Synapses that Fire Together, Wire Together: How a Daily Text Helps Our Brains

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban. And today we have a special treat. We have one of the leading speakers in what I would say brain health, mental health, behavioral health, behavior change across not only the US landscape but the world. Not only that, he's a podcaster himself, and he's also a co-founder and CEO of Cope Notes that we're going to learn a lot more about the impact there. Please welcome our audience here, CEO Johnny Crowder.

Johnny Crowder:

Thanks for having me.

Brian Urban:

Thanks for being on our show.

Johnny Crowder:

I really like starting the episode with the word yes. That just kicks everything off on the right foot.

Brian Urban:

It does. I mean, when I heard your story and I see you speak, there's no other word that can come top of mind, really, Johnny. I found you so thoughtful in expressing your experiences and how you've taken that and put into something that's actually helping others. And not just sharing your journey, but actually taking your journey into, I don't want to say a product but a thing. A thing that's actually helping people. But before we get into Cope Notes in particular, we'd love to have our audience get familiar with our guests. So, got to get to know Johnny Crowder before all the stuff I mentioned. Before worldwide speaking, founding a very cool text-based platform that helps a lot of people with behavior change, mental health. Who is Johnny Crowder? Bring us to current space. Who's Johnny before all of this?

Johnny Crowder:

I am only now just getting to know him. So, he's pretty cool, turns out, but I spent most of my life despising the guy, so I didn't really ever get a chance to figure out what makes them tick. But even when I speak, I always like to level set and tell people, don't be fooled by my title, or letters after my name, or anything. What you need to know about me is that I'm a human being just like you. And that's why I care about brain health. I have a golden retriever named Pepperoni Pizza. I love her to death. If you can't see on video, I have a bunch of model cars and posters of cars in my room. I love cars. I'm a big sneaker collector. I ride my bike a lot. I play pickleball. I love comedy. I used to teach and perform improv comedy for many years.

Brian Urban:

I can see that.

Johnny Crowder:

I've played live music for almost my entire life. I played guitar for over 20 years. So, there's all of these things that make me a human being first. And I think a lot of times when we talk about behavioral health, we focus in on like, "I survived suicide and I survived abuse, and I live with all these diagnoses," and that's important context. But when we're talking about this, I don't want to lose the familiarity that people build. I mean, think about it this way. When people hear about my story, a lot of times they think, well, he had it real bad, he had it worse than me. And I think, no, I'm the same as you. Don't allow yourself to disqualify yourself from the mental health conversation because you focus on what I've been through and not the fact that I'm a regular person just like you. I just went through a lot of these things, too.

Brian Urban:

I like how you said that. I think a lot of us see someone like yourself who has been very open with the personal struggles that they've faced to the level of, "Here's my human condition. Can you relate to it? And here's what I've worked through and what I've done from that." And I think a lot of people do say, "Well, I'm not as bad as that guy," or, "Thank goodness." But it's only a matter of sometimes inches. And your story I can relate to personally very well.

And I love that you've taken this and you've made something really great. And you're a voice in a personality to what I think health plans, healthcare, life science in terms of the ecosystem in the US have struggled with from a business standpoint is how do you help positively impact behavior change? And I think the missing piece is the human side of it. It's too much of a push in digital, too much of a push, and service, and drug, and a lot of other really important work too, but it's missing the human piece of it. So, I just absolutely love that about you. I'm so happy you're here today, Johnny. This is going to be exciting.

Johnny Crowder:

I appreciate it a lot. And I also want to mention that the thing that really shifted my heart when I was in treatment... when I started treatment, I didn't want to hear about it. "Get the medication out of my face. I don't care what your degree is in." And then what actually started to shift my posture towards treatment was peer support. So, I mean, picture this, I'm in school earning a psychology degree learning about neuroscience. And that's fascinating to me. It's moving, but it's not really changing my behavior as much as connecting with other peers with similar diagnoses like that human element that you just brought up. When I could say to somebody, "This morning I hallucinated that there was a wolf in my dorm room." And another person said, "Tell me about it." I was like, "What? You're not treating I'm crazy. You're treating me like I'm a regular person. You understand what I'm going through."

