Preventing Diabetes: A New Approach Through Telehealth with Laurence Girard, the CEO and founder of Fruit Street Health

[00:00:02] Hey, everybody. Welcome back to the Outcomes Rocket. So glad you tuned back into our podcast today. I have the privilege of hosting an amazing person. His name is Laurence Girard. He's a serial healthcare entrepreneur and is currently the CEO and founder of Fruit Street Health.

[00:00:21] Fruit Street delivers the CDC's diabetes prevention program via telehealth and live video conferencing with registered dietitians. The National Diabetes Prevention Program has been proven to help individuals with prediabetes reduce their risk for type 2 diabetes by more than 58%.

[00:00:41] Laurence has raised more than 33 million in equity financing for Fruit Street. He's a VC himself, just an incredible person. I'm excited to have him here on the podcast. Laurence, welcome. Thanks for having me. I really appreciate it. Of course, it's a pleasure to have you on.

[00:00:55] We're going to unpack what Fruit Street's doing for healthcare and for patients and dietitians. We're going to unpack all that. But first, tell us about you, Laurence. What got you into the business? What got you into healthcare and the VC, all that? Yeah.

[00:01:08] So when I was 18, I made a decision that I wanted to focus on something with a social impact and decided to go to medical school. And I had this unique experience where I was volunteering in my local emergency room while simultaneously taking a nutrition epidemiology course with a

[00:01:24] Harvard School of Public Health professor. And I realized that those two things were really polar opposites. One was focused on primary prevention and the other was focused on treatment in the emergency room, and by doing those two things at the same time, you

[00:01:37] ultimately realize that a lot of the patients that come into the emergency room have preventable lifestyle-related conditions such as type 2 diabetes, heart disease, stroke, obesity. I just realized that the healthcare system needed to do a lot more in terms of preventing diseases related to diet and lifestyle.

[00:01:56] So I became interested in public health, also became interested in telemedicine because I was volunteering for an education nonprofit that provided free online tutoring through video conferencing for K-12 students. And then I moved to Boston and I was in the bachelor's degree program at the

[00:02:11] Harvard Extension School, which is the division of continuing education, usually for older adults, but I pursued it as a regular age college student because when I was in high school, I was playing very high level soccer, which is how I got interested in diet and exercise.

[00:02:25] But when I was in Boston, my goal started to shift from medicine into entrepreneurship because I got exposed to entrepreneurship at the Harvard Innovation Lab at the Harvard Business School campus, and I just realized that there was a big opportunity to positively impact public health through technology,

[00:02:43] entrepreneurship, and business. And maybe I could have a larger scale in public health through entrepreneurship rather than just being a physician working with individual patients. And so Fruit Street started around 10 years ago as a summer project at the

[00:02:56] Harvard Innovation Lab, and I had some physicians from medical school invest as well as some business school alumni, and then basically became a public health entrepreneur ever since. That's fantastic. Super cool that you were deep into soccer, that you were amazing at it.

[00:03:11] Well, that's where your diet and exercise and everything came from. And your inspiration for all that fueled Fruit Street, the investors and everything. It's been 10 years. So I'd love to learn from you and help the listeners understand what is Fruit Street all about?

[00:03:26] What do you guys focus on? I know I gave a brief intro, but help us unpack it a little bit more. The original product was actually different. It was originally a telemedicine software product that we would license to dieticians for $200 per month.

[00:03:39] And we've had large institutions use that software like Harvard Teaching Hospitals, DaVita Kidney Care, University of Michigan. But ultimately we met an executive at Fitbit that said to us, you really felt the perfect software for delivering the National Diabetes Prevention Program, and you should pivot into doing that.

[00:03:55] And so we changed the business model in 2017 and started delivering this diabetes prevention program. And basically what it is, is a program designed to help people with prediabetes avoid developing type 2 diabetes. And prediabetes just means that someone has elevated blood glucose and they

[00:04:11] have a high risk of developing type 2 diabetes. And actually one out of three adults are prediabetic today in the US, which is 96 million people. But eight out of 10 people don't know that they have it. So sometimes they go to their doctor and they realize, oh my God, I

[00:04:24] actually have type 2 diabetes and I have to take insulin or medication. And so 20 years ago, Medicare through the Centers for Medicare and Medicaid Innovation funded a $175 million clinical trial where they compared a lifestyle modification program to metformin, the drug to a placebo, to

[00:04:43] see if they could prevent type 2 diabetes. And what they found was that the lifestyle program was more effective than metformin in preventing type 2 diabetes. The lifestyle group reduced their risk by 58%. And if people over 60, they reduced their risk by 71%.

