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AQP Book Club Being Mortal: Medicine and What Matters in the End, by Atul Gawande

By: Jessica Horn & Emily Bak

We are so excited to make our first contribution to Aequitas’ quarterly newsletter! As the newest additions to the team, we’ve spent some time over the course of our first year here trying to further educate ourselves on our industry to add value to our clients and candidates alike. Both avid readers, we decided to choose a healthcare related book to book-club internally. We settled on Being Mortal by Atul Gawande. For those of you who are unfamiliar with the book, first of all, READ IT! It’s excellent. Atul Gawande is a general surgeon, and the CEO of Haven, and does a deep dive into the evolution of our country’s approach to treatment and care for the elderly and dying population. As science and medicine have advanced, people are living longer, but more often than not, suffering more. Treatment has become very institutionalized and he illustrates what care looks like today through personal stories and those of his own patients and peers. Needless to say, this sparked a lot of interesting dialogue between us and our team. We talked a lot about our own healthcare journeys and realized how fortunate we are to be exposed to so much innovation in our work. We feel grateful to work with companies that are striving to create opportunities for the future of healthcare and we want to open up the conversation to all of you.

Emily: As an intern, I always thought that what we did was really interesting, but now working here full time, I realize how applicable and valuable what we do is to the real world. While in college, whenever I got sick or had to go to the doctor, I would hand them my parents’ insurance card and never see a medical bill, getting the care I needed and thinking that this magical little card made going to the doctor easy and free. Post-graduating college, I’m realizing how challenging navigating the healthcare world can be. I no longer have the flexibility I did in college, a relationship with a doctor I trust, or the convenience and time to wait an entire month to see a doctor. One of my first weeks after moving to the city, I felt sick and went to the Urgent Care near my apartment. After waiting for a couple hours, getting to see the doctor for only ten minutes, and then getting prescribed medication, it led to me receiving a $1,000 bill in the mail, with charges for things like “going at night,” something that seemed ridiculous to me as the only time I could have gone was after work. When I came into work the next day upset, one of our coworkers reminded me that I should have used Slingshot Health. The platform allows individuals to see doctors in a low cost, convenient way. This creates the balance of getting treatment even with time constraints, something that would have been great in that situation, and pretty much any time, as I adjust to professional life. He told me that he’s met doctors that he now sees regularly and interacts with directly rather than going through admin to book appointments. I’m excited about this option of building more trustworthy relationships with my doctors, having the reassurance that if I do ever get sick, the process of getting better won’t be a burden.

Jess: I totally remember how overwhelmed I felt when I first graduated from school and experienced similar pressure when it came to prioritizing my budget, health, and time, no longer having the luxury of free time like I did in college. I think I’ve finally started to figure it out. As I’ve moved through different phases in life and career opportunities, it has become more and more important to me to find a balance, especially living in New York City. While New York is charged with energy and much fun to be had – it’s also crazy and overwhelming. A few years back I completely hit a wall, finding myself pulled in many different directions, and an opportunity to move to Denver presented itself. I love to ski, spend time in the mountains, and felt that living in another city could give me some perspective. After living there for a couple of years, I walked away with a greater sense of self and a better understanding of what I need to incorporate in my life to make me feel healthy. Now that I am back in New York, I’ve carried these lessons with me, and make it a priority to create time for myself, allowing me to be efficient at work, manage my time, and be the best version of myself for the people I love. I try to say “no” to things that don’t serve me, spend time with the people who share the same values, and create opportunities to leave the craziness of the city and spend time outside. I’ve learned that the times when I have low energy or stress, it’s often because I’m burnt out and not fully supporting my well-being and mental state.

Emily: There were a lot of examples in Being Mortal that demonstrated exactly what you’re talking about. When people are treated in a way that serves them as individuals, they find purpose and meaning in their lives, ultimately changing their overall wellbeing. In one example, animals, plants, and even a children’s daycare were placed into a nursing home. Just these few additions did more for the residents than the antidepressant drugs they were given prior. According to the book, compared to an average nursing home, the total cost of drugs fell by 38%, and deaths fell by 15% of the control facility. By bringing personalized care and attention to these people, and surrounding them with things that brought them joy, the overall desire to be alive and present increased. Whether it’s spending time outside in the mountains of Denver or caring for a bird within a nursing home, it’s important to consider that healthcare isn’t solely about the physical body, and that finding that greater sense of self increases overall happiness. As exciting as the city can be, it can feel lonely if you’re not taking the time to stabilize your mental health and do the things that make you feel connected to others. Purpose, meaning, and connection can be more valuable to quality of life than taking a pill.

Jess: I love that part of the book. It’s such a simple concept – to encourage individuality – that it’s hard to believe how revolutionary it is. I guess it is easy for us to take this for granted because we are exposed to people and organizations that are trying to instill this mindset every day. In our universe, we’re constantly speaking to execs or working with companies that are working towards elevating the human experience when it comes to taking control of our own health and having transparency. Even the most general form of care is being revolutionized. We see it with companies like Eden Health, for example, that is building a Primary Care platform to help people seamlessly navigate through their healthcare journeys. Not only do they make it easy to book appointments and make insurance costs more transparent and less stressful for patients to understand, but each person is assigned to a designated care team that will learn about his or her individual health and is available to them at any time. I imagine it’s such a relief to talk to a clinician that actually knows you and your story. I feel like I’m constantly having to explain my medical history over and over again or having to gather my past records. I never know whether I’m painting an accurate picture. This emphasis on building a relationship and having an option to speak to my own team through an app on my phone or even see them in person if I need to is so valuable.

Overall, you’re right, Em. There is a clear shift in mindset industry-wide in care delivery. Companies like Eden are emphasizing the benefits of primary care to prevent problems before they begin. Another one of our clients, T1D Exchange, is building a platform to help individuals living with Type I diabetes better manage their disease by leveraging real world data to improve outcomes for this population, along with educating the people that are caring for them. After reading Being Mortal, we’ve learned that there’s even a shift in what treatment looks like for terminally ill patients.

Atul Gawande talks about how very sick patients are gravitating towards living out their days in their own home and choosing hospice versus opting for treatment (whether it’s chemo, radiation, a new drug trial, or surgical procedures) where there is no guarantee that it will extend their lives and more often than not the treatment will decrease the quality of life.

There’s a study conducted in the book where researchers compare patients with stage IV lung cancer receiving two different approaches to treatment. One group received the usual oncology care (chemo), the other half received the usual care plus visits with a palliative care specialist. The group who saw a specialist stopped chemotherapy treatment sooner, entered hospice earlier, suffered less, and lived longer (by up to 25%). I think that this increase in awareness and move towards allowing people to make decisions about their own health, helps them figure out what is most important to them, no matter how scary. I’m witnessing this firsthand as I see how my parents and their siblings are approaching care for their parents who are sick. As my grandmother’s health is declining in her old age, it’s hard not to hope that a new drug or treatment might prolong her life. I doubt that when she was younger and healthier she was asked how she’d like to live out the end of her life. Despite how uncomfortable this conversation probably is, I can’t help but think that I would like to learn from this and broach this topic with my own parents. I would rather hear what’s important to them. We should all be able to make these decisions for ourselves.

Emily: I completely agree, and also felt that I would want to have this sort of conversation with my parents sooner than later. I think painful situations could become more tolerable if we educate ourselves and talk about what matters while we still can. Atul Gawande shows us how educating patients has become extremely important, we see evidence of this in some of the solutions our clients are building. Doctors are putting more of an emphasis on offering options, not just delivering treatment. Providing a well-rounded education on the consequences and options in treatment is necessary for the patient to make informed decisions. In Being Mortal we see many examples of how patients have better outcomes when their doctors spend time giving options rather than giving orders. When working with a client like CarePort Health, it isn’t difficult to convince people of their mission, as most people have come into contact with a situation where they, or someone close to them, feel lost and uninformed within the healthcare system. CarePort collects data to allow patients to make more educated decisions about post-acute care facilities. The product suite helps patients to understand that they can make choices and have more control over their own care rather than being handed a list of rehab centers at discharge and expected to choose at random. With a patient’s ability to see all of the options and information laid out, they have a say in their care journey that will lead them to making decisions that align most with what they hold valuable in their lives. It’s important to recognize that more people want to have a voice in their care, which is why so many companies like CarePort are creating innovative products to change the traditional system.

