515: Healing Minds, Changing Lives: The Meru Health Experience

Kristian Ranta, the founder of Meru Health, shares the company's journey from its inception to its current status as a leading provider of mental health solutions. Kristian reflects on the decision to pivot Meru Health from a wellness-focused to a healthcare-centered company, emphasizing the importance of overcoming fears and listening to intuition in entrepreneurial pursuits. He discusses the challenges and rewards of building a healthcare startup, highlighting the complexities of navigating regulatory frameworks and securing insurance reimbursements. Throughout the conversation, Kristian elaborates on Meru Health's unique approach to mental healthcare, which integrates therapy, coaching, and app-based interventions to offer users a holistic and personalized experience. He underscores the significance of community support in mental health treatment and explains how Meru Health's platform fosters connection among individuals facing similar challenges. Kristian also delves into the company's plans for expansion, both within the United States and globally, while addressing ongoing challenges such as securing insurance reimbursements and maintaining high standards for talent acquisition. Meru Health Follow Meru Health on LinkedIn, X, Facebook, or Instagram. Follow Kristian Ranta on LinkedIn. Follow thoughtbot on X or LinkedIn. Become a Sponsor of Giant Robots! Transcript: VICTORIA: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Victoria Guido, and with me today is Kristian Ranta, CEO and Founder for Meru Health, a new standard for mental health care. Kristian, thank you for joining me. KRISTIAN: Thanks, Victoria. Great to be here today. Appreciate it. VICTORIA: Wonderful. To break the ice a little bit to get us started in the conversation here, I don't know if you can hear it, but I have a slight cold and congestion going on. And since you're a healthcare startup, I thought I would ask you, what is your favorite comfort food when you're sick? KRISTIAN: I don't know whether it's a comfort food or not, but I think kind of what I always consume if I get, like, some flu symptoms or stuff like that it's ginger, honey, and then garlic. I try to combine these things, and it's semi-tasty. Like, it depends on, like, how strong you make it, but it's definitely effective. So, it's been my go-to thing when I get sick. VICTORIA: Me too. I like to try to put all those things into a soup of some kind [laughs], some chicken soup. I've learned how to make some sort of version of congee, which is, like, a rice porridge, which I love because you can kind of just sit it on the stove, and it cooks all day. And you could add in all those flavors, and it comes together really nicely. For me, I think that's really nice to think about what you like to eat when you're sick because when you're sick, it affects everything else going on in your body. So, I'm sure you have some personal experiences about how your mental health and your physical health are all interrelated. KRISTIAN: I mean, totally. Actually, like, I've been a biohacker for quite a while. So, I've been, like, just trying a bunch of things, like, on the physical health side and, like, exercise. And I'm from Finland originally, so a lot of cold exposure, sauna, swimming in the icy water, stuff like that. And then, of course, a lot of, like, different dietary tests that I've done over the years. And I think there's, yeah, I've recognized that there's a huge connection, and it's like the mind and the body are not, like, disconnected. They're in a way the same. Personally, also, like, a big piece kind of for me in this regard has been my journey of meditation. So, I started maybe, like, 10, 12 years ago, started meditating every day, and then I've done a bunch of different retreats and kind of dug deeper. Especially through meditation, I've learned very [inaudible 02:15] to experience the connectedness of my thoughts, and my emotions, and feelings, and the body. So, anyway, that's, like, one of my favorite topics, so... VICTORIA: So, it sounds like you've always had this interest in the mind-body connection and how to optimize your health. How did that lead you, or what about your background led you to found Meru Health? KRISTIAN: I'm from Finland originally. So, I moved to the States in 2018 with Meru Health with my current company. But way back, I studied computer science, did my undergraduate and graduate studies in Finland. And then I kind of, like, ended up working at a healthcare company, a startup company, while I was still studying. And I worked there for a couple of years. And this company was a clinical trial software company, so making it easier for pharmaceutical companies to collect data in patient trials for, like, new drugs, and new developments, and stuff like that. I was basically at that company for a couple of years, and that was my first dip into healthcare and technology, the intersection. And I got so excited, and I realized that, hey, this is a place where I can use my excitement for technology and my skills and all that stuff. But I can also then, like, see the immediate improvement in people's lives and how we can help others, and that kind of resonated with me. So, I quit after two years and then founded my first own business, which was in diabetes, so one of my co-founders back then is a diabetic. And that's kind of, like, how