Sean Duffy, Omada, on scaling virtual specialty care

In this episode of the Pulse Podcast, co-host Alex West welcomes Sean Duffy, the co-founder and CEO of Omada Health, a pioneering virtual integrated care solution that addresses chronic health issues like diabetes and hypertension. Omada has made significant strides in the healthcare landscape, partnering with over 1,500 employers and health plans to support more than half a million members, while recently securing a remarkable $192 million in Series E funding. Sean shares his fascinating journey from aspiring astronaut to health tech innovator, discussing how his background in neuroscience and experience at Google shaped his vision for Omada.

Listeners will gain insights into the challenges and triumphs of launching a digital health company in a crowded market, as Sean elaborates on Omada's unique approach to delivering comprehensive care that integrates behavioral health support. The discussion also touches on the evolving role of employers in driving healthcare innovation, the importance of evidence-based solutions, and the future of virtual care in a post-pandemic world. Sean’s experiences and the lessons learned along the way provide valuable takeaways for anyone interested in the intersection of healthcare and technology.

Here are some key life lessons from Sean Duffy's journey and insights shared on the Pulse Podcast:

Follow Your Interests

Sean’s initial dream of becoming an astronaut highlights the importance of pursuing passions. Even if paths change, nurturing curiosity can lead to exciting opportunities.

Embrace Uncertainty

Sean’s decision to pivot from a traditional medical career to founding Omada illustrates that it’s okay to take risks and explore uncharted territories, especially when driven by a desire to make a difference.

Integration of Fields

Combining technology and healthcare is not just innovative; it addresses real-world problems. Sean’s journey emphasizes the value of interdisciplinary approaches in solving complex issues.

Value of Evidence-Based Solutions

Building a company on solid research and clinical trials is crucial for credibility. Omada’s commitment to evidence-based practices sets it apart in a crowded market.

Adaptability is Key

The ability to pivot and adapt to market needs, like Omada’s expansion into musculoskeletal care, demonstrates that flexibility can lead to sustained growth and relevance.

Collaboration Over Competition

Emphasizing partnerships with primary care providers rather than competing with them shows that collaboration can enhance care delivery and improve patient outcomes.

Long-Term Vision

Sean highlights the importance of patience and strategic planning in entrepreneurship. Success often requires a long-term commitment rather than chasing quick wins.

Learning Through Experience

Sean’s advice to aspiring entrepreneurs to engage in startups and side projects underscores the value of hands-on experience in developing practical skills.

Focus on Impact

Sean’s reflection on his contributions at Omada compared to traditional medical practice illustrates the idea that one’s impact can often be greater in innovative roles than in conventional paths.

Resilience in Challenges

The discussion around navigating tough fundraising environments and market volatility reinforces the lesson that resilience and adaptability are essential traits for sustained success in any venture.

Childhood Aspirations

Sean Duffy grew up dreaming of becoming an astronaut, showcasing an early fascination with exploration and innovation, which later influenced his career in health technology.

Educational Background

He pursued a degree in neuroscience and behavior at Columbia University, driven by a blend of his interests in technology and healthcare, inspired by his mother’s nursing background.

Initial Career Path

After graduating in 2006, Sean took a job at Google instead of immediately attending medical school, realizing the potential for technology to intersect with healthcare.

Pursuing Medical Education

He enrolled in Harvard’s joint MD/MBA program, indicating a desire to combine clinical knowledge with business acumen, essential for future health tech endeavors.

Internship at IDEO

During a required internship blending business and medicine, Sean discovered the transformative potential of digital health solutions, which led him to pivot from traditional medical practice.

Founding Omada Health

Inspired by the gaps he identified in the healthcare system, he co-founded Omada Health in 2011, aiming to create evidence-based digital health solutions that provide real clinical and economic value.

Recognition of Healthcare Challenges

Sean noted the skepticism between tech and healthcare sectors in 2011, motivating him to ensure that Omada’s solutions would be significantly better than traditional care options.

Building a Unique Company

He embraced the idea of being a builder at heart, focusing on creating innovative solutions rather than following a conventional medical career path, which he felt might not maximize his contributions to society.

Impact on Leadership

By choosing to lead Omada instead of completing his medical training, Sean believes he can make a more significant impact by addressing systemic healthcare issues through technology.

Vision for the Future

Sean remains hopeful about the future of healthcare technology and its potential to transform patient care, paralleling his childhood dream of exploration and innovation.