After reading this book, and coming into contact with different innovative companies everyday, we see healthcare moving towards people customizing their own healthcare experiences around what matters most to them, which in turn is affecting the doctor-patient relationship. Doctors have to take into account the whole person, and recognize that there isn’t one right way to treat or care for someone. For example, I want the convenience and low cost way of seeing a doctor, knowing that when I get sick, I can easily see someone I trust to give me the care I need. What’s important to Jess is a doctor who sees the whole person, encompassing everything from physical to mental health. People want a say and options in their care journey, a major theme in the book as well as in the companies we work with everyday. When you have a say in your healthcare experience and are being listened to and cared for in more of a holistic sense, your health and wellness can drastically improve, experienced through two New Yorkers and through the stories told in the book.

Coffee Chats with Nina: Understanding the Entrepreneurial Mindset – Part IV

Part IV of an Ongoing Series – Heavily Caffeinated & Highly Enlightened

Two years! I truly can’t believe that I’m already approaching my two-year mark as a member of the Aequitas Partners team. It feels like it was just yesterday that I moved into my first closet-sized NYC apartment and received a phone call from Tim Gordon. He offered me an opportunity to join his team, that I now consider family. To some people, two years might not seem like a long time. However, upon reflection, I can confidently say that this has been the most transformative timespan for my own personal and professional development in my life.

My skilled colleagues, our innovative clients, and the thousands of impressive candidates I’ve interviewed have all contributed to my development in this field. But I must attribute an important part of my recent growth to the insights I’ve gained from the highly-driven healthcare technology entrepreneurs who have opened up to me during my Coffee Chats. Last year, I set out to better understand the entrepreneur’s mindset and hear stories straight from the source about what it takes to build a digital health business from the ground up – and that’s precisely what I got! I was gratified by these leaders’ willingness to participate in my Coffee Chats with Nina series and the level of genuine authenticity in their shared stories. I had the chance to dive into some pretty touchy subjects and they didn’t hold back one bit. I heard unfiltered accounts of their experiences including all the ups and downs; everything from the first moments when they knew they had novel concepts to the times they thought they were going to fail.

For this final article of 2019, I’m taking a look back at some of the key insights and highlights from my discussions over the course of this past year. I’ll also share some thoughts on what 2020 might have in store for this series.

Wrapping up 2019

Since we are all focused on this complex, highly regulated, and emotionally charged industry we know as “healthcare,” we’re also familiar with the challenges that confront us in attempting to innovate in this space. Instead of developing solutions for industries such as retail or consumer goods, the founders I met with all chose the convoluted world of healthcare technology. On top of the typical challenges facing all entrepreneurs such as fundraising and team building, these leaders have many added obstacles, spanning HIPAA regulations to longer than average sales cycles. In my first article of the series, “Taking the Leap,” I dove into what it took for these founders to actually take that first big step to build their respective companies in this trying industry. I was shocked to hear about how often they felt ill prepared to enter these life-changing journeys. Despite spending years working as venture capitalists or practicing clinicians, all of the executives shared the common sentiment that they had to do most of their learning on the job. While the path to growing their businesses has been difficult, these leaders all refused to accept the status quo and they continue to be driven by the notion that there must be a better way of doing things.

Since there is no all-encompassing playbook for the obstacles faced while growing a startup, I heard stories of some tremendous roadblocks that these founders have overcome. They told stories ranging from how they bounced back after hiring the wrong team member to how they were forced to completely change direction after losing an expected investor in a major funding round. I also heard firsthand accounts of times when founders were offered advice from people whose only intent was to get something in return and instances where there were challenges in working with relatives and close friends. In my second article, “5 Things Entrepreneurs Wish They Knew Before Building Their Companies,” I shared some of the biggest lessons they’ve learned as well as some pointers they wish they were given prior to starting their businesses.

My last article, “What They Don’t Teach You in Business School,” covered the different aspects of being an entrepreneur that you can’t train for ahead of time. While most of the executives I’ve spoken with have earned advanced degrees from the most highly regarded institutions, they all noted the aspects of being a founder that you can’t study. Many of them underscored the difficulties they encountered in assembling their teams. I heard stories about overcoming communication barriers, discovering the best ways to motivate employees, and making tough decisions around hiring and firing team members. I also had the opportunity to dig into another key topic I was curious about – time management. They offered insights on how they’ve attempted to manage competing priorities across their work and personal lives. Finally, I learned about the different resources (i.e., books, podcasts, networks) these professionals often leverage to become better leaders.

Looking at 2020

In speaking with such a wide variety of digital health entrepreneurs over the last year, I’ve heard many different perspectives on what it takes to build a business. I’ve spoken with both clinical and non-clinical executives. I also met with a number of first-time founders in addition to leaders who’ve had experience from previously growing other companies. Heading into 2020, I’m excited to have some more pointed conversations with this eclectic group of ambitious individuals while also adding new executives to the mix who will offer other fresh perspectives on entrepreneurship.

While I’ve had the chance to cover a number of interesting topics, I feel that there is a lot more to explore. Moving forward, I’m planning to tackle a host of new topics such as the challenges specifically facing female founders and the impact of major healthcare policy changes on these entrepreneurs’ business strategies. I’m also hoping to learn more about the dynamics of working with a co-founder versus going at it alone. Additionally, I’ve been increasingly curious about investors’ perspectives on many of these topics and would love the chance to connect with a variety of leaders in that space.

Moving into this next year, I welcome feedback from our readers on things you want to learn or questions you wish I had asked. Please send any thoughts directly to me at nina@aqpsearch.com. Looking forward to sharing more insights in 2020!

An Interview with Kevon Saber, CEO of GoCheck Kids

Kevon Saber is the CEO of GoCheck Kids, a digital health platform designed for the advanced screening of vision impairment in children globally. The company is based in Nashville, and is currently screening children on 4 continents. We sat down with Kevon to talk about the business, his vision, and what it’s like to scale a global digital health company.

Tim: GoCheck Kids is on a pretty incredible mission. Why don’t you tell us a little bit about the company.
Kevon: The company was started by Dr. David Huang who actually invented the most widely used diagnostic in all of ophthalmology. He recognized that most children in America weren’t being screened for the most prevalent disability in the country – vision impairment – because of the absence of an affordable screening tool. He decided he was going to leverage his expertise in biomedical engineering and ophthalmology (he’s got four degrees in those two areas) to invent a product that is actually affordable. GoCheck Kids is a third of the price of the competition and as a result has made vision screening affordable for pediatricians in the U.S. and globally. Our goal is to catch every kid with vision impairment (that’s one in five kids in the U.S.), so that they can see and learn, and ultimately fulfill their potential.

Tim: You were brought into the company as the CEO a little over two years ago from a career outside of healthcare. What drew you to this business?
Kevon: I had said to myself and to my friends for years that I wanted the rest of my career to focus on elevating human flourishing. And I hoped to bring together my background in technology and entrepreneurship for a cause that ultimately would make a big difference in the lives of many people. Preventing the most prevalent disability for children in many countries, GoCheck Kids fit my first criteria. I was also really impressed with the quality of the team. They were the kind of people I would hope to recruit to found a company, but they were already assembled, which of course makes everything go a lot faster. Thirdly, I talked to twenty of their customers, and their enthusiasm for GoCheck Kids’ affordable impact on seeing, learning, and the rest of life was galvanizing. Those three factors were intoxicating and I couldn’t help myself.

Tim: Being new to healthcare, what was the biggest challenge in navigating the healthcare landscape for you early on?
Kevon: I had many steep learning curves, but the biggest thing I underestimated was the increased complexity associated with regional variation in payors, regulatory requirements, and customer preferences. This diversity in the operating environment is also a positive – it encourages a company to practice managing change – which of course is the only constant, and especially in healthcare.

Tim: In your view, what makes GoCheck Kids different than the alternatives available for the advanced screening of pediatric vision impairment?
Kevon: There are a few pediatric photo screeners that have been available for ten years or twenty years, and they are actually very effective. The challenge is that they aren’t affordable, and they increase administrative burden due to their lack of, or negligible EHR integration. We are a third of the price, without compromising on clinical efficacy. That’s probably the biggest reason, in addition to the prevalence of vision impairment that we have skyrocketed. We have grown from about 1,700 pediatricians in the U.S. when I joined just over 2 years ago to over 6,500 today.

The second big way GoCheck Kids is different from other photo screeners that preceded us is that we are a fully digital product that is in the cloud on a modern operating system, enabling us to very easily integrate with a hospital system’s electronic health record. We are already integrated with the EHRs representing most of the market today and every quarter we add additional EHRs. Ultimately, a hospital system isn’t just saving money and impacting outcomes while using GoCheck Kids but they’re also saving a lot of time. This means clinicians can spend more time with patients.

