Patients First — Scale (Part 3)
Utilize your scale-optimized components and established brand & relationship to reach the full potential of your product in new markets, then extend beyond it towards your greater vision.
This was originally published on Medium.
This post is Part 3 of a series. Click for the Overview, Part 1, and Part 2.
Expand your core product to new markets
Expand your core product itself
Expand your core product to new markets
At this point, ideally your product has three qualities: product/market fit in your first area of focus, end-to-end with embedded modularized tech and processes, and a formed relationship with your patients. Now is the time to expand towards new strategic focuses.
Your modularized components and relationship with patients will facilitate these expansion efforts, but of course it’s important to anticipate where these elements are applicable and where new considerations are necessary. Blind spots are inevitable, but you can mitigate their total volume strategically.
Notably, Oscar prioritizes new markets through “Network Scorecards”, through which they’ve evaluated 350+ markets based on developed metrics considering access to care, quality, population health capabilities of health systems, etc. Meanwhile, while launching Rory (Ro’s women’s health vertical), Dr. Melynda Barnes noted that a key learning was regarding awareness of women’s health issues — while Roman was able to learn from 20 years of DTC Viagra marketing, Rory’s launch felt the challenges of women’s health issues not being mainstream. As such, they had to build processes around education and awareness for relevant topics.
If you’ve constrained geography, these are the paths for geographical expansion:
Pure geographical expansion (ex. relocating to new city)
New customer types (ex. aggregated demand, product distributors, self-insured employers, MA markets, etc.)
Strategic business development
If you’ve constrained categories, these are the paths for categorical expansion:
Needs of existing patient base
New patient types
Strategic partnerships can provide both categorical and geographical expansion. If the partnership company’s values and product aligns thoughtfully with yours, it’s a powerful way to expand your reach.
Capsule
Geographical expansion: After three years purely in NYC, Capsule has begun its national expansion, starting with Boston, Chicago, and the Twin Cities, and citing the cities’ health systems’ innovative histories and COVID as the main reasons.
“To support this unconventional model, we have an unconventional growth plan. Rather than open one market at a time, we are working to lay the foundation — the people, the process and the technology — to enable us to expand in a different way, and in continued partnership with all of the stakeholders in health care.” — Kinariwala
Strategic partnerships: Capsule hasn’t been very public about its partnerships, but in December 2019, a partnership with Oscar was announced.
Cedar
Strategic business development: Cedar engages in innovation development partnerships — notably health systems ChristianaCare and Novant Health in creating a pre-visit product.
New customer types: Originally starting with provider groups, Cedar began expanding to AMCs, national staffing agencies, oncology groups, and HCOs.
Maven
New customer types: After starting DTC, Maven was one of the pioneers of selling to self-insured employers, and has since also sold to health plans.
Existing patient needs: Maven’s launch of Maven Campus was inspired by the organic demand and niche needs of college women.
Strategic business development: Most recently, Maven partnered with MassHealth to provide free COVID-19 telehealth assessments in Massachusetts. Early on, Maven converted consumer company Snap into an evangelist customer, allowing for further success with Fortune 500s. Maven also piloted Maven Campus at NYU, Columbia, and Fordham.
Strategic partnerships: Maven’s partnership with the health benefits navigation platform Castlight Health allows easy Maven integration for Castlight customers.
Oscar
Geographical expansion: Oscar will be expanding to 12 new markets in 2020 to a total of 26, as a part of its plan to “expand at a rate of 4–5 cities every year, in individual, small group, and other market segments.”
New customer types: Medicare Advantage, Small Business
Strategic business development: Oscar’s network construction often relies on partnering with marquee health systems in the market, like Cleveland Clinic and Mount Sinai, or insurance companies, like Humana and AXA.
Strategic partnerships: Oscar’s forays into new customers were augmented by partnerships with Uno Health (for Medicare Advantage) and Cigna (for small business owners).
Ro
Existing patient needs: Zero was launched as a result of “thousands of members asking for our help on how to attack the root cause of their ED.”
New patient types: Rory provides Ro with access to the 50% of the population not covered by Roman.
Strategic partnerships: Ro partnered with Gelesis to distribute Plenity, entering into weight management.
Trialspark
New patient types: Trialspark continually offers new conditions — currently with capacities in dermatology, pulmonology, gastroenterology, and endocrinology. Trialspark’s partnership with Pfizer is focused on inflammation and immunology, extending beyond existing programs (at the time) in skin conditions (vitiligo, atopic dermatitis, psoriasis and alopecia).
Strategic partnerships: Trialspark partnered with 23andMe to enhance patient recruitment and enable genotyping-based studies, and with Limbix to extend into digital therapeutics. Most recently, Trialspark, with Sam Altman (YC, OpenAI) and Dr. Mark Fishman (Harvard, Novartis), launched Project Covalence, a project focused on COVID-19 project acceleration.
