awesome, even using Things like Google AdWords is not HIPAA compliant. Google is not HIPAA compliant, so we have to add special technology to it. So that's the first thing. Second is we make sure that no patient information actually enters into the AI stream. So while some of the text components will enter and we'll review notes, none of that actually gets fed to AI in the public domain. So we have our own AI servers. It's private instances and we only retain it for a short period of time, which generally are the minimum required by the payers. So, you know, meet the requirements of our contracts.

Jennifer Conrad (9:23)

And then I guess the other sort of scary thing for people now is the idea that AI may be replacing therapists or even just suggesting things in a way that is perhaps not appropriate. So how are you thinking through how much AI can suggest treatment? Suggest lines of questioning without replacing the role of a therapist?

Ray Wolf (9:42)

AI can present the human with things to think about. Say, hey, have you checked this? Hey, have you thought about this? And I think that's our approach and our model is we're Always going to let the human be the final decision maker when it comes to care. But there is an area that we think about often is what about those people who can't overcome the barriers to get in to get with someone? Licensed clinicians, you know, even the $2030 co pays right now are a challenge. You know, we think about can AI be used in a sufficient way to bridge them either in a crisis till they can get care or in a situation where they're never going to go get care. So we're looking at that closely. There's a lot of legislation that's coming out right now, but we're approaching that piece a little bit cautiously. But when it comes to enabling the clinician, we're moving forward as fast as we can.

Jennifer Conrad (10:33)

And as far as regulation, what do you think would be helpful as far as clarifying the roles of AI?

Ray Wolf (10:38)

I think that the user of AI sometimes may not be aware of where the information is coming from and the sources and we might be influencing that. I think we go into AI and we talk to our Alexa and we talk to Siri on our phones and we go in there with 100% trust. So I think if we can inform people as to what level of trust for the information. You know that little bird seed at the bottom of your chatgpt that says AI information may not be accurate. I mean nobody reads that it's not sufficient. We assume that it's trustful and we assume that it's accurate and we think that it might be as good as a doctor. But I think this is where we need to have a different type of communication.

Jennifer Conrad (11:21)

One of the things that a lot of companies go through is as they're growing very quickly, they have to think about trade offs. You know, do you take a little bit of a cut on margins for market share? Do you move fast or do you worry about quality? So how are you thinking through these questions?

Ray Wolf (11:35)

So we start out, first of all, we have a system of care that has a quality level that's non negotiable. So we didn't go into this thinking that we were going to have to have a low quality of care because we're an insurance based model. And five years ago people suggested that, they said, well you could just get lower quality, less trained individuals. And we said that is not a model we're going into. So we established extremely high quality in a system of care. And that's really where the engineering and the system thinking came back in is a lot of people have good intentions but they don't have the ability and the thinking to go create a quality of care to integrate multidiscipline. So we have Doctors, we have PMH NPs, we have licensed therapists, and all of them actually work in a POD structure. So we have a level of care. The place that we're having to work really hard is opening it up to people who have different types of insurance, particularly government insurance, Medicaid and Medicare. Individuals with Medicaid really struggle with finding care. Medicaid doesn't pay enough for most clinicians to accept. We have set a model because our purpose is about expanding access. We're accepting everybody. So we haven't turned away a single patient that is on insurance now. We haven't solved the ones. The situation where people don't have insurance. And that's really the next big challenge for us that we're overcoming is how do we make ourselves so operationally efficient that we can open up our doors broadly to everybody on every insurance plan. We don't even want to have to think about Medicaid or what they take. It's like, come on, come with us. And if you think about the doctors that refer to us and about 95% of our patients come through referrals through primary care or OBGYN or a health system, they're not going to work with you if you say, hey, Ray, I only take United and Humana, but please don't send me those Medicaid patients. So it's like, send everybody. We're going to take care of them. And we treat patients 5 to 95 virtually online, 7 days a week, 8 to 8. It's really been tremendous. But we still have one big challenge that we're working on and racking our brains is even though patients get referred for specialty care, still only 50% actually follow through. So we're investigating and understanding what's going on. What are the barriers, how can we overcome? And we're not going to rest until we get 100% of those referrals into care, making sure they complete their care plan so that they can have a

Jennifer Conrad (14:01)

better life and looking forward to the next year or so. What do you think are gonna be the biggest headwinds or barriers to growth, whether it's regulatory, macroeconomic climates or things like that. What do you think for you is keeping you up at night?

