Lessons from Dr. Patrick Carroll, Hims & Hers, on Evolving Care through Telehealth and Patient Engagement

(upbeat music) - Hi everyone, I'm Andrew Parambath, host of Paris Healthcare Playbook Podcasts. At Pair, we partner with Sounders from IDEA to Series A, and we're excited to share stories from trailblazing healthcare leaders on building healthcare businesses from zero to one. Today, we're excited to get to know Dr. Patrick Carroll, CMO of hymns and hers, an American telehealth company that sells prescription, and over-the-counter drugs online, as well as personal care products. Dr. Carroll is a physician and executive that leads clinical, quality, and the expansion of hymns and hers into all 50 states. Previously, Dr. Carroll served as group vice president and chief medical officer at Walgreens, and oversaw retail clinic business units, as well as clinical programs and health system alliances. He's also the former CMO and VP at Integrated Care Partners at Artford Healthcare, and he also graduated from the College of the Holy Cross and received his MD from Dartmouth. With that, we'd like to thank Dr. Carroll for joining us here today. - Great, super to be here, Andrew. Appreciate you spend some time with me today. - Thanks so much, Dr. Carroll. Can you take us back to the beginning? You know, we'll brought you into medicine. - Well, that's a great question. I came from a very large family, Irish Catholic family, and no one in my family actually went into healthcare, and I was the second to youngest, and I always was very interested in science, and also very interested in just, you know, how you can apply, you know, science and interface with folks to really advance care. And, you know, so medicine seemed like a great fit, and at the time, it still may be today. It was fairly hard to get into med school, and, you know, and so I love that challenge, particularly as I went through my undergrad, you know, putting it out there that, oh gosh, medical school's impossible to get into. I said, well, I think I can, that, and so I enjoyed that challenge too, and it's, but you know, when you're in high school and then college, you don't know exactly what the right fit is for you in terms of a career. I think the one thing that medicine is offered in retrospect is the ability to really change career paths within medicine and do different things. Even though you have an MD and I was trained in private care, you can pivot at any time in your career, and I think that's been kind of a theme of my career journey is doing different things. And it's really kept me engaged and interested in healthcare. - That's awesome. I kind of like to think of the MD as a passport, right? It's just, you can practice clinical medicine, but you can do so much more than that. And you do that. You worked as a CMO and DP at integrated care partners at Hartford Healthcare. What was that experience like for you? - Yeah, you know, I'd even take a couple of steps back is, so I went from undergrad at Holy Cross and then Dartmouth med school and before I went to med school, I was accepted in my father's set congratulations, but coming from a big family without a lot of financial resource, he says, now figure out how to pay for it. So I actually signed up for something at the time called the National Service Corps, which was a great program. They essentially said, look, we'll pay for your medical school. You'll get a stipend every month. In return, you serve for an underserved population in this country. That being said, at the time, they showed me pictures of little towns of Vermont with foliage and said, hey, sign here. You'll be in Northern Vermont doing family physician work and I thought, wow, that's exactly what I want to do. And the government will pay for me. So sign me up. Well, of course, you know, don't always trust the government 100% because I went through Dartmouth, I loved it, did my residency in family medicine and then lo and behold, you know, six months before you die with your residency, you get a computer printup from the federal government. It says, here's the available sites to pay back the next four years. And there was no towns in Vermont on that list. I will tell you that. You know, I'm gonna help you. Which I was totally unfamiliar with. And some wife and I talked about it and said, let's just go for it. Let's try this adventure. And my wife is an obstetrics nurse so she could actually fit in in any road that we decided to go down. So we ended up in Shiprock, in Mexico, the Navajo reservation is literally the most formative four years of my career work with Indian Health Service. And it was so valuable for me, not only an experience, but also my view of healthcare and the challenges of access to care, so folks who are struggling socioeconomically to manage their own health. And it really informed their remainder of my career. To the point, after I finished my first four years with Indian Health Service, I went into primary care practice for 25 years in Concord, New Hampshire, seeing folks, I'd say from nursery to nursing home, the full gamut of primary care, including inpatient care. And in 2009, I decided to go back to the Indian Health Service. So the same place where I started 25 years before, I returned for a civic project who was really around setting up school-based health