How bad is Gen Z's mental health? Interview with Wave CEO Dr. Sarah Adler

Dr. Sarah Adler, founder and CEO of Wave and clinical associate professor of psychiatry at Stanford University, shares her journey from childhood through an eclectic academic path at Columbia University, a brief stint in medical school, and an unexpected career turn at a hedge fund. 

Her story offers a unique perspective on how personal experiences --in Sarah's case a diagnosis of ADHD at age 40 --can ignite a passion for mental health and drive innovative approaches to care.

We  explore how Generation Z is revolutionizing the healthcare landscape with their digital-first approach. By segmenting Gen Z into older, middle, and younger cohorts, we uncover their distinct preferences and the challenges of engaging with them through traditional healthcare methods. Our discussion highlights the pressing need for healthcare systems to adapt to meet the demands of a tech-savvy generation, emphasizing the role technology can play in providing accessible and efficient care.

Finally, we tackle the critical issue of the growing demand for mental health services amid a shortage of licensed therapists. Dr. Adler shares innovative strategies, including the integration of data and technology and the use of health coaches trained in accredited programs to deliver evidence-based treatments. We stress the importance of building a robust data infrastructure for measuring outcomes and maintaining mental well-being, both at Wave and beyond. 

When Sarah touts the benefits of starting every company meeting with a mini-mindfulness exercise, I challenge her to try that out in a sales call! We'll see how it goes.

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links:

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Host David E. Williams is president of healthcare strategy consulting firm Health Business Group.

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:00 - David Williams
More than 40% of Gen Z individuals have a mental health disorder and when they seek help, social media is often their first stop. Today's guest Wave founder, dr Sarah Adler, is facing the need with an innovative tech-based approach. Hi everyone, I'm David Williams, president of strategy consulting firm Health Business Group and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. My guest today is Dr Sarah Adler, founder and CEO of Wave and clinical associate professor of psychiatry at Stanford University. If you like the show, please subscribe and leave a review. Sarah, welcome to the Health Biz Podcast. 

0:00:48 - Dr. Sarah Adler
Thanks for having me, David. 

0:00:50 - David Williams
So I was checking out your LinkedIn profile. A lot of very, very interesting things all the way along the line, and currently what you're doing is very exciting. But let's start a little bit at the beginning. Love to hear about you. Know I'm not a psychiatrist so I'm not going to really ask about your childhood in the same way that somebody else might, but I'm always interested in what your childhood was like. Any influences have stuck with you throughout your career. 

0:01:13 - Dr. Sarah Adler
I think so. I think the most formative experience of my childhood that I didn't actually know was a formative experience at the time was that I had undiagnosed ADHD was a formative experience at the time was that I had undiagnosed ADHD and I actually found this out when I was 40 years old and my son was diagnosed, as many adults with ADHD do. And when I sort of apply that lens and look back onto my childhood and all of sort of the struggles and the difficulties that I had and sort of this idea that I was really never reaching my full potential, it actually brings a lot of things into relief. And when I think about it, even on a family that I had, and sort of this idea that I was really never reaching my full potential, it actually brings a lot of things into relief. And when I think about it, even on a family systems level, my entire family has undiagnosed ADHD, and so you can imagine what that would look like and how it impacted sort of my appreciation of psychology, psychiatry, mental health and mental health awareness. 

0:02:04 - David Williams
So I've heard about this before where someone will go and what's happening with their kid. They'll get diagnosed and then they'll be diagnosed with the same thing and that'll explain a lot. But I haven't heard as frequently when it comes with actually a psychiatrist. So can you explain that? 

0:02:18 - Dr. Sarah Adler
Yeah. So yes, I am the clinical psychologist who missed the diagnosis in herself as well as I also missed it in my son and my daughter. So this is why we don't treat our family members without a doubt. I was not at the time an expert in ADHD, although I have made it my job in life to know as much about ADHD as I can. But ultimately, I think a few things are at play. 

