Enabling Healthy Aging at Scale – Carly Stockdale, CEO of BestLife Holdings

Shiv Gaglani: Hi, I'm Shiv Gaglani and today on Raise the Line, I'm really happy to welcome entrepreneur and investor Carly Stockdale, the co-founder and CEO of BestLife Holdings, a platform of age management organizations, including the Foundation for Healthy Aging and Cenegenics. 

She's carved a unique path in healthcare, starting with earning bachelor's and master's degrees in public health from Yale, and then working in traditional academic medicine at Mass General and other large hospitals. She later transitioned to the digital health startup world as the CEO of ChartRequest, the first self-service medical record exchange platform.

Her passion for women's health led her to become the first operating executive at Prelude Fertility, which she quickly built into the largest U.S.-based fertility clinical network. Since 2011, Carly has invested in and advised many digital health companies independently, as well as the growth team at Morgan Stanley as an Entrepreneur-in-Residence. I'm looking forward to asking her about trends she's seen across the industry—particularly hormone therapy—as well as her approach to investing and work at BestLife.

Before we get started, I'd like to give a shout-out to our mutual friend, mentor, and advisor Mitch Rothschild, as well as Alan Patricof who started Primetime Partners which has also invested in Carly's companies. Carly, thanks for taking the time to be with us today.

Carly Stockdale: I'm super excited to be on here Shiv, and thanks so much for having me.

Shiv Gaglani: As we like to do with all of our guests, I would like to start with learning more about you and what led you from an interest in public health and working in a hospital system to investing in the digital health space.

Carly Stockdale: As you mentioned, I got started in academic medicine. I was working at Mass General and a number of really, large healthcare institutions in the United States. Amazing missions, great people to work with. The pace was a little slower than what I'd like to work in. 

I went into consulting soon after that. While the pace was quicker, you just miss the implementation, or really rounding back to delivering on the recommendations that were given. For me, I entered a moment early in my career where I just wasn't feeling entirely fulfilled. It was fine and I think for many people on this podcast, you know, you put your heart and soul into what you're doing, so you don't ever want to say you're "fine." 

I went on a personal journey. I could probably do a podcast on that personal journey, but it culminated in me sitting on the steps of the San Diego City Hall and ultimately buying a house that was being foreclosed on. I partnered with someone, and we ultimately flipped this house and I made my entire year's consulting salary in two months.

For me, it was a real moment of disintermediating my time with my revenue generation ability. It was very significant for me early in my career. That was 2009. I continued on alternative investment paths along the way, using the money I’d just made. Digital health was really becoming a thing. Rock Health was starting in San Francisco. TechStars had opened up a digital health accelerator in New York called Blueprint Health. I actually moved there to start a company and I sat behind another company…guys named Reed Mollins and Andrei Zimiles who were starting a company called Doctor.com. Andrei and Reed were just giving hundreds of pitches a day. It started pretty terribly. Over the course of months and accumulation of years --I'm sure Reed has overly earned his 10,000 hours -- the pitch got so much better and the product became so much better, and what they were promising was getting delivered. 

Even before that, I could just see so much grit. I think for me, investing in digital health companies was really about investing with people alongside me in the trenches that I knew would have the fortitude to get through a lot of really significant trials and tribulations early on, as always happens. And also, people who are just really passionate and working on meaningful problems.

It was really simple. Doctor.com was kind enough to let me participate in all their subsequent rounds. They were actually acquired by Press Ganey earlier this year. I'm very fortunate to say that I made back the money that I put into all of my subsequent investments, and more, from that. But for me, it's been a really awesome journey, and it starts and ends with the people.

Shiv Gaglani: That definitely resonates with me, and especially that realization of being able to disintermediate your time from your impact by creating something that will outlast you or bring a lot of people together and do something pretty amazing for a period of time. 

Speaking of your investments and interests, a particular interest I know of yours is women's health, and we've had several people on the podcast who are also interested and dedicated to maternal health, which is having a renaissance moment it seems over the past year and a half or two years.

We had Chelsea Clinton from Metrodora Ventures on and Deena Shakir at Lux Capital, who talked about these issues, among many others. Everyone has a personal story. I would love to hear anything you're willing to share. Tell us why you're focused on women's health. What gets you most excited about the space right now?

