Yes We Can

Hi, everyone. Welcome back to this week's episode of Yes We Can. And I am so excited to have Joanna Strober here today.

Hi, Joanna. How are you? Hey, Michelle. I'm good.

I'm happy to be here. I'm so excited. I mean, Joanna is an amazing operator, founder, and an expert in the future of health and telehealth and women's health.

And so there's so many words that I just said, Joanna, that I'm very excited to dig into today.

So thanks so much for being here. This is fun. Awesome.

So let's start. I said founder and operator. Well, today in your day job, you're the CEO of a great company called MidiHealth.

So why don't you tell the audience a little bit about this new company you've started and who your customers are and how it's going?

Great. So MidiHealth is a platform for women in their middle life to take care of all the things that happen during that period of time.

We think about sleep loss, anxiety, migraines, weight gain, face and hair issues, all sorts of things that happen that require care don't require in-person visits and that you need expertise for.

And so we spent a year basically talking to the top experts in the country on each of these categories and getting amazing protocols created.

So we are able to, if you're not sleeping through the night, we can help you with that.

If you are having anxiety attacks, we can help you with that.

All with the lens of looking at you as a woman during this age stage and what's going on in your body to help you manage your health issues during that time.

So the really exciting thing is that everything is covered by insurance. So we're not a consumer company.

We are in network with insurance companies. And when you come to us, you can have a telehealth visit and your insurance company will pay for it.

And then we get you the right products that are appropriate for you to help you feel better.

And then most importantly, we iterate. So you come back, we talk again, we keep on working on the same symptoms or different symptoms, but we're there for you for a long period of time to help you feel better.

I love this. As somebody who, I guess is, what did you describe women in the middle of their life?

Is that what we're doing? Yeah, exactly. Okay. Yeah. Well, so think about it.

You have a pediatrician when you're young and you have a geriatrician when you're old.

So we're MIDI and we have MIDI attritions for the middle of your life. I mean, that actually makes a ton of sense.

Okay. So as somebody who fits this target market, I am the middle of my life.

I'm also a woman. And how you said about a lot of those things that you said about, you know, when I talked to my girlfriends, like, oh, I can't sleep anymore or all these different sorts of issues.

And it's like, where do you go?

So the answer is MIDI. You go to MIDI. Yes, that's exactly right.

And the truth is you don't really understand that they're related to hormones and they're related to the changes that are happening in a woman's body as you're aging.

So, you know, for me, when I stopped sleeping, when I was around 45, I called my doctor and I explained to them, I was waking up every night at three o'clock in the morning and they didn't look at me as like, there are certain things happening in a female body that we need to be taking care of.

So they suggested therapy because they thought I was maybe anxious and they gave me some sleeping pills and they said, well, those could make addiction, but you can take them for a little bit.

But really what was happening was my hormones were a mess. They were depleting and I needed the right therapy for that.

And it took me a long time before I got that level of expertise.

So my goal is to help people before they have to spend so much time working on it.

Well, and it's so it's so crazy that there wasn't an obvious answer right away.

So that that kind of makes me a little angry. So I love that you're doing something about it and making it better for for for all the other women in the middle of their lives.

As you said, the women middle of their lives for, so they don't have to have that same sort of experience because that's, that's not okay.

Well, so in part of the challenges, you know, most women, the people who, the women who know this the best, not the women, the practitioners who know this the best are OBGYNs.

They've had some training in this, but most people become OBGYNs to deliver babies.

And so after the baby comes, you kind of get fired by your OBGYN, and then you don't have a place to go with people who are true experts in women's health.

Interesting. You know, as you think about, okay, so earlier this week, when we were getting ready for this conversation, you were at a telemedicine conference.

And like, I think what you're doing in MIDI is so super cool.

How has COVID like what happened during COVID that allowed you to start this business?

Maybe you can talk a little bit about this, because I think this just opens up a realm of opportunity for others.

So, I mean, what people realize during COVID is you truly can get medical care online, right?

I mean, 90% of what you need help with does not require in-person visits.

They require someone to listen to you, to ask you a bunch of questions about your symptoms, and then to get you the right products that can take care of you.

And the big thing that happened during COVID is the insurance laws changed.

So previously, doctors couldn't get reimbursed for telehealth visits.

