The World’s Toughest Job” online job advertisement led to a viral video compilation of the 24 applicants interviews. The candidates vied for a position described to offer 135-hour workweeks, no vacations, no breaks, no pay, and required degrees in medicine, the culinary arts and finance. [Spoiler alert] While “mother” was the role described, the role of caregiver was my first guess.

There are 85 million mothers in the United States. Not far behind (and often overlapping), every year more than 65 million Americans provide care to someone who is ill, disabled, or aged. AARP’s Public Policy Institute’s report, “Valuing the Invaluable,” estimated that this hidden segment of our healthcare system represented $450 billion of unpaid, unaccounted for, services in 2009.

Our population is aging and mental health is a pervasive and growing issue in elderly. The role of caregivers will become more critical then ever. Our healthcare system is not prepared for the dire consequences of psychiatric syndromes and conditions that we will face as the population ages – both for the aging population, as well as their caregivers.

The geriatric age group is the fastest-growing segment of the population. These users of healthcare services will rapidly overwhelm the resources available to them, and their caregivers, as there an inadequate number of clinicians being trained for eldercare, and the necessity of provision of care to the caregivers is not widely recognized.

According to the National Institute of Health (N.I.H.), “it is estimated that 24.3 million people worldwide have dementia, with 4.6 million new cases of dementia every year” and the number of people affected is expected to double every 20 years to reach 81.1 million by 2040.  This impending health crisis will inundate the healthcare system, creating emotional and financial burdens for families, with caretakers struggling to fill gaps in health services.

Caregivers, often overlooked, struggle with feelings of guilt, isolation, resentment and depression. The American Association of Marriage and Family Therapy’s research concluded that 50% of family caregivers had clinically significant depression. Caregivers also experience higher levels of anxiety, physical illness, and risk of death. Frequently without proper support of their own, increasingly overworked caregivers hang on in exhaustion, constantly aware of their own fragile mental states. It is important to recognize the mental health and wellness of caregivers as they are a critical piece of care for the elderly.

At TalkSession, we strive to increase patient’s access to quality mental healthcare across the care continuum. Related to our work in geriatrics, I conducted an interview with a caregiver who highlights the desperation of her dilemma.  Sadly, Stacy’s story is all too typical.

Stacy was 34 years old when she started caring for her father full-time – a role she took on “in an instant,” as she recalled her initial days as a caregiver.  “I just noticed there was a change in his voice, as though he wasn’t quite certain who was on the other line.”  Stacy quickly made her way from her Atlanta home to her father in New York City.  What she discovered still impacts her years later as she continues to balance the needs of her father with the needs of her family.

Stacy found her father locked in his home, which had become a toxic environment due to hoarding.  His body had been ravaged by illness and lack of care.  “I often wonder if I had gotten to him earlier if the outcome would have been different,” she shares.  “I feel like I should have known. There were signs, just not very obvious signs.  He was adamant about no longer using Skype, but it had been our way of keeping him connected to his grandchildren.   Why would he suddenly not want to use it at all?” 

In trying to keep his changes in appearance and the shame of the condition of his home a secret, Stacy’s father was creating distance from family and friends.  Over a two-year period Stacy learned that her once outgoing father had managed to hide his condition from all of his family and friends, “He had forced everyone away and I didn’t realize it.” 

This common problem is too often a reality and it presents an even deeper issue as the success of treatment can depend on early intervention.  “In a two week period I learned that my father had not only Early Onset Dementia, but also tiny masses in his lungs and prostate, believed to be cancer.”  Stacy’s father, just 62 at the time was otherwise healthy, active, and a non-smoker. 

“I wasn’t prepared.  I went from being the daughter he cared for, to a stranger.  He didn’t know me; his rejection of me was difficult.  I felt guilt and shame all at once.”  Unprepared for what would come next Stacy sought out resources for treatment – resources that were largely unavailable.

With siblings scattered throughout the country, it became evident she would have to take on this responsibility alone.  “I have 3 brothers, one is married, the other two are fairly young, but somehow I thought when it came to dad we would share in decision making and care.”  This couldn’t have been further from reality.  In fact, the reality for Stacy was that she became the only person involved with her father’s medical care.  Making decisions was left to her discretion.  Her once tight bond with her siblings has become non-existent as the conversations have become more difficult. 

Stacy shared that at times she feels isolated and that her siblings avoid her to avoid dealing with their own feelings about their father.  “It is a struggle,” she says, “making plans is fragile.  I am always aware that all plans could be derailed depending on how dad’s day shapes up.” 

Dealing with medication, incontinence, and adult proofing a home are the unimagined but all too real daily chores that have become a part of Stacy’s life.  This comes at a heavy price, seriously adversely affecting her career, relationships and family.

“I don’t complain, he took care of me,” she shares, “but it is a burden.  I feel guilty that I sometimes want him to just say thank you, but so many days he thinks I am his enemy who has him trapped.” 

According to Pew Research, over 1 out of every 8 Americans is a part of the “Sandwich Generation” – providing care for a parent while simultaneously raising a child. Through my work with TalkSession, I spoke with a geriatric nurse, who expressed the difficulties of this dichotomy:

 ”The hardest thing has been watching my two year-old grandchild grow and develop, while watching my mother decline. They approached each other at one point in terms of abilities: my mother declining and my grandchild developing. And then they separated with my grandchild learning new things and my mother forgetting them. Living this tragedy and being a victim is horrific; the only thing that is somewhat consoling, is the knowledge that my mother is unaware of her disease and that the main burden of “living with Alzheimer’s” rests on my shoulders, not hers. Some days, though, I am unable to see her as a nurse would and the realization hits me that this is my mother.”

Caregiver burden will likely become a recurrent theme in larger mental health crisis. The impact of this is larger than most realize, as the depth of the link between physical illness and mental illness is still unknown.

As for those who will need care, the Alzheimer’s Association reports that in 2013, 15.5 million family and friends provided 17.7 billion hours of unpaid care to those with Alzheimer’s and other dementias.  To put a dollar figure on that care it amounts to $220.2 billion, with more than 60% of this care being provided by women.  The burden of caregiving is responsible for an additional 9.3 billion dollars in health care costs for caregivers, with 1/3 of caregivers reporting symptoms of depression. 

As we embrace new healthcare mandates, it is critical that mental health for geriatric patients is a conversation that is at the forefront of our dialogue because we will need to provide specialty care for these individuals as well as the people who devote time to care for them.

The impending surge in cases of dementia creates an urgent need to take aggressive action now to address the needs of our aging population and their families, because these are the tough jobs that need to be filled.

2014 will be a formative year for new business owners and early-stage entrepreneurs. For those would-be entrepreneurs debating the startup leap?  There is no time like the present. For current founders, in our hyper-pressurized worlds of being incubated, accelerated, and constantly switching modes between pitching and executing, how do we successfully navigate the labyrinth to success?

First, an important note of change from a year ago: the funding landscape changed with the JOBS act in 2013.  Continuing into 2014, there will likely be a shift in the role of the investor into a more hands-on player in businesses.  More non-professional investors will become angel investors and entrepreneurs will benefit from their domain expertise.  And finally, in Darwinian fashion, competition for market share amongst the venture capitalists as a result of increased numbers of angel investment syndicates will clear the decks of the low-value add venture capital dollars.  All of these attributes will effectively benefit the entrepreneurial community.  Now, how do we become successful founders?

Below are 10 tips for the entrepreneur (or entrepreneur-to-be) to make 2014 the winningest year yet. 

1)        Don’t fear Goliath

At some point founders will be asked after a pitch, “Why can’t Google/Facebook/Apple do this?”  The answer lies in the story of David and Goliath; in the notion of all frogs started as tadpoles.  A startup is a nimble entity that can pivot, grow, change and ideate more quickly than large companies.  In Malcolm Gladwell’s newest book, David and Goliath: Underdogs, Misfits, and the Art of Battling Giants, he examines our misconceptions about what constitutes an advantage.  Gladwell says it best himself,

“We have a definition in our heads of what an advantage is — and the definition isn’t right.  And what happens as a result?  It means that we underestimate how much freedom there can be in what looks like a disadvantage”

Tightly defined budgets, small teams, and offices in “the cloud” may seem like a weakness, but these are also these are the attributes that can drive us to success through being “lean and mean;” more efficient and more maneuverable.

2)        Maintain a 95% / 5% focus ratio

We are entrepreneurs because we have visions of how to make something better; usually, many things better. Always keep two active lists. The first consists of core focus areas - those that are integral to our businesses. We should try to focus 95% of our time and effort on this list. The second is the 5% list; the list reserved for the ideas that get us temporarily excited, but ultimately are distractions. In order to maintain open minds, keep creativity flowing, and continue to develop long-term visions, the 5% list is very important. As a startup with a small team and limited resources, if we spend 95% of our time on core needs and responsibilities, we will be more successful.

3)        Learn from Breaking Bad

Inspiration can be found in unexpected places, like in the addictive series Breaking Bad based on the life and work of a man in the business world of crystal meth.  Star-of-the-show Walter White exemplifies the importance of creating a perfect product, the value of loyalty to one’s team and business partner, and how in business, there will be many challenges through competition, life/work balance, and risk-taking.  Of course a few viewings of Locked Up Abroad based on real-life law enforcement should provide sufficient inspiration to not become engaged in the illegal and illicit recreational pharmaceutical industry.  Bottom line: as entrepreneurs, we should look to other industries or life for inspiration to gain fresh perspectives.

