Latest / StartUp Health NOW Podcast / Former Livongo President Dr. Jennifer Schneider Talks Moonshots, the Teladoc Merger, and How to Be a Transformative Leader

Transcript

Former Livongo President Dr. Jennifer Schneider Talks Moonshots, the Teladoc Merger, and How to Be a Transformative Leader · StartUp Health NOW Podcast

• 0:00
  [on-hold music] Welcome to StartUp Health NOW, where we interview the health transformers and change makers reimagining the future of health.
• 0:27
  My name is Unity Stoakes, the co-founder and president of StartUp Health. And today, I'm honored to welcome back Dr. Jennifer Schneider for a one-hour interactive fireside chat. Um, Dr.
• 0:41
  Schneider was with us just over a year ago at the StartUp Health Festival, and obviously so much has changed, uh, over the past year, so we wanted to check in, um, and, and really have a, a thoughtful conversation about the future of health and, and, uh, where things are going.
• 0:58
  Dr. Schneider is one of today's extraordinary healthcare leaders. Uh, in fact, recently being named by Modern Healthcare as one of the 50 most influential industry executives. Wow. Um,
• 1:14
  as the former president and chief medical officer of Livongo, uh, Jennifer was responsible for everything from product and data science and engineering to marketing and growth strategy.
• 1:27
  Uh, and in fact, in her final year with Livongo, uh, she led the company through the largest consumer digital health IPO in history, a secondary offering, a convertible debt offering, and really the industry's largest merger ever between Livongo and Teladoc.
• 1:47
  So look forward to digging into all of that. Um, in fact, I think the company was then valued at around $19 billion with that transaction, so congratulations. Um, also excited to share and thrilled that Dr.
• 2:01
  Schneider has just joined the board recently of a StartUp Health company, CityBlock. Extraordinary company. Um, and previously, Dr.
• 2:11
  Schneider, you're also a doctor, a physician with Kaiser Permanente, as well as a mother. Um, but I thought we'd go back to the beginning. I know you were also, or are living with Type 1 diabetes, um, from the age of 12.
• 2:26
  Um, but I wanted to kinda go all the way back to the beginning and understand, um, why you decided to come into healthcare and, and begin your journey as a physician. Take us back to the beginning. Su- uh, sure, Unity.
• 2:40
  And first, thanks for, um, the opportunity to come back. Um, always a pleasure to get to have, get to have a conversation with you.
• 2:46
  Um, so my, um, interest in h- in healthcare really stems from when I was diagnosed with Type 1 diabetes. As you said, I was 12, and I had all the classic sym- symptoms.
• 2:57
  I lost a bunch of weight, was really thirsty, taking jugs of water to bed with me.
• 3:03
  And, um, knew nothing about diabetes, had never really interacted with the healthcare ecosystem apart from standard childhood immunizations. Um, and was in a small town in Minnesota.
• 3:14
  Spent some time in the intensive care unit.
• 3:17
  And as I emerged and found an endocrinologist at the Mayo Clinic, uh, really became, from the get-go, my condition to monitor, to take care of, and I developed an incredible relationship with my endocrinologist, um, Dr.
• 3:31
  Roger Nelson. Uh, and it was a, the e- entryway, if you will, into healthcare.
• 3:37
  And so I think there's, you know, writing samples from when I was in the sixth grade as a 12-year-old around wanting to become an endocrinologist because it was such a formative, uh, experience for me at the time.
• 3:50
  I, I love how you still know the name of, of your doctor. It's almost like how some people know the names of their, their early teachers. Um, that's, that's an incredible story there.
• 4:02
  Um, was th- was there an aha moment that really, um, was that the aha moment, I guess, just by being around doctors, being in the healthcare system, where you then set off on that journey to become a physician yourself?
• 4:18
  Yeah, and I think it's actually even more than that, and the reason I know Dr. Nelson's name is because he's journeyed with me through my life.
• 4:26
  Um, and so, uh, and, and what I loved most about the experience was not the diagnosis, but was this clear relationship development where, as I was learning around the skills I would need, and the medications, and how to monitor, and how to eat, and how to adjust, what he gave to me was he absolutely empowered me to be at the center.
• 4:46
  So as a 12-year-old child, I was at the center of this thing that I was going to live with for the rest of my life. Not my parents, not him.
• 4:54
  Um, he was gonna give me the tool set and be that person with whom I could have the tough conversations. And that, the concept of that, even more so than the medicine itself, was really intriguing to me.
• 5:06
  And I started to think about, um, you know, I'm, I've, I was always fairly academic, and so the medical components of the science were really attractive to me.
• 5:15
  But it was that combination of this empowerment around individual people that was highly inspirational.
• 5:22
  So it wasn't just science in a silo, it was science translated to empowerment, and so that drove the desire to, um, you know, take pre- premed courses, take the MCAT. I still ventured.
• 5:34
  I spent a year at Oxford studying religious, religions and, um, ar- arc- architecture.
• 5:40
  So I kinda went all over the map, but came back toward, uh, medicineAnd then when you, when you went into medicine, then started practicing, what, what was that experience like?
• 5:51
  Um, obviously, I, I think you were at Kaiser Permanente, which, which has a unique way of, of practicing. Um, what was your experience like?
• 5:59
  Yeah, so I did my medical school training at Johns Hopkins, um, which was very formal and very formative in terms of a very c- uh, correct, distinct way of performing medicine.
• 6:10
  I then did my residency training in internal medicine at Stanford. So went from, you know, East Coast to West Coast, and learned a lot through that transition.
• 6:20
  And then I came out, I did a chief year at Stanford, which is a junior faculty year, worked, uh, some at Kaiser Permanente, as well as did some, um, local hospitalist work writ large.
• 6:31
  And what I learned from that experience was the systems are radically different.
• 6:36
  Um, and I really became, was, was, became a big fan of the integrated system at Kaiser because of the communication, the streamlined communication that was at the best interest of the patient.
