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Transforming Healthcare through Habit Change

Season 1  |  Episode 2
Healthcare isn't just about managing diseases but keeping people healthy and changing some habits can be the perfect start.
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Rachel Schreiber:
Hello and welcome to the Spark, a view of innovation and healthcare. I'm Rachel Schreiber, your co-host, and in this episode we're speaking with Jeff Ruby, founder and CEO of NNewtopia. He and his team have created a habit change company that prevents reverses and slows chronic disease while reducing healthcare costs. I'm joined by Stuart Hanson, CEO of Avaneer Health.

Stuart Hanson:
Thanks Rachel, and thanks Jeff so much for joining us. I'm really looking forward to learning more about your unique, innovative approach to behavior change, habit building, all of the above. There's been so much discussion of late just around weight loss and the impact on people's chronic disease conditions. I'm really excited and inspired by what you guys are doing. So really welcome to this first inaugural episode of The Spark. You're our first guest, and I want to start with a little bit of context that you might've heard about as you embarked on having this discussion with us. Healthcare is really, really hard. You've been doing this for a long time. A lot of people really tackle the challenges of healthcare and decide and commit to swim upstream. And despite how difficult it is, how long the sales cycles are, the current kinetic momentum of the status quo is really hard to fight.

Stuart Hanson:
And what we've found so far, especially as we started to schedule guests out for the spark, is that usually there's a very unique personal story. We are all consumers of healthcare. We all work with our families, we work with our friends, we work with our loved ones on their journey through the healthcare experience. And usually there's some personal inspiration that commits folks like you and folks like a lot of the folks here at Avaneer to really commit to doing something different and impactful in healthcare. So before we even hear about NNewtopia, I'd love to hear your personal inspiration story. What is your spark for what you embarked upon when you created this business and what keeps you inspired every day?

Jeff Ruby:
Thank you very much first for having me, Stuart. Pleasure to be here. Pleasure to be here, inaugural guest. And yes, you're absolutely right. There's generally healthcare innovators or entrepreneurs come from a personal place. Some men have to persevere, but it's generally that personal story that hopefully keeps people tethered to their true north. So for me, it was an experience with my dad. So I started out, I don't have a traditional healthcare background. I'm not a medical doctor or a health scientist professional at all. I did a JD MBA and thought I wanted to be a corporate lawyer as many of my family members are. I became one, and I just found it was the absolute wrong fit. And I had a weird week in my life where on a Monday I resigned my position as an associate at a big corporate firm. Three days later on Thursday, I got a call from my dad.

He was 54 years old at the time, was just diagnosed with abdominal cancer. It was one of those weeks in your life when now my professional career was up in the air. My family's health was up in the air and it sort of opened my eyes to what I now call our sick care system. And it was my dad's diagnosis that sort of made me aware of healthcare. Prior to that, really no one around me had been ill and I had no reason to look at it. And what I was amazed by was just the massive system that opened up to embrace him in this illness. And yet what I was astounded by was where was anything to keep him out of it. And there was really nothing there but his own wits and his own decisions. And then a couple weeks later, we pulled every string as most of us do to get into a doctor first oncology appointment.
My dad's first question was, doctor, how did I get this? And the oncologist came back with the Mr. Ruby. A lot of this has to do with some unlucky genes and your lifestyle choices. And Stuart, I must admit, in that moment, I'd been at school a long time, that formula of genetics and lifestyle leading to cancer, no compute, I didn't know what he was talking about. I also had this moment of where does anybody find out this equation of lifestyle genes to stay healthy? And it really sort of lit up this itch that I've been scratching now for 20 years over four startups to try to answer. And effectively, I wake up every day trying to figure that out, not just for my dad, but for millions of individuals who are just like my dad or others. And also for the payers out there who are largely intervening far too late in the equation,

Stuart Hanson:
It's a sad but inspiring story and certainly explains your new lifelong passion, career lifelong passion for what you're doing. Why don't you tell us a little bit about how your platform and team is tackling that issue?

