Mike, are you coming up? I don't think so. All right. My name's Jess Tassan. I cover healthcare services at Piper. I'm so excited to be here with the Teladoc team. CEO Chuck Divita in his first conference appearance, I think, ever since taking the helm? It's out of. And CFO Mala Murthy. Yeah. Thank you guys so much for joining us. We're really happy to have you. Welcome. So I want to kick it off with just a question for Chuck. So you were appointed CEO of Teladoc on June 10, 2024. You came to Teladoc from GuideWell, where you served as EVP Commercial Markets. You showed up with the perspective of a customer, and now you've got the perspective of an operator about six months in. So just considering those two perspectives, where does the Teladoc product portfolio have the most opportunity for growth in the enterprise market? Any capabilities or assets that you didn't appreciate as a customer but now realize have tremendous potential for commercial penetration? Yeah, great. Well, first of all, thanks for having us, and good to meet you in person. Seen the screen, but haven't met in person. So just a frame of reference, what commercial markets at GuideWell was, just because I think it's going to be relevant to the answer. So I had scope for all of our individual consumer products, so the Affordable Care Act business, over a million lives there, all of our B2B health plan business in terms of employers, small, medium, large, insured, and large national self-funded accounts, and all the sort of operations and so forth that go underneath that, about six million lives and $23 billion in premium. So when I took accountability for that role, I was the CFO before. Every visit, every interaction, more valuable, count more, right, so a set of investments against that. And I think that's especially important if you think about the membership growth that we have had in the last, call it, 12 to 18 months. We've had significant membership growth. An opportunity for us to harness that membership growth is with more visit growth. And we are actually seeing it in our performance today, right? We are seeing strong visit volume growth, and we will continue to build and grow on that, so I would say the first bucket around investments is around how do we make those visits and those interactions more valuable? To Chuck's point, it's around how can we equip the clinician, the provider, to make those more valuable, whether it be closing care gaps, whether it be from a clinical perspective, etc. The second is around chronic care, right? How do we continue to drive innovation? How do we continue to differentiate? How do we get more people, more recruitable through our funnel to actually enroll in our Chronic Care programs? Because you know that is when we derive economics from Chronic Care. And we have a strong Chronic Care program. We have a lot of products in that. And so there is a real opportunity for us to drive enrollment, especially because if you look at our 94 million members, the penetration of that with our Chronic Care programs is still in the teens. So there is adequate runway for us to continue to drive enrollment from a Chronic Care perspective. And then the third is around things that will allow us to continue to make progress on value-based care arrangements. Now, we are not new at this. We've been doing this for a while. But we have always said we will be methodical. We will be prudent about it. And so we will continue to build on that as well. So that's sort of how I think about when you talk about roadmap and investments. Those would be our focus areas. Okay. That's helpful. I want to come back to two things you mentioned. So first, on the Chronic Care side, what percent, or can you give us some sense of how much of your Integrated Care membership has access to a Chronic Care solution today? Yeah. We haven't made public how much of it has access to Chronic Care today. What I will say is if you think about the overall GenMed base that we have, so think about the 94 million members, it's no secret. It is highly core telehealth is highly penetrated. What I would say to you is the penetration of Chronic Care into that base is still in the mid to high teens, right? So think about the runway. Now, you are right. Not every one of the remainder has a chronic condition. So it is also somewhat defined by how many of those are real recruitable. But there is adequate opportunity ahead of us. Okay. Awesome. So then on the Integrated Care business, I guess just my question is, is this a low single-digit growth business over the long term, or does it have the potential to return to mid-single digits, long-term growth, or even accelerated to high single digit? And if it's a mid-single digit growth business, kind of are these three buckets of investments then sufficient to get you all back to that level? Yeah. I'll start at a high level. I mean, and this is not new news to everyone here, but if you look at the trends in healthcare, the 7%-10% medical cost inflation every year, the population's growing, you've got a strong prevalence of disease burden. So there's significant tailwinds in terms of opportunities to impact that healthcare spend. Also, our book, in terms of, and Mala mentioned this, but in terms of visit volumes, that's growing mid-single digits now. Our chronic care enrollment is growing. So do I think that this is a business that can grow mid-single digits or more? I do. I think we've got the secular trends, and we've got the capabilities to do it. I think we're also operating in this dynamic where it's a very, some of the t hings that we do, it's a mature market. Teladoc has been a trailblazer, I think, in many ways to get the adoption of virtual care. But it's been widely adopted, I'm sure, for everyone here. And so how do you evolve in that environment where we're really operating in a fee-for-service system and having visit volume? So I think there's some things that need to transition in our business, back to Mala's point about adding more value. But the underlying strength of the company, the membership growth, the visit volume growth, and the tailwinds, I think, give a lot of confidence to the growth trajectory. Okay. That's helpful. So then just, Mala, during the 3Q call, you suggested that 2025 integrated care growth could be kind of in the range of the 0%-2.5% year over year, consistent with the 4Q guide. Can you kind of help us understand the components of that outlook, especially in light of the longer-term hope for or target of mid-single digit? And then just has anything kind of changed in the intervening four weeks since you guys printed that you want to talk to us about