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Ep 72: Lobbying for Better Telehealth Regulations with GC Adam Greenberg
45 Plays2 days ago
What do you need to know about managing government affairs for heavily regulated, high growth brands? Is it perhaps the most interesting part of a GC's job? And will it actually lead you to Washington D.C. or maybe other slightly less glamorous cities?
Join Adam Greenberg, Advisor and Fractional General Counsel at APG Advising, as he shares lessons from years as top in-house counsel at healthcare start-ups Warby Parker and Ro about lobbying state legislatures to make telehealth more accessible to customers across the United States.
Listen as Adam discusses the legal needs of direct-to-consumer businesses, working with lobbyists and legislators at a state level, sharing notes with your closest competitors to change regulations, destigmatizing embarrassing medical topics, and much more.
Read detailed summary: https://www.spotdraft.com/podcast/episode-72
Topics:
Introduction: 0:00
Deciding to become a start-up lawyer: 2:56
Dealing with government affairs issues at Warby Parker: 7:15
Lobbying state legislatures: 10:35
Going state to state with a small budget: 19:16
Becoming the first legal hire at Ro: 26:30
Building out the legal team at Ro: 30:08
Talking with legislators about erectile dysfunction medication: 37:10
Lobbying for direct-to-consumer brands: 42:51
Does the CEO need to be involved in state lobbying?: 45:21
What Adam is up to now: 47:39
Rapid-fire questions: 48:54
Book recommendations: 52:29
What Adam wishes he’d known as a young lawyer: 53:47
Connect with us:
Adam Greenberg - https://www.linkedin.com/in/adamgreenberg3/
Tyler Finn - https://www.linkedin.com/in/tylerhfinn
SpotDraft - https://www.linkedin.com/company/spotdraft
SpotDraft is a leading contract lifecycle management platform that solves your end-to-end contract management issues.
Visit https://www.spotdraft.com to learn more.
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Transcript
ED Medication Legal Misstep in Minnesota
00:00:00
Speaker
In Minnesota's law, um unsure how this happened, but erectile dysfunction medication got added to the list of drugs that were illegal to prescribe online. Paired with a number of dangerous drugs that made sense,
00:00:17
Speaker
And so we were blocked from operating in that that product, that product line in Minnesota for a while. And we decided um to offensively build relationships, go to the state, excuse me, several times and kind of figure out what was going on there and see if there was appetite to do something about that, especially as ah a company like Roe had really I really flourished and had done some incredible things and had um really positive health outcomes for for patients. And the thing that actually, I think, tipped it over the edge where folks aren't taken seriously, we we presented data on the prevalence of erectile dysfunction in military vets. And then presented data on lack of access for those military vets to get the care that they need for ED.
00:01:07
Speaker
and um that kind of won the day for us.
Adam Greenberg's Legal Expertise with Startups
00:01:17
Speaker
What do you need to know about managing government affairs for heavily regulated high growth brands? Is it perhaps the most interesting part of a GC's job? And will it actually lead you to Washington DC or maybe other slightly less glamorous cities?
00:01:39
Speaker
Today, we are joined on the abstract by my friend Adam Greenberg, a startup GC extraordinaire. Adam has worked for a few consumer brands that I think that we are all familiar with, especially if you spend any time in New York City or on the subway looking at ads. He was the second legal hire at Warby Parker, the D2C glasses company.
00:02:03
Speaker
He was later promoted to run the legal team as the head of legal and public policy. He was also the first legal hire and general counsel at the digital health platform Ro, which used to be called Roman, where he helped scale the company to 800 employees and a $7 billion dollars valuation. And most recently, he was the first legal hire ah general counsel and the interim chief people officer at Blank Street,
00:02:32
Speaker
which is a high-growth coffee startup. These days, Adam is spending his time as an advisor and fractional GC to a number of high-growth startups while he keeps an eye out for what GC gig might be next.
Warby Parker's Regulatory Challenges in Opticianry
00:02:47
Speaker
Adam, thanks for joining me for this episode of The Abstract. Thanks for having me. It's awesome to be here. Yeah. OK.
00:02:56
Speaker
Your journey in the world of startups begins with Warby Parker. I feel like when you joined, that was like one of the coolest, nothing is not cool anymore, but one of the coolest companies out there to be working for one of the fastest sort of growing brands in the world. How'd you land that gig?
