Go-to-Market Secrets from the Brains Behind Digital Health Unicorn, Thirty Madison

Demetri Karagas is the Co-founder and Chief Operating Officer of Thirty Madison, the healthcare company focused on delivering personalized treatments to specific chronic condition areas and creating exceptional outcomes for all. He drives strategy and execution across Thirty Madison’s offerings, with a constant focus on providing personalized, quality care to each individual. His human-first approach to developing every part of the customer experience—from the online doctor consultation to the medication’s packaging—has led the company to achieve record growth in a short amount of time. Demetri’s background in building and scaling customer-centric companies such as Homejoy (acquired by Google) makes him ideally suited to balance momentous company growth with first-class customer care. When he’s not poring over the latest patient reviews to find trends, he can be found running outside in his Astoria neighborhood, reading the latest historical fiction novel, or trying to find the spiciest food in New York City.

Top 3 Trends in Healthcare

Sohum: Looking back at 2023, what were your top 3 takeaways on the healthcare landscape?

Demetri: One is zeroing in and focusing on the importance of quality. Since the explosion of digital health through the pandemic, we have been seeing that the winners in the space are those that actually deliver better quality. They are doing so at scale, in a more convenient, patient experience-focused way. 

Another is the consolidation that has happened and is happening in this space. Consolidation can help provide better offerings, more expansive offerings, and a more comprehensive offering.

And then third has been the renewed focus on women's health. I think we've only scratched the surface on what we as an industry can do there.

One additional area where investors have still been deploying, is creating comprehensive offerings for benefits. There has been more renewed interest from payers, from employers, from benefits folks and it’s been exciting to see. 

Future of Digital Health

Sohum: How has your and Thirty Madison’s view of digital health changed over time? Pre-pandemic vs post-pandemic? Looking at your crystal ball, what does the future hold in store?

Demetri: It's so interesting to think back that it was not that long ago that most people that you would speak to never had a telemedicine interaction. Or if they did, it was a very basic urgent care interaction. Pre-pandemic, there was a lot of convincing and skepticism, because it hadn't really been done before. 

Then COVID hit, and overnight, everyone was forced, in a suboptimal global situation, to use digital tools to provide health care. And what we saw was there were a lot of people saying, “Wow, hey, maybe this could work!”, right? When you look back, you see an incredible amount of money coming in and an incredible number of companies popping up. While you could certainly say the hype has slowed down, what I think is really exciting is that we're just at a stronger baseline now. 

Now we’re asking what the areas where telemedicine and digital health can be the superior ways to provide care. It can cut wait times and be convenient for folks who may not have been able to make it to appointments in certain areas and in certain conditions. It can also provide a higher quality experience and a higher quality level of care. The last thing is that it really provides choice to patients and consumers, allowing them to take control over their healthcare journey.

If I were to look into a crystal ball, I think you start seeing more examples of digital health companies moving up that acuity chain. There’s been a lot of examples of scaled offerings for care areas that are perhaps simpler to diagnose and treat. As we start having more tools and better diagnostics that can be done remotely, it starts unlocking the ability to go into chronic condition management, cost management, and driving better outcomes for more patients over time. 

Healthcare Go-To-Market Approach

Sohum: Obviously Thirty Madison is known for producing some of the most beloved D2C telehealth brands on the market like Keeps and Cove, but how has the organization been approaching other channels recently? Payers? Providers? Employers?

Demetri: This is an area where we sit at an interesting point relative to a lot of other players in the space. Because you're right, we had our initial growth through D2C channels, building brands that consumers, as patients, loved. But we also have been operating within the payer space. 

One is broad coverage of our offerings, enabling people to use their benefits, both through fee-for-service contracts as well as broad based PBM coverage. The second starts getting into more unique and strategic deals, which include all-inclusive rates and risk-based agreements. 

We also have a pretty exciting offering for our TelePrEP service with CVS Caremark, which enables patients to come in and receive telemedicine offerings at no or very low out-of-pocket cost. The third area that we're thinking about is identifying what's missing from our offerings. We go and talk to employers, payers, other decision-makers and ask about the gaps they’re seeing.

Go-To-Market Obstacles

Sohum: What challenges or obstacles, if any, have you faced in go-to-market? Do those obstacles change based on selling directly to patients or going to payers and providers?

Demetri: Yes, I would say, these two approaches and their sales cycles couldn't be more different. The great thing about D2C is that it can be fast, you can get something out there, test it, and move quickly. If you provide a value proposition to a patient they will take their credit card out and pay for something. But you're at the mercy of how you reach out to those patients. 