Initial Inspiration

The speaker was drawn to medicine with a desire to give back to humanity by improving health and addressing healthcare challenges, reflecting a strong belief in service and contribution.

Self-Reflection

After spending time at Omada, the speaker realized that their contributions to healthcare through entrepreneurship were more impactful than what they could have achieved as a doctor, highlighting the importance of self-awareness and recognizing one’s strengths.

Understanding Market Needs

The speaker identified a gap in the healthcare system, emphasizing the need for continuous, day-to-day support for patients, particularly in managing chronic conditions like diabetes and hypertension.

Innovative Solutions

Omada was founded with a digital-first approach to healthcare, focusing on creating a supportive ecosystem for patients that includes connected devices and dedicated care teams, illustrating a belief in leveraging technology for better health outcomes.

Holistic Care Model

The development of a comprehensive care model at Omada, which includes hardware, health coaching, and community support, reflects a commitment to addressing both the physical and emotional needs of patients.

Strategic Market Focus

The company targeted self-insured employers early on to ensure that their services were covered and accessible, demonstrating a strategic approach to market entry and sustainability.

Building Relationships

The emphasis on forging strong relationships with employers and health plans has been crucial for Omada’s growth, showcasing the importance of networking and collaboration in business success.

Resilience in Business

The speaker noted the competitive nature of the healthcare market and the necessity of perseverance, reinforcing the belief that success often requires long-term commitment and resilience.

Adapting to Change

The speaker acknowledged the dynamic nature of the virtual care market, indicating a belief in the importance of adaptability and continuous innovation to stay relevant.

Long-Term Vision

The focus on playing the long game in healthcare sales and operations underlines a belief in patience and strategic planning as essential components for achieving significant impact in the industry.

Recognizing the Importance of Trust

Early on, the founders of Omada understood that establishing trust in digital health was crucial. They invested a million dollars to achieve high trust accreditation, knowing it would be a time- and capital-intensive process.

Building a Strong Evidence Base

The team prioritized clinical trials and research, creating a robust evidence base that differentiates Omada in the market. They recognized that digital health solutions would face skepticism without substantial proof of efficacy.

Setting High Standards

By committing millions annually to clinical research, Omada aimed to set a standard for digital health, ensuring their solutions could pass the “medical director test” and be recognized as credible in the healthcare community.

Strategic Expansion

Omada adopted a selective expansion strategy to address the complexities faced by employers managing multiple point solutions. They aimed to simplify care delivery by offering a holistic approach to various health conditions.

Responding to Market Needs

As employers expressed fatigue with managing numerous contracts and care plans, Omada positioned itself as a comprehensive solution provider, alleviating administrative burdens while ensuring high-quality care.

Flexibility in Offerings

Omada remained adaptable, allowing clients to start with specific services (e.g., musculoskeletal care) while also promoting the benefits of their broader offerings, reflecting the evolving nature of the healthcare market.

Understanding Care Delivery Limitations

Recognizing that not all care can be delivered virtually, Omada conducted an analysis to determine which services could realistically be provided online, revealing that about one-third of care could be managed digitally.

Commitment to Collaboration

Omada emphasized its role as a partner to primary care providers, aiming to complement rather than compete with in-person care, and positioned itself as a support system for managing chronic conditions.

Investing in Integration and Coordination

To enhance the patient experience, Omada focused on interoperability and coordination between digital and in-person care, ensuring seamless transitions for patients who require both types of services.

Building a Sustainable Future

By addressing the complexities of healthcare delivery and fostering strong relationships with primary care, Omada aims to create a sustainable model that enhances patient outcomes while navigating the evolving healthcare landscape.

Recognition of Fragmentation

The speaker identifies a significant concern in digital health regarding the fragmentation of solutions that exist outside the traditional healthcare system, emphasizing the need for integration.

Commitment to Integration

They express a strong commitment to gradually creating a seamless experience between digital health solutions and in-person care, aiming to enhance the overall healthcare experience for patients and providers.

Feedback from Primary Care Providers

Through listening sessions with primary care providers, they learn that clinicians desire evidence-based, concise summaries of patient data rather than overwhelming raw data, highlighting the importance of digestible information.

Focus on Accountability

They emphasize the role of coaches in the Omada platform who not only support patients but also ensure that necessary actions, like medication adjustments, are communicated back to primary care providers (PCPs).