I always knew with my son that something, perceptually, was going on. Early stages of diagnosis with ADHD are sometimes called sensory processing disorder and kids who don't like tags, who are running around, who have just sort of a different vibe about them, and so I certainly didn't recognize it. As I started to learn about ADHD, the diagnosis, we tend to think of it as being just hyperactive, but it is a whole panoply of symptoms that are so complex and interconnected and it started to really help me shape and frame some of the things about myself that I didn't recognize, and I didn't even recognize it when I was in grad school. There's a lot of things with white coat syndrome we sort of do recognize about ourselves and we think we have every disorder that we're studying, but ADHD, it was not a thought in my mind until my son's diagnosis. 

0:03:33 - David Williams
Very interesting. Well, we skipped ahead a little bit because I was going to ask you about childhood and that not your son's childhood yet, but just going to school, columbia, I saw you went as an undergraduate. What was that like? 

0:03:44 - Dr. Sarah Adler
You know, the Columbia University system is spectacular because it's this great combination between being on a campus with walls and being in the middle of New York City, and so, for me, as an 18-year-old, I could not spend enough time roaming the streets of New York, seeing movies, absorbing the culture, eating all the good food walking around. I loved it, and the academics were awesome also. It really sort of gave me the opportunity to delve into an incredible curriculum and studies. That was just awakening and eye-opening, so I loved it. 

0:04:19 - David Williams
That's good, and did you go to work at a hedge fund after that? 

0:04:22 - Dr. Sarah Adler
I think I saw, I sure did, did yeah, why not, you know? Why not? So I was actually um, I was actually pre-med and, uh, decided I had a crisis of conscious, a little bit of a crisis of faith, um, right, as I was entering med school, and decided I couldn't go um. So I was a med school dropout, believe it or not, and my first week it was a real. My grandparents were not happy, neither were my parents? 

yeah, not no one one. No one liked that, and the only thing that I was really qualified to do was working finance after that. So I really didn't have any real skills, so I took what I could get. 

0:04:54 - David Williams
Right Now, that makes sense that you know, like you can't, I kind of mess up the family narrative, right, like my daughter, my granddaughter, oh, where she'd go to school. What you're doing next, then it's okay, some other little deterrent, but I think you made up for lost time. 

0:05:07 - Dr. Sarah Adler
Hopefully. 

0:05:09 - David Williams
All right. So you did the hedge fund for a while and then where did you go? Where did you go from there? Because I see a lot of different things. Maybe I could diagnose ADHD from looking at your LinkedIn resume. 

0:05:19 - Dr. Sarah Adler
I think you probably could. It really does. I really have sort of tapestried together a career that is incredibly exciting. I've done a lot of things. I like to do a lot of things. That's how I kind of keep myself stimulated and really focused. 

I'm a very intellectually curious person, so if I'm not learning, I'm kind of I'm asleep. So I need to be kind of feeding my brain a lot of the time. So after I worked, when I wanted to go to med school, I wanted to be kind of feeding my brain a lot of the time. So after I worked, when I wanted to go to med school, I wanted to be a psychiatrist. That was always my dream. And so after I got married and my husband, who's a techie, basically said hey, it's time to move out to Silicon Valley, and I said, great, what a great time for me to stop doing this 80 to 100 hour a week job that I can't stand and that I'm actually not that good at, and pivot back or return to a career trajectory that is really interesting to me, mission aligned and kind of is what I want to be doing. And so I applied to grad school out here and was lucky enough to get in and kind of the paths collided in a way that worked out really well. 

0:06:27 - David Williams
That's good. Now did the family go back to understanding what you were doing and being happy about where they thought you were headed? 

0:06:34 - Dr. Sarah Adler
I will say my father, who actually just passed away a month ago. So I think it is totally appropriate that I revere him in this podcast. I think there was no happier day of his life when I became a professor at Stanford. So, yes, they were very happy. I thought they were happy with hedge fund too, but it just was such a departure and I'd worked so hard in pre-med I couldn't understand it. But yes, everyone I think my family has been a great support and very proud of me, which is nice. 

