November 28, 2022

Episode 111: Cyrus Massoumi, Founder of Dr. B

Cyrus Massoumi is the founder of telehealth platform Dr. B, the founder and former CEO of ZocDoc and member of the Board of Advisors of Columbia University's Mailman School of Public Health. He's also the founder of startup VC firm humbition and has been recognized by both Fortune and Crain's on their 40 under 40 lists and by Fast Company as one of the Most Creative People in Business.

Julian: Everyone. Thank you so much for joining the Behind Company Lines podcast. Today we have Cyrus Massoumi, founder of Zocdoc, and current founder and CEO of Dr. B, the new telehealth platform that is improving access to everyday prescription. Cyrus, thank you so much for jumping on the show. I'm really excited to chat with you especially.

In the, you know, coming from the healthcare space, there's a lot of innovation that's happening. I, I, I didn't chat about this before, but I actually worked in the prescription space as a, at a local pharmacy from age of 14 to 20 you know, cutting my teeth in small business. So there's so many things that fascinate me about the, you know, mechanics around getting prescriptions, the.

You know the prescription process and, and provider network and all these things that really encompass getting people the help that they need. But before we start any of that, tell me a little bit about your journey about Dr. B, Zocdoc, who got you into the healthcare space and, and starting to innovate with technology.

Cyrus: Well, my I guess I would credit my mom with that. So, at a very young age, my mother really wanted me to be a. It. And so she would tell me that the best thing about being a doctor is that you always have access to healthcare and much to her and, and access to healthcare is the most important thing she would follow, and so much to her dismay.

I unfortunately never became a doctor. But the lesson of the importance of access to care stuck. And sort of followed me throughout my, my life. I remember shortly after my mom had tried to influence me to be a doctor, I learned that a woman who was like a second mother to me, Didn't have healthcare coverage, and that meant she didn't have access to the most important thing.

And I was so worried for her. And I, and I remember well, I, I still, the worry that I felt is something that 90 million Americans feel every day because there's a lot of people in this country who either have no access to care because they have no coverage or they have no access to care because they can't afford to use the coverage that they had.

Yeah. So I ultimately, I, I think that the, the access problem in healthcare is probably what led me to start Zocdoc. I was on a flight flying across the country. I had a really bad sinus infection. My plane landed in New York and I ruptured an eardrum and I needed to find an ENT doctor on short notice, and I went to my insurance company website.

I started calling doctors and I was calling doctors who, whose offices were no longer operational. I called one doctor who was dead, and I'm like, why is it so hard to book a doctor's? So that's what led us to start Zocdoc and expand the company over the next decade to expand the entire country across 50 different medical specialties.

And though we were able to improve access by enabling people to click on a, a specific doctor appointment time and click an and get an appointment instantly, we, I, I always thought that, that we never did enough for those people who didn't have coverage. And that was probably my biggest regret is that I didn't do enough to help everyone.

And so I always told myself that when I if I were to start another healthcare company, that when I did, I would make sure that we're, we're treating every single person. And so fast forward now I left Zocdoc, I joined the board of the, the Mailman School of Public Health at Columbia. I learned a lot about.

Many public health issues, but namely the inequities that, that, that are rampant in our healthcare system. And then, then Covid breaks out, and as you may recall, that covid sort of shined a light in a lot of the inequities that have come about because of healthcare. And we. As the vaccine was being rolled out, I saw an opportunity to help improve the access of the vaccine for all people.

So what was happening was back when we, we had very limited quantities of vaccine people were waiting in line all day hoping that someone would NoShow or cancel on the vaccine appointment and they could get their vaccine earlier than what was being recommended by the local governments. And what that meant was that people who could financially or physically afford to wait in line all day were the ones that were getting those excess shots, which were about 20 to 30% of our entire vaccine supply back when the vaccine was the most valuable commodity on earth.

And those weren't the people who were necessarily dying from covid. So what we initially started to do with Dr. B was take that access vaccine and reallocate it to people who needed it most, who couldn't maybe physically or financially afford to wait nine line all day, but they desperately needed the.

And so we made sure that over a million vaccines were reallocated in this prioritized way. And then when the Covid vaccine became ever present, we had this amazing team and, and decided, let's go solve another problem of healthcare access and inequity, namely access to everyday prescriptions. So there are so many people who, half of all adult Americans, I struggle with some chronic illness.