I went into healthcare. And, for me, then learning the mind and body connection started at the same time. Pretty much I kind of, you know, again, mentioned that I've been meditating for a while. So, I started meditating, and I started just learning about these things and just, like, became super curious to understand the human experience on a more broad basis. So, that's how I started. VICTORIA: I love that. And I'm curious if you could talk more about the mind-body connection and also maybe to describe, like, how these issues are treated currently. Being in the United States, it's like, you have a doctor for your body, and then one for your brain, and one for your teeth, and one for your feet. And it's kind of interesting that it's broken up that way. But what's your take on how healthcare treats people now for mental health versus physical health symptoms, and what would be the ideal state? KRISTIAN: I think that's one of the fundamental challenges of our time, that there's all these silos in healthcare. Because, again, what we know already today is that, like, your emotions and your thoughts have a huge impact on your physical body, and, you know, you can experience that yourself. Everyone can experience that by doing meditation, and yoga, and things like this. And you can start learning and feeling and seeing that, like, very concretely in your own ways. There's also something called biofeedback, which you can do with some of the apps like Aura and, like, Headspace and others. And then you can you do it with some wearables like with Fitbits and others, where through your breathing, you can, like, instantly see, actually, the changes in your heart rate variability, meaning that your nervous system state changes in real-time. So, some of these things were, like, eye-openers for me. And I realized that if we, like, keep on focusing on some areas separately, that's going to be challenging because, you know, we're not going to see the full picture. And that's exactly what Western medicine is doing today. On the other hand, I think there's hope because, you know, there's more and more interest and more and more, like, bridging the gap here going on with companies like Meru, but also with, like, many, many other companies and many other providers and practitioners that are working in this domain. That's kind of, like, fundamentally the challenge that if we, let's say, we go to a physical doctor, like, a primary care doctor, they never, almost never, address any of the mental health things, although we all know that they have a huge impact on your physical health. Like, there's a ton of research that stress has a big impact on your diabetes, as an example, and your glucose balance if you're a diabetic. Like, usually, no doctor, you know, your endocrinologist or diabetes doctor will not talk about the stress or will not really, like, address the mental side of your diabetes. So, I think still, like, disconnected, but there are numerous areas where reconnecting these things better will be beneficial. And that's, again, one of my sort of personal goals in life and my mission to, like, drive this change [inaudible 06:06] in the future. VICTORIA: Well, that makes sense to me as someone...I grew up with a parent who had type 1 diabetes their entire life. And what's also, like what you're saying, what's not discussed is if you get a diagnosis like diabetes, that also has an effect on your mental health. And you can stress about it. It can lead to depression. It can kind of make everything a lot worse. Do you also have any personal experience that led you to be really motivated in solving this problem? KRISTIAN: One thing that I've openly shared is that I, unfortunately, I lost my oldest brother, Peter, to suicide. You know, the story with him, he was struggling with mental health challenges for a long time. He got access to care in terms of, like, he got medication. And, you know, prescription medications, unfortunately, for him, just made it worse. And he ended up, like, not really, like, benefiting, but just actually, like, struggling more and more. And that's actually one of the things, also, what I realized when I founded Meru Health after my, you know, I used to be in diabetes with my first ventures. But now building my third healthcare business, Meru Health; it got started from my realization that the mental health industry is broken. Like, most people are only getting access to psychiatric drugs, as an example, as a sole remedy. Like, you know, they don't have access to a therapist. They don't have access to any kind of support. They just see a PCP for 10 minutes, and they get a prescription, and off you go. And then the PCP, you may not see the PCP anymore at all, or maybe in, like, three months, you have, like, a phone call with them or whatever. So, like, that's kind of the experience also with my brother through which I realized this is not adequate. This is crazy. Like, if that's the way we're trying to treat these conditions, it's not going to work. And through that, I did a lot of research and a lot of investigations in my early days before founding Meru Health after I had sold my last company. And what I realized, there's roughly, like, two-thirds of people that get access to mental health care, like, either psychiatric medication or maybe some therapy. Two-thirds of people still they don't respond to that care at all. One-third will respond, and