So the reason why you were coming in was actually insurance was driving that, right?

It wasn't being driven by the need to see you in person, it was driven by technology, and it was driven by insurance.

So those insurance rules have changed for telehealth. So now, when you go to your doctor, you can have a telehealth visit, and the doctor can get reimbursed in the same way that they would get reimbursed for a regular visit.

And because of that, now doctors can also get licensed across state lines.

And so they can provide much more comprehensive care to people across the country if they are licensed and have an insurance contract in each of those states.

So now there's this very interesting opportunity for healthcare companies to become a global or national brand, right?

So now a healthcare company can actually get licenses in multiple states, can get insurance contracts in multiple states, and you can actually create a brand for healthcare that you couldn't have done before COVID, and before all these rules change.

That's like a big structural change that kind of all of a sudden opens up all this opportunity for great entrepreneurs like you to say, well, let me go solve this problem in a way that helps all of us as consumers.

I love this. It feels like that this is the future. So Joanna, when you were at the conference on Monday, like paint a picture for the rest of us, because you've been living this, how things will look for us, especially when it comes to healthcare kind of going forward now that some of these very profound structural changes to the insurance being reimbursed and this across state lines, national brands, like what does that mean for the future of healthcare?

So I think, you know, I don't know, five years from now, seven years from now, most healthcare is going to be like this, right?

You're going to talk to your doctor online.

They're going to send you a link to an app that you will use to identify whether you have skin cancer.

They will send you a link to an app to, and that already exists, that's not new.

There's going to be at-home pap smears. You know, women actually only need pap smears every five years.

There's great companies creating on at-home pap smears.

So you will not have to go in for that. There will be a lot of, and there's a bunch of interesting technologies getting created.

So healthcare is really going to come to the home. You'll talk to the practitioner.

They will understand your symptoms and they'll send you the right tests.

And then they will be able to prescribe you the right medicines and you won't have to go in.

The great thing is also that, so part of what we've been doing is these protocols, right?

So there's brilliant doctors who have been doing great research on all sorts of different ways to help you.

Historically, you've had to go to that doctor, right?

People have flown all across the country to go to that doctor.

So now you can take their protocols and they can train others to administer those protocols and you can do all that on telehealth as well.

So I think we can actually get much better care for lower costs using telehealth solutions.

Oh my goodness. I love this. And so, I mean, there's so much, I mean, it seems like the winners in this new world are for sure the consumers.

Like all of us have this better care, lower costs, so much innovation will come better, easier, more democratized.

Are there people that you think that are going to resist this change, that are going to make it hard, you know, cause resistance so they don't get left behind?

Do you see that at all in your day-to-day? So some of the stuff that's difficult is actually state licensing laws.

You know, states have a lot of power over the licenses they give.

And one of the big things is stopping this from happening faster is that it takes an enormous amount of time and money to get your, to get people licensed in each state and credentialed in each state.

And then you have to do a contract with the insurance company in each state, which just makes no sense.

This is just a historic, but you're displacing a lot of laws.

And so that's actually the biggest challenge I think is going to be navigating that.

I think that will happen over time and we'll have to figure out different ways, just in the same way that Amazon is now staying in state taxes, right?

You can imagine that you can have a national license. I mean, healthcare is no different in California than New York.

You should not have to have separate.

So eventually maybe you'll have a national license and we can just share the revenue between the states.

So there's really, the thing that's going to hold it back is just regulatory and, you know, how fast that changes.

But the demand from consumers is so high that I feel like that's going to happen.

Oh, wow. It's so interesting.

You know, I don't work in healthcare, but I work in tech. And one of the things I see as somebody who kind of looks at the Internet and the acceleration technology is what I say is, Hey, look, if you're a policymaker, if you're on the regulatory side, embracing how the Internet's becoming more a part of business and everyone's life, you could, and the technologists need to embrace the regulatory side, the people who do get to shape the future, because it's happening right now.

Like, you know, I mean, there's just like information, meanness, online bullying.

There's just so data privacy. There's so many laws that are getting talked about and proposed around the world that the people who are leaning in are shaping the future of what's going to happen.

And that really, when you were just describing this, it seems like the same in healthcare.