That human connection actually convinced me to start participating in treatment. So, I always try to lean into that. Even when I speak at an event, I tell everybody it's a bunch of healthcare CEOs or whatever, and I tell them, "Everybody, take off your name tag and put it under your chair. Take off your badge. You're not chief this, you're not doctor that. You are Brian. You are a human being." So, I love that you started this conversation with asking that because that's the core of peer support, is like who are you underneath everything?

Brian Urban:

Man. And the way that you even opened up our conversation, "I'm just getting to know him." Man, you go deep. And I'm excited to talk about how I think your work is going to hopefully hit the ears and brains of leaders and certain parts of our healthcare ecosystem to really adopt and start to make population by population impact. But before we get there, I want to talk about the birth of Cope Notes in particular. I think this is really interesting. I saw a few of your TEDx speaking events that you had done globally and millions of people have seen it online. And I think a lot of people have taken that away into something they can do in their life. So, when I hear you speak, I think that is something that's happening. And you told a story about how you were writing down on sticky notes, and putting them in different places, and where you were living at the time to give you disruptive thoughts to take away some of the negative thoughts that were cycling or that would continue to pop up in your day-to-day life.

And it seemed like that was a point that you took to the next step, which was you sent out a text message one day to about 30 some of your friends to a random time about what you were feeling at the time and thinking about... and I think it was something to the degree of everyone could relate to the message. I don't remember the message that you sent in particular, but it triggered everyone to say, "Thank you. How did you know? I really needed this." And they were having different experiences in their life that message connected to. It seemed like those two events triggered the birth of Cope Notes. And then I want to talk about what Cope Notes really is today. But is that the birth story of Cope Notes? And bring us up to current time of where it is.

Johnny Crowder:

Yeah, that's a huge part of it, is trying to surprise myself, trying to interrupt my own negative thoughts, and not being able to surprise myself. The same way that it's hard to tickle yourself. So, I wanted to build something that could surprise me and other people with these interruptions. A lot of people don't know this, but I have been trying to build Cope Notes for a long time. So, even before it existed. So, before Cope Notes, I ran a digital peer support program called Not a Therapist. It was like notatherapist.com. It's not online anymore, but it was. Also, Brian, this was pre-telehealth. So, everybody thought I was crazy. They're like, "What am I going to do? Talk with somebody about my mental health online? This guy's ridiculous." So, I was admittedly a little bit before the curve and-

Brian Urban:

Far before, yeah.

Johnny Crowder:

... I ran that for about a year. And to be honest with you, it failed. It couldn't scale because it was like one-to-one peer support online. So, in order to support more people, we needed to hire people. But I, in my business genius, made this resource free. So, I could not hire any employees. And then before that, I ran something called Better People, which was a traveling in-person support group. So, I was touring with my band and each night we played a different city. So, I'm traveling all over. I'm doing support groups in different cities. And that couldn't scale. So, then I'm like, I need to make that digital.

So, if you trace back, I used to do in-person support groups locally. Then I did traveling support groups. Then I did digital peer support groups. Then I did Digital one-on-one peer support. Then I did Cope Notes. So, Cope Notes has been in revenue for six years. But people miss all of the attempts. Do you ever wonder what was before Microsoft? What was he working on? He probably tried a few versions of Microsoft before that we never heard about just because they couldn't scale.

Brian Urban:

Yeah, no, so then that's even more context to the creation of and where we are today of Cope Notes. And it's funny that you said that. I absolutely relate to you in terms of the business genius. I think a lot of the stuff that I've always loved to do is give things away, and then have that be a part of the circle of love and the circle of help with what's being done at the time. So, I would always get in trouble for giving away all of my toys in kindergarten, taking them into class, and then leaving with nothing. Because it just made people happy. It doesn't work as a business model and especially in the US landscape in most all terms.

