 I can see you. Good morning, everyone. Thank you for joining us. My name's Chris Bischoff. I'm a managing director at General Catalyst. We're a multi-stage venture capital firm. And I think one of the few venture capital firms have dedicated a fund just to health care. And we're the largest player in health care globally at the venture stage, having deployed over $3 billion in the last 10 years in the space and being very lucky to be associated with some terrific companies that are really changing how health care is delivered. And I'll touch on that in a second. We're very lucky to be here today with Jennifer Snyder. Jenny, do you want to introduce yourself? And then we'll get in from there. Sure. So thank you, Chris, to be nice to be on stage with you. We've known Chris for a long time, but we're just chatting backstage. It's the first time we've actually been on stage together. So I'm Jennifer Snyder. I am the chief executive officer and co-founder of a company called Homeward Health, where we are focusing on re-architecting health care delivery for the people that live in rural areas. And we're starting in the United States with older individuals. My background in training, I'm an internal medicine physician and a health services researcher, so a geeky doc who likes numbers, and found my way into the entrepreneurial world first at a company called Cast Light Health, which was one of the first unicorn IPOs in the digital health care world. And you want to tell the audience when that was? I do. So that would have been 2000. We took the company public in 2013. Right. This was the real beginning of health tech in the US, right? Yes. Right. And at that time, there was a lot of evolution. We were positioning ourselves. Are we a health care company? Are we a technology company? What do investors understand? How do we talk about what we're building? That company was really focused on transparency into cost and quality, and enabling consumers to make better choices and better decisions. And that was a marquee company, I think, primarily, if you look back, because of the talent in that organization. So you stayed there a couple of years, and then you were pulled into Lavongo, a bike I called Glenn Thomas. Yes. Yes. And tell me why you laughed, Cast Light. Right. So I will spend a moment in Cast Light. Giovanni Collella created a real great culture in terms of bringing together incredibly talented, smart people to build Cast Light. We took the company public, and I was introduced to the concept of what Glenn Tolman was building at Lavongo by someone that I know who is really, really high IQ and very, very low EQ. And she said to me, she said, this is probably a business that you should go be a part of. And I said, if it's ringing any of her EQ bells, I should go check it out. And at the time when I met Glenn and the team for a company called Lavongo, they were looking to build and emphasize, how do you change people's behavior, people living with chronic conditions? And this is something that really resonated to me. I have type 1 diabetes. It's the reason I became a doctor in the first place. And this idea that we collect data on ourselves, and then we go in and see a physician three months or six months later, and they make like 20 seconds of recommendations as though that's going to fix the issue or the problem, has always kind of seemed broken to me. So I fell in love with the idea of leveraging data in the ecosystem to change behavior for people living with chronic conditions. And so joined Lavongo in 2015, first as chief medical officer and then moved into the role of president, where I oversaw the data science team, the engineering team, the product team, design team, the marketing team, and stayed with Lavongo until we took the company public and eventually sold in the largest digital health care transaction in the United States. Yeah, I want to pick apart some of that, because I think it was very counterintuitive in 2015 to do what you did, this combination of hardware, software, and services. I remember I was lucky enough to be an investor in that business. And a lot of people said, well, look, we're either a services company investor or we're a hardware company investor or a software company investor. And the idea of combining the three was a bit of anathema. Why do you think it took so long? And why do you think Lavongo was able to break out and be so successful? It's a great question. I think that we were in the hardware business because the hardware that we needed to deliver our model of care did not exist. And by that, I mean, where we started was a blood glucose meter that, when people checked their blood glucose, not only showed the person their number, but sent it to the cloud. And so we could run our data algorithms to actually return a message specifically meant for that person right back through their meter. So this idea around behavior change, an instant signal, an instant response, that's why we were in the hardware. We needed the hardware piece. I don't think we wanted to be in the hardware business if you look back at where we were at the time. You remember that journey. And then the software that we built around with the data algorithms. Again, this is before chat GPT. And in fact, we positioned at our IPO as AI, AI because of what we were doing with the software and the