• 6:47
  And so this idea that I could look at multiple different sources of information in a single platform and have an understanding so when I approach that person, I didn't have to repeat a bunch of questions, and I had a sense as to what was going on, was very different and distinct from some of the other places that I had practiced, which was much more siloed from information.
• 7:06
  So then my learnings in practicing there were a lot more around systems of healthcare delivery and communications and data.
• 7:13
  I also learned about myself, in that I enjoyed, uh, practicing, uh, medicine, but really what I loved is the interactive dialogue that I got from other colleagues.
• 7:23
  That was a lot of the academic training environment, and less so when you removed yourself into, um, more of day-to-day practice.
• 7:29
  So it was a little combination of both, which then launched me into a new direction in terms of the healthcare career. Yeah.
• 7:36
  Um, so what was the moment where you went from kind of doctor to, we call people like doctor-preneurs, whereas, uh, you're- Right... you're going into building, um- Right...
• 7:48
  what, what was the moment that kinda led to that?
• 7:51
  So for me, it wasn't, it, it was, uh, very different in that I didn't, um, it wasn't a career track, like I'm going to go to m- he- you know, go to medical school and then do residency and then become an entrepreneur.
• 8:03
  That was never in my mind. What was in my mind is I like to f- fix and work on really hard problems.
• 8:10
  And so I had gone, um, I did my training, medical school, my training, gone out into practice, and had come back to get a master's in health services research because I was really fascinated with the idea of taking data in the ecosystem and trying to leverage that.
• 8:26
  And in that process, I had the fortunate opportunity, uh, to work under a man named Alan Garber, who is both an internal medicine doc and a health economist, currently a provost at Harvard.
• 8:37
  And his friend was this crazy, um, psychiatrist by the name of Giovanni Colella, who was on, a serial entrepreneur who was on his second or third company at the time.
• 8:47
  And what, um, Giovanni was trying to do with the company that was ultimately called Castlight Health was, in essence, create a free market in healthcare.
• 8:56
  And I thought to myself, that is an incredible, incredible idea to tackle, right?
• 9:01
  So keep in mind, I'm hundreds of thousands of dollars in debt from going to medical school, and my friends, you know, are complaining about the $40 copay to go see their primary care doctor, but they'll easily drop $200 to someone who's never graduated from high school for a haircut.
• 9:18
  And, and I just kept thinking, there is, we are missing the point here. The value ecosystem is, you know, com- completely, um, shrouded, and we're not making the right choice.
• 9:27
  So I loved, I loved the concept and the problem, and that led me into digital health. It w- and it, you know, it wasn't as though I wanted to be an entrepreneur, it wasn't as though I wanted to go into digital health.
• 9:35
  It is, I really wanted to make a difference in an area that I thought there was a big problem that would empower and create a better healthcare ecosystem if we could help to solve.
• 9:44
  And I do think that Castlight did a beautiful job in unveiling this idea that cost and quality, um, are, are much more, there's much more nuance there than you typically assume.
• 9:55
  You assumed if you chose an in-network doctor, you had done all your due diligence and made the optimal choice, and that wasn't quite the case, right?
• 10:02
  And so I think Castlight did a nice job of shedding light into that part of the ecosystem.
• 10:07
  And yeah, Castlight was obviously one of the early, uh, companies that went public in, in the space, so it's really, uh, cool that you got to go through that journey as well.
• 10:17
  I'm, I'm sure that, uh, maybe some of those lessons learned led to things that happened at Livongo, which we'll get into. Um, so from Castlight, you then went, was it Livongo after Castlight? Yes.
• 10:29
  I had, so my personal journey, I had had, um, two, two children at, at Castlight.
• 10:35
  We had taken the company public for over a billion, um, a rare unicorn status, was where, when digital health was really early on in its journey, right? Mm-hmm.
• 10:43
  And then, um, had, one of my really close friends had interviewed for a chief medical officer at Livongo. And, um, she has incredibly high IQ, um, and said, "Hey, Ai Schneider, I think this is a job for you.
• 10:56
  Like, I actually think this might be the right job for you."
• 10:58
  And so I, I met, uh, Glenn and the team and really, truly just fell in love with the idea of leveraging data in the ecosystem to drive behavior and behavioral change.
• 11:09
  And certainly, the experience at Castlight was helpful from both a go-to-market strategy in terms of selling into large self-insured employers, partnering with benefits leaders, and, and we'll get there, but on the IPO roadshow as well, because I got asked, well, almost every, uh, with every meeting, got asked a question relative to Castlight versus Livongo.
• 11:28
  Right. Right. Well, and I, I love that you started, and let's dig into Livongo here. You, you, you started as chief medical officer and then became president.
• 11:40
  Um, and I also love that you had so many different roles within, uh, within your time at Livongo, starting with the product.
• 11:49
  And, and I wonder, um-You know, it seems like the world, world aligned where your experience from childhood, um, living with type 1 diabetes, um, I'm assuming really brought a lot of value to how you thought about building, uh, what you guys were doing at, at Livongo.
• 12:10
  Yeah. I'll start with the product side. And, you know, we talked a little bit around my own diagnostic experience around being diagnosed at Mayo Clinic. And the concept...
• 12:19
  And I'll tell you, you know, when I first interviewed for the jobs, one of the things that struck me the most is I have always, had always hated the word diabetic.
• 12:27
  And it always been like, oh, I just, like, I, that is not who I am. Like, I am not a diabetic. I'm Jenny Schneider. I happen to have diabetes. I also have these other attributes. I am not that one thing.
• 12:37
  And Livongo was the first time in a professional setting, um, where the language really mattered. And we, at Livongo, made a very, you know, very clear point that it was not a diabetic, it was a person with diabetes.
• 12:49
  In fact, when Zane Burke joined us as our CEO, he used to joke. He said, "I've never had so many people correct the CEO." He came from Cerner, right? 'Cause he inadvertently used the word diabetic.
