Future of Telehealth & Obesity Care with the CEO of Ro Zachariah Reitano

Thanks for having me. Super excited to be here. I was smiling big time as y'all were introducing yourselves and telling your stories, but also cracking jokes.

Thank you. Yeah, we're going for it. So we'll see. We're hoping, you know, it's a leap of faith for sure. No, I saw my wife was she's a video journalist and she was at Vox for about five years. But she started her work working on this idea on the side. And then that side thing became the main thing when you know you scratch that passion. And so it's I know that I saw at least up close and she saw with me when you take that leap from a side project to the main thing. It's scary. And it's intense, but y'all are doing it and it's such an incredible thing to see.

Yeah, absolutely. I think the easiest way maybe is like how Ro started because it is a personal in the same way that what y'all are doing is very personal and you're motivated to help others in the same, you know, shoes. I can tell this story with a big smile on my face because everyone is doing okay. And is alive and well and it's definitely brought us closer together, but everyone in my family at some point in time has had some life-threatening illnesses, myself included. So, I have a congenital heart condition and I had a heart procedure when I was 18. My sister has had her own health challenges as well. My mom has a neurological disease and my dad who's a physician has also had four heart attacks and a stroke. So, growing up, I was in and out of the health care system and in and out of the hospital and in the doctor's office as a loved one, as a son, and as a patient myself. And my dad being a doctor, he saved every single one of our lives. And he did it in an incredibly unique way. And what I say is when your dad is your doctor, there's this really special thing where yes, they care about your health. Absolutely. But they care about your health in service of you living a happy and fulfilled life. Right? Very rarely do people wake up and they say, you know, in my wildest dreams, I hope that my blood pressure is 120 over 80. That rarely exists, but it's health is a means to an end. And so my dad, whenever I had these health challenges, he would talk about them and he would help me achieve them, but within through the lens of what type of life I wanted to lead, what my goals were. And so this concept for me of which is what we think about what we're building at Ro this concept of goal-oriented healthcare and starting with what patients want. And I'm sure separately a therapist would have a lot to say about this but in many ways I think what I'm trying to do is recreate my dad with software right recreate the experience that I had growing up. Which is health is a means to an end and it starts with what a patient wants. It definitely obviously delivers what they need. But that's the core of where it starts and it allows people to play offense in their life. And I think too much of health care and it's an important nuance, but too much of health care we think about from a defensive perspective. Right? When people talk about preventive health or longevity, they're actually the same. You would do the exact same thing, but one sounds like you're building a superpower and the other sounds like you're just preventing them, waiting for something bad to happen or to prevent something bad from happening. So, when I was 18, I had a heart procedure, and the main side effect of my heart medication was erectile dysfunction. Every 18-year-old's dream when they're in college, obviously. And, you know, but I had a really strong relationship with my dad. He was an internist, but he was an expert in infectious diseases, and he actually specialized in sexual health. And so, you know, some kids have birds and the bees conversations when they're 12. I had here's what gonorrhea looks like and you need to work on them. And so and these weren't like diagrams. These were like photographs from his textbook. So when I was 18 and I had trouble being intimate, I did feel comfortable at that point in time talking to him and it was linked to my heart condition as well and he navigated both of those seamlessly and he treated both of those with the same level of concern that I as a patient had which at the time right or wrong were fairly equal weight or at least I obviously knew intellectually that I needed to take care of my heart and that it would be something that would be with me for years and decades to come but I also wanted to have the same college experience that other people did, right? And so he helped navigate that with me. And then he had this ethos which is just he would always say to me, he's like, 'I got you.' Like, 'You don't have to worry. I got you.' And so that, you know, Ro's sort of phrase that we use a lot internally. It's on our website. It's our, you know, if you can say it's our slogan, it's a slogan, but it's this idea of we got you. You come here and we'll take care of it. And so when I was 25, I started to experience heart symptoms again. And this is at the same time that my co-founders were having their second and fourth kids respectively. So all of us were going in and out of the health care system, going in and out of the hospitals and I was doing the stress test, the halter monitor, the blood test, the whole thing. And I was represcribed that same medication that I was in college and had the same exact experience again where my dad said, you know, like don't worry, I got you. And at the same time as we were engaging with the healthcare system, my co-founders and I were at a venture studio and we were looking for problems to solve. We knew we wanted to build a company together. You know, I do think that generally speaking, if you have the right people, you sort of wait for the right idea to hit you and then but it first starts usually with the people. And so the idea was always to build a place that mimicked the experience I had with my dad growing up, but we started with sexual health and then we expanded beyond that. And so when I think about, you know, when you ask like what Ro is, it's goal-oriented healthcare and we start with what patients want and we try to deliver that in the most effective and easiest way possible. And so patients come to us and they say, I want to lose weight and then we have a comprehensive obesity care program. They say I want to have better sex and we have products for sexual health. I want to have a child and we have fertility products and services. I want to have better skin, we have skincare. Same thing with hair or whatever it may be. And so I think that is you know the experience that I had growing up definitely influenced what I work on now and that's how we think about it and that's how we build and the way that we have tried to deliver the easiest and most effective experience for patients is by vertically integrating the most important parts of care delivery. So we have a national digital doctor's office live in all 50 states. Our EMR is built from the ground up. We have our own CLIA certified and CAP-accredited lab for at-home lab tests. We also integrate with Quest and we have pharmacies distributed throughout the country. So when you think about working backwards from what a patient wants and what they need but through the lens again of their goals. It's the seamless connection between a doctor's office, pharmacy and lab. All through the lens of helping them achieve their health goals so that they can achieve their life goals. And we'll talk about that exactly as you said today, right? It started with the medication, but in two years in it's so much more. And it is again it's your health in service of the life that you want to live. And so that's how we think about it. That's how we build and that's sort of what has motivated me to start Ro with the team and one of the reasons why I genuinely skip into work every single day.