00:03:14
Speaker
It was very cool it still is very cool. I love that company. It was a combination of dumb luck and some strategy. so i was I was working at Skadden at the time in the New York office. and I started my career at Skadden in the litigation group. um After about a year in that group, I took a year off and came back to California and did a one-year clerkship on the Ninth Circuit. and and After that experience, I felt like I wanted to build out my skill set beyond litigation um a bit more. and It's already starting to think about what a career and a life outside of a law firm, i'm still being a lawyer, but outside of a law firm might look like. And Skadden was nice enough to um let me back into the firm in New York and their real estate transactions group and spent um under three years, just under three years in that group. And during that time period, really started to get interested in in-house work and um and how to set myself on a path to being in general counsel one day. And I started to look at in-house opportunities in the real estate world and just didn't feel incredibly passionate about it. And I had already asked Skadden if I could change groups once. So I was like, I might as well give it a shot and try again. and I think it was at a recruiting event and cornered the head of the IP and tech transactions group and was like, it seems like your group's awesome, doing really interesting work. I see people getting really interesting jobs in house outside of this group and
00:04:52
Speaker
Yeah, how about it? Can you let me in? And I was lucky enough, they let me in that group as well. That was a little bit strategic and spent um under a year in that group and was at the office working one night and saw a public posting for um the role was titled commercial counsel at Warby Parker. to second lawyer They were hiring. And ah interestingly, in the job description, they had called out a preference for someone with some litigation experience, some real estate experience, because the company was starting to build out its motor stores, and some tech transactions experience. And I might have been the only attorney fickle enough at the time in in New York to have spent time in all three of those groups at a firm like Skadden. And I applied. I didn't really know anyone at the company at the time um directly, but hustled to
00:05:48
Speaker
find as many people that were connected somehow to the company, to their investors, to their founders, to their outside counsel, and hit up everyone. And um was very lucky, very fortunate to get that job. And um the first my first week, I think, when I met um Neil Blumenthal, who's one of the co-founders, co-CEO's, he must have been hit up by, I don't know, five people that somehow knew me and knew him. Well, you have a lot of people in your corner who really wanted you to have this job. So you know it was it was definitely um an exercise in um getting your resume to the top of the pile. I love that. That's a great story. I mean, on so many levels, right? like Not knowing exactly where the experience is going to lead you that ends up being super useful, being willing to ask for something, even if someone might say no. People do whole webinars on what you've just talked about, which is how can I get my resume to the top of the pile? How can I leverage my network for that. We are going to talk less about the real estate side ah and the IP side today and a little bit more about the government affairs side, which I think is really interesting. I haven't had a ton of conversations on this podcast or on government affairs yet. And I also haven't really had one in the context of D2C brands like you've worked for, which I think people might sometimes forget are regulated or forget have government affairs challenges.
00:07:15
Speaker
What are some of the unique public policy issues that Warby was dealing with or having to think through? so um I think it might be a surprise to some people that ah Warby operates in a pretty regulated space actually. um The practice of opticianry, so those are the folks often often licensed um credentialed who work in optical shops who are making sure the glasses fit your face appropriately, making sure you could see appropriately through them, taking measurements, fitting you, adjusting the glasses. In many states, that's a regulated practice and a licensed practice. So we had a you know a large um ah group of of opticians working at the stores.
00:07:58
Speaker
ah We were also innovators in selling a prescription product, which classes are also FDA regulated as a medical device online. So there were a host of um of of regulatory areas to um understand and keep in mind there.
00:08:14
Speaker
And optometry, the the eye doctors who are giving you eye exams, we're also performing those exams in some of our stores, a ah clinical practice licensed, also pretty heavily regulated. So from the early days, my work included understanding the regulatory environment um and helping build the business model in a way that took that into account.
00:08:37
Speaker
But my public policy and government affairs work didn't really start to take up a large area a large portion of my time until the back half of my tenure at Warby when I was part of a small team that was helping launch the company's first virtual care product, an online
Launching Online Vision Tests: Navigating Telehealth Laws
00:08:58
Speaker
vision test. Cool.
00:08:59
Speaker
I, as the lawyer, wasn't launching anything. I was advising the folks who were who were building it. But the first version of it was this this um this really innovative, first-of-the-market patented technology where you're syncing your phone to your computer. You're standing 10 feet away and seeing some imagery on your computer and answering questions based on how you're seeing that imagery on your phone.
00:09:23
Speaker
On the back end, an eye doctor is taking a look at the results and potentially, based on how you're seeing, ah writing you a new prescription for your glasses. Wow. To build out this product, and we wanted to launch it as many states as possible, I first had to get smart on ah state-by-state telehealth laws and regulations, healthcare, care primarily is governed at the state level, um unless you're in the med Medicare space, health insurance space. Most of the day to day practice delivery of medicine and health care is is regulated by state ah statutes and regulations implemented by state boards.
00:10:01
Speaker
sir So the first the first order of business was getting getting my arms around existing laws and regulations, both general telehealth, what are the tools that patients can access? What are the tools that providers can access to provide care remotely? And then specific to what we called ocular care um or optical care, were there any laws and regulations specific to the delivery of ocular care through virtual methods?
00:10:26
Speaker
um And that that influenced which states we were initially launching in. So it's taking you to a lot of state houses as opposed to to D.C. I mean, I think when people think about lobbying, a lot of the times they're thinking like, in fact, they may not even be thinking, hey, I'm going to the FDA or I'm going to the Department of Transportation or what have you. They're thinking like Capitol Hill, Congresspeople, senators. Right. What do you think is misunderstood or or underappreciated about doing good work or or going out and engaging on a state-by-state level? Yeah. um Great question. i'll i'll tell I'll give you a little bit of background of how I even got in, how how that work at Warby um really transpired. When we were building the product, that my my focus wasn't on um lobbying or government affairs at all. I was really just understanding the existing regulatory environment. But when word got out that we were
00:11:20
Speaker
that we were planning on launching this product, the optometry industry. So the folks who are typically giving you eye exams um often own an optical shop right next to the office where they're giving you the eye exam and trying to sell you glasses or contact lenses. ah They found out we were launching this really innovative product that they feared would um undercut their their business model, which is to get you in the chair, give you an eye exam, and then walk you next door and sell you a pair of glasses that are typically 2, 3, 4, 5X the amount that you're spending on a pair of Wharton Parker glasses.