But Cope Notes now as I understand it, there's the free model, which I believe came out of the Cares Act that you are able to really elevate to help give a free text message randomly throughout the day, one per day for a year. And there's an expiration to that. But that's at that individual peer support model that you still had. But there's a lot of use cases and case studies that you have on your site for youth, and also for employees, and then also for government. So, take us through what the model is today and where you think the most impact is being made.

Johnny Crowder:

Yeah, to be clear, I'm about to show off some real business genius savvy right now. I started Cope Notes as a just direct-to-consumer resource. I had no plans for enterprise. I had no plans for serving large groups. I basically just wanted to create something that I could use. And honestly, people in the metal, and hardcore, and tattoo, and skateboard punk kind of community could use. So, I was very narrow-minded when I first started this. I didn't consider all of the use cases now. And originally, the thinking was I want to offer... I knew that it couldn't be free because my last couple projects failed because they were free. I didn't have any money to build. So, what I did was I said, if we have charge, I want it to be such a compelling offer. Like Seth Godin talks a lot about ethical capitalism.

And one thing that has stuck with me that he said was, you want to charge half of what you could because your customer would pay double, because they're so happy with what you gave them. But you want to love your work so much that you would do it for half the pay. Do you know what I'm trying to say? So, you want to do it because you love it and the pay is extra. But you also want your customer to think, "What a screaming deal. I would pay double for this." So, when we set up the pay model, we said, we want to offer a full year of daily mental health support for less than the price of one therapy session. That was our big value prop. And a lot of people were like, "Holy crap, I'm all over that."

But then we still wanted to make it free for people because we would hear people say, listen, everybody has 10 bucks. Everybody has 10 bucks a month. If you tell me you don't have 10 bucks, you're lying. Unless of course you are one of the many people that we serve who literally do not have $10. So, we have partnered with governments to serve foster care programs and to serve unhoused populations like low income households. And this is where it gets really cool. And how we've scaled is because yes, if you have 10 bucks, you buy Cope Notes. And trust me for the amount that you get for proven mental and emotional health outcomes, 10 bucks, you're not going to find anything cheaper. I mean, unless let's like journaling or meditation, which I guess is free.

Actually, there's lots of things that support your mental health for free. So, I'm going to pedal that back. But I'll say this, if you actually don't have the money, a lot of people qualify for government programs or programs through their work, or through their school, or through a local nonprofit where they can use Cognos for free. And I always had a passion for making it free. I never thought to ask the organizations with funding for resources like this to be the person who pays for it. So, that's really changed our model from yes, we still have direct-to-consumer People sign up on our website every day. But we do a lot more outreach to these large programs that support mental health for thousands or hundreds of thousands of people.

Brian Urban:

I love that because you still have where you natively create the model, the peer-to-peer, the B2C. But then now the B2B, I think where this fits inside EAP programs for employee assistance programs, how it fits inside health plans across different lines of business, Medicaid, Medicare Advantage, commercial, this appeals across the board. And it's interesting now because your model is so different than a spring health, than a better help, Lyra. There's so many mental behavioral health service models out there that are more sophisticated and also more costly and more complicated. And I think in terms of engagement, I feel just not knowing the metrics from those companies I mentioned, which are extremely well-backed by venture capitalists, private equity firms alike, the engagement side of it is what really matters.

So, I'm curious about your engagement because we see a lot of people saying, "Get away from your phones. Get away from your devices. Unplug," which is basically impossible. But the text messaging is more at the synapse level. The synapses that fire together, wire together is something I think you said. Hopefully I got that right. But that's where it is in the preferred modality of basically everyone in the US across the world, too, and develop nations, those that have access to cellular technology. So, is there danger to this? Or do you think this is the way? I mean, clearly it's been working, but I want to get your thoughts on that.