clinics, providing more screening evaluation, particularly for Navajo teens and pre-teens struggling with anxiety, depression, and suicidality. And then also did a big population health project for the Indian Health Service at that point, in the Navajo area to help with an EMR conversion. So it was a perfect fit in terms of going to primary care, you know, my formative years after residency with the Indian Health Service, you know, looking at how you provide access to really high-quality care with extremely limited resources. We were doing population health before anybody coined that term back then, 'cause, you know, you had to manage really high-risk, high-complexity populations with very limited financial resources. And then doing primary care for 25 years as a family physician, it really gave you the full view of healthcare from start to finish. And then going back and doing another population health project, a particularly focused on adolescent medicine in 2009 to 2011. So unbeknownst to me that last instant, you know, in that project for two years with the Indian Health Service actually made me attractive to risk-based organizations who were focused on population health. So coming out of the Indian Health Service in 2011, I got recruited by atrious health and really high value at the time 2000 physician, multi-special group based in Boston. And I was a regional chief medical officer for them. I was involved with the first Pioneer ACO, which is the first Medicare Shares Savings program with atrious, a particular focus on carry-after care, Medicare advantage, and risk products coming out of that. And then after a few years at atrious, Hartford Health Care decided, look, we want to run a Medicare Shares Savings program. We want to do a clinical integration network. We want to get into more risk-based, value-based care. And so they kind of poached me to join them. And I loved it because it was really my first experience working in an integrated delivering network. You know, you have the hospitals, you have a very large physician group. And then the fairly new concept of the time was this clinical integration network. So you take all of the affiliated physicians in the community who are not employed by the hospital. But say, look, we'll help you run some of these risk-based contracts. And we'll give you some of the tools, you know, both in terms of analytic tools and support, such that you'll do better in the value-based world with us if you try rather than try to alone. So it was a great experience. It is also a real learning experience for me, learning how to work within an integrated delivery network. So it was a lot of fun. I enjoyed it. But I also saw the challenges of, you know, the not-for-profit health system world and trying to help them convert into a different mindset going from, you know, really just fee-for-service, re-in-type reimbursement into a risk-based contract. So my time at the need health service even helped with that. But definitely my time at Atria's Health set me up well to my work at heart for health care. And that's quite the journey and lots of information and insight gained from your previous experiences to help inform your work with Hartford Health Care. What drew you into the organization of Walgreens? You know, it was interesting. So part of my work at Hartford Health Care was to really focus on our own employees and where they were spending their money, where we were spending our money. You know, we, gosh, at the time, I think over 20,000 employees and family members. And I started looking at utilization particularly in the emergency room for our own employees. And there was a trend. There was a fair amount of folks who couldn't get that really acute, you know, episodic care that they needed if they couldn't get into their primary care physician and ended up in the emergency room. So I kind of looked under the covers and said, well, what are these retail clinics doing? And at the time, even CVS-minute clinics had a few in our area. And I said, wow, this is interesting. So, you know, for an upper-restaurant infection or, you know, flu or a tightest media, you can get immediate access to retail type clinic experience without having to go over the emergency room. So I found that acidating around the same time. Walgreens recruited me, they said, "Look, we have a chief medical officer position that's specifically focused on our four to five hundred retail health clinics, and would you be interested?" And so I said, "Well, that looks fascinating. At the time, retail clinics were the hot commodity, and I said, "I'd love to explore what that would look like, particularly as a family physician, a lot of experience in acute episodic care, as well as chronic care management." And so when Walgreens approached me about it, I didn't really think of for-profit versus not-for-profit, but I said, "I'm going to go for it. It looks really interesting." And some of my first few years at Walgreens was really being both a chief medical officer, and then eventually the business leader for their retail health clinics. And I saw the good and the bad of what retail health could do. From a business standpoint, the good was it did bring a fair amount of volume into Walgreens. A lot of the scripts were filled right in our store, so that made sense for Walgreens. Where it