Ray Wolf (14:16)

You know, our patients are really feeling the economy. We hear it. We're treating patients that are under financial stress all the time. So we have more patients requesting hardship waivers, which we offer as well. So I think the economy right now, any uncertainty with economy is affecting the every person and what we don't know is how many people are not really getting care because of that. So we worry about that. The regulatory environment is still kind of cloudy cms, the regulations around telehealth haven't been clarified. Some of them expired at the end of September and now with the government shutdown it's been delayed. We really think that the government is going to make the right choice. As a matter of fact there's great bipartisan support for mental health and for telehealth but you know, we got to get everybody back to work and we got to get the laws put into place.

Mike Hoffman (15:07)

After the break, Jennifer digs into how Ray would navigate a sudden budget shock.

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Jennifer Conrad (16:16)

Imagine you had a budget shock of 30%. What do you cut back? And what is protect at all cost?

Ray Wolf (16:23)

So the protect at all cost is our system of care, right? We don't cut back on the system of care, it's just not in our values. But what we take a look at is we really take it on as an operational challenge. As a matter of fact, we've had a payer recently who was our third largest referrer who cut back 30% and they just cited hey the market's competitive and if you want to play with us. So we did recently just have a 30. And what we did is we got the team together and we said okay folks, every season, every year there's at least one thing. Like last year it was change, healthcare went down which really had a cash flow impact. And we said what are we gonna do? And we take a look at it and we take a systems approach. We have a growth mindset and we tackle these and we ask ourselves under what condition can we continue to deliver this care and deliver access and what do we change? And I will tell you, knock on wood. So far we have not changed any benefits to our employees. We have not reduced any education investment. As a matter of fact, we've enhan that. I'll come back to that because I think that's important. But we have not added to any of our operational staff. So you know, you have to grow pretty fast to be number 54 in the Inc 5000. We have not added operational staff in about two years because we are using technology and we're scaling and we have moved the mundane tasks to AI and automation and then the rest of it is going to high human touch. So places that human touch matter. And you see across healthcare where a lot of people are going away, it's kind of like leave a message, we'll get back to you in 48 hours. Or they just email us. We're actually answering the phone. So we answer the phone 99% of the time and we're going to continue to do that. One thing I want to mention, you know, that's really important is we're a behavioral health company and we refuse to make sure that our people do not struggle. So whether you work for us full time or whether you're a contractor because you only want to work 16 hours a week, everybody gets no cost access to behavioral health care as well as their family members. And this has really proven tremendous. And really opening it up to the family has really been the greatest retention tool. And I could tell you the narrative out there is that there's a supply problem. We don't experience that. As a matter of fact, we're able to be very selective. We hire one in three that apply to our company. One, we want to make sure that they fit with our culture and they're going to thrive. And then the second is we want to make sure that they meet our standards of care.

Jennifer Conrad (18:51)

And how many employees do you have right now?

Ray Wolf (18:53)

So overall we're at about 227 and it just continues to grow. We're growing about 10% month over month. Currently we see about 8,000 patients a month across six states.

Jennifer Conrad (19:04)

And is your staff remote or partially in office?

Ray Wolf (19:08)

Everybody's remote. So it's work everywhere and it's work anywhere that you like. We love when people go and want a sabbatical and do remote deal. We've had people who go to Europe for a couple of months on the operational side, that is, or they want to Go to another state like Hawaii and work from there with, spend two months with relatives. It's like, it's great. So the virtual remote has really been a big attraction for us to bring talent. The second thing, which our surveys have shown, is the fact that we kind of are extreme listeners. We listen to our patients, which builds trust, and then we listen to our clinicians and our operational staff. And even though we can't always do what they would prefer, or at least not in the moment, the act of listening really makes a big difference.