[00:04:58] So that was published in the New England Journal of Medicine and it led to Medicare and Medicaid paying for the program and players in health plans. And then the CDC building a national public health program where organizations like Fruit Street deliver the program.

[00:05:11] Most of the programs are in person at churches, hospitals and YMCA's, but we deliver it online through telehealth and live group video chat on Zoom with dietitians, and then we issue people a wireless scale, a Fitbit, and they can take pictures of their food in our mobile app.

[00:05:25] We've also recently partnered with LabCorp for blood testing. And then we have another partner called Modified Health. We're working on integrating for actually delivering medically tailored meals to people. Oh, very cool. Yeah. It's a great program that helps people avoid type 2 diabetes, lose weight and get healthier.

[00:05:40] Amazing, Lauren. On the founder's journey here, I always am intrigued by this. That happens so often, right? You start with something and then it turns into something else. Like what was your instinct when you heard that Fitbit's CEO or that Fitbit executive's feedback?

[00:05:55] Did you have some resistance toward it or were you just like open to it and did it? I was pretty open to it because I was aware of the National Diabetes Prevention Program already. And I did realize that to succeed in healthcare, you have to align

[00:06:06] with insurance reimbursement. Totally. So because this program was reimbursed by insurers, it actually made a lot of sense. And they had actually introduced us to another partner that helped us with the marketing of enrolling people from these health plans into our program as well.

[00:06:20] So it made a lot of sense. But yeah, I think always these startups, you never have the same product that you had when you started. But I think what didn't change is the mission of the company, which to use technology to prevent and treat lifestyle related disease.

[00:06:35] And so I think that doesn't always change in a startup, but sometimes the manifestation of the product does. Yeah, no, I love that. I love that. Appreciate you highlighting that. And so shifting to what you do different and how do you do it better out there?

[00:06:49] Cause there's, there's programs that that provide guidance and claim to a lower A1C. But what makes you guys different? What makes Fruit Street different? Some of the other digital diabetes prevention programs are companies like Omada Health or Lubongo, Noom, Lark.

[00:07:05] And they're classified by the CDC as an online diabetes prevention program, which means they do not have live classes through video conferencing. In contrast, Fruit Street's classified as a distance learning program, which means they'll have live classes.

[00:07:19] And so we were actually competing quite a bit with them for contracts with employers and commercial health plans because both delivery modalities are allowed, but actually there's new CDC and Medicare regulations going into effect.

[00:07:31] On August 1st of this year, which will allow for a new delivery type called in-person with distance learning option, which to make a long story short allows for the distance learning model to be delivered and only the distance learning model is eligible for Medicare reimbursement.

[00:07:45] You cannot use an online model. Yeah. Because I think Medicare feels that if I had to guess it would be that it's the most similar to an in-person experience having these live classes and there was actually a paper published that analyzed the virtual delivery of the program

[00:08:00] through telehealth during the pandemic was allowed temporarily and the outcomes were just incredible. So I think that really the difference is having these live classes where it feels like you're in the same room as the other person. Yeah, it's a big distinction.

[00:08:13] I could tell you that people are tired of bots. People are tired of automation. As helpful as it is when it comes to our day to day, like man, I'm going to give you an example. I recently tried upgrading my LinkedIn profile from core to advanced.

[00:08:29] It's been two weeks and I'm literally still dealing with like emails where I should be able to self-service that, but whatever, if you want me to go through somebody, have them call me and like, that's the point, right? Make it simple. And I think follow through increases.

[00:08:42] So that's a really big distinction. Appreciate you helping us understand that. Okay. So what about setbacks, man? We want to learn from you. Our audience wants to know how to improve their businesses too. So what's a big setback that you were faced with that

[00:08:58] you've made big learnings from? Yeah, we made that original business model pivot from software licensing into diabetes prevention in 2017. And then our revenue really started to grow. We've enrolled about 45,000 patients now and we're generating at our peak $4 million in revenue. And that was through a distributor.

[00:09:16] And that distributor would basically distributed us to employers and health plans, like one of these benefits navigation portals for them. And actually they decided to build a competing product and reached the contract and just moved the patients from our product over to theirs.

[00:09:34] And we were forced to sue them. And we basically went from having millions of dollars of revenue to zero overnight because that was really all of our customers. And at that point it seemed pretty bleak.