And if you don't have access to care, managing that chronic illness can be quite complex and expensive. And so there are many, many medications that have what's called a very high therapeutic index. They're very the risks relative to the benefits low risk relative to high benefit. And so for those, those types of prescriptions, we wanted to make a very efficient way for every American to get access to the, the treatments when they need it.

And so we started with Covid Antivirals. So for those people who are unaware there's medication now that if you get covid, you can get better a lot faster. And Vir are the name of these medications. And the problem with prescribing them is that you need to get access to these medications within five days of getting covid.

So that means that someone needs to have healthcare coverage. They have to know have a primary care doctor. That primary care doctor has to have availability to see them. That person has to hope that it's not a weekend, that their doctor's not gonna be unavailable. And all of that has to happen within five days, which is really difficult for a lot of people to.

So what we decided to do is roll out a service where anyone that gets covid can go online across 42 states and they can take a picture of their COVID test, fill out an online health assessment, and within one hour a health practitioner will treat them and if they qualify, they'll send the antiviral medication to the pharmacy of the patients choosing.

And we do that for $15, which is less than the average copay. For almost every American, and if someone can't afford $15, we actually treat them for free, making it the first telehealth service in the country that I'm aware of that treats everyone regardless of their ability to pay.

Julian: Yeah. It's, it's incredible. And I'm curious on what are the mechanics behind, you know, doing such quick service in say, you know, an industry that's historically very slow, you know, there's a lot of loopholes, there's a lot of red tape to, to go through. You know, what, what are ways that, you know, is it your previous network from Zocdoc?

Is it, you know, new partnerships? Is it going directly to the manufacturers? How are you offering such a fast service in this.  

Cyrus: So we're leveraging technology one to be highly efficient in everything that we do. And so we're really trying to make sure that we are the lowest cost and most efficient option for people.

Number two, because that's our, our positioning that we're trying to be low cost and highly efficient. We're able. Have a higher volume of patients who use the platform, and that enables us to load balance, to make sure that we're growing our, our provider network accordingly, and that they're utilized.

This is all utilization game to make sure that the providers that are on the platform are their time is, is valuable, and that their time is being maximally allocated to patient care.  

Julian: Yeah. Speaking from the provider's perspective, you know, what are the typical silos? You mentioned your story about needing to get a provider, you know, a healthcare professional to treat your, you know, your rupture ear from and your sinus infection and in a short amount of time, and some people weren't even, you know, alive.

Where are the sort of information, and, and is it from, and who, who's kind of, I don't wanna say responsible, but who can be kind of an active party in, in decreasing those silos? Is it the. Or is it companies, you know, in connection with those providers? Is it, is it patients? Where does this joint information come from to kind of, you know, offer the accessibility that is out there, but maybe, you know, there, there's a disconnect by, by receiving it.

Cyrus: So, that's an interesting question. I think, I think the the way our health system has been set up in the United States, it's fee for service. So you have an issue, you go to a doctor. You get treated. That means that there are players in the health system that perhaps benefit from people who don't get treated on a short term basis and are not necessarily incentivized to make it easy for patients to get the care that they need.

So if you just look at the, the business model of insurance if they were thinking very long term and they, they knew that a patient was gonna be with them forever. They would have incentives to invest in preventative care and do get the patient to go to the doctor. But if the average American is changing their job every couple of years, and that's where most of the commercially insured people are coming from, there really is no long term incentive that, you know, from a policy perspective, we've tried to do things in this country that make longer term incentives for, for insurance companies to, to think on a different time window, but, In running their business, they have to think about the short term.

And the short term. There isn't necessarily an economic incentives to get you to be a consumer of healthcare services. Yeah. So as a result you know, that directory that I went on for my insurance company, I would surmise to say that there was no economic incentive for whoever was in charge of that directory to make it better.

Yeah, I'm sure that they, they wanted to make it better, but they probably didn't get all the resources they needed in the company to go call every doctor's office. Like, are you still operational? Are you still here? And you know, the it's, it's so cumbersome for doctors to get access to become part of an insurance panel that if they choose to stop accepting an insurance, typically they're just gonna stop accepting it.

