A Digital Health Home for Clinicians - Guy Friedman, CEO of SteadyMD

DR. RISHI DESAI: Hi, I'm Rishi Desai. Today, we return to a frequent topic on Raise the Line: how the telehealth boom is impacting providers and patients and what the future holds for this modality. Our guide today is Guy Friedman, CEO of SteadyMD, a company he co-founded in 2016 to improve primary care delivery. SteadyMD rapidly expanded to providing telehealth care in all 50 states and developed a level of expertise in launching and scaling online services that led to supporting other companies to do the same. It currently works with leading employers and online first companies delivering primary care, behavioral health, digital pharmacy, and other telehealth services. A previous guest on Raise the Line, Deena Shakir of Lux Capital, is a major investor in, and board member of, SteadyMD. Guy, thank you so much for being with us today. 

GUY FRIEDMAN: Thanks for having me. I appreciate it. 

DR. DESAI: Absolutely. So, SteadyMD is not the first company you started. Tell me a little bit about your background and how you became at this point, a serial entrepreneur.

FRIEDMAN: Sure, yes. The entrepreneurial journey starts in Philadelphia after I graduated from my MBA program. I started a company in the edtech space. There was this emerging growth of online programs in edtech, similar to what we're seeing now in digital health—we're pretty parallel. My company pivoted into this, but the eventual product was a platform for online proctoring of exams for colleges and universities. So when you take an exam online, we record you over the webcam or watch you over the webcam and observe you so you couldn't cheat on your online test. 

I did the full entrepreneurial round trip with that. We raised the VC round. We sold it. I worked for the acquirer. But while I was developing that project, I always thought there was this application to telehealth. It's because it's the same thing, scheduling the visit, connecting up with someone on the other end, maybe logging into a system that's different for each and every user that comes in and things like that. 

After I left, I did my earnout after the acquisition. I took some time off and really just studied the whole healthcare ecosystem for opportunities specifically focused on telemedicine. I got really passionate about primary care and building out a platform that would really build trust and relationships between patients and clinicians. And so, the first iteration of SteadyMD was born out of that, and then it eventually evolved into the company today. 

DR. DESAI: Just to understand the healthcare space and what attracted you to it, what was it that brought you into this sphere, and specifically, primary care? 

FRIEDMAN: Yes, I think as a founder, at least in my experience, you really want to make as big an impact as possible if you're going to be working on something. Healthcare, like no other industry, affects so many lives, on the patient side as well as the clinician side, which is what we really focused on. A lot of our focus over here is maintaining and building relationships with clinicians as well as our partners and our patients. I think I was just inspired by the sheer magnitude of the space and the opportunities there. Even if you burrow into one little corner of the healthcare industry, you can actually make a huge impact. So I think it was just a combination of the desire to really make a big impact on people's lives in a positive way. That was really the first motivation. 

Then I love complex and tricky business problems, and I think healthcare has an ocean of them. So the ability to have such a wide breadth of things to focus on, and really focus on what you're passionate about inspired me to start looking at it. I love helping people. I love that every day you can wake up and if you do a good job, it impacts people's lives in a positive way. It's really just a great opportunity and I'm lucky to be in the industry and be where we're at. It's a big opportunity and responsibility for us at SteadyMD to all our partners and patients to take care of them in the best way. That's really been my motivation from the start.

DR. DESAI: Maybe I can use that as a launching point for this which is, you know, there are a lot of virtual care platforms and SteadyMD offers a number of services. Walk me through, from a patient standpoint: what is different from what they get on SteadyMD that is not available elsewhere, or available in a different way, so that people can really ground for themselves?

FRIEDMAN: SteadyMD works with partners across the digital health spectrum, from labs to urgent care, primary care, mental health. Each one of those businesses in that space has a different clinical protocol, clinician type, order of operations, and clinical operations around executing on an appointment. What we do is we help all those companies with their on-demand clinician workforce and their clinical operations with our team as well as our product and technology. 

There are some incredibly innovative companies out there, and we allow them to have greater access, a greater group of the population. So I like to think of us as really enhancing and allowing all these innovative companies to grow and thrive. Most of the companies work with us because they want to focus on their product and tech, their patient experience, maybe the clinician experience. The infrastructure for a digital health company to operate is such a complex and rigorous process, that it really makes a lot of sense to partner with us instead of trying to do it on your own. That's the reason a lot of these companies do that. We let them focus on building the best product possible and allow it then to expand access to that across the country.

