Over the last ten years, I’ve negotiated health tech investment deals, sutured stab wounds, and built multiple products intended to prevent or treat disease. Through all of these experiences in the medical world, I’ve heard the same refrain again and again: “the healthcare system is broken.”
It’s true. We are pouring more and more money into healthcare and getting sicker. There are dramatic inequalities when it comes to access and quality. Digital medicine and health tech have struggled to deliver sustainable business models that move the needle on human health.
My career has been an on-the-ground study of these problems and the opportunities for change. I started in private equity, where I learned to evaluate healthcare products and businesses through an investor lens. Sparked by a desire to impact people’s lives directly, I got an MD, learning through clinical training how medicine is actually practiced. From there, I started my own company, a Y Combinator-backed digital therapeutics startup, and later led Strategy & BizOps at Verily (formerly Google X).
These experiences made it clear that we have to start doing things differently. I joined Levels because doing things differently is built into our company DNA. Here’s our approach and why I think we might be on the right track.
Levels Is Putting People First
Many hospitals and healthcare companies claim to put patients first, but they are structurally designed to put patients second (or third). An example: You go to your primary care physician for an annual visit. You discuss the back pain you’ve been having. The physician recommends you lose weight and take ibuprofen, knowing that your insurance won’t cover an MRI. Seven minutes later, you’re on your way home without real answers, knowing you’ll have back pain for another year. What happened to being patient-centric? Doesn’t the customer always come first?
The customer does come first, but you are not the customer. It’s worth saying again: You are not the customer! Who pays the physician for her services? The insurance company. The insurance company is the physician’s customer. Because of this, physicians are financially incentivized to prioritize insurance company demands over patient demands. Having trained with many physician colleagues, my experience is that almost all physicians want to spend more time with patients, but demands from insurers, health systems, and other stakeholders have transitioned the practice of clinical medicine away from this kind of patient-first approach.
Another structural challenge to patient-centric care is gatekeeping. Most Americans have to go through their insurance companies or employers to get medical care. Insurance companies often tell you what physicians are “in-network” and can require you to have a referral to see specialists. Once you’re in the physician’s office, the physician herself adds an additional layer of gatekeeping, deciding what labs, medications, and other services you will have access to.
Levels is doing things differently. Rather than selling to insurers or employers, we sell Levels directly to individuals. Our members are our users and our customers. This direct-to-consumer model has several downstream implications. First, it means you can purchase Levels yourself. You don’t have to convince your physician to prescribe Levels or your insurer to pay for it. You are empowered to be in charge of your own metabolic health by being able to access and use our products directly.
When it comes to product development, our direct-to-consumer model also simplifies the equation considerably. We only have to create value for you, not your insurance company, employer, or physician. Every morning, we wake up and ask: how can we build a better experience for our members? This is true customer-first, human-centric product development.
For example, we launched a home blood-testing service looking at several metabolic health markers not often taken in a standard physical, including insulin levels. A phlebotomist goes to your home, takes your blood, and you receive the results in the app a few days later. Getting these labs through the standard healthcare system would be challenging: very few providers would be willing to prescribe them, and payers would likely balk at the idea of covering them. We decided to provide this service, essentially at cost, because we believe having access to a panel of blood tests relevant to metabolic health creates powerful information our members can use to optimize their food choices, track their health progress, and become the captains of their own bodies.
Perhaps having a direct-to-consumer business model sounds like an obvious thing all companies should do, but it’s relatively unusual to see healthcare companies with enough of a consumer market to pull this off. It’s still early for us, but our more than 25,000 beta customers have provided early signals that this might be a viable path forward.
If you sell to payers, hospitals, or other traditional health system stakeholders, you are tying your company’s success to a fundamentally broken system. Does this mean Levels will never be a product prescribed by physicians or covered by insurance? Not at all! It means that, as our product and business evolve, we will constantly ask, “does this make sense?” rather than assuming that we have to fit into the traditional system.