4)        99 Problems? Just fix one

My excitement over my company sometimes leads me to talk about the problems we are going to address in what I call, “phase 27”.  Investors don’t want to hear about “phase 27”, they want to know in simple terms, what one problem our idea will fix, how we will fix it, how much will it cost to fix it and how much is that solution worth.  Our musings might excite clients on the possibilities of “phase 27,” but in reality this is harmful, since an entrepreneur cannot deliver these dreams right now in “phase 1.”  Preserve sanity and reputation by not over-promising and under-delivering . No matter what the situation, remember to set expectations properly with regards to what we can do right now, and maintain the focus of solving just one problem.

5)        Clear the clutter

Clutter includes: toxic people, time drainers, unnecessary events, and non-crucial product features.  Founders must wear many hats, and choosing the ones that bring the highest value is critical to success (and maintaining sanity).  Ridding our lives of physical clutter and learning to gracefully remove the social clutter will leave more room in our lives for new thoughts, perspectives and positivity.

6)        Work harder than anyone

Be the first one to work and the last one to leave.  As an entrepreneur, we set the tone for our teams. Also, resources for startups are limited and precious. The more an entrepreneur can do personally, the more the entrepreneur is investing in the venture, and can allocate financial resources elsewhere.

7)        Simplify it

Get product feedback from an eight-year-old, an eighty-year-old, and every decade in between.  No one will ask for more complexity.  My app started as 36 pages of detailed wireframes.  The current design consists of one large circle with a call to action written in a large font with an accompanying icon.  An eight-year-old knows what it means, and an eighty-year old can read it and knows what to do without instructions.

 8)        Talk less, listen more

To get to the user-interface described above, I have to thank my client. In a seminal meeting, a client tested my app’s prototype and asked, “Can the whole platform just be one button?  If I press the button, I get the service.”  I replied, with “of course you can,” then sprinted to the office to improve the interface.  One person’s musing substantially improved our user-experience.  Often, as entrepreneurs we are too deep in the weeds of our own visions, and could benefit from listening to users, testers, investors, potential clients and anyone not directly involved in the product’s creation.

9)        Nurture your network: they are an entrepreneur’s most valuable asset

It is the assets not listed on balance sheets that can often drive the biggest growth.  Networks grow from friends, coworkers, peers, former teachers, bosses, and clients. It is this network that will help entrepreneurs the most in the early stages to turn napkin ideas into successful businesses.  Find other entrepreneurs in your particular industry and watch your network grow exponentially.  We need to find those who believe in us, believe in our ideas and together with other entrepreneurs in our networks, grow successful businesses.

10)      Implement digital detox

I became addicted to my company this year. Zeal is great, but beware of diminishing returns. I was not sleeping well (or much at all) nor socializing.  So, I took a vacation - one without access to Wi-Fi or cellular service. I felt like a mother leaving her child with a babysitter for the first time.  It was nerve-wracking, but the stress lifted after a day. And after a week of startup sobriety, I returned to find my business completely under control. That week did wonders for me and for my business. I slept more regularly, got fresh air, and interacted with people outside my startup bubble. I believe the physical and mental renewal of a digital detox will far outweigh a founder’s inclination to “work-til-ya-drop”.  We should regularly do our businesses and ourselves a favor by powering-down, and rebooting from time to time.

Nurture your network; maintain your relationships. It is the innate power of a good founder’s network that will turn napkins into products and products into successful businesses.

Recently, I was honored to attend StartUp Health’s Healthcare Transformer Summit, co-located with Cleveland Clinic’s Medical Innovation Summit. Thirty startups from around the world represented by 45 entrepreneurs convened to spend three days reflecting on the past quarter and gearing up for the future. It is from networks like this one that I personally and professionally grow most as an entrepreneur, gathering the knowledge, stamina and motivation necessary to build a business. Here are five reasons why networks are an entrepreneur’s greatest asset:

1) Other entrepreneurs make the road less lonely.

The entrepreneurial network fosters a coalescence of idiosyncrasies in whatever is left of our circadian clocks, to make each entrepreneur feel connected and in sync with one another (despite simultaneously holding the titles “Chief Executive Officer” and “Head Janitor”). The people who answer my work-related, non-emergency calls at midnight without fear or judgment are the other entrepreneurs in my network. They are an invaluable source of daily support. At our most recent meeting we had a “speed update” in which we interviewed each other and offered advice. I heard “I’ve been there,” echoing across the room regularly. The level of support was palpable. If contemplating starting a business, I highly recommend that founders seek out networks of entrepreneurs, particularly ones in a similar industry, with whom to connect. Quickly, they will likely feel like family.

2) Collaborations are important.

As startups, we have limited resources. We are advised to maintain focus, while also being nimble enough to pivot. The necessary checklist to start and run a successful business is endless; collaboration is not only valuable, but also necessary. Collaboration can be as simple as sharing resources: the best-value-for-the-dollar accountant or a great graphic designer. And it can also go much deeper, as…

3) …Your network will become your partners, customers, and brain trust.

Within the Startup Health Academy there are many complementary businesses. We have domain-specific startups – mine is in mental health, for example. We have process-oriented startups, such as Care at Hand, which empowers lay caregivers to participate in care management. We have software technology-specific startups, like itMD, which focuses on cloud-based HIPAA-compliant image sharing. And we have device companies like Basis, WalkJoy and Cerora. When we put those segments of vertical knowledge into one room, we see powerful forces align, partnerships formed and deals done.

4) They finance you.

Networks do not only consist of entrepreneurs. If you are starting a business it is likely based on a past job, personal passion, or domain expertise. Where did that motivation come from? How are you learning about your market? One of my angel investors is one of my first customers. Another is my former boss. One is a friend and colleague from my banking days and another is a former professor. Your network consists of people who believe in you on a personal or professional level. The inspiration and catalyst to move past a napkin idea will likely come from your network.

5) A bigger pie beats a bigger slice.

One expensive important lesson I took from business school was the concept of Integrative Bargaining. One plus one can equal more than two. How? With the following ingredients: 1) a foundation of trust, 2) an understanding the others’ needs, 3) the ability to speak honestly, and 4) similar and/or synergic goals – the pie of success can multiply for everyone. The key is to understand motivations. As an example, take a business productivity app with a founder who was motivated to solve a problem he endured himself as a business owner. His motivation is not to grow a business productivity application empire – it was to solve a problem. Another entrepreneur – someone in his network has another business, one that distributes apps. That founder’s goal is to run a large successful business. If single app-guy teams up with empire-seeking guy, everyone is happy and the two are stronger together than alone. Increasing the size of the pie of success begins with a trusted network. If we sincerely have each other’s best interests at heart, we can make more constructive decisions. There are many existing networks – from casual ones like Meetup Groups, to the more formal incubators like the Nike Accelerator, TechStars, or Women Innovate Mobile. There is a network for every aspiring entrepreneur – and the power of that network may just be an entrepreneur’s greatest asset.

In the future, healthcare will be largely in our hands.  Here are the top 5 reasons while the future of healthcare will lie in mobile technology:

1)    Evolution: Mobile phones, are just “phones” 

Our smartphones hold incredible power and functionality.  We no longer have to dig through our belongings to find our single-year-day planners.  We don’t have to go to the pharmacy to drop off film to see our photos, order double prints, place a set of prints in a photo album, and mail a set to our families in order to “share.”  We no longer even risk losing our contact lists and schedules since we can storage information in the cloud.  Technology has placed our camera, GPS, calendar, our entire record collection, game system, entertainment system, enough online shopping to replace the local mall, and oh, yes, telephone in a gadget not much larger than on old cassette tape.

Have you noticed that there are fewer numbers listed on business cards?  And more recently, fewer physical addresses are listed.  Our “land lines,” “office numbers,” and “mobile numbers,” are becoming consolidated.  We do not needmultiple communication mechanisms if we have a reliable one that is always with us.

I do not refer to my phone as my mobile phone; it is just my phone. 

The frictionless nature of mobile technology has improved the quality of our lives and become the mainstream standard by which we all live.  We take for granted the ease digitization has brought to our lives.

I look forward to that phenomenon’s evolution in healthcare – an evolution that has already started to transform our lives, but has not yet reached the tipping point.  I predict that very soon there will be fewer referrals to “mHealth,” because we will just call it “health,” and “mobile medicine” will just be “medicine” just as our “mobile phone” is now just our “phone.”

2)    Mobile empowers us…

For the month of September I utilized thirty sensor devices and wellness applications.  On www.quantified30.com, I tracked my activity, sleep, food and beverage intake, vitals and moods.  I learned valuable insights into my sleep patterns in particular, and changed a few habits for the better.  The advent of wearable technology we are currently witnessing is just the first baby steps to self-empowerment only possible through mobile technologies.

The market is still fragmented and actionable data is still very much a self-managed process.  Nevertheless, the foundation has been laid for us to personalize and empower our own health and wellness.  The future will undeniably bring real-time communication between patients and providers through integrated mobile devices when patients request an on-demand solution. 