Tim: You mentioned a bit of it already but how has the company grown under your leadership, and are there some wins that you can share?
Kevon: We have grown from 1,700 pediatricians to 6,500 pediatricians which has also represented about a tripling of the company’s revenue. Our burn rate has been cut by eighty percent without any layoffs, driven purely from the growth of the business and our investments in efficiency. More than the numbers, what’s really fulfilling for us is the impact that we see. We look at a lot of big numbers around screenings and referrals but what we love, of course, is hearing the actual stories from pediatricians. Those stories fall into three different but equally fulfilling categories:

First, every day we discover children who are not seeing the chalkboard or whiteboard very well. Their learning, their confidence, even their relationships were compromised because they had vision impairment. Once this impairment is addressed their whole trajectory is changed, because seeing is learning and learning is potential.

The second category consists of kids who are actually losing their vision permanently (this isn’t just a benign issue that glasses can fix); those kids are also not learning. Stories like these are fulfilling because these are children who are going to lose twenty percent or seventy percent of their vision in one or both eyes if it weren’t for GoCheckKids.

And fortunately, this last category of issues is much more rare: retinal cancer. This disease usually spreads from the eye to the brain and will not only cause a child to lose their vision in both eyes but also their life if they aren’t caught very early. The magic of GoCheck Kids, is that we enable pediatricians to catch these issues early and while they are still treatable, which saves a child’s learning, vision or life. We believe every child deserves to see what they’re capable of.

Tim: You mentioned impact here and there’s been talk about GoCheckKids’ ability to make a global impact. Has that begun, and how do you see that evolving overtime?
Kevon: We received our CE mark, which is the FDA equivalent in Europe last year. And already about 15% of GoCheck Kids screenings are in Europe. We actually have a few pilot customers in Asia right now. We’ve also just landed our first customer in Africa, so now GoCheck Kids is being used on four continents to protect the learning and vision and potential of children. We are definitely excited to expand our global footprint and impact which of course is being made possible by the portability and the affordability of the approach we are taking: putting a proprietary advanced technology on a smartphone which has a significantly lower cost of manufacturing and distribution than a traditional medical device.

Tim: Very Cool. How do you think about company culture as the leader of an organization that you weren’t the founder of?
Kevon: You know, when I was in Belgium a few days ago, a candidate who was applying to work at GoCheck asked me what single characteristic is true for everyone in the company. We were having lunch and I didn’t even have to drop my fork, it was obvious. Everyone at GoCheck Kids is passionate about our mission. They are passionate about protecting the potential of the kids we serve and as a result, elevating human flourishing.

When I joined the company, it was tempting to take my business and life principles and kind of impose them on the company and the culture and the people. But I realized that probably wasn’t going to be as effective as just taking a more patient approach. What I did was just observe and listen to see what the principles were that people at GoCheck Kids already had. My job was actually more of a scribe as opposed to an agent of things. And then to create a discussion with the team to see ‘what are the great aspects of the culture already existing and where we can improve.’ Our work here is never done, but I feel like taking a more patient approach ultimately has resulted in a commitment to principles and a culture that is broadly shared by the company as opposed to the likely resistance that I could have experienced if I was imposing my own principles.

Tim: So with all that in mind, what keeps you up at night?
Kevon: The one thing I’m thinking a lot about right now is how to provide a product that’s disruptive (not to hospital systems or doctors): radically changing affordability and access to care. However, that’s really hard to do if hospital systems put vastly more affordable digital products through an unnecessarily long decision cycle. If so, digital health companies can’t reap the full cost advantages of being digital because they have to spend a lot of money on sales and marketing, on these really long sales cycles. That’s not something that I think GoCheck Kids or any hospital can figure out in isolation, but as we sit across the table and talk about our mutual desire to advance outcomes and lower costs, we have to find a way to compress the sales cycle if we plan to both boost outcomes and lower healthcare costs for the whole system.

Tim: Awesome Kevon, that was great.

Reflecting On Our First 5 Years: 5 Things I Wish I Knew At The Beginning

By: Tim Gordon

It doesn’t feel like five years. In fact it feels like just yesterday I was sitting down at my  kitchen table to figure out how to start a company. So much has happened since then, and without the support of my now-wife-then-girlfriend who apparently missed the memo that being an entrepreneur basically means you’re unemployed, none of this would be possible. I’ve watched in amazement as we’ve grown – bigger offices, new website iterations, the launch of this newsletter, new clients, new investments, and most importantly – more team members. The impact of adding
each and every one of the people on our team has reverberated through the entire business, taking it somewhere I never could have even flirted with on my own. Through all of that, I’ve learned countless lessons – many the hard way – but on the whole have found these challenges far more rewarding to power through than those that came before. In honor of our 5th Birthday, here’s five things I’ve learned that I wish I knew at the beginning.

  1. Always Be Selling Like You’re Going Out of Business

    This sounds obvious enough, but things are tricky in a services business when you’re an army of one. We don’t sell widgets, and we didn’t invent a better mousetrap. We don’t cold-call CEOs, suggest it’s time that they replace their CFO and offer to help them with that. Sales cycles are all over the place. The shortest has been 1 week, the longest – well I’ll know the answer when we start doing work for companies we started building relationships with the year I founded the firm. In the beginning, I was worried that I’d sell too much and not be able to deliver on the
    work without having a team to support me. In hindsight, this was bananas. This would have been a wonderful problem to have. Alas, it was not the problem I had. After some reps, I quickly learned that I always needed to have the same urgency around our business development efforts as I did around our delivery. This got easier once our team grew and I could split my focus more evenly, but the reality is, no revenue, no business. Even when things are going well, get your ass out there and sell more.

  2. Hiring The Right People is Transformational

    Duh, right? Shameless plug for a search firm? Maybe. But if you want to trace the first inflection point in our business, there’s an exact date that just happens to match up with our first hire. You have to white-knuckle your way through the productivity dip that follows, but when you come out the other side of it, the return on investment is huge. When you get it right, you see the early formation of your company’s culture, you get freed up to focus on other things (see Lesson #1), the next hire gets incrementally easier to on-board via shared institutional knowledge, and, it gets a little less lonely. Just a little. There’s a chicken and egg element to this when you’re bootstrapping the business and haven’t raised capital, but there hasn’t
    been a single thing that we’ve spent money on that has a better return on investment than our people.

  3. Understand Why People Say No To You, But Even More Importantly, Why They Say Yes.

    In the beginning, I heard “No” a lot. A lot. Turns out, starting a company is an exercise in getting your teeth kicked in every day, and coming back for more. Good thing my dad’s a dentist. When we wouldn’t win an engagement, I very infrequently knew why. I could take a good educated guess, but rarely would a prospective client tell me straight up. One-man shop, track record, etc. Over the last year, a number of our clients have told me why they said “yes” to us, and it was a strangely profound realization that that was probably more important for me to understand. I should have asked every damn client we had why they picked us, because some of the unsolicited feedback surprised me. It highlighted that they cared a lot about the
    things about us that I thought they should care about, but feared they didn’t. They chose us because of our size not in spite of it, our clear focus, and the belief that we would do anything to deliver for them. It showed me that the story about us that I wanted to tell, was in fact the one that people wanted to hear. Who would have thought? Which leads me to my next lesson…

  4. Trust Your Gut

    You know. You know you know. But you zig when you knew to zag. At what point do you start to listen to that feeling that clearly knows better than you? I should have listened more often. I’m happy I listened when I did. Instinct led me to make some bold (for me) calls over the last few years at times when all the evidence said not to. A number of those moments represent huge inflection points in our business, and frankly are why we’re still here. Other times I didn’t trust my gut, and I really should have. This one requires constant awareness on my part, because I still miss it sometimes, but I’m getting a lot better at paying attention. I think the brain subconsciously does a phenomenal job of cataloguing experiences in the form of data, and when it’s trying to tell you something based on all of that computing power, you should listen.

  5. Balance is A Key To Longevity

    I say “A” and not “The” because there are others, but this one has been hugely important for me. In the beginning, at that lonely table in my one bedroom apartment, 10 feet from my bed, it was hard to figure out when the work-day started and ended. Even sitting on the couch in the evening, being able to see my “office” led to pangs of guilt. I’m starting a company, shouldn’t I still be working? I think the answer was no. This is a marathon, not a sprint. Finding time to get above it, rest, reset and come back ready to go made a big difference. Taking the occasional vacation to realize that I could and the world wouldn’t come to an end was really important. We just aren’t meant to keep going without taking a break, and I’ve got to set a good example. Happy employees make for a happy company and happy clients, and they need to know that it’s not only OK to rest and reboot, but that it’s an expectation. As a founder, I had to be deliberate about placing boundaries (with some flexibility) for the benefit of everyone, not just me.

