Sean is the Co-founder and CEO of Omada Health, a Silicon Valley digital health startup tackling chronic disease.
Prior to Omada Health, Sean was enrolled in Harvard’s joint MD/MBA program, and previously worked in IDEO’s Health & Wellness group driving innovative work for providers, health technology companies, and employers. Sean also spent two years at Google and served as an editor at Medgadget.com.
Do you think we could start by hearing a bit about yourself and your background?
Absolutely. And kudos to you guys for encouraging this movement. I love that the dialogue around doctors being entrepreneurs is more part of the zeitgeist now, which is just a beautiful thing to see. It’s neat to hear you guys in London progressing that. In the US I’m seeing similar efforts. I was in a joint medical school/MBA program for a great period of time at Harvard, and when I was there it was like two people who were kind of interested in entrepreneurship. And now, they’re putting it as a more formal part of the curriculum. The Dean is super energized to make it more visible and help folks realize what an entrepreneurial endpoint might look like for folks who are going through medical training.
I grew up kind of as a huge computer nerd. Loved, just loved technology. My mom was a nurse. It always felt like it’d be a beautiful place to build a career in healthcare. It just felt like a good thing for the world. I went to undergrad at Columbia, and studied neuroscience, and did all my premed requisites. And graduated in 2006 at this moment where Silicon Valley was just back on fire. You had Google doubling head count year over year. The power of software was being illuminated. And I just found myself reading all these tech blogs versus studying the chirality of a molecule.
You either had to do medicine or you had to go into tech, that’s how I internalized it. So I ended up getting a job at Google and worked there for a couple years, and quickly realized the world’s more nuanced and complicated than that, and after spending some time there had the ambition to do something in tech-meets-healthcare. I thought, I’m going to do something in the primary care space, and applied to only MD MBA programs. I got into Harvard, which is a five-year program. They ask that you take an internship that’s a mix of business and medicine between your first and second year, and as a piece of that I ended up at a design consultancy, IDEO, where I started talking to the CDC. I kind of got the idea for Omada and the rest is history. So at first I paused my medical training, took a year off, and took another year off, and I went back for a third, and I had to make a choice. I just kind of carried on this path, so that’s a quick context of my background.
I know you’ve left medical school, but what are your thoughts about being able to balance a clinical career with an entrepreneurial one? Do you think it’s feasible, or do you think you have to jump into something like you have?
It depends on your specialty, in terms of the practice of medicine. I think you can be an internist or family doctor that practices still a day a week to stay connected to what the reality of treating patients is like, or maybe an emergency medicine doctor. I think you can be an orthopedic surgeon and go all in on entrepreneurship in an advisory capacity. But if you want to start it driving right, probably not. I mean everything worth doing in life is harder than you imagine it to be, once you get going. As an entrepreneur you’re just fighting gravity each and every day, so it requires an all-in, full-in, dedicated approach I think. But there are certain specialties where you can find that balance there.
Great. Thank you. So why don’t we jump in to Omada Health. Could you tell us a little bit about Omada health, and its first product, Prevent?
The Prevent dashboard on the iPad showing your progress summary.
We’re a company that’s about four years old. We started as an internal project at IDEO, a design firm based in San Francisco. The thesis for Omada is that, at least when we founded Omada, which was 2011, the state of digital health was not as evidence-driven as we felt that it needed to be. I looked at what companies were building good products in digital health at that moment, and imagined my critical medical director, and medical colleagues in school, and whether they view them with excitement and as a way to impact critical outcomes. And then I found out that usually the answer to that question was no. That wasn’t necessarily the fault of the companies innovating in this space. Most were consumer oriented. But there’s a longer road, and a higher burden of proof, to build something on the enterprise healthcare side. You need to start with evidence, and generate evidence, in order to gain access to the buying community. We wanted to look at ways where you could blend really consumer-forward design in tech with clinical rigor.
I’m really interested in obesity-related chronic disease because it’s just crippling people, and economies across the globe. Most would argue it’s the epidemiological crisis of our era. I started just doing puppet searches, and there’s this amazing body of literature in diabetes correction that shows that you can take individuals at high risk, deliver a very high touch lifestyle program, intensive behavioral counseling program, and reduce that risk. But it requires a heavy instrument. You can think of Omada’s Prevent program as a digital evolution of this sort of approach that’s been shown in the literature to work face-to-face. And it’s mapped onto an effort that’s happening in the US called the CDC’s National Diabetes Prevention Program, the NDPP.