3)    … and it empowers our healthcare providers

It is undeniable that a computer’s memory is beyond that of any human’s capacity.  Until scenarios like those found in the movie Limitless becomes a reality, the human mind has a limited memory and scope of acuity.  Mobile can augment, manage, organize and analyze the increasing deluge of information at the fingertips of healthcare providers.  Electronic health records are at providers’ fingertips and providers will have the ability to apply the art and the science to the raw data. Importantly, evidence-based research will increasingly pull out trends by cross-referencing data points, enabling providers to make better informed decisions regarding patient care.

4)    A New Dimension: Contextual Healthcare

Mobile technology provides contextual awareness around patients through Bluetooth, GPS signals, environmental, and social factors.  This creates the opportunity to provide patients with the best care – the most relevant care – at the time and place patients need it most, while mitigating the risk of recall bias.  Mobile gives healthcare the power of context and immediacy, a tremendous phenomenon that I believe will lead the force in healthcare technology development

5)    Better, Faster, Stronger.

HIPAA, PHI: Acronyms that translate into the need for security of data.  For messaging and transmission of data, mobile is more secure than traditional mechanisms.  I recently spoke to a healthcare facility that admitted to one-third of patient logs unaccounted for on any given day.  If that patient log were to be recorded on a mobile tablet, that data could be securely transmitted to HIPAA-compliant cloud storage, and not only would data not be lost, but adherence to collecting data would be higher.

Healthcare is an industry ripe to reap the benefits of efficiency in the mobile arena.  I strongly believe that in the very near future we will reach the tipping point needed in market adoption of mobile healthcare-related platforms and usage.  Critical mass adoption will create an environment that will make healthcare more accessible, affordable and efficient.

 

 

Last week marked National Mental Illness Awareness Week. Mental healthcare is a critical problem in the United States; one that will likely worsen before it improves; one that desperately needs immediate attention.  It is a problem that is intractable with a breadth of scope that is difficult to truly conceptualize.  Healthcare might be the single most important and immediate challenge we face as a nation.  No country pays more for healthcare and receives less value than the United States.

I was fortunate to have the opportunity to present TalkSession and represent the innovators’ perspective at two forums in the last month. The first, Behavioral Health IT Innovations Conference, was held at the White House and sponsored by the NIH, SAMHSA, ONC, and the ONDCP on September 16th – at the exact same time that the Navy Yard shooting was underway.  The second, The Knowledge Network: Collaborating to Bridge the Science to Service Gap in Behavioral Healthcare, was coordinated by Centerstone Research Institute in Nashville, Tennessee, the research affiliate of the largest non-profit provider of community-based behavioral healthcare, on October 3rd and 4th.

I liken TalkSession to healthcare’s equivalent of a starry-eyed astronaut, pre-1969, in the height of innovation in the context of the Space Race.  In advance of the Apollo 11’s mission to the moon, astronaut Neil Armstrong said, “I think we’re going to the moon because it’s in the nature of the human being to face challenges. It’s by the nature of his deep inner soul… we’re required to do these things just as salmon swim upstream.”

In the spirit of challenges, solving the nation’s most critical problems requires a triangular alignment of forces – similar to the forces at play during the race to the moon.  First and foremost, we must understand and want to solve the problem.  Second, the problem must have a potentially viable solution within our technological and cognitive grasp and capabilities.  We will not have all of the answers readily before us, but critical in our quest for answers is the startup mentality of build, experiment, learn, pivot, and try again with a sense of urgency. Entrepreneurs are ultimately seeking an efficient and implementable solution to any problem.  And lastly, the necessary institutions must be supportive of the solution and aligned with efforts to solve the grand problem at hand.

#1: Both the White House and Centerstone Research Institute, do understand and acknowledge the mental healthcare challenge as a major societal impediment, but there is a dichotomy in the substance that each organization puts forth.  The Executive Office of the President, government agencies, private and public institutions alike discussed the periphery of innovation around the mental healthcare problem.  Some presenters, like Dr. David Mohr of Northwestern University, Dr. Adam Kaplin of Johns Hopkins University, and Dr. Judson Brewer of Yale University are testing and implementing actionable technological innovations in mental healthcare.  A few government agencies are indeed enacting test programs to foster innovation.  Nevertheless, NIH–backed studies report that it takes an average of 17 years to put 14% of research into practice.  With the risk of stating the obvious, we can’t wait 17 years to address the nation’s healthcare problems.  I hope to give my children and grandchildren more than just a FitBit, but to bequeath to them a device that provides diagnostic tools and connects them with experts to monitor their health effectively and efficiently, while fitting into their pockets.

As I outlined in my White House presentation on “The Future of Mobile Medicine”, 90 million Americans are currently underserved by mental healthcare access.  In January, after the ACA and Mental Health Parity Law come into effect, 62 million more Americans will have benefits to mental healthcare.  The current cost for provision of mental health care to the nation nears a staggering $1 trillion dollars; numbers difficult to comprehend at present, let alone when there is a massive surge in demand.  State-to-state medical license portability regulations are parochial, antiquated, stunt innovation and limit our ability to scale solutions for what is a national problem that does not respect state lines.  The current reimbursement system is fragmented and an intractable burden to successfully navigate, effectively driving providers away from potentially alleviating and cost-effective telemedicine programs.  If we already have a recognized demand problem, I ask how the country plans to deal with a two-fold increase in demand to an already overtaxed behavioral healthcare provider network?  I believe technology, and specifically telemedicine, is the only functionally and economically viable solution.

 #2: We indeed have an existing viable solution at our fingertips.  Technology has far surpassed the pace of regulation and policy innovation.  At TalkSession, we envisioned, designed and built one possible solution platform.  It is a solution that does not require delving into arcane advanced analytics.  We built it from common sense with a streamlined user-experience.  The issue of systemic inefficiency can be solved through technology.  We have plenty of future bells and whistles, artificial intelligence, and predictive modeling in the pipeline that will add incredibly powerful contextual relevance to mental healthcare delivery.  But as for the core problem?  That can be solved right now with existing technology.

#3: Alignment of the institutions: Against the backdrop of the current federal government shutdown, I wholeheartedly emphasize that it is that is the lack of indispensable institutional alignment and commitment to solve the problem facing our nation that is the impediment to advancing our effort to solve healthcare equality.

The White House

September 16th, 2013: Behavioral Health IT Innovations Conference

7:30am: I arrived at the White House, pumped full of adrenaline and hopeful to meet like-minded innovators in the mental healthcare technology space.

8:00am: the 25 or so other speakers and myself began the day energized and inspired. Other speakers included Todd Park, Chief Technology Officer of the United States, Gil Kerlikowske, Director of the Office of National Drug Control Policy, Westley Clark of SAMHSA, and a plethora of academicians.

9:15am: Within the first hour we were unexpectedly and rapidly shuffled to the Indian Treaty Room in a seamless location-change, bringing with us the live stream and nearly uninterrupted timing (N.B: the government can indeed move quickly when necessary). Unbeknownst to the cellular-signal-less attendees, the Navy Yard shooting was occurring as we began to discuss innovation in behavioral healthcare.  It was illustrative irony at it best; or, illustrative irony at its worst.

Overall, that day at the White House showcased an interesting mix of presenters. Commendation is deserved by the government for bringing in at least five government agencies together to coordinate one conference on Technological Innovation and for maintaining continuity throughout the day, despite the chaos taking place outside.

It will be a long road to align all of the stakeholders in behavioral healthcare to move the field forward but the stakes have been put in the ground.  Hopefully the woeful tragedy of the Navy Yard shooting that commenced at the same moment of our recognition of the need to streamline the mental healthcare industry through technology will prove to be an accelerant for change.  We need more discussion, and more importantly, action, for behavioral innovation through technology.  We need more early stage technology companies weighing in on the here and now of what is implementable today.

“The important achievement of Apollo was demonstrating that humanity is not forever chained to this planet and our visions go rather further than that and our opportunities are unlimited. I believe that every human has a finite number of heartbeats. I don’t intend to waste any of mine running around doing exercises.” –Neil Armstrong.

Centerstone Research Institute

Sue Siegel, recently penned an article and quoted the late Walter Cronkite who famously said, “America’s health care system is neither healthy, caring, nor a system,” and Sue further added, “while the national story is compelling, the truth is communities feel the real burden”.  CRI represents the communities.  While the White House was unstructured and provided a platform, Centerstone was engaging, thoughtful, and impressively open-minded.

The community-centric mentality provided a vast contrast in energy to the White House event two weeks prior.  The panelists were impressive and included Dr. Benjamin Druss of Emory University, Jeff Hammerbacher, Chief Scientist of Cloudera, and Dr. Kevin Niswender of Vanderbilt University.  Topics covered forward-thinking research on the application of artificial intelligence in mental healthcare, the link between metabolic regulation and mental health, and the power and potential of data, and other exciting ideas whose practical application could immediately improve provision of care.  Nevertheless, I realized as I listened to the panelists, the audience, and the representatives of the community clinics… their eyes glazed over at each mention of the phrase “algorithmic predictive modeling.”