What I’m Working On

I, like our company, am a work in progress. I find that when I share what I’m working on out loud and with others, it helps keep me accountable to it. There are two things that I’m trying to improve on daily. The first is patience. And not the “I’m an impatient person and that’s a weakness masquerading as a strength” type of a BS answer to an interview question. I mean impatience in a form that I’m not proud of. It’s something that I’ve been working on for a long time, and probably always will be, but it’s important to me, my team, and my family that they get the best, most patient version of me so that we can continue to do amazing things.

The second thing, is stopping to celebrate the wins. I think we’re like most growing companies, in that we spend a lot of time unpacking the things that we mess up, or fail at, and very little time patting ourselves on the back for a job well done. I’ve been guilty of this my whole life, but I’m making a concerted effort to focus on our wins – big and small – because we should and it’s important. I worry that if we don’t we may forget how to have fun doing this, and if we’re not having fun, what’s the point?

An Interview With Carolyn Witte, Co-Founder & CEO of Tia

Carolyn Witte is the Co-Founder and CEO of Tia, a New York City based modern gynecology  and wellness practice designed to personalize and integrate a holistic approach to omen’s healthcare. Designed to be a one-stop-shop for female health, Tia opened their first clinic in Flatiron in the Spring of 2019, with plans to expand in the coming months.

Tim: Tell us a little bit about how Tia came to be, and what inspired you and Felicity to found the company in the first place
Carolyn: Tia really started out of my own and Felicity’s frustrations with the healthcare system as patients. We very much approached the space from a patient-first point of view, having gone through our own really frustrating diagnosis process in our early twenties that exposed to us everything that was fundamentally broken about women’s healthcare – specifically the fragmentation, lack of personalization, and, something that we talk a lot about: lack of soul in healthcare. It’s been quite a journey over the past two years taking our patient experience and marrying that with the provider reality, and really saying, ‘well, what would healthcare really look like in design, with the female experience at the center of it?’ That’s what Tia has been really about.

Tim: And for those that don’t know, what is Tia?
Carolyn: Tia is a lot of things. We are not a clinic with an app, or an app with a clinic, but at our core: the next-gen women’s platform fundamentally changing the way women interact with the healthcare system at large. What that means in practice is we build all sorts of products, tools, and services, from our personal private women’s health advisor app to our first brick and mortar Tia clinic here in New York City. Everything we do or build is designed to help women be their own patient advocate and get meaningfully better healthcare.

Tim: Women’s health is having a bit of a moment right now – and sensibly, as depending on where you get your stats, upwards of 78% of women are the primary healthcare decision-maker in their household; what do you attribute the explosion of companies focused on the space to?
Carolyn: Yeah, it’s interesting. I think there’s a tension between this realization that women spend 80% of the healthcare dollars and therefore are “a niche market,” as this market used to be described as. With the other side of the coin, which says that that women have – we believe whole heartedly at Tia – fundamentally different, distinct healthcare needs than men; and therefore, necessitate their own product experiences and healthcare offerings designed with them at the center of it. As we say at Tia, ‘women aren’t small men,’ and the healthcare system at large has all too often treated women as such.

Tim: What was the biggest challenge that you faced in getting Tia started?
Carolyn: Where to start. That continues to be a challenge we face: We’ve always had a really big, bold, grandiose vision for building a new model of women’s care from the ground up. The question of where to start, sequencing and prioritization has always been the challenge. We started as building an information-only platform, and quickly learned that we couldn’t really achieve our goals, or our vision, without getting into care delivery ourselves, which was the next chapter. I think now the challenge continues to be what are the next, and the next, and the next chapters, and the right sequencing to really enable us to achieve our long-term vision?

Tim: Along those lines, how do you differ from other women’s health providers?
Carolyn: First and foremost, we’re not just a women’s healthcare provider. We’re a technology platform at the core. In many ways we’re three businesses in one: a technology platform, a clinical services business, and a direct-to-consumer brand. And Tia’s magic is really at the intersection of brand experience, technology, and best-in-class clinical care.

Tim: When you talk about that technology, what role does it play in your view in revamping the patient experience that you’re providing?
Carolyn: We view technology as the tool that’s not only about revamping the patient experience,but changing the provider one. I think the biggest realization for me as the founder, who approached the space originally from a patient-first point of view, was realizing that, to fix women’s health for women, you need to fix it for providers too. So we view technology as a bridge that can serve as filling the gap or the void between patients and providers, and build a new relationship-based model of care for the modern healthcare system that is missing today at a time when healthcare is becoming more fragmented, more transactional, and less human. And we use innovative technology to fill that void.

Tim: So what are your plans for expansion?
Carolyn: Big plans. Expansion for us looks like an array of different, sort of, chess moves, opening up more Tia flagship clinics in other cities around the country. It’s been amazing to see how in demand this new care model is that we’re building since we opened our first Tia clinic 3 months ago – expanding our scope of practice beyond core gynecology and basic primary care. We found that women want literally everything from Tia – from fertility to mental health to OB – and the challenge of where and how to expand our scope is a big one. And the third thing is scaling our technology platform through other providers is something we are starting to think through as a way to reach more women at scale and really productize that part.

Tim: At this point, what keeps you up at night?
Carolyn: Sequencing. The same thing that has always kept me up at night, and doing the right things in the right order. I think we have worked really hard to get where we are, and validate it a lot and prove that women and providers really want this new care model, and that they trust Tia, which is the ultimate thing we’ve earned. Their trust is hard to earn and easy to lose; and thoughtful scale, thoughtful sequencing, and expansion is the key thing to fix up here and what keeps me up at night.

Tim: Remind me, how far into this are you? How long have you been at this?
Carolyn: Two and a half years.

Tim: Which is kind of a lifetime in a startup, right? What’s one thing you know now that you wish you knew at the beginning?
Carolyn: Aligning incentives among all the different players in the healthcare system is key to success. You can’t just build for patients. You can’t just build for providers. You can’t just build for payers. You have to build for everybody. And figuring what that thing is that fulfills everybody’s needs and wants is the secret.

Tim: Hmm, that’s a good one. I like that one. Great thought to end with. Thanks Carolyn!

Coffee Chats with Nina: Understanding the Entrepreneurial Mindset – Part III

By: Nina Mermelstein

Part III of an Ongoing Series- What They Don’t Teach You in Business School (or startup summer camp)

We often applaud successful entrepreneurs for creating innovative solutions that are aimed at changing the status quo. Our culture prioritizes entrepreneurship skills so much that we now offer summer camps such as Biznovator and school programs like We Grow to empower young entrepreneurs. Where were these amazing programs when I was stuck sweating in the summer heat at tennis camp? By the time I attended university, my school offered a brand new minor that I was excited to partake in called “Entrepreneurship & Management.” We analyzed corporate case studies, developed business plans, and built mock marketing agencies.

I generally agree with the idea that it is important to instill entrepreneurial skills such as creative thinking and teamwork in children and young adults. However, I have also come to understand through my continued Coffee Chats with Founders and CEOs in the digital health space that there is a lot about entrepreneurship that we can’t learn in summer camp, college, or even business school. Below I’ve pared down my findings into three categories: honing people skills, balancing competing priorities, and leveraging available resources.

The “People Stuff”

Over the course of a business school education, you might dive into classes focused on finance, organizational behavior, management, or accounting. However, one entrepreneur who earned her MBA from one of the most prestigious business schools in the country noted that while her education was incredibly valuable, it didn’t exactly prepare her for all of the “people stuff” that came along with building her business. For example, she found herself embarking on new and exciting quests to better engage her employees and establish a strong company culture. This was what she called “the fun part” of learning on the job. She was also confronted with much more difficult predicaments regarding underperforming hires. No book or course had prepared her to determine when is the right time to let someone go or even how to fire an underperforming employee. She said that as a founder, “it’s important to gain more comfort in living in the grey area, rather
than in a world that is just black or white,” especially when working with and making decisions about your team members.

Another founder spoke about her successes and challenges while bringing together a group of employees with a variety of skillsets and work experiences. She knew early on that there was a great benefit in assembling a team that would offer a diverse set of perspectives. While she was proud of her success in hiring an eclectic team, spanning clinical researchers to software engineers, she was quickly confronted with a significant communication barrier. Since her team members came to the table with different specialized skillsets, they became frustrated when trying to speak and understand one another’s views and ideas. Her background as an investor never fully prepared her for this type of challenge. She found herself acting as a translator between a physician with 5+ years of clinical care experience and a product expert who had never worked in healthcare before. Once she made a more concerted effort to level the playing field by creating a company culture that invites people to ask questions and never assume that any concept should be immediately understood, her team began working well together.

