Tuning Healthcare, Episode 15: Nurturing Positive Change Within the Healthcare Ecosystem

Dr. Jennifer Schneider, Cityblock Health Board Member and Former President of Livongo Health

This episode of Tuning Healthcare features Dr. Jennifer Schneider, former Chief Medical Officer and President of Livongo. Dr. Schneider was also the Chief Medical Officer of Castlight Health and trained as an internal physician at Johns Hopkins and Stanford, where she was the Chief Resident. She recently joined the Board of Directors of Cityblock and is an executive in residence at Endurance Partners, a private equity firm in New York City.

Dr. Schneider shares her notable startup experience and provides unique perspective on being a parent, athlete, clinician and consumer of chronic disease healthcare.

“My journey is that I was diagnosed with Type 1 diabetes when I was 12 and that was a pretty deep jump into the deep end of water in the healthcare ecosystem. I come from a family where there are no physicians and very few healthcare workers at large. It was really from that experience that I was inspired to go into healthcare.”
– Dr. Jennifer Schneider, Cityblock Health Board Member and Former President of Livongo Health

In this episode, Dr. Schneider and Lumeris Senior Vice President Nigel Ohrenstein discuss:

• Solving health inequality through the advancement of value-based care and use of data
• The inordinate amount of opportunities for improvement within the healthcare ecosystem
• The significance of key motivational factors in driving behavior change
• Which current healthcare trends will be boomerangs and which will be Frisbees
• How to apply lessons learned from parenting and athletics to business

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• Read Transcript Below:

  Nigel Ohrenstein:  I’m joined today by Dr. Jenny Schneider. Jenny is the former Chief Medical Officer and President of Livongo. Prior to that, she was the Chief Medical Officer of Castlight Health. Jenny trained as an internal physician at Johns Hopkins and Stanford, where she was the Chief Resident. She recently joined the Board of Directors of Cityblock and as an executive in residence at Endurance Partners, a private equity firm in New York City. In this episode of Tuning Healthcare, Jenny and I discuss the lessons you can learn from being a parent and an athlete and how you can apply those to business, how we can solve health inequality, especially through the advancement of value-based care and the better use of data. Jenny shares which current healthcare trends will be boomerangs and which will be Frisbees. And finally, if there’s one thing that Jenny could change about healthcare, it would be data into operability and transparency. Join Jenny and me as we tune healthcare.

  Nigel Ohrenstein:  All right. Excellent. Jenny, thank you so much for joining us today. I’d love to start by learning a little bit more, how you got into medicine, what inspired you to do that and then also what inspired you to sort of move to the business side and focus on sort of the impact you could have on the business side of healthcare as opposed to purely just on the clinical side?

  Jennifer Schneider:  Sure. Well, thanks for the opportunity to converse with you. So delighted to get to be able to do that today. My journey is that I was diagnosed with Type 1 diabetes when I was 12. And that was a pretty deep jump into the deep end of water in the healthcare ecosystem. I come from a family where there are no physicians and very few healthcare workers at large. And it was really from that experience that I was inspired to go into healthcare. And a large part of that was my own endocrinologist was a man named Dr. Robert Nelson. And he was wonderful in terms of allowing me at the age of 12 to take ownership of the condition and ownership of the day-to-day decisions, not my parents but me and that experience resonated a lot with me. And I think it has actually shaped how I think about healthcare today in terms of this idea of empowering people to allow them to make optimal choices.

  Jennifer Schneider:  The jump into business was not intentional. I’m a somewhat non-linear person. What I am absolutely at my core is interested in core gnarly hard ideas. And so I had this opportunity. I did my medical school at Johns Hopkins. I did my residency at Stanford. I did a cheap year, which is a junior faculty year. And then I had an opportunity to go back and get a master’s in Health Services Research which is, how do you look at data, big amounts of data and make healthcare decisions. And in that journey, I had an opportunity to work for a gentleman named Giovanni Colella, who’s a serial least successful entrepreneur and at that time was starting a company that had undergone three name iterations, Maria Health to Ventana health and then became Castlight Health. And the problem they were trying to tackle was how do you create a free market in healthcare?