[00:09:45] I mean, we believed in the product, but it's like, how's this going to work? How are we going to go sell to employers and commercial health plans against the big players like New Malmata, Livongo, these companies that have raised

[00:09:55] hundreds of millions, if not billions of dollars, and then something happened. All of a sudden we realized that Medicare was going to reimburse for only our delivery type. And then we got a grant from the American Diabetes Association and now we're registering with the Medicare provider.

[00:10:10] And now these positions that we've built relationships with as investors and advisors are now able to introduce us to their colleagues who can refer their patients. And we even got invited to things like the CDC headquarters for a conference.

[00:10:23] We got invited to the White House conference on hunger, nutrition, and health. And I think we always hoped for the Medicare reimbursement, but we didn't know when it was going to happen. And I guess the point is that if you do good science in healthcare and you do

[00:10:35] things that are evidence-based and build a good patient experience, sometimes the payers actually do cooperate like Medicare, but it can take 10 or 20 years. The original paper was published 20 years ago around the diabetes program. So what I would say is that sometimes it takes time for payers to get

[00:10:51] on board with what you're doing. But if you deliver good clinical outcomes at a reasonable cost, and there's a good patient experience and a good clinician experience, then you're achieving the quadruple aim of healthcare and you'll probably succeed in the end, but you need

[00:11:05] to be extremely patient in healthcare. That's a great message, man. And what an oh shit moment when that happened. But thankfully you guys were able to retool, had some alignment on the payer side and then boom, you guys are off to the races.

[00:11:19] And today I guess August 1st is that timeline where you guys will have another moment where Medicare will reimburse only what you guys deliver. So that's super exciting. And I want to give you and your team kudos for turning the corner on that. Thank you.

[00:11:33] Yeah, it's a huge opportunity. There's 66 million Medicare beneficiaries with one contract that you would automatically be basically approved for original Medicare, which is 33 million people and then the other half of Medicare is Medicare Advantage. They're required to contract.

[00:11:47] And actually in the Medicare population, it's not one in three people that are pre-diabetic, it's one in two. So yeah, it's just great to see Medicare focusing more on prevention. So kudos to them as well for trying to shift the healthcare system into

[00:12:00] prevention, which we really need as well. Totally man. A hundred percent agree with you there. Look, I've really enjoyed our time together. For the folks listening, for the employers and the payers, maybe even the providers, what call to action would you leave them with today and what's

[00:12:16] the best place they could find you? Yeah. So for the providers, I would say that when you're doing those A1C tests or the fasting blood glucose tests, and you find that your patients are pre-diabetic, really they should be referred to a CDC recognized diabetes

[00:12:28] prevention program, whether or not that's Fruit Street or their local YMCA or another program, even some of our competitors have great programs as well. But it's really the right thing to do for the patient. So then instead of going from pre-diabetic, having type two diabetes and all the

[00:12:42] associated complications, they can reverse their pre-diabetes, lose weight and go back into the normal state for their blood glucose. And so I'd really encourage physicians and providers to reach out to fruitstreet.com and we can set up a relationship with your practice to help

[00:12:58] you enroll your patients into the National Diabetes Prevention Program. And then for employers, self-funded employers, health plans, Medicaid plans as well, and Medicare Advantage plans really is the right thing to do, first of all, but also it's been proven to save money.

[00:13:11] If you prevent someone from developing type two diabetes, you can save thousands of dollars of health care costs. And then if you're a person listening to this that has pre-diabetes or you don't know, you can go to our website and take a one minute risk quiz for pre-diabetes

[00:13:24] that was developed by the CDC. And you can quickly just see if you might be at high risk for pre-diabetes. But ultimately, you might want to get blood tests like an A1C test to check if you're pre-diabetic, if you're between 5.7 and 6.4 on an A1C test, you

[00:13:38] have pre-diabetes, but the good news is that it's reversible by joining the National Diabetes Prevention Program. That's amazing. And folks, everybody knows prevention's the key here. Awareness, it starts with awareness. So great to hear that resource on the website.

[00:13:52] Lawrence, folks, check out the show notes of today's podcast with the amazing Lawrence Gerard. You'll find links to get in touch with him. Check out his company, Fruit Street. And just take action on the things that you worked on today.

[00:14:06] Changes are happening and you got to do the right thing for yourself, your patients, now's the time. Lawrence, thanks for being with us. This has been a lot of fun. Thank you.