0:07:05 - David Williams
Great. Well, I'm sorry for your loss, but I'm happy that you have the opportunity to talk about your dad a little bit here. Thank you All right. So now help me understand where you went from there and how you wove your way to Wave. 

0:07:17 - Dr. Sarah Adler
Yeah. So when I got to grad school at Stanford Stanford, as I think we all know, is kind of a hotbed for academia and industry colliding and I had all of these amazing spreadsheet data skills from my hedge fund days, which was great, and I really do have sort of an empirical thirst for data and measurement. When I got to Stanford, I was lucky enough to enter a research lab that was looking at how do you create and design evidence-based treatments or treatments that work and then disseminate them. And so I fell into a research lab with an incredible mentor who really kind of helped launch my critical thinking and my research career, and I fell in love with designing interventions and especially designing interventions and then measuring them to make sure that they work. And especially in our field psychology, psychiatry can be a little bit of a black box, which is part of down later how we get to Wave, but measuring those outcomes and making sure that you are providing care that is measurably effective is fundamentally what became my passion and my mission. 

I ended up being off job cycle after I had my second. 

I had my first kiddo the first year of grad school, my second kiddo my last year of grad school, and so I was off cycle when I was applying for postdoctoral fellowships and ended up kind of falling into this amazing two-year postdoctoral fellowship at the Clinical Excellence Research Center, which was founded by a healthcare luminary named Arnold Milstein and he had just started. 

It was the first year and they needed an expert in behavioral weight loss, eating disorders, obesity. 

That happened to be my area of study and my area of expertise. So I joined their team and we were trained in user-centered design through the design school and the bio design teams and our mission was to develop new healthcare delivery models that were better, faster and cheaper. And so how do you maintain stakeholder needs while aligning financial incentives in order to drive down the cost curve in healthcare, which we all know is a massive problem? So I was trained to build those healthcare delivery models on cross-functional teams for a year and then, almost even more importantly for my current work, I had the opportunity to sell those models into health plan self-insured employers and really kind of learn how to talk to those folks and what their pain points were and how to get those new healthcare delivery models adopted. So that was a real paradigm shift in my career. So it was the combination of wanting to design interventions that work, learning how to measure them and then really understanding the crazy healthcare system and the financial that drive it, in order to really make change. 

0:10:08 - David Williams
Great, all right, that's a good explanation. So let's talk about mental health, and Gen Z in particular, and we hear a lot about Gen Z and mental health. What would you say is the state of mental health of Gen Z? 

0:10:21 - Dr. Sarah Adler
It is the ever apparent question. So a lot of people ask me the question of is Gen Z really more miserable or is it just that we're talking about it more? And I saw an article actually recently I can't remember if it was the New Yorker, I think it was the New Yorker where there was a psychologist who was talking about how a psychologist in England who was talking about the fact that we are talking about mental health more is actually causing the problem that I wholeheartedly reject and disagree with Anyone who says they have one answer for any system-based problem is troublesome to me. 

But I think that it is a combination of a lot of things. Gen Z is the first generation out there who has had full access to digital information in an oversaturated way from day one. Everyone in Gen Z is a digital native, and they are constantly inundated with not only opinions and binary opinions on every political, socioeconomic, sociopolitical event that's happening in the world which is awful because the world is kind of a disturbing place these days but they're also inundated with a culture of being observed constantly, regardless of how they're interacting or observing constantly, and so that really creates a different neurochemical profile, which I fundamentally believe is part of the problem. So it's not just social media, it's not just the fact that the world is falling apart and it's not just that Gen Z is talking about all of these things more, but it's kind of a combination of all of those things. But I do actually think that Gen Z is suffering. They're talking about their suffering, but they have reason to suffer as well. 