They're not gonna call the insurance company and get removed because what if they wanted to join later? So now all, you know as a result that there's not a ingrained behavior. And I'd say the relationship between physicians and payers is probably one of the most strained relationships of any type in this country.

And so you know, between that difficult relationship and the lack of an incentive to keep these directories up to date into, which is the first step to how patients access care in many circum. That is probably the reason for the silos you're talking about. Yeah.  

Julian: What, where, how have the incentives changed now?

Cyrus: I don't think the incentives have changed necessarily. I think that there is movement in the US healthcare system of moving to what they call value-based care. So rather than primary care provider, for example, to be compensated by every time that you consume a service, they would get a flat fee for managing your.

So now all of a sudden, the provider is aligned to managing costs on behalf of the patient, on behalf of, of the insurance company. And there are many who believe the only way that healthcare costs in America will be contained, if you would mm-hmm. is by moving to a value based system because it further aligns the economic interests of, of all parties.

Yeah. And I think Kaiser Permanente, which is a you, you mentioned you're in California. This is a big health system that's both a payer and healthcare provider in California, and they've managed to be very effective at, at containing their costs relative to the US healthcare system as a whole.

So I think there is some. Promise in that model. The problem has been that health systems in the United States as they tried to transition, they've only transitioned partially, and it's very difficult to operate as both a fee for service and as a value based provider at the same time, because you're operating two businesses that are kind of diametrically opposed at times.

So how do you make decisions? And so there hasn't been a huge amount of success yet in this space, but many believe that's what we have to get to for American Healthcare to really be under control from a cost perspective. .  

Julian: Yeah. Outside of Kaiser, are there, do you see a lot more private companies? I, I was a part of Oscar Health and there's like there's a super popular one when I was living in San Francisco where you would pay for the overall service.

You'd get access to a bunch of providers, different doctors for different services, but it'd be a flat fee, which seems, you know, the value based incentive. Approach. Where's the, is it the shift coming from private companies and that evolution, or, or is it now moving into kind of the more, you know, the larger providers like the Anthem or the Blue Crosses of the world?

Where are we in that timeline?  

Cyrus: So, The larger payers like the anthems of the world, as you mentioned, are definitely doing, and, and they have, as I understand, numerous pilot projects in support of different ACOs and. Many provider organizations across the country are also trying it out. I, you know, I'm not this is not my area of, of deep expertise to sort of pinpoint who's doing it well, who's not.

There definitely are pockets in the country that are working, but there are fewer of those than those that are not working. Okay.

Julian: yeah. Shifting to Dr. B and in. A little bit more on the access to prescriptions, as I mentioned, you know, I, I, I had a fairly, fairly intimate experience with the pharmaceutical industry, you know, working from an independent pharmacy who also compounded, made prescriptions from scratch.

So it was an interesting experience to see the, the differences between the providers and patients access doctor networks and how they all kind of, It, it, I wouldn't say it was like it wasn't like a symphony, you know, it was like a battle of the bands or, or something along that nature where, where everyone was in a little bit of friction and conflict.

But shifting to Dr. B, how are you giving patients the access? Are you partnering with the manufacturers of, of these, these drugs? Are you. Yeah, I, I'm just so fascinated on how you're able to allow people to access to this on what seems like a sliding scale in terms of payment for, for the service.

Cyrus: Yeah. So at $15 to get treated by a medical provider seven days a week in generally an hour, that is superior service on multiple dimensions. And so one of the big . One of the things that we try to do at Dr. B is to keep our costs down as well as possible so we can transfer that value to the patient.

So we're not in a position where we can spend money on a Superbowl ad or money on lots of subway ads or billboards, et cetera. We're really focusing on, on giving patients a great experience. And hope that they will in turn refer their friends to us. And even though the company's really young in our, our telehealth service, we only publicly launched it in August, but a meaningful portion of the patients that come to us are coming through word of mouth.

Yeah. And so I think that if people have a good experience they tend to tell their friends about it. I also think that you know, there are a number of , healthcare entities, public health officials, etc. That are sending out information about Dr. B to their constituents because it just makes sense.