Jeff Ruby:
Yeah, so I would say very much in the belief that in this equation of our human health, many of us have heard this statement before. The percentages may vary. You have got a social determinant component, a genetic component, but the very largest component is our lifestyle behaviors, the things we choose to do or not to do on a day-to-day basis. And so we really define ourselves as a habit change company that focuses on preventing reversing and slowing chronic disease by effectively building and stacking new durable habits in nutrition, exercise, and mental and emotional wellbeing so that we can have a positive impact across physical risk factors, mental and emotional risk factors. So it's a whole health approach. And in doing so, we partner with whoever is at risk, whoever is the payer, could be a self-insured employer, could be a health system, more and more advanced primary care or risk bearing providers who need to deliver an outcome. We are remarkably good at engaging and delivering those outcomes effectively through behavior and repeat behavior change, which is why we call it happy change. And so I would define us as a humans, helping humans amplified by the world's best engagement technology to do and achieve just that. And we go at risk for all of it. So we are a value-based provider in that if we don't deliver those outcomes, we don't get paid.

Rachel Schreiber:
That sounds really unique. Some of the aspects that you're talking about are the genetics that focus on habit change and going at risk. What are some other ways that you're very different from other providers in the industry?

Jeff Ruby:
Well, so I would first say as providers go and I have a massive respect or providers writ large though generally the provider focus out there has largely been on identifying, diagnosing, prescribing, treating, and ultimately surgically managing illness. When you think about primary prevention as a focus and discipline, it isn't really there in any skilled way in primary care. And PCPs, again, critically important, that's not what they're trained to do. And so we're largely coming to fill just an unmet but massive need, which is who is helping and inspiring individuals to make the right choices to stay. And even if they are moving along that continuum, how do we manage to do that? So I would say writ large, we're trying to fill a gap that doesn't exist in a scaled way. And to your question specifically, I'd say the secret sauce is in the way that we match up our participants to our inspirator, who are our coaches at Newtopia, through this personality matching and this focus on behavioral genetics and sort of genetic engagements, really different, totally different than what anyone else is doing with genetics in the market today.

Rachel Schreiber:
That is really significant, especially the genetic insights and then the personalized, the fact that you're matching them to the right person who can coach them the best and walk them through in that journey. That's really interesting.

Stuart Hanson:
Yeah. I've got another kind of question on back to your personal story. So how do you first get a consumer engaged or how do you partner with their health plan or their employer to help get them engaged so that they even know that they should be doing things around habit change? And is it all about weight loss? Is it about folks that are pre-diabetic and they finally, that's their wake up call? Or is there a continuous thread or a common point of how you get that consumer engaged upfront? Because that's the key to your personal story once you get 'em engaged. Your dad didn't get engaged until he got a diagnosis, and obviously that's too late, but how do you really drive that engagement earlier in their healthcare journey?

Jeff Ruby:
Look, it's taken some time to figure that out. I must admit. We've been around for 15 years and we've been really, we spent the first iteration, the first couple of years direct to consumer trying to figure out if we went directly to individuals, what would that be too? And we learned the hard way that individuals really aren't spending their hard earned money trying to prevent chronic, it's not a consumer behavior and an immediate gratification generally that led us to becoming a pure play weight loss company. Nothing wrong with that, it just wasn't our men we're looking to prevent chronic disease. Then we began partnering with enterprise first self-insured employers, then health plans, and now with value-based providers as well. And what we learned is that trying to approach an individual at a moment of fear or a moment of change is a great way to do so.

And so we began to tie ourselves to risk identifiers that were being used as part of the day-to-Day benefits or day-to-day health plan mechanics or even medical mechanics, which is someone takes a blood test or a biometric test or completes a health risk assessment or maybe meets with a case manager or goes to visit an onsite clinic or meet with a pharmacist to hear that they're heading toward the diagnosis of obesity, type two diabetes, a hypertension, cardiovascular disease, maybe even early cancer. In that moment of “uh-oh,” we want to be there as a, here's something you can do about it and do about it immediately. And that's where we found our best point of contact and engagement today.