0:12:04 - David Williams
They're talking about their suffering, but they have reason to suffer as well. That makes sense. I remember in the days of texting and observing, teenagers were texting and I actually thought that the next cohort that came along, which I guess became Gen Z, would become smarter about it. They'd say look at these people, they're so pathetic. They're just texting on their phones all the time. And of course, it went much worse from there, with thanks partly to Steve Jobs, I suppose, and the iPhone as part of it. But there really is something different about this generation than what we've seen before. 

0:12:31 - Dr. Sarah Adler
Absolutely, and I think even we see that in functional MRI data, as we see that the brain really does react from it. There's a lot of great books out there around you know the dopamine addiction and all of these things, but neurochemically their brains are hardwired differently and and just as the boomers brains were hardwired differently with the advent of television and technology does tend to do this, and so it is about sort of, rather than being reactive and trying to clamp down on, get rid of social media entirely, but how do we learn how to understand our relationship with social media, be mindful to your point and know when it is a problem? And so it's definitely a little bit of a battle, and I think new technology always creates neurochemical differences in the brains of the generations that are using it. 

0:13:19 - David Williams
So at the same time, we have these weird things going on with the technology and the brain. We talked about the healthcare system a little bit before, and that's its own problem, Nevermind. You know what we're dealing with with Gen Z, and so, in a way, you know, we know Gen Z is interacting differently with the healthcare system. May or may not be a bad thing. I mean, I'd like to figure out how to interact with the healthcare system and I'm a healthcare expert. So how does Gen Z interact with the traditional healthcare system? How do they do it differently? 

0:13:45 - Dr. Sarah Adler
You know, it depends. I tend to, when I'm kind of a data junkie, as I said, and I tend to think about Gen Z as, like, it's trifurcated into three different cohorts. There's the older Gen Z, there's the middle Gen Z and then there's the close to Gen Alpha Gen Z, and they all actually interact pretty differently with the health care system. We have to remember the oldest Gen Zers are 26, 27 years old at this point. One of the things we do know about them is they are much more adaptable to experimenting with digital entry points. In fact, they want digital entry points. This is a generation that was raised on tech space and I don't know if you have children or you've ever tried to force a Gen Zer to make a phone call like an actual phone call. 

0:14:23 - David Williams
I have four. My oldest is 26 and my youngest is 18. So I think I've got this whole span pretty much. 

0:14:29 - Dr. Sarah Adler
So you should actually be telling me. But it's very difficult to get a Gen Zer to actually pick up the phone and do anything, and so digital entry points are so fundamentally important. But the really great part of that is it does kind of reduce the barrier to entry, of course. So they are interacting. They're far more app native, digital native, and so the opportunity to reach them in different stages and phases of sort of the care continuum is actually kind of a white space in my mind. So, whereas it's really hard to get a gen, what's the generation after boomers? I don't even know what it's called. 

0:15:08 - David Williams
Yeah, that's me, Gen X. That's why it's? Because nobody knows anything about it. 

0:15:12 - Dr. Sarah Adler
Oh yeah. So it's really hard to get a Gen X. That's me actually also too. I'm thinking about the other direction, the older folks. It's very hard to get them to adopt a digital-. 

0:15:21 - David Williams
Above the boomers. 

0:15:22 - Dr. Sarah Adler
Above the boomers. 

0:15:23 - David Williams
I don't even know what that's called yeah, it's like the silent generation. 

0:15:27 - Dr. Sarah Adler
Okay, that's why I don't know because it's the silent generation, it's very hard to get them to adopt to new technology and it's actually much harder to get Gen X. Gen X is the worst in terms of adopting new healthcare because they've got all the data stuff going on as well. But Gen Z also interacts with data in a very different way. They really do think of data as more of a commodity and not all the time, but are actually far more accepting of having systems hold their data without some of the worry that I think some of us older folk have. 

0:16:00 - David Williams
Yeah, yeah, makes sense, all right. So one of the things that I hear there's so much demand against the healthcare system and then when you see a number like 40%, I mean it's a plurality, it's close to a majority. It's just so many people needing help and it's not as though there's that many more people that are providing the help and there's more, maybe, of an interest or an openness to seek help. So how does this gap possibly get bridged, even with technology, frankly, which I know is part of the answer? 