When it was my turn to present, I surprised myself.  Usually the rabble rouser of the group – showcasing the latest device or pressing the audience to isolate the barriers to early stage innovation, I actually found myself saying to the audience, “we need to take a step back,” because while I too am fascinated by the possibilities the future affords us in mental healthcare technology, the stark reality is that first we have to get Americans access to basic mental healthcare.  We need to get average Americans to walk before they can run. 

After the public Q&A, the CRI leadership sincerely asked, “How can we help foster change?  We have a “knowledge network,” a network of thought leaders who run community clinics.  How can we use that to foster innovation?”  CRI took a refreshing implementation-style approach to the access problem in healthcare.  If I called them tomorrow with a plan, I believe that Centerstone would put whatever resources they could into implementation if it would effectively address public health problems related to mental health.  Nevertheless, their power and their resources could not possibly match their altruism, knowledge, and thought leadership.  This is where “institutional alignment” needs to come into play.  We need all players on board at the same time with the same goal.

The Future

TalkSession partnered with GE Ventures & Startup Health Academy – an accelerator committed to the long-term success of the companies selected as “Healthcare Transformers.”  That combination proves a powerful force.  GE is the single publicly listed security that has survived the test of time from the original Dow Jones Index in 1896.  GE is the country’s oldest industrial company.  And now?  GE is making a big bet.  For GE, it is not about a make-or-break capital investment – it is bigger than that – it is about GE’s willingness to innovate.  And to their credit, driving innovation at a company with over 300,000 employees – is inspirational to an early stage company.  

As innovators, we try with our blood, sweat and tears to rationalize outdated regulation, or present logic to officious bureaucracy – challenges that can be the defeating factor to an early stage company.  GE’s top leadership’s willingness to bring in young, innovative, zero-sigma-trained founders and listen to their perspective with an honest curiosity and collaborative approach?  That makes me appreciate why GE has stood the test of time and continues on as a global powerhouse.  GE understands innovation and the value of vision.  GE is a company whose revenue was almost $150 billion – projections even the loftiest entrepreneur would not pitch.  Yet, GE’s executives are eager to listen to startup founders who have very few years of experience, but novel and transformative ideas.  I aspire to maintain the spirit of the entrepreneurial and the innovative, regardless of the stage of my company.

Since 1972, no person has been back to the moon, and no one has traveled as fast as Apollo 11.  Optimism for the power of technology is re-emerging, as is the belief in technology as an “accelerative thrust.”  Ironically, it was Jeff Bezos, CEO of Amazon, who in 2012 utilized advanced sonar scanning to uncover the F-1 engines that launched Apollo 11 into space, under the Atlantic Ocean’s surface.

Venture investing has spent over two decades structured in a way that investor opportunities lie in solving incremental problems; not grandiose ones.  Venture investing moved away from funding transformational ideas and focused on consumerism, on gaming, on apps that allow shoppers to find the lowest prices or hear the latest music.  Arguably, these incremental investments will lead to solutions for large-scale problems, but today’s investment landscape is much different than the early days of investment into Intel, Apple, and Genentech. VCs have struggled to invest profitably in large-scale projects to create solutions in areas such as energy and healthcare – areas where large amount of capital is needed and the development time line is long.  The most frequent industry headlines in the media focus on the app that reaches a million downloads in the shortest amount of time, not the ones spreading the seed of change to tackle the big problems. GE has always been at this intersection: technology and innovation. GE Ventures and their initiatives in Healthymagination and Ecomagination are perfect examples of making investments in incremental solutions with a time-tested model in order to structure solutions to the big problems.

Technologists, business leaders and policymakers agree that we need innovation in healthcare.  We see convergence from the White House in their efforts to foster innovation initiatives under difficult circumstances, and from the research institutes that want to help the needy on the ground and have the willingness to bring creativity and open minds to the table.  Ultimately, the take away message from these two timely events is that we must address the gap between research and practice.  Existing technology can fill this gap, and we need institutional and investment alignment to create the harmony necessary to win the Healthcare Race.

President John F. Kennedy once exhorted us, “We chose to go to the moon, not because it is easy, but because it is hard.”  We need to choose to invest in healthcare; in mental healthcare, because it is hard and because it is necessary.

As an upstream-swimming entrepreneur in healthcare IT, I have great respect for GE’s long-term commitment to solving global issues.  The riches emerging from venture capital and the LBOs of the 1980’s turned the views of investment from one of funding long-term profitable solutions to big problems, into one that funded the quickest-to-commercialize solution: sometimes useful, but sometimes just ‘cool for the moment”.  This change in investment mindset stunted our nation’s ability to solve the great problems and stripped us of the ability to get to the next moon. I believe there is a wave of change upon us, as public fundraising is an option for early stage companies, as organizations like GE and Startup Health Academy support entrepreneurs working on big problems, and as investment consideration and returns increasingly includes an element of social responsibility.

I am grateful that TalkSession is partnered with GE, and that GE Ventures is looking to early stage companies to help foster innovation and solutions for big problems through a long-term commitment.  It is my hope that this new paradigm in investment reflects that the best exit strategy is a big solution.

Remember founding father Ben Franklin’s advice that ends in, “Healthy, wealthy and wise?” There is no place where the interconnectedness of those very attributes Franklin championed are more evident than in the workforce. Not only will a mentally healthy workforce directly translate to direct benefits for the American worker, it will bolster businesses’ bottom lines by greatly reducing lost productivity, absenteeism, and worker’s compensation and disability claims.

It is well known that the costs of mental illness in the U.S. are enormous. We must confront these needlessly exorbitant tolls while also embracing the idea that an investment in a mentally healthy workforce will reap benefits far beyond keeping commerce running smoothly; and for a longer period of time as the working population ages. According to the Confederation of British Industry, quoted in the World Health Organization report “Mental Health and Work: Impact, Issues and Good Practices,” “We… are convinced that the mental health of a company’s employees can have an important impact on business performance in the same way as do industrial relations climate or inadequate training.”

The consequences of employee depression cost billions of dollars in lost productivity. Figures range from $23 billion in lost productivity for employers to a staggering $193 billion annually in lost earnings for employees themselves, according to the results of a 2008 study in the American Journal of Psychiatry. The problem is exacerbated for the part-time workforce, wherein absenteeism increases to 13.7 days in those who are depressed, up from 8.7 days yearly in the non-depressed 

Mental health issues in the workplace have consequences that strike beyond the individual employee himself. Apart from absenteeism, mental health concerns can diminish work performance, interfere with inter-staff and client relationships and be destructive to overall company morale. As staff morale sinks, issues like increased turnover, worker injury, errors, productivity reduction, and inefficiency increasingly rise to the surface.

The solution is to proactively and primarily address the holistic wellness of the person, and the employee second. The preventative approach is far more cost effective for taxpayers, beneficial to businesses, and the actual employee. Again to draw on Ben Franklin’s wisdom, “An ounce of prevention is worth a pound of cure.”

From a business standpoint, holistic programs aid the employee in mind and body are an investment not only in the employee, but also in the company. In much the same way that improving infrastructure in our country, including roads, bridges, airports, will secure a sunnier future for a wide swath of the population, investing in the mental and physical well being of the American workforce will pay similar dividends. The society that harnesses human capital to assist people with mental wellness will maximize potential. It can take people from being unemployed or underemployed to having their talents fully utilized and this stands to harvest the most from a workplace that recognizes the critical importance of the mind-body connection. President Obama’s FY 2013 Budget includes a plan to renew and expand America’s infrastructure, which would result in employing many, particularly in the construction and manufacturing sectors.

The thinking is that by reinvesting in wellness programs that would put Americans to work, these projects would continue to reap rewards in the future not just in the jobs they produce but in the enhanced future capacity of the community. Modest spending in programs to bolster employees’ mental health infrastructure, as viewed through the prism of Employee Assistance Programs (EAPs), health insurance programs and wellness plans and disease management should easily pass this same litmus test of a cost-benefit analysis.

The data is convincing. When programs are put to work to help employees with issues such as alcoholism or substance abuse, domestic violence, depression, and other mental disorders, there is a rise in productivity. The George Washington University Medical Center’s Ensuring Solutions to Alcohol Problems program affirms that for the condition of depression, “A large body of research shows that high-quality treatment of depression can reduce days of work missed and cut low productivity days.”

As far back as 1990, experts tabulated the cost to businesses for each depressed worker at $600 annually, with two-thirds of these costs related to absenteeism and lost productivity. This is where mental wellness plans must bridge the tremendous gap between a worker’s current reality and the bright future. The funds expended must be used more effectively and proactively to create an environment of mental wellness. Ultimately, the goal should be to help the workforce become healthier and creating and investing in a mental wellness plan is a factually robust evidence-based approach to accomplishing that goal. Perhaps most interesting is that many of the modifications that help depressed workers become more productive in the workplace; telecommuting, flexible work schedules and occasional breaks during work hours, cost very little to employers, benefit nearly every employee and are demonstrated to increase overall employee productivity. 

A robust mental wellness program is the gateway to help employees and companies. The plan must create an environment that helps prevent mental illness or mental illness recurrences. This new proactive business and social culture would see huge returns on the investment into such a plan given that there is a $7 return on every $1 investment in expanded diagnosis and treatment of employee depression. That return on investment is certainly a pretty penny earned. Ben would be proud.

