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Lessons from Dr. Patrick Carroll, CMO of Hims & Hers, on Evolving Care through Telehealth and Patient Engagement
Dr. Patrick Carroll, MD, CMO of Hims & Hers, an American telehealth company that provides access to prescription and nonprescription solutions online and through a variety of retailers nationwide
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.
Today, we're excited to get to know Dr. Patrick Carroll, Chief Medical Officer (CMO) of Hims & Hers, an American telehealth company that provides access to prescription and nonprescription solutions online and through a variety of retailers nationwide (and in the UK)! Dr. Carroll is a physician and executive who leads clinical quality and the expansion of Hims & Hers into all 50 states. Previously, Dr. Carroll served as the Group Vice President and Chief Medical Officer at Walgreens, overseeing retail clinic business units, as well as clinical programs and health system alliances. He is also the former CMO and VP at Integrated Care Partners at Hartford HealthCare.
In this episode, we dive into Dr. Carroll’s experience in Primary Care, his work with Walgreens and the retail model of healthcare, Hims & Hers' focus on the consumer and why it has been successful, along with challenges in the DTC space for healthcare.
If you prefer listening, here’s the link to the podcast!
Working in Primary Care and Implementing Population Health Programs
Dr. Carroll's journey began in a big Irish Catholic family, where no one had ventured into healthcare before. Despite being the second youngest, he had a deep interest in science and how it could improve people's lives. Medicine seemed like the perfect path, even though getting into medical school was tough.
After studying at Holy Cross and Dartmouth, he got accepted into medical school, but the cost was a problem. He joined the National Service Corps, which paid for his education in exchange for working in underserved areas. This took him to New Mexico's Navajo reservation, where he learned a lot about healthcare challenges.
After his time with the Indian Health Service, he set up a primary care practice in New Hampshire for 25 years, caring for people of all ages. In 2009, he returned to the Indian Health Service to work on projects like school-based health clinics and population health efforts.
“Establishing school-based health clinics and conducting comprehensive screening evaluations, particularly for Navajo teenagers and preteens grappling with issues like anxiety, depression, and suicide marked a significant endeavor. I also undertook a significant population health project for the Indian Health Service in the Navajo area, aimed at assisting with an EMR conversion. This role aligned perfectly with my path towards primary care. Reflecting on my formative years post-residency with the Indian Health Service, I gained insight into providing access to high-quality care despite the challenge of limited resources. We were essentially practicing population health before the term gained recognition, as we grappled with the task of managing high-risk, high-complexity populations within the constraints of limited financial resources.”
Dr. Carroll’s experiences gave him a unique perspective on delivering quality care with limited resources. He later transitioned to roles with Atreus Health and then Hartford Healthcare, where he embraced new ideas like risk-based care models.
Hartford Healthcare's strategic vision crystallized with a determination to initiate a Medicare Shared Savings Program, establish a Clinical Integration Network, and embrace a risk-based, value-oriented approach. Dr. Carroll found himself enticed by their proposition to join their ranks. This moment was when he first stepped into the world of integrated delivery networks. In this complex network, there were hospitals, a big group of doctors, and a new idea at the time called the clinical integration network.
This network's essence was about bringing together doctors from the community who were not tied to the hospital. They were given important tools, like analyzing data and strong support. The aim was to help them succeed in value-based care by working together, instead of doing it all alone. This experience was incredibly valuable, combining an insightful journey with a big learning curve about integrated delivery networks.
Yet, even as they collaborated and explored, the challenges in the world of not-for-profit Health Systems couldn't be ignored. Changing deep-seated mindsets, moving away from the usual fee-for-service model to the unexplored territory of risk-based contracts, was a tough journey. Dr. Carroll's earlier time with the Indian Health Service prepared him for such challenges, and his experience with Atreus Health further honed his skills, providing a strong foundation for his work at Hartford Healthcare.