here? Nice try. I'm not going to be in the business of giving mid-quarter guidance. So that's not happening. That's so exciting. I know, but let me just sort of tell you how we are thinking about revenue growth for next year, so we typically do not give an early view or a preview into next year's revenue growth, but we did so in October because we were seeing certain trends in our business, especially on the Integrated Care side, that we felt was important to calibrate this region, so if you think about the puts and takes on our revenue growth, I would say, to answer your question head-on, the selling season commentary that we made still holds. I would say we sell through many different channels: employer, down market, TPA, reseller, etc. And I would say they are all on track from a selling season perspective relative to our expectations. We continue to sell. We sell right up until December 31st, and I would say things are on track. The one channel that is an important channel for us where we have seen softness, as we talked about on the call, is in the health plan channel, and it's not surprising entirely, right? They are seeing a lot of macro events, things that are keeping them distracted. We are seeing some pause, some slowness in their decisions for us to partner with them on new populations, new products and services, etc., but we continue to have strategic top-to-top conversations with them. For many of our larger clients, the conversations we have with them, that Chuck has with them, are as partners, not vendors. And those continue, and those will continue to bear fruit, so that is sort of theme number one. Theme number two is what Chuck touched on, right? We are seeing nice membership growth, and what that means is two things. One, we will continue to add members next year, whether it be with new logos, existing logos. But importantly, those are a driver and a source for visit growth, right, which drives revenue as well. And that drives in your revenue, as well as we will continue to drive enrollment. So with our marketing efforts, we will drive both visits and engagement as well as enrollment. And then the last dynamic I would point to is the fact that with all of the membership we have, we certainly are seeing some mix changes, mixed trends. In certain of our clients, there are discussions we are having on more of visit fee-based arrangements, more visit-based arrangements. That is not new, by the way. That has been happening now for a while. But that is why the point that Chuck made around more value for visits is so, so important. That is why using all of our assets and capabilities, our data assets, the fact that we have more than 500 million interactions, all of that is data, rich data, and arming our providers, arming our clinicians as vehicles for us to actually drive close care gaps, drive enrollment, drive greater engagement, that is also going to be increasingly a source of revenue and a revenue growth for us. Plus, the more members we have, the greater the opportunity for us to cross-sell and upsell. We've always talked of land and expand, and expanding is all about revenue-accretive expansion, so those are the ways I think about our revenue growth. That's extremely helpful. I have two follow-ups. So does the 0% to 2.5% year over year basically assume no new bookings post the earnings call? Yes. Yeah. So no. To be clear, the 0%-2.5% included a certain expectation and forecast for bookings through the end of the year, as it always does. Okay, and then just on the core kind of virtual care PMPM, it sounds like there's a little bit of pricing maybe pressure, but that you all are responding to that with enhancements to the value prop on the visit and that you won't necessarily see PMPM degradation in 2025 if you can deliver and demonstrate the incremental value. Yeah. I think the, and we touched on it, but there's not pricing degradation. There's mix change. And they're not the same thing. If we have a subscription-based model, which that's really how this industry kind of was adopted early on because customers didn't know, "Okay, what am I buying?" So there were PMPM models. And there were companies like Teladoc that said, "We need visibility and to staff up and so forth." And so there were these subscription-based models, which are still out there and will be out there. But as it's matured, it's going to operate more like the rest of the U.S. healthcare system, which is fee-for-service medicine. It's like you get paid when you do something. And so I think that that's what's going on in that PMPM mix. I wouldn't call that pricing pressure. I would call that mix changes. The good news is the underlying volumes of the business are growing. So what does that mean? It means it's resonating in terms of we're selling more members. The membership is growing. And two, we have more visit volume, meaning the patients are saying, "I want to use Teladoc for this event." Those to me are important. But I think the pricing pressure is more of a mix item, in my view. Okay. And is it kind of contribution margin neutral in so far as your PMPM versus visit fee? Yeah. So if you look at, again, this is not a new phenomenon. This has been unfolding over the last several quarters, I would say. If you look at how our gross margins just have been holding up over the last several quarters, I would argue in both segments, they have been holding up reasonably well. So that doesn't happen by magic, right? So we are being very thoughtful about how we price. We have actually taken up our actual visit pricing in the last several quarters across our book of business. So we are thoughtful about how we price, how that translates into gross margins, and ultimately into Adjusted EBITDA margin. Yeah. Think about subscriptions as capitation. So what hurts you in capitation utilization? Because I'm getting paid this, but I have to do more activity. And low utilization is your friend. But in a fee-for-service environment, utilization is your friend. So it can cut both ways. I'd rather be on the side of having more engagement and more activity with the patients because that gives more opportunity to demonstrate our value proposition and build upon it. So I don't think that change is necessarily good or bad. It's more reflective of the rest of the U.S. healthcare system. And now it's up to us to say, "Well, how do we activate more visits?" So therefore, make it more relevant to people that want to use Teladoc. And how do we make those visits more impactful for our customer? Because if you think about it, we're uniquely positioned. Most of the rest of Fee-for-Service medicine is aligned to what that