Market Readiness for Chronic Care Solutions

The speaker notes an increasing interest from providers in chronic care management, especially as many are now entering risk-based arrangements, indicating a shift in healthcare delivery models.

Addressing Overburdened Primary Care

They highlight the challenges faced by primary care providers, such as high attrition rates and an aging population, which necessitate innovative delivery models to maintain healthcare quality.

Operational Partnership with Providers

The speaker discusses the importance of being an operational partner to providers, particularly in fee-for-service environments, to enhance the integration of care without necessitating direct payments for services.

Self-Insurance Dynamics

They explain the significance of self-insured employers in the healthcare landscape, noting that employers bear a substantial portion of healthcare costs and have the potential to drive innovation in the system.

Evolving Employer Sentiment

The speaker observes a shift in sentiment among employers and benefit managers as they seek better healthcare solutions due to rising costs and employee dissatisfaction, positioning Omada as a key player in this transformation.

Empowerment through Innovation

Ultimately, the speaker believes that as employers recognize their power and responsibility in healthcare spending, there is an opportunity for digital health solutions like Omada to lead the way in improving care delivery and reducing costs.

Vision for Change

The desire to start a nonprofit focused on creating active internships and partnerships between MPH schools and benefits organizations stemmed from recognizing the unique needs of large employers and their healthcare spending challenges.

Identifying Gaps in Care

The realization that simply transitioning in-person care to virtual formats during COVID-19 was insufficient, leading to the belief that innovative care models are essential for effective healthcare delivery.

Market Validation

Conducting a survey to gauge attitudes towards virtual care confirmed the belief that virtual care is here to stay, but it also emphasized the need for a deeper integration of virtual capabilities within the healthcare system.

Strategic Confirmation

The results of the survey reassured the leadership that Omada was on the right path, reinforcing their approach to integrating virtual care into existing healthcare ecosystems.

Acknowledging the Nonlinear Journey

Understanding that success is rarely a straight line, they recognized the importance of overcoming challenges and making mistakes along the way, which ultimately led to growth and learning.

Innovative Pricing Model

The decision to move away from a per-member-per-month pricing strategy to a model that charges based on actual usage allowed for better alignment with client value and operational efficiency.

Pioneering Billing Solutions

Successfully contracting as a covered entity and creating the first digital-specific CPT code through collaboration with the American Medical Association transformed how they billed for services, integrating them into the healthcare billing ecosystem.

Value-Based Approach

Developing a value-based pricing model that treats their services as proper medical expenditures rather than wellness budget items created a more sustainable financial structure for the business.

Commitment to Innovation

The belief that continuous innovation in digital experiences and care models is crucial for the future of healthcare, driving their push for more integrated solutions in the market.

Future Aspirations

A hopeful outlook for the future, with an emphasis on fostering a flywheel of innovation in healthcare by advocating for better clinical expertise within benefits teams to address the unique needs of diverse populations.

Foundational Trials

The success of Omada in acquiring its own CPT code was primarily due to the rigor and evidence provided by extensive clinical trials, establishing a strong foundation for their digital health model.

Massive Fundraising Round

In a strategic move, Omada raised a substantial $192 million in a Series E funding round, aimed at enhancing their operational capabilities and preparing for a potential public market entry.

Integration of Services

With the new capital, Omada focused on integrating behavioral health support into their existing product lines. This was based on the understanding that managing chronic conditions like diabetes often involves addressing co-occurring mental health issues like depression.

Prudent Financial Management

Acknowledging the uncertain economic climate, Omada adopted a cautious approach to spending, ensuring they could sustain operations and profitability even if the downturn in the market extended for years.

Recognition of Market Challenges

The leadership recognized the tough fundraising environment and the challenges facing startups, particularly those lacking a solid business model or product-market fit, which could hinder their survival.

Emphasis on Talent Retention

Despite the difficulties in fundraising, there remained a strong demand for talent in the digital health sector, indicating that innovative individuals would continue to find new opportunities to contribute.

Anticipation of Market Recovery

The team expressed optimism about the future, suggesting that while the current environment was challenging, historical patterns showed that economic downturns would eventually lead to recovery.

M&A Strategy

Omada considered mergers and acquisitions as a potential avenue for growth, particularly for integrating companies that offered complementary services, though they approached these opportunities selectively.

Focus on Integrated Experience

The acquisition of a musculoskeletal care company highlighted Omada’s commitment to creating a seamless, integrated healthcare experience that combines technology with clinical support, enhancing patient care.