0:16:30 - Dr. Sarah Adler
Yeah, fundamentally I think it's a. Let's see if I can get this right, because I'll probably go off on a tangent and add more bullet points to it. But I'm going to say it's a four-pronged strategy. Don't hold me to that. Maybe it's three, maybe it's five, but I'm making all the McKinsey consultants out there cringe because I'm not fully exactly. 

0:16:48 - David Williams
Yeah, because also in consulting, just so you know, there's always three things, and if it turns out there's two or four, you say, well, the second one, that really is two things. Or if there's four, you say that one's less important than these first three. So there's usually about let's say three and let's see if we get it. 

0:17:01 - Dr. Sarah Adler
So I'm going to say there are three things. 

There are three main things. So, and ultimately, I think, as you sort of pointed out, there are 550,000 licensed therapists licensed therapists in the country and there are exponentially more demand, and so the human capital variant is not going to meet the demand and there is no way I see posts on LinkedIn every day we need to train more therapists. No, that is not the right solution. There are a couple of things we do need. We do need to make it more attractive and more appealing to be a therapist. So reducing costs associated is a very expensive field to go into which deters people from actually joining the field. And also then we abuse our therapists horribly and so they burn out and they are forced to work hours at a very low pay, so it doesn't seem like a very appealing job. But ultimately, I believe that we need to be using data, and with data I'll say technology. We need to be using human capital appropriately and efficiently and we really need to be working to align the financial incentives between the stakeholders, which is kind of, again, the fundamental problem in all of healthcare is that when your consumer and the person who is paying for healthcare, when the financial incentives, are not aligned, you're going to run into trouble. So, more tactically, what I'm talking about with that is, and kind of what I've tried to build at Weave is that we really do need to have an understanding, especially in the mental health field, of what does work, and this kind of harkens back to my early days of building things that work and measuring them. That is actually a very hard technological thing to do. It is not only hard to get people to give you information about how they're doing, but it's also very hard and very expensive to build technological infrastructure that allows you to get that data and then use it and measure it and measure outcomes. So, ultimately, I believe that building systems that work, measuring outcomes, having a data infrastructure that allows you to use that data to determine who belongs in what care pathway at what time which kind of leads me to my second point, which is the human capital aspect. 

Right now, my field is very, which is the human capital aspect. 

Right now, my field is very much an acute phase care field, so if something is wrong you show up. So that is not effectively looking not only at the data but really the lifespan of what mental health looks like. That's the reason my company is called Wave is that mental health is actually like a Wave. It goes up and down in different times. You need different care options at different times along that life cycle and we really should be managing mental health as more of a chronic disease, as more as that has a prevention, that has a maintenance, that has remission and really only assigning the appropriate level of care when needed. But right now it's like everything is a nail and we're all hammers. Is that anytime you have an acute mental health crisis you go see a therapist or you go see a psychiatrist and really there is far more opportunity to leverage evidence-based care. So interventions that we know work delivered by lay health care providers and really monitoring heavily when someone needs to step up in care to a more resource intensive or an expensive practitioner or intervention. 

0:20:05 - David Williams
So some of these lay people I think I've seen the term coaches used. I think maybe that's what you do at Wave. What kind of a role do they play? Is it just sort of a dumbed down therapist, or is it a different role? And then how do they integrate with the more traditional? I'm sure you're going to say it's not dumbed down, but it's got to be something else. 

0:20:23 - Dr. Sarah Adler
No, I think it's, I know I like, I like that. That's it. It's better than a lot of what I hear about coaches. 

0:20:28 - David Williams
I think. 