Rachel Schreiber:
And that compliments what the physician is doing in that office, the labs show a problem. Newtopia has a way to solve that. That makes sense.

Jeff Ruby:
And where it really makes sense is, again, is more and more primary care. PCPs are moving to value as opposed to a fee for service. So in a fee for service world, we could actually be seen as competitive, moving someone over to us would prevent another appointment and therefore impact the fee for service world. But in a fee for value perspective, it becomes a really fantastic adjunct and bolt-on seeing more and more interest in it.

Stuart Hanson:
Makes sense. Yeah, I mean, I think the other thing that's really cool about the model and the way you guys are tackling it is to really embrace the at-risk and value-based care component and finding the right employers and the right health plans and getting the right data, the right cues to recognize that a patient's at risk and a patient needs a value-based type of plan. That's really the key in terms of my thoughts in terms of where you get that consumer, that patient engaged. It's really inspiring. I love how you guys are tackling it. Thank you. What kind of outcomes and results are you guys starting to see from some of the engagement in the value-based platform?

Jeff Ruby:
They've been really fantastic. The other iteration of Newtopia is we started our life inside about, we wanted proof. We wanted to demonstrate the efficacy of the platform the same way that a drug is ultimately proved out. And so we really were very fortunate to partner up with Aetna at a moment. They had a division called Aetna Innovations where we were identified as the leading platform candidate to impact physical and mental emotional risk factors. And they only ran it three year large scale randomized control trial inside the Aetna population to demonstrate that. And so inside of that randomized control trial, we were being evaluated on a weekly basis for three years. I effectively bet the company on just doing that for three years. And we were able to publish and peer review our outcomes.

And so in there we began to really see the power of both the engagement side. We're seeing engagement rates really high, high, we're at high 70% at the end of 12 months, dropping to mid fifties at the end of 24 months, dropping to mid forties at the end of 36 months at about 40% at the end of 60 months. So consider, we have participants who are with us for five years or longer.

We’re seeing pretty incredible rates of reduction around body weight in between the five to 10% on average body weight reduction, moving metabolic risk scores. A1C reductions are fairly dramatic as are movements around blood pressure. And we're seeing great clinical improvements around depression, anxiety, sleep, and resilience scores as well. And so all of that is clinically validated. And again, because we go at risk for that, it has to be demonstrable or we don't get paid. And so we're all aligned to drive those outcomes. So it's either win-win, win, or quite frankly no win-wins.

Stuart Hanson:
Let me just underscore before I pass the mic to you, Rachel, effectively a three year pilot, we talk about the persistence and the commitment and betting the farm or betting the company on a thesis. Three years is a long time. So kudos to you all for being in a position to take that bet and to bet on yourselves and your ability to really create that level of change. But 40% impact our retention after 3, 4, 5 years is insane. I don't know of any examples I've heard like that

Jeff Ruby:
And look serious kudos as well to Aetna for having the vision to put together that we got incredibly lucky to be part of it. We were with incredible companies like Teladoc and able to, and then Newtopia was a third and then that division was shut down. But that work has now persisted. We've been working with Aetna now for over 10 years now with the entire CVS population as well. So it's been a really longstanding innovation partnership and we are incredibly grateful and fortunate for it.

Rachel Schreiber:
So I wanted to hear more about the Alice Walton Heartland Whole Health Institute, which you recently announced. It sounds like it's a community approach was really interesting and exciting. Tell us more about that.

