Lessons from Neil Patel, Patina Health, on reinventing primary care and the aging experience

Neil Patel, CMO of Patina Health, an on-demand virtual and in-home primary care for patients 65 and older

Mar 15, 2023

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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. Neil Patel, Chief Health Officer of Patina Health, a new model of primary care for adults 65 and over that reimagines the journey of aging through virtual and home-based care.

Dr. Patel is a trailblazing healthcare leader who has been involved in innovation in the primary care space. Prior to joining Patina, Neil served on the executive leadership team of the Boston based startup, Iora Health, leading special projects across different regions in the US. He also served as the medical director at Grameen VidaSana, Harken Health, Freelancers Union, and the Atlantic City Special Care Center described in Atul Gawande’s influential 2010 “Hotspotters” article. Neil went to college at the College of New Jersey, and went to Rutgers New Jersey Medical School for his MD. He trained in family medicine at Boston University.

Patina raised 50 million of Series A venture funding in a deal led by Andreessen Horowitz and Google Ventures, along with F-Prime capital, Rock Springs Capital, and Viking Global Investors.

In this episode, Neil shares his journey in medicine, his work in healthcare leadership as one of the founding team members of Iora Health and Patina Health, and advice he has for founders who are trying to improve healthcare delivery.

If you prefer listening, here’s the link to the podcast!

Neil’s Path to Medicine:

Neil grew up in a small town called Kearny, New Jersey. He lived in a working class neighborhood just across the river from Newark, NJ. Growing up in the 80s and 90s made Neil appreciate how diverse the world was.
“I grew up in this interesting environment where my sister and I were the only people of color. I had this interesting childhood of learning how to sort of fit into a culture that was different from my family’s and I’m grateful for that.”
When Neil was in high school he wrote about understanding his privilege and all the opportunities that were in front of him. He wanted to apply that privilege to help others by directly being in service to those that were in need. This motivated him to pursue medicine, and as a physician, Neil believed he could drive insights and work towards improvements in the healthcare system.
When it came to his specialty, Neil chose family medicine because of the breadth of training. He trained to deliver babies, sought out opportunities to learn how to treat folks with end stage illness and HIV, supported behavior change in patients, and learned how to trust nurses and specialists in the healthcare delivery system.
“Family medicine was the quintessential generalist training that I needed to work in all kinds of places. There is an influential book called Donde No Hay Doctor (Where There Is No Doctor) that taught villagers how to practice medicine. I wanted to learn it all and it made me covet information and expertise from other specialties”

What It Takes to Be a Healthcare Leader:

You have to be creative!
- Practicing in family medicine exposed Neil to a population of folks that are underserved. Underserved populations are not just people in rural areas or urban cities, but can include seniors with Medicare who have fantastic insurance. This exposure led Neil to be creative in his care and his ability as a leader.
  “Sometimes there isn't always a playbook for how to provide real, life-changing, empowering care to folks who work for the trade union in Atlantic City, or those that are over 65, or those with chronic and multiple conditions. The creativity you need to have to approach individuals for their care was invigorating and useful in my experience with entrepreneurship and healthcare leadership.”
You have to listen to your team.
- Neil recommends a great book called Tribal Leadership, that he read early on. The book teaches leaders to listen to their teams, pay attention to the clues, and nudge the culture and the team along the way.
  “You cannot just set a vision and expect the entire team to jump to it, but you have to construct the mechanisms to guide your team to the vision you hope to ultimately achieve.”
You have to be willing to learn for your patients and your stakeholders.
- A healthcare leader will not always have all the knowledge needed to serve their patients and stakeholders, but they need to take it upon themselves to learn. Whether that is learning about finance or a different language, a physician and healthcare leader should be willing to learn for the benefit of their patients.

Neil’s 10 Year Experience with Iora Health

Iora Health is where Neil got his startup education. The central belief of the Iora team was that primary care can be the key lever to transforming the lives and health outcomes of individuals.
Neil was one of the founding team members who had to think through design and strategy for the company to best position Iora Health as a disruptive force in healthcare.
Iora Health started in the trade union space, moved to the employer-based space, began to invest in Medicare Advantage and think about senior care, and then placed a huge bet on the Affordable Care Act marketplace for a few years. Iora Health then pivoted back towards senior care and medicare advantage, which were areas that Neil heavily focused on.
“It felt like my experience with Iora Health was like 10 startups rolled into my one experience”

How Neil Succeeded at Iora Health

Neil shares that to succeed with his work at Iora Health, he had to constantly learn for his patients, trust in his team, be willing to experiment, and not be discouraged by his failures, but learn from them.
Iora Health was a fast-moving organization that scaled effectively for many reasons. Neil comments that one of the strongest reasons it was able to grow was due to its strong culture and focus on values.
“We treated everyone with the same kindness that you naturally learn to treat patients with. We learned to hold onto the culture of support and built teams and systems around our culture. We had a sense of resilience and took care of each other. While I was an architect of the culture and system, I was also a beneficiary of it.”