DR. DESAI: Now, you've mentioned from the beginning the aim was to match patients with providers that “got them,” really understanding their needs. How do you do that, and how is that different from the current model? 

FRIEDMAN: If you think about our roots, I think we were pioneers in this idea of allowing patients to match with the doctor that's aligned to them in their interests and background and history. That was really what we worked on for years, honing that. That was the product. It wasn't a byproduct of another product. Our product was matching patients with the doctor that was great for them and then building a long-term relationship with those patients. 

So if you think about the industry and how there's been a huge explosion of different digital health options, they're sort of doing the filtering on the front end of, “This patient is really interested in this care modality. They were interested in solving this specific problem.” That's the new pitch at all these point solutions that have been launched, and we can help find the perfect clinician for those patients.

It's really an extension of what we were doing in the past. It's just at a bigger scale, and helping other companies match that philosophy. When we were in the consumer business, we were fully focused on virtual primary care. Now we can help everyone in the industry fulfill their vision around matching their patients with the perfect clinician for the patient.

DR. DESAI: As a pediatrician, I'm just curious. I haven't used SteadyMD and I'd love to try it out but how would it work on my side? Would it ask me questions like what kind of patients do you like to focus on?

FRIEDMAN: Yes. Most of our partners are digital health companies themselves. We've worked with pediatricians or primary care doctors. They would sign a contract for a relationship with our physician group and then we'd source opportunities for those clinicians to work in a digital space. So, if we work with many companies from the digital health ecosystem, you'd have the opportunity to work on different platforms that care for patients in different ways. Our job is to really match that demand with supply and be the connective tissue between digital health companies and the clinicians who want to work in digital health. 

DR. DESAI: With that in mind, what's the pitch then for providers to get them to join your team?

FRIEDMAN: It's a great question. We want to be the best place in America for clinicians to work, and live that. I mean, obviously, at the high level, we want to enhance trust with our clinician network, make sure that they know that they're given the autonomy to care for the patients in the best way possible. We have invested a lot in clinical leadership to make sure we're screening out opportunities for them, making sure that they're clinically effective and viable. Make sure they have a voice when there's an issue to a clinician as well as maybe the business side.

Then I think on clinician value prop, there are so many opportunities to work in digital health. Five or six years ago, TeleDoc maybe was an opportunity and maybe one or two other companies. Now, there are literally hundreds, if not thousands, of digital health companies that you could possibly work for. We really act as your agent and your partner in finding the best opportunity. So, instead of trying to apply to a single company and working for them directly, you can work with us and have the opportunity to work for many different opportunities in the same category or space. I think clinicians really value that, because it allows them to focus on caring for the patient the best way and not a specific company that they put all their chips in. 

Also variation, right? If you want to work on different modalities, we can let you work for multiple digital health companies via our platform. We have a really robust technology that connects the digital health company's clinical protocol, their appointment modalities, things like that, into a technology that allows our clinicians to work for multiple companies. So it's a really interesting and varied day if you can be exposed to all these different cool digital health companies, versus doing the same thing again and again.

DR. DESAI: You guys have expanded beyond primary care at this point, right? What are some of the other services you guys have gone into? 

FRIEDMAN: We're obviously leaders in primary care. We've expanded our network greatly, with NPs, MDs, DOs, and PAs in that space as well. Our mental health product is growing fast as well. So that's mostly mental health therapy.

DR. DESAI: Got it. That makes sense and obviously, there's a huge need for that now, to the point where it's almost considered part of primary care, right? 

FRIEDMAN: Absolutely. I'm super excited about what I'm seeing. I have the best job in the world because I have a front-row seat to all the innovators. If they're growing or they're starting out or even these giant companies, we get exposed and we get to hear about all the cool things they're doing. Then in the next sentence, yes, we're going to help you grow and make sure that any patient that wants to use this, they're going to have access to a trained clinician that understands your business and is able to execute across that. 