0:20:28 - Dr. Sarah Adler
I think the true answer is it remains to be seen, and the best way for it to be seen is for us to be looking at this empirically is to be is to be providing interventions using coaches, collecting the data and then reporting on peer reviewed outcomes, on whether or not it's effective and and, and I also think there's a there's a real distinction between like, the, the. The question of like what is a coach? And like what does a coach do also remains to be seen, because you have there's a company that's about to be launched that is going to. What I've heard is that it's going to have a lifestyle life coaching and there someone's going to hire bunch of actors and they're going to use AI to tell them the right healthcare thing to say so is that a coach? Not the way we do it, what we do at Wave, and where we think the real opportunity is to take health coaches. We train them ourselves. We have a coach university that is a national board accredited organization. So it's really about kind of the quality same way therapy is as it's about the quality of the training program that they're getting, the kind of conceptual thinking they're being trained in, the kind of supervision they're getting and then really giving them evidence-based treatments that work. 

So cognitive behavioral therapy, dialectical behavior therapy, training them in these treatments that work, and then creating infrastructures that are making sure that they're delivering the care that we know is effective. And so that's how we really see the leverage with coaches. Now, coaches only go to school. Most of our coaches are master's level, but other than that, they go to school for six months. We train them intensively, and so the resource allocation to train coaches is so far less that not only is it a more efficient and effective intervention, but it is far easier to expand the workforce, and so that's really where we think the leverage is. Now, the standard kind of thinking around coaching is that they are only good for very specific things related to behavior change. We fundamentally don't believe it. We have to prove it out, but there is 30 years of data in the cardiac and other sort of medical spaces that show that health coaches who are trained in things like motivational interviewing are really fantastic for getting behavioral change in a physical health. 

0:22:42 - David Williams
Makes sense. I think some of what you're saying, where the reputation for coaches is about behavioral change, comes from groups like Noom that had the insight to say let's go beyond just the app and let's add the coach, and that's been sort of a secret sauce for them, but maybe it ends up being too limiting. I want to ask you about something that's maybe seemed out of order, but it made me think about it when you're talking about coaches, which is the role of self-care, both what people are doing digitally, and I'm also thinking about the role of substance use or substance use disorder as well, because another thing that's different about Gen Z is that they're around in an era of legalized cannabis, and what I see at least anecdotally not in my own house, maybe, just because I don't see it is a lot of self-medication and maybe trying to go in a direction which is probably ultimately not helpful, but I don't know how this all fits together. 

0:23:33 - Dr. Sarah Adler
Yeah, I think it's actually. It's pretty tricky and I think I can give you my theory, but I can't say that this is all backed in science. It's maybe backed in like 30, 40% science and then the rest is my opinion. 

But ultimately I think that the combination of sort of the pathos or the misery that Gen Z is feeling due to all of the things we talked about before the world falling apart, social media their brains are different and then on top of that, it leads us for that Again, if we're a dopamine seeking generation. 

Self-medication is absolutely going to be a factor in this. The legalization of cannabis I don't have the data on what that looks like longitudinally and whether or not that's having an impact, but I absolutely think that the danger is there and I will tell you. I have an 18-year-old daughter and I can tell you anecdotally that watching her cohort and watching her peers use substances and the kinds of substances they're using, the potency that they're using, the access to it and also just the different again like hedonic reward-seeking behavior that they're engaging in, does feel qualitatively different from my upbringing and I kind of was a wild child. So even in balancing out my own personal experience, where I think I was on the far end of the extremes and watching what seems to be the norm, I feel is concerning. 

0:24:59 - David Williams
Yeah, all right, well, we may do a different podcast on that. 

0:25:03 - Dr. Sarah Adler
Happy to. 

0:25:05 - David Williams
Let's talk about how do you measure outcomes? I appreciate it actually that you, that you're not coming in saying boom, boom, boom, this works 100% of the time. How do you think about doing the measurement? What are you trying to measure? And then, what kind of evidence do we have at this point? 