only one-sixth will actually reach full remission of symptoms, meaning that they are completely in the clear with their symptoms. So, that was kind of a crazy revelation for me that, like, two-thirds, like, are not getting anything out of these treatments. So, that's how I kind of eventually then realized that, okay, we got to rethink this model. Like, this model isn't working. Like, if we are only giving people mainly access to these two remedies and only, like, one-third's getting any benefits, then this is, like, really bad. Like, we got to do something about it. And that's again why, you know, I founded Meru Health and Meru Health being about a more holistic approach, not just about, like, talk therapy or psychological aspects, but also sleep, nutrition, biofeedback, learning to regulate your body, your nervous system. There's a community, peer support community, and there are providers. You work with providers as well. But that's on the background why I kind of became super passionate about mental health care and what were some of the insights that I gained where I realized that this system is, like, so broken; we got to do something about it. VICTORIA: Well, I have so many questions about Meru Health. But before we get into that, you mentioned you had started two other healthcare companies before this one. So, as a serial entrepreneur, what lessons were the most important that you took from those previous experience going into starting Meru Health? KRISTIAN: There's many. So, I mean, like, first of all, when I founded my first company, I was, like, straight out of school, like, pretty young. And, I mean, like, I struggle so bad. Oh, it was such a hard journey. Like, it was a medical device company, glucose monitoring. So, founding a medical device company in Finland back in the day straight out of school was, like, a huge struggle. Eventually, we, you know, we sold the business after, like, seven years or so, but it was, like, a big learning curve for me, a lot of blood, sweat, and tears [laughs] for sure. I think few learnings from that first business were it's extremely important to design your culture, and, like, culture is everything. Like, culture eats strategy for breakfast. So, if you don't have a culture that's clearly thought through and designed, it's going to end up being whatever. Like, I mean, like, every organization has a culture, but, like, mostly, the culture has not been intentionally designed. And why that's important is that if you just let it grow weeds, whatever, it will grow in various different directions, but it does not necessarily serve its purpose that you may have had in mind. And, again, what I realized is that when you hire people, and you start growing the company, it's extremely important to, like, calibrate the values of, like, why are you doing this? What's important for this culture? Like, how do you want to work? Why do you want to work? And then, like, what are the kind of different rules and rituals and, like, habits of the organization that will make it successful in its mission? I never knew that when I founded my first company, and the culture became, whatever, erratic. Like, you know, it was just, like, really hard, also, because of that. And we were not able to recruit the best people or the right kind of people for the right roles because we weren't clear on, like, what are the values? Like, why would someone want to work with us? And how to streamline these things. So, I think that's the single biggest learning for me so far on my entrepreneurial journey that you got to very intentionally think about why do you want to build a company, whatever company you're founding. Why do you want to do it? What's going to get you up from bed every day to do your thing? And then, like, how do you want to work? Like, how do you want to work, yourself, accountability? You know, all these things. And what do you expect from others? Like, how do you want to work with other people? So, that's kind of, like, what we actually...with my current business, Meru Health, like, we had, like, a value workshop with my co-founders before we founded the company. And we actually spent a lot of time in aligning and thinking about, like, these questions. Like, why do we want to do this? And with Meru's case, all of us founders we have mental health struggles in our family, so we all kind of came together because of that. We wanted to, like, help fix, at least make a dent in the system. And then, you know, we kind of spend a lot of time thinking about also, like, how do we want to work with each other? The listeners thinking of founding a company, it's just really, really important to think about, like, also, how do you work? Like, what's the level of accountability with each other? And then, how do you, like, if you hire the first employees, how do you also translate these things to them as well so that there's cohesion, that there's, like, alignment in the team? Because if all the arrows, so to speak, if they all point out in different directions, you're not going to create momentum, which you'll need to be able to break through and get to your first milestones as a company. So, I think that's the most important. I could, you know, talk about that for a day or so, but that's, like, the most essential learning for me personally, which I've applied, like, carefully after that. VICTORIA: Well, I can imagine that having a clear vision