From Iora to Patina, a New Disruptive Paradigm for Primary Care

Patina is a model of primary care for adults 65 and over. Neil shares that at Patina they listen to adults 65 and older. They ask questions like where do they want to be when they are sick? Where do they want to be when they are well? Where do they make the best decisions?
The consistent answer for all these questions is not in the hospital, but in the patient’s home. So Patina built an operating model around the patient’s home where they can reimagine the journey of aging through virtual and home-based care.
“We visit the patient’s home, get to see their kitchen table, can perform a home safety evaluation, and we believe the home is a position of comfort and power for the patient.”
Why did Patina concentrate on the age of 65?
- 1. You need to have a focus. A business needs to have a firm vision and focus. If you want to do audacious things in healthcare, you have to be focused with a certain subset of patients or the population.
- 2. Allows us to hire the right kind of team with clinicians and staff members who have years of experience working with an aging population.
- 3. Ties back to the central mission of Patina which is to help seniors feel like they are being seen and heard.
  “People that are 65+ are drowning in a sea of healthcare access but they are not seen or heard. This is an incredibly undeserved group that is not seen for their strengths. At Patina we try to leverage the strength of our patients to help folks take care of themselves.”

Building out the Minimal Lovable Product

As Neil puts it, MLP is a minimum lovable product. A product that crossed over into this imagined threshold of lovable.
“We wanted our product to be more than viable, and wanted to go to market with as much learning as we could get. Lovable required a certain level of discipline and safety. The idea of moving fast and breaking things does not apply to healthcare because we have real people and real lives that depend on Patina.”
“But safety can also be paralyzing. It’s easy for clinicians and other stakeholders to get paralyzed by edge cases, so building a lovable product involves taking risks but learning quickly.”
One example Neil shared for the MLP was having patients use DocuSign for consent.
“When we launched, we were willing to show up with actual pieces of paper if patients did not feel comfortable using Docusign. Later, based on what we learned, we built a wonderful, patient-centered workflow for consent that allows almost all our patients to complete consents online.”
When creating a minimum lovable product you have to deliberate with your team, prioritize things you cannot compromise on, be willing to take risks, and ultimately learn quickly.

The Future of Patina:

Patina by definition is a color that forms due to an oxidized chemical reaction. In essence, it describes something that grows more beautiful with age or use.
The future of Patina is serving patients and growing the organization. Neil hopes that the organization can be in every state and delineate the true beauty and strength that comes with age.
“When you get older it is not just a problem list. You have certain strengths, and at Patina Health we are trying to use those strengths to make better decisions based on what matters most for the aging experience and better health outcomes.”
Patina Health hopes to be everywhere and bring this innovative model of care to folks no matter where they are.

Neil’s Perspective on CVS Health Acquiring Oak Street and other Big Players Moving into Primary Care.

Neil shares how excited he is about all the recent activity in the primary care space
“Primary Care was so underinvested for so long. I remember the head of Internal Medicine wondering why I wanted to go into family medicine even with my decent test scores. To see all this action in primary care is incredible!”
CVS Health combining its health services with Oak Street can bring a premier value-based care experience focusing on serving medicare advantage patients.
Neil believes that big players like CVS Health and Amazon getting into the primary care space can bring innovative practices and synergies that can raise the bar for the entire industry. Real innovation can come from the “bottom up” and it will be exciting to see how big players react with all the activity in the primary care space.

Advice to Founders on Building Successful Healthcare Companies

Neil shares that successful founders need to have a combination of being audacious, narcissistic and confident while having radical humility:

1. If founders really want to be disruptive, they need to reimagine systems like healthcare. They have to approach investors with an audacious proposition believing that only their team is uniquely equipped to solve or innovate in the space.

“When I present to my investors, I have a tremendous amount of confidence but I also have to balance that with humility, and be willing to learn from those that invest in me and my company and learn from the patients I hope to serve.”

2. Founders should also learn quickly and be comfortable with unfamiliar situations.

“Agile development teaches us that you don't know where you're gonna go until you're almost there. As founders and leaders you have to set objectives but allow your team to inform the strategy.”

3. Founders should turn instincts into systems and test out their ideas and plans with thought experiments.

“It is important to turn instincts into systems and processes if you are trying to scale effectively. You have to think to yourself how can my team generate the same outcomes if I have half the talent, half the motivation, half the expertise. It’s really hard early on, but simplifying your strategy and focusing on doing a few things well as an early stage healthcare startup will help founders become incredibly successful.”

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Interested in Patina Health or joining their team? Learn more on their website, Twitter, and LinkedIn.