Transcript
Speaker: Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
Speaker: Today's guest is Joe Murad, the CEO of Vita Health and someone who's seen healthcare from nearly every structural angle. Across companies like eHealth, Pocket Doc, and WithMeHealth, he's led and scaled companies tapping a wide variety of problems and at Vita Health today, he's raised over $200 million to build an integrated model that brings obesity medicine, cardiometabolic care, and mental health under one coordinated care team.
Speaker: And in today's conversation, we unpack why healthcare often breaks at the handoffs, why stacking point solutions doesn't solve the human problem, and what it really means to own the patient full journey.
Speaker: Hi, Joe. Welcome to the Healthcare Theory, and thanks so much for coming out today. Appreciate Thank you for the the opportunity. Of course. And I want to start with your background. You've been in healthcare for quite a long time, but not just in healthcare, you've been leading healthcare companies. And I think that gives a great oversight to different facets behind healthcare. But I'd love to hear what are the biggest leadership lessons you've carried through those experiences?
Speaker: And if you could walk through your prior companies like Polkadot, WithMeHealth, what were the missions behind those? And How did each of them kind of carry over to what you're seeing in healthcare care broadly today?
Speaker: Yeah, I had the rare chance to see how kind of money, data, and decisions move throughout the healthcare care ecosystem from multiple angles, right? So exchanges, interoperability, PBMs now direct care through Vita Health. So, and I see problems probably less than as eight an isolated point values and more a systematic values across alignment and incentives.
Speaker: and And that perspective certainly has shaped everything we're building in Vita Health. So for instance, on the exchange side, whether at eHealth or ExtendHealth, we witnessed how you can have, you know, really have people who have all sorts of opportunities to to be inviting to these rich technical environments, but it's completely unfriendly unfriendly to them. So too many options, not enough guidance, certainly no accountability for whether people are ending up in the right plane or not. and And that really taught me a couple of critical lessons, but
Speaker: you know, if you don't design around the memble member's actual decision journey, even the best products on paper are going to fail. And I just. We had places like Pocket Doc, we worked on rails and interoperability and we could see really how fragmented data and archaic transaction pipes. So we make it simple for things to needlessly be brittle. So whether it's eligibility checks, pricing, transparency, preauthorization, all harder than they should be because the plumbing is broken inherently.
Speaker: And that reinforced kind of my belief that innovation sitting on top of broken plumbing just kind of moves the friction around and instead of removing get entirely. And then I'd say lastly, yeah with me health, I've dropped squarely into the complex ecosystem of PBMs and pharmacy where we suck some of the real dynamics. So whether it's spread pricing, misaligned rebates, opaque economics, they're all routinely put, you know, the financial interests of the intermediaries ahead of the clinical interests of the patients.
Speaker: and plate sponsors who are subsidizing it and and that's a big reason why they push so hard around precision medicine use and therapeutic alternatives and responsible prescribing and transparency really just trying to know move the economics directly into outcomes instead of volume and so if any anything you you probably get some of my skepticism about some bolt-on thickness so most things break at the handoffs whether it's between you know coverage data pharmacy and providing the actual care itself so which is why yeah i'm really probably drawn to these integrated value-based models that and treat everything in one system.
Speaker: Yeah. And I'd love to hear like, why hasn't like you described the, like kind of the system today, because I think what we were seeing is that there's so many different silos from different point solutions or silos. like hypertension, chronic care, different diabetes are all tackled almost in their own silos. And then from another perspective,
Speaker: There's different like fragmented payers and benefit companies. This whole system is a little fragmented, but within where you guys are today, like what is the kind of landscape that will you were in before you started to build Vita Health? What did that look like? And what were the core problems you had seen and that you wanted to maybe tackle and and and build around?
Speaker: Yeah. So it's it's not necessarily you can be missing technology. I think it's missing accountability for some of the long-term outcomes, specifically with chronic conditions and mental health.
Speaker: So everything to your point is, is carved into silos, whether it's plan design, whether it's PBM, whether it's point solutions, prior care, nobody owns the full journey. So You know everyone is is typically optimized for their particular slice.
Speaker: So think about it, plans for annual budgets, provider for visits, PBMs for the drug economics, vendors around kind of the engagement metrics, but no one, no one owns whether people actually get better or stay better and, you know, chronic and and mental health conditions blend.
Speaker: a number of things, whether it's biology, behavior, psychology, but it lacks kind of this structural accountability that slices them into separate vendors and and different workflows. And that's kind of flawed at the core.
Speaker: Vita flips that by kind of owning the full journey across obesity, cardiometabolic disease and mental health. And we only effectively succeed if outcomes improve and costs improve.