Yeah. Everyone wants to the pandemic to go away and for those that get c which was our first treatment to, to, to get that treatment simply and conveniently and inexpensively. And I, I think that as we, as I mentioned before, we're not just staying with, with Covid antivirals we, before the end of the year, will have 15 new treatments on the platform, across four different medical specialties, and we'll be adding more treatments and more specialties all the time.

So, you know, I, I think key key for us in one of the, the things that we are hyper focused on is, is how do we build a big business without having to pour hundreds of millions of dollars into marketing?  

Julian: Yeah. Yeah, it's, it's fascinating that you discussed the, the word of mouth concept. I was talking to another founder and we were discussing the different, you know, go to market strategies.

You know, a lot of people you know, use, whether it's marketing emails or you talk about paid advertising but the word of mouth can be so effective, just doing good work and having that. Kind of network effect spread amongst the different users that, that join your platform. What have you seen so far in terms of user growth since you've launched in August?

I'm assuming, you know, you had a really strong core of individuals using your service, had a really great experience. You've said a lot of the new users are, are just from word of mouth. What have you seen in terms of growth on your platform?  

Cyrus: You know, it's, it's been very strong so much so that we've had to grow our provider network by a factor of 10 in the last three months.

So we we are definitely keeping up the demand, but it's, it's it's requiring us to work at a pretty fast clip and you know, that that is been an absence. Of a covid wave. Thankfully, the last three months covid has been manageable in this country. We haven't seen a spike. Yeah. Unfortunately many folks expect because fewer Americans are boosted.

I think less than 10% of the US population is boosted at this point. So it's at a, you know, we were several iter several times higher than that when we did the first wave of, of vaccine. So as a result should a God forbid another wave arrive here which public health people predict may happen around the Thanksgiving timeframe?

Yeah. You know, I think being able to sort of keep up with that will be very, very critical for us because people are gonna start depending on the service, seeing as a lot of Americans haven't been vaccinated. Yeah. Which, by the way, if I can make a plug, I just think it's you know, the new vaccines are obviously credly important for for us as a, from a public health perspective, and hopefully those listening.

I was just saying that being being vaccinated is incredibly important, not just for ourselves and our families, but from a public health standpoint is part of what keeps will keep America safe and keep the pandemic to become a afterthought.

So please get vaccinated if you have not been ready.  

Julian: Absolutely. What what are ways, you mentioned moving fast and quick. What are ways that you've structurally within your team have been able to do? So, is it, you know, is it some sort of, you know, agile strategy that you're implementing based on your previous experience?

From a management standpoint, how are you able to move so quickly? With the demand growing and having, being able to actually 10 x your provider network, which isn't a small feat you know, it's especially in a rapidly changing environment. Is so dependent on the you know, kind of the, the I don't wanna say impulse, but the, the increase in cases and people needing help.

Cyrus: So when I was running Zocdoc, I had a formula for success. And that formula was there are four things, great people, hard work, focus and time. And if you had these four components, I thought. Pretty much conquer anything that you would want. And over time what I realized and learned was that hard work actually is only temporary.

What makes hard work permanent is if you're purpose aligned to what you're solving. And so my new formula for success is great people purpose alignment. Focus and time, and I don't have anyone on my team who doesn't care deeply about the mission of making healthcare more efficient and equitable.

And as a result of that it's amazing what people will achieve if they're working on something they deem to be among the most important things in this world. Yeah. And so I have an amazing team that cares very deeply about the patient. We have a huge amount of patient empathy in our company. And I think that's part of that's part of what's made us successful and will help us continue to be successful.

Julian: Yeah. What are some of the biggest challenges that Dr. B faces today?  

Cyrus: Well, we already talked about making sure that we can build a big brand without having to spend huge amounts of money in marketing. , I would talk about another one, which is a cultural cultural one, which is you know, at Zocdoc when I was running the company, we won all sorts of best Place to Work awards.

We were named the number one best place to work in Old New York in like 2011 or 12, I think. And I really there, there's a whole a statement in business. Tactics, beat strategy, and I very much believe that culture beats tactics. The culture is everything. Yeah. And because we were started during the pandemic, as with many companies, we are remote remote first, and how do we how do we maintain and build a super strong culture as we scale up our business being, being remote?