  Jennifer Schneider:  And as someone who was hundreds of thousands of dollars in debt from a very expensive medical school, which I enjoyed, it was the right decision but I definitely had the financial debt coming out of that. It used to drive me crazy that my friends would complain about a $40 copay to go see their doctors, yet they easily dropped $200 to get their haircut. And the person who was doing their hair had graduated from high school. And here I was a physician trying to repay my hundreds of thousands of dollars of loans and this idea around not truly understanding the value in healthcare and this routing of the cost and the quality was really, I think, an incredible problem to tackle, that’s what Castlight did. So I didn’t join intending to go into digital health, intending to go into business, I joined a very powerful and inspiring leader to tackle authority problem in healthcare.

  Nigel Ohrenstein:  That’s amazing. So, do you think we’ve made any progress in the consumer understanding the cost of healthcare, understanding the sort of the pros and cons of picking one physician over another?

  Jennifer Schneider:  I don’t think we’ve crossed the finish line on that, but I know we’ve made substantial success. And the reason I know that, is from when I started at Castlight, we used to have to pull up these slides to say to our client, large self-insured employer, “All of your in network prices, let us pick colonoscopy or x-ray in-network docs, look at, there’s a 300 X variability for in-network docs.” And people would be like, “What? That’s amazing.” There was then a whole slew of media written about that. We’re not even talking about quality yet but just around cost variation for in-network providers. And so I think that the understanding of that as a writ large, as a country has changed. And I think Castlight played a large role in that. Now are we at the place where every time you consume healthcare, you’re actually looking to see, what’s the highest value decision, both cost and quality? The answer is no, certainly not. But I think we’ve started that dialogue and I think cost and quality transparency platforms and some guidance around those have helped that, but we still have a long way to go.

  Nigel Ohrenstein:  No, I think that’s definitely true. I mean, I agree with you we’ve made progress, but I do think that we’re not yet at the point. Just the same way as when I go on to Amazon and I look and see, I want to buy something that was popular this past winter, at least in New York were outdoor heaters, so we could entertain outside and do that in a socially responsible way. But I could go online and I could read the reviews and I would have a pretty good sense, if I’m buying one for X or I’m buying one for 10 X, what it is I’m getting. I think we still have room to go and a ways to go unfortunately until the consumer can do that.

  Nigel Ohrenstein:  One of the things we always say in Lumeris is that, what makes help see healthcare that much different is that, to do that you really often need a physician to help you. I don’t have that level of depth of knowledge to make those same level of choices because ultimately this impacts my health care. So, I think we have made amazing strides. I think we’ve still got a ways to go. But it’s going to be fascinating to watch as we move forward here over the next decade, that’s for sure. So, your LinkedIn for those that haven’t seen it, I love the tagline. It’s mom, sorry, author, mom, athlete and then healthcare executive working to improve the world. So my first question, are these in order of importance or?

  Jennifer Schneider:  No. It’s funny as you read that, I was just literally thought to myself, it should actually say mom because if it is an order of importance, it should be mom first by far. It should probably be, mom athlete, healthcare executive, author, it’s probably the right order of importance. So, they’re in there but maybe not ordered the correct way. I’ll have somebody fix it.

  Nigel Ohrenstein:  I know, I couldn’t work it out. At first, I thought maybe I’d forgotten how to do things alphabetically or don’t know. And then I’m like no; surely my high school education was better than that, but it’s fascinating you put those in. So tell us a little bit about why each one of those are important and why put them in because I’d imagine there are or I would know there are 50 attributes and qualities that you could have used for your tagline but you picked those. So tell us a little bit about those.