Speaker: And I think a huge issue that we're seeing today is that it's, of course, fragmented at the systemic and macro level. But for patients themselves, the process is fragmented, too. I know sometimes with like, a I have conflicting answers. And it's even worse when you have people that you think are really credentialed giving conflicting answers. So you have...
Speaker: a whole complicated care process that very difficult to get through with no advice and single point of contact. But what does that actually look like for the end outcomes? Could you walk us through the patient journey? What was it like before vita Health was able to kind of get involved?
Speaker: Yeah, so I think you'll find like the stacking solution it may may solve a procurement problem for some of these large self-funded employers, but it's not solving the underlying human one, right? So on paper, it looks incredibly comprehensive, but in real life, it's pretty exhausting for the member.
Speaker: And it's chaotic because you have multiple apps, you have conflicting advice, you have no single owner. We believe that you know the patients are actually trying pretty hard, but nothing feels coordinated and and no one actually really owns them end to end.
Speaker: So Vita is intentionally the opposite. Like our members are surrounded by one care team, whether it's registered dietitians, obesity medicine, physicians, coaches, licensed therapists, they're all working around that whole person care and working from one record and one plan. And that same team is managing the prescribing of medications like GLP-1s.
Speaker: And they see all the mental health signals, the blood pressure changes, the daily behavioral changes, and they adjust that in real time. So it's a coordinated, less fragmented process that dramatically improves a member experience.
Speaker: So, i mean, it's really interesting. I mean, I think that patients, it is a a difficult problem for them and the human side is often overlooked because oftentimes you're just going see the numbers it. But if it almost seems like it's an obvious problem, like we should integrate these silos and break these down.
Speaker: But I mean, it's not so easy as you've known. But what was the inherency of this? Like, why was it so hard to solve when you guys were building your solution? What were the main pain points that kind of left this system as it is rather than allowing for like integrated care solutions in mental health or chronic care or MSK or any other area to just quickly kind of fix it.
Speaker: Well, I mean, ah at the at the highest level metabolic instability is isn't really just a single not and problem to say or it's a systemic problem, right? So the systems issue in obesity is is usually a symptom of deeper behavioral, psychological and environmental drivers.
Speaker: And when you actually take a step back and you map real member journeys and overlap The overlap is is fairly obvious. It's stress, it's sleep, it's mental health, it's nutrition, it's finances. They're all connected, right? And Vita was effectively built on that premise. We did actually tackle on like mental health or medications onto the coaching programs.
Speaker: We actually started with an integrated care team for day one and medications, coaching, therapy, nutrition, they're all, they're all, they aren't all add-ons and and they're one coordinated model. And so that helps enables us to kind of treat the member differently, tie as well.
Speaker: Yeah. And was that, and and when you're building that solution, but what were kind of the first principles? seems like one of them was like coordinating care. So getting different people from different perspectives to help orient this process. But beyond that, like what were the different constraints that you had when building a solution that you would not work? And what are the things that you like kind of must have known starters to build a good product? Because I know for a lot of things like this is not a very expensive, cheap solution, GLP-wise and even step therapy can often, even with step therapy can often get expensive. So what are like kind of this fundamental design decisions or assumptions that set Vita apart from the traditional model?
Speaker: Yeah, I think it's again, it's reiterated. It's not looking at this as one particular issue. It's a connected issue across multiple different symptoms, right? So if you have the capability to treat everything under one umbrella, stress, sleep, mental health, you know all those things, nutrition and I'd be able to coordinate it in ah in a way in which it feels interconnected. It solves these underlying problems around what was historically a fragmented experience for the member.
Speaker: Yeah. And what does that look like at the end of the day? Because I know you have an integrated care model that you're basically combining these different issues. But could you walk us through like how that works for members? So, for example, if someone with diabetes or anxiety or like joins the program, like how do the i mean, you have coaches, therapists, dietitians, clinicians all working together. Like, how does that get coordinated? And what does that look like for the actual person who ends up joining the program?
Speaker: Yeah. So, and there are multiple ways. if you take it kind of a step back and look at the way we've architected the experience for the member, we start by addressing all the drivers and and not the diagnosis, right? So behavior, stress, sleep, the things I just mentioned, but the the care plans are, are sequenced very thoughtfully, right? And we start with fundamentals. So nutrition, movement, mental health support, medication, when clinically appropriate.
Speaker: And then we track more than just weight, right? So we we track clinical biomarkers like BMI, A1C, blood pressure, as well as kind of the mental health or our our medication adherence, as well as daily function. And our team adjusts in real time if something is off.