Which is why working within the healthcare system and with payers is so essential. People just have an expectation that, and rightly so, they should be able to use their health benefits. A lot of treatments are simply out of reach if you are not able to use your health benefits. One of the challenges when you’re a startup is that it's slow. Large organizations just work at a different pace. They have millions and millions of patients, billions in revenue, all these stakeholders. As a result, there are a number of things that it takes to actually get to a deal done. 

Showing the proof points to really demonstrate why someone should take a chance on this, and having confidence in what they're putting in front of their clients and patients is something that really is going to provide value. That's where it's really about trying to identify what those offerings are that will move the needle to fill a gap - driving better outcomes, better experience, cost control. 

Cost, Quality, and Engagement

Sohum: From your perspective, what roles do cost savings, quality of care, and member engagement play in health plans' motivation to onboard digital solutions? Are some more important than others?

Demetri: The way I like to think about it is that there are table stakes, right? Like something first has to be able to provide a high quality of care. But at the end of the day, when you're talking about one of the largest drivers of cost in the entire economy, it does come down to the dollars and cents. If you can get people to use an offering and it can drive a superior outcome, it will reduce cost, right? Usually. 

Where I think you can sometimes find a shortcut within some of the sales cycles is having a really great economic ROI. Cost is a huge thing employers are dealing with. If you can provide high quality offerings in a cost-effective way, that’s really the magic there and the promise of digital health.

The Rise of Point-Solution Fatigue

Sohum: The concept of point-solution fatigue has been voiced repeatedly this year by employers, health plans, and even patients - from the digital health lens, what are your thoughts on this problem? Generally, in healthcare, is there right or wrong when it comes to specialization of care for targeted populations, but also choice overload bias and being overwhelmed with solutions?

Demetri: There was an incredible amount of investment that went into the space, which led to an incredible amount of innovation. Too many options leads to decision paralysis and a paradox of choice. When someone's looking for healthcare offerings, especially with how new digital health is, people will often default to what they know - their brick-and-mortar provider, their PCP, urgent care, and even the ER. 

People don’t understand, know how to, and have the time to sign up for all their benefits. As a result, you actually have less usage and less engagement than could be ideal. And because of the point solution fatigue and so many things getting tested, there ended up being a lot of acquisitions and failures.

So what we have to figure out, as an industry, is how do we help people understand what is the right thing to use for them? People have to know about it, find out about it, use it, and know how it’s different from other offerings, all at the right time. 

Integrated Virtual Healthcare

Sohum: Given this recent proliferation of specialty point-solutions, health systems and plans are considering more integrated and aggregated approaches to virtual care. What approach is Thirty Madison taking to address that?

Demetri: One approach is continuing to offer more things within the Thirty Madison family. While we might not be able to solve all ten pain points a customer has, we can probably solve more of them than most others. We really want to be able to offer the most critical things that people need, and then iterate, experiment, and find additional ways to help. 

The Market for Innovation

Sohum: How can the broader early-stage healthtech ecosystem support your mission and drive innovation for Thirty Madison?

Demetri: For startups, we’re figuring out ways to work together and go in with joint offerings that are more comprehensive. Big organizations, like payers, have a lot of things going on. The easier we can make it to plug-and-play, the better and more scalable. 

I've also been really excited to see some of the partners ask about new economic models. How can we think about how digital health doesn't really fit nicely into a fee-for-service world? Perhaps we should think about ways where we can make it really deliver value and savings to the plan and the employer, and also make it economically sustainable for these innovative digital health offerings.

Upcoming Digital Health Tech

Sohum: Aside from Thirty Madison, what digital health companies are you most excited about?

Demetri: One thing that's on everyone's mind is AI and how AI can allow companies like Thirty Madison to provide great care in a more cost effective way. We're talking to a number of companies that help with automations and AIs that can allow everyone from our MDs to our care coordinators, RNs, and pharmacists to be operating atop a license. 

The other thing is that as someone who obviously is a big fan of the Thirty Madison model, I've been excited to see this sort of innovation happening outside the US, too. There's a number of companies that I'm involved with helping that's basically similar to the Thirty Madison model, but in Sub-Saharan Africa. 

2024 Key Priorities

Sohum: Finally, what are you and Thirty Madison most looking forward to for the rest of 2024? What are the most pressing priorities?

Demetri: In case you haven't noticed, everyone in the world likes profits now! No, but, in all seriousness, we've done a lot of work and I've been incredibly proud of the whole team and ability to continue. We are growing and continuing to drive growth this year, but doing it in a sustainable way, delivering profitability, which we've now done since last year. This gives us control over our own destiny and the resources that we need to continue investing in new things that we can offer our patients. 

We're here to provide an incredible experience, amazing health care for our patients. Also, we have a couple of exciting launches coming down the pipe to be able to offer new things for our patients and hopefully continue to serve them well. And do that through a number of the brands that we have today. And who knows, maybe some new ones as well.

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