The Balancing Act

As a millennial living in NYC, I often find myself struggling to strike a balance between my career responsibilities, social activities, and self care needs. If I find balancing these
priorities difficult, I was curious to know how founders and CEOs, who have more at stake, attempt to balance their work and personal lives. When I asked these entrepreneurs how they maintain balance, I often received a laugh and the response: “I don’t.” My Coffee Chats have taught me that the idea of a true work-life balance is unattainable for someone who is building a business from scratch. While striking a perfect equilibrium of work, self, and family needs is unlikely, I’ve learned about a number of tactics that these founders have employed in an effort to distribute their time in a way that leaves them feeling fulfilled.

I spoke with a second-time entrepreneur who shared that work truly was his number one priority while immersed in his first entrepreneurial venture. During the time that he built this first business, he also became engaged and got married. He found it difficult to create a separation between work and home life, as he was constantly thinking about the needs of his company. Since then, he and his wife have had children and he has further recognized the need to strive for more work-life balance in his new role as CEO of a different startup. For him, the key was to hire an energetic Chief of Staff with the bandwidth to juggle multiple projects and the ability to take things off the CEO’s plate. With this incredible new hire offering a safety net for any immediate work-related tasks, the CEO is now able to go home at 5pm and spend more quality time with his wife and children.

I’ve also learned about the concept of career-life integration rather than attempting to compartmentalize different aspects of work and home life. I spoke with another Founder, who in addition to her work responsibilities has two young children and two parents in need of care. She said that she is not striving for perfection in any one area, but instead thinks of ways that she can integrate her work and home worlds. For example, working in a startup gives her the flexibility to take her children to school in the morning and to be home with her family at dinner, although she will often sign back online in the evening to answer emails once everyone is asleep. Since her company has grown, she reminisces about the times she was able to get more hands on and involved in the smaller tasks associated with building the business. However, she has investors who say to her, “you can’t do it all, you really need to hire others who can help you.” By making the decision to shift many of her previous responsibilities to her capable employees, she is able to find more time for other aspects of her life.

The Resources Available

Making time for continued industry learning and professional development is difficult, especially when you are a Founder who can barely find a minute to eat lunch. A number of entrepreneurs voiced their tendencies, for better or for worse, to hunker down, trying to get everything done. However, they often forget to pick their heads up throughout the day to leverage the resources available to them- whether in the form of consumable materials like journals and podcasts, or in the form of people such as mentors and advisors.

One CEO mentioned that he started using a time tracking device to compare how he would like to be spending his time with an accurate assessment of how he is realistically spending his time. He discovered that he wasn’t dedicating as much attention to networking, mentoring relationships, and industry reading as he would have liked. He now has an hour carved out on his calendar every day to read the news, blogs, journals, and other relevant publications.

A first-time founder described how he immediately immersed himself in all the resources he could find online about starting a company and raising funding. He said that First Round has ggregated an incredible variety of resources for founders. Additionally, he mentioned how he was inspired by Nike Co-Founder Phil Knight’s book Shoe Dog and he spoke about the lessons he learned from the book The Hard Thing About Hard Things by Ben Horowitz. Other great resources that entrepreneurs shared included a number of different podcasts, such as How I Built This with Guy Raz, Masters of Scale by Reid Hoffman, and Reboot with Jerry Colonna.

In regards to human resources, many Founders have found wonderful communities where they can share ideas and personal stories with others who can relate. Some leaders I spoke with took advantage of networks built by unique co-working spaces like The Wing, while other leaders have joined what are effectively “business leader support groups” offered by companies like Venwise. I’ve also heard from some entrepreneurs that they enjoy seeking guidance from people in their existing network that comes in the form of family, friends, and friends-of-friends who can relate to starting their own businesses.

These coffee chats have deepened my respect for entrepreneurs and what they are juggling on a daily (or minute-by-minute) basis. They are constantly pulling different levers, continuously learning how to better manage their teams while making time for their personal and home lives, as well as their own professional development. This has also brought to light the psychological impact that many entrepreneurs feel when attempting to portray 100% confidence all of the time without showing any signs of weakness. Michael Freeman, a psychiatrist and faculty member at the UCSF School of Medicine found that Founders are 50% more likely to report having a mental health condition. I wasn’t surprised to read that statistic given everything I’ve learned about
entrepreneurs’ competing priorities and need to depict an impenetrable vision of leadership.

Mike Tyson once said, “everybody has a plan until they get punched in the mouth.” Many of the CEOs and founders I’ve spoken with have incredible educational pedigrees and work experiences, but there is only so much they can do to plan and prepare before actually building their businesses. At the end of the day, these executives are just people who face a lot of the same challenges we are all familiar with, whether it’s about maintaining some balance in our lives or overcoming difficult team dynamics. I believe it is important to continue to have an open dialogue about how we can best support and empathize with these driven Founders so that they can achieve success in their businesses while also maintaining their personal health and happiness.

How Starting My Own Company Made Me Better At My Job

By: Tim Gordon, Founder & Managing Partner

It blows my mind that we’re going to be five. Five! I’ve now officially been running Aequitas Partners longer than anything else I’ve done in my professional career. Five has me a bit nostalgic. Reflective. Grateful. I’ve tried to be mindful and celebratory of milestones that we’ve reached over the years as the business has grown, but I’ll be honest – I’m bad at it. In quiet moments I celebrate these things, but it’s usually fleeting and then it’s back to work. It’s something I’m working on. As we close in on our fifth anniversary as a firm, I thought it fitting to revisit the first thing I wrote when I was “giving content a try.” As I read through what I wrote, it felt more relevant than ever, and reminded me of how incredibly uncomfortable I was writing it the first time around. Now felt like a great time to dust it off, polish it up, and drag it into 2019.

Part of why I wanted to revisit this topic is because my belief in its impact hasn’t changed, and if anything has only gotten stronger. Empathy may be the most important, accidental thing I’ve gained from starting my own company. Friends and family would tell you that I’ve always been empathetic; tough but fair. I’m the guy that people usually came to with their problems when they needed someone to listen and maybe give advice. I’m a good listener, and was always good at relating to people. I’m talking about empathy in a different way here. It’s been nearly 5 years since I took the leap and founded Aequitas Partners. It’s been a wild ride that’s gotten more exciting each month, and I’m not kidding when I say it feels like a blink. Days, weeks and months disappear, and I regularly lament to anyone that will listen that if I had a super power it would be the ability to slow time down and live in moments longer. I’ve made what I view as an offensive number of mistakes (no one beats me up quite like me). These mistakes are different though; these challenges, stresses, missteps, screw-ups, missed opportunities – have actually taught me things. I’ve learned to separate that from the trivial. Interestingly enough, the one thing that quite possibly has had the most profound and unexpected impact on me is a simple byproduct of starting the company in the first place – building my own team. It was true when I wrote this the first time, and it’s true now.

The irony of this is not lost on me. I’m in the business of hiring, so shouldn’t this be easy? As an executive recruiter, I’ve been fortunate to work with some incredible entrepreneurs and CEOs across Healthcare in recent years, helping them identify C-level and leadership team members across every functional role. What I had yet to do when I wrote this the first time, was find team members for myself. It’s now a little over two years since we hired our first person – Steven Berman – and the subsequent growth of our team has given me a small glimpse into what each of my clients must be experiencing when they ask us for help. Something that seems low risk, such as hiring a summer intern, at the time felt like it came with the weight of the world. There were nights tossing and turning as I did the math on whether I could afford to hire that person that could be an absolute game changer, and when the right time to pull the trigger was. There’s that gut feeling that someone just isn’t the right choice, even though they look great on paper. There’s the realization that with a team comes a tremendous amount of personal responsibility – they need engaging work to do, a steady paycheck, health benefits, professional development, training, career growth, and general investment from me in them. And they deserve it. Conversely, I need them to be ambassadors for the brand; every person they interact with needs to walk away impressed and intrigued by our story. It’s scary as hell.

But it has also made me better at my job. I now have a level of empathy that’s difficult to recreate, having not walked a mile in a client’s shoes. I’ve never been a hard-sell search guy – not with candidates and not with clients. I try my best to shepherd both parties through the process, adding insight when I can, and pushing back when it’s required. I try to do all of this while not losing sight of the significance of the decisions that both parties are making. Our clients are investing a significant amount of money in this process, both in us, and the executives they hire. Mistakes are costly, potentially meaning lost clients, lost revenue, and unhappy investors. Add to that, that this is just one of their priorities on a list that never ends, and you gain some perspective. Similarly, the executives we recruit are making what most would consider life-altering decisions. Leave a good job for what might be a better one? Relocate their whole family for what might be a career-defining opportunity? Take a cut in their cash compensation in favor of a bigger equity stake in something that could create generational wealth? Living here in the middle, it’s easy to lose sight of the gravity of these decisions.