I hope she's okay.

Yeah. Well, I appreciate that. Both piggybacking on what both y'all mentioned, a friend of mine, and I don't know whether this is her phrase or her dad's phrase or a friend of hers, but she said she's been experiencing some pretty significant health challenges recently. and she said you know a healthy person has many goals and an unhealthy person has one goal and I think that as you said like when that takes over I think people underestimate the role that someone with a health challenge the role that that plays in their lives especially if it's something that they might not fully appreciate the weight of it themselves if it's not something that they've experienced right there's tremendous stigma both with sexual health. And with obesity and we're going to talk about both of those today and the intersection between them and the combination, but if you haven't experienced it yourself, it's hard to see the impact that it has on someone's life. And that it impedes them from living the life they want to lead. So I think for us that's been something at the core that I think my dad was and which is natural for a father but I think maybe atypical for the health care system in general but was so unapologetic about his desire to help me live the life I want to lead and then use medicine and healthcare as a tool to do that. So it started with what I want. What do I want? And rarely does a healthcare interaction I can't you know rarely does it start with when a patient walks in and the doctor says what do you want today? Like what would you like to achieve and work backwards from there?

Absolutely. Yeah. Go ahead. Sorry. Cool. Let's get into it. Nice and juicy.

Oh, there's so much. Obviously this journey is so, you know, personal for everyone and so there might be it's very likely that there are individuals who experience both ends of the spectrum that you described. But I think speaking sort of generalities and averages and what the majority of people experience but that's not always again the majority is not everyone but what we refer to at Ro what we talk about when we talk about GLP-1s is we often refer to them as jetpacks for positive behavior change. And it's because they really again as you said that there's so many things that the individual themselves obviously needs to do right it's Cat you you kicked off this was saying it's not a silver bullet, right? And that's 100% true. But that's why us it's this boost. And when we think about the positive behavior change, it's these little things that start, right? If someone's able to quiet that food noise, right? And then they're able to eat a little bit less and then they're able to sleep a little bit better. And then they're able to exercise a little bit more. And then maybe that positive feedback loop starts to kickstart and those things piggyback on one another. And before you know it, that person is sleeping far more, they're exercising far more. Not only are you seeing a reduction in calories about 20-30%. But you're seeing what people eat dramatically shift. We see that in our own data. We see that in surveys. So, people are eating far more poultry, fish, vegetables, and far less confectionaries, sugary drinks, and things like that. And then what you're seeing is you're seeing people date a little bit more as a result, right? you're seeing again the exact why it'll be it'll time will tell but you are seeing people particularly women purchase more lingerie that could also be because there are changes in body composition over time as well right so there's a bunch of things here but I do think you are seeing this positive feedback loop and overall if someone has more energy if they are able to achieve if they have more energy because they're sleeping more and exercising more and eating better and that might lead them to engage in different activities or be more social or have more confidence. We see that a lot in the data as well. And that might lead to a natural consequence of them being more intimate with their partners. And we saw in the Wall Street Journal the article that you talked about. I thought one of the awesome quotes that Danielle had was she said, 'The last eight months of our marriage is better than the previous 12 months of our marriage.'