The NDPP is an Affordable Care initiative that had just been funded right before we incorporated, and we talked to the CDC as we were gearing up. The idea was to work to make evidence-based programs that could show results standard of care across the US for individuals at high risk for type 2 diabetes. And we shared a vision of working to make these programs digital, so they could improve access and convenience, and they said, “Show us the data.” And that got the thing going.
Phase 1 to 4 of the Prevent diabetes program
The way Prevent works, in a large part, is based on what’s been shown to work in ‘in-person’ programs. A lot of times it’s pure support and social relationships that deliver the effect that you want. And if you interview people who have gone through these original programs, what they say is, “Amazing, yeah, the curriculum was great. But the main thing was I got to learn from others, and I felt curable.” So, Omada’s Prevent works on a timeline where we take individuals at risk, we match them into small groups based on demographics. We then pair them with what we call Prevent coaches who are certified according to the CDC standards in the US to deliver these programs. We mail people digital scales that have cell phone chips in them so it’s pre-connected to their private account as part of a ‘Welcome package’, and then we kick them off on a sixteen-week foundational timeline where week by week we unlock lessons. We mail people packages as they go through the program, and it’s kind of a ‘drop-in’ approach delivered digitally. We provide this program on behalf of health plans or employers that carry the financial risk of paying for beneficiaries’ or workers’ healthcare. Last year, we brought more than 30,000 participants through the program, and we are planning to cross 100,000 by the end of this year.
Fantastic. Do you think the partnership with the CDC was vital to you growing so huge?
I think it helps a ton. What’s neat to see is similar efforts at Bell’s firm in the UK, if it hasn’t crossed your radar, there’s actually something called the NHS National Diabetes Prevention Program, and the CDC’s been a good convener and they’ve helped align stakeholders. We’ve all got to lock on too, because on a given trajectory we’ve got, about 40% of adults at some point in their lives will find out they have type 2 diabetes. We cannot accept that outcome. The CDC has really bolstered the dialogue in this space, and we came in to really help deliver scalability across all states. So it has been very instrumental. It helped us maintain conviction that this was something that the clinical world would embrace with open arms versus fight against. And it just got us really energized to swing hard at it.
I understand you’ve secured quite a large amount of funding recently. How did you first go about securing funding for Omada Health?
Early on, getting funding was challenging. We sought venture capital, we deliberately designed the business to be for-profit because for impact to happen, you need an enterprise like Omada to be able to reinvest profits and grow. It needs to provide value sustainably. And so we just went out to see the investors. It’s one of those things too where any first time at bat, you know venture-backed entrepreneur will say the same thing, but you kind of look back on your seed paycheck and you feel so honored that anyone gave you money. It was hard because you don’t know as a medical student with a little bit of business experience and an entrepreneurial heart, you’re on a very steep learning curve. You don’t know the right words to use when talking to an investor, or what a VC even is. So your first fundraising process is very eye-opening. But, you know, just determination and grit gets it done, like anything in life.
Fantastic. Clearly, the evolution shows that it was all worth it. Just picking up on other challenges that you’ve been through as Omada’s grown, have there been any other key challenges you’ve faced? How have you overcome them?
The challenges are two-fold. One is operational product challenges, and the other is market challenges. On the product side, and the operational side, we have a very intricate operational model by design, because we think it’s the right experience for the person. But I don’t think there’s another company that I know of out there that literally matches people up, mails them equipment, bills it, makes sure it’s registered to the right person, deals with hardware, supply chain, a warehouse, gets it there on time, launches people on Sunday, makes sure there’s a coach that’s trained and available, balances forecasting capacity, has a code that’s on a clock base where each week something changes, packages that are mailed. It’s very intricate. And we had to design for scale, and we have yet to disappoint a customer, which is nice. But it is a machine that was very hard to set up. It sounds so easy. “Oh cool a group, like that’s Facebook.” But you actually dig into the details of what it takes and where the rubber meets the road in all the product and operational complexities, and it’s beautifully intricate. So it’s actually pretty hard, that was a lot of learning.
And on the market side, healthcare in any country, in the US, of course, is especially complex. And in medical school they don’t teach you how to follow a dollar in healthcare, or where exactly you are distributing value, or how your value proposition here might affect a stakeholder there. So you have to be in a mode of constant curiosity. I just remember the first year of Omada, any time I found someone who had domain expertise and I felt like was willing to mentor someone up-and-coming in their knowledge, I would just take them out to dinner and ask questions until they probably wanted me to leave. There’s just so many details, it’s so hard. Building any business is very, very taxing and challenging, of great reward and a sense of purpose, but it’s very hard. Healthcare I actually think is especially hard. I really think it’s a level up. And I would imagine that’s true in the UK as well, but I do think there’s a bar that’s slightly higher for various reasons based on complexity and regulation here.