00:11:59
Speaker
And their
Warby Parker's Fight Against Restrictive Legislation
00:12:01
Speaker
approach was to draft model legislation, take that model legislation state by state. And if passed, it would have essentially outlawed this new technology. It would have required a patient to be in person face to face in front of an eye doctor in order for that eye doctor to ah be able to, under this their standard of care, write a new prescription for glasses or contact lenses.
00:12:24
Speaker
And this is before we launched the product. So we wanted to make sure that there ah wasn't a national or almost national regulatory barrier for launching this really cool product that we thought was great for customers, great for providers um before we even set to launch it. So I was coming from Skadden. I was a corporate lawyer. I'd never done any policy work or lobbying work ah prior to that.
00:12:53
Speaker
and We started to see these bills pop up at at state houses across the country. and At that time, I was the only lawyer at the company and the founders were like, we don't have a policy team. you know um I guess here's a little bit of budget. know go Go figure it out. Go see what you can do.
00:13:14
Speaker
um So that's what I did as a scrappy startup lawyer, um called in a lot of favors, and tried to make friends who could educate me on what the hell I should be doing, even to start, where to start. And um for better part of a year, um spent a significant portion of my time traveling to these state houses, sometimes hiring local lobbyists,
00:13:41
Speaker
and having conversations with legislators on both sides of the aisle, um educating them on the product we were building, why policies they were considering would be harmful to their constituents, both their constituents who are providers and their constituents who are or our customers and patients, and try to keep open ah this business model um and not get blocked and safe that were important to us.
00:14:05
Speaker
So back to your question was about what what did I learn about yeah about the work during that time period? So first thing I learned was if you're hiring a lobbyist in a state and advocating certain and any policy issues at a so at a state level, that's public information. There's a public database that shows which companies hire which lobbyists.
00:14:30
Speaker
So I would go to those databases and states that we were thinking about advocating in and operating in and see who other innovators who were disrupting and potentially threatening the traditional business models of incumbents in the space who they were hiring. So I'd look at Airbnb, Uber, Lyft, Amazon. and Because i had ah I had a feeling that these lobbyists understood how to work with tech companies who were building creative products, who were taking on big players, who were much better funded, much better connected at the political level. And they'd help they'd they'd be the the right people to help me strategize. how Is it even possible to go after Uber?
00:15:15
Speaker
these new bills and and and try to influence them in some instances, try to kill them.
Strategic Lobbying and Deregulation Efforts at Warby Parker
00:15:19
Speaker
That's where I started. i Also made some friends at at Uber, at Lyft, at Airbnb, who would just give me some guidance on how to even go about starting to think about creating a policy program um and a government affairs program. And would cold cold call these lobbyists and say, hey, you know, Warby was maybe five, six years old at the time. So it was becoming a household name, certainly in major metropolitan areas, but not not in in places like Kentucky, which was a state that I ended up spending a lot of time in. So I'd explain who I was, what the company was, the issue we were working on, and then try to get a sense of
00:15:59
Speaker
um Were these the right folks who had the right connections and can get me in the right rooms to have conversations to to impact policy, to impact which direction this bill was actually going? have I was surprised by, as a ah small company with not a massive budget to be spending, um we weren't contributing to political campaigns. We were hiring lobbyists and trying to get to Capitol Hill and have conversations with influential policymakers.
00:16:27
Speaker
um I was surprised by how much impact we were able to have as ah as a pretty small business and emerging business. And I think that's partly because if you find the right people who can get you in the right doors, folks that have those personal connections to the power players um in state government and in the in the state, senator state house, that's super helpful. I also think we had a really good um argument. and We were. Right. um and and Another thing that i that I found really interesting um and a little surprising was that the work that I was doing but didn't feel legal at all. i was I didn't feel like I was utilizing any of the lawyerly skill sets that I had learned either at Skadden or as an in-house counsel at Warby at that point. It was much more of a sales kind of role um and yeah and evangelist kind of role, company spokesperson.
00:17:25
Speaker
And what we would do was, um depending on who we were talking to, if it was a state whose legislature was dominated by Republicans, we'd craft our argument to re that we thought would resonate with them. If it was a state that was dominated blue, we would craft our argument that if it was a state that was split, we'd have to give both arguments.
00:17:48
Speaker
and high level on the right side of the aisle for what we were advocating for, we tended to focus a lot on deregulation and trusting the doctors who went to medical school, did their residency, are board certified, have their licenses and Let's put trust in those professionals rather than having the government dictate to those professionals how they could treat their patients, what new technologies they feel are appropriate in treating their patients. and and The left side of the aisle, it was all about
00:18:24
Speaker
access, opening up access to health care, especially in um communities and that are struggling with health care access, yeah ah both urban and rural communities. And it was all about um affordability. Let's find ways to for vision care specifically to create accessible but also affordable vision care and prescription products.