loop, yep, the infinity loop. But ultimately coming back to services because health care is personal. And at the end of the day, there's a person with whom you're interacting. A lot, a lot can be done through software, but there's a trust element and a hands-on, a physical touch element, both of which are really important to ultimately drive some of those behavior change. And for those in Europe, you're probably aware of the RPM market remote patient monitoring. This was the company that really started that revolution in the US. And today, the hundreds of companies in this space. And as you say, hardware has become undifferentiated. You can buy hardware from China at a significant discount. But when you were there, even getting a Wi-Fi or a connected device was hard. And what's interesting, I think, in that market today is that differentiation has gone back to the services level. The hardware is accessible. The software is easier to replicate, maybe. But the actual delivery piece is hard, finding the patients, engaging the patients, maintaining the patients. One of the things that distinguished Longong I think was this feedback loop. And tell us a little bit about why it was unique and why that was so different to health care in general, this ability to get that information. Right. So we used to call this the lavongo moment, the magical moment. And I'll give an example. So people with diabetes run into trouble acutely when their blood sugar is really low. I don't know if anybody in the crowd. I can't actually see anybody in the crowd. I was going to ask for a share of hands, but it would be hard for me to see. But for those of us that have diabetes, when your blood sugar is low, you feel your heart's racing, your sweating, your thinking's unclear. And you're not actually completely sure what to be doing. Our ability, when someone would check their blood glucose and have a low blood glucose, would trigger an alert and send it to a certified diabetes educator who would call that person within 30 to 90 seconds. That person would receive a call in their phone and a counsel and a support of what actions to take and having your friend there when you needed in a moment of crisis. So it really allowed us to intervene and gain and build a trust that's very differentiated. The other time is when people would check their blood glucose and they would have a blood sugar that wasn't in a crisis of being low, but maybe wasn't exactly where it should be, a little bit high, a little bit elevated. We'd give them an automated message around how to control that and how to make that better. And this idea that if you decide you're going to go on a fitness kick and you're going to go to the gym and then three months later, you're going to go tell somebody what you did to get feedback is not as effective as going to the gym with a personal trainer stinging over your shoulder telling you that you're doing a good job or you need to do this differently. So when you think about the lovers for behavioral change, it's really this continuous, instantaneous feedback loop. Not, we'll remember what happened three months ago and talk about it later. Yeah, and then training the data. Yes, right, yeah. And very few chief medical officers or physician leaders become technologists, right? It's a very, very hard leap, you know, and let alone commercial leaders. How did you transition from being a, you know, John Hopkins, Stanford doc to a technologist and then ultimately, you know, becoming president and leading some of the commercial efforts of the organization. Yeah, and it's interesting, I had in the buddy program, which Chris and I were talking about backstage think is absolutely wonderful that happens here at Slush and I met Richard and I think he's in the crowd somewhere again, there's the hand, yeah. So Richard is a GP and he's now back in school doing some industrial design. So working part-time as a practitioner and going back to school. And we had the conversation that it's very difficult for physicians in particular or clinicians, people who are trained in the medical system, it's like a tunnel. You enter in, you have to be smart, you have to be empathetic, you have to work hard, be understanding, then they kind of put you in this tunnel and tell you all the things that you need to learn and you come out on the other side without a lot of honor off-ramps. Chris made a comment to me as we were preparing for this that so many physicians that he's interacted with in Europe are female and they're very, very smart and they follow a similar path when you ask yourself the question, why? Because we've built these systems for clinicians that are really hard to get off of. And so I think it takes a spark, an idea, a belief that when you run into the wall of something that you care about, that you can go fix it, right? So for me personally, I often tell the story that people say, well, how did you end up where you are? And I say, well, it's because I'm a middle child, which is that I saw my older brother try to do what he wanted to do and get into trouble. And so then I figured out a way to do what I wanted to do but not make his mistakes and find ways around it. So I'm wired a little differently. But I do think there is some element of being fortunate or being willing to take some risks here. And I think that those clinicians and