Jennifer Conrad (19:53)

Is that something that came from you or how did you realize that listening was so critical?

Ray Wolf (19:58)

As the CEO of the company, I get to set the tone. And honestly, I started out as a big company guy. I was in big companies, billions of dollars. I was building big businesses, and I realized I didn't have as much control over the culture and how we operated. And then I just started moving into entrepreneurialism. And this is my 12th company that I worked with. And like any entrepreneur, I have stories of didn't work out. You know, I have stories where I only got it so far. But I will tell you, Talavero, behavioral health is the number one purpose that I've ever had. I think the message I would just say, you know, for everybody, whether you're in healthcare or not, is the challenges that you see in life. No matter what they are, we are not helpless. And technology is. Is the great equalizer. Right now. We're able to solve this. So we're winning the behavioral health. We are. And we're going to take it across the nation. We're in six states. We're going to move to 22, and we're going to make it accessible. And then once we make it accessible on the insurance, we're going to figure out how to get everybody into it, even if you don't have insurance.

Jennifer Conrad (21:00)

So you said you've helmed about 12 companies. How can you tell this company's going to make it? This company's not.

Ray Wolf (21:06)

It's really a kind of a gut feel inside. I've been doing this a long time, and I'll say I have never had the knowledge I have now to make a company successful. You know, when you're a little bit younger and a little bit more energetic, you think you have all the answers. You know, you actually have to make a lot of mistakes to figure out how to go do it right. So we've taken the learnings. We know when we built our company to 100 million, what we should have been doing when we were A million. And we think about this on a people, process and technology basis. And right now, if you ask me, how am I going to scale, where's the growth going to come from? It's on culture. So a couple things that we're doing there, we're adopting the whole principle of teamship. We invest in our leadership, but we're doing and moving towards a mode of teamship with, as Keith Farazi writes a lot about this. So teamship is important. We have established the mindset as growth and we have something called the televaro way, which is how to think about things, how to think about problems and challenges and reject the systems of the past that kind of tax our ability to innovate. And then lastly, we just developed a social contract. So the social contract is just really a guideline of how we're going to behave towards each other. And if you think about a culture, it's no more than the behaviors that you turn to habits and the habits that you put into systems, and then essentially that governs your entire company.

Jennifer Conrad (22:28)

So what sort of things are in that social contract?

Ray Wolf (22:31)

First of all, mutual respect. The other one is you're able to bring up concerns and exceptions to everything you want to do. But in all cases, you are moving forward. So we are going to experiment and move forward. The other is some things that come from me, like arrayism. It's kind of like go ugly early. Problems don't get better over time. So listen, if you spot something that isn't working in the company, you gotta let us all know. And while we rather not hear it, hearing it is really the first step to solving that. Following the social contract 100% of the time is not the easiest thing. I mean, I will tell you, writing down the rules of engagement, and I really would wonder how many companies out there actually have behavioral rules of what they do. We've set the bar super high. I have never had the bar set so high. And now we're holding everybody to it. But it also is what attracts people to the company is because they kind of know what to expect. They want a no surprise environment. They're happy to work hard for you, right? But if you come back and every day you're changing your mind and you got a new idea and all of a sudden your values change, it's not gonna work out so well. So bringing predictability and certainty not only to patient care, but bringing it to your operating model and how you're gonna behave has really been a boom. Like, we do not have a talent shortage as A matter of fact, we have a lot of people. You know, our goal has always been is we want people breaking down the door to get into the company. And we're getting pretty close there. The word is getting out. People wanna be part of this movement. And what we're doing at Telavero plus, it's great. I mean, it's a great purpose. Everybody wants us to win.

Jennifer Conrad (24:05)

Because you have your pick of candidates, how are you deciding who's going to be a fit?