00:18:49
Speaker
um for people that might not be able to afford it in the in the traditional healthcare context. I mean, this all really resonates with me. I started my career working on public policy in like the commercial drone space, and we had to go state by state and very similar to you. We wanted to introduce our own model legislation, and we had to craft our arguments depending on like what we thought would resonate and engage local representatives.
00:19:16
Speaker
I guess a question for you and also an observation maybe, a question would be, how do you do this on a small budget, like you said, as opposed to going to the CEO and saying, like, this is a bet the company deal, you need to give me millions of dollars. And then an observation just being, it reminds us of the time period, but, you know, telehealth like this, I'm thinking of what we've lived through with COVID over the past four plus years, right? I would i just sort of think like the whole landscape around this now has maybe totally changed. And the argument around I should be able to to get new glasses so that way I can see what's on my computer
00:19:57
Speaker
from my home office or from my living room, right? Like when you might not have might not have been safe for you to leave your house, right? I mean that, like I would just think that today that would resonate maybe so much more like you were early almost in a sense.
00:20:12
Speaker
Yes, I think today, today post-COVID, it's a lot easier to sit in a room with a state politician um and have that politician understand why telehealth is important and what telehealth is. Back then, this is pre-COVID, it was a lot more challenging and telehealth was was still an active practice then in 2017, 2018, but most people thought of thought telehealth as a basically a Skype or a Zoom visit with your doctor when you're traveling or you're sick and you don't want to go into the doctor's office. Kind of like the conversation we're having right now with audio and video. yeah What was really hard for a lot of folks to compute was
00:20:57
Speaker
How on earth could an eye doctor who's not having a face-to-face live conversation with their patient possibly know what this patient's prescription should be? so And you you have really limited time in those rooms. you know you Maybe you have 10, 15 minutes.
00:21:13
Speaker
So, um you know, I was really fortunate to work with technology teams, data teams, and marketing teams to help craft the what we thought were the most effective sound bites because I mean, i I myself barely understood the technology. as an attorney. so and And these politicians have so much on their plate, right? yeah Some of them, they're at the state level, sometimes it's not even a full-time job. They have their own their their attorneys, their doctors, right? They're doing this as a part-time gig. So they've really limited time and bandwidth to understand the patented technology that goes that that was built behind this really cool vision care tool.
00:21:52
Speaker
So that was part of the the really interesting challenge of how do you how do you explain what this is in a 10, 15 minute meeting where it's going to resonate that this is safe, this is the way of the future, this is good for my constituents, this is something I should support. um how To back to your question about about working with the the executive team of fighters. Yeah, like how do you, yeah.
00:22:15
Speaker
We were fortunate that the issue that this issue was not a bet to farm kind of policy.
Balancing Regulatory Engagement and Visibility
00:22:24
Speaker
If there was a nationwide ban on this kind of remote vision care tool, it would have been really unfortunate. it would have it It would have limited what we thought was a future growth driver of the business, but it wouldn't have tanked the business. I don't think it would have.
00:22:40
Speaker
I don't think it would have materially harmed our ability to eventually go public or raise money. But it was but it was still important to us. So we were we didn't have the pressure of if these bills pass our core business model, which was selling selling glasses online and in brick and mortar stores, that was not going to be impacted. So we did have um there was less anxiety around government.
00:23:06
Speaker
um It was more of a nice and nice to have. And then we would um try to, a little bit more of an art than a science, that would try to make a some sort of calculation on um how important is the state to our business, right? And that's typically population. You know, we knew at that point, we knew where our stores were, we knew who was buying online from us, and we tend to ah put more weight and spend more time on states that were important to the business.
00:23:33
Speaker
And then after some initial discovery conversations with folks in this in that in those states on the ground before we actually hired a lobbyist, we try to gauge what's the likelihood of success here. Are they dealing with serious budgetary issues? Are they dealing with like gotten control? Are they dealing with other other things in healthcare care that are, you know in in their eyes, more important? and is it Or is this is its not an issue they want to take on this legislative calendar? And if we thought their likelihood is low, that they'd even pay attention to us, that's a reason to not go into the state.
00:24:08
Speaker
And then one thing that I think this is this is not just at Warby, but kind of all all startup founders grapple with is, um do we even want to get on the government's radar? um I know a lot- A lot of founders like, just and and and it makes a lot of sense, a lot of founders like staying quiet. If something passes that requires us to operationally make changes to our model that impacts our business, we'll deal with it then, but we don't want to be the the face of pushing policy forward because we just don't want to get on the government's radar. um We were less concerned about that because we were
00:24:45
Speaker
very confident that what we were doing both on the e-commerce and brick and mortar side and on the the virtual care side um was medically sound and a ah great thing for customers and and and for the country. um So there was less concern there, but that's that's part of the calculation that I think a lot of CEOs and founders make of is this the right time for the business to be being front and center in like the psyche of regulators. like I've had those conversations myself. Yeah.
00:25:14
Speaker
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00:26:25
Speaker
Now let's get back to the podcast.