It's almost like if you are a policy wonk, or you love the lawyer, you love the regulatory side, and you want healthcare, like this is a great place to lean in and same with the healthcare entrepreneurs and experts to lean into the regulatory side, because together you're going to get to shape the laws that will help dictate kind of how this industry proceeds over the next 10 years, which I think is super exciting.

I think the consumerization of healthcare is real.

And technology is obviously what's enabling it.

But I do think over time, consumers are going to get more and more demanding about what healthcare they get.

And they're, they're going to want access to the best.

And it shouldn't be limited to them by what state they're living in. Right, or which neighborhood they live in, or where they can get an appointment, because there's only so many in person appointments, like there's lots of, right, there's lots of constraints.

It's interesting. I learned at this conference, I didn't even know this, that there are only so there's something called NAMS, which is the National Association of menopause practitioners, there are less than 800 trained people who are accredited by them in the whole country.

So we have 57 million women in menopause and 800 practitioners, that doesn't work, right.

And if you talk to them, they have year waiting lists to get into their practices.

And part of that is if you have an in person practice, there's a lot of overhead that goes into that.

And a lot of so you can be so much more efficient if those people can do it online.

But we have to figure out how to scale that type of care. And technology is really the key to being able to do that.

Wow. And and entrepreneurs like you at MIDI who are like, I'm going to help make this accessible to way more people.

I think that's super exciting. That's great. So let's say someone's listening.

They're like, Oh my god, Joanna is awesome. I am that I want to start I want to start something in this space.

Like what advice do you have for entrepreneurs who care about health care, and they're hearing about some of these structural changes, which creates opportunities for new entrants?

Any advice you have for budding entrepreneurs who want to do something in healthcare, health tech?

So I think the last five years were about pills. And they were companies like hims and hers and row that we're giving you access to meds.

And that was really important.

But I think the next five years is going to be about care. And how do we improve care?

And, you know, I think figuring out different, different methods of scaling great care is, is just a great opportunity and challenge, but it's a great opportunity.

Whether it's primary care or specialty care, there's not enough practitioners, period.

And so technology is a great place to, to start, right, figure out what care you can scale.

And, you know, I think, and I do believe strongly in the consumerization of in healthcare.

So figure out what, you know, whether it's kids who have ADHD, that's a really good place to start.

Or, you know, there's an incredible company called the quick, which is doing this nationally.

So for eating disorders, there's another company called no CD, which is doing treatment for OCD, people who are suffering with OCD, like there's really good companies getting started that are focused on different areas.

And they're just beginning, there's going to be lots more.

And I think there is a big opportunity to create more companies here.

Amazing. And as you're saying, like, when you talk back to, well, do you really have to see someone in person?

Or can you have a conversation like this to listen back to your words, listen, and then get the right products in their hands.

A lot of those are good examples of places where you probably don't need to go see someone in person.

You can probably do a lot over the Internet.

Yeah, exactly. Okay. So that's for people who are starting thinking about starting a company.

I think that's great about kind of what's been big, where the small opportunities going forward.

What about somebody who wants to get in and spend their time, like change careers?

Because they're like, oh my God, I've been waiting for this moment for the consumerization of health.

We've been talking about it for a long time, but it does feel like things have changed.

And COVID was one of the catalysts to help enable that.

And they listen to you, and they're just so excited.

As someone who's worked in this space, that you hire people in this space, you see your peers hiring people.

What advice do you have for someone who's thinking about changing careers or getting into this space as part of their career?

What advice would you have for them? There are a lot of really interesting online groups that you can find that are talking about this.

And I actually have access to a bunch of Slack groups in the health world.

And afterwards, we can try to share some names.

But start talking to people about what they're hearing, what's working, what's not working.

Everything that you are hearing about in the rest of your world is coming to healthcare.

It's becoming more consumer, right?

And so we have to work on everything, licensing, payments, all the things you need for shopping now are coming here.

So there's a lot of people who are talking about this.

And I think there's going to be a lot of innovation.

And so there's good... I mean, healthcare is 18% of the economy, right? And so you think about a lot of that going online, there's just a lot of innovation happening.

And I would just find other people who are starting companies or working at companies and network with them and hear what problems they're having.

Until we started this, we didn't understand we were going to have to work with a company for licensing, we were going to have to work with a company for billing, we were going to have to think about just co-pay management.

