As a driving force behind e-commerce game changers like PayPal and Google Wallet, Stephanie Tilenius has already helped transform the way we shop. Now, she's hoping to bring that same sense of revolution to the healthcare industry.
Healthcare spending in the U.S. is estimated at more than $3 trillion, with more than 75% of that is spent on people with chronic conditions, according to the Centers for Disease Control and Prevention. Vida Health, which Tilenius cofounded in 2014, aims to lower these costs and improve people’s well-being using a subscription-based app that pairs patients with health coaches.
The San Francisco-based company says its mission is “to use technology to connect people to provide continuous, connected and collaborative healthcare that drives better outcomes at a lower cost.” I spoke with Tilenius about the details of that vision and why she thinks this is an exciting time for health technology. This interview has been edited and condensed for clarity. You can hear the full interview on Inflection Point.
Fortune: What does your mission statement mean, in practical, everyday terms?
Stephanie Tilenius: We're trying to help people stay healthy and prevent against chronic disease. If you have a chronic disease, we help you manage it so you live longer and healthier. And we save insurance companies and employers money by helping their members and employees stay healthier.
Walk us through the experience of someone who has just signed up for the app.
After you’ve downloaded the app, you're instantly connected to a coach. You give us a little information about yourself, and then we match you to five health coaches from which to choose. It's a HIPAA-compliant app, so it's safe from a privacy perspective. All of your health data can be shared there, and you will start messaging with a coach and defining your health goals. It's sort of like Facebook Messenger and FaceTime all in one place. Then, depending on whether you have a chronic condition or whate your goals are, we can help you, and we put you on a program or you start tracking. For example, we connect over 100 apps and devices so we can get all your data and learn more about you. It's an on-going, continuous relationship.
How does this work with insurance?
We are working with insurance companies to get reimbursement and to be part of your HSA. We are also working with large employers and insurance companies to roll it out as part of a benefit.
If you read the fine print of Obamacare, there's up to 30% of employee spend on health care. So, if an individual has a $10,000 total annual spend, the employer is allowed to give them up to 30% of that back in incentives. They're called participatory incentives and outcome-based incentives.
We see a lot of employers giving out bonuses for participating in biometric screening or coaching. If you achieve certain health goals, such as number of steps taken or blood pressure or cholesterol level, they'll give you a discount. We've seen employers go up to $2,500 a year cash back to the individual, which is quite meaningful.
Why is the role of biometric screening?
Many employers want you take a blood test, so we take the claims data and map it to biometric and behavior data, allowing us to give them a profile of the risk of their population.
Where does a doctor come into the equation?
We work with doctors. In fact, we've had doctors who recommend Vida, and then their patients come back and they've lost weight and improved their blood sugar level and the doctors are really pleased. Doctors spend 7 minutes, on average, with a patient. They don't have time for day-to-day progress reports. We have a report that we send back to the doctor as well.
What is the role of the health coach?
We have a national network of coaches, and it includes specialists such as nutritionists, personal trainers, cardiac nurses, and diabetes educators. They create specific, individualized programs to help users reach their health goals.
You have different types of coaches — the cheerleader, the innovator, the drill sergeant. How did you come up with these profiles?
When we first started hiring coaches we were very focused on clinical expertise. We had nurses from UCSF, Stanford, Duke—all over the country. We quickly realized that successful coaching depends on a combination of clinical expertise as well as empathy, and the ability to get at the inner motivations of individuals. We learned how to match personality to the individuals they would actually stick with. We now allow people to pick the coach and their desired way of working.
What's your preferred coach type?
I like a drill sergeant. I like someone who's positive, of course, as well, but someone who is aggressively keeping me moving and pushing me.
How does having your own company impact how you spend your day and what does it mean for managing your own health?
It's very similar to my entire career in the sense that we're building a new business, we're building a new platform, and it's intense as it always has been. I've always been a builder. Even at eBay I was really an intrapreneur and building new businesses there. The same at Google. It really doesn't feel that much different. The benefit of a startup is you can be a lot more agile.