Look to your left. Look to your right. Look behind you. Look in front of you. One of the people you just saw has been diagnosed with a mental illness. 

Many people ask why I started TalkSession. I left a career on Wall Street, got an MBA and now run a consumer healthcare technology company with a clear mission of making mental healthcare more accessible, affordable and acceptable through cutting-edge technology. My trajectory would beg the question, how did I get from the Goldman Sachs trading floor to bootstrapping a mental healthcare platform? 

Some of the reasons are practical, like the fact that the healthcare system is broken, mental healthcare is particularly inefficient and mental illness affects not only the overall health of our population, but also our economy.

Some of the reasons are more personal, including the fact that mental illness-related stigmas are still pervasive and affect not only the afflicted, but family members and friends. My mother suffered from major depression, fully evident from when I was 12 years old. At such an impressionable age, I possessed neither the wherewithal nor the perspective to seek help for myself. In fact, it was preternaturally engrained in my mind that I should not tell anyone about my family situation. The topic was simply taboo.

While I was able to put my head down, focus on my studies, pursue athletics and take control of my life, I became determined to make sure that the next 12 year-old in that situation could have more options than I had, have more opportunities to get the help she deserves and also make sure that the act of getting help is acceptable. 

With recent buy-in from Hollywood (Thank you, Harvey) and President Obama, we are seeing support from influencers that can affect real social change.

Jennifer Lawrence used her 2013 Oscar win for Silver Linings Playbook, to champion this very cause, “I don’t think we’re going to stop until we get rid of the stigma for mental illness. I know [writer-director] David [O. Russell] won’t. And I hope that this helps.”

Lawrence continued, “It’s so bizarre how, in this world, if you have asthma, you take asthma medicine; if you have diabetes, you take diabetes medicine. But, as soon as you have to take medication for your mind, there’s such a stigma behind it.”

President Barack Obama is also active in this cause. At his White House conference on mental illness earlier this month, Obama said, “We whisper about mental health issues and avoid asking too many questions. The brain is a body part, too. We just know less about it. And there should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love.”

And so, as the topic becomes more mainstream, it begs the question, what can we be doing as every day citizens to make things better?

Dr. Lloyd Sederer, author of The Family Guide to Mental Health Care (with a Foreword by Glenn Close), and Medical Director of the New York State Office of Mental Health, comments, “Unless we take action, as Melissa suggests, four out of five people with mental conditions will continue to not receive the right kind of help — help that works. That’s a tragedy we can prevent.”

Here are three suggestions from TalkSession on how each of us can make a daily difference:

1. Realize the Numbers: Mental Illness Affects Millions. Support Innovators Who Drive Change
According to National Alliance on Mental Illness (NAMI), one out of four American families includes a member diagnosed with some type of mental illness. Indeed, one out of every 17 people is saddled with mental illness in the United States at any given time. 

It’s also important to realize that mental illness does not discriminate. The affliction strikes people of every race, gender and economic background. While many mistakenly believe this illness can be overcome with simple willpower, this is sadly not the case. Mental illness is a serious medical condition, and must be treated as such.

Consider these words from Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law: “Mental health parity means that issues such as depression or schizophrenia would be treated for as long as necessary, much as a broken arm is treated until it is healed, rather than having limits on allowed visits per year or insurance policies that don’t include mental health at all.”

Vote for and fund politicians who will help end mental health disparity in our country. Seek a candidate who has those ideals. Ending stigmas surrounding mental illness will be challenging, but a feat we must proactively work to achieve.

2. Integrate Mental Wellness into Daily Life
By openly talking about mental health problems we will help others realize the scientific fact that mental health issues are medical issues — and they are not only pervasive, but they desperately need to be understood and treated.

Mental health also starts with each individual. Take care of your own mental health by doing what you need to do to remain mentally well. If its mediation, medication or meditation, do what it takes to keep your mind healthy. Brain health is one of our most valuable assets. Do all that you can do. Be a shining example of mental wellness to everyone within your own personal sphere of influence. 

3. Practice Empathy

Empathy will go a long way to improve stigmas around mental illness. Here are active steps one can take to improve empathy:

· Be curious about strangers. When given the opportunity, talk to someone with whom you are not acquainted, be inquisitive, lend an ear. Who knows? You may be the only person who actually took the time to care about that particular person that day, that week or that month.

· Listen. Really listen. Think about it: When you talk to somebody, how much do you actually hear? Probably not enough. Make a conscious effort to take in what a person is saying and do not be afraid to open up about yourself.

· Inspire change. Empathy typically seems to happen only on an individual level. However, mass action and social changes are often inspired through great empathy. Plant seeds in the children you influence. Plant them on your social networks, too, and plant them in your friends and co-workers. You may be surprised by your influence and impact.

· And, finally, empathize with your adversaries. Instead of making “enemies” out of certain people with whom you do not agree, try understanding what is being said. Seek to find out what drives the other person, and realize that most of the time, people are inherently good.

So where does this leave us?

Mental and behavioral health is an area where we can take steps today that will have a significant impact on improving the lives of the next generation. That is why I started TalkSession. We have the opportunity to make a difference during our lifetimes that will carry on as a legacy to improve health and happiness in the perpetuity. So, let’s create change.

By Melissa Thompson

In the early years of their friendship, Sigmund Freud once said to his younger colleague Karl Jung: “I’ve only opened the door… it is for men like you to walk through it.”

The door is wide open; frameworks have been built; and, now advances in neuroscience and new technologies promise to finally push psychotherapy through the proverbial door.

Foundation: Freud’s legacy

Freud enhanced psychotherapy in two ways: 1) uncovered the value of the unconscious and a more nuanced perspective of the brain; and, 2) fathered psychoanalysis, a form of treatment that is still widely taught and practiced today. Freud had a background in neuroscience, but scientific and technological limitations at the time precluded him from explaining higher cognitive processes through research. This led to Freud’s transition to study the brain through psychoanalysis from which he built a framework. Freud’s method is criticized for its lack of empirical evidence. Nevertheless, he was not equipped to provide such evidence. 

Flexibility: Freud knew his limitations

Freud was keenly aware that his theories would be influenced by advances in biology. The scientist repeatedly took ownership of his elaborate interpretations, knowing that scientific advancement would amend many of his theories. For years little research was done and the fields of biology and psychology drifted apart. This needs to change.   

What would Freud do? Marry the fields

Currently in courtship, neuroscience and psychology research are already showing major positive outcomes from their collaboration. Through imaging technology scientists can detect structural changes in the brain as a result of cognitive therapies or prescription drug therapy, especially related to OCD, depression, memory, learning and fear responses. Last month, in the largest genetic study of psychiatric illness to date, scientists discovered links between five major psychiatric disorders: Autism Spectrum Disorder (ASD), ADHD, bipolar disorder, major depressive disorder, and schizophrenia were shown to share genetic commonalities. What is the implication? Among other applications, through marrying the science and psychology by using technology, psychiatrists can hopefully increase treatment outcomes by using someone’s individual genome to better predict which prescription drugs would work best.  New technologies utilizing artificial intelligence mechanisms, personal data tracking and monitoring, audio feedback analysis, and Bottom line: the linkages scientists find in the brain will have vast implications on our mental health, which is at the heart of our overall health.

Government: Joining the party

Today, Obama announced a $100 million initiative for 2014 to develop better technologies to understand the human brain.  The project, “Brain Research Through Advanced Innovative Neurotechnologies,” or it’s diminutive: “Brain,” comes at a time when nanotechnology development is mature enough to devote considerable resources and a “dream team,” to important developments in neuroscience that will hopefully have profound effects on Alzheimer’s, PTSD, traumatic brain injuries, and mental healthcare.  The project, which will involve both private and public institutions, does not yet outline specific goals or a timeline, but its scope has been compared to that of the Human Genome Project.

Technology: Freud would embrace the app culture

Some of the biggest issues with Freud’s work remained: “how can we quantify Freud’s theories? Is there empirical evidence that this theory works?”  I strongly believe that if Freud could have, he would have embraced technology and the ability to quantify his process. Freud knew we could not fully understand the biology of the brain, and consequently, his approach was more art than science. Now, science is getting closer to creating the holistic puzzle to help scientist solve pervasive challenges for brain health.

This process will take a long time and require patience. Nevertheless, I believe we are on the brink of amazing discoveries in neuroscience and impactful implications for mental healthcare treatment. Through technology, today we have the ability to understand much more, to treat more effectively, and soon, to potentially better determine what treatments work.  While science is still at a nascent stage, I believe the next 2-5 years will be the tipping point for this field.

 

This week Samsung delivered a flash-mob style performance in Times Square ahead of its Galaxy S4 device unveiling tonight at Radio City Music Hall. Literally, turning the U.S. wireless communication competition into a circus. In another limited-edition special, Apple’s VP of Marketing, Paul Schiller, defended Apple’s products and pointed out major flaws in Samsung’s products and tactics to the Wall Street Journal. Samsung is delivering its new product with circus-like fanfare. In a quick role-reversal, we have Apple on the defense, and Samsung on the front-line (but not in front of true innovation).