doesn't make sense for a company like Walgreens is that they did not, at the time, benefit from folks who need to hire level of care or referrals for CTs and MRIs and all of that. And it's a tough business model to run unless you can really achieve very high volume. And that was always a challenge in retail health, because your scope of care was fairly limited around cuted episodic care. You know, they're getting acute respiratory infections, the urinary tract infections. And we did provide excellent high quality care. We had over 1,800 nurse practitioners at the time when we had all of those clinics. But from a business model, we realized it was a time to pivot and change at Walgreens. I was involved in kind of a change in their strategy about retail clinics. That's a wealth of information. And for me, I'm not super familiar with retail health clinics. It's just from my experience as a consumer, not really much as a medical student. How has retail health changed while you were there at Walgreens? So the typical model is if you have a like a Walgreens store, you have 16,000 square feet. And what we would do in selected stores were car route three to 400 square feet, usually right by the pharmacy. And you had a kiosk, so the kiosk essentially is where the patient came in and registered. And it was a very lean clinical model because it was essentially just a nurse practitioner who was working out of two exam rooms. Patient would come in, register for a visit, and they'd take him in the exam room. Almost like a primary care visit, but really was focused around 30 diagnoses. And then if they required antibiotics, the prescription was written most of the time they'd fill them right there at the pharmacy, which was next door. We would ask the patients if you want information shared with your primary care physicians, some did, some didn't. But it was really around 30, fairly low acuity diagnoses. So it was really about efficiency, access to care, diversion from emergency rooms. So it was a model that served its purpose. I think the challenge, and I think all of the players in the retail clinic space have realized that is, how do you actually start taking more risk and provide more holistic primary care services beyond just those 30 diagnoses? And so you've seen what CVS is done going to the health hub, which is a great strategy. We did at Walgreens as we started exploring what would it be look like to partner with health systems? So they could actually run the retail clinics at Walgreens. And in return would work with them in more depth around some of our pharmacy programs. So we ended up transitioning the majority of the clinics over to really great health system partners like Advocate Aurora and Vanderbilt. So they would run the retail clinics. They would employ the nurse practitioners. They also benefited from those patients who needed primary care referral or specialty referral or ancillary care services. And then where Walgreens benefited, it still kept that foot traffic coming in and out of Walgreens. And then we worked with that health system partner around pharmacy programs, whether that being a 340B program or specialty pharmacy. And so it was a really nice collaborative work with relationship where we developed deeper connections with health systems around the country. So essentially over about a two year period, we made a full transition from us running the retail clinics to health system partners running the clinics. That's really incredible. And having that purposeful partnership aligned with Walgreens and kind of creating alignment between the Walgreens and the health systems seems great. And then Walgreens is also stepped up and focusing a lot on home health. Were you involved in any of that? I really was. That was not a prime strategy at the time I was at Walgreens. Well, what I did help them with was the strategy around where do you go beyond retail clinics? What's the next step? And so what we realized is what was most value is to have a full scope primary care practice right at a Walgreens store. So instead of 300 square feet, what would it look like to take 2500 to 3500 square feet and actually embed a full family practice, primary care practice, much like I did for years in private practice and put it right in the store. Why was it beneficial? Because that was the patient center medical home. They would be seen for conditions, chronic disease conditions, diabetes, hypertension, and they'd have access to convenient locations, full scope primary care provided by primary care physicians and primary care nurse practitioners. And then they would benefit these practices from the support from a pharmacy at Walgreens around medication adherence around questions could go right to the pharmacist. So it was really the model that we landed on at Walgreens. And I was involved in the early days with how they worked with Village MD around that, which is a great primary care organization. And that's been a very successful strategy for Walgreens. And so we deemphasized the retail clinics and really doubled down on full scope primary care embedded right at a Walgreens store. Awesome. Thank you for that. And then you went from this, you know, billion dollar company or multi-billion dollar company at Walgreens to, you know, a startup at the time, hymns and hers. What made you go