  Jennifer Schneider:  First of all, I’m complimented the fact that you think that I have more than four assets, 50 might even maybe. I don’t know what those are, but we can offline about that. But I’m actually going to start in my order of importance, which is mom and it is for two reasons. One is because I have three children. I call them the foxes. They’re hilarious. They’re eight, 10 and 12 right now. And they’re the sort of the center of everything. But I also have learned so much from being a mom, how I tend to them, care for them, inspire them or try to inspire them and discipline them, that has translated so much into the business world. And I wrote an article, early days of Castlight, that I never published, that I had this one day where I was having these same conversations at work that I was having in my house and my children. They were slightly different words used but the concepts were exactly the same.

  Jennifer Schneider:  And I very, very often in the business world think to myself, “Who’s your mom? Did your mom intend for you to act this way?” And so trying to think of those principles. One of the key things in our house is we never say the word can’t because I believe that once you start to put limits on yourself, you believe those limits. We often use “you’re not allowed to” -that one is definite.  You’re not allowed to, but you can do anything. You’re just not allowed to jump off the roof, but you could. You could fly but you’re not allowed to try that while moms with you in the house sort of thing. I think second is athlete and it’s a large part of me.

  Jennifer Schneider:  Every day I find at least an hour to do some sort of cardio workout, run, bike, swim, but also there’s this idea around endurance and that sort of translates into the business world, particularly in startups, which is you get up every day and you do the work. And there’s something incredibly rewarding to getting up every day, even when you don’t want to, to do the work, to get to the finish line, to drive forward. Healthcare executive is kind of what I’ve been employed to do. That’s been paying the bills for a while. So that’s my tagline. My parents still to this day ask me “Do we still tell people you’re a doctor? You still see patients.” I say, “You can tell people whatever you need to tell people to make you feel good about yourself. It’s all fine.”

  Jennifer Schneider:  And then author, and I think that one probably started at the front in the LinkedIn because it was after writing the book and we were trying to promote the book that I wrote. So that’s probably was the order there, but I did have an opportunity to write a book called Decoding Health Signals which really described what we did at Livongo. And I was responsible for the product marketing, engineering, data science clinical, but what we had done was created an experience by deeply understanding the condition for people. You’ve made a comment that I registered in the back of my brain around believing that physicians play a role in healthcare. And I think they absolutely play a role in healthcare. However, as a physician, I think they play less of a role than the healthcare ecosystem thinks that they do play.

  Jennifer Schneider:  And so this idea around in order to get anybody to do anything, you have to deeply understand what it is that motivates them. And as you build solutions to bring to market, it is truly living in their shoes for a while and understanding how to change behavior. And we give you an example, we hired a lot of our own internal workers at Livongo with chronic conditions. And I live with Type 1 diabetes because it’s very different to say, “Oh, those diabetics they should X, Y, or Z.” Then to actually be one of those people and actually have to do that every single day, 365 days a year for the rest of your life. So there’s a very judgment mentality around “I can’t believe that those diabetic people.” We refuse to use the word diabetic.

  Jennifer Schneider:  We would say those people who have diabetes because they’re people first and foremost, you have to understand what motivates us. Very few of us wake up every day and say, “I want my hemoglobin A1C to be less than seven because that’s the endocrinology guidelines.” Now we wake up, what do we do? We say, “I’ve got a full agenda. Nigel’s going to interview Jenny in a podcast and I have to prepare for that and make sure this is done.” We’re not thinking about these specific things that healthcare physicians are trained to kind of judge and look at guidelines. So, this idea around how do we deliver this experience by deeply understanding our people? My reference, Dr Roger Nelson at the Mayo Clinic. And one of the things I liked about him is, he got how to motivate me. I was a 12-year-old independent, fiercely independent, wanted to go to the Olympics as a runner. 

  Jennifer Schneider:  And he figured out how to motivate me to care for my diabetes because of who I was not because of the clinical guidelines. And that’s what we’re trying to do I think in healthcare as we create these solutions.