Regulatory Challenges in Digital Health at Ro
00:26:30
Speaker
Let's talk about your time at Roe, which I think when you joined was called Roman. When you transitioned to that gig and and decided to leave Warby, what were you most excited about taking on there and tackling there as their first legal hire? I was really excited about working for another pioneer in an industry similar to Warby. You know, Warby really felt like best in class, one of the first of its kind in um direct to consumer e-commerce, digitally native brand. And it felt that same way in the early days at Roe, that we were defining a new category. So that was that was really exciting. yeah And not only defining a category for consumers, but defining it in a really quickly evolving, sometimes really unclear and regulatory space.
00:27:19
Speaker
you know We were um providing medical care on our platform. We owned and operated a number of pharmacies, mail order pharmacies. So when you see a doctor on the platform, if it was appropriate, the doctor or nurse decided a prescription was appropriate. um Our pharmacies would send you medication right to your doorstep. so there's Telehealth law, scope of practice and and malpractice issues, their pharmacy laws and regulations, again, regulated differently state by state. FDA concerns because we're doing a lot of advertising of health care and prescription products um across various channels. There's this thing called the corporate practice of medicine, which is any health care lawyers listening out there is these kind of arcane laws that say companies themselves are not permitted. This is in in um several states across the country are not permitted to practice medicine themselves. um So what you have to do is create this kind of convoluted corporate model where you're creating an entity that's owned and operated by a clinician.
00:28:26
Speaker
They are providing the care themselves, hiring the doctors, and doing quality controls, training doctors, and that what's called a a professional corporation. That professional corporation is then um signing a services agreement with the for-profit corporation.
00:28:44
Speaker
Got it. So just a lot of um a lot of different areas of law, mostly at the state level, some federal level with FDA FTC, um ah to keep it all straight. and And that for me, that was an exciting challenge. And I was fortunate, I was really fortunate to come into an environment um working and and reporting to Zach Ray Tano, who's co-founder, CEO of Rho. And from the early days, he wanted to create a best in class legal and regulatory group in-house. I think he was looking at it the right way, which is an innovative way if i think for a lot of founders to look at legal. But he was looking at legal how can his legal team be a strategic asset? We want the best and the brightest in-house who understand the business, understand the product,
00:29:33
Speaker
like live and breathe Roe and what we're building day in day and um use this complicated and evolving legal and regulatory landscape to our advantage.
00:29:45
Speaker
and And that was a really cool philosophy and that ah made me really excited and and drew me um into the company and was then really fortunate to be able to build out a team of folks who, especially in healthcare, knew a lot more than I did about the space um and have a legal and regulatory team where I was surrounded by real experts that I could learn from.
00:30:08
Speaker
So with that in mind, I guess, did you really have to make the case for government affairs hires? I mean, I'm sure to a certain extent you did. No CEO that I've ever worked with is willing to give you a blank check because they're always thinking about how do I answer to my investors? um How did you go about doing that, like building the government affairs team, making the internal case for that budget, that sort of thing?
00:30:31
Speaker
Yeah, so I actually never hired um anyone internally to do government affairs. I liked doing the work, so I didn't mind taking on um a lot of it myself. And i I just decided I wanted to cash those chips for for lawyers on the team. um So it was a combination of myself and external consultants. I got very fortunate when I joined the company um ah Tusk Strategies, which is a venture fund slash regulatory advisory shop or early investors in a row. And I was very fortunately ah gifted a relationship with a with a regulatory consultant who is ah the best in the business at at telehealth legislative and regulatory issues. Her name's Quinn. Shout out to Quinn. She is the best. And she she was like my Sherpa through like ah across all of these issues and really became my um
00:31:31
Speaker
my core partner in monitoring the landscape, mostly the state level, and then helping assess when is the right time for us to engage? What are the right issues to engage on? And then once we decide to engage, what's the best strategy? Who do we hire on the ground locally? When's the right time for me to fly to the state capital in Spain?
00:31:53
Speaker
two days of full meetings, ah being the face of the company, introducing folks into row, into direct to consumer telehealth. And um and then we'd we'd also um take advantage of industry associations like the American Telemedicine Association. Sometimes we would decide not to engage because we knew that there were larger, better funded companies who were on our same side. And we were like, yeah, for this issue, we're OK free riding. We trust that there we don't we don't need more cooks in the kitchen on this issue. We really trust. And then for others, um you know I made it a point to become really friendly with the GCs of our
00:32:32
Speaker
main competitors. And um I learned this from the Uber lift model, they would they would share notes, what's going on? What are you guys working on? What are like, what are your concerns? And we would all we would all talk. And sometimes I'd be like, hey, you you guys take this one, like, trust you, you got it. And sometimes we'd say, you know, we're going to hire up in this state and we're going to run with it. If you want to work together, we're happy to do that. And that was um kind of how I managed all of that.
00:33:00
Speaker
How did you decide beyond that maybe where you were going to engage or where you were going to spend most of your time or were you going to be sort of more offensive in certain states versus more defensive? like I'm curious the decision making or the different factors that you were weighing there as you look across a somewhat complicated landscape, I guess. You listed out like six different areas where there was regulatory engagement. Yeah. Ours was our our key issue, at least in
Roe's Advocacy in Asynchronous Telemedicine
00:33:32
Speaker
the first couple of years, was around something called asynchronous telemedicine. So in a traditional telehealth consultation, like I said before, it's it's on Zoom. You're talking to your doctor. You're using audio and video.