The Paradigm Shift in Mobile Technology

Samsung’s Galaxy S4 “phablet” will have a screen that is predicted to be 0.2 inches larger than its predecessor. The inclusion of more innovative features for the S4 - flexible screen technology, eye-tracking software, an 8-core processor- are long shots at best.

Samsung is smartly capitalizing on Apple’s recent PR missteps, tanking stock price, and stagnant pile of cash. There is nothing extraordinarily innovative about Samsung’s new device, aside from the extravagant promotion by dancers donning top hats and the number “4” on their tuxedoed-clad backs. In terms of the actual product and the actual technology, the S4’s incremental improvements in technology will not make substantial impact on user experience or consumer value.

Where is the innovation?

While the S4 pitch rings as “better than the iPhone,” I credit Samsung for smartly spending their marketing dollars to build awareness now, while Apple goes silent. Samsung’s future pipeline of products, will indeed offer valuable innovation.

For years, Samsung has been investing alongside Intel to create the Tizen operating system: an open-source software platform that will create a robust and adaptable development environment, providing a consistent user experience across devices. The Linux kernel and WebKit-based system integrates harmoniously with gadgets other than our phones, phablets and tablets - including our cars, appliances, smart TVs.

Which company has an integrated system of devices beyond the media realm? One who could integrate an open-source, flexible platform into its suite of products? Samsung. Now we are talking innovation.

Apple’s Reality Check

Innovation today means being open, transparent, integrated and creative. Apple needs to make a radical shift to maintain leadership and brand equity.

Indisputably, Apple is known for innovation. The company’s mission is to bring “the best personal computing experience to students, educators, creative professionals and consumers around the world through its innovative hardware, software, and Internet offerings.”

The U.S. wireless market is nearly saturated; competition is fierce and only getting stronger. The “new, better, and faster features,” have become meaningless buzzwords. Innovation itself is a buzzword, but true innovation is much more than just bells and whistles.

Apple needs to rethink innovation as Steve Jobs would have, and renew its commitment to its mission bringing the best experience to the global market. Apple currently has an untapped opportunity: improving global health, education, and economies. There are rumors that Apple is creating a lower cost iPhone later this year. This move would be a step in the right direction, as Apple’s high price point is prohibitively expensive for the developing world. Beyond access to the device, the larger issue is operating system capability. This presents Apple with a large market opportunity, but the company would have to consider a major strategic shift: one to open-source software.

Modern Innovation: Creation of Shared Value

Apple’s closed-operating system has allowed Apple ultimate price and quality control. Nevertheless, regulation often stunts innovation. As a case study, let’s look at mobile health. Mobile phones promise to improve healthcare, acting as handheld portable healthcare devices, both in self-managed care, remote assistance, and more integrated solutions.

My own healthcare technology venture aims to deliver higher quality treatment at a more affordable price point - to help more consumers access mental health treatment. Open source technology was and continues to be a crucial component of our product development.

mHealth technology has facilitated new ways to diagnose malaria, tuberculosis, and hookworm, detect allergens and pathogens. In the future, our smart phones will have the ability to detect cancer, HIV, and other serious conditions based on a droplet of blood or saliva placed on our screens. These are meaningful technological developments.

Where can Apple live its mission of innovation?

The difficulty of global shared value creation lies in cost and technology delivery. Apple needs to move beyond its comfort zone and innovate beyond the familiar. If Apple indeed creates a lower-cost smartphone, and most importantly, employs an open-source operating system, I believe the company will reinvent itself, regain its position as a world-class market leader, and truly live its mission of global service and excellence.

Once a year New York City is overcome at 5pm with color-blocked swarms of people donning shiny new running sneakers; people whose eyes are still glued to their blackberries monitoring the market close; an assembly of ethnically-balanced, clean-cut twenty-two to forty-five year-olds wearing a version of the shirt, “JPMorgan Corporate Challenge: TEAM MORTGAGE-BACKED SECURITIES!” Garish? Indeed. Nevertheless, there is a lesson to be learned from the Wachovia Water Bottle squad.

My thirteen years as a Girl Scout and several years imbibing the Wall Street Kool Aid, led me to wholeheartedly believe that the workplace should foster charitable giving and teamwork- no matter the stage of the company. In my former life, I worked at an investment bank, where at least one day a year we were required/allowed to donate a day to “Community Teamworks,” and participate in a charitable program.  I cleaned parks in Brooklyn, served meals in soup kitchens, and mentored underprivileged youth on personal finance. Wall Street “maximizes value” a bit differently, insofar as the service days coincidentally fall on the same days as the photo shoot for the Annual Report.

An important lesson I extrapolated and continue to develop is the need to establish process and foundation for social impact early on in companies – no matter the stage of the venture. My most trusted colleagues were those with whom I spent those Teamworks days. This altruistic foundation fosters a culture with roots firmly planted on the socially conscious spectrum of kindness and giving. Further, the environment and cause forges bonds amongst coworkers that could not be replicated through a shared Dropbox or a Monday morning meeting.

I run a startup. We are frugal with funds, prudent with payrolls, and worry about waste. Nevertheless, there are so many ways to creatively contribute and establish a corporate culture to continue the tradition. Here is my approach.

1) Evaluate your altruism.

Pick what kind of altruist you want to be and analyze your motivation. If funds are flowing and donations on behalf of your company are an option, spend wisely. If a company chooses to buy matching headbands, raise money from Facebook friends and bring along a photographer to prove the event happened – there is societal benefit in that as well. My suggestion is to optimize this process for your company’s situation, and make sure to consider the unquantifiable benefits that occur on your own company’s side- teamwork, spirit, and time spending bonding over non-traditional work activities. These decision inputs would include: the size of your team, budget, leadership inclination, and mission of the company itself.

2) Create shared value.

This year at our company Christmas party, we spent a portion of the evening writing Christmas cards and making gingerbread houses for a residential foster care facility.  We delivered these by hand, along with Christmas trees and cheer. Total cost? $150. Surprising the children was incredibly gratifying, but beyond that, the positive spirit in the air amongst our own team was palpable. I witnessed people who rarely worked together, in part due to their proclivity to stay behind their laptop screens, bonding over frosting-piping and giggling over their poorly engineered graham cracker rooftops that perpetually squashed their “perfect homes.”  The amount of shared value we created far surpassed the $150 outlay. 

3) Use what money can’t buy. 

Talents in the startup world run wide and deep. I have met the most creative, innovative people I have ever met along this journey. Like artists who donate paintings for auctions, we have skills and creations that we can use to help inspire others around us and create more value than the dollars we can donate. As our friends at Skillshare have shown us—there is tremendous value in knowledge sharing. Startup leaders are inspired; they have the ability to take risks. Some are whiz programmers, while others create brilliant concepts that the world has not yet seen. Startup teams have qualities that are rare and valuable. I would urge people to share these attributes. 

If we think about it… Wall Street charities funds foundations, foundations source programming, and the programs attempt to hire people with similar skills as we have amongst ourselves in the startup community, to work on their projects that are commissioned by the Wall Street dollars.  It becomes quite convoluted. Take your mission and carry it out with your own team!

4) Rally support around WHO is important to you. 

Lastly, be attuned to what is important to the people around you.  Whether it is cheering for your colleague in at his basketball league games or by donating to a friend/coworkers Kickstarter project—helping people in their pursuit for charity makes you a part of the process itself.

No matter your role in a company, the type of company in which you work, or the financial state of your professional life, everyone can do something.  Wall Street firms might have big bucks, but there is no leg up on the size of one’s heart and creativity.  The foundations and processes we establish early on yield exponential returns in perpetuity.

Healthcare needs fixing.  Regulations stunt innovation, people are uninsured or underinsured, physicians’ are mired in red tape, and politically driven laws have unintended effects on the healthcare system. 

Despite the regulatory difficulties, 2013 will surely be an exciting year for healthcare. I predict that we will see an increase in self-management and collaboration.  We will see an influx of innovation in mainstream health-related consumer products, data will be more readily available, and industries will make more productive and practical use of the data we are able to collect. 

I have a business in consumer healthcare technology.  As we build the technology, we constantly worry about HIPAA-law, adherence of state-to-state guidelines, and protecting the livelihoods of providers, who are regularly subject to changes in laws and require continuous education on legal nuances.

Here are five trends that I believe will dominate the healthcare front in 2013.

1)   Testing, testing, 1,2 3….  Self-monitoring devices take the stage.

This year for the holidays I got myself three gifts – unintentionally, all digital health-related devices. I bought a pattern-monitoring bracelet (Up by Jawbone), an iPhone-enabled lego-like system that detects electromagnetic field radiation as well as the “organic-ness” of my fruits and veggies (MyLapka), and a scale that graphs my weight on an accompanying iPhone app.  In 2012, the Nike Fuelband put self-monitoring devices on the radar of the mainstream consumer and the field is getting bigger.

The efficacy of these devices is still evolving. There is clear room in this space for innovation, aggregation, and higher efficiency. 2013 will be a year of competition amongst many new products, and we will undoubtedly see incredible technological advances passed on to the consumer in the form of novel “toys” that if used with intention, will better our interactions with our own healthcare management. 