  Nigel Ohrenstein:  That’s great. And so I couldn’t agree with you more that a lot of those different things cross into the business world. And I think, but they also cross the other way as well. A few years ago, I read a book by Stuart Diamond, it’s called Getting More. I don’t know if you’ve ever read it but it’s really about the art of negotiation and how sort of the whole concept of win-win is sort of an old concept and really it’s about, how do you understand, a lot of what you just said really. Actually, your endocrinologist when you were 12, is naturally would have been a perfect example of this. How do you understand the other person’s situation and how’d you enable them to sort of get what they might want but also at the same time enable you to get what you want as well.

  Nigel Ohrenstein:  And it’s something that ironically, I took back into being a parent. And when you reframe it in different ways, it’s amazing how they respond well to it. And I’ve done a number of LinkedIn posts, but I would say I learned as much from sport that I’ve applied to the business world than from any formal education that I’ve ever had. And I look at, my kids today don’t have enough. Yes, they do sport out of school but then self-motivated to do that. But within the school setting themselves, it’s incredible how little exercise there is. And I think that’s got to change because just separate about the importance of exercise but just the lessons we learn around teamwork, supporting others, not getting on somebody’s back if they make a mistake because that just leads them to make more mistakes and there’s so many lessons from sports and the list goes on.

  Jennifer Schneider:  Mental stamina. It’s funny because when you look at resumes, there are a few things that stand out to me and people who try something a little AB normal, they have something a little weird, I always think it’s interesting because it shows that they’re proud of who they are and they’re willing to share that on a resume. So people who put on, I don’t know, magician or I do homing pigeons or something kind of that’s a little bit AB normal. But then same with athletes, look at team sports and almost always team sports for me because I think to your point, you learn and in the business world, it is a team sport. It’s 100% team sport. It’s about building a team, motivating a team, being a player, which means sometimes you’re successful, sometimes you’re not. How do you handle both sides of that? How do you win? How do you lose gracefully? Great lessons.

  Nigel Ohrenstein:  Totally agree. So you touched on Livongo briefly there. Tell us a little bit more, I mean, about what you had set out to achieve, maybe a little bit about, seems like the end of it was quite a wild ride as you went through multiple transactions and in particular we’d love to learn, what excites you the most as you look back about what you achieved there?

  Jennifer Schneider:  So the mission of Livongo, what we set out to achieve and every employee I think would be able to quote our mission statement, which was, “Empower people with chronic conditions to live better and healthier lives.” That’s what our goal was. And it really was this idea around those of us with chronic conditions or with loved ones with chronic conditions, how do we actually make their life easier? And in making things easier would improve their health and improving their health would reduce the healthcare costs. Three value propositions, people had to love a new experience, how to make them clinically better and reduce costs. And we built what I would say is, it was a wild ride toward the end. In fact, I just got three boxes of tombstones from the bankers, literally just the other day, which was the IPO, the convertible debt offering, the secondary offering and then the transaction with Teladoc.

  Jennifer Schneider:  So, they all came at once because it was such a whirlwind effort those last 18 months. I think you asked what I was most proud about and I would say two things. One was the team that we built; we built an incredibly mission driven oriented team. And that goes a long way in terms of getting things done. I think without that leadership and focus on building our own internal team and then internal values, we’d never would have been able to accomplish what we did from a business standpoint. From a business standpoint, the thing that I’m most proud about is that we change lives for people with chronic conditions. In fact, the day that we merged with Teladoc, the $18.5 billion got all the news press but internally we celebrated we had achieved over 1,000,000 active users on our set of solutions.