Jeff Ruby:
Yeah, so I would say Newtopia has been incredibly lucky and fortunate and I've mentioned I think innovators attract other innovators. And so whether it was the innovation partnership we have with Aetna now CVS Health that got us started, it then moved to JP Morgan Chase and we completed the first and only Haven trial inside the JP Morgan population and continue that efforts with Morgan Health. We worked with Accenture for years in their health innovation group, and now this represents another landmark innovation partnership choice to stand back and say, Alice Walton has this incredible vision and this incredible mission to transform health and is very aligned to looking upstream at behavior and habit change. And so she's built the Alice L. Walton School of Medicine in northwest Arkansas and also the Heartland School Health Foundation. And so she's coming at it from both an education and from a community perspective, really using northwest Arkansas as a proving bed and then ultimately wanting to scale throughout the us.

Jeff Ruby:
And so this first landmark coaching demonstration project is the first initiative of the Heartland Whole Health Institute. We're incredibly grateful and honored to be chosen to be part of it, to lead the inaugural effort. But as you said, Rachel Abby is all about identifying providers and employers in the community all with similar either patients or members or employees who have out of range risk factors or early type two diabetes, early hypertension, so that we can demonstrate the power of habit change to prevent reverse and slow those conditions. And also the ability to reduce costs in a significant way for whoever the payers are responsible for those individuals

Rachel Schreiber:
That's expanding past the employer model. So I was working in the wellness disease management in the early two thousands, and it was an employer choosing a company and then adding to their benefits or a payer saying, for my members in these populations, they're going to have access to this program. And maybe there's portals and there's challenges and things like this. This goes way beyond it, way beyond those the great efforts. It's important, but the impact as you've talked about, is significant of what Newtopia has done. But then you're also taking it where people are, which is they're in their doctor's office, they're in their communities. It sounds like it's like it's bringing your habit change to the people.

Jeff Ruby:
Yeah, very much. And I mean, we're incredibly excited to be partnered with both Ms. Walton and an institute that has the vision to do that, that recognizes that it requires the community, the employers and the providers all coming together to make an impact at a community level and a local level, but also having a vision that can scale and recognizing that, I think, I mean, what we've experienced is that for so long, if there's been a question, are employers going to pay for this? Are payers going to pay for this? Are now value-based providers going to pay for this? And I think what Ms. Walton has injected is what's the role of philanthropy and what's the role for foundations to come in and really catalyze and kickstart some of these efforts as well. And so again, just feel very grateful to be part of what we hope is going to be a really new groundswell moment with an incredible mission and mandate behind it to really demonstrate why looking further upstream, again, not necessarily sick care, which has been condition management, wonderful, but how do we prevent folks from having to do that in the first place and move upstream earlier?

Jeff Ruby:
That's the work that we're embarking on and that we take very, very seriously exciting.

Stuart Hanson:
Congratulations. That's another great, and a series of great partnerships for you all to partner with leading organizations on. I'm inspired by what you guys are going to be able to do with that. Very cool. Shifting gears really quickly, one of the things that folks don't always talk about in healthcare, they're now talking more and more about wellness and preventative care as opposed to sick care. But another stepchild, if you will, in the healthcare or the wellness industry is around mental health. Are you guys working to translate this model of early signal identification into ensuring people are also taking care of the rest of themselves mentally and psychologically? Because stress, anxiety, obviously, I think we're measuring a lot more mental health related issues and challenges, but we're certainly seeing a spike, and I've experienced that in our family as well, and it's just as severe as a cancer diagnosis or a cardiovascular condition and can be even more dangerous for folks. Long-term wellness.

Jeff Ruby:
So a hundred percent agree, and I would say there's been a dangerous labeling of physical health on one side and mental health on another. And there are a group of individuals that do one versus the other. And I think that designation needs to go away. There's one health, what happens here at Pop matters tear down and vice versa. And so to try to suggest that what's happening physically isn't impacted mentally and mentally is impacting physically is impossible. And so we really come at it from, there's one health in our whole personal approach is very much how can we become a student of that individual, learn about them from a social determinant perspective, from a personality perspective, from a readiness to change perspective, from a genetic perspective, understand them physically and mentally, and then provide this coaching approach to build and stack new healthy habits both physically and mentally. So ultimately, yes, we are looking to impact anxiety scores, depression scores, resilience, sleep and mood as equally as blood pressure, blood glucose, triglycerides, cholesterol and or overall waist circumference, all of which is part of the mandate here and what we're focused on. So we would evenly say we are a mental health as well as a physical health in terms of the habits that we're focused on.