At several key points in Prevent, you will receive special gear, starting with a wireless scale that’s already synced to your account.
It’s interesting you mentioned the fact that you used to ask as many questions from the people who have done this before. Is that one of the tips you would give to new people starting out, to try to find someone who’s gone through this, who’s done all this before, and try to get advice from them?
Absolutely. There are so many, and I always really work hard to pay it forward and help people too, because I’ve relied on so many others to help me. The learning curve is very steep so you have to accept and enjoy that. Even outside as you’re going from a doctor mindset to an organizational-builder mindset, one of the things that’s been most helpful to me is before I’ve hired any executive, and I’ve learned my lesson on this, I’ve made sure to talk to at least five back-channel or friends, or whatever, deemed to me as being excellent in their roles. And then you just like totally, authentically grill. Like ok, cool, who are you? What’s your training been, how did you grow as a person? Who’s your team? How are they compensated? How do you interact with those other functional leaders? What’s great in your role, what’s good, what’s bad? And you start doing that before you even think about hiring the person so that you’re better able to pick up on the attributes of excellence because you by definition cannot do their job, so that’s been helpful and really grounding.
It was hard because you don’t know as a medical student with a little bit of business experience and an entrepreneurial heart, you’re on a very steep learning curve. You don’t know the right words to use when talking to an investor, or what a VC even is. So your first fundraising process is very eye-opening. But, you know, just determination and grit gets it done, like anything in life.
So building on what you just said about advice for people starting out, do you have any other key tips that you’d give to entrepreneurs just starting out that you think are your golden tips?
There’s an entrepreneurship panel at Harvard Medical School, they asked me to be on it, and one of the questions that surfaced was, it’s always the “should I leave my profession?” question, or “should I leave medical school to do this?” question. It’s something that I get a lot here in the US. And my answer’s always quite consistent, which is, if you find a problem where you get so latched on to it and it just pulls you so hard that it starts to make the decision easy to leave, then that’s great, leave. If you don’t find something that you’re so hungry to work on, don’t. I think it’s a little of a counterintuitive answer, like for me, I got so energized by the possibility that we could wake up in a world where programs like Prevent are standard of care. Nothing else started to matter. You just stop caring about anything but working as hard as you can to make it a success, and you don’t care about reputational risk, you don’t care about the fact that this thing you worked so hard on, to get to medical school, isn’t even an option any more.
I would say make sure you find a problem that pulls you that strongly. And there’s a two-fold reason for that. The first is that it’ll help make the decision easier to leave, but the second, I think if you interview CEOs who’ve brought the company all the way through to an amazing success, or built lasting organizations, and you asked them what it was, I would wager that 7 out of 10 would say first, determination and grit. Because it is very hard and you have to be pulled so that you feel like anything that gets in your way, no is not an answer, you’ll just figure it out. And that’s the advice I would give to people who are weighing staying in the profession versus not. At the moment they hit that problem where at night they’re thinking about it, and while practicing they’re thinking about it, that’s the time to make the move.
What are your plans for 2016? And also any plans to come to the UK?
On the latter, absolutely. We caught wind of the NHS National Diabetes Prevention Program and submitted a qualifying questionnaire for that. We’re putting our name in the hat to see if we might be able to help deliver on the strategic ambition there It came at a very nice time where we’re starting to think about next chapters and market trusts. We’ve already incorporated in the UK, I’ve been interviewing for full time roles. I’ve been out there a bunch, you know, and also presented at the King’s Fund conference, so absolutely we’re super excited about it.
What’s next for Omada? It’s more of the same on the commercial front. We’ve grown our team pretty extensively, working to make sure we tell folks about Omada that are interested in implementing these sorts of programs on the product side. We’re really pushing in a super exciting clinical agenda. A number of publications that have already been underway will come out that we’re really excited about, and really investing in even further event generation, which we’re excited about.