Vision for Future Growth

With a solid financial base and a clear vision for integrating services and enhancing patient experience, Omada positioned itself for future acquisitions and sustained growth in the digital health market.

Initial Vision

The journey began with a clear vision to build a business focused on addressing healthcare needs, rather than simply aiming for a quick exit or IPO.

Listening to the Market

Armada’s leadership committed to staying attuned to buyer feedback, ensuring their offerings aligned with market demands while maintaining a focus on their core products.

Cautious Approach to IPO

Despite being on the verge of going public, the decision was made to delay the IPO to ensure careful planning and a strong organizational foundation, recognizing that going public is just the start of a new chapter.

Long-Term Strategy Over Short-Term Gains

Emphasizing the importance of long-term stability, the leadership acknowledged the potential volatility of public markets and the distractions it could cause for employees and the business.

Valuing Practical Experience

The advice offered to aspiring entrepreneurs highlighted the importance of gaining hands-on experience in startups, reinforcing the belief that real-world exposure is invaluable for future business leaders.

Encouragement of Side Projects

Aspiring entrepreneurs were encouraged to engage in side projects as a way to practice entrepreneurship, emphasizing that practical experience fosters essential skills and creativity.

Hiring Philosophy

When hiring MBAs, the focus shifted from the degree itself to evidence of practical accomplishments, seeking candidates who demonstrated creativity, energy, and a drive to progress businesses.

Personal Growth through Challenges

The founder reflected on his own growth journey, noting that starting Armada from scratch provided unparalleled education and experience, reinforcing the belief that challenges lead to personal and professional development.

Commitment to Mission

The passion for Armada’s mission and the desire to continue contributing to its growth underscored a belief in the importance of meaningful work over traditional career milestones.

Embracing the Journey

Ultimately, the narrative conveyed that entrepreneurship is a continuous learning experience, where the journey itself is as significant as the destination, fostering a mindset of resilience and adaptability.

Discovery of Passion

The speaker realizes their love for building and creating, which opens up a new world of possibilities beyond traditional paths.

Embracing Startup Culture

They immerse themselves in the startup environment, recognizing it as a fertile ground for rapid career development and skill acquisition.

Skill Diversification

Over time, they accumulate a diverse set of skills and tools, likening it to building a “palette of instruments” that enhances their ability to innovate.

Reevaluation of Goals

The speaker reflects on their past desire to attend medical school, acknowledging that while it could be fulfilling, it no longer aligns with their current ambitions and contributions.

Valuing Experience Over Tradition

They come to appreciate that real-world experience in a dynamic setting can be more valuable than formal education at this stage of their career.

Commitment to Contributio

The speaker expresses a strong desire to focus their efforts on areas where they can make the most significant impact, steering away from paths that may not utilize their unique skill set.

Networking and Collaboration

Engaging with like-minded individuals in the podcast, they reinforce the importance of community and collaboration in personal and professional growth.

Continuous Learning

They emphasize the importance of ongoing learning and adaptation, a mindset fostered by the ever-changing nature of startups.

Gratitude for Opportunities

The speaker expresses appreciation for the opportunities that have shaped their journey, highlighting a positive outlook on the unpredictability of career paths.

Aspirations for the Future

They conclude with a forward-looking perspective, eager to explore new ventures and continue building on their diverse experiences.

1. Personal Background and Early Inspiration

– Sean Duffy dreamed of becoming an astronaut when he was a child and still holds that aspiration, expressing hope for future space travel opportunities.
– He has a two-year-old daughter who frequently asks him if they can go on a rocket ship together, reflecting his desire to share that experience with her.
– Sean grew up in Colorado and was a self-proclaimed computer geek during high school, indicating an early interest in technology.
– His mother was a nurse, which influenced his interest in science and healthcare from a young age.
– He studied neuroscience and behavior at Columbia University, fulfilling all pre-med requirements but ultimately chose not to go directly to medical school.
– Sean worked at Google for a couple of years, where he realized the potential for integrating technology with healthcare.
– He attended Harvard’s joint MD/MBA program, which provided him with a blend of medical and business education.
– His internship at IDEO, intended to be a brief experience, unexpectedly led him to co-found Omada Health.
– Sean believes that his unique contribution lies in building solutions rather than practicing medicine directly, emphasizing the importance of finding one’s best match for contribution.
– He identifies himself as a “builder at heart,” indicating a passion for creating and developing innovative solutions in the healthcare space.