  Jennifer Schneider:  That was the thing that our team was most proud about. And so again, it was really around changing lives. We need a big emphasis every time we had an internal town hall or an external conference to bring our users on stage and have them speak to us. And it was really an incredibly powerful component that we knew we were making lives better. We also knew that there’s a lot more work to go ahead, really excited to have done the transaction with Teladoc that moved what we had built further down the field. And there’s a whole other, maybe at the five- or 10-yard line now. So there’s a lot more yard still to run to accomplish what I think can be built as we look to change the healthcare ecosystem, particularly for people with chronic conditions but could not be, again, more proud of the team we built and the way we changed lives.

  Nigel Ohrenstein:  Right, no. It’s excellent, congrats to you on everything you achieved there. One of the topics that is close to both my heart and close to the things we try to do at Lumeris, is to do what we can to help reduce the inequality of health care that exists in the country. It’s really terrible, America and in the world we are today and the innovation we have and how great this country is particularly for someone who wasn’t born here. It’s an incredible country and yet we have such inequality of care. So I was fascinated by your recent posts when you joined the board of Cityblock, that it was all about the inequality of healthcare and I must admit that I was not aware that that was so cool to Cityblock’s mission, again, maybe misinformed but saw Cityblock slightly differently. So tell us a little bit about why you joined the board and how can we tackle health inequality? It’s such an important topic.

  Jennifer Schneider:  No, thank you for the question. I’m going to talk about maybe three different parts about health and inequality through three different organizations. The first one is I’m actually going to reflect-back and I’ll get to Cityblock because that’s the one that I’m most excited about at the moment. So I will not forget your question. I’m going to start actually with Livongo and this idea around touching people who are in need. One of the things that we did as a startup and now General Catalyst does with their whole portfolio of companies, so that’s the second organizational component here, is actually put aside a bunch of equity pool. So when the company has an exit, that, that equity goes to a service orientation as a nonprofit. And so Livongo was hugely successful from an IPO and a transaction that equity was incredibly valuable.

  Jennifer Schneider:  We created millions of dollars as part of the core central thesis to driving Livongo. And we had three different key ideas where we wanted to donate that money. But the reason I bring that up is, General Catalyst was a co-creator, founding member, early venture team. They now hold that same principle in terms of responsible innovation as we build in the healthcare ecosystem. So, there’s ways to do that and which I think is a really interesting component. Cityblock is really focused on the populations of people who have not been served well. So, they have a large part of their portfolio is Medicaid population and very few is almost zero, I might venture to say. Companies in digital healthcare have received funding or been successful to manage risk and Medicaid population.

  Jennifer Schneider:  And they’re doing it digitally and at scale with the core focus on improving the lives for that population. And if you’ve not met Lyah Romm and Toyin, the co-founders of Cityblock, they are an incredible duo and they emanate passion around the care for these people and driving a business and that can actually deliver a new business model and care models at scale. I am so proud to be on the board and I’m actively involved in a regular recurring basis because I feel so passionate both about the team, they’re building the right team, but about this space and what they’re able to deliver. So it’ll be really a fun, I think, to get to watch and to follow Cityblock over time. They have a great start and lots more to come.

  Nigel Ohrenstein:  That’s great. And again, I’m sure you’ll bring a lot of value to them as well as you take that role. So, what else would you like to see sort of the broader healthcare ecosystem doing to tackle health inequality?

  Jennifer Schneider:  Sure. Well, I think there’s a number of things. I think payment reform, I think going to value-based payments where people are allowed to see what that looks like, again, back to our earlier costs around cost and quality transparency. I think creating solutions for all walks of people. If you think about digital health and healthcare in general, as we collect data, we have an ability to drive really quickly and understand differentiated outcomes at levels that are greater than kind of large populations and truly understanding what does it look like if you’re African-American or if you’re Asian or if you’re a woman, if you’re a man, if you’re transgender and we’re applying the same clinical treatment to you with the same utilization of words, you’re not going to have the same outcomes. 

