Finding Your Place in the Healthcare Ecosystem

Bill Snyder is a seasoned healthcare executive with over a decade of leadership experience. Upon graduation, Bill started at Humana, where he gained a comprehensive understanding of the healthcare business. Eventually managing the Chicago office, a $600 million operation, he learned a lot about healthcare nuances, including provider contracting and commercialization. But Bill always had an entrepreneurial drive, spending his weekends and evenings working on personal projects. After Humana, he joined an early-stage diabetes company focused on health plan partnerships. Then, he recognized a critical gap in digestive health and decided to pursue it.

Bill has personally witnessed the distress of GI tract diseases from his family and friends. He knew that patients suffered from frustrating, non-specific symptoms, and a complex and expensive diagnostic process. “Often, these conditions are misdiagnosed and mistreated, leading to unnecessary procedures and ongoing symptoms,” says Bill. The problems also aren’t discussed as freely, due to the stigma around talking about what happens in the bathroom. So conditions like irritable bowel syndrome (IBS), GERD, Crohn's, and ulcerative colitis are often dealt with in silence. Yet, one in four Americans suffer from chronic digestive conditions. That makes 70 million Americans, which is twice as many as those suffering from diabetes. Deciding to be a part of the change, he joined Vivante Health in 2019.

Vivante's mission is to “revolutionize digital gut health”, as Bill puts it. Their digital platform GIThrive is designed to deliver care for those suffering from chronic digestive issues. It’s a comprehensive virtual program designed to provide accessible and personalized care. Through the platform, they are addressing difficult diagnoses, reducing the associated costs, and aiming to mitigate feelings of isolation. 

GIThrive offers patients online queries to understand each unique situation and their risk factors. In turn, they create personalized, evidence-based care plans prepared by a team of physicians, dietitians, and health coaches. Patients can also find ongoing support and get the right type of guidance when and where they need it. The on-platform physicians can diagnose, prescribe, and order tests as needed. In the broader picture, Vivante also offers educational content and behavioral health modules to provide comprehensive support. 

“The long-term plan is to be available to people on the individual level through their plan sponsor. But today, it's a little bit more targeted towards larger employers,” Bill explains. The company is currently operating on a business-to-business-to-consumer (B2B2C) model, meaning they reach their users through self-funded employers and health plans. 

Thanks to their targeted approach in this massive market, Vivante is experiencing tremendous growth. Counting over 100 employees, Bill has recently closed their series B funding with an impressive $31 million.

Key Learnings From Bill’s Experience

• As a digital health company, you have to know where your product or service fits in the overall healthcare ecosystem. That way, you know how to interact with other providers and consumers, and in turn, you can connect the dots for your end-users about the precise role you play in the care they receive. 
• Ensure your product is financially accessible for adoption. That requires you to understand different plans and regulations and demonstrate your product’s clinical efficacy and potential for cost savings. Target customers that you can create a clear win-win situation for. 
• Show your progress to build trust with potential investors. Network and communicate with them on a regular basis. Focus on sustainable growth and understand your business’s unit economics in detail so you can articulate and justify your decisions.

Healthcare Startups are a Contact Sport

A digital health solution must either enhance or replace existing care delivery and payment models. Reinventing everything from scratch is rarely a winning strategy. However, each of these scenarios position you in a different place in the ecosystem, and each of them requires a different go-to-market strategy. Sometimes, great ideas might not fit well in the current healthcare workflow. It's important to understand where your product fits and continuously engage with your customers.

First and foremost, you need to understand the problem you’re solving and where it fits in the broader healthcare landscape. “If it's not a big problem, if you're not impacting a lot of people and improving something significantly that you can point to, it's really difficult to break in,” Bill states. 

Secondly, you need to step back and determine where your solution stands within the existing, established healthcare workflow. “You have to think about how you interact with the plan and with other providers,” while also focusing on the member and the patient, Bill explains. 

To answer these questions, deep clinical expertise is non-negotiable. "If you're not a clinical founder, you have to have a really strong clinical team," Bill advises. The same thing applies to coverage and reimbursement, too. Partnering up with functional experts helps you navigate the complexities and ensure that your solution is properly positioned to deliver maximum benefits. 