to that? Yeah, that's a great question. And it's interesting to me to look back on why I even decided to explore working at a telehealth startup based in San Francisco. I actually got a kind of a cold outreach by a recruiting firm and they said, Hey, this is company called hymns and hers. It's based out of San Francisco and they do telemedicine. I had never heard about it. Never. It was what and what do they do? Yeah. And this was pretty pandemic. So, you know, telemedicine wasn't all the rage. And so as I frequently do, I went to my three millennials and I said, What do you think about this company hymns and hers? Why should I consider even leaning, you know, Walgreens to go there? And I said, Dad, you've got to check that out. She said, That's where we get our health care, you know? Wow. It's acne or it's, you know, some conditions, you know, hair loss. What have you? I said, we Google up a symptom. And then there's content that's online that would direct them to a site like hymns and hers, educate the consumer. In this case, it would be one of my three millennials. And then they'd get 24/7 access to a virtual physician. And they loved it. And so I said, Okay, I'm going to trust my kids once again. I'm going to go out there and interview this job. But I went out to San Francisco. I met the CEO Andrew Dutum. And I was sold after talking to Andrew. He had a vision. It really, you know, at the time we talked about, you know, providing care access to stigmatize conditions, you know, things like care loss and dermatology and sexual dysfunction. But it's a much broader vision these days. It's really about normalizing health and wellness for customers. And you don't have to talk into Andrew. I said, wow, this is a company that's, you know, moving fast, very focused on expanding as a demographic, particularly millennials and younger, who they relate to like no, not that other coming from health system world. That was always a challenge for us at hard for healthcare. How do you relate to that younger demographic? And then just the vision he had to grow the company into other verticals. And we talked about even in my interview, I said, Andrew, it seems like it would be an ideal platform to actually offer mental health services. And he goes, Pat, come here, absolutely work on that together. So I came out of the interview just to energize. And it was a career risk for me, though, right? It was going from a very stable, large healthcare pharmacy organization to literally start up. And I was probably one of the first 60 employees. But I was just so, so sold on the vision to access to care, particularly for millennials and younger. In fact, our underserved population, because my kids, my three millennials, let me tell you what they don't do. They don't go on to a health system website and say, "Where do I find a primary care physician?" As I said, they Google up a symptom, they empower themselves to learn about it, and then they look for telehealthism. So that was all pre-pandemic, you know, nine months before the pandemic started. I helped them expand to get into 50 states, built out. a larger virtual physician and nurse practitioner on network for them and really took in some of my learnings from being a leader at a health system and at Walgreens and building out a really robust quality structure. So when you, you know, a virtual visit is done. It hymns in hers. There's a very, very good chance that that encounter was going to be reviewed by a quality team that I helped stand up last year. I think we did over 50,000 encounter reviews. So we really sent up, set up an expanded provider network, but as importantly, a really expanded quality care platform. So we could be very confident that the quality was there when our customers received care off of our platform. So it's been an exciting journey. Help take them public about a year after I started there at hymns in hers. And it's just been hyper growth sense. Yeah, congratulations with all the success for hymns and hers and healthcare is moving towards becoming very consumer centric and maybe health systems and other, you know, incumbents into healthcare ecosystems a little bit slower to adopt, but companies like hymns and hers are very much centered around the consumer and delivering a great experience for people of my age and younger. And yeah, absolutely. I think that's a great point. Andrews, you know, one thing I learned from day one at Walgreens, you have to be consumer focused and coming from traditional healthcare, even my own primary care practice, I wasn't always consumer focused, right? It was like, you will build, I will build it, they will come. And then at Walgreens early on with our retail clinics and everything that Walgreens did, it was hyper consumer focused and coming to hymns and hers, that was really a foundation of everything we did is, you know, what's the customer experience? Are we putting too much friction in that experience? So they're kind of turned off from accessing care. How can we deliver high quality care in the most efficient frictionless way possible? And we think about that every day at hymns and hers. And I honestly think, you know, traditional healthcare could learn a little bit from that that you have to be consumer focused. And I see things changing at health systems to be just that, you know, I'm