  Jennifer Schneider:  I was just thinking about this today. I was on a call earlier with my old Chief Medical Officer, Dr Bimal Shah and he was describing to me, he lives in Durham, North Carolina, that his nanny does not want to receive the vaccine. And she’s a Black woman and is part of their family. And he was describing that he completely understands her prejudice given where she grew up and what her experience in the healthcare ecosystem has been. And so we have this idea that, “Wow, isn’t the vaccine great for us? And why would these people not take it?” It’s back to your earlier conversation, well, they have good reason. They have good reason to not take it. So what is the reasoning and how do we think about that and what is the solution then that we can give to them that allows them to achieve the same health outcome, either through explanation or through frankly different solution to get to the same health outcomes. 

  Jennifer Schneider:  So, it’s again, this is thinking out of the box rather than putting people like, “Wow, these people didn’t do what the healthcare specialists said they should do, therefore they’re at fault.” Versus, “Let’s figure out this belief systems and access and figure out how we can deliver to these people options to achieve the same healthcare outcomes.” I went to Johns Hopkins for medical school, you can’t get more classic. They wouldn’t even let med students take the elevator. We had to climb eight stairs to prevent, it presents short of breath. It was short white coat until he became a doctor, very, very traditional. There’s a lot of great stuff that has come out of that, very scientific but I think there’s a different approach, which is to say, “Let’s look more at individual and populations of people that are different from White men in the clinical trials.”

  Jennifer Schneider:  And not just, is the medicine working or not but what’s the belief system, what’s the access? And so I had somebody tell me recently that they thought one of the most successful traits of new companies or new ideas is people who are not linear thinkers and that they can actually truly take a problem and say, “Here’s 10 different ways to solve the same problem.” And people will be like, “That’s a crazy way to, you’re going to try to open the door by shooting a rubber band at the fish tank to break the water to flood?” But the idea is right because we can then start to iterate and find the right solution to bring to other people. I think that’s a large part of health disparities. We build one thing; we build one mouse trap and we’re confused why it doesn’t work for everybody.

  Nigel Ohrenstein:  No, I think that’s exactly right. And in part probably proven by the fact that some of the great models of care in this country like Kaiser, have struggled when they’ve taken the model outside of their home state because what works in one model, particularly when you control a lot of the pieces of the healthcare ecosystem, doesn’t work as well in other parts. Although the flip side to this, there’s something great about tradition. I took my kids recently before the pandemic to see the college I went to in Cambridge and they were like, “What’d do you mean you can’t walk on the grass? Why don’t you just walk straight across the grass?” And I’m like, “No, you just don’t do that. That’s tradition. You have to be a fellow to be able to walk across the grass. And that’s then.”

  Nigel Ohrenstein:  So, the same time there was something special about tradition that holds some of the elements of society together. You live out on the West Coast and so that’s one of the things I think has enabled the West Coast and obviously particularly the Silicon Valley area to be such a hot bed of innovation is because people do think outside of the box and they do think in ways that are atypical to how we might think about it. So, what fascinates me right now are a whole host of trends in healthcare that have been really sped up by the pandemic. And it’s an unbelievable time to be in healthcare, which is truly great. And so what I’m interested in discussing and hearing your perspective, Jenny, what are the forces you see that are really strong and you’re excited about and which ones will be boomerangs and which ones will be Frisbees?

  Jennifer Schneider:  It’s a great question. I think that the remote monitoring, the ease of access to physicians and vice versa for physicians to patients at home, is here to stay. I think that was here. I think that got accelerated but that I think is not going anywhere. I think that will continue. That said, I think that we will see in addition to that, a more specification based off of data as to when it’s appropriate and when it’s not, versus it always is, or you get to pick, I think we’ll be skid smarter as a healthcare ecosystem around that. I think laboratory testing, I think this idea around co-access to COVID testing and frankly, I think most of us are pretty impatient as individuals where you still have to wait 24 to 48 to 72 hours. I think that will change. I think you’ll start to see a lot more home-based and there are today, these businesses have accelerated, the let’s get checked of the world.