• 12:59
  And we said, "It is not a word that we use." Because we're treating people, and a person is not their condition. So we had a lot of people within Livongo whom had chronic conditions.
• 13:10
  But the concept of treating a person as a person rather than as a condition is all about building an experience that resonates with each individual person. Living with a chronic condition is one aspect of your life.
• 13:22
  It is rarely the most important, and it is almost never the only aspect. And so that recognition and development of products that allowed us to develop products that people loved, not just liked, but loved.
• 13:36
  Because we actually really understood what that's like around living with a condition. We made every employee call our members on a regular basis once a month. So it was an empathy.
• 13:47
  You know, we had our members come up and, um, present. At every conference that we gave, we had member panels, and that was one of the most powerful sessions.
• 13:55
  'Cause we were here to solve something for people, not to solely create a business that did, that did well financially. We were really focused on solving that pain point, absolutely obsessed with that experience. Yeah.
• 14:09
  One, one of the, the things obviously that's, that's important to companies as they're just getting going and then scaling and, and becoming successful is attracting people like yourself, is, is getting really great, extraordinary people to join their team.
• 14:25
  Uh, what, what did Glenn or what did Livongo do, um, what attracted you, I guess, to Livongo from the beginning as an organization? Or were there things that kind of stood out to you, um, from the very beginning?
• 14:40
  And, and the reason I ask is there's a lot of founders on the call, a lot of companies just getting going, and they're trying to build their teams.
• 14:47
  They're trying to attract, um, extraordinary people like yourself to, to join their mission, to join their health moonshot. Yeah. And I, and the founders out there know this, but mission matters more than anything else.
• 15:01
  Like, mission, um, trumps strategy every day of the week. And we were very, very explicit around the types of people we were looking to join. We were very committed to diversity out the gate.
• 15:12
  We were very committed to people who would internalize what we were trying to accomplish. Didn't matter what school you went to. Didn't matter how fancy you were.
• 15:20
  We were literally trying to build a team, and that team required a fair amount of buy-in to the mission.
• 15:26
  There's plenty of jobs out there, and you could find a mission that works for you, you know, in different organizations.
• 15:31
  But it was really critical for us that we would talk a lot about, um, what we were doing was empowering people with chronic conditions to live better and healthier lives. Not helping people, not making people better.
• 15:42
  This was not an us versus them. This is an we all. You know, we had the unfortunate or fortunate, depending on which side of the coin you wanna look at, advantage of looking at chronic conditions.
• 15:55
  So a large majority of our employees either have a chronic condition or have a very close family member with a chronic condition. I live with type 1 diabetes. Glenn's son had type 1 diabetes.
• 16:07
  Dave Engberg, our chief technology officer, his father had type 1 diabetes, was on dialysis.
• 16:14
  And so we had a very personal connected experience, and that, um, was something that we maintained and worked really hard to maintain throughout the course and journey of our, our, our business building.
• 16:26
  In fact, at the time that we did the transaction with Teladoc, many, uh, you know, will ta- will talk about the $18.5 billion exit.
• 16:35
  Our entire team will talk about that was the week that we had a million members actively using the Livongo platform.
• 16:41
  Again, the absolute focus on what we were delivering for value to the end user above and beyond kind of the economic success that the company saw.
• 16:50
  And that requires, uh, you know, beating the drum, con- consistent messaging, consistent leadership, and understanding when people don't fit the, they're not the right cultural fit, and letting them go.
• 17:02
  It's better for them, and it's better for you. And we've had, we had lots of l- those along the way. And it's not, doesn't mean the people were bad. It doesn't mean the organization was bad.
• 17:10
  It means it wasn't the right fit to keep that, um, that mission, um, f- first and, and central. Very, very committed, uh, uh, a very committed leadership team on, on mission.
• 17:21
  And it, I think back to Castlight had that as well. I know Todd, Todd Park and, and some of those, many of the, the folks on the team.
• 17:30
  I mean, I, it's, it's clear, um, from those organizations that have really paved the way that this concept of empathy and mission and understanding really, um, you-- It's like no matter who you meet within these organizations, you can just feel it.
• 17:48
  Um, whether it's at a conference or, or in a meeting somewhere, I, I think that seems to be a consistent trend. Um, I would say the same thing about CityBlock, by the way, um, and Aya and the team there.
• 18:01
  Um, you really get a, an understanding of, of the empathy side of things, the real person thing. So I'm, I'm glad you touched on that.
• 18:09
  Um-So from chief medical officer then to, to president and really running the operations for the, for the company, can you walk us through that transition? Sure.
• 18:21
  Well, I would start by saying, um, when I entered the organization, it was very clear that the organization, uh, needed a chief medical officer.
• 18:30
  It was also clear for me that I didn't want to only be the chief medical officer for my existence in the company.
• 18:36
  So those discussions happened early on, and my influence and drive really spanned a lot of the, um, different departments.
• 18:44
  In fact, the transition internally from chief medical officer to president, I had been doing a lot of those different pieces of the roles throughout.
• 18:51
  But when I did the transition, I took over not just the clinical operations, um, but also all of the product, the engineering, the data science, the marketing, and our growth strategy.
• 19:03
  And then spent most of my time, you know, traveling back in the days when we used to travel. Unity, remember those days? Um [laughs] and, and speaking and selling, um, was a lot of what I did.
• 19:15
  Um, uh, it was a lot of external facing work. And so how, how did you manage all of that? I m- did you have, um... Maybe take us through kind of how you organized that. You're out on the road selling as a road warrior.
• 19:29
  You're, you know, on stage. You're also managing product and, and all, and growth.
• 19:36
  Um, did you have a whole team of different leaders, or how did you kind of set that up operationally to be able to thrive in the early days? Yeah, and, um, so it's, it's a great question.