Carly Stockdale: It's so exciting to see so many investment dollars go into the space, and I think the impetus of my interest in women's health was personal in nature. At some point it really came down to a core idea behind some very fundamental health economics. Kenneth Arrow came up with this way of describing imperfect health care markets through information asymmetry. Inherently, there's always information asymmetry between doctors and patients, right? Google doesn't make up for that gap. What was interesting about the areas that I focused on in women's health -- let's start with fertility -- was, in 2008, fertility preservation or egg freezing was made non-experimental by the American Society for Reproductive Medicine. Women were not only unaware that they should be thinking about freezing their eggs earlier than they were -- usually in their 20s or early 30s – but also that after you're 35, you should really think about going to a reproductive endocrinologist after six months of trying to get pregnant versus trying for a year. This very fundamental information not only was not known by patients, but also is not being communicated by OB-GYNs, who are more frequently seeing the patients on a daily basis.

That gap between not only the patient's understanding and the doctor's understanding, but also between a reproductive endocrinologist and the OB-GYN is pretty significant and pronounced. Over the last few years, I think we've really seen an explosion. Women have gotten very educated on their options here. That's so exciting.

I think now my interest in the later stages of women's health is along the same lines, where many women who are going through perimenopause or menopause are approaching their physicians and being told, “This is just a time of life. This is how you manage it.” They're not necessarily being given options or even the latest research that's relevant to interventions at that stage of life. 

Their experience going to an OB-GYN who went through the standard medical education over the last thirty years is very different from the physicians who proactively take a stance of learning from the North American Menopause Society or really doing their own research on the space.

 That gap of information is ultimately what drives my interest in women's health. It just happens to be something, of course, that's very personally interesting to me just because I will -- and 100 percent of women will who ultimately live long enough -- spend most of my life through menopause, right? I want providers who are very educated in the space, and I want to have as much clinical evidence as possible to guide my choices through that time.

Shiv Gaglani: Definitely. I think one of the nice things about the direct-to-consumer renaissance that happened twelve years ago -- but it seems it's really caught steam now – is more patients and more providers are updating their knowledge about their own health. 

This is actually a good segue into the next question. As you know, Osmosis is a teaching company and we love to fill in knowledge gaps. I'm curious, if you could snap your fingers and change medical school curricula or teach anybody anything, what are some of the things you're most interested in people learning that they don't already know right now?

Carly Stockdale: Such a great question and I'm so grateful that a few years ago, I partnered with a lecturer at Stanford University, and she really gave the menopausal lecture to Stanford medical students who were not OB-GYN students. It was a few hours, and it represented almost the totality of their exposure to menopause, which was frightening. The change I would make is I think making some early fundamental investments in women's and men's health and then applying some better data science to the interpretation of those results.

If we look at the early 90s, I think many people who listen to this podcast probably remember when the headline was estrogen or hormone therapy equals breast cancer. What happened was a study called The Women's Health Initiative that came out, and it was about 26,000 people and the headline tied these interventions to ultimately breast cancer and different negative outcomes.

It took us almost twenty or thirty years later to say, "Okay. Actually, these initial studies were very fundamentally flawed. The average age in these studies is 64 years old and the biggest risk factor for many of these cancers is age itself." 

As we think about hormone therapy, we really need to look at interventions occurring in the perimenopause years. Re-analysis of the WHI trials really shows that not only can interventions in that time improve very real symptomatology, such as cognitive decline, but you also have a beneficial effect on the cardiovascular system. Reducing coronary disease and all causes of death are associated with many of these interventions.

I think my biggest ask would be that medical education is expanded to include a deeper look at hormone therapy. not only for women but also for men. Men's hormone therapy, I think, went through something very similar. At some point, testosterone was associated with prostate cancer and cardiovascular disease. If you look at a lot of good research by Dr. Mohit Khera and Dr. Abraham Morgentaler, you'll see that there's a very beneficial and important impact from testosterone as well. I think some of that re-education which most doctors don't have time to do for patients on a one-on-one basis would be really fantastic in the medical education itself.