Speaker: And beyond that, I mean, you have but and oh with that, I mean, you're tracking these biomarkers and everything like that and have these different care individuals and within them, like, how do you make sure there's like interoperability there? Because I know a huge issue is that a clinician might think one thing and then a therapist might think another, and that won't get communicated always. And there's also patients like HIPAA violations that you can like kind of go through. so you have to kind of share information about a patient and make sure there's one kind of complete profile. What does that look like?
Speaker: Kind of getting everything across on the right side. So there's one complete picture of the patient and important data isn't left in one silo, but not the other. Yeah. So we we start again by ingesting all sorts of comprehensive data around that number, whether it's the, the claims data, the patient reported outcome data, lab data, we build these copies of enriching number profiles. We bang that up against our clinical rules, that analytics engine to make a determination, where do we intervene and which intervention do we actually deploy?
Speaker: So for instance, I can get you kind of deeper into, you some of the the the core principles around how we move them through this process. If you want to go to, you know. Yeah, I agree.
Speaker: Yeah. So, I mean, in this day and and I'll start with just because what we're seeing in the direct to consumer players who are advertising, come and get access to these medications, like, yeah, funds for vanity purposes, you know, three clicks and little clinical oversight, if any at all.
Speaker: And we believe you know entirely differently at GLP once and how we believe you know they're they're powerful tools, but it's not a strategy in their own right. So the question is never about just can we prescribe? It's should we prescribe and what are the programs that we wrap around it?
Speaker: So we start with just the most rudimentary adhering to our clinical protocols and evaluating a member's response to behavioral change first. So then we'll you know assess how individuals respond to these less expensive anti-IBC medications before moving on to the more expensive GLP ones.
Speaker: i And so for plan sponsors, this really ensures that we're not defaulting to the most expensive tool first. And then and the next step is our obesity certified physicians apply a very clear evidence based pathway.
Speaker: And they're looking at this in the whole context. Right. So clinical risk, mental health status, what are the members goals? What are they trying to achieve as well as kind of the surrounding support system for that particular individual?
Speaker: And when um medications are are clinically appropriate, our physicians will prescribe. and We believe the relationship and we've actually kind of built out the relationships in a more formal manner where some of these PBMs enable us to streamline some of the pre-authorization process.
Speaker: So we remove the friction and they have access to a a more smooth kind of experience with, with fewer delays. And we don't just stop at the script, you know, we optimize it. Well, whether it's, you know, again, these registered dietitians managing the nutrition and the side effects, or our team actually monitoring the the medication adherence closely because I've got to prescribe want make sure they're taking those medications.
Speaker: And they ultimately our coaches are reinforcing day-to-day behavior. Uh, because we need, you know, we need to ensure that they're, that's accompanying the, that what's on the label around this prescription of those medications that ultimately our therapists are addressing any emotional and psychological statuses of those particular numbers.
Speaker: And then equally as important, like we're totally comfortable saying no, like ah we're saying no. And when the risk reward benefit is off and it isn't right for that particular member. And that's probably the difference between where I consider precision medicine and just writing scripts that you see from some of these three click pill mills.
Speaker: Yeah, and i think in some ways it's interesting where Vita in this case is a lot of like almost power in the situation. You guys are the ones allowing the incentive with the employer, the employee and clinicians. And oftentimes those aren't the same. Like if you have an issue and that what GLP wants can serve, you see this in the, you see so many ads every single day.
Speaker: Your friends take it, they lose 30 pounds. And so you really want to take it you think that's the solution. And then on the other side for the employer, they know it's expensive. They know it might not work for everybody. And the clinician knows that too.
Speaker: So, I mean, how do you align that? Because I mean, there's almost, it seems like there's, it's difficult to find a solution where it works for everybody, especially when people want and hear about GLP One so much.
Speaker: What does that look like for you guys to manage those internal issues where at the end of the day, you're serving many people with different incentives, but no one's kind of prioritized over the other. so I mean, what does that look like almost?
Speaker: Yeah, so I think like we, that's why we're so anchored around outcomes and not utilization, right? I think that's, it's critically important. So in our view, utilization just tells, know, are people actually showing up and the outcomes tell you if it's actually, if it matters.
Speaker: So for members, things like sustained weight loss, better A1C, better blood pressure, improved mental health, and ultimately just a better quality of life, right? Sometimes we get lost with what folks are really trying to achieve.
Speaker: For instance, we have one member, his goal was simply just being able to you not use a seatbelt extender on an airplane. So again, yeah as we get lost, but for clan sponsors, it's a little different, right? So sometimes they're looking at medication spend. They're looking at trying to manage or mitigate some of the trend on their pharmacy spend. They are looking for fewer hospitalizations in the ER business.