Ray Wolf (24:09)

We do a clinical interview for that and then we have a series of questions that really ask them for. Can you tell us a time where you demonstrated this behavior? So can you tell us a time where you faced the challenge and how you dealt with it? Can you tell us a time about where you have a colleague who was pushing you into a situation? Did you speak up with candor or if you saw someone making a wrong choice or maybe it wasn't really as informed as possible, what do you do? Like, tell us about that? So we've just implemented that in the last three months as part of it. And so we're a little bit early. Just because you were successful in a similar role in another company, that doesn't mean inside of Televaril, because we operate differently. How you thrive, all those things affect the environment, everything down to the pay plan and your colleagues.

Jennifer Conrad (25:02)

Tell me about a recent mistake you would make again, because you learned so much from it.

Ray Wolf (25:06)

Sometimes it's hiring mistakes. On the surface of this one individual that I'm thinking early on, we're like, you know, this person doesn't seem to be a great fit. What we were challenged, and I'll say one of my executive coaches challenged me, is kind of change the context and say, ray, why don't you listen a little bit closer? And the individual was actually informing us of a blind spot that we had. When you're doing this for five years, you get caught up in a little bit. We listened to this individual and we found out they were bringing a perspective that we needed to pay attention. And now what we're doing is we're intentionally starting to hire people not only that have, like, experiences, but have different experiences. We think the next breakthrough in our entire company and care is going to come from someone outside of behavioral health, not inside a behavioral health.

Jennifer Conrad (25:57)

Is there anything that I haven't asked you about that you wanted to bring

Ray Wolf (26:00)

up or, you know, I think as a CEO of a company, one of the things that, you know, how do I sustain myself and how do I conduct myself? You know, with folks, you're always in the spotlight. You know, people are looking towards you and you really have to be very humble. You know, you have to realize that you make mistakes. You have to be very human. I have people who, who have very human problems. A mom who runs our billing department, she has five kids and today she had to take her son into emergency room. And you're thinking, oh my goodness, what are you going to do about billing? Billing's not going to get out. I'm going to lose a day of cash flow. But you really have to keep yourself in check there, make sure that you always are family first with that and then second, you have to think about this as a journey. So I have family needs, I have energy needs. I got to take care of myself. I give myself mental health time and break, you know, whether it's getting out in nature, putting away electronic devices. So people and companies need to make look towards a CEO and say, you know what, you're an important player in this role. What are you going to do to take care of yourself? Because we need you to be at the top of your game because we're dependent on you for certain things that we don't do.

Jennifer Conrad (27:10)

Is that something you've had to learn over time?

Ray Wolf (27:12)

Yeah, absolutely. I mean, listen, I burnt myself out. I ran and ran and ran. I didn't sustain myself. And it's a combination of sleep, health, family, friends, you know, it goes out of balance sometimes, you know, we all do. My daughter got married this year. It was a joyful time. But my goodness, the amount of time and energy that went into it. You know, one of the joys in my life right now is I have a 17 month old grandson. My non negotiable is 3 o' clock on Fridays. I pick him up, we watch him overnight until 11 o' clock. And there's no unless there's an emergency. Telavero does not creep into that space. The other thing I'll just share with you, our company is actually on the calendar. I put out what I call cognitive free time. So 4 o' clock on Friday to 7am on Monday, unless it's a patient emergency, you do not send emails, texts, team messages to your colleagues because you get them out of their flow. They're recharging on the weekends. But again, an emergency, of course we do that. But you have to take care of yourself. You have to take care of your people.

Jennifer Conrad (28:12)

That's great. Well, thank you so much. It's great to meet you and please do stay in touch with all of us.

Ray Wolf (28:17)

Yeah, likewise. Ink is wonderful, and we hope to be here for another four or five years.

Jennifer Conrad (28:22)

Yes, for sure.

Ray Wolf (28:22)

All right. Thank you.

Jennifer Conrad (28:23)

Thank you.

Mike Hoffman (28:26)

That's all for this episode of youf Next Move. Our producer is Blake Odom. Editorial, editing and sound design by Nick Torres. Additional editing from Sam Gibauer and Tad Wadhams, and our executive producer is Josh Krishna. If you haven't already, subscribe to your Next Move on Apple podcasts, Spotify or wherever you listen. And your Next Move is a production of Inc. And Capital One Business.