Dr. Jeff Wessler (MD MPhil FACC) is a virtual cardiologist, the Founder of Heartbeat Health, and on clinical faculty at Northwell Health.
I never expected to be in business. I was trained as a cardiologist and assumed I would spend my career in academic medicine.
But six years ago, I started a healthcare company with the goal of using technology to help detect and treat diseases early, hoping to save lives and reduce healthcare costs. The inspiration for this came from treating patients who only learned they had serious heart disease after arriving at the emergency department with a heart attack or stroke.
It didn’t quite go as planned. In fact, I had to completely change my business model and customer base twice. Along the way, I’ve learned a couple of lessons about running a company with an ambitious mission, lessons that might be helpful to entrepreneurs all along the growth path.
Chief among them is that the disciplined methods of science are as useful in the boardroom as in the laboratory and operating room. But before I get to them, some background is in order.
Discovering New Models
At first, I wanted to encourage people to seek early cardiac care by building a more convenient patient experience. Although much of our care could be delivered through video visits, at-home diagnostics and a mobile app, in this phase, we also saw patients face to face in a midtown Manhattan office.
While it at first felt successful, unfortunately, as we evaluated the data, we discovered that we were attracting the wrong kind of patients. They were what doctors call “the worried well,” healthy people who want extra assurance that nothing is wrong with them. We were financially sound but failing at our mission to detect heart disease early and reduce adverse cardiac events at scale.
Ironically, this model likely increased overall healthcare spending because we were performing echocardiograms and other diagnostic tests on people who were not in high-risk groups. If that continued, we might have had trouble partnering with value-based care organizations, which only want to pay for services that deliver positive outcomes.
First Pivot: Employer-Sponsored Benefits
So we looked for a new model for how best to get in front of people who would never have thought of making an appointment with a cardiologist. Our hypothesis: Find them at work.
We reconfigured our offering as an employer-sponsored benefit. We ran “pop-up screening” events in office building lobbies and cafeterias in New York City. In a few months, we had dozens of companies participating. They primarily were looking for benefits that their employees would value. If, down the road, our preventive care would lower their healthcare costs, that was a bonus.
We might still be building an employer-sponsored business if it weren’t for the Covid pandemic. When everybody works at home, you’re not going to find many patients at the office.
Second Pivot: ACOs
So we pivoted again. This time we decided to take on a more complicated experiment, but one that would serve a population we knew had a high risk of heart disease: older Americans. We had shied away from this group before because of the complexities of dealing with Medicare. Now we dove in and learned as much as I could about the government insurance program.
I discovered that Medicare was experimenting with a new way to control costs by giving networks of healthcare providers—called Accountable Care Organizations (ACOs)—a financial incentive to keep people well. We figured ACOs would be especially interested in our approach to preventive cardiology. Indeed, when we spoke to these groups, they said that treating people with heart attacks and strokes is one of their biggest expenses.
Four Lessons For Keeping Your Startup On Track
While we are still learning every day, adjusting our patient care protocols and our financial arrangements, I think it’s clear today we are on track to achieving our original goal: saving lives and money at the same time.
When I think about what it took to stay in business through so many changes, I think of four lessons that may be useful, whatever business you are in:
1. Stay focused on your goal, not how you reach it.
Our mission was straightforward: Reduce the number of heart attacks and strokes and adverse cardiac events. Yes, I put a lot of effort into our first mobile app and then a protocol for screening for cardiac risk in an office lobby, but as soon as I realized those were not helping us save lives, my company abandoned them and tried something else.
2. Run your company like a scientist.
My training in the scientific method helped me understand how best to stay on track amid many competing options. Everything we do has to be supported by evidence, not assumptions. You create a hypothesis, test it and keep what works. Throw out the rest. Then repeat a million times.
3. Find investors who share your vision and time horizons.
When we wanted to close our initial cardiology practice, our investors could have pushed back. After all, we were growing and profitable. Luckily, our board was very supportive. In part, that was because they were very experienced in healthcare, which meant that they knew that the biggest returns come from the best long-term clinical outcomes.
4. Move fast, but be prepared for results that take longer than you want to materialize.
Speed has been an important part of our company. We will try things fast and move on if they don’t work. That didn’t mean we achieved our goals quickly. I’ve learned that you need to give yourself the leeway of patience and be prepared to reset your expectations and timelines as you go. Everything will take a lot longer than you think, particularly in traditional industries like healthcare.
Despite the setbacks and delays of the past six years, it’s clear that I am able to help many more people sooner than if I had tried to solve the same problems in an academic setting. While the learning process never stops, staying true to the mission and being disciplined in your approach can help you ensure long-term success.
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