and a set of values that you all know you're working together helps create a good emotional environment for everyone who's at the company, including you who's going to be repeating what the values are, and what the purpose is, and what you're trying to get done as the CEO. KRISTIAN: Totally, yeah. Yeah, and, I mean, like, I can also, like, maybe continue on one more point there. One of the values for Meru Health we actually chose compassion and kind of kindness. Why did we do that? Like, many people have asked us like, "Why do you have, like, compassion or kind...like, why is it relevant for your startup?" Well, I think it's extremely relevant because, like, there's not enough kindness in the world. If you're kind of intentionally building kindness into your organization, you know, you're also going to enjoy the journey so much more yourself. Because myself and my co-founders, we all figured that, like, we've all been part of other startups and being in, you know, at consulting firms, and we've been grinding like hell at different places. And, you know, it can be exciting. It can be fun. But it also can be pretty, like, challenging sometimes. But we figured that if we are able to instill or kind of, like, inject kindness into this kind of founding spirit of our company, into the culture of our company, Meru Health, you know, it's going to be so much more fun for us and also for all the future employees. We know it's going to be hard. Like, building healthcare businesses and healthcare companies is really, really hard. It can take, like, a long time. It's a marathon. It's not a sprint. So, you kind of, like, need to do it for a long time and be committed and hold yourself and the team accountable. But you can do it in a way that's fun, and you can do it in a way that's, like, kind. You can be respectful, and you can be kind towards others. And it's going to be much more of a pleasant journey. So, that's one concrete example of, like, what came out of our value workshop and why we chose kindness or compassion as one of our values. VICTORIA: I think that's so important and a really great foundation to build your team on and to really find the best talent that fits what you're trying to do. So, once you founded the company, you had your values workshop. What were some of the early discoveries in your process for founding Meru Health that maybe led to a pivot or a change in the way you were approaching the problem? KRISTIAN: I had a pretty good sense of, like, what the problem was. So, as I described, like, I did a lot of research on the problem and, like, really understanding what are the caveats in the current mental health care system? Like, what's not working? So, I had a pretty clear understanding. And, again, like, having built other healthcare businesses before, I kind of, like, had a lot of experience already in general, like, how to build healthcare businesses. So, that was kind of a helpful starting point for me. But what happened, actually, in the early days was that we first started from a more preventative perspective. So, actually, our first product was more of kind of a coach-led or a kind of a...it was more, like, a coach-led approach to workplace wellness and prevention of mental health problems. And we kind of built an app-based program where, you know, we'd have a coach work with you through video calls and through chat, and then you'd have, like, different lessons and different activities in the app on a week-by-week basis. And, in many ways, like, that worked pretty well. Like, people were excited. We got engagement, and we sold that to, like, a bunch of enterprise customers. And there was excitement. But we realized a couple of things in the early days, which is really important, and this was, like, the first half [inaudible 15:57] when we had founded the company, that a lot of people didn't really have a clear problem when they came to us. Thus, the engagement wasn't there. So, people were kind of, like, just "surfing," quote, unquote. They were coming in and testing and trying it out. But they maybe were stressed and stuff, but they weren't really, like, having a real problem that they wanted to solve so that they would actually spend time with the product and, actually, like, learning skills, changing behavior, things like this. So, that was one big realization for us. The other thing we realized was that in our societies, unfortunately, prevention is not yet valued, meaning that there's no money in prevention. There's no...it's really hard to build a business when there's no, like, existing payment pathways or existing reimbursement from insurance companies. Many of these structures are missing in our environment or in our society, meaning that then we kind of realized that it's really hard to scale this kind of a business because it's really hard to make an impact because no one's willing to pay for prevention. Even though we had, like, great results already, and there's some good evidence already out there, but still, it's not the same as, like, the healthcare industry definitely exists and is working. And there's a problem, and you need to fix the problem. And whatever sickness or illness it is, there's kind of reasons and investments for fixing this problem. So, we pivoted this to be a healthcare company, not a wellness company. We actually applied...pretty much applied the same product idea. We just replaced the coach with