Experience with Walgreens
As part of his role at Hartford Healthcare, Dr. Carroll focused on their workforce and healthcare spending, which included over 20,000 employees and their families. His attention turned to scrutinizing the utilization patterns, particularly regarding the emergency room visits by the organization's employees. He noticed a trend where individuals sought acute episodic care in the emergency room due to challenges accessing their primary care physicians promptly. This prompted him to explore the landscape of retail clinics, including CVS Minute Clinics in the vicinity.
“In cases of infections, flu, or otitis media, one could readily access a retail clinic experience instead of resorting to the emergency room. This concept intrigued me. Coincidentally, it was during this period that Walgreens approached me. They presented a chief medical officer role dedicated to overseeing their considerable network of 400 to 500 retail health clinics.”
Intrigued by the prospect and with his background as a family physician adept in acute and chronic care, Dr. Carroll accepted the opportunity. During his initial years at Walgreens, he assumed both the role of chief medical officer and later took on the role of business leader for the retail health clinics.
From a business perspective, the retail health clinics brought substantial volume to Walgreens, with many prescriptions being filled on-site. However, the limitations of the model became evident as it struggled to cater to higher-level care needs or facilitate referrals for specialized services like imaging.
“The challenge in retail health consistently revolved around a constrained scope of care primarily focused on acute episodic conditions. This encompassed issues like acute respiratory infections and urinary tract infections. Our care delivery at Walgreens was of exceptional quality, supported by a team of over 1800 nurse practitioners during the clinic's peak. However, looking at it from a business standpoint, it became apparent that Walgreens needed to reconsider its approach to retail clinics, recognizing the requirement for a more comprehensive and adaptable model.”
Model of Retail Health Clinics and How Walgreens Changed Their Strategy
The conventional Walgreens model involved dedicating a relatively small portion of their 16,000 square-foot stores, typically about 300 to 400 square feet near the pharmacy, to retail clinics. These clinics operated with a lean clinical setup, usually staffed by a nurse practitioner in two exam rooms. Patients would schedule appointments resembling primary care visits, primarily aimed at addressing approximately 30 specific medical conditions. If antibiotics were required, prescriptions were readily provided, often filled conveniently at the nearby pharmacy. Patients were also given the choice to share their information with their primary care physicians. While this model efficiently provided access to healthcare and contributed to reducing emergency room visits, its primary focus was on treating low-acuity cases.
However, the challenge facing the retail clinic industry was how to transition towards providing more comprehensive primary care services that extended beyond those low-acuity diagnoses. CVS, for instance, introduced the Health Hub as part of their strategy. At Walgreens, a new approach was explored: partnering with health systems to have them operate retail clinics within Walgreens locations. In exchange, Walgreens collaborated more deeply with these health system partners on various pharmacy programs.
“We eventually transitioned the majority of the clinics to excellent health system partners such as Advocate Aurora and Vanderbilt. These partners took over the operation of the retail clinics and employed the nurse practitioners. They also saw advantages in handling patients requiring primary care referrals, specialty referrals, or ancillary care services. This arrangement proved mutually beneficial as it maintained consistent foot traffic to and from Walgreens. Additionally, we collaborated with our health system partners on pharmacy programs, encompassing initiatives like the 340 B program and specialty pharmacy services.”
This cooperative effort led to a highly effective working relationship, resulting in the development of stronger connections with health systems nationwide. Over a span of about two years, a full transition occurred, shifting from the management of retail clinics by Walgreens to their health system partners.
During Dr. Carroll's tenure at Walgreens, his strategic contributions extended beyond this transition. He also played a pivotal role in shaping the vision for Walgreens to host full-scope primary care practices within their stores. This involved expanding the clinic footprint to 2500 to 3500 square feet and embedding comprehensive family practice primary care services right in the store.
This was beneficial because it represented the concept of a patient-centered medical home. Patients could receive comprehensive care for chronic conditions such as diabetes and hypertension in convenient locations. This care was provided by primary care physicians and nurse practitioners, offering a full spectrum of primary care services.
Furthermore, these practices benefited from the support of Walgreens' pharmacy services, including assistance with medication adherence and direct access to pharmacists for any questions. The integration of these practices with Walgreens' pharmacy services allowed for seamless communication between patients and pharmacists for medication adherence and inquiries. Collaborations with organizations like Village MD were instrumental in implementing this successful strategy.