2. Building Omada and Entrepreneurial Vision

– Sean was initially drawn to medicine out of a desire to give back and contribute to making humanity healthier.
– He has had a transformative experience working in the entrepreneurial trenches at Omada, leading him to reconsider his path in medicine.
– Sean believes that his contributions at Omada are more significant than what he could have achieved as a traditional doctor.
– He emphasizes the importance of day-to-day support in healthcare, contrasting it with the traditional model of infrequent doctor visits.
– Sean describes the experience of working with patients as akin to having “paratroopers dropped in” to provide immediate and continuous support.
– He has a strong focus on ensuring that their product is covered and reimbursed, making it accessible to those who need it most.
– Sean has amassed a growing network of over 1,700 employers and numerous health plans, indicating a robust business model.
– He acknowledges the dynamic and competitive nature of the virtual care market, likening it to a “wild west” of thousands of offerings.
– Sean advocates for a long-term strategy in healthcare, recognizing the risk-averse nature of the market and the challenges of shortening sales cycles.
– He has a commitment to staying focused on their mission, often saying “no” to opportunities that might divert them from their core goals.

3. Integrating Technology and Healthcare

– Sean emphasizes the importance of trust in the healthcare sector and how it influences business practices.
– He has a strong belief in the necessity of clinical trials and peer-reviewed studies for digital health solutions, viewing it as essential for overcoming skepticism in the market.
– Sean has invested millions of dollars annually into clinical research to establish a credible evidence base for Omada.
– He recognizes the complexity and administrative burden faced by employers when managing multiple healthcare solutions, advocating for a more consolidated approach.
– Sean conducted a thorough analysis of healthcare services, categorizing which can be delivered virtually versus those requiring in-person care.
– He maintains a commitment to not compete with primary care providers, seeing Omada as a complementary partner in patient care.
– Sean has engaged in partnerships with healthcare data companies to analyze patient care encounters and improve service delivery.
– He is adaptable to market changes, allowing clients to choose specific solutions from Omada based on their immediate needs.
– Sean has a proactive approach to integrating digital solutions with traditional healthcare services to enhance patient experiences.
– He has a vision for the future of primary care, predicting that management of certain conditions may shift away from PCPs over time, positioning Omada as a supportive partner in that transition.

4. Challenges and Opportunities in Digital Health

– Sean expresses concern about the fragmentation of digital health solutions and aims to create a more integrated experience with in-person care.
– He emphasizes the importance of providing actionable, digestible health data to primary care providers rather than overwhelming them with raw data.
– Sean highlights a growing interest from primary care providers in chronic care management, particularly as they face increased workloads and a shortage of clinicians.
– He discusses the challenges of adapting healthcare delivery models to accommodate both value-based and fee-for-service patients.
– Sean notes that self-insured employers play a significant role in the U.S. healthcare system, bearing a large portion of private commercial spending.
– He reflects on his experience working at Google, providing insight into the complexities of self-insurance and employer-sponsored healthcare.
– Sean acknowledges the evolving sentiment among employers and benefit managers regarding healthcare costs and employee satisfaction.
– He recognizes the need for innovation within the healthcare system and the potential for employers to drive that change.
– Sean is committed to fostering collaboration between digital health platforms and primary care providers to enhance patient care.
– He conveys a sense of urgency regarding the need for new delivery models to address the increasing healthcare demands of an aging population.

5. Entrepreneurial Philosophy and Personal Growth

– Sean is interested in starting a nonprofit focused on building active internships and partnerships between MPH schools and benefits organizations.
– He believes that having clinical population-level expertise within benefits teams can lead to better healthcare solutions and innovations.
– Sean emphasizes the importance of rethinking digital healthcare experiences beyond just virtual visits, advocating for new care models.
– He acknowledges that the path to success in business is rarely linear, highlighting the inevitability of challenges and mistakes along the way.
– Sean has a unique perspective on pricing models in the healthcare industry, advocating for a model that aligns financial incentives with the value provided to clients.
– He was involved in creating the first-ever digital-specific CPT code in U.S. healthcare history, which allowed for billing through claims in a new way.
– Sean appreciates the complexity of integrating virtual care capabilities within the traditional healthcare system for maximum impact.
– He expresses optimism about the future of virtual care, believing it will continue to evolve and be recognized as a permanent fixture in healthcare.
– Sean values feedback and insights from benefits consultants, which have influenced his strategic decisions in the company.
– He has a forward-thinking approach, aiming to push the market for more integrated virtual care solutions year over year.