a therapist. And then we basically still had the app-based experience for, like, learning, like, homework, things like this. And that's kind of how it, like, structurally changed. So, that was our pivot. We've actually only pivoted once, and I'd say, like, fairly minor pivot even because the same product, same idea is still there. It's more just, like, a little bit of a twist on, like, okay, we're not trying to, like, prevent things in a way. We're not trying to sell it as a preventative, but we started selling it as a healthcare intervention. And maybe one more thing I think it's going to be essential or maybe interesting for everyone listening. I actually had the idea of building the healthcare intervention from the beginning, but I was too afraid to, actually, like, pursue it. I was too afraid because I felt that, oh, like, if we're going to build a healthcare company, like, it's harder, you know, it's going to be, like, complicated. We have, like, this new approach, the mind and body approach. It's going to be, like, novel. It's, like, hard, you know. So, I had all these fears in my head, which kind of prevented me from, like, really jumping. My intuition was already telling me that this is the way to go, but I pushed it aside. And I was kind of like, hey, it's going to be easier to just, like, start with this preventative angle with, like, you know, you don't need clinical providers. You can have, like, coaches. It's going to be easier, you know? So, I was kind of, like, taking the easy path. I was kind of, like, too much listening to my fears, not my intuition. And, eventually, we ended up pivoting, and we ended up where I had actually imagined the whole thing being from the beginning. But I wanted to tell this because, at least for me, on my journey, it's been, like, many times that I realized that sometimes these things are, like, if you distill them to the essence, like, what's the essential question here, it's like, is it the choice of fear or choice of love? And is your choice in life in, you know, being a founder, in life in general, is it coming from a place of fear, or is it coming from a place of love? That's something which I think was kind of another key learning for me that I was so often making decisions that were based off of a fear. And I was kind of, you know, choosing things because I was afraid of something versus not being, like, excited about something or believing in something. MID-ROLL AD: Now that you have funding, it's time to design, build, and ship the most impactful MVP that wows customers now and can scale in the future. thoughtbot Liftoff brings you the most reliable cross-functional team of product experts to mitigate risk and set you up for long-term success. As your trusted, experienced technical partner, we'll help launch your new product and guide you into a future-forward business that takes advantage of today's new technologies and agile best practices. Make the right decisions for tomorrow today. Get in touch at thoughtbot.com/liftoff. VICTORIA: Well, one thing I've heard from therapy is that the feeling of fear, the answer is more information. And maybe you could tell me a little bit more and our listeners, like, what makes creating healthcare apps scary? [laughs] What are some of those challenges that are different from what you might expect just building a wellness app that's not having health data involved? KRISTIAN: Yeah. Healthcare is, of course, like, regulated, and there's, like, you know, there are certain standards for care depending on whether it's mental health care, diabetes, or cardiology, or other areas. Like, there are certain things, like, you know, you need to have licensed providers who can practice medicine. Or if you have a medical device, you need to get FDA approvals. So, it's, like, a way, way heavier, you know, process. And it, like, has a lot more regulations and rules and different legal implications, data security implications, patient health information, you know, HIPAA, all these other things. So, it's just a much, much more regulated space in general, and what that means is that it's slower. It's going to be slower to build. It's going to be slower to validate. The feedback loop is going to be slower. It's going to be more resource-intensive. You're going to need to invest in more resources. It's going to need more, like, expertise. You're going to need, like, regulatory expertise, like medical, clinical, all these other things that you don't need when you're building a wellness company or a product. So, it's just a lot heavier and just, like, way more regulated. And the risks are also much more prominent in a way that you, as the CEO or the founder, or you as an operator, may end up being challenged even in court if something goes wrong. So, there's just more risks, and you got to think about, like, insurance. And, like, that's broadly speaking, like, some of the challenges of building a healthcare company versus building a wellness company. VICTORIA: So, as a founder of previous healthcare companies, you might have already built those networks to get access to people who can help you with those things. But if you were a new founder and you know you want to start a health tech company, how would you go about building your team to fill in some of those gaps around the areas you need help in? KRISTIAN: It's going to be a learning curve. There's, like, no single book or no single