From Walgreens to Hims & Hers
While employed at Walgreens, a well-established billion-dollar company in the retail health sector, Dr. Carroll received a recruitment offer from a San Francisco-based telemedicine startup. This was in 2019, a period when telemedicine hadn't gained the widespread recognition it enjoys today. Uncertain about this new opportunity, Dr. Carroll turned to his own children for advice.
"I turned to my three millennials and asked, 'What do you think about this company, Hims & Hers? Why should I even consider leaving Walgreens to join them?' They enthusiastically responded, Dad, you've got to check it out. That's where we receive our healthcare, whether it's for acne or other conditions. We simply Google our symptoms, and it leads us to platforms like Hims & Hers, where we get educated as consumers. They explained that it provides them with 24/7 access to virtual physicians, and they genuinely loved the experience. So, I decided to trust my kids and explore the opportunity."
Dr. Carroll met the CEO Andrew Dudum, and was captivated by the company's vision. While initially focused on addressing stigmatized conditions like hair loss and sexual dysfunction, the broader vision was to normalize health and wellness for customers, particularly middle millennials and younger individuals.
Transitioning from a stable position at a large healthcare pharmacy organization to a startup with fewer than 60 employees was undoubtedly a career risk. However, Dr. Carroll was inspired by the vision and the opportunity to improve access to care, especially for populations like millennials.
“My three millennials, let me tell you what they don't do. They don't visit Health System websites to ask where to find a primary care physician. Instead, they search about their symptoms, empowering themselves to learn more. Then, they seek out telehealth visits.”
Dr. Carroll played a pivotal role in expanding the company's reach to all 50 states, building a robust virtual physician and nurse practitioner network, and enhancing the quality of care provided to customers. This journey included taking the company public in 2021 and witnessing its rapid growth where by the second quarter of 2023 it had over 1.3 million subscribers.
In a healthcare landscape shifting towards being more consumer-centric, Dr. Carroll's work with Hims & Hers exemplifies the company's commitment to delivering exceptional healthcare experiences, particularly for individuals of his generation and younger.
Prioritizing Consumer Needs: Hims & Hers Diverse Product Approach
From the very beginning of Dr. Carroll's journey at Walgreens, he learned the paramount importance of being consumer-centric. Transitioning from traditional healthcare, even his own primary care practice, he realized that consumer focus was sometimes overlooked. It used to be a "build it, and they will come" approach. However, at Walgreens, there was a profound emphasis on the consumer experience. Every aspect of the service was scrutinized to ensure minimal friction in accessing care. The constant pursuit was to deliver high-quality healthcare in the most efficient and seamless manner possible. This philosophy remains at the core of everything done at Hims & Hers.
“I genuinely believe that traditional healthcare can draw valuable lessons from this approach. I've observed shifts in the healthcare landscape during my time on the board at Christiana Care, a prominent healthcare system in Delaware. In our board meetings, there's now a strong focus on consumer and customer perspectives, a noticeable change from a decade ago when these priorities were less prominent."
In order to support the continued focus on the consumer even while expanding, companies need to build a structure that focuses on how to recruit and retain high-quality providers while ensuring their accountability for delivering top-tier care, especially in the virtual health space. Providing a quality experience rooted in evidence-based guidelines is non-negotiable. This is one of the pillars that underpin Hims & Hers—clinical excellence founded on quality.
Another critical consideration is whether to offer a single clinical vertical or diversify into multiple clinical services. Each option has its merits and drawbacks. The approach at Hims & Hers leans towards a multifaceted offering. They have expanded into mental health and broadened their product lines, including dermatology and sexual health. Mental health, in particular, has experienced rapid growth. By housing multiple clinical services on a single platform, they aim to provide a comprehensive healthcare experience for the consumer.
"It's crucial to evaluate if your solution is unique and effectively addresses a genuine problem in need of a solution. Does your offering stand out from competitors? In the context of HIMS and hers, I can confidently affirm that we have successfully achieved this distinctiveness."