Hiring our first few folks was a crash course in how much time and energy needs to go into making someone successful at what we do. My perspective shifted dramatically from being a one-man shop and worried about providing for myself (and subsequently my wife), to include these other incredible humans who were willing to get in the boat with me. The loyalty I feel to them for taking that leap, and the tremendous effort they’ve put in to building this company with me is something I’m not sure I’ll ever be able to articulate. It also raises the stakes. Payroll gets bigger, offices get bigger, infrastructure costs grow, and the investment of time back into our team grows. To say it never keeps me up at night would be a lie. The gift it gives me though, is the good fortune to currently be working with the best people I ever have. The pressure to deliver for them, in that light, feels appropriate.

Spending time thinking about building my team has given me an immense respect for my clients that do it every day, and arguably with more at stake. It’s helped me be more patient as clients reach their own conclusions. It’s made me acutely aware of all the things that are probably going through their minds, even though they might not say them out loud. It’s made it more personal. I now know where they’re coming from, not just in theory, but in practice. In a business that is so intensely driven by relationships, I’ve come to appreciate that my internal challenges have given me a window into the minds of those who we aim to help. As I reflect on the last 5 years, this perspective and empathy has to be one of the most important things I’ve gained, and has unquestionably made me better at what I do.

Coffee Chats with Nina: Understanding the Entrepreneurial Mindset – Part II

By: Nina Mermelstein

Part II of an Ongoing Series — 5 Things Entrepreneurs Wish They Knew Before Building Their Companies

As part of my mission to get into the headspace of entrepreneurs, I’ve continued to have in-depth discussions over coffee with a variety of digital health founders and CEOs to hear about their experiences firsthand. We’ve covered everything from early successes and challenges to lifestyle changes and resources utilized.

In my first article, I shared the insight I gained on the initial phase of an entrepreneur’s journey (see Part I: Taking the Leap). Since all of the entrepreneurs I’ve engaged with have experienced some form of growth, whether it was in terms of fundraising, team size, customers or users, I also wanted to get a sense of the different obstacles they encountered in getting to where they are now. Furthermore, I wanted to understand if, in hindsight, there was any knowledge they wish they had to best tackle those challenges.

I asked all of the leaders a very open-ended question— what do you wish you knew before building your business? Since we still lack a time machine (I’m working on it…), I received a variety of candid responses to my question that I pared down into five themes that I’ve shared below.

1. Manage Your Own Expectations

The importance of managing your expectations came up in the majority of my discussions. These leaders are incredibly mission-driven and often have personal health experiences that underpin their businesses. Their passion can also be coupled with the impatience of wanting to see the results of their work right away. In an incredibly high-stakes, complex industry, with longer than average sales cycles, the foresight to manage expectations becomes even more essential.

One first-time founder echoed the necessity for managing expectations as it relates to timing. Her initial vision for the business involved securing a certain number of customers and team members within two years. She soon realized that she needed to re-adjust her mindset regarding the speed for business growth. After three years since founding the company, she now has a much more robust product and business model and is finally seeing that anticipated growth.

Another entrepreneur shared how she has experienced the pressure for immediate growth from both the investor and founder side. During her time as a venture capitalist, she watched many companies succeed and fail in the digital health space based on their speed to market. She witnessed founders underestimate the uniquely long sales cycles and she also saw the external pressures that investors often place on founders to produce immediate results. She watched companies that raised huge amounts of capital and had great leadership teams run pilots before they were ready and eventually shut down. When building her own business, she almost fell into the same trap. She had an innovative idea that began gaining momentum and she wanted to hit the ground running. Instead, she took a step back, recognizing that there were many things that needed to be done first, beginning with administrative processes such as creating the proper governance and legal structure.

2. Not All Advice Is Free

For many entrepreneurs, the network they build early on can lead to long-term customers, investors, advisors, and partners for their businesses. That being said, it is also important to be wary of some new relationships that can be harmful for the company over time.

One founder experienced this scenario when he set out to build his company and was connecting with different people who offered to help him in a variety of ways. Some of those people were genuine and well intentioned. Many became long-term trusted advisors and partners for the business. Unfortunately, there were also many individuals who approached him offering introductions to potential investors or customers only in return for official advisory board seats or shares in his business. Since he is a younger first-time entrepreneur, there were a number of instances where people tried to take advantage of him. Initially, he caught himself thinking “I can’t believe I’m only three months into building this business and this person can take me to the next level.” He quickly learned that he needed to be wary of the people who promise the world, whether they are investors, dealmakers, or even corporate development executives at large companies. While he still believes that every conversation is worthwhile and creates an opportunity to learn something new, he is much more wary of people who make big promises.

3. Patience Is A Virtue

Taking on an executive operator role at a company you’ve founded doesn’t always come naturally, despite having years of work and management experience. Even for entrepreneurs who have founded multiple businesses, they often have to adjust their leadership styles to effectively manage teams at different companies. For first-time entrepreneurs, the path to becoming a successful CEO and team leader can be bumpy and some executives forget to be patient with themselves as they grow into these new roles.

I spoke with a first-time founder & CEO who had a strong network of healthcare executives and was able to quickly assemble a world-class team that was distributed across the country. She soon realized that despite having recruited an extraordinary team, she wasn’t prepared for what it took to manage their day-to-day activities. She found herself spending multiple hour-long sessions coaching different team members each day, which took time away from her other necessary executive responsibilities. She is learning that it is all about motivating people and making them feel like they are bringing their best selves to work everyday, empowering them to work more independently. This often requires getting to know her team members on a personal level. With the help of trusted mentors and advisors, she is continuing to hone her leadership skills over time.

4. Roll with the Fundraising Punches

It’s not a surprise that fundraising makes it to the top of the list of challenges that founders face during the early stages of building their businesses. Some founders have experienced fundraising difficulties throughout their entrepreneurial journeys. However, many first-time entrepreneurs are facing unfamiliar obstacles with potential investors.

There is no true playbook for handling these “fundraising blows,” but one particular founder shared an interesting example from when her business was in need of “life support” funding and how she handled her precarious situation. She was working with an angel investor who had completed their due diligence and was about to sign on the dotted line. The investor pulled out right before what was supposed to be a relaxing Thanksgiving holiday. This founder had thought the investment was pretty much a done deal, so this news was completely unexpected. Instead of taking it personally or dwelling on the lost capital, she immediately went back to the drawing board. Knowing that she needed to secure financing to sustain her business, succeed for her existing customers, and support her employees, she had to focus on what was next. This mentality and thick skin enabled her to move on and successfully secure funding from new investors.

5. A Sticky Situation: Mixing Business with Friends & Family

Consulting with close friends and family during the early stages of building a business is natural. They are the trusted people you go to for advice and support in all aspects of life, so of course you would come to them for something as personal as starting your own company. I spoke with a founder who chose to bring two of his children into his business early on. Their comfort with one another and honest communication was of great benefit to the company culture.

On the other hand, I’m sure we’ve all heard the horror stories of friends and families that have been torn apart by going into business together. Since my profession involves interviewing executives across the healthcare industry, I’ve heard my fair share of these stories involving leaders seeking capital or business partnerships from friends or family and then watching those relationships fall apart.

I spoke with an entrepreneur who faced this common predicament when deciding whether to co-found her digital health business with her best friend from childhood. Since they were concerned about whether their friendship would transfer well to becoming business partners, they each spent time separately thinking about their vision for the business and strategies around growth, company culture, and other fundamental concepts. After spending several days apart thinking about their personal visions, they came together and compared notes. Once they realized that they were aligned, they decided to start their business together. They continue to use this method for making any big business decision – thinking about it separately at first and then coming together to make sure they are on the same page. They never anticipated that their initial process as friends would develop into a very important business strategy.

Conclusion:

At the end of the day, entrepreneurs will never have all of the answers and nobody can truly prepare them for the constant challenges they face while building their businesses. Based on my discussions, I believe that the ability to “block and tackle” should most definitely be included in the founder job description. Entrepreneurs have to constantly be nimble as their companies evolve while maintaining dynamic energy around what they are building.

My coffee chats have provided me with incredible stories about the early successes the entrepreneurs experienced, whether it was making a key hire, raising significant capital, or gaining traction with the number of users or customers. Other founders mentioned positive feedback they received from early customers or users about their product or service that reinforced the importance of what they were creating. While all of these leaders have experienced some failures and had to overcome a variety of obstacles, they have also taken the opportunity to celebrate their early wins, both large and small. These short moments of recognition have helped propel their businesses forward.