And again that's one individual, but you do see and y'all said this this medication is life-changing. And I think when you talk about that, I think it's and again this is from seeing my dad's experience because he's been on Mounjaro for about two years and Ozempic for two years prior to that. Again, the medication was this kickstart to this overall really incredible change in lifestyle and it helps him continue to maintain it. So I think you are seeing really fascinating ripple effects from people taking this medication in their social life in their personal life in their professional life. And it's really wonderful to see overall again there might be some to your point where it also is impacting the reward center of the brain right and so it'll be interesting to see over time like the weights of these impacts right is the positive weight of having more energy sleeping more eating better that evolution in body composition how does that outweigh for every individual very unlikely but does that outweigh the also the impact on the other side. So that's what we've seen. We have seen it be and serve as this jetpack. Overall I think you're seeing that and it's been really exciting to see again the impact that it has on patients' lives.

There's there's it's really powerful what you just said and there's two I'd love to just double click on them and tease them out for the audience because I think there's two really important things that you just said and I want to make sure I emphasize them. double click and tease them out. So I like the first is this idea that you said Kim like I think it's really incredible and very rare that you were able to there was almost you were incredibly patient at the very beginning in terms of really just letting yourself have these micro wins, right? I'm not going to let the dishes pile up. I'm going to move a little bit more. And I think with any healthy and positive behavior change in general, a lot of times people this is part of the stigma like people are very familiar with what the ideal is like the ideal diet, the ideal exercise regime, whatever it may be. People have, you know, it's been pushed forward for decades. Generally speaking, right, it's how do I get from here to there, right? And so a lot of times people try to rush and then they'll either it's naturally like it would be as if you wanted to try and learn how to ride a bike and the first thing you try to do is run a 100 miles. And so the small wins that you could stack there the dishes and things like that. It's really important that community when they start it's the same thing which is let's say you're walking 2,000 steps a day and you hear oh I know the ideal is 10,000 plus. You don't have to go 10,000. try for a week to be at 2,500 or 3,000. Month later, try 4,000. Right? When you try to think about the time horizon that you're trying to make improvements on is the rest of your life. And so, you're not rushed to the finish line. Same thing with dosing as well, right? You don't need to rush to the highest dose. I know it's really it's easier said than done because people want to see those results faster, but camping out at those lower doses, making sure your body gets used to it and comfortable with it. and working with obviously your provider to achieve that. But it's those little wins, right? 2,000 steps, go to 3,000. You're drinking three Coca-Colas, but you love them, try two, and then try one, right? Instead of going...

These little wins stacking inch by inch is a really important thing to take away. The second thing that I think is really important from a psychological perspective is the nature of guilt. And because one, the stigma leads to it, but two, it's so... my dad is a physician, right? And so he knew the biological processes, he knew from an intellectual perspective all of the things that you said, right? His body is mimicking a starvation response, it's driving him to eat, knew that it wasn't just a matter of self-discipline, he knew about the concept set point and energy balance and all of those different things, right? Intellectually, he knew it did not remove the sense of guilt for him. He still felt it was his fault. He still felt that he had done everything for his family except take care of himself. He was able to help me, my sister, my mom. He worked constantly, but he felt... we asked him, and this was a big point of tension between my mom and him. It was a big point of tension and it was always something that, and we've had conversations about this, that he felt tremendous guilt because he thought, why can I not do this for my family? Why can I not not eat this extra thing? Why am I in the kitchen at 2 in the morning? And this is someone who has a much higher IQ than I do and he had been there for his family in every other way. And so he carried with him for 20, 25 years this deep sense of guilt and shame. And even though intellectually he knew he shouldn't, it didn't matter. Then he went on GLP-1 once and his food noise disappeared and within two weeks he was able to quote unquote be the person that he wanted to be in terms of the decisions he made. And when I tell you it was like a dam broke, he felt this intense form of catharsis and he and I have had conversations about it that has brought both him and myself to tears because he said for 25 years I felt this sense of guilt and shame and then I took this medication and what it showed me was what I knew intellectually. It actually proved to me, even though I knew it, it proved to me that it wasn't my fault, that it was a biological response, that it wasn't a form of lack of self-discipline or willpower, and that it wasn't that I didn't want to be there for my family enough to make these decisions. And I think that's really important for people to hear time and time again because maybe if they hear it enough, hopefully they won't carry that same weight even if they don't have access to the medication just yet. Because I think again those two things, those micro wins that stack, but that true change and that true experience of having that guilt wash away, I think is really important for people to consistently hear. It's one that we hear so frequently from so many.