Childhood Aspirations

Sean Duffy grew up in Colorado with dreams of becoming an astronaut, influenced by a love for technology and a background in healthcare from his mother, a nurse.

Educational Journey

He attended Columbia University, where he studied neuroscience and behavior, completing pre-med requirements but feeling uncertain about pursuing medical school.

Tech Industry Experience

After graduating in 2006, during a pivotal moment in Silicon Valley, Sean worked at Google for a couple of years, where he realized the intersection of technology and healthcare was ripe for innovation.

Return to Medical Education

Sean enrolled in Harvard’s joint MD/MBA program, aiming to blend his interests in medicine and business.

Internship at IDEO

During a required internship between his first and second year of medical school, he spent the summer at IDEO, a design and consulting firm, which ultimately shifted his career trajectory.

Founding Omada Health

Inspired by the potential for digital health solutions, Sean decided to drop out of medical school to co-found Omada Health, focusing on addressing significant healthcare challenges through technology.

Identifying Healthcare Gaps

Sean recognized the need for a digital health company that could create transformational changes in care and outcomes, rather than just incremental improvements.

Navigating Skepticism

In the early 2010s, he faced skepticism from both the tech and healthcare sectors, which motivated him to ensure that Omada’s solutions were evidence-based and clinically valuable.

Building a Unique Model

Sean’s vision for Omada was to create a comprehensive virtual care solution that stood out in a crowded market of point solutions, ultimately serving over half a million members.

Recent Growth and Funding

Under Sean’s leadership, Omada Health has grown significantly, partnering with over 1,500 employers and health plans, and securing $192 million in Series E funding in 2023, solidifying its position in the healthcare landscape.

Initial Attraction to Medicine

The speaker felt drawn to medicine as a way to give back and contribute to improving global health, believing that serving humanity through healthcare was a noble path.

Realization of Greater Impact

After spending time at Omada, the speaker reflected on their experiences and concluded that their contributions to the company were more significant than what they could have achieved as a doctor, despite the fulfillment that medical care could bring.

Introduction to Omada

The speaker joined Omada, a digital health company focused on providing virtual care, particularly for chronic conditions like diabetes and hypertension, emphasizing the need for a digital-first approach in healthcare.

Focus on Metabolic Health

Omada initially concentrated on the metabolic space, addressing conditions such as pre-diabetes and later expanding to diabetes and hypertension, showcasing a commitment to addressing prevalent health issues.

Acquisition for Expansion

To broaden its services, Omada acquired a company specializing in physical therapy, indicating a strategy to enhance its offerings in managing musculoskeletal diseases.

Patient-Centric Model

The company developed a model that emphasizes continuous, day-to-day support for patients, contrasting with the traditional healthcare system that often provides infrequent visits and limited emotional support.

Innovative Care Delivery

Omada’s approach includes mailing patients necessary medical devices and pairing them with dedicated health coaches and diabetes educators, creating a supportive ecosystem for managing chronic diseases.

Strategic Market Focus

From the outset, Omada aimed to make its services accessible by ensuring coverage through self-insured employers and collaborating with health plans, recognizing the financial barriers many patients face.

Growth and Partnerships

The company has successfully partnered with over 1,700 employers and numerous health plans, establishing a strong market presence and demonstrating its effectiveness in delivering virtual care.

Long-Term Commitment

The speaker highlighted the importance of perseverance and a long-term strategy in navigating the competitive healthcare market, emphasizing the need for sufficient capital and a focus on building trust with clients in a risk-averse industry.

Recognizing the Importance of Trust

The journey begins with a clear understanding that trust is crucial in healthcare, leading to an early investment of $1 million to achieve high accreditation standards such as SOCK 2 Type II.

Investing in Clinical Trials

The company commits to conducting extensive clinical trials, acknowledging that building a robust evidence base is essential for gaining market credibility, especially in a skeptical digital health landscape.

Establishing a High Standard

The team sets a precedent in the digital health industry by prioritizing the publication of clinical research, investing millions annually to ensure their solutions can withstand scrutiny.

Identifying Market Needs

Recognizing the complexity faced by employers managing multiple point solutions, Omada strategically decides to expand its offerings to provide a holistic approach to healthcare solutions.

Simplifying Healthcare Management

By offering a comprehensive suite of services, Omada aims to alleviate the administrative burden for employers who are overwhelmed by managing various contracts and solutions from different vendors.