An Interview with Matt McCambridge, Co-Founder & CEO of Eden Health

Matt McCambridge is the Co-Founder and CEO of Eden Health, a New York City based healthcare organization that provides high quality, technology enabled primary care services to employees on behalf of their employers. Backed by Greycroft, the company is in the process of expanding their footprint nationally.

Tim: Start off by telling us a little bit about how Eden came to be; what inspired you and Scott to found the company in the first place?

Matt: So many things in healthcare come back to a personal story that people working in it have felt in their own lives. A lot of the system is broken, and everybody’s been to the doctor, and confronted it in one way or another. So, for me when I was a kid, I had a really transformative experience with my sister who got very sick around the age of 14 and would end up in the ER over a dozen times. She had really complicated issues. She has all of these stories of waking up and doctors on staff saying “Oh she’s on drugs” or “Oh she’s pregnant” – and none of those things were actually happening for her. We then went on this nearly four-year process where she visited over 70 specialists. We would show up to a specialist, do all the same tests, all the same imaging procedures and then they wouldn’t even help you find the next person to go to. Over the course of 4 years and over 70 people, we saw the problems of the healthcare system day in and day out. We got lucky when a primary care provider coordinated her care and got the right prescription in the hands of my sister. She never went to the ER in the same way again. So we had this all too common healthcare experience where we confronted the realities of the healthcare system up close. That inspired us to build a primary care company, because primary care is the most fundamental building block of good and cost-effective healthcare. Along the way to building that primary care company, we found out that insurance was a huge impediment to people being able to get the kind of care that they need. So we combined those two and added mental health and that’s really the suite of offerings that we present to employers to create an entirely new environment for their employees when accessing care.

Tim: Sadly, a familiar story. So how exactly does Eden work?

Matt: We combine virtual care, insurance navigation, in-person primary care and mental healthcare. On the virtual care side, you get a dedicated, collaborative care team. Whenever you reach out as a member, you get exactly the same set of providers in person and virtually. This enables our members to build meaningful relationships with our providers, and streamline care for more effective delivery for complex cases like my sister’s. Even if you have a straight-forward dermatology issue, you still want to make sure your health concern is followed up on and resolved quickly. Our continuous, 24/7/365 virtual care is the way patients should be able to access their healthcare.

Insurance navigation is essential to providing excellent healthcare. For example, if you get a big bill in the mail, you can take a photo of it through the Eden Health app, and our team can act on your behalf to help resolve and often reduce your bill. On top of this, we have a network of primary care offices where our members can see Eden Health providers in person. Members can see our primary care providers same day and for extended appointments that cover their entire physical and emotional health. This type of comprehensive experience from one solution is unique for an employer to offer, compared to what they’re able to do exclusively through their insurance plan or by piecing together several different, unconnected solutions.

Tim: What made you guys decide to focus on mid market employers as your target customer base?

Matt: Employers are the transformative healthcare buyers in the U.S. right now. They are the buyers of healthcare for 160 million people. They are aligned on wanting to provide excellent quality healthcare at a fair price, and they are able to move quickly, and independently from much of the rest of the healthcare system. They have allowed us to do something like provide 70 percent of all our care virtually, coordinate all of your specialty care, and follow up over the course of days, weeks, months and years like Eden Health is able to do.

Most employers have not been able to get cutting edge solutions, which have been typically reserved for the fortune 1000. The mid market is just as interested in offering a fully integrated healthcare delivery system for their employees, which makes it a great opportunity for a company like ours. Of course, we work with much smaller and much larger companies as well, but there’s just a huge need in this market segment.

Tim: One of the more compelling components of your recent fundraising is the investment from and partnership with Convene. How do you see that partnership accelerating your scale nationally?

Matt: If you’re an employer today, you have a distributed workforce, and that’s what our virtual care system is built to support. We are building Eden to offer care in every single state. We are in multiple states across the country already and will be in all fifty by the end of the year.

Providing better care and offering companies the ability to work directly with primary care providers in any location and at any size was the idea for partnering with Convene. We currently have clinics in New York and by the end of 2019 we’ll be building locations with Convene in Chicago and DC. We will then be going to cities like Philadelphia, Boston, Los Angeles, San Francisco and others. Employers are now going to have access to a distributed network of physical primary care clinics that they can tap into anywhere they are.

Tim: This is a good segue into the next question. What have you seen to be the biggest challenge in marrying technology with a more traditional brick and mortar healthcare services organization?

Matt: This has not been a super difficult thing for us to do. Based on the history of how insurance payments developed, we’ve gotten to thinking that virtual care is somehow different healthcare than getting in-person care. We want to dismantle the idea that there is telemedicine and in-person medicine – it’s all medicine no matter where it is provided. In fact, virtual care is often better than in-person care. If you’re sick, you’re going to be sick for hours, days, weeks, months or years. You’re not sick for just the ten minutes that you’re sitting in a physical encounter with someone. I think the fact that we send people who have the flu through the subways of our cities or make them drive to their doctors office and then get other people sick along the way is a crazy notion.

From a virtual perspective, we’ve been able to take 70 percent of our clinical interactions, do them virtually, and then focus on making the physical care about longer appointments, spent with more complex chronic and sometimes comorbid patients. This has made our physical clinics more successful and easier to manage by providing so much virtual care. It has also helped to create the incredible healthcare experiences that our members love.

Tim: Along those lines, you have talked a lot about creating a “delightful” experience for your patients. How have you reengineered the patient experience to achieve some of those goals?

Matt: There are two ways that stand out. The first is the level of access. We have an average of seven-minute response times from our care teams, who are available 24/7. This enables them to be with somebody throughout their entire care episode. In some cases this translates to staying with our patients virtually during the trip to and out of the emergency room. Knowing when they are seriously sick, being able to follow up at any time, and having access to so much of the healthcare system through the same offering is a new experience for our members when they start using Eden Health.

The second is our integrated model of care and insurance navigation. You, as a patient, no longer have to think “Which person do I go to for an issue with my knee vs. an issue with my hip vs. the fact that I also have a fever?” which is often confusing to navigate yourself. Instead, you can start at one place always and use Eden Health to manage all of your health and financial aspects associated with your care. I think that integration and accessibility are the main ways in which patients are getting a totally different experience with us compared to elsewhere.

Tim: You guys now have successfully raised capital, you’ve won enterprise customers and you have hired great people. So at this point, what keeps you up at night?

Matt: Making sure we’re continuing to hire great people is the main thing that I stay up thinking about. From a patient relationship perspective, you build on top of interactions with great providers. You have to make sure that they are truly excellent every step along the way. From a company building standpoint, making sure that you have people who are mission-oriented, excited about what we’re doing and interested in navigating the difficulties of healthcare is the ultimate goal. Getting those people in place allows us to continue to scale the organization. That’s really the main thing that I think about.

Tim: What kind of culture are you building at Eden and how do you see that tying back into the mission that you’re on?

Matt: Our mission is to provide health and well being to people everywhere. In order to do that, we are building a company in a pretty fundamentally different way, with the combination of the virtual and personal care along with insurance navigation. We have to make sure that every idea that we advance in the company is interrogated, criticized and ultimately implemented in a team-based environment that makes sure that we’re sourcing the best ideas and bringing them to fruition. We of course have ‘patients first’ as our primary value. In order to achieve that, I really look at our value of “speak up, and act with conviction,” meaning you need to surface your thoughts around the idea that we are advancing and be capable of communicating it, and everyone on the team needs to be capable of receiving that feedback. When we make a decision as a team, we move forward and effectively execute that decision in order to either provide better care for patients or to provide care to more patients.

Tim: So, as you reflect a little bit, as you guys enter the next stage of your growth, what’s the one thing you know now, that you wish you knew at the beginning?

Matt: I just wish that I had found Aequitas Partners day one. (laughs)

Tim: (laughs) Be careful Matt, that’s on the record.

Matt: (laughs) I stand by it.

When we first started the company, we came with this idea of ‘let’s just provide primary care’, even just in person, very standard, traditional primary care that was going to be high quality and sold to the employer. But, what we realized along the way, as we really began to listen to employers as much as we could, was that just the provision of medical services does not get you far enough to really change the way the healthcare system delivers care. You have to fundamentally focus on the way people receive care, so adding technology seemed logical. You have to focus on the way people interact with their benefits, including insurance navigation. You have to think about those other huge impediments to appropriate care on the mental health side, which is why we’ve added mental health providers. So, I can’t boil it down to just one thing I wish I knew, but we’ve learned a ton from our employers along the way just by listening to them and building things that they wanted and that our patients wanted.