On that note, consistently engaging with different parties is another pillar of success. According to Bill, operating in the healthcare space is a contact sport. Being in the field and understanding customers' needs as well as their purchasing journey is crucial for business growth. Vivante, for example, works with large-scale employers who cover healthcare for their employees (B2B2C model). In this context, it’s important to make integration incredibly easy for employers. That’s why Bill is in regular contact with the platform’s members. He collects information continuously to improve their offering and the overall patient experience. “We're always talking to our members and trying to gain information in terms of what more we could be doing for them and what we are not thinking about,” he shares. 

Prove Clinical Outcomes and Economic Impact

While regulatory approval is a major milestone, the journey to widespread adoption doesn't end there. Figuring out coverage and reimbursement is a huge box to check, because when you get approval from FDA, you need to know who is going to pay for your product. Getting a device or solution approved is one step, but ensuring it’s financially accessible for adoption is another step that’s just as important.

The healthcare reimbursement landscape is complex, with different types of coverage such as fully-insured, self-funded, Medicare Advantage, Medicaid, and others – each with its own regulations and requirements. For now, Vivante works with large employers to distribute the GIThrive platform. And for that, they need to convince them, cater to their needs, and essentially, make the platform alluring.

These types of customers are more receptive to innovative solutions like Vivante’s, which have the potential to lower costs and improve employee health outcomes, Bill reports. He sees a future where working directly with employers will become more common in the industry, as innovative employers increasingly prioritize benefits that enhance their employees' well-being while also being cost-effective. 

It's crucial to help employers make decisions easily. To do that, Bill champions providing compelling clinical outcomes and cost savings, and ensuring ease of integration. For that, you need to demonstrate clinical efficacy, not just once, but continuously.

The clinical outcomes don’t have to be revolutionary studies or groundbreaking outcomes. For example, Bill’s first move was to compare pre and post-analysis of the company’s customers. Starting off, individual patient anecdotes were important to establish trust. However, it doesn’t end there. “Clinical rigor should always be part of the company's DNA, and you should always be thinking about what more you can do,” shares Bill. He intentionally started off with lower acuity members on the platform to gather some vital data and establish efficacy. As they amassed information and refined their platform, GIThrive became equipped to support higher acuity populations. Currently, the Vivante team has a few publications underway, which will help to further promote GIThrive. Bill summarizes, “We started with the clinical measurements that we know we can stand behind when we're talking to other providers or clinical governing bodies.”

Beyond the context of clinical efficacy, Vivante also has to prove the safety of personal data of their platform’s users. That’s why they have certifications like HITRUST and SOC 2 Type II, to show that the patients won’t suffer from data breaches on sensitive personal health information.

“Go out and show them how you’re going to take the cost out of the system for them and make their members feel better,“ Bill concludes.

Know Your Numbers Inside and Out

Vivante successfully raised an impressive $31 million in 2023. However, Bill is quick to remind us that it’s not about a one-time win, but a matter of sustainable growth. Success in fundraising depends on solid business fundamentals. As Bill puts it, “It comes down to the unit economics of the business”.

Growth is alluring, but Bill reminds other leaders to keep an eye on profitability while scaling the business. That’s what’s most attractive to potential investors.

GI health is a massive market with a potential for a huge impact. But potential is not what Vivante solely capitalizes on. As Bill explains, they have “top-line revenue growth with really healthy gross margins, as well as a path to profitability.” His advice? “Know your numbers in and out.” Track your key performance indicators (KPIs), understand your customer acquisition costs (CAC), and calculate your lifetime value (LTV) ratios. “Know where you're going and how you're going to get there," Bill says. The ability to clearly articulate and justify your decisions builds trust, ultimately helping you secure capital.

Bill also emphasizes the importance of viewing capital raising as a strategic process. You can't just scattergun your approach and respond to every opportunity. Instead, leverage your network, carefully curate a list of potential contacts, and initiate fundraising efforts with existing capital. “For anyone who's raising capital, the best time to raise is after you've just raised,“ Bill suggests.

Maintaining ongoing communication with potential investors is key. The point is to keep them in the loop, develop relationships, and build trust rather than just interest. Bill advises to send regular updates, even when you're not actively fundraising. This way, as he puts it, you can show them that you not only met your promises, but exceeded them. 

Lastly, Bill underscores the importance of being selective with partnerships. Having support from your board makes a huge difference. Take it from him, “Sometimes it can feel so desperate and you'll take money from wherever you get it. But that's a detrimental mistake. Taking capital from misaligned investors disrupts progress and creates a problematic cap table.”