institution is trying to accomplish. Our visits are aligned with what our customer's outcomes are. So I think it's a different model. And I think if we can lean into some of these investments and tell that story and demonstrate that value proposition, it does make us uniquely positioned. But it's a little bit of a transition, which is why we called 2025 that year. And by the way, just to be clear, none of this is going to happen en masse, right? All of these are gradual transitions. To be crystal clear, we are still contracting with many, many, many clients on the traditional PMPM and visit fee only. So we continue to make progress in contracting with our clients across different models. Okay. We will try to keep that in mind, the gradual nature of actual business. So I want to understand, does Integrated Care today contain any contribution from behavioral health? And can you just explain to us, how does revenue recognition work on the EAP side? So once a member advances from kind of EAP benefit into paid BetterHelp, is the revenue recognized in different segments? How does it work? You want to take that one, and then I'll answer it. Yeah. So let me just sort of start at a high level. So in direct answer to your question on EAP, I would say revenue is recognized for EAP within the BetterHelp segment. Okay? It is a small part of BetterHelp today. But let me sort of broaden your question a little bit. We actually have a solid mental health business on the B2B side. We don't talk about it a lot, but it is actually, we do about a million visits a year. It is a business from, if you think about the clinical services, it spans digital, coaching, therapy, and psychiatric. So across all of it. And if you think about the scale of the business, I talked about a million visits. Across the enterprise, if you think about total B2B mental health, including BetterHelp EAP, it's about a $150 million business. It's not small, right? We have been seeing nice growth in mental health visits this year. Got it. Okay. So I guess just I didn't realize quite how large that is or necessarily that you all offered psych. So that's really helpful. I guess just on the one million visits, how many of your 93 million-plus integrated care lives have access to this Teladoc BetterHelp— Yeah. Teladoc, sorry, mental health product? Yeah. So if you think about our 94 million, we are about, call it about mid-50s% penetrated with our B2B mental health offering. And the other thing to note is this is where the power of the breadth of our products and services just matters. If you think about our chronic care program and our chronic care bundles, included in that bundle is digital mental health, right? And what that does is two things. One is it is well known that if you have a chronic condition, typically one of the comorbidities is you have some kind of a mental health need. And it allows you to actually, if you address that, it allows you to get better outcomes on your chronic conditions. The second thing is it actually allows us to have conversations with our clients to upsell from digital into the other programs and services around mental health. Very, very helpful. Okay. So that changes my, I think, perspective on mental health a little bit on the Integrated Care side. So what case would you make to investors that are reluctant to maybe ascribe value to the DTC mental health business or BetterHelp in terms of its growth potential, its value prop, free cash flow contribution? Why should investors ascribe a multiple to this business when it feels kind of like the market does not? Yeah. Let me start, and I'd like Mala to chime in. But I'm new, so I can still kind of claim that for a little bit longer. We'll see. It's not really landing with Mala. She's like, "You're not there." Six months in. BetterHelp is quite an amazing asset. I mean, from my standpoint, you go from a $100 million revenue to over $1 billion. It's the largest by far, many multiples larger than anything of its kind. It has a growing international business, is generating strong cash flows, and importantly, is meeting an unmet need. We're talking about consumers reaching in their pocket to pay for services because they either can't get access or they want access in a different way than going through their benefits. And so it's helping a lot of people. And we've created some amazing capabilities there from a consumer standpoint to micro-target and resonate and match people through machine learning with the right kind of therapist so they have low switching costs, has a 70 Net Promoter Score higher. It's a really, really interesting asset. Now, does it have headwinds? It has headwinds in terms of the tough comps we had last year. We've had higher acquisition costs. So I'm not discounting the pressures that the business is seeing. But being inside, I can see the amazing potential there. And we're starting to see green shoots of stabilization. So from my seat, I think it's—I understand the point of view, but to me, I see it hard not to ascribe value to something that's by far the largest of its kind, probably in the world. Yeah. And everything Chuck said is right on. What I would add, Jess, is if you think about the power of the scale we have on this platform, right? We are able to match 95% of users who come onto this platform within 48 hours to a therapist that is uniquely suited to their need. So the reason why our net promoter scores are 70 or higher, which is considered to be very strong, is because of things like that. And the reason I would say there are encouraging signs of progress is, one, if you think about the US business that we are looking to stabilize, we did see in September users stabilize relative to June, right? Now, I don't want to make much of a data point, but it is an important data point. And so we are looking to continue to stabilize that business. So that's number one. Number two is an important pivot for expansion is international DTC. We are seeing nice growth internationally. International growth was actually one of the reasons why our user count in September stabilized versus June. And those are at healthy economics from a cap perspective, a cost of acquisition perspective. So we will continue to make progress on international. The third is, and we have talked a lot about this benefit coverage, right? Access to benefit coverage. We are making good progress on putting in place the backend capabilities, the operational capabilities, as I call it. Now, what we need to do is actually talk to peers in terms of being an in-network provider. That's going to take time. We are going to do that through 2025. So I do expect the ramp of.