Johnny Crowder:

Yeah, it's really funny. We play well with others. I don't have any beef with any other beef or health provider. But I can say that we have higher engagement than a lot of the biggest players out there. And it's funny because people are paying 40 or 50 times more for those resources than they are for Cope Notes, but they're using Cope Notes more. So, I've always found that to be an interesting dichotomy of you pay more and you use it less. But I think something really important to point out is part of the reason why people use Cope Notes more is because we're talking... if you're listening and you're like, "What the heck is it?" We send one randomly timed text message each day that contains some type of health education content. So, a psychology fact, a journaling prompt, and exercise that's written by a real life peer with lived experience with whatever they're writing about, reviewed by clinicians, and based on proven psychology principles.

And over time these messages literally interrupt negative thought patterns and train your brain to think healthier thoughts. What is really interesting is that if it takes an hour to have a session with somebody through an online therapy or coaching platform, you're talking about a 15-second interaction with Cope Notes on a daily basis. And rather than you having to initiate booking an appointment with a provider, we actually reach out to you. So, it's a proactive resource. It's preventative interventional. You don't have to remember to use it. You don't have to take the initiative.

And anyone who has ever lived with depression, or anxiety, or stress knows that the hardest part is taking the initiative. It's booking the appointment and showing up. It's putting on your running shoes in the morning. It's opening the book that you know need to read. It's taking that step. So, we remove that and we say, we will take that step for you and instead guarantee the consistency necessary. So, the way that I explain it to people is, which would you rather do? I'm assuming if you're not a doctor, you can still answer this question, which is healthier, having one plate of green beans with each dinner throughout the week? Or eating three and a half pounds of green beans once every other week? We know the answer to that. And Cope Notes is really the small simple thing you can do periodically rather than letting it all bottle up and then dumping it all out.

Brian Urban:

I like that you said that because it is incremental change that accumulates over time, like compounding interest or compounding savings, things like that from a financial perspective that's very black and white. But from the mental behavioral health perspective and even physical, too, I think a lot of your analogies go into exercise and the physical components of mental health. It's steps. It is incremental change that adds up and that you can visibly see and feel over time. So, the consistency, the reps, the inbound side of your model. I think I would imagine is the secret sauce to your engagement metrics that you're seeing that are so very different from some of the other more patient to provider sort of outreach. And for a population that wants help, and deserves help, and needs help, that additional step being alleviated is huge. So, I just made some assumptions there, but thank you for validating. I thought the engagement would be more rewarding.

So, I'm curious, Johnny, there's a couple things that you have in your story that are so interesting and inspiring. You talk to a lot of different audiences. And I think this is the cool generational impact that you'll have in communities and households. You talk to youth, you talk to healthcare executives, those incarcerated or coming out of incarceration, and everyone in between. So, of all these different types of audiences that you speak to, who's the most engaged? And this is outside of Cope Notes world, but in your speaking world, those that you engage with personally, who's the more engaged audience? I'm curious of everyone that you speak to on a weekly basis.

Johnny Crowder:

This is tricky. I haven't seen a clear pattern. I'll speak in front of a bunch of middle schoolers and they're like hanging on every word and they're like, it's fascinating to them. And I can joke around a lot and there's a lot of humor. And that's fun in its own way. I gave a keynote in front of construction and engineering CEOs, like a huge group, and these guys were... you could hear a pin drop. So, it's weird because two very different personas and it really matters to both of them. I'll say maybe one of the groups that I enjoy working with the most are people who work in caring professions. So, these are healthcare workers, these are educators.

I think I like these groups because they feel it in both directions. They feel it like, "Well, part of my job is to support the people that I work for, the clients that I serve. But then another part of my job is supporting my own mental and emotional health as I'm doing that support." And I think why I like speaking for those groups and why they're so engaged is because it's two for one. It applies not only to the people they're serving, but then also to maintaining their own health so that they can continue doing the work they care about rather than burning out, or quitting, or turning to unhealthy coping mechanisms to deal with the stress.