And that is something in my. That I've never, never done before. If I was do it in an office, it would kind of be relatively straightforward because I, I'd done it before. Yeah. But this is sort of a new challenge that I'm really want to make sure we get right, is because if we don't succeed and have a strong culture, we won't be able to do what we're doing at several orders of magnitude bigger than what we are today.

Julian: Yeah. If everything goes right, what is the long term vision for Dr. B?

Cyrus: My vision for our company is I believe that everyone in this country should have access to healthcare. Full stop. I think it's a basic human right now, how the US healthcare system has evolved and how divided our political system is. There is a very low probability that from a public policy perspective, meaning our, our federal government will be able to.

Such services. So I think it's incumbent upon private sector companies to figure out a way to help bridge the gap to make sure that every American has access to care and that it's not the number one thing that bankrupts Americans, which it is today. So in order for that to be true, I think we need to be able to navigate, help patients simply navigate through the healthcare system such that they're directed to the modality of care that is the.

Cost effective and efficient for what the patient needs. So if you need a prescription refilled, you go down one path. If you have a specific you know, unknown condition, you go down a different path. If you, you know, need to get a, a complicated surgery, you go down a different path. And, and how do you make sure though that, that we're not using the most expensive resource for the most simple thing?

That's one of the easiest ways, I think to, to maintain. Maintain cost. And so I think that I'd like to play a part long term in, in that vision of making sure that every American receives care and that they have the most efficient method possible to treat them.  

Julian: Yeah, that's fantastic. Yeah. I would like to ask this of not only for selfish research, but also for my audience as well.

What books are people, whether it was early in your career or even now, have influenced you the most?  

Cyrus: So I'll talk about three. There I talked about purpose alignment. I think Simon Sinek's Start With Why is just an amazing look about the power of purpose alignment in organizations and how you message to your employees, to your, your users.

And so I would give that book a plug. It's definitely influenced me. On a healthcare side, Robert Pearl, who was the CEO of former CEO of Kaiser wrote a book called Mistreated that talks a little bit about a lot about the problems in America healthcare specifically. What I, what I I've gleaned from that book was just how, you know, cost.

Is such a huge problem in healthcare, and what are the ways you have to actually curb that cost from occurring? We, we talk a lot about inflation. You hear about it nowadays as much as you heard about covid a year and a half ago. But one of the things that people forget is that for the last 40 years healthcare costs have been increasing signif significantly faster than the economy as a whole.

There's been massive inflation in healthcare and I think that. That it's a, it's a great book that, that every, everyone should really understand why we're in the situation we're in and what possible solutions are. And I think lastly a book I'm reading now which is written by Ken Segal.

It's called Insanely Simple. It, there's lots of books that are written about Steve Jobs and Apple, but this book is the, the only one I've read that takes the lens of simplicity as one of Apple's core value propositions and talks about how they're able to infuse simplicity in their product. And it wasn't just, is someone in a product, meaning being like, this is how we're gonna do things.

It was pretty much ingrained in every aspect of Apple's culture. Yeah. So I haven't finished it in total, but I am really am fascinated by it and it's inspired me to. Continue to push for simple and simpler solutions for patients, because in healthcare, as you mentioned, from your own experience battle of the Bands versus some elegant symphony it needs to be an elegant symphony.

And that requires huge whacking of from the Steve Jo's metaphorical simplicity stick that, that is talked about in this book.  

Julian: Amazing. And, and last little bit. And I, I appreciate you spending time on the show and I know you gotta run, but where can we find you? Where can we support Dr.B? What?

It's the LinkedIns, the, the website. Give us all your plugs so we can be a part of, or even receive care from Dr. B. .  

Cyrus: Yeah. So I would direct everyone to hi Hopefully you and your family or loved ones do not need access to Covid antivirals, but if you do we can go and, and, and walk you through those treatments, and we'll be offering and releasing treatments continuously every week, every month.

So for people who are sufferers of chronic conditions we may be able to help you get access to critical medications when you need them.  

Julian: Amazing. Well, thank you so much, Cyrus, for being on the show. I hope you enjoyed yourself and I hope to maybe extend this episode at at a later time. But I really appreciate your time and, and thank you again for being on the show.

Cyrus: Very nice to meet you. Thank you for having me.  

Julian: Of course.

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