On the product side, tons and tons of cool stuff. Where we think that digital can deliver on an innovation promise is just the fact that if you’re delivering these programs in a face-to-face setting, it’s quite hard to measure the specific aspects that might make the experience better for someone, or lead them to a better versus worse outcome. Digital, it’s the exact opposite. You can see when people do the curriculum lessons, when they weigh in, when they log in, how they engage with their coach. So we have, you can think of it as mini randomized control trials. We’ve got ten going out at once inside the Prevent product, measuring things like group sizing, or adaptive targets and goals, or interactive curriculum. And the intention is to, in some ways, resign ourselves to the reality that the cake will never be done. You can’t put a recipe like this in the oven, hear it ding, and then, great. You’re constantly evolving it, because humans are so amazingly complicated and behavior change is so hard.
And so the next chapter for us is innovating on top of what we’ve learned through data and design, and making it even more personalized. So where we can look at you, and we have enough people now that we can say, “Look, based on your demographics, your early data trails, and your early patterns, here’s the extra element that we think will help make you the most successful.” So that’s the 2016 chapter for Omada now that we have the data to do it. It’s really fun. We have more than 4.5 million weight readings that we’re able to model off of, which is really neat.
if you find a problem where you get so latched on to it and it just pulls you so hard that it starts to make the decision easy to leave, then that’s great, leave. If you don’t find something that you’re so hungry to work on, don’t.
That’s fantastic. What are your thoughts in terms of the broader digital health ecosystem? Are there other key areas in the digital health space that you think are really growing quickly right now?
That’s a space I’m super excited about. When we were trying to figure out what to call ourselves, it literally hit me that the best model for programs that are aimed toward publishing and delivering outcomes reproductively was more of a therapeutics model, so we started describing that. And there are lots of other examples of that that are coming out that are great. There’s a company that’s starting in the UK, with a presence in the UK and now in the US, called Big Health, with a CBT program called Sleepio (click here to read our interview with Peter Hames, Co-Founder of Sleepio). There’s others following suit where they’re publishing data on the digital effectiveness of what they’re doing, like WellDoc in the US, like others. It’s emerging, but I’m really excited about it.
I think what most excites me is what I think is the reality which is ten, twenty years out, I think the majority of pills, procedures, whatever it is, I think the majority of them will be coupled with some sort of digital experience. I really think that. Early indications of that are companies like one in the US called Recovery Record, where they provide a patient facing and a doctor facing app system that helps doctors treating eating disorders do an even better job and have a better engagements with the patients, and then the patients are logging in. It’s leveling up the experience and the treatment through digital, and I think that’s just going to sweep medicine, and I’m so excited for it. So that’s really the intersection between what we’ve done as medical professionals historically, and tech, to amp up outcomes, is going to be really cool. Now there are challenges, as healthcare is a little bit slow. But there’s tons of progress happening – I mean even like Bupa, you know the gig there is an indication that they’re leaning in on this, so it’s great.
what most excites me is what I think is the reality which is ten, twenty years out, I think the majority of pills, procedures, whatever it is, I think the majority of them will be coupled with some sort of digital experience.
Where do you hope to be in five or ten years? What are your aspirations, personally?
I want to be doing Omada. I was talking to my girlfriend about this. Every moment in my career, I’ve always felt like I was itching to, I don’t know what it was, but I was always itching. And now, even though it’s a lot of work and a ton of stress, I’ve never been happier as a human. And of course I have financial aspirations, but I feel like I have more legacy aspirations. And it just feels fun. The way I look at it, we’ve got a lot of ambitions people at Omada. There’s a ball coming our way, we’re all standing at the plate, and we are just swinging as hard as we possibly can, and my dream would be that ten years out, I’m still at Omada and we’re a global, lasting enterprise. Twenty years out, epidemiologists are looking back at obesity related chronic disease and they maybe see a little bit of a bend, and they’re trying to figure out what it is that caused it, and then they start poking and say, “Look, I think it may have been Omada!” that’s what I want. That’s the New England Journal of Medicine article I want an epidemiologist twenty years from now to write.
I’m sure you’ll achieve it, the way you guys are going. Fantastic. Knowing what you know now, is there anything you would do differently?
Tons of stuff. It literally is true. Even the little tactical things. Like I would probably have run my first fundraising process differently, because now I know what a VC is. I would have hired certain people earlier, some later. The list goes on. Any entrepreneur is going to make their own set of mistakes, but with determination usually you can suffer through them. So there’s a whole host of stuff.
Great, thanks Sean, your insight is really appreciated – and we look forward to seeing what the future holds for you and Omada.
– interview by Dr Avi Mehra and Dr Nick Dragolea