Speaker: and really any and all productivity science, because that's ultimately what they're trying to achieve. And if we're doing our job, we're lowering the total cost of care for those members. And then for the the broader ecosystem, it's about really fewer preventable complications for diabetes and heart disease, get less unmanaged depression, anxiety, and and all the other stuff that that people are are or operating without, like consistent therapy with or without medications for that matter. and ultimately driving a more durable care model.
Speaker: And that's why our model has been built to optimize medication effectiveness adherence, as well as all these side effect medications and not just access. And on that note, I think driving or durable pair bottle, it's obviously not the easiest thing to do. And I mean, there's a lot of her modalities to reach a patient because oftentimes the conditions can have the perfect advice, but adherence on the patient side is just as difficult to get.
Speaker: And I know you have a lot of different modalities, like an app, a remote monitoring devices, virtual sessions with coaches and dieticians. So a lot of different ways to reach the patients. And that can be overwhelming at times, or it can be the perfect process for some.
Speaker: And I'd love to hear, like, how do you intermingle all these different modalities and devices to keep people integrated? And what does that process look like? Are people downloading an app? Is that the point of interface for all the different contacts? Or is it something different where the app is something to engage with time to time? What does that entire process seem?
Speaker: Yeah, we don't really, i guess we leave the modality up to the participant, right? In the, in the member, their preference, because some people like to talk on the phone. This is why we have clinician led kind of for focused attention as, as particular members, as well as leveraging any other access point that they prefer. So whether it's a text message, whether it's leveraging the app that we've constructed, whether it's the interaction with their care team. So it's really fairly module and it enables those individuals to, to work off the preference of whatever modality that that's, that's their choice.
Speaker: That makes a lot of sense. It is like a very individual process. I can imagine everyone wants some sort of different thing or the other, and that's how it should be almost like healthcare should be personalized as much as it can be.
Speaker: But I also know that employers don't I would say healthcare is often little resistant to change and employers, even though they want to save if money, it's a different thing what when it comes to their like kind of their overall benefits. Like it takes a while to sell to employers, right? And to partner with them and to create a long-term plan going forward.
Speaker: So when you started Beauty Health and you're building the solution, you had a personalized system, different people in different areas. How'd you end up getting in the door and selling to these employers and offering your value prop? Like what did that process look like, especially when you're starting to scale and it's like these long sales cycles might be a burden on the business.
Speaker: What was the kind of your philosophy and working around that and making sure you had a flywheel that would grow your business forward? Yeah, a great question. i mean I think in this day and age, and it fear opens the door specifically around the GLP one costs, right?
Speaker: Pharmacy spend, employee pressure, you get all the advertising that you're just talking about, practically the consumer. But really the real proof closes the deal. And we have a 10 year operating history of success.
Speaker: And when cell phone employers see these kind of real outcomes and these costs improvements there in and the fact that we're willing to put our fees at risk, that kind of model becomes unavoidable.
Speaker: And more and importantly, it stops feeling like just another vendor and starts feeling more like an entire ecosystem upgrade. And so we leverage that in this market opportunity, whatever that phrase never waste a crisis. This is a perfect example.
Speaker: yeah And when you say like, I love that phrase, like fear opens the door, evidence, evidence kind of closes it or proof closes it. And I think the fear is something that our employers see like every day and that their bosses are telling them with all this news. But I mean, I think the evidence part is almost like a chicken and the egg situation, right? Like you have to bring evidence that this model, this new model can work and it's not been proven. So how do you prove almost? It seems difficult. But how did you go about that in the early days when you were building out and just, I mean, trying to show them something that you don't really have to show almost.
Speaker: Yeah. So I think we think beyond just the scale, I mean, there's a tendency for people to say, how much weight did I lose? There's a, there's a critically important kind of what's the clinically relevant weight loss. Yeah.
Speaker: We did to actually all these other improvements in your, in your with some of the biomarkers in which we actually track. Right. So are we improving their quality of life? That's ah just ah an example where some people get so caught up in this moment. And that's why I think there's a there's a a natural tendency for people to get intrigued by these these direct to consumer models because it's an access point, but it doesn't wrap around the right care.
Speaker: And so you get this misinformation and market. Where I think the opposite of what beta does is we actually drive really good adherence. So if you are going to prescribe some of those medications, ensure that they're actually taking them and ensure that it's actually improving their quality of life.
Speaker: And it's not just about the weight loss. Yeah, that makes sense. I think adherence is, we just had an episode of someone who works in clinical trials and adherence is a huge issue. it's it's all It's very hard to fix. there's like a whole psychological element of that. And it's really hard do that without getting on the ground with clinicians. And that's something I wanted to ask about. I mean, a huge part of your job you're pretty high up and you're not the one talking to patients. and Maybe maybe you and I shouldn't be the ones lying on patients, of course. But for the people that are the clinicians, like how do you enforce?