It's really fun to hear the different approaches that are out there. I'm super bullish on the digital health industry because of that. A lot of times, people are doing these new and innovative things that haven't been tried—obviously, with the rigorous clinical research behind it. I think there's this explosion of offerings to patients for everything under the sun. Great companies are going to emerge out of that. We get to see them and help them grow and scale. It's actually really enjoyable for me, just out of the intellectual part as well as the amazing business for building. So yes, that's a big part of this. 

DR. DESAI: Can you share some examples of the companies that you work with? What are some of the specific things that they do that are creative that you've noticed? 

FRIEDMAN: Sure, absolutely. We're not going to reveal any client names unless there's permission, but there are different buckets. There's the direct-to-consumer point solutions that are trying these really innovative and scalable approaches to solving pretty complex issues. There's new and innovative therapy companies with really cool tools and rigorous clinical backing, and they work with payers. There are all the different combos of virtual primary care, from, “We have a physical location and we need help with the online portion of this,” to “We're fully online,” to “We're urgent care plus access to this in-person experience.” 

There are just so many interesting approaches to things across the spectrum: home testing, and then with pharma delivery as well, there's been a lot of innovation to unlock there. Now you're seeing the combination of testing plus follow-up plus a longer-term relationship with the patient, which we're engaging with as well. So there are just a lot of cool examples out there. 

DR. DESAI: The federal government has facilitated the use of telehealth across the United States with new regulations. Do you expect that those regulations would be made permanent? If not, what do you think happens then? 

FRIEDMAN: I think some of them will, and some of them will go back to what it was pre-COVID. I think the biggest one is the Medicare in-person requirement which they waived early on in COVID. What a great natural experiment, right? 

So now we know, I'm not aware of it, not working out really well for people that actually used it. That was a big one. The good part about a lot of these, about COVID, and specifically what you're talking about, is we had a natural experiment with maybe thousands if not millions of appointments. Now we can actually see the data on, “Did telehealth have a real impact on outcomes?” So I think that's a good example. I think that one will be made permanent in my opinion. 

It's very hard to say, “We onboarded a patient via telehealth and now we have a relationship with them,” and you eliminate that. It's that risk you're taking something away. So I think that one is a no-brainer. The one that's exaggerated is the multi-state licensing, because that's really at the state level. I'm the biggest proponent of one federal license for clinicians, but I think that one will take a little longer to break down, probably by compacts and stuff like that, just to get into the weeds a little bit.

So those are the two big ones. Then there's some other stuff that happened, but those are the two that we really pay attention to.

DR. DESAI: Along those same lines, are there some common misconceptions that people have?

FRIEDMAN: It depends on how in the weeds you are, of course. From the layman, somebody who's not in the healthcare space, the state licensing in the state-level regulatory environment is always a shock even though their startup founders are not in the industry. There's always this, “The clinicians need to be licensed in the state where the patient is.” At that moment, every digital health entrepreneur says, “How hard is it to license a doctor in those states?” 

I think the magnitude of the regulatory environment is under-exaggerated, even for people who start companies. I think when I originally started SteadyMD, I didn't know the journey we had to go on there. It's like a matrix of laws, and then on one vector is all the states—which you have to go, actually, state-by-state and analyze it that way. Also, things that seem simple can get really complex really fast. For example, scheduling an appointment. But then you add in the callbacks, synchronous appointments, on-demand, follow-ups, and re-schedules. It gets pretty complex really fast. 

I think sometimes the sheer complexity of the business gets under-exaggerated, even within the industry. Many times, that's where we live, right? At SteadyMD, we try and take all that complexity and our mission is to simplify that for ourselves as well as the industry. 

I think that's probably the biggest thing I hear is an assumption about that specific piece, and eventually you get to the point where you're like, “This is something we really need help with,” and that's where we come in. 

DR. DESAI: Of course, you're talking about MDs or Dos, but then it gets complex when you start thinking about nursing as well. That's another ball of wax. 

FRIEDMAN: Oh, yes. All the legal and regulatory stuff around that, and then just forecasting demand and building out a clinician workforce that can flex up or flex down based on your forecast. It's really complex and really difficult. That's why we're around. I think we're embracing that complexity and running towards it so that we can build a product that helps the whole industry get capacity. 