physicians that are in healthcare know the broken parts of healthcare differently. And so, and you experience them and good companies come from creating solutions to real problems. And so there's a real desire and a real appetite for people who are practicing medicine to take different angles and help fix those issues. And I would argue that most of the great healthcare companies are not built in Silicon Valley, right? Because they don't have necessarily that understanding the system or understanding the patient. Because you can over engineer the technology relative to the services. You can misunderstand the importance of go-to-market. There's lots of traps if you just say I build the product and they will come in healthcare. The other thing obviously is you're a woman leader. As you thought about your career in healthcare, you said you mentioned that over the majority of the workforce in healthcare are women. And yet when you look at the leadership level within healthcare, particularly the leadership in the traditional healthcare system, there's not so many women in those slots. How did you find, did you find moving up in these organizations? Did you find like the work glass ceilings you had to break through to get to the leadership positions you achieved? Yeah, it's a great question. And again, I think I'll start with 80% of healthcare decisions are made by women, right? So women are typically the CEO of the household and they're making healthcare decisions for themselves, for the children and frequently their male partner. And so we have to think about just building businesses like if we're trying to sell or convince somebody to do something, we need to understand those people. And so I say as a female executive, I used to say the best people to work with and for is a smart man who loves his daughters, right? And I do believe that. I do believe that like smart women will include men in leadership teams, smart men will include women in leadership teams, particularly in healthcare. And it doesn't just stop with gender. There's so many variables of the people that we're trying to serve. And so trying to understand, put your mindset into what you're building for the person that you're serving is critical, I think, and success. And so Lovongo Web Public, it became an $18.5 billion company that was then sold to Teladoc. You know, we sat there at the table and there was an opportunity for you to go join Teladoc or we tried to engineer an opportunity, right? And you know, you were actually right. You know, I wanted you to go. It would have been better for the share price if you had gone. Why did you decide not to stay with that journey? Why did you say, let's start my own journey, let's go back and let's figure out, you didn't know then that you would start Homewood, right? So you took a decision not to continue that journey, but to start again. You know, tell us a little bit about why you, you know, because you could have gone on and led a, you know, multiple thousand person organization over a period of time. But you wanted something different. Tell us a little bit about that decision. Yes. So I think at the end of the day, I was an M committed to the mission that we were on. And I think the decision to combine the assets from Lavongo with the assets from Teladoc, I fully believe that that was the right decision. I don't second guess the decision. It became clear at parts of that journey that the leadership felt maybe slightly different from that and that my ability to be effective in delivering on that mission would not, I would not have been as successful as I wanted to be. So it's independent of the size of the company, the cap table, the company, how many people report to me. I kept thinking like, am I gonna, is my time spent here gonna do what I want it to accomplish? And I wasn't sure. As you know, we had a lot of conversations about that. And so I joined General Catalyst as an executive in residence and spent some time thinking about what was the next big thing that I could spend time on with a true belief that I've now been in the ecosystem enough that I've made a bunch of mistakes that I'm therefore slightly smarter and wanted to use that experience to do some good in terms of bending the arc of healthcare in the right direction. And so with the General Catalyst team and my co-founder and partner, Amar Kendal, we really honed in on how broken healthcare delivery is in rural America. But I do wanna say that worldwide there's three billion people living in what constitutes a rural environment and 62% of those people cannot receive adequate healthcare. And so our thinking here was given all the experience we've had in building technologies and technologies to scale services, let's put the hardware piece aside because hardware is now ubiquitous, but let's figure out how we can differentiate and deliver high-quality healthcare to people in these remote areas that it's not only dependent on more service elements, but on the technology to be able to scale those services. So that's why we launched Homeward Health. Yeah, and I think there are a couple of things there that are important. Our mission at General Catalyst on the healthcare side is high-quality care that is more accessible, more equitable, and obviously more efficient. And one thing you forget perhaps in Europe in certain parts