  Jennifer Schneider:  Home-Based laboratory access with speedy turnarounds, I think is actually also here to stay. What I don’t know is but I’m hopeful is, it’s interesting to watch which of the waivers and accelerations within the government from a legislation standpoint are here to stay and what will revert. I think there’ll be an inordinate amount of pressure now that we’ve caught a glimpse into the possibility of how we can deliver healthcare to different scale to continue those. So, things such as Hospital at Home, which was a waiver given because there weren’t enough hospital beds in the study of the COVID crisis. I think a lot of us have realized, “Wow, there’s a lot of people who would rather be in the hospital at their house and actually can do that successfully.” Now that’s under waiver status for reimbursement. Will that stay or not? I don’t know. 

  Jennifer Schneider:  So that one to me is an open question that has a chance to really be a Frisbee. Will it be a boomerang? I’m not sure. There are pressures on both sides, economic pressures on all sides, as well as pressures on all sides. And I think that, I went to graduate school, oh man. So I went to medical school in 1998. I did my masters in 2005. And at that time, I took a healthcare class by Dr. Jay Bhattacharya, health economist at Stanford. And he said, “Fee for service is dead.” Fee for service is still not dead. And so will we really transition to value-based arrangements? It seems like we’re progressing there more and more, that new players are almost always held to that standard. That’s super encouraging in which means that incumbents will then come around. 

  Jennifer Schneider:  So, to me, that’s I think a Frisbee that’s like, I don’t know what those arrow bar things are, the things that go slower right as you throw them in the air. Then boomerang, I don’t have a ton of boomerangs right now, but time will tell, other than the legislation has the power to make things boomerang.

  Nigel Ohrenstein:  We’ve, as Lumeris obviously, long been advocate and trying to help the movement towards value-based care. And one of the things we have seen ironically in the last year is that a number of health systems are actually speeding up the move to value-based care because whilst they always felt healthcare was recession proof, it hasn’t been pandemic proof for them and if they had more of their revenue and value-based care, they would have been better protected through the pandemic. So we’re actually seeing how systems speed up that move to value-based care. I think if you add that to the fact that their business model is really under enormous pressure on so many sides right now, if you look at the physician aggregators, if you look at home health, the payers obviously, their business models under pressure as well. So they’re going to be tighter. 

  Nigel Ohrenstein:  I think that in my opinion is where the cusp of sort of an explosion of hospitals really embracing value-based care, but we’ll see. We’ll see what happens over the next five years. All the market indicators we see are that we’re about to see a really strong explosion of particularly health systems embracing value-based care.

  Nigel Ohrenstein:  So, since you’ve left, Livongo obviously you’ve had enormous opportunity to sort of assess the market and see what’s out there and you obviously joined the board of Cityblock. And so recently also you’ve become sort of a partner in residents, Endurance Partners. Are there other, I mean, without giving away anything that is sort of your next great investment, are there areas of healthcare in particular that, obviously we’ve touched on inequalities of care, but are there other areas that you look at and say, “Hey, this is an exciting area that I’m really focused on and I’d love to be able to do something unique in this space?”

  Jennifer Schneider:  It’s a really great question. I would say that the answer is there’s so many broken pieces of healthcare that there are an inordinate amount of opportunities, so that’s the good news and the bad news. And for me, I think personally, the ideas I am most excited about something that’s pretty different from what I’ve done in the past, meaning I love the virtual care part. I love what we did with Livongo but me personally doing that in another condition or on another platform is maybe not as interesting to me tackling some of the other aspects of healthcare and there’s plenty of them. We talked about laboratory, we talked about Hospital at Home, we talk about payment reform and kind of how you get to value across the ecosystem. So the answer is I’m still looking and I’m not sure exactly where I’ll end up but I am eager to get back into an operating role and really grateful to be a part of the General Catalyst team, whom is a very, very smart and fun to work with, as we look through what’s happening in the ecosystem. 