0:25:18 - Dr. Sarah Adler
Yeah, so I am a measurement-based care junkie. I have built out four different measurement-based care systems, including the one that is currently being used in ambulatory care at Stanford Psychiatry, and so that is a big question that I will try not to take up the rest of our time with. I think the really important thing to your question on how you measure, you invest in a data infrastructure that allows you to, in a very low cognitively burdened way, get measures to people as quickly as possible. Very low cognitively burdened way. Get measures to people as quickly as possible, and you get them oriented to taking measures and giving you information. You also have to train your providers to believe in the power of measurement, because the power of measurement is not only are we proving our outcomes, are we demonstrating an ROI, but it's actually part of the treatment. Every time a patient takes a measure, they're actually learning something about themselves. If their clinician is oriented to be able to review that information with them and keep them invested in measurement. It's the same with an Oura Ring or a Fitbit or anything else, right? So there's an element of this in the system is that you have to train your providers to use measures and believe in them, and you also have to train your users or your patients to use them as well. So there's a little bit of implementation science in there. 

Ultimately, what we look for is a combination of things that we can validate against the peer-reviewed literature. Phq-9 is sort of the gold standard for depression. A GAD-7 is the gold standard for anxiety. Those are fine. I need to ask those questions because I need to actually ask the more important measures that I believe and then validate them against it and say no, no, no, look, I'm doing these things too. 

So we actually use a set of proprietary measures that look not only at symptoms but also look at what we call the social determinants of health. So what are the systemic factors that actually could be impacting both health systems physical health systems and symptoms and mental health systems as well and so we fundamentally think it's more important to get those data than to really focus on what the gold standard is that's being paid for. So we send out self-report measures. We also, if our users let us, collect other sorts of data in terms of how they're using their phone, how they're using the app, we collect qualitative data. We've got some really cool features that allow for journaling and allow you to talk to your coach and all of those different data points we can use to really make determinations of whether or not people are feeling better, getting better, living the lives they want, both according to the gold standard metrics and also according to their own perception, which is fundamentally important too. 

0:28:00 - David Williams
So working in a startup or a fast-growing company can be great for mental health, but there's also you hear about people that burned out from it or felt it exacerbated whatever else they had. So in your own laboratory within Wave, are there things that you do to try to enhance mental well-being at the workplace? 

0:28:18 - Dr. Sarah Adler
Absolutely so. I am a huge believer. There's a lot of things that I hope we do, but you'd probably actually have to ask my staff whether or not we're actually my team, I should say of whether or not we're doing it effectively. One of my favorite things to do, though, is to facilitate a culture of open and honest communication, and so I really highly encourage everyone to follow some systematic processes on like thinking about OKRs in terms of how we run things in a uniform way to create containment and feelings that everyone knows what's expected of them. And that's really kind of built into our culture is that, when you come to Wave, you know what your job is, you know what your strengths are, you know what your growth edges are, and you are working with a manager or you're working with a teammate who knows those things about you too and can orient, so it's a culture of mindfulness. Another application of that is we do check-ins at the beginning of every single meeting at Wave. It doesn't matter who the meeting is with or how big the meeting is. There is a moment of mindfulness where you are asked to look inward and give information about your current state. Again, we abstract that at different levels depending on who's in the meeting and what that actually allows. And I actually do this at the board level as well. It's the funniest thing. The first time I did it with my board of directors, my larger board of directors, and everyone's looking around and I'm saying I'm going to explain to you why I'm doing this. 

It is really important that everyone knows the stress level of everyone else in the room so that we can be mindful of that when we're interacting. And you have that level of empathy and compassion and it bleeds into your communication. So, for example, if I'm showing up after having a really rough morning or a really crappy night of sleep, I want you to know that my stress level might be high and that might make me more vulnerable to my emotional experience. And I want, I want to be aware of that and I also want to make you aware of that so that we can have the most productive, effective communications that we can. We don't say all of that, but that's how I explain it to people. It could be as simple as um. What is the what one of my team, my team members, asked yesterday if your mood was the sky, what would it look like? So it could be as abstracted as that. 