on the board of Christiana care, a really great health system in Delaware. And at our board meetings, we talk a lot about the consumer and customer. I think 10 years ago, health systems were not as focused on that. Definitely agree. And you mentioned this before, like you helped hymns and hers expand into 50 states. And that's remarkable, especially with all the growth that you guys have achieved. Do you have any advice for, you know, future entrepreneurs and current founders? How to get that kind of expansion with their company? You know, I think you need to build the structure that can handle that expansion. So first and foremost, really focus on how are you going to recruit high quality providers? And how are you going to hold them accountable for high quality care, particularly in the virtual health space? Customers expect a quality experience. They expect that you're following evidence based guidelines. Those are also table stakes. And so when you build a digital virtual health company, you need to make sure that from day one, that is a pillar of what you're offering. And quite honestly, that's one of the pillars at hymns and hers is clinical excellence based on quality. And so that is the first, to me, building block in building a virtual telehealth company. I think the other question you have to ask is, are you just going to be a one offering vertical, which is a lot easier than offering multiple clinical verticals? I think they're pros and cons to each. I think the road with Gunn down at hymns and hers absolutely makes sense. We added in mental health. We've added in an expanded line of products for Durham and sexual dysfunction. And mental health is really one of our fastest growing verticals. So we see the advantage of offering many different clinical services on the same platform rather than just to offer one alone. So if you were going to go into that startup world, that's a fundamental question you have to answer at beginning is, are you just going to be hyper focused on one condition or are you going to offer many? And there's pros and cons to each. It's definitely easier just to do one. But I think in the longer run, it's more sustainable to have multi-service offering. And then I think you also have to look at, are you providing a unique solution? And are you solving a problem that needs to be solved? And is what you're offering differentiated from your competitors? And I would say we've been able to do that at hymns and hers. Our focus today is looking at different verticals that we can expand into. But also for the ones we offer today to offer a more personalized experience, not just from how we interact with the customer, but in terms of the products that we offer them, you know, we launched a compounded finasteride minopsidil for hair loss for men, hugely successful. And then we pivoted from there and actually in our men's sexual health offering, we now offering what we call hardmins, which is actually a personalized, tubal PDE5, you know, like a generic Viagra type medication. So you can get a combination of a short acting PDE5, something like a sedentifel, and then add into Dalifel for a longer acting. And that's been very well received. We just launched that a few months ago. And as we've launched just for, you know, men and women's hair loss, minoxidil, and then added in supplements like a biotid with that. So a big part of what we're doing going forward is to really relate better to the consumer to offer our eyes really unique proprietary compounded products and do it in a way that's responsible with a research team that investigates it, following all in every and all FDA guidelines around compounded products. But we feel that like that will differentiate us going forward to to normalize healthcare by offering personalized solutions to our customers. When it comes to products that you are offering, is there like a lot of market research or consumer research that you are doing as these are the products that patients really want and want to be able to get quickly? What's your thought process behind that him and her is in the product offerings that you guys have? Absolutely. So we have a dedicated insights team really speaks and surveys, our customers, our customers all every day. You know, we look at some of the external research, but we actually rely heavily on our own internal research because we know our customer and today I think we have over 1.3 million active subscribers. So we've been able to attract a huge number of customers with a very high NPS. So they stay with us because we are really hyper focused on what their experience is and quite honestly what they want. For things like the chewable hardmints or the PDE5s, they told us they'd like, you know, the medications in a different form factor, something that was more convenient, and they liked the idea of accommodation medication as opposed to just the short versus long acting one. That way they can cover both short and long acting with the same medication in a chewable format. So you have to listen to your customers and you have to be willing to pivot and change products and change your strategy on depending on what your customers give you for feedback. Definitely agree. And I think a lot of, you know, startups in the DDC space and, you know, having a subscription payment model, they