  Jennifer Schneider:  I also have a big belief that in order to go really far, we will have to see a lot more partners like we did at Livongo with Teladoc. And the reason to do that was because we really believe that whether we did it with Teladoc or somebody else, that was the next right step for the business model to actually get to a differentiated scale and provide more outcomes. You know as well as I do that there is a gazillion, and that’s a number that my kids tell me is an actual number, a gazillion of new startups in the ecosystem. And I think a lot about as I’m looking at these different organizations, how are you going to partner fit into a larger, broader ecosystem so that we’re not creating a bunch of different point solutions all attempting to do the same-ish thing but slightly different?

  Jennifer Schneider:  Sometimes when you look at these investor decks, it looks like you’ve gone to a Mexican restaurant and you’re always going to have beans, rice, cheese and a tortilla. It’s just going to be served in a slightly different combination. And so, I think that this idea of looking at specifics of the industry and really focusing on one or two elements that are incredibly broken and how that can link back into the existing ecosystem is the right approach.

  Nigel Ohrenstein:  I think that’s right. I think that the ecosystem is so ingrained that to believe you can wholesale change it, I think is a fool’s errand in my opinion and therefore having said that there are so many opportunities as you say, to make impact. And what excites me right now, perhaps more than ever and it’s sort of somewhat ironic saying that on the back of entering a second year of a pandemic, but there are a number of windows I believe to make really meaningful change which I think is beyond important because as we know, we continue to chart a course of unsustainability in terms of healthcare costs. So I’m hopeful and excited at the same time that we really have some really exciting winners but I agree with you, figuring out how to do that within the existing system rather than to believe you can change the ecosystem, is the best way to think about it.

  Jennifer Schneider:  Well, I think it’s kind of the only way and I’m chuckling to myself because I do sit in Silicon Valley and I’ve had the opportunity to meet and interview actually a number of really great thinkers out of other industries. And I’ve had some more than I can count conversations that are like, “That’s a really great idea. How would you be able to do that?” And the answer would be, “Well, we’ll just tell the payers that, that’s what they have to do.” And I thought, “Good luck with that. Let me know how that goes.” Again, there are ways to kind of innovate within the ecosystem and I think we all need to do that but I do think partnerships and deep understanding of how that will work, is the really only way to get to scale.

  Nigel Ohrenstein:  I think that’s right. So we like to end with what we call the quick-fire round. And so first question we have in this round is, what’s the best piece of advice you’ve ever given?

  Jennifer Schneider:  Never doubt yourself, bet on yourself.

  Nigel Ohrenstein:  That’s a good piece of advice. I think we’ve heard this one already but just, what do you do to relax, have fun?

  Jennifer Schneider:  Play with kids, go for long runs.

  Nigel Ohrenstein:  Not surprised those are the answers there. What advice would you give to your younger self?

  Jennifer Schneider:  This is a tricky one for me because I often think, if I knew I would be where I am today when I was younger, I probably would do things differently but then I probably wouldn’t be where I was today from not doing things differently. And so I think that the only advice that I would give is, again, similar to that piece of advice, just bet on yourself, know yourself, don’t doubt yourself, have conviction and play it out. You don’t need to listen to lots of people but come up with your own conclusion and live to that.

  Nigel Ohrenstein:  That’s great advice. And if you could change one thing about health care, what would it be?

  Jennifer Schneider:  Data compatibility and ownership, allow it to the end user.

  Nigel Ohrenstein:  That would be transformational. Hopefully we’ll get there before too long. Jenny, thanks so much for joining us today.

  Jennifer Schneider:  Thank you, Nigel. Really fun. Thank you.

  Nigel Ohrenstein:  Thank you for joining us today. Please follow us on your favorite streamer and don’t forget to rate us as it helps others find our podcasts. I hope you continue to stay safe and healthy. Please join us next time as we tune healthcare. This is Nigel Ohrenstein in New York.