The other fun part is that you get to set the culture. For example, we do a monthly challenge, and every time we have something new in the challenge. Like today at lunch we did our sit-ups, our v-ups, and our push-ups. Most of the company participates, so we can create the kind of culture we want. We do get our exercise in, and every Friday at 5 p.m. we have a run around San Francisco, and most of the company participates. It's great fun.
When you started Vida, were you employed full time elsewhere?
I was tinkering for a while before I started Vida. I did a bunch of prototyping, and then I really had the conviction to do it. I was intrigued by health care. I have used all these different apps, and I have all these devices, and I was doing triathlons at the time and testing everything. My parents both had chronic conditions, so I was interacting a lot with the health care system, and then all these ideas were flowing. I knew there was a solution in there, so I was just prototyping to see what I thought would make sense.
Vida must be collecting a ton of data. Are you figuring out why Americans are in such bad shape?
We spend $3 trillion on health care, and it's actually kind of scary. $8 out of $10 in health care spending goes to chronic conditions, many of which could be prevented. Our goal is to understand populations, even getting down to which coach personality matches which demographic and condition. So there's a lot of algorithmic work on the back end. I think you're going to see even outside of Vida, across health care and digital health in the next decade, this move towards precision, personalized medicine.
Why is that?
There's this confluence of events. There's mobile, social obviously, and cloud-based solutions that are evolving so we are actually getting at the individual, and getting at their behavior data, and their biometric and even their genomic data. But it's even more than that. It’s the hardware. We'll have nano sensors in our body, and we'll be able to detect markers ahead of actually getting a disease. It's a really exciting time.
Do you have goals for how this kind of treatment will make a dent in chronic illness?
Primary care doctors don't have time to manage an individual's nutrition, stress, sleep, and exercise. We fill that gap, and I believe health care is moving toward a continuous-care model. You have all your data in the cloud, you're talking to the experts you need to, you don't have to go see a physician as often, and you're more proactively managing your care and getting advice. There's also automated intelligence that will fill in the gap so we can leverage the doctors for the 1%, the top of their license, where we need them the most.
How is this going to help someone who has a problem, but doesn't want to go to the doctor anyway?
We recently had a woman sign up who didn't even know she was diabetic. Her coach figured it out very quickly and said, "Actually, you need to go see a doctor." She went to a doctor and the doctor was like, "Thank God you came across this app, and this coach, because I think it saved your life." Sometimes people say they want to talk about weight loss or fitness, and then we realize they actually have a condition.
Is there a down side to all this? Is there anything that could go wrong with this scenario? Not doing it the old-school way, going to the doctor?
I think the old-school way is working, but it's not very convenient for a lot of folks. A lot of people just don't have time to go to the doctor. People have their mobile phones, and they check it 150 times a day, and they can easily communicate with a healthcare professional on their phone through video. Why wouldn't you do that?
You started another company in 1998 that went public during the big tech bubble, PlanetRx.com. Is this kind of coming full circle for you? Is this a bit of a redemption?
We had an online pharmacy, and I did at the time have a vision for disease management and some of the stuff we are doing today, but the technology was not there. I've had some elements of what we're doing at Vida in my head for a long, long time, but it just so happens that right now the technology, between mobile and cloud, really enables it.
What's the best advice you ever been given about doing something that's never been done before?
Start with a tangible prototype, start small, or start with a sample set of customers. I think Paul Graham is famous for saying this with Y Combinator startups: "Do something that is non-scalable, and just start.” Just lay one brick. There's going to be thousands and millions of bricks that you need to put on top of that, but just get started.
Lauren Schiller is the host of Inflection Point, a public radio show and podcast featuring conversations with women who are changing the status quo. The above article is an edited and condensed version of the broadcast interview. Click here to listen to the full audio.