Success of Hims & Hers with Consumer Traction
Dr. Carroll and Hims & Hers have achieved remarkable success, largely attributed to their strong consumer traction. The company maintains a dedicated insights team that engages with customers daily, relying heavily on internal research to truly understand their customer base. With over 1.3 million active subscribers and an impressive Net Promoter Score (NPS), Hims & Hers has attracted a substantial customer base.
“Customers have conveyed their preference for medications in different forms, such as chewable tablets, and their appreciation for the convenience of combination medications. We take their feedback seriously, and we're always willing to pivot and adapt our products and strategies based on what our customers tell us."
Unlike some subscription-based models that experience subscriber drop-offs, Hims & Hers has maintained its customer base, as evidenced by their impressive Q1 2023 financial results. The company's success can be attributed to its unique approach in eliminating traditional healthcare friction points. They offer an affordable cash pay model with 24/7 access to high-quality providers, prompt medication delivery, and continuous customer support.
Hims & Hers goes the extra mile by maintaining round-the-clock availability, including weekends and nights, and conducting regular check-ins with customers. This commitment to excellence ensures a top-tier customer experience while still being cost-effective, making their model tremendously effective.
"At the end of the year, you're still paying less than what you would have to pay out of pocket in a $1,500 deductible scenario with insurance, without all the associated hassles of dealing with an insurer. This truly demonstrates the effectiveness of our model at Hims & Hers. Moreover, the direct-to-consumer healthcare business is challenging. It's not as simple as it may seem from an external perspective. It's not just about setting up a virtual health network, offering medications online, and sending them to patients; that's the easy part. In reality, it's difficult to establish a high-quality network, optimize the customer experience, and consistently deliver excellence, especially when customers are paying out of pocket. They rightfully expect a superior experience because it's their hard-earned money."
Provider Model of Hims & Hers
Hims & Hers has achieved success in part due to a well-structured provider model. The majority of their providers work part-time, dedicating around 18 hours or less per week to the platform, alongside their primary professions which range from emergency room physicians to primary care physicians, dermatologists, psychiatrists, and psychiatric nurse practitioners. Hims & Hers' appeal to these providers goes beyond competitive compensation; it centers around simplifying their practice.
One key aspect is the proprietary Electronic Medical Record (EMR) system. Unlike traditional EMRs that often burden providers with complex interfaces, Hims & Hers' EMR is designed with user-friendliness in mind. A significant portion of patient visits can be conducted using mobile devices. Clinical guidelines are embedded into the workflow, streamlining the process. When a customer initiates a visit and answers specific questions, the information is seamlessly conveyed to the providers, fostering two-way communication with the customers.
While asynchronous care is the norm for most visits, Hims & Hers acknowledges that some states mandate synchronous care, and their platform accommodates both. What sets Hims & Hers apart is the provider experience. Providers are compensated well, enjoy a seamless customer interaction, and are relieved of the burdens of dealing with insurance companies, pre-authorizations, and the typical administrative hassles encountered in healthcare. This fulfillment is evident in a remarkable statistic: a 97% provider retention rate, a rarity in the healthcare industry, where clinician burnout and retention issues are widespread.
If you are a clinician and interested in working with them, apply here!
Initiatives at Hims & Hers
Hims & Hers is continually evolving and shaping its future initiatives to enhance its offerings and provide a more personalized experience for its customers. One major initiative is the development of personalized medications. With a substantial distribution center pharmacy spanning 300,000 square feet in Columbus, Ohio, and a compounding pharmacy based in the Phoenix, Arizona area, Hims & Hers offers a fully integrated vertical experience. This includes providing content, information, education, provider visits, and the direct delivery of medications.
What sets Hims & Hers apart is its ability to track medication adherence and monitor side effects. Unlike traditional healthcare models where medication adherence remains a mystery, Hims & Hers, as part of its pharmacy chain, can monitor and improve patient compliance.
"When I worked as a primary care physician, I would write a prescription for a patient, but I had no way of knowing whether they were actually taking it. However, with Hims & Hers, we are intricately connected to the pharmacy chain. This connection enables us to monitor medication adherence, track side effects, and gain insights into the patient's overall experience. As we move forward, with more prescriptions being processed through our pharmacy, we are seamlessly integrating all aspects into a unified healthcare experience. This solid foundation allows us to consider expanding into additional healthcare verticals."