Can I ask you a question? You said something earlier that was really interesting. You said it's even more so something that you think about in year two. In terms of... and I'd love to hear more about that. Year two as far as like the... you said in terms of the emotional journey and what has changed for you in terms of what you can, you know, the things that you had to overcome in year one versus what you're now thinking through in year two. I'd love to just learn more there.

So, it's not... Yeah. Thank you for sharing that.

Yeah, that's right. And we built... Oh, go for it.

It's a great question. So, we built two free tools for patients just to help out the community navigate current... what we see as two of the current biggest challenges. One is finding supply and the other is understanding insurance coverage. So, we'll talk about the supply one first. So, we built that because as you know, millions of patients are on GLP-1s and there isn't a clear sort of first in first out system for patients to be able to get access to their medication on a reliable basis. And so every single month it's a hunt. I've seen my dad hunt different pharmacies nearby where he lives in Sarasota, Florida. I mean, he must drive to five or 10 or be on the phone constantly looking. And so, we wanted to try and... We built a tracker that did a few things. One, it let people see what drugs and doses were currently listed as on shortage according to the FDA. And that's useful for both patients and providers. Providers make decisions based off of that list and patients talk to their providers about it and they stay on top of it as well. And so we wanted to try and allow patients and providers to have as much information as possible to determine what the best next step is for that patient. So first is just a really easy way to understand the list for all GLP-1s because you know you go to the FDA's website and it's not built for the GLP-1 patient, it's built for all drugs. So what we do is we tried to synthesize it across so that patients didn't have to go searching for each drug. So that was the first thing just is this on shortage and if so what doses. The second thing that it did is it tried to help patients crowdsource where available supply was. So, someone can come on and say, 'I can't find GLP-1s.' And they say, 'What drug dose in their zip code?' And then someone says, 'Hey, I found GLP-1s. And here's the pharmacy that I found that GLP-1.' And it'll notify anyone within 100 miles of that pharmacy if their zip code falls within 100 miles that another individual found the same drug and dose at a nearby pharmacy to again help patients find where supply might be and a way for them to pay it forward. And that was entirely a free tool. Now, this might sound odd, but the best thing for that tool is that if it were useless, meaning in the sense if it weren't needed, great, fantastic. It's a real shame that we had to build this tool in the first place. And it's really bittersweet to see how well it has done, candidly. We've had over 60,000 shortage reports in just the last eight, nine weeks since we launched it. 40% of the reports are from Wegovy. Another 40% are Zepbound and another 20% are the combination of Ozempic, Mounjaro, Victoza, Saxenda, Trulicity. And so you really do see Wegovy and Zepbound having that challenge. Now recently, as you called out, sort of are these drugs on shortage presently? While all the doses are listed as available, the drugs themselves, so semaglutide and tirzepatide and liraglutide, the drugs themselves are listed currently in shortage, which I think is the FDA's best way to communicate their overall picture of the availability of the drug. And so we see that on the FDA's website, we see the majority of our patients who are written branded medication patients unable to pick up their prescription within 14 days. You do see that number increase over time. But again, it takes them maybe 25, 30, 40 days to pick up their medication. You've seen Eli Lilly and others and Novo on their earnings calls say that the pharmacy experience will be choppy. And then our wholesalers as well as pharmacies that we work with are backed up all across the country. They're on back order and they don't have the medications in stock. So, you know, while the doses are quote unquote listed as available, there's so many pieces of information from the shortage report to the drug itself being on shortage to pharmacies being on back order to earnings calls to patients being unable to pick up their medication. There's so many pieces of evidence that says it's not easy right now for patients to pick up these medications. And I think that that is, you know, such a massive problem. I mean, I'm preaching to the choir. This community is probably struggling with it every single day. That's why we built this tool to just try and make either of that information far more accessible and hopefully help patients find supply with one another. But that's a little bit of an update on the supply chart.

Yeah. And we've shared that data with the FDA.