I have seen so many successful companies while I was investing at Insight Venture Partners and saw all of the issues that they had getting started. I came in eyes wide open, and more importantly ears wide open, in terms of what we needed to know. So we tried to approach it as humbly as we knew how because there is so much to learn in healthcare and the more you learn about it, the more there is to know.

Tim: No more questions, but is there anything else you would want to leave for anybody who might be reading?

Matt: Work with Aequitas. You guys have been great, I really appreciate it.

Tim: It’s our pleasure, and thanks for doing this.

 

Digital Therapeutics: Why Your Next Pill May Be an App…

By: Steven Berman

Although clinical therapy has long been the cornerstone of the Healthcare industry, the Digital Therapeutics subset of digital health is slowly-but-surely establishing its own foundation. The nascent industry offers patients and doctors alike the ability to treat chronic diseases without solely relying on prescription medication. This disruptive technology is empowering patients while redefining how healthcare is delivered – and doing so for a large assortment of chronic conditions with minimal downside risk.

What are Digital Therapeutics?

Digital Therapeutics are essentially software tools that can improve a patient’s health much in the same way a drug can, minus the side-effects. Although such software has been around for nearly a decade, it wasn’t until 2013 that the term ‘Digital Therapeutics’ first entered the public lexicon. That was when Sean Duffy, CEO of Omada Health, began floating the concept at conferences and marketing events which he used to promote his pre-diabetic coaching software aimed at preventing full onset of the disease by encouraging patients to exercise more and lose weight.

Digital Therapeutics have since become something of a Shangri-la of modern medicine; the long-awaited bridge between Silicon Valley and Big Pharma. Veejay Pande, partner at prominent venture capital firm Andreessen Horowitz, even predicts that the industry will evolve into “the third phase” of medicine (the first two being small-molecule drugs and protein biologics). One key difference between Digital Therapeutics and traditional prescription drugs: launching an online platform involves jumping through many less hoops then launching a physical drug, and can cost billions of dollars less.

Because Digital Therapeutics don’t have to run through a battery of clinical trials, nor do they require FDA approval, the cost of bringing them to market is a fraction of that of traditional medicine. This should mean that the industry can scale rather quickly, as more and more platforms are provided for consumers with illnesses ranging from diabetes to asthma, to ADHD and depression. Yet despite the rapid scalability, traditional medicine need not be alarmed. With few exceptions, Digital Therapeutics serve to complement and even enhance a patient’s pharmaceutical experience, rather than supplant it altogether.

Types of Digital Therapeutics

We can classify Digital Therapeutics into three categories, based on their interaction with traditional medicine:

Digital Services: These platforms help guide consumers through lifestyle changes that greatly improve their patient outcomes. The aforementioned Omada Heath, which offers a 16-week weight loss program that guides pre-diabetics through daily nutrition and exercise routines, is a prime example. As a stand-alone service, this classification of Digital Therapeutics can neatly coexist with traditional medicine, and need not infringe on the doctor-patient relationship.

Pharmaceutical Support Devices: These therapeutics indirectly enhance the benefits of traditional pharmaceuticals. For example, Proteus Digital Health’s Discover medication adherence platform offers products such as miniature ingestible sensors and small wearable sensor patches that patients either ingest or wear on their clothing. The platform monitors relevant health and lifestyle information via digital technology, and the findings can be incorporated into the patient’s future prescriptions (type of medication, dosage, frequency, etc.). These platforms are meant to work in-tandem with traditional pharmaceuticals, by utilizing patient-specific data to foster more educated decision-making on the part of physicians.

Pharmaceutical Replacements: Here we have the exception to the rule. These therapeutics are actually looking to supplant traditional medicine altogether by providing clinical benefits via digital technology, without the need for additional forms of treatment. One example is Pear Therapeutics’ reSET application, which treats substance use disorder. In a recent clinical trial, the reSET app has been proven to promote a higher rate of abstinence than the traditional standard of care, which for substance use disorder happens to be outpatient face-to-face counseling. Because the trial’s results were approved by the FDA, Pear’s reSET app can be properly termed a prescription Digital Therapeutic, meaning a physician must prescribe the app, and patients receive the same coverage options as they would with traditional pharmaceuticals. Of course, much like the first two categories of Digital Therapeutics, the reSET app can be prescribed in-tandem with other substance use disorder treatments, but the fact that physicians can prescribe the treatment in-lieu of traditional medicine relegates the app into a third classification.

Wellness 2.0? Not So Fast…

Given that most Digital Therapeutics companies focus on lifestyle adjustment, it’s easy to see how the sector could be hastily lumped into the more comprehensive ‘Wellness’ space. However, Digital Therapeutics differs markedly from Wellness in that the latter is an imprecise category that broadly applies to the general public – think yoga, meditation, sleep and exercise apps – while the former is engineered with specific ailments in mind. Think apps for asthma sufferers, or patients with Crohn’s Disease.

In order to further distinguish themselves from the Wellness industry, Digital Therapeutics startups have begun embarking on clinical trials in addition to seeking regulatory approval from the FDA. Welldoc, for example, offers a prescription-only version of its BlueStar phone app for managing diabetes, which it claims is the “first FDA-cleared mobile prescription therapy.” Other platforms, such as the aforementioned reSET app, provide the industry a veneer of legitimacy that the Wellness space is still struggling with.

One area in which Digital Therapeutics mimics its more popular Wellness cousin, however, is in data collection. By their very nature, Digital Therapeutics are data aggregators. The platforms track patient populations across a range of metrics, and deliver results which can be harvested by professionals across the entire spectrum of Healthcare, from Big Pharma to hospitals and physicians.

A prime example is Oshi Health. Oshi delivers a platform that helps IBD sufferers examine their symptoms and explore lifestyle factors which can help contribute to a better quality of life. Patients continually input variables such as diet, stressors, sleep pattern, and activity/exercise routine. The app then delivers a wellness score, which indicates how likely the patient is to experience IBD symptoms in the near future. Patients can leverage the wellness score to learn what their IBD triggers are, and can tailor their daily regimen to reduce the frequency and severity of outbreaks. Currently, Oshi has over 35,000 members. The beauty of the platform is that as that number grows larger, the data becomes more relevant, since a greater patient population implies more statistically significant results. Those results not only help patients, they assist pharmaceutical makers and physicians looking to optimize their treatment of the disease.

Thanks to platforms like Oshi, user feedback, in certain instances, is the new clinical trial.

The Road Ahead

Despite the low barriers to entry and added health benefits, the road to mainstream adoption of Digital Therapeutics remains a bumpy one. Look how long it took to get on board with telemedicine! The key challenge facing the industry is breaking the longstanding belief that in order to improve their health, patients need to take a pill prescribed by a physician. This is a reality that’s been coded onto our collective Healthcare DNA for generations, and will likely take some time and effort to reverse.

To confront this immense challenge, the industry has begun advertising much in the same way any startup would – through targeted ads, social media campaigns, and via thought leadership articles on various third party publishing platforms. Some Digital Therapeutics companies are going the extra mile and allying with Big Pharma. Propeller Health recently partnered with GlaxoSmithKline on a “digitally guided therapy” platform. The company produces sensors which attach to asthma inhalers and provide patients feedback on their condition as they inhale. Patients have been shown to use their inhalers less often as they leverage the new technology.

The good news for the Digital Therapeutics industry is that the low cost of adoption ties in nicely to the self-funded employer model. Employers looking to reduce Healthcare expenditure are adopting these low-cost technologies in the hopes that platform utilization will lead to reduced member expenses down the road. Many in the private sector understand the notion of spending now to save later, and the value-prop of Digital Therapeutics fits neatly into that paradigm.

The Future of Healthcare

Although Digital Therapeutics is a relatively new industry segment populated by a handful of niche players, the regulatory inroads already established, as well as partnerships formed with the likes of Big Pharma and insurance companies, are harbingers of future growth if there ever were any. Last year, for example, Cigna invested $50 million into Omada Health, and included the platform in their subscriber plan as a measure of chronic disease prevention and cost control.

By educating patient populations on their symptoms and triggers, as well as pharmaceutical companies and healthcare providers on the lifestyle choices of their patient populations, Digital Therapeutics offer a window into the opaque world of how patients interact with their specific medications. Given the lower barriers of entry to launch a Digital Therapeutic, and the widespread positive impact they can have on patient populations, it’s likely we will see more big name players in the Healthcare space making significant investments into this field over the coming years. That means it’s looking more and more likely that your next prescription may be for an app instead of a pill.