Part of my attitude relates to an experience I had. And this was within a single HIS. I wanted to…
Matt Scantland is founder and CEO of AndHealth of Columbus, OH.
Tell me about yourself and the company.
AndHealth is a digital health company that is focused on helping people reverse chronic illnesses. We started with migraine and are seeing patients for that now. We are soon launching for some of the most common and disruptive autoimmune conditions.
I’ve made a career of combining technology and healthcare. I started college thinking that I would be a doctor and ended up being a programmer, so I combined these two things in my career. Probably the biggest advantage that I have had is to have worked alongside an incredible team for my entire career, in some cases, literally going back to my internship in college. Many of these folks helped us build our last company, CoverMyMeds. They have been joined at AndHealth by a new group of telehealth experts and clinicians.
Each of us have our own “why” that we are at AndHealth. For me, I knew I had to do something like this because my own doctor helped me realize that I needed to participate in my healthcare. That was back in 2011, when my first son was born. At the time, I was busy with CoverMyMeds, but I knew that if I ever had a chance to do another company, I wanted it to be a company that helps support patients to participate in their own healthcare. That leads us to where we are today.
You intentionally use the term “disease reversal” as opposed to “disease management.” How do you distinguish those?
For many years now in our industry, we have focused on this idea of disease management, which is to try to tamp down the progression of cost and disease escalation. We now know that many chronic illnesses can be brought into remission if we can get the patient to change the behavior that is responsible for about 80% of our health. Once we understand that reversal is possible, the key question is, how do you achieve it? The answer is that you need to engage patients in a course of change. We have built a disease reversal company. We have built the whole business around how to support patients in making that change.
How does the approach differ from traditional office-based encounters?
The big idea is that we can get to reversal when we can get patients to participate. The core question then is, how do you get people to participate? We’ve built the company around what we’re calling a digital center of excellence that helps to make that participation easier. One important element of it is moving from delivery of care of that’s episodic and on-premise to one that is continuous and virtual.
For example, one of our early patients suffered from chronic migraine. She had moved around our healthcare system for years and years, never able to get to a state of disease remission and never able to figure out exactly, in the moment of a migraine, how to cope with the situation other than going to the emergency room. By moving this care to something that is continuous, we were able to dramatically shorten the feedback loop between trying a particular healthcare step and seeing whether it worked, to the point that we were able to optimize her acute medication and also identify the root cause of her migraine.
When we optimized the acute medication that kept her out of the emergency room, we had time then to work on actually reversing the disease. Her root cause ended up being a food intolerance issue that, despite many years in our healthcare system, had never been found. Once we were able to identify that food intolerance issue, we had moved this diffuse idea that we have around behavior such as “eat better” to the equivalent of a shellfish allergy, where just this one step was the difference between illness and health.
The tightness of that feedback loop makes it such that people with shellfish allergies almost never are eating shellfish. But compare that to someone with a cardiometabolic disease, where sticking to a nutritional program is hard. The only difference is how clear that feedback loop is. By moving to this style of care, we are able to shorten that feedback loop.
When we do that, we help the patient achieve a high return on effort. We don’t need to turn the patient into an Olympic athlete when we know the precise root cause of their illness. We just need to address that particular root cause. When we combine that with focusing on diseases that patients are highly motivated to solve, typically because of pain and disruption, then we are able to achieve a higher level of engagement than has ordinarily been seen in these digital health services, which have tended to focus on diseases that, while important, are pretty difficult to engage patients in early in the progression of the disease.
That’s why we started with migraine and autoimmune conditions. They share common root causes with these other illnesses. We can engage the patient in something they care about today because of the pain and disruption, but because of the shared root causes, we end up solving these other issues as a side effect.
Some of the app-focused programs assume that patients will change if offered education videos, scripted coaching, and reminders to modify their lifestyle. How much of your program will be based on psychology rather than technology?
We have built the DNA of the company around the science of how behavior happens. The more we have learned about that science, the more we have learned how big the opportunity is to do better. We do that by understanding the difference between health aspirations and health behaviors. The biggest lever that we have in our healthcare system to create behaviors that support health is to make them easier to do what we call create ability. For many people, we can create ability by making something that used to be time-consuming and expensive quick and inexpensive or free.
That psychology, building around the behavior design, is super important and is a through line in the company, from our technology to our business model and to the actual healthcare delivery. One important distinction between what we are doing at AndHealth and a lot of what has happened before is that we are actually the patient’s doctor rather than a wellness app. When we are the patient’s doctor, we are able to harness the credibility that comes with that.
Patients have shown our healthcare system that what they want is the most specialized expert care that they can get for their particular condition. Each of our reversal centers of excellence is staffed by experts in that therapeutic area, who take on the patient in the practice of healthcare so that we can manage medications, do labs, and have the whole set of healthcare services at our fingertips.