sometimes get a lot of subscribers, but then they also notice that some subscribers drop off after a couple of months or a year, but that's not the case for him and hers. I was looking at like through some of your financial reports and you guys had very impressive Q1, 2023 numbers. What do you think the secret is other than just knowing your consumer really well? Anything attributes to your tremendous growth and success that you guys have had? Look, I think the whole premise of him is in her works. And so coming very from very traditional healthcare, you know, having to, you know, have a patient, you know, and I'm a patient too at, you know, in traditional healthcare, you know, you have an insurance, but guess what? You have a $1,500 deductible. So essentially you paint out a pocket every year. It's almost like catastrophic insurance. And then, you know, the payer limits where you can get healthcare with whom. And then you have this whole black box called PBM. I'm not sure when I, you know, fill a script. How much they're going to pay and how much they're not going to pay. And so what we've been able to do is to eliminate all of those friction points and say, look, we have a cash pay offering. It's extremely affordable. You become a subscriber on our platform. You get 24/7 access to high quality credential providers who are there anytime you need them. You get a high quality visit. You get your medications sent to you. And you can have regular check ins and any issues that you have were completely reachable 24/7. We're not closed on weekends or nights. And we're going to check in with you on a regular basis, you know, that customer relation management and how's your experience been. And guess what? At the end of the year, you still paint under what you could pay out a pocket for, you know in your 15th century. 100-dollar deductible world with all the headache of dealing with the payer. So it is really a model that works tremendously well. And it's a direct to consumers, also hard business. It's not as easy as it seems from the outside. Oh, you just set up a virtual health network and you offer these medications online and then it gets sent to the patient. That's easy. No, it's not. It's hard to set up a quality network. It's hard to, you know, really optimize and perfect the customer experience and to continue to deliver day in and day out because they're paying out of pocket. They demand a good experience as they should because it's their money. Completely agree. And then I also saw that, you know, you have a lot of providers available at Hems and Hers, dermatologists, individuals in the mental health space. How does she go about, you know, getting those providers on board initially? Did you guys reach out to them or did you just leave like an open position that, you know, for physicians to apply into? Yeah, let's talk about the provider model. The majority of our providers are part-time. They work, you know, maybe 18 hours or less per week and they do it on their own time. So they have a day job, you know, whether they're an emergency or a physician, a primary care physician, a dermatologist, a psychiatrist, psychiatric nurse practitioner. And as a reason why we've had great success recruiting them, we pay very competitively. But more importantly, we make it easy for them. You know, they don't have to go on and be burdened, you know, with an EMR that is not customer provider friendly. We have a proprietary EMR. A great, great majority of his is they can do off a mobile device. They're embedded critical guidelines in the workflows, you know, a customer will come in, they answer very specific questions, they get surface to the providers, providers can review it and then it has two-way communication with the pay, with the customers. We do that in all the states that allow asynchronous care and most of our visits are asynchronous. But there are some states still today require synchronous care and we have capabilities to do synchronous care. And then what the providers see get out of it is they get paid well, they have a great customer experience, they don't have to submit to insurance company. They don't get, you know, pinged for pre-authorization and all the headaches that providers deal with today. They don't get that on our platform and they feel very fulfilled. I'll share a statistic with you to me, which is probably the most powerful from our providers is that even 97% potential rate. I never had that when I was working in any healthcare organization. So they love practically with us, they stay on our platform and it's just a good customer and provider experience. That's really awesome to hear, because what I hear from all other organizations is that there's a huge clinician burnout rate and retention problem. I'd also love to talk about the future of hymns and hers. You guys already had a tremendous amount of success so far. But are there any initiatives or projects or areas that you're really excited about for hymns and hers? Yeah, we're always looking at new clinical verticals, but I'd say we're also continuing to be intensely focused on what we offer today. I would offer a more personalized experience. And so for us, a big initiative are these personalized medications. And we have our own both large distribution center pharmacy, 300,000 square feet in Columbus, Ohio. So