Speaker: I would just say enforce, but provide a good standard. so the things are like standardized across everyone you see throughout the process, because just like how patients have different styles in terms of how they want to get clear conditions, have different styles in terms of how they want to deliver care. So throughout the organization, how do you like provide a standardized care process so that every clinician, dietitian has the same methodology they're going towards, but still has the flexibility to individualize care almost.
Speaker: Yeah, sorry. It goes back to the comment I made earlier about building these robust member profiles and curating likes for that particular member. But ultimately we're, we're generating and created these clinical pathways that are relevant to their, their condition. So each individual is completely unique as we can appreciate.
Speaker: So we have is built within this system infrastructure and the architecture what we constructed here at Vita Health. So it enables us to have some continuity in the delivery of that care.
Speaker: And we built it around kind of cohorts because people do kind of have a tendency to fall into the specific categories. And we can see based upon our operating history, what's most effective for those particular members.
Speaker: And then that makes a lot of sense. It's, I think to some level, like information is what helps a lot. You get a full picture. You're able to customize a solution and give clinicians a better idea of what to do.
Speaker: And two quick questions to kind of wrap up the podcast here. More about you, less so than about Vita. But i mean, you've embarked on this entrepreneurial journey many times before in healthcare. And i think something you said before was like perseverance matters and another, don't know, before you said that. And And that like, I mean, the timing and luck of doing all this should have be underestimated, but what does it mean to you to be like an entrepreneur in a system as entrenched as healthcare? And how do you stay, i mean, motivated and resilient when the industry can be like so slow and resistant to change and quite, I'd say difficult to kind of penetrate to.
Speaker: The great question. I mean, I think i love trying to solve some of these, these large chip problems. And healthcare is a perfect example where you have a complex ecosystem with a bunch of different moving parts and trying to be able to navigate that effectively and go deliver what I would consider kind of one longitudinal relationship for those members. So not having five apps for five problems.
Speaker: but actually move towards um where you can have a virtual front door with integrated care teams that kind know your entire full history. Again, relative to us, it's therapy, nutrition, coaching, medication, all deployed as needed without you know the patient having to navigate specific products.
Speaker: and make medication decisions inside of a coordinated long-term plan. And that's essentially what we're prototyping at beta, right? So I love the idea of being able to create this connectivity across the ecosystem and removing some of the friction and making a better member experience.
Speaker: But Joe, I mean, I really appreciate that kind of that answer there. And I think that you've worked again, as we've kind of spoke on different, different companies, but what's some advice that you'd have for people entering this space as like trying to become entrepreneurs or, or build things that are durable, but innovative at the same time.
Speaker: It's a difficult journey that, as you said, requires perseverance, but for you, i mean, what are the bigger things that lessons that maybe you'd take away from this whole process that you'd like to instill in others trying to enter healthcare?
Speaker: ah yeah We welcome all entrepreneurs to come up and disrupt, you know, what's happening and add a creative value here. And sometimes you need to, you know, have an outsider's perspective or a fresh perspective. I'm in and, and, and to break up kind of some of these large legacy thinking, error incumbents that have owned kind of the stranglehold on, on the market we serve. So.
Speaker: You know, I'd love to see nothing more than just this evolution of eliminating, you know, volume based payments and fee for service and single conditions, product strategies and data silos. Like just so we can eliminate that all and you bring in kind of this, this fresh perspective around, you know, having, you know one care team, one rich number profile, one record per person, payments tied to outcomes, not activity.
Speaker: medication embedded in a whole person care and ultimately a continuous, not episodic member experience. Bring me the entrepreneur who thinks that way. I love it. I think the marketplace would benefit for it.
Speaker: Of course. Yeah. And I'm super excited to see not only how that changes ah other people disrupt healthcare, but I think I'm excited for the journey behind Vita Health. I really appreciate you kind of sharing what was going on today.
Speaker: I think more and more going to see these chronic solutions or just any other medication or problems that we see in healthcare will have to be addressed to the lens of the employer. But it's important for the employer to make the right decisions on how that will be managed. So platforms like Vita or Centiro, like I've spoken to before, that can not only just provide good care, but integrate different points that it's one care journey that's easy to navigate.
Speaker: I think that's going to be the future, like so some personalized healthcare. So really appreciate the time again, Joe. Thank you again for coming on the Healthcare theory. I appreciate the invite. Thank you. Great job. Of course.