Levels Values Transparency
When it comes to traditional healthcare, most patients experience profound information asymmetry. Your physicians, insurers, and even employers often have more data, information, and understanding of your body than you do. Getting copies of your medical records can feel like a herculean task. The opacity of the system doesn’t end there.
Recently, I received a $500 medical bill from a top academic medical center. The bill was so confusing I could barely tell what I was paying for, so I called the billing department. The staff member couldn’t provide much detail, but after expressing my confusion and frustration to her, she said she could offer me a 35% discount on my bill. A negotiable hospital bill? I found that incredibly bizarre and yet another example of the lack of clarity that most of us confront when engaging with the healthcare industry.
Levels is doing things differently. At Levels, you are in charge of your body, data, and health journey. Every Friday at our company all-hands, we repeat the phrase: “Levels shows you how food affects your health.” This reminds us that we are on a mission to take the mystery out of good health. We want you to have all the information you need to make the right decisions for your body. Then, we want to make that information valuable and actionable for you. It’s not enough to know that your breakfast cereal spikes your blood sugar; we want to help you discover foods you love that will stabilize it instead.
Transparency is sacred to us because health is built on trust. We want you to trust us and to trust your body. We’ve worked hard to create additional transparency through our pricing model, how we’re building our business, and how we’re using member data. We want to redefine how people manage their health and think that starts with information equality.
Levels is Learning Quickly
Traditional healthcare is slow. On average, it takes over ten years and two billion dollars to bring a new drug to market. Many cutting-edge hospitals are still using fax machines. The NIH is still investing a disproportionate share of its research dollars into diseases that affect men primarily, at the expense of those that affect mainly women.
While there are compelling safety reasons to move slowly sometimes in healthcare, often this slowed pace of learning and adaptation is costly in terms of human health.
Levels, again, is doing things differently. Our mission is to solve the metabolic health crisis for a billion people. To achieve that, we will have to impact the health of all kinds of people, each with their own story and experience. This means people from different racial and cultural backgrounds, people on opposite sides of the income spectrum, people who speak other languages, who love different kinds of people, who live in single-parent households, single-person households, multi-generational households, and a new household every few months, and everything in between. We have to be able to help people who have mostly been healthy and also people who have always struggled with health. People with access to farmers’ markets and those who only have the corner convenience store or fast food joint.
We aren’t there yet. To get there, we will have to learn quickly.
First, we will need to push the science forward dramatically. We have the largest dataset of food logs and blood sugar responses, which grows more daily. We are undertaking extensive research studies approved by an Institutional Review Board to use this dataset to understand metabolic health for all kinds of people with various lifestyles. This approach of using large-scale, real-world evidence to push understanding forward means we will learn much faster than we would in conventional clinical trials, and our learnings will help us to improve the health of a much more diverse population.
Second, we are constantly learning how to improve our product. We primarily do this by talking with members through community calls, member groups, and by observing how people are using Levels.
Finally, we are constantly learning how to expand our impact to communities that are not currently able to become Levels members because the price of CGMs is higher now than many people can afford. We do this by freely sharing metabolic health information we learn through our research across multiple platforms, including our blog, podcasts, and social media. We have to keep pushing forward on this front. Ultimately, we want Levels to be accessible to everyone.
Levels and the Challenges Ahead
Succeeding in health tech is incredibly difficult. The healthcare system is broken, and we don’t know yet if tech will be able to fix it. I’m not under the illusion that the problems we must solve are easy. We are in the business of behavior change: to solve the metabolic health crisis, we must change what people eat and many other decisions we make daily regarding our health. If this were easy, nobody would eat that extra cookie, put off exercising, or lose an hour of sleep scrolling through Instagram. Human psychology is incredibly complex, and our behavior is in dynamic concert with our environment and many other variables.
I’ve been an investor, clinician, founder, product developer…but more importantly, I’ve been a daughter, sister, partner, and friend. There are so many people I love who I want to live full lives with strong, healthy bodies. So, I choose to be optimistic. I don’t know if we’ll successfully rewrite the playbook for individuals and the system as a whole, but I’m at Levels because I believe we have to try.