No one disputes that a percent of a patient’s health is behavior. The question is, do people believe that it’s possible to help them change? A core idea that we have at the company that comes from my own life and the life of the people here is that everyone can change if we give them the support to do so, and if we ask them to make a change that they care about. That’s why we focused on these areas and why we think this delivery model can help support people. It’s tougher to engage people with the garden variety app that counts steps. That’s not solving a problem that patients care about. That’s why we think this is different.
How does a patient’s primary care doctor participate?
That collaboration is such an important idea that we named the company AndHealth to reflect the idea that we can’t do this alone. We see ourselves as part of what I think will be a transformation in our healthcare system that we do mostly outside of the company, rather than inside. While we become the patient’s headache specialist, there are about 40 million migraine sufferers in the United States and only 2,000 headache specialists. This is one of the key challenges that we are helping patients solve, the problem of access. Even if you have good health insurance, the ability to get into a care team that understands how to treat migraine is hard.
By moving this care to a model that is more accessible and is available continuously, we are able to make a big difference in the lives of these patients. You can think of us as a referral from a patient’s primary care doctor or from their employer, because we are an employer-sponsored health benefit that helps complement the healthcare that the employer is providing to their employee.
How hard is it to convince employers and health plans to pay for your service?
Ultimately, we need to prove that we are achieving life-changing results for patients. If we can do that in this area, it will be an important new way that patients get access to care.
One of the reasons that we started with migraine is that leading employers are starting to recognize it as a silent issue, lurking just beneath the surface, much like how the best employers started to recognize mental health five years ago. It had historically been dismissed. It had historically not had great treatment options. It wasn’t generating the claims that caused it to get on anyone’s radar. It was a chicken-egg issue. If there wasn’t good access to care, there weren’t many claims, so it didn’t get onto the radar of employers.
But we now know that migraine is the leading cause of short-term disability for most employers. It’s a huge contributor to turnover. Because it disproportionately impacts women and people of color, it’s a lever against diversity, equity, and inclusion objectives for employers. We think that a proposition that is focused around increasing access to super high-quality care in a therapeutic area that impacts many of these employers, 20% of the employee base, and is actionable because patients are engaged around this disease, will be taken up by many employers. We are seeing that so far in the market.
Can you survey employees or look at company records to identify the opportunity, unlike wellness apps where employers may get some non-specific value from helping their employees with weight, exercise, or stress?
Exactly. It’s rare that we’re in a meeting with an employer where someone in that meeting doesn’t say, “I have migraines. That has been an incredibly difficult part of my life that has made it difficult for me to show up in the way that I want to at work.” Because it’s common, and historically patients haven’t seen a lot of good treatment options, we are hearing from employers that this is important to solve. Now that we know that it is solvable, there’s a lot of interest in engaging.
It’s similar in autoimmune conditions, although what’s a little different in autoimmune is it has gotten a lot of employer attention because the costs are so high. For the conditions that we are treating, simplifying a little bit, there’s about $40,000 in costs per employee, per year for those who suffer from the conditions. A good bit of it is pharmacy cost, but there’s also significant healthcare cost. That has gotten more attention, but migraine employees are expensive from a claims perspective and especially from a productivity perspective.
AndHealth isn’t primary care, where we need to be able to treat a patient who shows up with anything, and where we have a relatively diffuse cost or value proposition to an employer. This is something that’s targeted at the disease states that, one, are the most expensive and disruptive, and two, by narrowing, give us an opportunity to have a learning system that gets better really fast.
One of the underappreciated elements of digital health is the degree to which when we narrow and then run this through software where we’re force-multiplying the expertise of clinicians, we move to a learning system that is improving quickly. We have a credible chance to move in these therapeutic areas from a new company to the foremost expert quickly by narrowing. That makes achieving results for patients dramatically easier than if we tried to see a patient who shows up with any condition.
What are the most important lessons you learned from starting, growing, and selling CoverMyMeds?
The biggest lesson was to find a way to collaborate with the healthcare system. Because if we want to do something big, we need the help of the people that are already here. We can be transformative without being disruptive. That idea is so important. That’s why we called the company AndHealth rather than OrHealth. That’s a really important one.
The other is the idea of people first, putting not just the patient first in everything we do, but winning through our employees. We ended up being on Glassdoor as one of the top 20 employers in the country in the past. While we think the tactics that will get us there are different, because the world is different than it was 10 years ago, we are focused on being a place where clinicians and technologists can come to build something that makes a big impact for patients, but also makes a big impact in their career. Those two things are core DNA in the company.
What would you like to see happen with the company in the next few years?
We have already shown that we can produce what we think are life-changing outcomes. In our first study in migraine, we were able to get to a 60% remission rate for patients. What we want to do in the next couple of years is show that we can do that at scale for employers and in a way that generates a value proposition that makes this part of the benefits package for the leading employers. It’s about showing that we can create those life-changing outcomes with patients, in collaboration with employers, at a scale that ends up making a difference for the world. If we can do that, that is success.