Expand your core product itself
We’ve established that deepening your relationship with your patient through a longitudinal experience is critical. Naturally, this can be accomplished through impacting your patients through more parts of their patient journey. You need to identify net new offerings for your patients, upstream or downstream from where you currently operate in your patients’ care journey. If your direction is thoughtful, you’ll have the added benefit of unlocking new patient personas, expanding your broader reach.
This requires moving beyond your current core competencies. While new market expansion meant modifying your modularized components, here you will have to build essentially from scratch, while continuously assessing fit with the existing product and still designing for scale. Strategic partnerships can also be used to provide lift.
Capsule
Capsule has focused on national scale as its key priority for its next 18–36 months, and has been generally vague about any other priorities. However, Eric Kinariwala has hinted at plays in medication adherence and a patient front door experience on their patient-centric efforts.
“That needs to be the go-to, high-trust brand that you go to get anything with your healthcare whether that’s your prescriptions, whether that’s seeing a doctor online, whether that’s booking an appointment, whether that’s buying non-prescription products.” — Kinariwala
Cedar
Cedar is expanding from the post-visit experience (patient billing) to activities that occur pre-visit, including check-in tools and price estimates for visits, the latter enabled by a new partnership with Waystar. The company envisions eventually branching out beyond financial workflows as well.
Maven
Maven’s moves downstream have included forays into return-to-work care with Maven Milk, a nationwide breastmilk delivery service, and the acquisition of Bright Parenting to complement its forthcoming Parenting / Pediatrics product. Meanwhile, Maven Wallet accommodates the expenses/reimbursement experience and minimize claim rejections
Maven Planning, Maven’s latest launch, sees Maven moving upstream to innovate the preconception experience.
Oscar
Among its many initiatives, Oscar has continually invested into extending downstream into elements of care delivery. Virtual Primary Care includes virtual visits with primary care providers, but also a wide variety of other services for no cost to the patient — Tier 1 Prescriptions, durable medical equipment (DMEs), diagnostic imaging, vitals monitoring kits and in-home lab draws, all free and delivered to a patient’s home. In addition, Oscar announced a $3 Prescription List for commonly prescribed drugs.
Oscar’s partnership with Capsule will bring same-day delivery to eligible markets, while its Eligible integration enables point-of-visit cost transparency.
Oscar Center, launched in 2016 through a partnership with Mount Sinai, is a test lab for new provider products, but also could be a play for an expanded brick-and-mortar presence, as Nisarg Patel notes.
Ro
Ro’s $200M Series C will go into building its Collaborative Care Center, enabling downstream patient experiences in remote patient monitoring, chronic disease management, urgent care, and at-home testing through integrated devices. Additionally, Reitano envisions creating a more holistic care experience through building for additional downstream health providers, such as nutritionists, therapists, and social workers.
Ro’s partnership with Ribbon enables Ro to direct its patients to an offline, in-person care experience.
“We built our diagnostics ingestion and management infrastructure with these advances in mind so that as they enter the market, we can seamlessly integrate connected devices and sensor data into our platform.” — Todd Levy, Ro CTO
Trialspark
Trialspark envisions moving into patient outcomes in the long-term — “After a drug’s been approved, it’s almost just as important to understand the outcome these interventions make. We think we’ll play a non-trivial role in the value-based reimbursements discussion — how do we understand, after a drug has been approved, what outcome it’s making for a patient? There’s opportunity for us to contribute the evidence that’s needed to understand that.” — Liu, 38:57
Looking forward
Building in healthcare now is eaier than ever. The examples set by these organizations offer digital health legitimacy and unprecedented clarity in strategy. API enablers are emerging that allow newer organizations to quickly plug into and work with the healthcare data ecosystem — Particle Health and Redox for patient data, Ribbon Health for provider/insurance/cost data, Eligible for billing information, Commure for healthcare platform development, to name some of the best. The incubator and venture studio models (Redesign Health, AlleyCorp, Oxeon Partners) are seeing success as well, providing shared talent and ideation while distributing risk.
While how to build becomes an easier question to answer, what to build remains a persistent question. To start, the entire patient journey hosts a wealth of problems. I’m compelled by the approaches of Spring Health and Ginger in mental healthcare, Tia for women’s health, and Ride Health for patient logistics and transportation, largely due to their similarities with the approaches discussed in this series. Additionally, I think the continued rise of companies in this mold holds intriguing implications down the line in the problem spaces of patient routing, deeper automation of CBT, outcomes quantification/attribution, microinsurance, and value-based healthcare pricing/payment.
Still, there are so many trails left to blaze. The examples set by these companies establishes a clear theme — healthcare needs more boldness. As Malay Gandhi says, “the most exciting health tech companies will ignore the parts of healthcare that have become obviously anachronistic, actively discarding convention”. Rip out the assumptions, have a vision of what healthcare should be, then strive to be an entity to be reckoned with in that future.