Flexible Product Offering

Omada maintains flexibility in its approach, allowing clients to start with specific services (like musculoskeletal care) while also being prepared for more extensive multi-product offerings as market demands evolve.

Analyzing Virtual Care Potential

The team conducts a thorough analysis of care types, determining that approximately one-third of healthcare services can effectively be delivered virtually, while acknowledging the need for in-person care for the remaining two-thirds.

Positioning as a Complement to Primary Care

Omada emphasizes its role as a partner rather than a competitor to primary care physicians, aiming to integrate digital solutions with traditional healthcare to enhance patient care.

Investing in Integration and Coordination

The company is committed to making significant investments in interoperability and coordination, ensuring seamless collaboration between digital and in-person care settings.

Evolving with Market Demands

Omada continues to adapt to the changing landscape of healthcare delivery, positioning itself as a trusted and comprehensive solution for employers and health plans amidst the rise of point solution fatigue.

Recognition of Fragmentation in Digital Health (Past)

The speaker expresses concern about the proliferation of random digital health solutions that operate separately from the traditional healthcare system, leading to fragmentation.

Commitment to Integration (Present)

Omada is dedicated to gradually integrating their platform with in-person care to create a cohesive healthcare experience for patients and providers.

Feedback from Primary Care Providers (Present)

Listening sessions with primary care providers reveal their need for evidence-based, actionable summaries of patient data rather than raw data, emphasizing the importance of collaboration.

Creation of Digestible Reports (Present)

Omada focuses on developing simple and actionable reports to facilitate communication between their coaches and primary care providers, enhancing the management of chronic conditions.

Shift Towards Value-Based Care (Present)

As more primary care providers enter risk-based arrangements, there’s a growing interest in chronic care management solutions, positioning Omada as a valuable partner.

Overburdened Primary Care System (Present)

The healthcare landscape faces a talent shortage, with many primary care physicians considering leaving the profession, necessitating new delivery models to maintain care quality.

Operational Partnerships with Providers (Present)

Omada seeks to collaborate with healthcare providers, especially in fee-for-service environments, to help manage chronic care without requiring direct payment for their services.

Role of Employers in Healthcare Costs (Present)

Employers, who bear a significant portion of healthcare costs through self-insurance, are seen as key players in driving innovation and change within the healthcare system.

Evolving Sentiment from Employers (Present)

There is a shift in how employers and benefit managers perceive their role in healthcare, driven by rising costs and employee dissatisfaction, creating opportunities for companies like Omada.

Recognition of Employers as Change Agents (Future)

The speaker acknowledges the potential for employers to influence healthcare innovation significantly, suggesting that with the right capabilities, they can become champions for change in the system.

Identifying the Need

The speaker recognizes a gap in large employers’ capabilities to address unique healthcare needs due to a lack of clinical expertise within their benefits teams, particularly in large organizations with significant medical spending.

Vision for Nonprofit

They express a desire to launch a nonprofit focused on building active internships and partnerships from Master of Public Health (MPH) schools into benefits organizations to bridge this expertise gap.

Survey Insights

Omada conducts a survey revealing that while virtual care is here to stay, merely replacing in-person visits with virtual ones is insufficient for delivering quality care.

Strategic Confirmation

The speaker reflects on the survey results, confirming that Omada’s strategy aligns well with market needs and emphasizes the integration of virtual care within the broader healthcare system.

Acknowledging Challenges

The speaker discusses the non-linear journey of building a successful organization, noting that challenges and mistakes are part of the process.

Innovative Pricing Model

They highlight a successful pivot in Omada’s pricing strategy, moving away from a per-member-per-month model to a pricing structure that aligns with actual usage and value delivered, improving financial reliability.

Billing Infrastructure Breakthrough

The speaker shares how Omada successfully contracted as a covered entity, creating a digital-specific CPT code in collaboration with the American Medical Association, enabling billing through claims.

Value-Based Pricing Model

This billing innovation allows employers to treat the service as a medical expenditure rather than a wellness budget item, transforming Omada’s business model.

Operational Alignment

The shift in pricing and billing strategies ensures that Omada’s financial and operational goals are aligned with the needs of their clients, enhancing service delivery.

Future Outlook

The speaker expresses optimism about the market’s continued demand for integrated virtual care solutions, indicating a commitment to pushing for innovation in healthcare delivery.