• 19:47
  So for sure, it's all about team. Um, it's a team sport, not a solo sport, as we all know, and I had, um, a great team.
• 19:55
  And I used to say that the, what I was responsible for was the making and the telling the world about it.
• 20:01
  And my intent was to have leaders of, you know, engineering, of data science, of clinical, of product, of marketing that were very different because we were not trying to replicate medicine and technology.
• 20:13
  We were doing something transformational, and that required discipline and thought from a ri- a lot of different directions. So for example, we had, uh, Dave Engberg as our chief technology officer.
• 20:24
  Dave was a founding member of Evernote. And so when we used to talk about a lot of data, Dave would say, "Well, we have a cute amount of data," right, relative to what they did at Evernote.
• 20:35
  Uh, Cor- Courtney, um, LeClair was our chief marketing officer, and she had recently been the chief marketing officer for the Oakland Raiders. She also helped Steve Jobs launch the iPhone. She had worked at Disney.
• 20:46
  So she had this whole background of, like, incredible consumer marketing, which was very different from Amar Kendall, who was our chief product officer, who came from a device background.
• 20:58
  Bimal Shah, who was a func- you know, an active, uh, practicing cardiologist, um, who had come out of Duke.
• 21:04
  The reason I highlight these people is they are distinctly different, and I used to say all the time in our team meetings, "We need to have some sort of conflict.
• 21:12
  If we don't have some sort of sparks, we're not creating something new." And so it was really, like, my...
• 21:16
  I was, I was end- ended up being really a referee for when things couldn't get resolved or we had, you know, we couldn't quite figure out exactly what we wanted because we had so many differentiating viewpoints, and that was fun, right?
• 21:28
  That's when we knew we were creating something that was going to be differentiated in the marketplace.
• 21:33
  What, what was that like having, um, a, a dynamic team where, uh, several of the leaders didn't come from healthcare as the industry of healthcare?
• 21:44
  What, what was that like, and, and was that a, a challenge, or was that one of your secret kind of elements there? What, what are your thoughts there? I think it's yes and yes.
• 21:56
  You know, when we hired Courtney sh- Courtney, she said, "I don't know anything about healthcare." And I said, "That is why we are hiring you."
• 22:02
  Like, we are not trying to hire insiders to recreate what we've already done that's broken. We're trying to bring in people to create a brand new experience, and experience was really critical for us.
• 22:13
  So someone who could actually understand brand and, like, understand emotions and how you build that trust is a, is not something that we typically have in a lot of our healthcare offerings.
• 22:24
  Bringing someone in who'd done that in other industries without knowing all the acronyms for healthcare and clinical medicine was exactly what we wanted because she was bringing the absolute human-centric view.
• 22:36
  Partnering her with someone like a Bimal Shah, Dr. Shah, who's, you know, like, an incredibly well-trained, well-respected cardiologist, was a great combination. Really great combination.
• 22:48
  And so, and so it, it is all about, you know, I, my job was a lot of, um, just finding people and building team and understanding that if I could get different viewpoints together at the table, we were going to...
• 23:01
  our chances of creating something new and differentiated were much higher than if I brought all people who had all trained at Stanford and, you know, all done internal medicine residency.
• 23:10
  Like, that to me was not the right approach.
• 23:12
  And so it takes a leap of faith, um, but it's worth, it's worth the effort to really think through, you know, and then underscore that this is healthcare, so unless we had voices of women, voices of minorities, we were gonna miss a whole bunch of things that we are, needed to create to actually deliver a solution to take care of a broad population.
• 23:32
  Absolutely. And, uh, you know, I wonder if we could unpack, um, your, your journey at Livongo a little in the sense of maybe break it down into three stages. And I'd love to unpack some of the lessons learned.
• 23:46
  I don't know if you've had a moment yet to reflect on that whole whirlwind kind of few years there, but, um, there was the, the build growth phase, then this extraordinary IPO, which I think was very significant for the ecosystem and industry at large to show what's, what's really possible here.
• 24:08
  I know for many years there was always, "Oh, it's, you know, is there ever gonna be a real big exit?" and all these types of things, companies going public.
• 24:16
  And I think you guys really showed the world what's, what's possible. And then-This big merger with, with Teladoc.
• 24:24
  So I wonder if we could, um, dig into maybe a couple of the biggest lessons learned that you might share with the ecosystem back, um, at each of those stages, starting with, um, the, the, the growth phase.
• 24:40
  Um, and we talked about team already. It sounds like you guys really focused a lot on team and product.
• 24:47
  Um, what were some of your other early lessons learned upon reflection that, that you think other health transformers and entrepreneurs should really be thinking about as they're at that stage?
• 24:59
  Yeah, I think the, first of all, I think the build and grow stage is one of the most enticing stages to be a part of.
• 25:04
  And I say that because, you know, we established product market fit fairly early on, but the minute you think you've got product market fit and fail to continue to evolve and continue to innovate, you're already behind the game.
• 25:18
  So this idea that you have to continuously establish a listening feedback loop for your users was critically important. You know, what we had built early on was absolutely working, but we didn't stop. We kept listening.
• 25:31
  We kept trying to innovate. We got some of the innovations wrong. Like, we did some new things that didn't work, and that was with intention.
• 25:38
  You know, we as a early startup about, um, 2017, we established an innovation lab within our startup to ensure that we were never going to lose sight of new and novel ideas that we were hearing from our users, to ensure that it was, we were, we were continuing to innovate in what needed to be done, and our, and our clients.
• 25:57
  So we, in a B to B to C, um, business model, we listened to both to whom we sold and then to our end users. So I think that is critical to the success of anybody.
• 26:08
  I think the other part in the build and grow phase is don't get caught into the trap of comparing yourself to someone else. Um, don't try to be better.
• 26:17
  You know, I s- used to say all the time, it's not about being better than anybody else who's in this space. It's about doing something different that we believe in that's going to drive results.