2)   Tap, Swipe and Shake: Success Driven By User-experience

I have ulcerative colitis –a chronic, autoimmune disease that is affected by the types of food I consume, the time of day I eat, the amount of sleep I get, and the medications I take.  The site PatientsJustLikeMe allowed me to compare my symptoms with 1000 other people and might have provided useful insight.  However, my data entry took so much time that I could not reach the end nor a meaningful result.  New apps, such as Thryve for nutrition, are geared toward making the user experience engaging, the data entry simple, and the information meaningful, while also being beautifully presented.  Expect design to be a differentiator this coming year.

3)   Big data: more practical, more relevant.

In the past I have observed excitement about the sheer breadth of the data we have been able to collect.  In the past year we saw single apps dedicated to collecting data on one’s heart rate.  While cool to show friends, the novelty of a new data-collecting-app wears off quickly.  It is would be much more interesting to observe one’s heart rate that is cross-referenced with sleep patterns, life events, emotions, or food intake.  And it would be even more awesome yet, if that application took my patterns and made meaningful recommendations for improvement.  Recently companies have been applying data in smart, relevant ways, as the end user now demands an answer to the question, “how does this help me?” And companies are responding. 2013 will surely have notable big data plays that have practical applications to our everyday lives.  Startups I have seen lead this movement: Lumoback (measures users’ posture, and makes recommendations for improvement), OvaScience (aims to improve the success rate of in vitro fertilization through technology and user data), and the Hapilabs’ HapiFork that tracks the rate at which one eats and then advises the diner to slow down.  I predict that this year we will see companies create platforms and applications that make our desire to use monitoring devices and voluntary data sharing actually beneficial to one’s health. Check out this cool infographic on big data from Neolane.

4)   Dude, who stole my benefits?

As healthcare costs continue to rise benefit attrition will continue, particularly in the mental health space.  Mental health coverage is costly.  Treatment efficacy is more difficult to measure than for most physical ailments, and it is often the first arena of coverage dropped after vision and dental. I predict that we will see wide ranging effects from decreases in mental health care benefits.  Recently my state’s low-income health insurance stopped offering prescription benefits in the psychiatric medicine category. I believe that there will be a backlash against these policy changes as insurance companies realize it is more costly to deprive certain benefits to those in need than to offer them.

5)   Move Towards Collaborative and Voluntary Healthcare Data Sharing

HIPAA regulations dictate that our health-related data be kept private. Increasingly we see grassroots efforts to voluntarily collaborate on healthcare data sharing.  In 2012 we saw private insurance companies, such as Aetna and United, dip their toes into The Blue Button movement – which allows users of personal health records to download their personal health records.  With users in control of their own information, organizations such as Lybba.org and the Mayo Clinic’s data sharing lab have been facilitating the voluntary participation of data sharing in order to better understand medical conditions, improve care, and promote innovation.

The healthcare space is rapidly changing; its flux can be seen in headlines daily.  As entrepreneurs and investors move towards the appreciation of shared value and collaboration, I believe 2013 will bring a higher form of capitalism in healthcare.  Companies and consumers realizing the value of working together to discover solutions to address some of the most complex problems we face today.  I am excited to be a part of that process and a witness to the creativity and innovation of a difficult market.

Frenemy is a noun with nuance; its definition does not do it justice.  A frenemy is a person who can never fully be trusted and must be approached with the utmost caution. This relational phenomenon is highly present in the startup ecosystem.

Businessweek article stated that frenemies in the workplace are common, due to increasingly informal environments and the “abundance of very close, intertwined relationships that bridge people’s professional and personal lives…”

When I started a business with a friend, we soon shared an apartment that doubled as our office. Post-graduation, my MBA-classmates subsequently became my friends, my employees, and some my competition, and my former professor became one of my investors. Intertwined? Indeed. 

In this ever-shrinking world, six degrees of separation became two and fresh introductions are colored by the association of “mutual Facebook friends,” This combination led startups to become a quintessential breeding ground for frenemies.

Here are 5 Tips on How to Avoid the Enemy, Keep the Friend, and Maximize Your Work with Frenemies

  1. 1)   Realize that Frenemies are unavoidable. In the world of startups, the same faces and names quickly become commonplace; the community is small and made smaller by their technological prowess and hence, higher interconnectedness.  The nature of entrepreneurs makes them inherently more likely to fall into the frenemy category. We are generally Type-A, competitive, and motivated to change the world.  But people associate success with different costs.  Take part in the collaborative nature of the community, learn from them, teach them, but be on guard that the motives of others are not always pure.
  2. Build Trust Circles akin to a Russian Nesting Doll – In Layers.  I had a former classmate work remotely for me as a research consultant, while I was simultaneously helping him secure a venture capital job. I had spent many months creating investor decks, lists of prospective investors and partners, strategy plans, and financial projections.  When he fell off the map for a few weeks, he responded that he found a job.  I was happy for him. Two months later I found out he had become the CEO of one of our competitors and the copy on their site was taken directly from our materials.  As a bootstrapping, lean startup we didn’t have the resources to pursue the matter further than an email request copying our lawyers. Everyone working for you as a founder should sign a Confidentiality and IP assignment agreement.  Give limited access to employees who are not fully committed and trustworthy.
  3. Know Your Strengths, and Acknowledge Strengths in Others. Like a sports team, every player has a role, but as new people come in, roles change.  In the startup world, we as founders and first employees wear many hats, but must be able to know when someone is smarter. Inevitably, someone will be.  Insecurity breeds animosity. As part of a founding team in a startup, or in any professional setting, there will be internal competition.  There will be co-workers, managers, investors, and employees who outsmart you, or are more skilled in certain areas. Regardless of whether you are the CEO, CTO, Head of Sales, or an executive assistant, you are in your role for a reason. Don’t be afraid to ask your colleagues, clients and managers to share their perspective on your strengths and weaknesses. Own your highest value-add and ask others to help you with your weaknesses.  Realize that asking for help is a strength and will reduce the enemy-factor in your relationships.
  4.  Learn from the UFC: Enemies in the ring, friends outside the ring.  Ultimate Fighting is the fastest growing sport.  When friends Jon “Bones” Jones and Rashad Evans went head to head in a fight, Jones said, “It’s definitely going to be huge for the sport, teammates fighting each other. You know Rashad, we were friends and hopefully we can be friends after the fight. It’s just business. You’ve just got to get the job done.”  This applies internally to a team, and externally between companies.  It is easier said than done, but try your best to separate professional and personal relationships.  This may be one of the hardest aspects of a startup, and is often a determining factor between success and failure of a business. As a manager, try to facilitate non-business events that foster friendships and allow people to connect on a personal level in a controlled environment, while sticking to a more regimented business relationship with your coworkers. After you work hard, don’t forget to play hard.
  5. Support other startups: Pay it forward. I am a huge supporter of innovation, sponsored-challenges, and forward thinkers who can recognize future value before future revenue.  When you can, pay it forward.  The “it” is often just your presence and costs nothing.  When one of your startup friends invites you to celebrate his or her new office or soft launch, go! When you are asked to tweet out news of a company’s new product or TechCrunch coverage, do it!  As a founder, I realize that small acts that help promote other startups go a long way.  Support the ecosystem and try to be the friend, over the frenemy. 

Competition keeps you in check.  Competition forces you to look at your business and the decisions you make in the context of others.  We all want to focus on our product, but attention to the competitive landscape is inevitable.  We will pay the fee to register for a competitors’ site to see every attribute they chose.  We will learn from someone’s first mover advantage.  At the end of the day, we are entrepreneurs because we want to make a change in the world.  We want to innovate, improve, and fix inefficiencies.  Frenemies are inevitable, but everyone is in control of him or herself. The more we can support each other, the stronger we will all be.  

NEW YORK, NY – DECEMBER 12, 2010

Never has it been more important for young entrepreneurs to take risks.  While direct investment increases, and venture capital declines, brilliant young enthusiasts with out-of-the-box ideas have incredible opportunities to change the world.

Despite the prevalence of startups splashing headlines, a recent report from the Kauffman Foundation shows that the number of startups declined from 12 percent of all companies in the 1980s to now less than 8 percent: the lowest point on record.

The success of small businesses is crucial to our economic recovery.  This puts added responsibility on the shoulders of entrepreneurs risking their life savings on ideas that seem wild today, but may be mainstream in five years. 

Melissa Thompson, CEO of Talk Session, and a leader driving healthcare technology innovation in the startup world, understands the personal risk entrepreneurs face first-hand and offers ten tips based on her experience to help them succeed:

1)   A-team: Take your time to find the best team possible.  Recognize your strengths and weakness.  If you play to your strengths and find supplemental talent to round out your team, everyone wins.

 2)   Isolate Your Focus:  The startup story is one of four main parts.  These are what investors and supporters want to see.  The process: a) isolate one problem that exists that has not been successfully solved, b) create solution, c) formulate an execution strategy, d) determine it’s value and potential.

 3)   Don’t cross the Baker’s Dozen:  A synonym for “baker’s dozen,” is “devil’s dozen” – a phrase that arose from 13th century bakers hedging the potential of accidentally short-changing clients, which would result in their hands chopped off by an axe.  Thankfully, like technology, “digital execution” has evolved over time.  Keep a do list and limit it to twelve or so.  It feels good to have tangible evidence of productivity.