Major Fundraising Achievement

In a pivotal moment, Omada successfully raised $192 million in a Series E funding round, positioning the company to continue its growth and innovation within the digital health sector.

Strategic Use of Capital

The leadership outlined a cautious and measured approach to utilizing the new capital, focusing on improving operational leverage and preparing for a potential public market entry.

Integration of Behavioral Health

Omada began embedding baseline behavioral health support into its existing condition lines, recognizing the commonality of comorbidities like diabetes and mild to moderate depression, thereby enhancing their service offerings.

Market Adaptation

Recognizing the shifting fundraising climate marked by rising inflation and interest rates, Omada opted for a more private-focused strategy, ensuring stability during uncertain economic times.

Challenges in Fundraising

The podcast discussed the increasingly difficult fundraising environment for startups, particularly those lacking a solid business model or product-market fit, highlighting the potential for many to struggle in this climate.

Talent Retention and Opportunities

Despite challenges, the labor market remained relatively strong, suggesting that talented individuals from struggling startups could find new opportunities in different organizations.

M&A Strategy

Omada’s leadership expressed a cautious approach to mergers and acquisitions, indicating that while they would consider opportunities, integration of new clinical areas would need to align closely with their existing product lines.

Acquisition of Musculoskeletal Care

Omada’s acquisition strategy was exemplified by their addition of musculoskeletal care, which was seen as a way to enhance their offerings while maintaining a strong focus on integrated care experiences.

Future Acquisition Potential

The conversation hinted at the possibility of more acquisitions in the future, leveraging their capital to bring in companies that align with Omada’s vision and enhance their ability to deliver value to patients.

Founding Amada

The journey began with the establishment of Amada, where the founder, initially inexperienced, had no knowledge of venture capital or hiring processes. The company started with just three people.

Growth and Learning

Over 11 years, the founder gained extensive experience, evolving from a novice to a leader of a business with over 700 employees, viewing this journey as an invaluable education.

Focus on Current Offerings

The company’s strategy has remained consistent, concentrating on existing products and services while actively seeking feedback from buyers to adapt to market changes.

IPO Considerations

Amada has been on the brink of an Initial Public Offering (IPO) for several years but has chosen to wait, emphasizing that going public is not an end goal but rather the beginning of a new chapter.

Philosophy on Going Public

The founder believes that while going public can provide healthy pressures and opportunities, rushing into the public markets without careful planning can be detrimental.

Market Conditions

The founder acknowledged the volatility of the stock market and the distractions it can create for employees, reinforcing the decision to remain private longer when conditions are unpredictable.

Career Advice for MBAs

The founder encourages aspiring entrepreneurs to gain experience in startups and engage in side projects to practice entrepreneurship and understand the fundamentals of delivering value.

Hiring Criteria at Amada

While many MBAs work at Amada, the focus during hiring is on demonstrated accomplishments and the ability to drive creativity, energy, and throughput, rather than just the MBA degree itself.

Commitment to the Mission

The founder expresses a deep passion for Amada’s mission and a desire to continue leading the company, dismissing the idea of returning to complete a medical degree.

Vision for the Future

The ongoing goal is to build and scale Amada further while remaining adaptable to market needs and maintaining a strong focus on the company’s core mission.

Early Career Exploration

The speaker reflects on their journey of exploring various career paths, leading to a discovery of their passion for building and creating.

Startup Experience

They highlight the significant learning and growth that comes from working in a startup environment, where rapid career development is common.

Skill Development

Over time, they have acquired a diverse set of skills and tools, likening them to a “palette of instruments” that aid in their creative processes.

Reflection on Medical School

The speaker contemplates returning to medical school but ultimately decides against it, recognizing that their current contributions may be more impactful elsewhere.

Career Fulfillment

While acknowledging that medical school could be fulfilling, they prioritize their current trajectory and the unique opportunities presented by their startup experience.

Gratitude for Opportunities

The conversation reflects a sense of gratitude for the experiences that have shaped their career and the people who have supported them along the way.

Engagement with Podcast

The speaker engages in a dialogue on the podcast, sharing insights and experiences, which adds to their personal narrative of growth and exploration.

Continued Learning

They emphasize the importance of continuous learning and adaptability in their career, which has been enriched by their startup journey.

Future Aspirations

The discussion hints at future aspirations that align more closely with their current skill set and interests rather than a traditional path like medical school.

Closing Reflection

The conversation concludes with a mutual appreciation for the insights shared, reinforcing the value of storytelling in understanding one’s career journey.