• 26:27
  And so it's not about a, well, we also checkmark, checkmark, comparison by feature.
• 26:32
  We had a radically different approach to it, and we were unabashed, and we just kept plowing forward with our, with our, with our idea and boldness to be different. Yeah, I, I think, um,
• 26:44
  we, we think about that a lot where the, the true competitors is the legacy broken system as opposed to the few kinda innovators that are out there building at the same time, even tangentially or, or, or in the same space.
• 27:00
  I think, um, there, it's such a vast market opportunity when you really transform. I think that's a, a salient point there. Um, so when did the i- when did you know, hey, let's take this company public?
• 27:17
  What was the, the beginning of that? Had, had you been kind of leading up to that for a few years, and it was part of a plan, or did it kinda just happen all of a sudden?
• 27:27
  What, what was the early, early moments of that decision like? Yeah, it was, I think for us, you know, we saw really high traction with our ear- first product, which was diabetes. We then went into hypertension.
• 27:42
  We then bought a, um, a weight management company and bought a behavioral health company.
• 27:46
  And so the traction of our, frankly of our client growth, um, told us that we were at a p- at a position that we were doing something right.
• 27:54
  And it wasn't just the early sales, it was the number of renewals that we were able to retain and keep, uh, keep people that our differentiated model, business model of only paying us when people were using the service and demonstrating very clear outcomes of people love it, you have documented published clinical outcomes, and you save people money.
• 28:13
  That three-point had really kind of struck home.
• 28:15
  And so the conversation started, and for many entrepreneurs whom are on this or whom have gone through this journey, once you start those wheels, it's sometimes hard to kinda come back.
• 28:25
  And so you have to be very thoughtful and intentional around starting that process. We had the good fortune, um, there were four of us in what we called our 4LT.
• 28:34
  So that was Glenn Chairman, he was the founder and executive chairman, Lee Shapiro, who was chief financial officer, they're longtime business partners, and then Zane Burke, who was our chief executive officer, whom, who had, who joined us before going public, and then myself.
• 28:49
  All four of us had taken companies public before, and so we had an understanding of what it took, of what we needed, of wh- where we stood operationally, and how to manage our growing workforce through that process.
• 29:01
  And that was really beneficial, um, to us in that process. Obviously, you know, there, there was a lot of funding entering the space, a lot of new exciting companies emerging.
• 29:14
  Um, did you notice kind of an inflection point, um, as you were going through that process when you were out on the street? I know for years, um,
• 29:25
  the health innovation sector really hasn't gotten a lot of love, hasn't gotten a lot of, um, focused attention from, from the street. Was it, did you notice it, that starting to shift at some point? For sure.
• 29:40
  I think in the IPO process itself, right, and this is again, having come out of this with Castlight, which was on the very early version of that, which is, you know, innovation is going to happen in healthcare, and it's going to be technology-driven.
• 29:54
  And then we, I think that was maybe just a little sooner than the market was ready to truly understand and grasp that independent of the business model and the what was built.
• 30:03
  Livongo, I think, hit that where in, the market was actually more receptive. It had been seeded.
• 30:08
  And so these ideas around, you know, what we were doing within healthcare relative, you know, we used to, um, spend a lot of time, and I credit, um, Hemant Taneja, uh, one of the co-founders and early investors out of General Catalyst, with, uh, this one slide that we used that really resonated, which was, you know, Facebook did for community what Amazon did for commerce, what Livongo is doing for healthcare, right?
• 30:33
  So this idea around really putting something on a platform, leveraging data in the infrastructure, and delivering an differentiated experience with better outcomes and lower, and financial rewards was really something that hadn't been done in healthcare, but had been done in other industries.
• 30:48
  And those industries were farther, far along enough. And frankly, our client, um, growth, our published studies show that we were on the same trajectory in a different sector.I find that so awesome and extraordinary.
• 31:01
  It's like one slide crafted to tell an extraordinary story, um, made such an impact for you for your, on your, on your journey. Um, uh, you know, we, we focus a lot on, on storytelling.
• 31:18
  The whole concept of health moonshots is really about that mission and, and storytelling.
• 31:23
  Um, were there other big lessons learned during the, the IPO process like that, that upon reflection really helped make it a, a success? I think that...
• 31:36
  Uh, I'll, I'll throw a little joke in here, um, at the end, but I think that the, the, um... It was this parallel to other industries that really set the stage.
• 31:44
  I think the documented, um, kind of irrefutable, if you will, outcomes for us, and it was the three core tenants, which was the net promoter score.
• 31:53
  It was the clinical published outcomes, that we were improving clinical outcomes, and then the number of clients for whom we were doing risk sharing deals, and they were showed, um, documented financial return on investment.
• 32:04
  Those were kind of the three, okay, that's hard to argue with whatever, whatever the what is in the meat, right?
• 32:10
  We were, we were very fortunate to have a very, um, a delight- delightful, sexy maybe product demo in terms of our diabetes offering that brought that to life real time.
• 32:22
  But I really think it was the setting and the context of other industries and those three te- tent poles.
• 32:28
  The other part I would say from an IPO process, and some have been through this, is our team, you know, we had four people on the roadshow, which is pretty atypical, and the four of us worked like a seamless team, and it was obvious to investors.
• 32:42
  So we had, you know, different disciplines, different backgrounds, a clear energy that worked well together.
• 32:49
  And in fact, we had a, you know, a series of, of word games that we would sometimes play with each other in the process to keep the energy up and to keep it high.
• 32:58
  So very, very strong believers in storytelling as a part of the success, and we hit that right exactly where we were able to describe the business and throw the ball out just a little further as to what we were going to do next.
• 33:11
  That was the perfect storytelling, and we had the great group of people with the right energy cross-functionally amongst the four of us to be able to deliver that, um, on the roadshow. So, um,
• 33:24
  would a lot of entrepreneurs, Health Transformers on, on the session and will be watching that, um, are you happy you went, went public? Yes. Good. Happy we went, happy we went public.