When you go to the doctor, they take your credit card, and they do the co-pay, right?

But that co -pay, they don't know what it is until after your visit.

So that's very hard for an online company.

So if you look at all these different parts, there's so many opportunities to make online healthcare better, and to create technology companies that will do that.

So I just think that there's going to be a lot of really big companies that are getting it formed that are virtual first companies, and figure out what problems they're having and help them to go solve them.

I love it. Sounds like a great time to get into the industry or if it's something that's passionate to you, it just feels like there's a lot of growth ahead.

And I always think in your career, being a place that's growing is a good place because you're learning a lot, you're put in a place where you have to make decisions that you feel like you're not quite qualified, but then you learn a lot, you get the recognition, which is great.

And it's part of the future. So it's an exciting place to spend your career.

That's great. So before you started MidiHealth, you started other companies that got acquired by Weight Watchers, you've had a long operating career.

Tell us a little bit about your last entrepreneurial endeavor. So in 2015, we created Curbo, which is the first digital therapeutic for childhood obesity.

And we licensed the Stanford Pediatric Weight Control Program and turned it into a digital platform for basically connecting coaches to children to help them and to their families to help them to get healthier and learn healthier eating habits.

And we ran that for a number of years and then sold that to Weight Watchers, to WW.

What was that experience like? Especially if you're a parent with an obese child, incredible.

So what was it like working with your clients there and with the parents?

And then the transaction being bought by Weight Watchers, what was it like being absorbed by a much larger organization?

There's so many different angles.

So first of all, it was the most rewarding thing ever. I mean, I'm hoping this is equally rewarding and I think it will be, but starting that company, I had been an investor for most of my career.

I had not actually been working in companies, but the opportunity to really help people, I think is just what the great thing is about digital health, is that you can truly make a difference in people's lives and do it in a way that you just feel great about going to work every day.

So I loved it. It was very early when we started that in digital health. And so there was a bunch of challenges.

We couldn't get insurance coverage. This was all pre-COVID, couldn't get any insurance coverage for the products.

It had to all be consumer pay.

And as you know, there's a huge population of lower income children in this country who have issues with their weight and we were unable to reach those people because it had to be a cash pay company.

If I had to start it all over again, I would do it all insurance, which you could do now, which you couldn't have done before.

And then what we realized at some point for Curbo, which was really interesting, is there's a huge challenge in weight loss companies, which is that if you're successful, someone doesn't need to use you anymore.

Right. You lose your attention as a problem.

Yeah. Retention is a huge problem. And the better my product was, the less people needed to use it.

So we were not trying to keep people on it longer, right?

Our goal was to teach children really good, healthy eating habits.

And once we did that, they didn't need us anymore. And so we realized that we would be much better off as part of a larger organization that already had customers and we market to those mothers for their children rather than growing it on our own.

So Weight Watchers was a perfect company for us to partnership because they have women in our demographic who had children who needed to learn healthier eating habits.

So actually the transaction was super successful for us, but the team is all still there.

We have hundreds of coaches who are coaching kids and it's been a great, it was great for us.

Wow. Amazing. I mean, it's pretty cool that you were an investor.

You were passionate about this idea. You did it and you sold your company to a bigger company and now you're back to an operator again, starting another company.

I mean, who did you, like, is that what you expected, Joanna, or is this kind of- No, totally not what I expected.

I think most of my career has not been what I expected.

I definitely have done a lot of different things and been really fortunate to get to try a lot of different things, but nothing was actually particularly planned or organized.

But I think getting back to what you said, find opportunities, right?

I'm always telling my kids and their friends, go to things that are growing, find areas that are growing, find companies that are growing, because there's so much opportunity to grow in your career when you find areas of growth.

And so that's what I've been able to do. I feel like you and I give the same advice to people we talk to because I think it's so similar.

I couldn't agree more. Okay. So as an investor who turned to an operator and a founder, I mean, both, right?

You're both an executive and you're a founder.

You're both hats, or have worn both hats. Right now you're the founder, but when you're at Weight Watchers, you were an executive there.

And I feel like I'm a founder, but I run a big company, so I'm also an executive.

It's both hats. What are some things that have, and again, there's a lot of investors that listen, or maybe people who were investors that want to go into operating, but don't even know, or they're scared, a little worried.