Stuart Hanson:
That's great. Yeah, I love the whole focus on wellness overall. And you're right, it's not two independent systems and you don't have one problem or the other. There's a lot of, I don't want to call it a comorbidity, but a lot of cross condition impact. Certainly when I'm depressed, I eat more and it doesn't help my overall wellness. So there's obviously the whole body health approach that you're taking is really cool.

Jeff Ruby:
Yeah, definitely.

Rachel Schreiber:
So Jeff, you founded Newtopia more than 15 years ago, and we can already hear the number of pivots that you've made and the changes and how Newtopia has evolved. I'm interested in hearing what advice do you have for other founders and innovators who are on that

Jeff Ruby:
Path this Stuart mentioned at the outset, it's challenging to change the status quo. I think the latest stat, there are 4.5 trillion reasons why the system wants to remain the same. And so I think the advice is there's got to be a passion. There's got to be a fire, there's got to be a, why do I believe that I and the team I build can impact that? And then there's got to be the persistence and the grit to recognize that there's going to be pushback against it. And so then it's doggedly proving that this works. So finding the evidence, whether it's getting as fortunate as we were to partner with Aetna at a time to run the kind of study that we did, but also having the courage to bet the farm on it so that if it worked, we continue. If it didn't, we would shut down, but if that something else.

Jeff Ruby:
So really being focused on evidence and outcomes, creating a model that ties your revenue to those outcomes, I think is absolutely critical. Too many vendor models and epms that are out there, it's a lovely model, but it absolutely encourages zero outcomes. And so that the real challenge if you're going to embrace it. And then the next is just find a champion, find a partner. It could be a small local provider, it could be a local health system, it could be a national or a regional, but really focus on those relationships, prove it to them first. As big as the idea is you have to prove it somewhere and then from there build. And that's really, I think the best shared experience, less so advice that I can provide in terms of what's worked so far for us.

Rachel Schreiber:
That last part sounds really important.

Stuart Hanson:
I think the idea of, I think it's Lean startup, one of the mentalities of managing a startup or a laser focused initiative has been to persevere or pivot. And I think what you just described is pivoting, persevering, right? Keeping the end in where you're trying to go. You know what the impact is you're trying to create. You may take bends in the road and different paths to get there as you find these key partnerships and key things that you're committed enough to bet on. I think that was really well said. You said it way better than I did, but appreciate that. I'm inspired by what you guys are doing and this is exactly the kind of dialogue that I was expecting us to have. But even more so the fact that you guys are really leaning in very early into this value-based care world, which is hard.

Stuart Hanson:
It's especially hard for a startup. Startups don't take three-year pilot bets very often. They only do that if they're willing to persevere, pivot to get to the end goal and create the impact that they're looking for. So kudos to you and to your team for everything that you all have accomplished. Well, I think we've already explained or had given you a chance to describe the vision. I just have one last question before we wrap up, and it's more around the direct to consumer approach. Have you maintained that can go to Newtopia.com and sign up and get involved and see if their health plan or their employer would participate or even participate independently?

Jeff Ruby:
So we did shut down that direct to consumer approach. Again, it's not as if we don't have a desire for consumers. What we've realized though is that Newtopia really when there is an insurer of sorts, a payer who is for financial reasons, willing to invest on behalf of their employee, their member or their patients, and the timing of meeting that employee member patient at a moment that they are motivated to do something. When those two pieces come together, what you now have is this sort of that perfect timing, that sweet spot, because what it also offers us, Stuart, is the challenge with direct to consumer oftentimes is the length of engagement in a direct weight loss model. And we experience this lead. We know we have two, three months of engagement until a very short term goal was met and then they wanted to forget.