• 33:36
  The timing was, the timing was great. I think it's a great for... It's a... You don't go, you don't go public, uh, in like, you know, going public is a, a mile marker on the road to a successful company, right?
• 33:47
  It is a massive branding event. Mm-hmm. Um, it i- it forced, it's a forcing function for a number of operational metrics that you need to have to run the business at the scale you are by the time you go public.
• 33:58
  And so I think it, we was, the right choice, the right time with the right team.
• 34:03
  And you, you leveraged that momentum in such an extraordinary way because you continued that story and, and pretty soon after, uh, that leads to the next phase I was hoping we could unpack, which is the, the big merger, uh, with, with Teladoc.
• 34:19
  Um, how quickly did that start developing? So we've, we, you know, we continuously did internal strategy work, and so that was something that I led with our team.
• 34:30
  And so we were always thinking about what's the one, three, five-year, and we had recurring sessions with our team.
• 34:36
  Um, as the, as the ecosystem was shifting, and it shifted quite drastically at the setting of COVID, right?
• 34:42
  It became very clear to us that what we were doing, but was not going to accelerate, but the acceptance of our business model was complete acceptance.
• 34:51
  Meaning, what we did is we only charged people when, charged people for users, and we were able to deliver an experience almost all remotely to improve outcomes and decrease costs.
• 35:02
  And so that remote part became vernac- like vernacular. We're all stuck in our house. It's where we get our, our, our doctor's office visits for a year because of the COVID pandemic. So it really accepted the...
• 35:12
  It, it really accelerated the acceptance of what we were doing. It was in that time period that we said, "Okay, we're now where we thought we'd be in about three years, and so what does that next act look like?"
• 35:24
  And for us, we had been building the, um, um, you know, the infrastructure to do that.
• 35:28
  We had been having conversations with a whole host of telehealth providers to incorporate providing prescribing, um, powers into our platform as we delivered care on behalf of our members.
• 35:41
  So that work had already been u- under, s- had been started. And then we had a number of other, um, areas in which we wanted to move into to d- to take more risks, so other high spend areas. So the priming had been set.
• 35:55
  You know, we started to look around the ecosystem and had, you know, a couple of different strategies to get there.
• 36:00
  At that time, um, you know, the, the, uh, Lee Shapiro, our chief financial officer, Drew Turitz, the business development person from Teladoc, took a walk and he said, "You know, we may be interested in taking a look."
• 36:12
  Now, the merger of that, it expedited and accelerated much of what we were looking to accomplish as an individual company.
• 36:19
  And so we had a long, hard conversation around, is this the right approach to combine the two to actually move forward the way we need to?
• 36:27
  Will it get us, us, uh, combined us there faster, and is it the right thing to do for the healthcare ecosystem? And the answer, as you can tell, was a yes, because we, we, we went ahead and moved, moved forward with it.
• 36:39
  Yeah. I mean, and, and in record speed, um, and, and during a p- global pandemic, I might add, um, which there's probably a whole book j- just, just in that.
• 36:50
  Um, which I think is actually a really good segue to, um, the, the moment we're in today. You know, this, this moment of a, a post-pandemic world.
• 37:02
  Um, one year ago, um, we convened our entire-Family of companies, portfolio of companies, over 300 companies, in March, a year ago, to try to understand what was going on. Oh my goodness, global pandemic.
• 37:20
  Um, it, it was really, at that point, we kind of demarcated, there was the BC world, the before COVID landscape, and now everything moving forward is after COVID. Um, we see it as this extraordinary
• 37:38
  moment, uh, a new window, if you will, to... And you kinda described this, where your three-year plan condensed almost to an immediate plan. Um, w- how do you see this moment that we're in?
• 37:52
  Um, obviously we're only a year in, um, but it seems so much has changed, um, from adoption and understanding, to market opportunity, to public market viability, to increased capital, and, and I think most significantly, um, usage of, of platforms like, like the one you all created.
• 38:17
  Um, how do you see the world today, and, and what would your, your thoughts be, um, that entrepreneurs and innovators and investors should be thinking about in this post-pandemic world?
• 38:31
  Yeah, it's a really great question.
• 38:32
  I mean, I think some of the key principles that we saw, which is the acceleration of delivering care in a user-friendly way, which means typically, like, in their house or in their office, uh, is, is likely here to stay, so a lot of the virtual components are, I, I believe are here.
• 38:50
  I think that, um, the underlying data infrastructure to understand when it's virtual versus when it's in person is still in development, and I think that we'll continue to finesse that, that, that element of, you know, some people have called it a hybrid model.
• 39:05
  I call it a brand-new model, because I think it's, again, not mashing physical and virtual together. I think it's understanding when each, each is appropriate.
• 39:13
  Um, I think that as you're looking in the ecosystem, and I spend a lot of time now, I'm, I'm working with General Catalyst, the venture company.
• 39:22
  Looking in the ecosystem, there's a lot of people whom are coming in and doing, um, the Livongo of fill in the blank, right?
• 39:30
  Um, and you've probably heard that or seen that, and the, and they're gonna do everything that Livongo did with the merger with Teladoc.
• 39:36
  They're gonna do A to Z in the telehealth component, and, and, and so there's a number of, of, uh, items like that.
• 39:42
  Now, in my mind, that, if we have 500 new companies that are going to be doing that, it's actually going to create more confusion within the ecosystem, and not less.
• 39:52
  And so I think it's this real moment for investors and for entrepreneurs to decide, what is that specific piece that you are uniquely tackling, and with whom should you partner to deliver that component, rather than kind of come into the ecosystem at a moment where virtual care is hot and say you're gonna do, do the soup to nuts.
• 40:12
  Like, what is it that still remains broken, and what is it that you're delivering on?