What, as you look back and you kind of reflect, any words of wisdom for investors who might want to get involved with an operating role?

Such an interesting question. You just have to be brave, right?

A lot of this really is about being brave. I mean, when you have an investor, when you're an investor, life is definitely a little more steady.

It's not as many ups and downs.

Right. And so when you take the jump to go to a company, particularly a really early stage company, the ups and downs are huge, and you have to be ready for that.

You just have to be ready for a lot more chaos. But I actually find that super exciting.

But you do, you have to be, it does take courage, and you have to just be brave, and I think if you really feel good about your idea, it's much easier.

And quite honestly, if you feel like it's a, like the world would be worse off if you didn't do this, that like driving, that can really drive you to feel like you have a special idea, other people don't understand it, and you can really make a big difference if you do that idea.

I feel like that's, for me, that's very motivating.

I love that. Oh, my God, you and I, I know we don't know each other very well.

But like so many of the things you say, I say, I mean, again, I wasn't an investor, but like the same, being part of something that's bigger than yourself.

It's so rewarding to be part of that sort of team.

And so I love all of that. Okay. Oh, my God, like right now, I have the most amazing team.

I mean, like, I look forward every day to going to work with my team.

And I think a lot of that is you working together on a team where you all really care deeply about what you're doing is an incredibly rewarding experience.

Definitely. And then especially if you're making progress and you have a good business model attached to it, and then you, this larger mission, and then that you feel like you can contribute all of a sudden, that's the shiny unicorn that's so hard to replicate.

Like it's all of those pieces lined up and sounds like you really have that with MIDI, which is great.

Okay. So as somebody, you know, you had Curbo and now you're starting MIDI.

Are there any surprises or lessons learned kind of starting your second company and insights when entrepreneurship has had, because you're like, you're in it.

And there's lots of other people who are about to start companies or have started companies, any lessons, current lessons.

And I feel like with entrepreneurship, things that were big five years ago are no longer the thing.

It's something else because it's just moving so quickly.

So any insights or lessons learned you could share with us over the last year?

You know, all of my friends who have started companies, I always think of them as like the little engines that can, right?

Like it's that kind of thing.

Like, I think I can, I think I can, I think I can. And like a lot of challenges come every day.

Like you're just kind of unaware of what's going to, what the next challenge is and what's going to feel like it's going to throw you off.

And of the people I know who have done this most successfully, it's just this like belief.

Okay. I could solve that problem. I can solve that problem. I can, and you just keep on looking for ways to solve problems.

And you know, I don't know what those problems are going to be for someone else.

You know, we find out, oh, we can't do billing for, as I mentioned, you know, the co-pays.

We don't know what the co-pay is before the visit.

So we can't tell someone what, what they're going to pay for my visit.

That's crazy for everyone who came to our company from e-commerce, right?

Using that as, as one example. Right. You want to know how much you're going to pay for something.

I mean, it's a very basic, yeah, consumer. Very basic question.

Yeah. And then I can't tell you that, or, you know, that's like, oh, okay.

Like, wow. We're going to fix that one. And then, okay. Our, we are not trying to be a pill company.

So we want you to have all of your drugs paid for by your insurance company.

Well, it turns out that that's really hard to do. So, you know, okay.

How are we going to solve that problem? Well, for right now, we're actually not going to sell you the drugs.

We're going to send you to your pharmacy because we care really deeply about having your insurance paid for your drugs.

Now that's like, not what I started my company thinking.

I really thought we'd be able to figure out on day one, how to send you the products directly and have your insurance company pay.

So then you go, okay, you change this. Like, I think it's like, but I think I've watched a number of people do this.

And I think it's that attitude. Oh, heck, I can solve this problem, solve this problem, solve this problem, and just try not to get too frustrated by each one that comes because there's going to be a lot.

So interesting.

You're the, I'm now your analogy of the little, I'm envisioning you as a little train, the little engine that could go along.

You're like, I'm going to go around here around.

Well, it's interesting is what you're describing. And I have that book, the little engine that could, a girlfriend of mine gave that to me years ago.

I forgot about it until you just said that, but you're taking me back to when we started Cloudflare where again, there's just lots of obstacles that you have to deal with.

And it's like you, you're the founder, you have to deal with it.