00:33:45
Speaker
At Roe, for a lot of the conditions that we were treating and medications that we were prescribing to patients on the platform, um we had designed a system where our providers were capable of treating patients asynchronously. so Patient provides a host host of medical ah history, host of symptoms, um some biometric information, um and each each condition being treated, each medication being prescribed had its own standard of care and its own protocols that we'd go through. um But for a lot of the help you can get online these days through telehealth, it can be done asynchronously. And when I first started at Roe, we'll call it maybe half the states allowed prescribing and treatment through asynchronous modalities, if asynchronous technologies, and many required in audio and video communication.
00:34:46
Speaker
So, for the offensive work, and these are in scenarios where doctors are saying, I'm going to meet the standard of care through asynchronous um communications, I don't need to have um a ah real-time face-to-face conversation in order for me to understand everything I need to know about this patient and treat them appropriately, like I would in an in-person clinical setting.
00:35:09
Speaker
So some of the um proactive work what we would do was um building relationships at states that require that had certain requirements that we thought went too far um and in the technologies that were allowed or not allowed to be used through telehealth. Offensive is it's a slower build.
00:35:27
Speaker
and you're building relationships you're establishing credibility with policymakers and you're hoping that what you do is is is um establish that expertise in in your field where ah the day that they're considering a policy um that's related to your expertise they're actually picking up the phone and calling you. hey I remember that The meeting I had with Adam at Roe last year talked about asynchronous telehealth. They seem like they know their shit and they seem like they're like they're they're they're doing really good things for patients. They really care about doing the right thing. They really care about expanding access and lowering costs and meeting patients where they are. um I want their opinion on how I should be crafting this legislation. And that's that's the proactive work.
00:36:15
Speaker
huh um We did that a lot in New York and California, naturally. Those states, you you know this too, often when when they pass laws, other states especially, sure ah states that are dominated by ah Democrats are on the same side of the aisle, they will often take a look at what they're doing and and follow suit.
00:36:35
Speaker
would be a catalyst for for other states to look at policy. And then defensively, we would we had a a pretty tight monitoring system where we would know instantly when um something in our ballpark would it get proposed. And similar to what I talked about at Warby, we try to make that calculation, is this important enough? What else is going on with the company? Are we in the middle of a fundraise? Are we in the middle of an M and&A deal?
00:37:00
Speaker
Are we launching it for us? Is it worth our our time and our team's bandwidth and and our what's our likelihood of success to go engage in that state? I mean, here's a question for you, actually, about Roe in particular. Unlike eyeglasses, I mean, Roe started as like erectile dysfunction medication right and then and expanded to be a sort of suite of different brands. right But you can think of the brands as often dealing with but either sort of sexual health or other conditions that, I don't know, some legislators might be uncomfortable talking about. and At the time, I suppose maybe the world wasn't quite as politicized as it is today around some of this, but anything that you would share about how you dealt with tough questions from legislators or legislators who almost like
00:37:50
Speaker
you know, took the meeting but then didn't really want to talk about it or engage with you. Or also, you know, I mean, you seem like a very, you know, very comfortable person, right? But like how you get comfortable having that type of conversation with legislators over and over
Removing ED Medication Restrictions in Minnesota
00:38:04
Speaker
again. It's not talking about like optometry and cool red and blue, you know, see-through glasses, right? yeah Yeah, it's a great question. I certainly, when looking back at myself in law school, didn't expect me as a general counsel sitting and with state senators talking about erectile dysfunction and the benefits of of Viagra and how it's prescribed on the internet. I didn't expect that for my career. But like um for us, it's it's it always started with the medicine. Rho as a company had medical DNA and in its blood since the day that the company was founded.
00:38:46
Speaker
So we would and and that and that was that was how we handled it internally, too. um You know, these aren't things to joke around about or make like sure little snide comments that were were this this is health care. um Everything had a medical basis to it. Everything had research behind it. um we We took the medical route really, really seriously. So that's always kind of what what our starting point was, like providing good care, helping people where they have needs even if those needs are stigmatized and embarrassing for them. I mean, that was one of the great value propositions of of a company like Ro is if you're embarrassed to talk to your doctor about some of these issues, this is a judgment free judgment-free zone. And we what we tried to do was you know bring down some of that stigma on on some of these conditions. so but but But for me, who talk who at the company, I talked about it all day every day, became so natural, sometimes I'd have to i'd have to check myself and recognize that someone I'm across the table from, like a politician,
00:39:50
Speaker
It might not be so comfortable talking about it. so um We would stick to the medicine as much as possible. and what i always i owe when When I travel to state capitals and would often do would often testify in front of a panel or a committee at the House or the Senate, I realize pretty quickly that no one really wants to hear from the lawyer. like I'm just a company lawyer. so begged Begged our awesome chief medical officer to like, please come with me and please chat with me. um So right, I had that I could like shut up and you know, I could talk about the policy, but then like shut up and like actually have someone who is a trained medical professional, a doctor talk about um talk about the medicine and it was always really helpful to have doctors with me. I'll give one example though of how we, in our in some of the and some of the government affairs were de-stigmatized it and actually um got a lot of interest and from from politicians in in one state. um Minnesota, there was a law in the books since the early 2000s that really was meant to address these pill mills um online where
00:41:00
Speaker
You can um plug in your name, your address, and your credit card information, and they'll send you just about anything, including opioids. And there was a lot of a lot of overdoses during that time period. And states and federal government, the DEA enacted a lot of policy and a lot of legislation to to address it. In Minnesota's law, unsure how this happened, but erectile dysfunction medication got added to the list of drugs that were ah illegal to prescribe online, um with interesting with you know paired with a number of dangerous drugs that made sense. And so we were blocked from operating in that that product that product line in Minnesota for a while, and we decided to offensively build relationships, go to the state,
00:41:51
Speaker
me several times and kind of figure out what was going on there and see if there was appetite to do something about that, especially as a a company like Roe had really and really flourished and had done some some incredible things and had really positive health outcomes for for patients. And we ah the thing that actually, I think, tipped it over the edge where folks started taking it seriously, we we presented data on the prevalence of erectile dysfunction in military vets.