• 40:16
  Um, and we've seen a lot of c- of companies come in with some really great founders and really great ideas, and I think staying focused on that and looking to partner and, and build across the ecosystem is actually the way that we will create the longest term, long-standing value, um, uh, for, for healthcare, and I think that, that should be the goal.
• 40:35
  And I think w- doing that, I think you will absolutely have a successful business. So do you, do you think we're in a, almost a, a great platform race now where, where one or two or three or four,
• 40:49
  um, big platforms emerge, like Teladoc Livongo, and then these hundreds of solutions out there that maybe are more like feature sets get rolled in, into that?
• 41:01
  What do y- how do you see the next couple of years developing out? I do. I, I do think that that would be an optimal outcome, which is to look at a few of these platforms that will win. And there'll be a few, right?
• 41:14
  And they'll have different characteristics. Um, and then f- the different kind of verticals, if you will, are, will be more apps or features driven off of those, those platforms.
• 41:25
  And I think where you fit in that ecosystem, which populations, which payment mechanisms, whether it's fully in- fully insured, self-insured, Medicare, Medicaid, I think some of those will be differentiators.
• 41:37
  I think sometimes the populations will be differentiators. You know, we've seen some interesting companies looking at individual characteristics that are not, uh, distinctly condition related. You know?
• 41:47
  So, like, Folx is an interesting company, and they're, what they're, those companies are starting to do is look at, what's the engagement piece of pulling somebody into the platform?
• 41:56
  So I think there'll be a number, a number, uh, in those different directions. And so m- I often get asked, and you didn't ask, but I'll volunteer anyway, what's my biggest advice for entrepreneurs in this ecosystem?
• 42:07
  And I think it's, it's, um, uh, think consistently and every day around, what is the value that you're delivering to the end user, and why is that not in existence, and why is what you're building and delivering differentiated from the current ecosystem?
• 42:23
  And I think if you stay focused on that, you will find value in your company.
• 42:26
  That, that was the obsession that we had at Livongo, was we deeply understood how much it was hard to live with diabetes, and so we built solutions that made it easier for people to do that.
• 42:37
  And that was our, that was our success, because people wanted to stay on it. They wanted, you know, we drove better outcomes. But you can only do that if you can get people to use it.
• 42:46
  So it's, it's the obsession with the end user. I, I, I love that, and I think you layered onto that, and you mentioned the word a minute ago, collaboration.
• 42:55
  Um, and this concept of collaborative, uh, innovation where even at Livongo, you partnered at, was it Dexcom, um, a, a year ago, um, where you took your strengths and layered it on with others.
• 43:10
  I, I think you did that over and over.
• 43:12
  Um, what are your thoughts on-Leaning into what you just said, layered in with, with collaboration with others to kinda supercharge where you're at, um, to be more valuable to the end user. Yeah.
• 43:29
  I think that I, I'm a huge believer in, you know, if you wanna go fast, go it alone. If you wanna go far, go at it together.
• 43:36
  And so creating collaborations, whatever business infrastructure those look like or seem to be working for those different entities is the right, and that you need to rely...
• 43:46
  Just like on building teams, you can't do it all, but what you can do is understand what you don't have, and you can find people to do that with.
• 43:53
  And I think that is going far, is lasting value in the ecosystem and will transform healthcare.
• 44:00
  Um, I think you can do a lot of, in the musical world, a lot of one-hit wonders, right, by doing it alone, but it won't ultimately transform, um, the ecosystem unless it has long-staying power.
• 44:09
  So big fan of collaborations, partnerships. It doesn't have to be a merger and acquisition. There's lots of different ways to structure that. That's great.
• 44:17
  And I think great, and by the way, I think great entrepreneurs approach the problem with that mindset. Mm-hmm. And I've seen some who kind of approach like, "Nope, I'm gonna take my company. This is my company.
• 44:25
  I'm gonna take it public, and that's the definition of success."
• 44:28
  And you're like, okay, well, maybe that'll happen, but you have to be open-minded to think about creative ways to get to the solution that you're delivering, including leveraging all the other wonderful builders and people in the ecosystem.
• 44:42
  You, you just said a magic word, um, that's near and dear to our heart, which is mindset, and we focus on what we call the health transformer mindset.
• 44:49
  I wonder, um, through your various journeys and experience, what mindsets, um,
• 44:57
  you always look for, um, or have, have focused on, either for yourself or, or with your team, that you think translate to, uh, success? Yeah.
• 45:10
  The, the biggest one for me is, um, is the ability to ask questions and listen. A- and again, you'd mentioned CityBlock, and we both know Aya, and I've gotten to know Aya and Toyin.
• 45:21
  And I think to me that, th- they are the right founding team and the right leaders because they are constantly asking questions around how to get better.
• 45:29
  They're not telling you how great they are, and they should, they could, 'cause they're great, but they are constantly asking how to get better.
• 45:36
  And that to me is the team that will win because they're not, they're not done. They don't have the solution. They're obsessed with finding something incrementally better for the purpose that they're serving.
• 45:46
  So to me, it is about constant questioning, being able to have the hard conversation. Don't look at yourself. Don't read the press release about you. Don't congratulate yourself. Like, that is not what this is about.
• 45:57
  This is about ultimately delivering a valued service, and you can only do that if you're obsessed with doing that every day. Wonderful. Um, so we, we only have a few minutes left, uh, just about 10 minutes.
• 46:10
  Um, I wanted to get some of your predictions, um, for the future, and then we'll, we'll share, um, some biggest insights at the end. Um, so I'm gonna try to get to a few more questions.
• 46:23
  I've been trying to weave some of the questions in, uh, organically throughout, but w- where are we going? Uh, um, think out a few years, um, you know, maybe the next 10 years or so.
• 46:36
  Um, it seems like the last year has been a, one of, of transformation in many ways or really the last few years, but accelerated over the past year.
• 46:45
  Um, how do you, how do you think about the future in terms of health, um, healthcare? Are you more optimistic than a year ago? Um, what do you see developing over the, the coming years?
