Vida Health brings on Dr. Patrick Carroll as Chief Medical Officer

I spoke with Dr. Carroll about what drew him to Vida, some of the recent trends in healthcare, and what he hopes to achieve in his new role.    

VatorNews: Let’s talk about Vida and how you became involved with the company. What was it about them, about their solution, that intrigued you and that made you want to be a part of what they're doing?

Pat Carroll: The foundation of my career has been as a family physician for over 33 years. I did very traditional primary care: I had a panel of 3,500 patients, many of them had chronic conditions such as diabetes, hypertension, elevated cholesterol, and certainly depression and anxiety. And through my years as a family physician, I saw how all of those intersected and one condition influenced another. You really could not treat diabetes in isolation from someone's behavioral health issues or from their hypertension or elevated cholesterol; cardiometabolic and mental health all intersected. And so, that always was a challenge in my career as a family physician.

As I moved on and I took leadership roles, leading a large medical group in the Boston area and then as the Chief Clinical Officer at Hartford Healthcare, and then even at Walgreens, that just reinforced that all of these conditions actually intersected and influenced the health outcome for patients. Particularly when you manage Medicare Advantage programs and commercial risk programs, what you would see is that rising risk of patients, the folks with multichronic conditions, overlaid with mental health issues are always a challenge. And what I saw, and what I see at Vida Health, is that intense focus on treating conditions holistically, not separating one out from the other. I see that as the trend, actually, in healthcare: we have to address everything in unison, as opposed to a one off. They've had some really impressive results through the coaching platform, through the counseling platform, for both mental health as well as for the cardiometabolic conditions, making recommendations to providers, with a really high touch interface interaction with patients. And so, I just saw a tremendous opportunity and I really feel like, for both employers and payers, and even health systems, the new reality is you need to treat all of these things holistically as opposed to separately and Vida is already getting great results without taking that kind of next step to get into the prescribing world.

And so, coming on at Vida, learning a lot about the company and learning about their great programs and then really exploring intentionally whether the next step may be prescribing a virtual network of providers and focusing on some particular conditions where there's a need in terms of access. So, a lot of exciting opportunities to grow. But also I love the model that they have today.

VN: Yeah, there's definitely been a change in the way we think about mental health in the last few years, starting before the pandemic, but the pandemic really brought into focus the health crisis that was going on in America. There has been that shift toward not thinking about physical health and mental health as two separate things, but as one one person with two things that interact with each other. Have you seen that that's the larger trend in the industry, or is Vida sort of an outlier in integrating those two parts of the person?

PC: It is definitely a larger trend in the industry but Vida was early on to recognize this.

I'd look at one condition in particular: diabetes, which is a national epidemic, with 75 million pre-diabetics, 30 million diabetics, and a third of those diabetics are actually complex with multichronic conditions, hemoglobin A1Cs over 8.5. What Vida has recognized is if you actually bring in a diabetic patient to provide not only nutritional counseling, with their CDCS and their coaches, but also do the PHQ-9, do a depression screening, particularly for the higher risk diabetics, they're two to three times more likely to be battling mental health conditions, particularly depression and anxiety. Vida actually has some good studies out there that show that when you address both the mental health condition in a diabetic, as well as their underlying diabetes, the hemoglobin A1C actually improves significantly more than if you just addressed the diabetes alone. So, the proof is there in the results that they've seen and I definitely think that that is a trend, particularly for payers and employers, because they've seen this interaction. They've seen how one condition builds on another.

VN: You were previously the Chief Medical Officer at Walgreens and you joined Hims & Hers a couple of years ago. What in your experience, especially at those two companies, makes you a good fit for Vida? What are you going to take from those experiences and bring to the new company?

PC: For Walgreens, really the view of the impact of pharmacy on healthcare results. At Walgreens, we focused a lot on medication adherence and what we saw is medication adherence is a major problem in folks with chronic disease, particularly diabetes. Over 50% of diabetics are not adhering to medications. So, that pharmacy influence in terms of getting good health outcomes is something that really was reinforced through my five years at Walgreens. 

The other thing about Walgreens that I took away is they're a very customer focused company. Coming from traditional health care and working with health systems, that was a revelation to me. I know health systems are getting there today but a company like Walgreens, and Hims & Hers, are very customer and consumer focused and I'll bring that experience into Vida too. We really need to understand what the motivation for change is among our customers and we do a lot of motivational interviewing at Vida to that end. We need to understand the reason why they want to change and give them the tools to help them make those changes. That comes from a very consumer facing organization and certainly I learned that at Walgreens and at Hims & Hers.

VN: So would you say that you're going to be trying to make Vida more consumer oriented?

PC: It already is. It's a really high touch organization. The average diabetic who's coming onto our platform gets connected with a coach and then a dietitian, it's really high touch. This is not healthcare through a bot. Now, we have the technology to deliver care in a seamless and scalable way but the foundation for what we do is still personal video, also asynchronous interactions with those customers. So, very, very high touch, very consumer focused. They've already had the secret sauce on that. What I’ll build on is really how you carry that through and perhaps add in that prescribing ability to really complete the healthcare journey for the customers.

VN: Talk to me about what your responsibilities at Vida will be going forward? What are you in charge of?