Shiv Gaglani: We'll take note of that. I think that's a really good topic for us all to explore because as we know -- and as Alan and Abby at Primetime Partners have made a whole fund for -- people are aging and more and more people will need these types of therapies and are seeking that knowledge out.  That actually is a good transition to your company, Best Life Holdings. Can you give our audience a bit of a sense of what Best Life is and what you're hoping to achieve with it?

Carly Stockdale: Yeah, absolutely. The name really says it. We're building a platform that enables healthy aging at scale with access to physician-supervised hormone therapy and other really critical age management services. We're really opening up so that our clients or patients have more access to insights that are specific to them.

Our north star metric is to improve people's biological age. Your biological age is the impact of the pace of your body's aging. Your biological age reflects a combination of genetics, lifestyle factors like exercise and your diet, and other determinants like the demographics. We really want to impact that through the education of other health care providers through our foundations, and membership in our programs such as Cenegenics, and other programs that we're looking to start.

Cenegenics has been around for over 25 years. It's our peak performance and longevity membership program. We've served over 35,000 patients and the Foundation for Healthy Aging has educated over 1,300 Physicians nationally on our program. We're really looking to expand the impact with patients and other providers who can better understand all the important interventions that we can do to ultimately reduce and delay the onset of chronic disease.

Shiv Gaglani: As we know, Alan jokes that he's going to live to 114, and so I believe he is leveraging Cenegenics for some of that.

Carly Stockdale: Right.

Shiv Gaglani: Can you talk to us about what makes it different? You're growing. You have many different centers, and there's a pretty awesome onboarding protocol around it with hormone therapy and genetic testing. What are some of the things that our audience should know about it since some of them may be recommending things like that?

Carly Stockdale:  I definitely recommend having one of our doctors or health coaches on the podcast because they can speak much more extensively on this. We've got a group of almost thirty physician partners. The average time that they've been at our organization is over twelve years, and an even larger group of health coaches has similar longevity in the company. 

I would say the number one thing that describes the program is we facilitate the collection and analysis of deep and personalized analytics. Every quarter, we are collecting over ninety biomarkers that really give us an indication of what your overall state of health is. In addition to that, our customers are coming to centers around the country for almost a full day of analysis. They'll hop on a bike, we'll get their VO2 max. We get a really precise understanding of their peak oxygen level. Cognitive scoring based on the reaction time and memory. Just a real understanding of other functional tests, looking at your exact body composition, visceral fat, bone density, and getting an ultrasound to look at your coronary arterial vein.

I call Cenegenics the ultimate investment and practice in improving your health. For me personally, it had a pretty massive impact. We've recently put together a collection of about 3,500 patients that have gone through the program, and we’re looking at the impact on things like visceral fat, overall inflammation levels, VO2 max, and it really seems like an amazing and very highly statistically significant trend line of improvement. We're excited about publishing some of that data later this year.

Shiv Gaglani: That's awesome. I'm really excited to see it and clearly it's an area that, as time goes on, there will just be more and more of an interest in it. Most of our audience are early-stage healthcare professionals or even students. What advice would you give to them about meeting the challenges of this moment in our healthcare system, especially given how diverse your own career has been -- from public health to work for the health system, to now running a company.

Carly Stockdale:  There's so much to do in healthcare. It's such a gift to be able to make the world a better place and see a demonstrable impact on either population health or other people's individual health. I think anyone can find a great place to exist in this field. I think choosing your pond is so important. Like when you're choosing a college, you don't go to NYU if you really want a very isolated small pond to be in. You don't choose a small private school if you want to be in a big city like New York.

I think choosing your pond is an important thing to do as it relates to your field. If you look at reproductive endocrinology, for example, that's an industry or a field that was created 35 years ago by two physicians who were in a family that very desperately wanted to have a child. Those two physicians were willing to really push the envelope. Then a number of physicians after were willing to experiment in order to figure out how to procreate without sex.

Every five years you see the innovations in that field move so fast that our idea of ethics and public policy can't keep up with it. Do you want to be in that kind of pace surrounded by massive amounts of dollars going into research? And then contrast that with if you look at primary care for women. I was talking about the North American Menopause Society. There haven’t been massive influxes of research dollars in that field. If you want to be the person that's really putting forward the seminal research on new interventions that typically haven't been reimbursed, you can stand out in that field, but you can't expect too much movement around you. You have to be more the changemaker in that field.