place where you can learn all these things. But I'd encourage, like, there's some great materials online for sure in, like, learning, like, what to consider when building a healthcare company. ChatGPT or Google will help you kind of get started on some of the essentials. But then I would, like, pretty quickly, I would try to, like, immerse myself in the different circles or communities where there are other healthcare founders, where there are people who've already been building healthcare businesses, where there are maybe advisors or maybe, like, accelerators for startup companies. You want to learn these things from people who've already been doing these things. You don't want to try to, like, learn everything from books. It's going to be too slow, and you don't know what you don't know. So, you don't know how to, like, ask the right questions. If you talk to people who've already been doing these things, they will be able to tell you, "Hey, you're not asking this and that question. Like, that's an important thing. Like, you should consider A, B, or C." So, I would say that, like, surround yourself with people who've been building healthcare businesses before and maybe try to get into an accelerator or just, like, find advisors, more, like, experienced people. VICTORIA: That's great. It's all about community, which brings me back to the question I had about Meru Health. You mentioned there's a community aspect built into the app, and I was wondering if you could talk a little bit more about that feature and how it plays into the whole model. KRISTIAN: Community is important. So, a lot of the people who struggle with mental health problems also very often feel that they are very much alone, so that was the case with my brother. Like, he also felt very much alone with his depression that, like, no one will understand me. Like, I'm the only one who's feeling like this. I'm feeling isolated. But there are so many people who are struggling with the same kind of thing or same kinds of emotions and feelings and symptoms. And through our community feature, we have, like, people who are experiencing similar issues going through the Meru, you know, intervention. They can now, like, connect with each other, and they can, like, reflect with each other and see what's going on. It's a moderated kind of a forum type of a thing. So, licensed providers are always moderating and, you know, also being part of the discussions there. So, they're also contributing. But it's very much of a place for people to reflect and see that, like, these struggles that I'm going through are not just...it's not just me. Like, there's also other people. You don't need to feel so alone. And you can share with others and see that, hey, there's ways to heal. There's ways to get better. You know, you're not alone struggling with these things. VICTORIA: I think that's a really powerful point about making that connection, making that community, and feeling like you're not alone. What other features make the Meru Health app unique in solving this problem? KRISTIAN: We are basically a clinic, like, you know, we call it a virtual clinic. So, we have providers. There are, like, licensed therapists. We have doctors, psychiatrists. We have coaches. We have care coordinators. So, these are all real human beings that are actually practicing medicine and supporting our members or our patients. And then, we have an app-based program, and the app is basically your home for accessing the Meru services. So, whether you're doing video calls or whether, you know, you can do them through the app. Or you can be chatting with your providers, or you can get access to, like, you know, support from the care coordinators if you need to navigate your insurance benefits or things like this. And then, basically, in the app, you're going through different modalities of care. So, one of the unique things about Meru, like, why we built the company, why the company exists, is to kind of make this more holistic or more, like, a lifestyle medicine approach to mental health care, make it available for people. And it includes not only talk therapy or cognitive behavioral therapy, which is the normal typical way of, like, doing talk therapy. It also includes a lot of, like, mindfulness practices, a lot of...sleep kind of is a big topic where we help people understand that, like, there's no mental health without proper sleep. And it's also a physical health issue if you're not sleeping. So, sleep is essential. There are many things that you can learn, you know, like some sleep hygiene things, meaning that, like, you shouldn't do, like, blue lights just before bed. You shouldn't do, like, exercise just before bed. You shouldn't eat big meals before bed. So, there's many, many things that you kind of, like, once you learn to know, you'll improve, like, your sleep dramatically. And once you improve your sleep, you improve your health. Like, it's a direct correlation. So, these are things that we teach people as part of one of the modules there. Then there's, like, nutrition, as we call it, food and mood. So, there's a huge connection between, like, certain nutrients or diets with, like, mental health. I'll just give you a really quick example. Processed foods are really detrimental to brain health and, mental health, and also physical health. But, like, most doctors, if you're talking to most healthcare professionals, most, like, primary