We existed because we were a bit of a shame by nothing like that, you can't have a five year relationship, which is what's really required to make the kind of foundational primary prevention Abbott change to impact the course of people's best health and also disease state. And so we've learned through the hard way that it's actually through an enterprise model, getting that timing rate that is the sweet spot to make this work. And so the answer is right now, you can only access a Newtopia through an employer who's sponsoring this as a benefit or through a health plan, providing it to their members or to a value-based provider network offering it to their patients.

Stuart Hanson:
And certainly most of our listeners are going to be approaching this podcast from a B2B perspective, but we're also all consumers. And I think you're inspiring a lot of folks individually as well. Any advice you would give to our listeners in terms of how to either get their employer engaged or find out if their employer or their health plan is already engaged in Newtopia? Any advice on that front or just in general how folks can learn more about what you're doing and how they could potentially get their populations involved?

Jeff Ruby:
I mean, again, we're always looking for new relationships. I think we've just scratched the proverbial surface with some wonderful innovative partners. And so I think it would just be asking your benefits leadership on the employer side, asking your health plan if this is covered, benefits for your health insurance or asking your PCP or your physician if this is something that they're extending as part of their value-based offering. Cool.

Stuart Hanson:
Great advice. All right. Well, awesome. Thank you so much for all the discussion. To

Rachel Schreiber:
Wrap up, I was going to ask you a wrap up question of what key phrase describes the vision of what you're creating? Is there a key phrase that describes it?

Jeff Ruby:
I think what I've said a number of times is Newtopia is really trying to make healthcare about keeping people healthy as opposed to managing people once they become ill. And so it's that we're betting on individuals that we can inspire individuals to live healthier and remain healthier, whether that's on medications or off medications, especially in this whole conversations around GLP-1. But it's really about making healthcare, about keeping people healthy.

Rachel Schreiber:
Well, if we had 15 more minutes, we would talk about GLP-1

Stuart Hanson:
A little bit of a deep dive topic. Yeah, maybe we'll regroup with you on that one, Jeff. I think

Jeff Ruby:
We'd love to.

Rachel Schreiber:
All right. Well, thanks for joining us today, Jeff. It's inspiring to hear how Newtopia is challenging the status quo and how you're driving habit change. And this is the kind of innovation that we as individuals need and as our greater healthcare ecosystem needs. So thank you for the important work that you're doing and keep it up. Look forward to connecting with you again later.

To learn more about Newtopia, our listeners can go to Newtopia.com and we'll share that link in the show notes as well.

Stuart Hanson:
Thank you for tuning into another enlightening episode of The Spark. We trust our discussions have sparked new and fresh perspectives on healthcare innovation and encouraged you to find ways to reinvent the healthcare experience.

Rachel Schreiber:
Don't forget to explore the detailed show notes for this episode. Share the insights with fellow innovators and email us at thespark@avaneerhealth.com to share your thoughts, comments, or reactions. Your engagement fuels the flame of innovation, and we look forward to continuing this transformative dialogue with you. Until next time, keep this spark alive.

In this episode, Jeffrey Ruby, founder and CEO of Newtopia, explains the focus and mission of his habit change company, which aims to prevent, reverse, and slow chronic diseases while reducing healthcare costs. Throughout the conversation, he talks about Newtopia’s approach,  including its partnerships with employers, health systems, and value-based providers. Jeff discusses the company’s emphasis on primary prevention, the whole health approach, and the use of personality and behavioral genetics to match participants with coaches. He also highlights Newtopia’s success in engaging individuals, achieving positive health results, and their collaboration with Alice Walton’s Heartland Whole Health Institute.

Tune into this episode for insights into Newtopia’s innovative approach to healthcare and its efforts to shift the focus towards keeping people healthy rather than solely managing illnesses!

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