00:42:19
Speaker
and then presented data on lack of access for those military vets to get the care that they need um for ED. And that kind of won the day for us. yeah and we And we ended up having partnering with some some legislators and and stripping ED medication from from that bill and opening up that market um for for the company, but um trying to find trying to find issues and and real data that that resonate with what what legislators care about is is pretty critical. yeah i mean That strikes me as potentially one of the core advantages that's inherent to running a sort of like consumer-focused brand or a D2C brand. i mean Obviously, there are then
00:43:06
Speaker
risks to consumers as opposed to businesses, right? And we know legislators and regulators probably care more about risk to people and their health and their livelihoods and they do about how two businesses are transacting with each other. So you might be on the radar of more regulators, but there is that sort of built in advantage, right? Of, okay, when we're going out and we're trying to lobby for something or trying to do something ah offensively, we can marshal these human stories as opposed to look at the numbers or look at the sort of abstract numbers of job growth in your district. I'm curious, talk to us a little bit about about that and what was interesting to you. What you see is the differences between working for a D2C brand as opposed to a B2B brand.
00:43:51
Speaker
Yeah, DTC, it's a double edged sword. um here If you're providing great service and great products and your customers and patients love you, they could be a real asset in policy work or a great asset in PR work. yeah it's um But but the the other side of the of the coin is if you're not and there are complaints, people feel like they were taken advantage of, they were overcharged. and they didn't get what was promised to them. The opposite is true where complaints, um better business bureau complaints, complaints to the FTC. Those are the things that there if there's a groundswell of a lot of um a lot of consumer complaints, those are the things that end up getting on
00:44:36
Speaker
certainly plaintiffs' attorneys, but on regular regulators' radars as well. right so Then you're your you're known to them for reasons you don't want to be known to them. so it's so it's it's a ah There are pros and cons to that. we I've thankfully worked now for three very consumer-oriented businesses whose north star is to create a positive consumer or patient experience. So I've fortunately been able to deal with a lot of the positives of working for a consumer business and leverage great stories, great health outcomes. And and when that's the case, it it certainly helps your policy work.
CEO's Strategic Role in Policy and Media Coordination
00:45:19
Speaker
You mentioned bringing the CMO in, Chief Medical Officer in, as opposed to Chief Marketing Officer, um to your work at Roe. Talk to me just a little bit about how much the CEO needs to be involved in government affairs work in your experience, either from a sort of like setting the strategy perspective or from an actual, OK, we're going to do a day where the CEO comes in and meets with folks. and
00:45:46
Speaker
How do you think, what's the right way to manage that relationship? I think on state level issues, um probably not required very much unless the CEO just has a personal interest and wants wants to get in the mix. yeah But you know a lot of the tactical work like like creating a one pager, going to the state capital, setting up two straight days of 15 meetings each day, probably not necessary. And again, we weren't we weren't dealing with bet the farm kind of issues. So maybe if maybe if the company's lifeline depended on how a certain bill went, um maybe the CEO gets gets a little bit more involved.
00:46:29
Speaker
um we would We would coordinate on it, and and the decision to go engage in a state ah was certainly um a decision we would make together. How much bandwidth do we have? Sometimes when you're engaging um on public policy matters, it's a lot of it behind the scenes, but sometimes, um especially for like sexier issues.
00:46:49
Speaker
and you know I don't think telehealth is that sexy, but some reporters thought i thought thought it was. um it would There would be media on it, or someone would report on my testimony in front of the New Hampshire Senate right um ah about asynchronous telehealth. So just to be prepared for that. And then if there were media, um if the CEO was um giving an interview or there was media coming out. Sometimes we strategically talk about, does it make sense to talk about some of the policy and government affairs efforts to shine a light on what we're doing? So we coordinate a little bit in that way. I think if you're i think of your work if you're in DC and working on high level DC matters, you maybe want to get the the founders and the executives a little bit more involved. Can you tell us, I know you're advising a number of different startups serving as a sort of fractional GC or outside GC to them. Can you tell us a little bit more about what you're you're up to now since leaving Blank Street a few months ago?