care doctors, if you go to see a primary care doctor about any mental health concerns you may have, like, 99% of them won't tell you anything about your diet. They won't tell you anything about processed foods being very detrimental. And, again, so we are kind of including things like these, which are all based on science. Like, there's a ton of research behind these things. And we've also, ourselves, done a lot of research with Stanford, with Harvard, with other universities. But that's kind of another example of, like, some of the essentials that go beyond just the standard talk therapy in helping people more holistically learn skills, learn knowledge to help them get better. VICTORIA: That's really cool. So, what does success look like six months from now or five years from now? It's a long process, so... KRISTIAN: We're now, like, 130 people at the moment at Meru Health. So, we've kind of, like, come quite far from the early days of, like, just building the product, getting the first customers, doing the first validation, publishing the first research studies, first clinical studies showing that this is effective, so forth. But there's still...it feels like it's day one still because we're going to feel that we're just getting started with, like, you know, we work mainly with insurance companies. So, there's a lot of insurance companies like Cigna, and Aetna, and United, Optum, some of these ones that we work with, some Blue Shield Blue Cross. But there's so much opportunity. So, we're now available for, like, 30,000,000 Americans. Obviously, there's way more many Americans we could be available for. So, we're constantly working in making our footprint bigger so that more and more insurance companies would reimburse for Meru's services so that people in different states and different areas can also, like, access these services if they want to. And, like, I mean, as I mentioned earlier, building a healthcare company is a marathon. It's not a sprint. So, we've now been building, like, six-plus years, you know, probably, like, another five, six years until we'll be, like, fully, like, reaching all the people in the U.S., hopefully, and so forth. And then, you know, we actually founded the company...initially, we founded from a place of, like, we want to build a global company. We want to democratize access to these kinds of, like, new healthcare services also, beyond just being in the U.S. The U.S. is just a really great place to start these kinds of companies, in many ways, the perfect place. But we also are, you know, we're looking at expanding into some European countries in the future and, hopefully, even beyond that. But that's something what's happening now and what we're thinking about for the future. VICTORIA: Great. So, it's getting to expand your footprint with who has access to it in the United States and then even looking beyond, globally, and seeing how wide you can reach. KRISTIAN: Yep. Exactly. VICTORIA: I love that. Okay. And then, what are the challenges that you see? What are those blockers or issues on the horizon that would prevent you from reaching your goals? KRISTIAN: I guess one challenge we're facing is that, as I mentioned, we work with insurance companies quite a lot, so some of these big names that I talked about and some more, like, regional smaller insurance companies. But one of the things is that since our care philosophy and the modalities of care we offer, like the sleep and nutrition, the biofeedback wearable, some of these other things that are not typical to mental health care, that are not conventional mental health care, getting reimbursements and getting this kind of a more comprehensive approach, getting it reimbursed by insurance companies is actually quite a challenge. Because insurance companies typically reimburse for very select standardized and kind of known services and, like, standard types of care. And it's harder for them to reimburse for something which is, like, novel and very different, even though we've published now 14 clinical studies, including, like, randomized control studies, which is the gold standard in clinical research, and then also, like, large, large, like, thousands of people, single-arm trials, which are, like, more like population trials. So, we have, like, a ton of evidence to show that this is very effective, actually, roughly 2 times more effective than standard of mental health care. So, it's very much more effective, and people are maintaining the gains. We've published also our, like, one-year and our two-year data. So, there's a ton of that evidence there, but it's still hard to bring in this kind of innovation into the market. That's one of the challenges that we're working on. Then, it's always a challenge to find the best talent, to hire great talent. I've learned over my career to always challenge myself in, like, making sure that we always think through, like, how can we hire the best talent for every role and not let your standards, like, drop. If you're growing fast, you got to hire more people. That is extremely, extremely important. And it happens so easily that when you start growing faster, you got to hire for multiple roles. You actually start, like, lowering your standards because you face pressures on, like, hiring people faster and growing faster. VICTORIA: And I wanted to ask you, too, about your background in computer science. And as you're