most of our medications today are fulfilled through that. And we also have a compounding pharmacy based out of Phoenix, Arizona area. So we're able to actually provide a fully integrated vertical experience. You get the content, the information, the education, you get the provider visit, you get your medication sent to you. And guess what? Unlike most healthcare models I'm involved with, we know whether folks who are adhering to the medications or not. When I was in primary care physician, if I saw a patient I wrote a prescription, I had no idea whether they were taking it or not. But him's in her sense, we are part of that pharmacy chain. We can see the adherence and we can see side effects. We can see all of that. And increasingly as more and more of the scripts are actually filtered our own pharmacy, it's all totally integrated into one experience. So we have the kind of the chassis, the structure to expand into other verticals. So today, you know, peak focus on, you know, personalizing the medications in proprietary products. But we are looking at other verticals. You know, there's this rage around weight management. You know, we're absolutely looking at that space, but we want to do it right and probably a little different in terms of a holistic experience that's offered out there today. It's not just all about the GLP ones and the GIP meds. It's really about how you provide access to weight management using both generic medications. And of course, at the end of the day, perhaps some folks will call for the GLP ones and GIPs. So we haven't jumped into that quite yet, but that is something we are actively exploring. And then again, we just perfect the verticals we're in today. You know, our mental health is growing very quickly. We're really focused on that kind of low-domotored anxiety and depression, a huge issue in this country, and just continue to focus on how we make that experience and access better and better. You know, today it takes eight to ten weeks to see a psychiatrist. We, someone comes on our platform, they can access a provider for mental health in less than four hours, actually in some months, even less than two hours. So it's more immediate access to care for a condition that's really challenging and continue to perfect our mental health offering. So you'll see us entering new verticals, but it's not like we want to do, you know, ten at one time. We want to perfect the ones we have. We want to focus in on the products we offer, focus on the customer experience. And they're very thoughtfully strategically looking at new verticals. Appreciate that, and that's a luck with that endeavor for Hems and Arrows. And are there any challenges being in the D to C space? I think the big challenge is it takes a lot of investment in time to build a great brand and we've done that at Hems and Arrows. So day one, it looks easy to get into D to C's as well. I can charge the customer directly and offer a service on a tell-all visit, but if people don't know about you and you don't have a trusted brand, it takes time and money to develop that. And so the challenge in the D to C space is to continue to build your brand awareness and really to emphasize trust and safety because the fastest way your brand can take a hit is not to deliver quality experience. And that is always a challenge in D to C. And I think for us, it really has made sense. It's been a good strategy to offer more than just one vertical diversify. Definitely agree. And I feel like word of mouth marketing is like the best, right? I try out your products and your services. I think it's amazing. And I tell my family and friends all about you and it's like a very exponential way, way to grow. That's the best way to market. That's right. Did you guys do any like brand ambassadors or influencers very early on for him's and yours? Yeah, we did. And I'm not the guru in marketing, but we use, you know, TikTok, we do YouTube videos up. We actually have just launched our own recording studios, media studio in Brooklyn, New York. Believe it or not, this position here has been on TikTok videos around. That's awesome. I was afraid to look at it after it was all filmed, but I hear I did okay. I passed, I guess, but we bring in our specialists actually do a lot of that direct to consumer media, which we find is very powerful, both in terms of education when they're on a platform, but also in the general media for awareness of what we do and the conditions we serve. Incredible. And Dr. Carl, maybe one day I'll see you and you'll be TikTok famous. Are there any areas that you think are going to be impacting this space, any like policy, any technological investments, anything that you are excited about that's going to be changing health care in this space? Well, you know, it's been a tremendous learning experience coming through the pandemic. A lot of the telehealth regulations were eased a bit, and now that we're, you know, looking at the other side of the pandemic, some of the restrictions have remained doubt and, but you know, you always have to be looking at what's next in telemedicine and what the travel, what the next challenges are. I think they're justifiably on the customers end, you know, privacy concerns. You know, we have a HIPAA compliant EMR, you know, we are, we follow every privacy law whether it