4)   Let Failures Fuel You:  Failing on a daily basis is part of the startup territory. It is imperative that you control your emotions and not displace your anger on your colleagues.  Mistakes can feel like a crowbar to the shin and as the leader it is your duty to coach others through keeping their mistakes in perspective.

5)   Everyone Has a Boss, Never Forget: Part of the reason you are starting your own company is so you don’t have to work for a boss.  But in reality, everyone has a boss.  The President of an investment bank has to answer to his or her Board, shareholders and high-net-worth clients. Even retired self-made billionaires likely have to answer to their spouses.  So regardless of one’s “CEO and founder” status; maintain humility, treat people kindly and manage wisely – both up and down.  The way you treat others sets the tone for your entire company.

6) Don’t Code Where you Cook: Working from your home can be purgatory – it blurs the line between work and play and hinders productivity.  If you don’t have office space there are alternatives: shared office space or desk-for-a-day rental services.

7)   Report Card on the Fridge 2.0: Celebrate something you did well every day, week, and month.  Particularly when leading a team, these small celebrations go a long way to inspire and motivate the team.  Creative gifts trump expensive ones, and emailed compliments on top of verbal ones often get forwarded to significant others’ and parents with pride.  Think of it as the modern day “report card on the fridge.”

8)   Bring passion: Find people with similar missions.  The company you keep will drive your venture forward and you’ll enjoy the journey every step of the way.

9)   Learn From Those Before You: I recommend that every aspiring entrepreneur read the books Rework, written by the founder of 37Signals, Venture Deals by Brad Feld and Jason Mendelson, and Thinking, Fast and Slow, by Daniel Kahnemann.  I wish I read these before I started my venture, as it would have saved me a lot of time and money. 

 10)   Reboot Your Mind, Body, and Laptop: Since you are not making money until your venture succeeds, you have a 24/7 job.  However, make sure you close your overheated laptop every now and again, hit the gym, laugh with friends in person, and return to technology with fresh motivation.

Everyone wants his or her dream job, but few have the courage to take big risks. Two years ago I attended my Business School reunion and it was clear that I was part of the 1% who effusively loved her job. I was also in the 1% of alumni who had a salary of zero dollars per year.

Now, eighteen months after graduation, my classmates are leaving their jobs in droves to similar roles that with a slight change in name, title and uptick in optimism. Sadly their hair, complexions and dreams are all becoming shades grayer – in a much less sexy manner than the book.

Most corporate nomads prefer to stay within their comfort zone, and can you blame them? Steady paychecks, 401K plans, health insurance, an actual office with support staff, an HR department to source talent, cafeterias with reliably bland good, often black car service if you stay past 9pm and corporate AMEXs for the lucky ones.

To some, risk has a very different meaning than to someone like me. For some, the risk is working at a boutique bank over a large one. That boutique bank or consulting firm seems like a big move, a bit risky. And for them, it is.

There are a few important truths to face if you are thinking about jumping off and in to a startup, be it your own or someone else’s.

The corporate “holy grail” jobs are often inversely correlated to happiness:

Goldman, Bain, BCG, Morgan Stanley…. Are all the same names despite market and moral turbulence. Enter Sharon – an anomalous example of a classmate who proved a useful lesson.  After a year’s worth of 16 hour days in glass offices with her friend Excel (together creating strategy matrixes), she left her Consultant title and six-figure salary, and took her Ivy MBA to become a bartender in Canada.

Tired of urban life, and truly happiest when engaged in casual conversations, she realized vanity does not equal happiness in a job.Startups can hardly be glamorous, yet given Sharon’s training, I would put money on her ability to make a perfectcocktail from a recipe – she is not necessarily a startup gal, but she did learn that she is better suited for casual conversations with strangers while she’s shaking and stirring.

An unrealized problem amongst most of my corporate peers is that recipes are guides, not rules. To make any individual’sideal cocktail, it would likely diverge from the exact formula. Starting a company is creating one’s ideal concoction, for those who can accept the risks.

Perfect matches are hard to find in love, friendships, and careers:

The only perfect, complete match, is found in math. In practical life, there are no one-size fits all jobs, quizzes or algorithms that can dictate happiness.

Some of us are born Type-A entrepreneurs who start businesses out of their parent’s garages. Some, like me, go through a push-and-pull process to potentially have the chutzpah to jump from corporate to startup.

We rely on “corporate security,” (call it “resume building”) and spend a few years in which everyday seems incredibly important, yet over time aggregates into a bland resume block that garners respect, but also accounts for time lost.

You are the job, you are the recipe:

Creating a completely new venture is not easy. There is no padding to fall back on aside from the trust I have in myself. But like Sharon, I broke it down. What is at the core of my happiness? Fixing inefficiencies, technology, self-exploration and improvement, entrepreneurial collaboration, reading about studies in psychology, and the agility to move around physically and between projects. How was I going to find that match in a job?

I could not and did not want to. I started TalkSession. It is no different for me than anyone else who might fit in to this paradigm of creating the job and the recipe: you have to do it, no one else will.

However, dipping in a toe is okay, too:

Corporate environments provide security, structure and salary. Startups provide a blank canvas. Everyone falls at a different place on the spectrum of risk tolerance and I do not wish to preach to everyone to take that leap.

Even if the startup is not your idea and despite your intact 401k, everyone can participate in the entrepreneurial process and at least alter the corporate recipe a bit more to his or her liking. We spend so much time dedicated to our jobs – we best be happy doing it.

More than half of my team spends their 9 to 5’s at full-time jobs. I keep my office open after hours, on weekends, and cater to their schedules. My startup gives my team the infrastructure to keep their job and simultaneously leave their legacy.

Whether it is through angel investing, participation in brainstorm sessions, or sharing contacts, everyone on the spectrum can participate in the startup process and take a change at changing the world.

To have a startup one needs to realize the worst-case scenario of falling down with no cushion. Whatever your next move might be, do the research and make an informed decision. I love the startup world and for me, there is no going back. But certainly that is not for everyone. Jumping into risky and unpredictable waters can be scary, but if you have the chops and the dreams, I believe it will be worth it. And if you are risk averse, you do not have to bleed corporate blue or include the JPMorgan Challenge on your list of “things to do.” There are ways to participate in the startup world, make a mark on the world, and still maintain some security. 

Nov 12, 2012

Parallel to the old office adage, “Don’t dip your pen in the company’s inkwell,” is the startup version, Don’t code where you cook.

Today, there is an unfortunate imbalance in the office space market. Corporations continue to layoff employees, and leave their glass-walled offices half-vacant, occupied by the “lucky survivors” with overworked stares and underwhelming enthusiasm.  Office space is gold for startups. I recently searched for a new space.  We needed three desks, access to a conference room, and WiFi. 

The best I could find was $400 per person, at a shared space, in a less-than-desirable neighborhood.  While I loved my college days of roommates and shared bathrooms, something seemed wrong with this system.  I recently met a State Senator and explained the workspace challenge.  He wanted to help.  He wanted to keep tech startups in his district – but two real estate broker referrals does not a free office make.

As our lease ended, we relinquished our well-adorned-donated digs and moved to another foster office.  During the search process, we were tempted to move our company’s base and ourselves to the West coast, almost solely by the lure of free space.

This startup conundrum is a huge opportunity for local governments.  Cities want the infrastructure, intellectual capital, reputation, and youthful vibe brought by startups.  Simple aggregation and donation of excess space would increase a district’s popularity and reach into the Web 2.0 economy.  For the past few months, I have been irked leaving meetings with my design team at the banner: ENTIRE FLOOR FOR LEASE: 4500 SQUARE FEET. 

This waste feels worse than the trees that make up the yellow pages.  Empty space is a major lost opportunity for startups, the local communities, and the landlords who own the spaces. (For once, landlords should take a lesson from the lawyers’ new standard of startups’ bill deferral).

To run a start-up at a faster pace than you run your operating expenses, here are a few guidelines:

Fact 1: Despite the desk dearth, it is necessary to get exposure beyond the “home/office incubator.”  My co-founder and I self-incubated for the first three months of our business, and after three days we referred to it as the purgatory.  Get creative and find outside space (your productivity and co-founder will thank you!).

Melissa’s Alternative Space Recommendations:

1)   Boutique Hotels:  generally all have kind staff and offer free WiFi.  Downside? One becomes a bit of a high-tech gypsy.

2)   Ask friend’s with jobs in “fancy offices,” if they know any companies in the building with excess capacity.  We have been lucky taking this route.

3)   Loosecubes: great service to find a desk-for-a-day

4)   Planes, trains and buses: for any out town meetings take advantage of the WiFi and uninterrupted silence for hours of roundtrip relaxation.

Fact 2: If you can’t be together with your team every day due to space or geographical constraints, there are some great online collaboration tools that can ensure accountability.

Top Collaboration Tools:

1)   Asana: Great design is simple design.  Asana is easy to use and frictionless between developers and non-devs.

2)   Dropbox: I am not sure how I lived without it.

3)   Trello: Great UX, hot with programmers.

Bottom line, whether it’s by ordering a 3rd latte or loitering in a hotel lobby- get yourself out of purgatory, gain fresh perspective, connect with your team, and make something great.