0:30:33 - David Williams
Nice, I saw your LinkedIn post on that. I didn't realize you did it with a board. Do you do it with outside parties like on a sales call? 

0:30:40 - Dr. Sarah Adler
No, I don't. I don't do it on outside parties with a sales call On a sales call. I could try it and see what would happen. 

0:30:46 - David Williams
I don't know. 

0:30:48 - Dr. Sarah Adler
You on a sales call. I could try it and see what would happen. I don't know. You know what. I'll give it a try. You saw my LinkedIn post, but it is sort of a graduated version of how are you today. I will tell you, though, when people ask me that question, I always answer. I'll tell you how I am today because it's a, and sometimes I'll pause and I'll sort of say how am I today? So I try to model the behavior, even if I'm not trying to force external folks to do it. 

0:31:11 - David Williams
Good, Well, listen. Anybody who's meeting with you for a sales call should listen to this podcast anyway, so they'd be forewarned. Oh thank you. How do you see the company Wave evolving? What's the plan? 

0:31:22 - Dr. Sarah Adler
So the plan has always been the same, which is to first and foremost, demonstrate clinical efficacy and then scale Crazy, I know. 

So we actually want to do things really differently and build differently, and I'm very lucky enough, I'm fortunate enough, to have investors that will tolerate that, because it is really sort of the opposite recipe for most digital health, which is scale as quickly as possible and worry about the rest later. 

So we really have started off by building an amazing technology infrastructure that allows us to do the data stuff that we want to do and to provide services and collect outcomes data, and we have certainly not 100% of people get better, but our rates are pretty high 70% of people, I can say with confidence, do actually get better, and you don't have to take my word for it. 

We're actually publishing in a peer reviewed journal to make sure that people believe us when we say it. Now that we have, we've spent the building time getting the data to demonstrate that not only are outcomes really great and people are getting better, but how that translates into business is that we can demonstrate a return on investment for the people who are paying for it, and that has allowed us to go contract with Aetna in California as an in-network provider for our new care delivery model at competitive rates, at rates that are good for the unit economics of the business, as well as to sell into employers, which we're just starting to do now. And it's the right time, because employers are very, very fed up, as I'm sure you know, with not seeing ROI on the solutions that they're purchasing. 

0:33:04 - David Williams
My final question for you today is if you've had a chance to read any good books lately, anything you would recommend and I actually always ask anything you recommend to avoid. 

0:33:14 - Dr. Sarah Adler
Anything I recommend to avoid. I haven't read, so I'm you know. I think there's two kinds of people in this world the ones who will finish a book even if it's terrible, and the ones who are totally happy to put it down. If it's bad, I'm not going to continue. 

So, I can't recommend ones to avoid and then I don't really give it a chance. So I acknowledge that I actually try to read as a forcing function, because it's a multitasker. It meets a value of being a parent as well as a value as being a reader. I try to read whatever my kids are reading, and so most recently I actually just reread Catcher in the Rye for the first time in. I don't even want to say how long a long, long, long, long time. 

0:33:55 - David Williams
I'll say, in a generation. 

0:33:57 - Dr. Sarah Adler
Yeah, multiple, probably multiple generations and I have to say I got a lot out of it. I got a lot more out of it than when I read it probably in seventh grade, so that was super fun. And then also I'm reading a series of less intellectual stuff. There's a British writer who wrote 22 books about a female psychological investigator, and I can't even remember what the series is called. The protagonist is named Maisie Dobbs and that's more of kind of like I wouldn't say it's a beach read, but it's more on like the reality television side of the spectrum and my stepmother absolutely loves these books and so I'm reading them really to feel closer to her. 

0:34:38 - David Williams
Outstanding Well. Dr Sarah Adler, founder and CEO of Wave and clinical associate professor of psychiatry at Stanford University, Thanks for joining me today on the Health Biz Podcast. 

0:34:49 - Dr. Sarah Adler
Thanks, david, it was my pleasure. 

0:34:52 - David Williams
You've been listening to the Health Biz Podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.