Brian Urban:

Wow, that is such a variation across some of the audiences you just mentioned there. And back to the generational impact, I think your model in terms of public health is so suited that it's going to change a lot of individual household community health overall. Because if we can address top line our mental health, and using a disruptive negative thought disrupting model like yours that's inbound, it's just going to change the way I think the happy index could be recorded in the US life, expectancy, and everything that trickles down to what healthcare utilization, healthcare costs amount to in the US. So, I'm curious, Johnny, right now with that said, do you have any developing relationships or partnerships that you could tease us with that's relative to maybe federally qualified health centers, or primary care centers, or health plans, or any of the above? I'm curious of any movement there. And if not, we highly suggest everyone in our audience listening to Johnny right now to reach out and develop partnership because this is underlying to human health. But anything you can tease us with or tell us about that, Johnny, would be wonderful.

Johnny Crowder:

Yeah, I was hoping that I would be able to announce this by now. Maybe by the time this podcast comes out I can, but we signed the biggest contract of our career last year. And we've been waiting for the go ahead to announce that we've already been serving this population. But I can say that we're doing a lot more work in the payer space and I think that that is a huge opportunity. It's always where I've seen Cope Notes fit in to the broader continuum of care. I'm always very clear about this is why we haven't raised any money because I'm not like, "Oh, yeah, and then we're going to offer a video platform and then there's going to be fill your prescription online." I don't want to do that, Brian.

Brian Urban:

All the additional features. Yeah.

Johnny Crowder:

I don't want to do that. I don't want to be the Walmart of mental health, no offense to Walmart.

Brian Urban:

No.

Johnny Crowder:

But if I want authentic Italian food and an oil change, I don't want to go to the same place for both of those things. So, what I want to do is I want to be the best mental health texting platform on the planet. We are going to be the top in our category. And other people can be the top in their category and we'll partner with them because I don't want to do video chat. For example, Cope Notes is a 100% anonymous and confidential. How are we supposed to maintain that if we do video chat or prescriptions? We don't collect PHI. We don't collect your health information. So, what I've been so passionate about in the continuum of care is... and this is why early VCs when we talk to, they're like, "Yeah, you should really try building this. You should really try building that." I thought in eight years you're going to be glad that we stuck with this because what we're doing is building the gap filler.

So, right now there are three huge gaps in the continuum of care, and this is where I think we're going to fit in long-term. Pre-care. So, these are people in wait lists. These are people who book an appointment and cancel. Actually 40% of all appointments are canceled for behavioral health visits. So, you're talking a huge group of people who either can't access care because there's not enough people providing it, or their schedule doesn't work, or they can't afford it, or they have self-stigma reasons why they don't feel comfortable seeing somebody. So, this whole pre-care group, give Cope Notes to them as an alternative. So, at least they're doing something. They're not just doing nothing. Then in your inter-care group, you have people who are engaging with care, but they need help in between sessions. Or maybe they're showing up to a session, but then they miss the next one. Or maybe they're a half hour late to an hour session, something like that. So, people who are sort of struggling with engagement, and this is a way to re-engage them and keep them engaged in care. And then aftercare they are graduating-

Brian Urban:

I love that.

Johnny Crowder:

... and adjusting to their new normal. What do you give them to help maintain and lock in the progress that they've made in a care setting? So, when I look at Cope Notes, I think it's the same as let's say Colgate or Crest. They make toothbrush, toothpaste. Maybe they make floss, too, maybe they make mouthwash. That's it. And I've always felt like VCs have told me, "You know what? You should do, Colgate. You should open a dentistry office that does root canals." And I'm like, "No, no, I am not interested in that." I want to be the toothbrush and floss that every dentistry office distributes because dentistry offices should not be manufacturing toothbrushes. So, I know our place in the continuum of care. And I firmly believe that 10 years from now, everybody will be thinking, "Why the heck did we ever try to make code notes do something else?" Because now the need for what they do is... everybody needs to brush their teeth.