Beyond the obvious, try to shadow and try to interview whoever you think you want to be because again, early in my career, I thought I wanted to be a transplant surgeon. It turns out that would have been a terrible idea. I think really getting to know the space and understanding what conditions you like to operate in is really helpful.

Shiv Gaglani: Yeah. No pun intended for the conditions to “operate” in. That's definitely good advice, and it's interesting how much a career zig-zags, right? How just being open to opportunities, and also knowing that things are not irreversible. Like, when you make a decision, you could still be a transplant surgeon if you wanted to at this point. A friend of mine's dad just graduated law school at seventy-nine. Very few things in life I think are totally irreversible. It's good to keep that in mind, too. 

Carly Stockdale: Well, I just want to build on that. You look at people and their careers and some people really go deep. I think you look at that in healthcare, too, right? Like if you're a doctor, many times you're focused on individual progress, and then there's different areas in the field where you focus on the expansion of different concepts to impact a wider audience. If we look at what BestLife is doing, we're focusing on expanding some of our programs with telemedicine. I think a lot of people on this podcast or people listening to this are thinking about their own practice that way.

There's always the possibility of changing industries. I think domain experience for most professions isn't nearly as important as for doctors. You have to get such specialized training. But nothing is precluding us from going back and reinventing ourselves.

Shiv Gaglani: Totally. You mentioned telemedicine. There have been a lot of trends that have been accelerated because of the pandemic, one of which is telemedicine. The adoption of that went sky high. You've been studying, and been in, the digital health space for a while. What are some of the trends happening that you're most excited about in digital health?

Carly Stockdale: It's so funny. When I was an investor, I could have summarized five of 100, but now as an entrepreneur, you're so heads down and focused on the ones that are really relevant to you. We are very focused on using telemedicine in a way that's highly impactful. As you saw during COVID, the expansion of telemedicine is pretty prolific, especially for acute needs. The number of programs that I think really do it well on a longitudinal basis are few and far between.

In the Cenegenics Program, for example, the average time in the program is 54 months. You know that people feel a lot of connection to the program and want to stay on it. How do we retain or even expand that patient loyalty or patient experience when it becomes completely remote, right? 

We won't need people to go into one of our twenty centers but we can actually see them anywhere. The trend of how to make telemedicine impactful for the longitudinal care programs is what I'm most focused on, and not getting distracted by the noise of people who are just avoiding a necessary visit for a UTI or something like that. We're really thinking about how do we help our patients develop relationships with the care team in a meaningful way when it's completely virtual?

Shiv Gaglani: Absolutely. I think that's good, not only for the patient but also for providers, in an age of transactional medicine. Being able to have longitudinal relationships is important.

Is there anything else you wish I'd asked you or that you want our audience to know about you, about Best Life, or the space? Anything?

Carly Stockdale: You know, Shiv, I'm really grateful to be on here. I think the ultimate takeaway and something you espouse all the time on this podcast, which I appreciate, is just always be learning. This field that we're talking about -- whether it's hormone therapy or reproductive endocrinology or many others -- is constantly evolving. You need clinical evidence to evolve that.

The best clinical evidence that we get comes from pharmaceutical companies. They're doing their controlled clinical trials, but if there are interventions like sometimes hormone therapy --which is definitely not under patent and could potentially serve as a substitute for medications that they make a lot of money on like antidepressants and anti-anxiety meds —it's harder to get that level of information.

I think it's important as a provider to educate yourself so that you can be the sherpa that you want to be for the patient that's coming to you, and then it’s critical for the patients as well to be educating yourself on the newest research that could come in, that really impacts how you live your life.

Shiv Gaglani: Those are some great parting words of wisdom, Carly. Thanks so much for taking the time to be with us today and sharing all the work that you’re doing to advance healthy aging through BestLife as well as the digital health space.

Carly Stockdale: Thanks for having me, Shiv. I appreciate it.

Shiv Gaglani: With that, I'm Shiv Gaglani. Thank you to our audience 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. Take care.