• 46:59
  So I'm gonna start this by saying I hate predictions 'cause I almost always get them wrong. So whatever I say, y'all, [laughs] d- don't, don't, don't put it in writing.
• 47:06
  But, um, I will answer the last part of your question for sure. I am w- super optim- optimistic.
• 47:11
  I think that all the people and the participants, you, the ecosystem, we are doing something that is, will forever change healthcare, and we have a rare moment.
• 47:20
  I do think the pandemic allowed us, um, more opportunity than we would have had, uh, i- uh, in a shorter amount of time. And so do I think that healthcare will look different in the next three to five years?
• 47:31
  Yes, absolutely. This is the transformational time. This came faster because of the pandemic than I think it would have otherwise. Um, what it will look like, I think we'll all kind of hold on and find out.
• 47:43
  I think obsessions around, um, experience will continue to exist because we understand how important people are in this ecosystem.
• 47:51
  I think obsessions around value, um, adding value into the ecosystem that have not always historically been there.
• 47:59
  I think, um, obsessions around, um, uh, access for people of all economic status will continue to be an obsession because it, it has to, because we're all in this together, and I think that part also, um, implies some around diversity.
• 48:14
  And so I, I don't know exactly what the solutions will look like, but it is an incredibly exciting time to be a part of, of the healthcare revolution from all different walks. I'm really excited.
• 48:25
  So, so it sounds like you're gonna stay in the ecosystem, stay in the industry, which is- [laughs]... awesome. Um, I hope that's the case, and it seems like it from all the great things that you're continuing to do.
• 48:36
  Um, we got a great question that came from, uh, Dr. Pierre. Um, he says, "How would you suggest medical providers who see issues in the system," um, maybe as you did when, when you were a practicing physician, um, be...
• 48:52
  what could they do to become change agents in healthcare, um, particularly without prior business experience? Yeah. Thoughts to the physicians who maybe wanna become doctor-preneurs out there.Right.
• 49:05
  So I think first and foremost that, um, we physicians in the ecosystem have unique track, unique insights to actually really understand the fine details of what's not working, um, and I think the responsibility to therefore do something about them.
• 49:20
  And so what I would say is, as a physician, and you're looking at the flow of patients or experiences or outcomes, and there are things that are really top of the list that are not working, spend a little time and research.
• 49:31
  Is there somebody that's starting to tackle that piece of the puzzle? If there is, they will love to hear from you. They will love to hear from you as a physician. You don't have to start your own company.
• 49:41
  You can, but there is, um, almost without a doubt somebody working on that. And if you don't find something, those are great ideas to bring to the venture companies that do a lot of hatching.
• 49:52
  And Unity knows about this, right? Like, where are we, where are the hatches starting to happen, right? Where we've identified a real issue, and like thinking about creative solutions to make that better.
• 50:02
  There are a number of organizations throughout that are really interested in helping build out solutions to the broken pieces of the puzzle that are not yet fixed. So, so true.
• 50:11
  Um, so maybe take out your, your magic wand. Um, and, you know, a- as a, as a mother, as a patient, as a doctor, as a entrepreneur, as an investor, um, what do you want more of?
• 50:29
  What do you wish the ecosystem to be creating now? If you could wave a magic wand and, and more entrepreneurs and innovators were doing X, what, what would that be? Yeah, it's a really great question.
• 50:42
  I, I was thinking about this a little bit on my run today, and, um, there is a lot of entrepreneur, um, em- emphasis and energy around virtual care. Um, and I do believe that that's important.
• 50:54
  We've seen the COVID pandemic, but there are still whole swaths of the ecosystem that remain broken, right?
• 51:01
  And so today I was thinking about medications and this idea around access to medications and affordability of medications, and we haven't really cracked that.
• 51:10
  There's been some, some progress there, but as writ large, as we look at specialty medications, or me with Type 1 diabetes, how hard the system makes it to actually get a medication that I absolutely have to have to live, right?
• 51:23
  There is... And that is not COVID dependent.
• 51:26
  And so I think that there is this tension between riding the wave of where we are with the acceleration of digital health companies, um, which is good, but there are still a number of broken pieces that remain that need to be fixed, um, i- in addition to the wave.
• 51:40
  And so I'm starting to think about those two different buckets and making sure that we're not just putting all of the energy into kind of the, the crisis of the moment, which I do think we should be riding, but that we continue to focus on the other bucket as well.
• 51:54
  Um, I just wanna thank you, Dr. Snyder, for, um, really being such a great, um, inspiring leader within the, the ecosystem for so many years.
• 52:05
  It, it really, um, is wonderful to see your, your success, the success of the companies you've helped build.
• 52:13
  Um, and, and I think there's, there's so many health transformers and entrepreneurs that see that and, and now, uh, see what's possible, um, can, can tell their stories better to, to the investor community, to, to the customers.
• 52:31
  And I think, um, the ecosystem of, of customers and investors, um, is now inspired more than ever before, and I think, um, that's in great part to the, the work that you and your teams have, have done over the years.
• 52:44
  So I just wanted to thank you, and also thank you for sharing your wisdom with the StartUp Health community, and, uh, we hope to see you again soon, maybe at the next, uh, StartUp Health festival, uh, soon. I hope so.
• 52:58
  Thank you, Unity, for the opportunity to, um, have a conversation with you. Um, I am inspired by the work that you do and the t- people on this, uh, and listening to this are doing as well.
• 53:08
  It's a collective we sport, and there's a lot of work in front of us. We have a, a lot of opportunity and a lot of work.
• 53:14
  [upbeat music] StartUp Health invests in health transformers from around the world who are committed to achieving audacious health moonshots.
• 53:28
  If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 330 companies, go to startuphealth.com. Thanks for listening to StartUp Health NOW. We'll be back next week.
• 53:40
  [upbeat music]