Brian Urban:

I love the analogy that you just laid out. And I think it's very difficult. You have an amazing self-discipline to not take additional funds to build more features, to make it more complex and more, I think of what the industry is saying, end-to-end type of service model. But knowing that your niche, it's the daily reps, it's the daily mental health push-ups, the consistency of it that makes it so unique and simple to do. If we make it so much, everything is so much. I applaud your self-discipline for not going down that path and to sticking to where you are.

So, with that, too, Johnny. So, you mentioned looking out eight years, you have this big relationship that you develop with a health plan that you're waiting to announce, and I think it's one of many that you'll have coming in pipeline in terms of your B2B work. But what does Cope Notes look like in five plus years from now? Is it still the same model? Is the contribution just magnified to millions? What does Cope Notes look like and feel like five years from now? Or maybe you already gave me that answer.

Johnny Crowder:

No, I love this question because I think... before I answer, I want to tell you, I met with this, this was a year in after I launched a company, maybe less. So, I'm like six months in or a year in, and I meet with this guy from a smaller regional insurance provider. And I pitch in my idea and I'm like, "I really think it would work for these populations and I think this is how you could fit it in." And we whiteboard it out everything. And he's like, "Okay, cool, keep me posted." And then so I check in with him every three months, every three months for five years. So, I'm following up with this guy periodically for year, after year, after year.

And then we have another meeting and he's like, "You know what? I think we should work on something together." And I was like, "I got to ask just between you and me, why now? What makes now different?" And he goes, "I meet with a lot of founders, and you're the only one who five years later is still doing what he set out to do." Everybody else is like, "And we're going to build this and then we're going to have that." And he's like, "Your focus on what you're building tells me that rather than building a bunch of okay things, you're building one extraordinary thing." So, that's my answer is five years from now...

I mean, I'll use the toothbrush example. Toothbrushes have changed a lot. The shapes of the heads, the way the bristles are aligned with one another, the technology of electric toothbrushes, how they charge, but they're all still toothbrushes. And I think as we build Cope Notes product, it's going to become... I wish I could share everything. We're doing a lot of cool product stuff. But I think what investors want to hear is, "This is going to fundamentally change everything about the product." No, it will make this product 10% better every month for the rest of time. And if you look at Cope Notes five years from now, I'll still be able to describe it the same way that I described it today, but your experience will be richer, and more nuanced, and more effective.

Brian Urban:

Wow, that could not have been more of a beautiful vision for what Cope Notes will be doing for the lives it serves, but also how. And a teaser as well, which I got to know what's happening. But I feel a follow up episode coming on, and that's where maybe we'll leave it. But Johnny Crowder, CEO, founder of Cope Notes, worldwide speaker, soon-to-be-future author.

Johnny Crowder:

Yes.

Brian Urban:

I'm waiting for a book drop in the future. Thank you so much for joining our little show here today.

Johnny Crowder:

I appreciate you having me. And real quick, anybody who's listening, who is curious about Cope Notes, I meet a lot of people who work in this space who say, "That's interesting, but not for me." I literally built this for you. I invented this for you. So, please, there's a free trial on our website. You go to Copenotes.com, you can use a week for free. It's totally anonymous. So, I'll never know who you are that you did it.

And I really encourage you to just spend 15 seconds per day for seven days just trying it, because you might try it and think, "I want to give a subscription to my stepdaughter or to my husband, or something like that." You also might want to use it for your team. But I really think that there's a good chance that you'll use it and think, "This is actually really helping me, and I didn't expect that." So, I really want you to have that opportunity to experience that. If nothing else, if it's not a gift for you, which I perceive it to be, treat it as a gift to me. Allow me to give you a week to show you what we've built.

Brian Urban:

And I'll tell you, Johnny, it's been a gift for me. I have signed up. I'm waiting, and I have my week to be able to experience it and happy to report back. So, it is something I should have led with today. But highly encourage that as well. For our listeners. And for more exciting insights and excerpts from our show, please visit us at Finthrive.com.