DR. DESAI: I'm curious. I've heard this rebut before about how, you've got Uber and Lyft. Here, we've got a similar sort of analogous situation where doctors can plug in; they can work on multiple platforms. Do you sense on any level a reluctance from clinicians to be participating in stuff like this? Because they're like, “Now I'm just a gig worker and I'm not really...”

FRIEDMAN: I'm really happy you asked that question because it's a key differentiator for SteadyMD. We've spent years thinking about and building a whole business model around not treating the clinicians like commodities. I know I've talked to hundreds at this point, maybe more—more than I can count. You have to really be respectful of the clinician experience and make sure they do not feel like that. It's one of the highest burnout professions, especially in primary care. It's not a sustainable model just to treat the clinician like a fungible commodity that you can put in and out of a piece of software. 

I would encourage all the digital health entrepreneurs and product people listening to build your product with that lens. When we're building our project of what the clinician sees and works with, we're really thinking about burnout and respect for their autonomy. Make sure that they're not being hammered by the same type of appointment for hours and hours. I think it's super important what you said, and no, I do not think you can make the analogy to the traditional gig worker. I think the workforce is very different in that we're really developing expertise around that specifically. It's not a pure linear optimization problem that you can just put on a spreadsheet. You have to really be very respectful to the clinician. If they're happy and comfortable, and they feel like they're being productive, and they feel like they're making an impact, they're going to do a lot better job taking care of patients. So if you want to impact patients' lives, make sure you're taking care of the clinicians in a robust way. 

If you ask 100 clinicians, a lot of them really feel burnt out. They feel like the administration of wherever they're working treats them like they're squeezing them for more and more and more. They feel underpaid. I'm really glad you asked that, because it's such a contrast to how we feel about our clinician network here, that I'm glad we got to it.

DR. DESAI: I'm glad. Maybe to follow up on that a little bit, what are some of the complaints you hear from people working in a traditional model and how is that alleviated? For example, I mentioned at the outset I'm a pediatrician myself, and I've worked in many different healthcare settings, including telehealth settings as well. What, in your mind, is the key difference? What are some key complaints that people had that have gone away?

FRIEDMAN: There's the objective: pay, pressure, boredom, like “This is a boring thing; I don't want to do this again and again.” Then there's stuff that's a little more subjective, like trust, autonomy, the feeling like you can raise a concern and be respected and it's not just all about pure business. Actually living out this idea that the number one priority is caring for the patient the best possible way, and we want you to focus on that, and building that trust with the clinician workforce. 

We work hard at it. Honestly, I'm not perfect, but my dream is really to be the best brand in the category. Not just be the best brand, but actually live it out and do it. So I think one of the challenges for me, personally, is how do you build that into the business model itself? Not just say it. It's not just a value statement. No. It's actually built into the business model, all the themes I'm saying. So maybe we could be a market leader in that. 

To me, that's a long-term position. In the short term, of course, you can go full Uber, but long term, I want to be the home for the clinician in digital health. Basically, we're the destination. We're the de facto place, and in order to do that, we need to live out those values. That's a big focus for us, how to implement that in a rigorous way while obviously maintaining a good business. 

Clinicians get it, though. They get it. If you're open with them and transparent, they get it. For some reason, there's just opaqueness that start-ups, and other digital health companies have with their clinician workforce. I try and be as transparent as possible, because trust goes both ways. When you need a clinician to help you on something, or you have a project that really needs someone to dig in and go the extra mile, they're going to be more likely to do that if you have trust and transparency with each other. To me, that's a big impact we can have on society, as well as our company, is to live that out.

DR. DESAI: That makes a lot of sense. I honestly think that's a fantastic note to end on, because a lot of students in the audience are probably excited about the options in front of them—options that they didn't have a decade ago even so. 

FRIEDMAN: Yes, come on, we'd love to have you. All the students listening, come on down. 

DR. DESAI: That's awesome. Well, listen, thank you so much for joining us today, Guy, and for sharing your wisdom about your journey. That was fantastic. 

FRIEDMAN: I love it, man. Keep doing what you're doing, too. I know you're making a big impact as well. I've known Shiv for a long time. I'm really happy where you guys ended up. Continue to do all the good work you do. Thanks for having me. 

DR. DESAI: I appreciate that. I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.