PC: Really overseeing the quality of care model. The programs are already in place, but just  to understand and learn about everything that's put in in terms of the quality structure, which is already robust. Let's see if I can add anything into that because quality of care is table stakes, everything we do needs to be evidence-based and focused on quality. 

The second piece that I'll have is, we have an entire team that's focused on payers and health outcomes and reduction in cost of care for some payer partners, and I believe by next week we're going to announce that Dr. Richard Frank, who was a consultant for us, is coming on full time to lead that whole payer segment. He's got deep experience working with multiple payers and will work with us around our relationship with Centene and in the Medicare Advantage pilots that we've launched. Richard will report up to me, but he is going to lead that entire initiative for Vida. So, it's great to bring his level of expertise on and to get him plugged in that aspect.

So, quality, building the team that Richard will be overseeing and then, if we get into the prescribing world, helping with recruitment and credentialing of prescribers. And, of course, I'll be very externally facing too, talking to folks like yourself and folks in the industry, just to explain who we are at Vida and how we're differentiated from many of our competitors and what we have to offer. Hopefully some of my experience and credibility in the industry will help get that message across.

VN: There's been a lot of changes in healthcare over the last couple years. I don't think I have to tell you what COVID did, but trends like digital health and telemedicine were happening slowly then just exploded as a result of COVID because people had no choice but to use these tools. Talk to me about that evolution. What's happened since early 2020? Where do you see healthcare now versus then and where do you think it's going?

PC: When I joined Hims & Hers in June of 2019, I did not have a crystal ball about the pandemic coming and that this was a good time to be in virtual healthcare. But then the pandemic occurred six months later and what we realized is that there's an access issue and a cost issue around behavioral health. So, we launched that and I was involved with that launch at Hims & Hers. 

What you're seeing, as we're in the midst of this pandemic, is there are certain verticals in virtual health that absolutely work, and are being adopted and are going to continue to grow, and one of those certainly is mental health; it works really well in the virtual space. What you have also seen, though, is the ambulatory, acute episodic care, urgent care type visits, even the primary care visits, are starting to drift down. During the beginning of the pandemic, 70% to 80% of ambulatory visits were virtual and now the last study I saw it's 17% or 18%. So, some of that is starting to decline, but guess what: it's still holding steady. 60% to 70% of mental health visits are virtual in the ambulatory space, and that percentage is going to continue. So, that's one trend. In mental health, there’s a huge access need and that's going to continue to solidify in the virtual space.  

The trend that is interesting to watch is this whole full scope, virtual primary care. As a family physician, what percentage of patients that I saw in my office could actually, today, have a virtual platform with home lab testing and peripherals and monitoring devices? Some people say 70%, 80%, 90%; certainly the payer community is investing in these virtual primary care models that, if you sign up with a certain payer, you may be offered a virtual physician. That's going to be interesting to see how it plays out, whether customers are going to embrace having a virtual primary care physician as opposed to a brick and mortar primary care physician. So, that's an interesting trend to watch but mental health is definitely going to stay up there because the quality is absolutely there and the access is absolutely there in the virtual space.

VN: Related to what you were talking about with primary care, there’s a change where healthcare is now 24/7. Rather than going to the doctor once a year, where they take your vitals and then it’s like, “see you in a year,” and you never have any contact with them, we’re now seeing remote patient monitoring and the ability to access that doctor at almost any time.

PC: Absolutely. :ook at what we've done for diabetes at Vida Health. We bring in monitoring devices where the blood sugar monitors get that data, we bring in the coaching expertise, we interpret how someone is faring based on their results, such as hemoglobin A1Cs, we make recommendations to the patient, and transfer that information to the primary care physician. So, it's really a high touch model and, as a primary care physician, I mainly see a diabetic two to three times per year, whereas the Vida coaches and the counselors and the dietitians for a diabetic are seeing them multiple times per year. And so, it is bringing healthcare where it needs to be for some of these chronic conditions. It's more high touch than as a traditional primary care physician I was able to deliver just by the sheer numbers of patients and the limitation in time as the primary care provider in a traditional model.

VN: What is success for you in this role? If you're looking down the road a few years from now, what do you hope to have achieved at Vida?

PC: Success to me is to work on a team like we have at Vida to help build and continue to expand on a really great model of care. We will have all the outcome measures that we’re held accountable for, as we should be, such as results on the cardiometabolic conditions, whether that is blood pressure control, which we've made remarkable progress on, or hemoglobin A1C reduction, which we've made remarkable impact on. But it's also about the customer experience; when you look at Vida and look at the NPS scores of over 80%, that means that the customers actually embrace the experience. Healthcare has never really done well with NPS scores, and so when I see an NPS score of over 80%, and I see health outcomes with reduction in cardiometabolic risk conditions, to me that's success. The customer experience, being consumer facing, getting the results that they deserve, and getting people engaged in their own health care, to take control of their lives and their healthcare, getting them to be active participants in their own health. Those are all focuses of Vida Health and just to be part of a team like that would be very exciting. 

I do also think there's an opportunity to grow in terms of, as I said, those prescribing capabilities, perhaps starting with mental health, to really make sure that we can optimize the results to even go beyond coaching and counseling to prescribing, because there's such an access issue in mental health. To even get access to a psychiatrist or psychiatric nurse practitioner or primary care provider, to get the medications that might benefit you.