thinking about scaling and expanding globally, what are you thinking about on the infrastructure platform side for the technology that you've built? KRISTIAN: What we've built so far is the patient-facing app, so that's the home for the patient to kind of access our services. For our providers, we have a network of providers that we also built them an electronic medical record. So, we kind of, you know, from the start realized that there's not an electronic medical record product out there that would fit our different way of providing care. So, we actually built that in-house by ourselves, so we have that now. And then, we also have a kind of a dashboard for our providers where there's, like, traffic lights. So, the system actually, like, sorts people based on different data inputs and places them in order of priority. Like, if someone's reporting suicidality as an example, that's going to be a red flag on a provider's dashboard. These different, like, categories, like, the red flags and then, like, more, like, amber and then green. So, that system is something we're constantly developing and fine-tuning on, like, improving the algorithms of detecting issues. And then, on the other hand, helping our providers to focus their time on the right patient at the right time because that's also really critical in care. So, there's plenty of work going on there. We're also working on our SOC 2, which is kind of this security standard in IT. So, we're working on our SOC 2 project currently internally. So, that's a pretty big one for us to mature into that. And yeah, so the platform is kind of evolving. We're kind of building more features. We're also building more of these different kinds of modules for people who are struggling with different kinds of issues. So, a concrete example, how can we better support people with post-traumatic stress disorder or people who have, like, panic attacks? And so, there's these kinds of more, like, nuanced areas of mental health where we can double down on by building different modularity and more individualized care pathways for people. VICTORIA: That's wonderful. I love that. Thank you for sharing all of it. Is there anything else that you would like to promote today? KRISTIAN: Yeah. Well, hey, thanks so much. I really appreciate you having me on this podcast today. What I, again, found useful as a founder, as an operator, is to take good care of yourself. Like, it's really important to also remember not to exhaust your resources constantly, but, like, try to kind of find ways to take care of yourself as a founder, as an entrepreneur, and also kind of, like, nurture yourself. Because, otherwise, I have lots of founder friends, lots of entrepreneur friends, and so many times people are, like, exhausting themselves. And they are kind of, like, running too fast or, like, trying to do this and that more and, you know, just do more and more all the time. You know, while that's important, it's important to be running. It's important to be kind of productive as a founder. It's also like a trap, you know. People also fall into a trap if they're trying to do too much at the same time. It's really important to focus on rather fewer things, and it's also very important to take care of yourself. So, self-care, self-compassion, I think, those are important themes that are not too often talked about when it comes to entrepreneurship, but I think that's something I've learned to be important. VICTORIA: It sounds like the value that you said as a company also applies for you as an individual, like, having compassion towards yourself and kindness. I think that's a really beautiful way to wrap the episode here unless...do you have any questions for me or thoughtbot? KRISTIAN: I've been following you a bit. And just curious, like, what's coming up for you? VICTORIA: For me personally, well, I bought a new house, so we're, like, renovating that in California. So, I'm actually switching to, like, maybe trying to do a little bit less travel compared to what I did last year, but going to more local things and getting, like, our San Diego CTO Lunches spun up again and meeting people here who are building really cool things. Lots of great health tech companies in San Diego also. What else do we have going on? I'm definitely going to be climbing. I'm going climbing on Saturday. And then probably in LA, I'll go up and do some climbing the next couple of weeks. So, I'm looking forward to having a little bit more balance to life this year [chuckles], the best-laid plans. But yeah, that's what's coming up and, just trying to, like, enjoy where I live, enjoy my family and friends and the companies that I work at, and do a good job. That's it. KRISTIAN: Great. Well, hey, appreciate it. VICTORIA: Yeah. Wonderful. Well, thank you so much for coming on, and being a part of the show, and sharing your story. You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at [email protected]. And you can find me on X, formerly known as Twitter, @victori_ousg, or on Mastodon @thoughtbot.social/vguido. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thanks for listening. See you next time. AD: Did you know thoughtbot has a referral program? If you introduce us to someone looking for a design or development partner, we will compensate you if they decide to work with us. More info on our website at: tbot.io/referral. 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