be state or federal and so you have to be aware of where that's going because I think that's a trend in health care that's gotten a lot of attention as it should be. I think telemedicine is here to stay though. It's particularly if you look at things like mental health, a lot of visits today for mental health in ambulatory care or virtual, because it's perfectly amenable to to provide to virtual health, things like dermatology, whether it's such a shortage of dermatologists, why Durham has been such a great vertical for us. And even in sexual medicine, it's sometimes hard for folks to come in and talk to the primary care provider, but it's so, you know, we see that as an area that's really amenable and it has been for us to do a virtual visit for that. And again, we see more and more states willing to accept asynchronous care, which we think is a big advantage to the customers. It's a very efficient, high quality visit, but we follow state regulations in those states that require synchronous. So there's always that pulling tug between, you know, asynchronous versus synchronous state regulations, federal-related regulations, privacy concerns, you just have to follow all of the laws that are put forth and more flexible enough that we do that. - Got it. And I know you guys primarily are operating on a subscription-based model. Did you guys ever take it with the idea of accepting insurance, or maybe I'm not, do you guys accept insurance at all for any of your- - No, so that's always possible, you know, we've looked at it, we've examined it. Today we just feel like there's such a tremendous opportunity to provide high quality access to care in direct to consumer. And quite honestly, the whole movement on the payers to go to a more shifting, more financial risk, particularly in high deductible health plans plays right into that strategy. - Definitely does. The policy is definitely being a regulatory opportunity for you guys with the Medicare advantage and the high deductible plan. And the last thing, you know, part of our podcast left to learn a little bit more about you personally. When you're now busy with work, what do you like to do for fun? - Well, you know, I have, my millennials all had grandchildren now, so I've got four grandchildren and they always descend on our house. We live near the coast and south coast of Massachusetts. And so we'll have the annual grandkids in invasion in July. So we're getting prepared for that. So some my role in that is to get the lobsters 'cause they all like lobsters. And then a little fishing boat that I like going out a little 21-foot center console boat and try to catch some sea bass and blue fish. And my grandkids now is they get older. They all fighting over the steering wheel. Say it's always the experience going out there with grandpa who's gonna steer the boat and me trying to make sure no one gets hurt on the boat. So that's what I enjoyed you and I enjoy, you know, my family watching my grandkids get older and then getting ready for them to come, particularly in the summertime. It's always a great event. It sounds like a really fun time for the grandkids. And then any advice for someone that wants to pursue a similar career to you? - You know, that's a great question, you know, particularly when I worked at Walgreens and I presented a lot externally, I would have a young physicians come up to me after talk and say, "Hey, I want to do exactly what you do." So I'm gonna go to med school. I'm gonna do a short residency that I want to become chief medical officer at Walgreens. So I want to come chief medical officer hymns and hers. And you know, it's, I've had a very non-linear career path and so one piece of advice I have for folks to stay open and willing to do different things. And I've done that and stepped forward at different points in my career and everything that I've stepped forward and kind of taken a chance on whether it be doing utilization management years ago or even doing two stints with the Indian Health Service. It all fits in. It all has, you know, given me skill set that is very applicable to each part of my career and the one thing I would recommend to a young physician, young physician who wants to become a physician entrepreneur is do some clinical practice because it's nothing better than to learn about health care by actually delivering health care in a traditional practice on the way. I'm not a big advocate of going, you know, college to med school to residency right into the business aspect of medicine. Practice or at least try to practice at least part time during your career. You really need to understand what, you know, patients and customers are going through as well as what providers are going through 'cause health care is not fun for providers these days and quite honestly it's not fun for customers. Unless you've actually been in there in the trenches doing it for a while, you don't appreciate the challenges as well. - Thank you so much for that, Dr. Carroll. So grateful to have you here today to speak on the Paris Health Care Playbook. It was incredible to learn about all your work experience, your job as a CMO Walgreens and now at Hymns and Hurres and we're so thankful for all the insight and advice that you've given to our audience today. - Great, I really enjoyed the conversation. (upbeat music)