While Hims & Hers remains focused on personalizing medications and developing proprietary products, they are actively exploring other healthcare verticals. One area of interest is weight management, which they aim to approach differently by offering a holistic experience that goes beyond conventional approaches, potentially including generic medications and GLP-1s.
Furthermore, Hims & Hers recognizes the pressing need for improved mental health access in the country. They are making strides in addressing low to moderate anxiety and depression by providing immediate access to mental health providers, significantly reducing the typically long waiting times to see a psychiatrist. This initiative reflects their commitment to enhancing access and experience in critical areas of healthcare.
In their journey toward the future, Hims & Hers emphasizes a strategic approach. They are not rushing to enter numerous verticals simultaneously but are dedicated to perfecting their existing offerings, focusing on product development, and enhancing the overall customer experience.
Challenges in the DTC Space
Entering the direct-to-consumer (DTC) space presents unique challenges, and building a reputable brand is among them. At Hims & Hers, the team has invested substantial time and resources in establishing themselves as a trusted name in healthcare. While it may appear straightforward to charge customers directly and provide telehealth services, brand recognition is absolutely crucial. Building awareness and, more importantly, fostering trust and ensuring safety are ongoing challenges within the DTC realm.
Maintaining a positive brand reputation is paramount, with a firm commitment to delivering exceptional customer experiences. Failing to meet these expectations can quickly erode a brand's standing. Therefore, there is a strong emphasis on not relying solely on a single product line by diversifying the range of offerings. Word-of-mouth marketing, fueled by content customers and passionate advocates, is central to the company's growth strategy.
In its early stages, Hims & Hers strategically partnered with brand ambassadors and influencers, leveraging platforms such as TikTok and YouTube for educational purposes and to enhance brand awarenessRecently, Hims & Hers even inaugurated its own media studio in Brooklyn, New York. Here, their specialists contribute to direct-to-consumer media, enhancing both education and general awareness regarding the conditions the company addresses. This multifaceted approach has proven to be highly effective in their journey.
Looking ahead, Hims & Hers has gleaned valuable insights from the pandemic, particularly in relation to the regulatory environment. While there were temporary relaxations of telehealth regulations, and some restrictions persist, telemedicine has become an integral part of the healthcare landscape. Specific areas like mental health, dermatology, and sexual medicine are exceptionally well-suited for virtual consultations. Furthermore, there is a growing acceptance of asynchronous care, which combines efficiency and quality in healthcare delivery.However, the team remains vigilant with regard to evolving state and federal regulations, privacy concerns, and the equilibrium between asynchronous and synchronous care requirements. The policy and regulatory environment continue to mold the healthcare industry, and Hims & Hers adapts its strategies accordingly.
Advice from Dr. Carroll:
A valuable piece of advice that Dr. Carroll shares is to remain open-minded and ready to embrace diverse opportunities. Throughout his own journey, he's found that taking steps forward at different points in his career has enriched his skill set. From venturing into utilization management to engaging in two terms with the Indian Health Service, each experience has contributed to his capabilities, making them relevant to various stages of his professional path.
Dr. Carroll advises young physicians who are aspiring entrepreneurs to consider participating in clinical practice. He underscores the invaluable insights gained by directly delivering healthcare in a traditional setting. Dr. Carroll believes that foregoing practical experience to swiftly move to the business side of medicine might not yield the same benefits. Instead, he advocates for ongoing, part-time practice throughout one's career, enabling a deeper understanding of the challenges confronting patients, customers, and providers. This commitment to practice also ensures staying up to date with the ever-evolving issues of the healthcare landscape.
Healthcare poses its challenges for both providers and customers. To truly comprehend these challenges, one needs to be in the trenches, experiencing the realities firsthand. Without this intimate exposure, gaining a comprehensive understanding of the complexities and nuances of healthcare remains a challenge and will ultimately result in the poor experience of the customers and patients you are trying to serve.
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