And I just, I think back to some of the things we used to say to our team. And I don't know if this resonates with you is, Hey, every time we solve one of this, it makes it, it's, it's, it gets us further along.

And it's also makes it, it's like, we're now one step ahead against somebody else maybe doing it.

So it becomes a barrier for somebody else to come in and do it too.

And so it's, yeah, there's a lot of problem solving along the way, which is kind of fun if you have the right people to work with on it.

I'm sure when people look at you now, they think, Oh, that was not that hard.

Right. They probably do. And I haven't said this for a long time, but when I first started Cloudflare, I used to say, if I knew how hard it was, I probably wouldn't have done it.

Yeah. Right. So like, I'm sure that now it looks easy, but when you started, I'm sure every night you like went to bed going, Holy shit, like, excuse my language, but Yeah.

Right. You're just like, wow, that's a lot.

And you kind of said as an investor, it's a lot more stable and entrepreneurships.

There's a lot of highs and lows. And I think your job as a founder and leader in the business over time is to get the highs and lows to be further apart so that you get to more of the stability and it's, everything's not a fire drill and emergency and it's more steady.

That's something Fred Wilson used to blog about on his ABC blog.

And I really, that really spoke to me kind of when we were growing our business where it's like the highs and lows are really common early.

It's why you go, it's so exciting, but at some point you gotta, you outgrow that.

And your job is to, to, to make those much further apart.

So I like that actually. Yeah. I did use that eventually. Well, and it's like today we have lots of highs and lows, but they're way more spread out versus, you know, when I was your stage, we had 10 of those a day.

Like I was high and low depending on the minute.

And it's just like, that's exciting, but it's, it takes an emotional toll.

Yeah. Yeah, definitely. Okay, great. So let's say there's people listening and they want to, they want to sign up as Middy, like for Middy, like your target audience.

Are you accepting patients? Yeah, we're accepting patients in California now, and you can go to joinmiddy.com and we'll be in many other states very soon.

Wow. So by the end of the year, we expect to be in all the states, but right now you can come to us and have a visit and we'd love feedback.

That's great.

And so the, the, the patients that you currently have, what are some things that you hear from them that gets you super excited about what you're doing every day?

Yeah. So I would say, I mean, if you look at, we have, we have this amazing onboarding process where you say all the different symptoms you're having.

And so we get to see before every visit, what someone is experiencing. So I went and looked this morning.

I'm like, oh, sleep is the one, like I think 80% of today's visits are sleep.

But yesterday it wasn't, it was anxiety. So sleep and anxiety are probably our number one and two.

People are definitely coming with skin and hair questions.

They're definitely coming with migraines. But I would say sleep and anxiety are probably the top two.

Oh, and, and hot flashes are number three.

People are upset about hot flashes, but not as much as they're upset about their, their sleep and anxiety.

Well, it's hard and hard to function when you can't sleep.

Exactly. What about bones? Like, like, oh, let's talk about bones.

Like no one out there is making sure you get your DEXA scan and that you're having enough calcium.

And this is actually one of the things we feel really passionately about.

We're going to make sure that our clients get their mammograms.

They get their DEXA scans. They find out how their bones are doing and they're taking good care of their bones because it's one of the most important things you can do for your body.

Right. And if you start early and do the right levels of calcium and vitamin D and other things, you can make a big difference as you age.

And none of us want to be those old ladies who are really, you know, frenched over and it's because they didn't get the right care.

And so there is a lot you can do also behaviorally to avoid that, but you need, again, you need trained practitioners and you need people who can help you.

Amazing. Well, Joanna, I am just so excited for what you're building for all of us.

I'm going to go and sign up and join MIDI.

I, you know, it's, this was great. And I'm, I'm really encouraged with the future of health, like this consumerization of health and making it better for all of us and our kids and whatnot, because it seems like there's a lot of opportunities.

So we wish you all the best luck. This was amazing. We'll have to have you back for how it goes and keep up the great work and keep, keep, keep being that engine that can.

Exactly. Thank you. You too. All right. Thanks everyone for joining this week's episode of Yes We Can.

We have Joanna Strober, the founder and CEO of a great company called MIDI Health.

Definitely go and check it out.

Thanks everyone. We'll see you next week. I'm looking forward to seeing everyone.

Thanks, Joanna.