00:47:51
Speaker
Yeah, it's been the transition period. It's been it's been fun. um i've been I'm working primarily with digital health startups, and some in a non-legal consulting and advisory capacity, some in a legal fractional general counsel role. It's been fun work. It feels like It's not outside. It's not outside counsel. It's not totally full time general counsel. say It's somewhere in the middle, but it's allowed me to have relationships with multiple companies at the same time and work on a great diversity of issues. Truthfully, I don't know if it's something I want to do long term.
00:48:29
Speaker
Yeah. It feels like a transitional period stopover for me until I figure out what I'm going to do next. But it's been surprisingly fun to do something a little bit different than what I had been doing for the past decade, which was one client, one company in it all day, every day, one mission to work on a variety of different things at the same time.
00:48:53
Speaker
And okay, some fun questions for you. I like this this part. What's your favorite part of your day to day? And you can take this either now or when you're working as ah as a full-time GC. It's a full-time GC. I think it was talking to my team. um Yeah. Thinking up with folks on my team. I think that the i've I've done the solo GC thing before.
00:49:19
Speaker
at Blank Street for a period of time at Roe, for a period of time at Warby. It could be an isolating gig. yeah um And if you're lucky enough as a GC to have a team, um I just loved spending time with them. I was at at Roe really fortunate to build and be surrounded by and incredible people and incredible lawyers that I learned a ton from. And now I just loved just bouncing ideas off each other, having that internal resource to call and say, am I thinking about this right way? Am I crazy here? like so if you know Play devil's advocate for a second. you know And um i just I really loved building those relationships with the team internally.
00:50:01
Speaker
See, what I love about that is now maybe for some of our listeners, think about if you're like on Adam's team or you're someone who's on a team with someone like Adam and you're hearing that, maybe you don't hear that all the time from your boss, right? Like your your boss or your GC might actually be showing up to work, super excited to pick your brain. You know, I feel like that doesn't get said enough, I guess.
00:50:22
Speaker
yeah but and and you know Often your GC ah is just as confused as you are. like like just There's no playbook here. and um you know I'm often um encountering questions for the first time in my career still. and um It's nice to have the relationship with your team where you could say like, I don't know what the fuck to do. What what do you think we should do? and Let's figure it out together. Come on, this is fun. um So that's i mean that's kind of how i I've managed those relationships. um i I don't think that ah and don't think there's a GC out there who still doesn't get and smacked in the face with things that they don't know anything about or how to navigate it. And having friends and colleagues who you could who you could coordinate with and brainstorm with is invaluable.
00:51:15
Speaker
Do you have a professional pet peeve? I think a couple. um
00:51:23
Speaker
we the but both are email related. I'm not doing a once over ah to check for grammar spelling before you send an email. there There will be typos, there will be like, that's just, that's natural, right? Not looking for perfection, but the once over, um i the the judge that I clerked for in in in the Ninth Circuit is so hardcore when it comes to grammar.
00:51:49
Speaker
and spelling and punctuation. and I think he just like instilled it in me that it matters. its ah it it ah It influences how your email would be perceived and read on the other end. So I think just the doing it once over before it's sent, and then um the email forward without any context, like the see below when there are just you know months worth of back and forth. And what am I supposed to do with this? that's I think that's that's a pet peeve I'd say. That should be everyone's pet peeve. I agree with that. Maybe you've had a little bit of time to read as you've been advising different companies recently. I'm a big reader and I love to ask all of our guests for book recommendations if you have one or two that you'd want to share with with our listeners.
00:52:38
Speaker
Sure. I recently reread Man's Search for Meaning by Victor Frankl. Heavy, heavy stuff. Not a fun book, but um meaningful to me. It was a book that my grandfather gave me. I still have the copy he gave me and every once in a while I reread it.
00:52:54
Speaker
Who's that by? You said? vi Victor Frankel. Victor Frankel, all right. Holocaust survivor and psychiatrist. Oh, interesting. and his His recollection and then kind of clinical theories about who how he's approached his work after after surviving. Wow. That sounds like a good read for, I don't know, and not a beach vacation, but like...
00:53:21
Speaker
And now we're back every night for two weeks to like really remind yourself maybe even also how lucky you are. And then lately I mean i must i must admit I've been doing a lot of reading on Twitter and I've been, yeah, a lot of doom scrolling and it's a good reminder. so Thank you, that I maybe should put that down and pick up a book. But yeah, a lot of it's a lot of time spent scrolling lately. um Okay, last question for you, Adam. My sort of traditional closing question for guests on the podcast. And that's if you could look back on your days of being a young lawyer, maybe at Skadden, just getting started, something that you know now that you wish that you'd known back then?
00:54:07
Speaker
It's a good one. I'd go back a bit further to law school. ah And I would have told myself being a lawyer does not necessarily mean you're a litigator. That's what it looks like on TV most of the time, but there is a ah there are plethora of options out there other than and going to law school and going to be a litigator or law firm. I just kind of assumed that's what it was and hadn't spent much time exploring what other careers could look like. I think I eventually got pretty circuitously to the place where I'm really happy and I really love the profession, but um hadn't even occurred to me back then that this what what I'm doing now was was a possibility.
00:54:49
Speaker
Thanks so much for joining me today. It was great to see you, Adam. This has been a lot of fun. You too. Thanks for having me. And to all of our listeners, thanks so much for tuning into this episode of The Abstract. And we hope to see you next time.