of Europe is that rural communities, you think rural communities are sort of the idyllic, right? And in the States that's not true. That's obviously not true in emerging markets in terms of access. And in Europe itself it's changing quickly, right? So in France, in some of the European countries as well as the UK, just getting that access now to high-quality physicians, high-quality specialists, hospitals, it's tough. They're closing in these communities and those communities are finding it harder and harder to get that access. And the reality is therefore the sort of mortality rate in those communities is increasing, right? It's just tougher. The jobs are going, the hospitals are going, healthcare's getting tougher. So it's a really global problem. And one thing I think I admire about what you did, Jenny, is you stepped away from Livongo, which had a big mission and you stepped into another big problem. Rather than say, I'm gonna do Livongo for X. In healthcare we had a sort of, in the rest of tech you had a sort of Uber for X or type mentality and there was clearly a wave of like, why don't I replicate what I know in Livongo in another condition? And you said, no, let's go after a really big problem. And I think for those entrepreneurs in the audience, going after really sizable problems, yes, they're thorny, but the upside is tremendous and your impact ultimately on healthcare and therefore your ability to build a sustainable business is significantly higher. But Jenny, perhaps to that end you can share with the audience some of the challenges of building homework, right? I mean, as you sort of, you said, look, I wanna, you come from a rural community, but how do you actually deliver better care in these communities? Yeah, so there's so much there. And so I'll start with answering that question and then maybe take it somewhere else. So at Homeward, we had really two core beliefs. One is could we build in a technology stack to scale services? So we can't invent nurses or invent doctors and magically wave a wand and have them appear. So how can we leverage the workforce that's retreating? It's retreating everywhere. The clinical workforce is retreating everywhere. How can we leverage a retreating workforce in an ecosystem where the care that's already being delivered isn't enough? Right. And so how do we leverage the technology to do that? And then the second piece, and frankly the intellectually most interesting piece from my standpoint, because it was new to me, is how could we do that in a world where we can align economic incentives? Meaning in the US, fee for service care is still the dominant reimbursement model. So every time I see somebody and I do something that I get highly paid for, I get highly paid independent of what their outcomes are. Right? Our thesis or my personal thesis in healthcare, there are only three big levers to transformation. One is technology, two is payment models, and three is workforce transformation. Right? The rest, if it doesn't fit in those buckets, you have a problem. Yeah. To your point, payment models, particularly for underserved populations, is a terrific opportunity. You know, and for those in Europe, we unfortunately don't have very much what the US call value-based care. But if you think about the concept of value-based care, you're pushing down the premium risk from the insurer to the provider and asking that provider to actually own the patient journey and the patient experience financially. And the upside is that if you deliver good quality care, you reap some of that benefit. The downside is if you're unable to do that, you know, you won't have a business. But it creates the alignment that Jenny was mentioned that is very powerful. But it's difficult to do on the other hand. Yeah, it's difficult because, again, most providers back to you asked about how to make the transition out of being a physician into something else other than a physician. Most physicians aren't used to taking risk and aren't used to building businesses on taking risk, right? So you're the lever, you're the clinical care, but you're not used to the underwriting of the financial models. That workforce transformation piece is critical. Yeah, it's really important. And so for us, when we started Homeward, we entered as a primary care doctor to go collect people in rural markets. And we got some, and those people were really happy, but we're swinging big. We have a lot of work ahead of us. And so we had to think through how can we actually take care of more people faster? And so that was a pivot for us in the business. You were asking me to talk about some of the hard parts. And we're now at a place where we actually, in our partnerships with the insurance carriers, we take on whole counties of their population. The people that they have in any given rural county, they give us that whole population that we're responsible for. That means we have to do two things. One is we have to work with all their existing doctors and help those doctors behave better, do the right things, invest in preventive care. And we have to come in and provide healthcare where there's not enough healthcare. We know that 10% of all counties in rural America have zero healthcare providers. So we have to do both. Right. And so that's- You have to be the enabler, but also the delivery. That's right. Yeah, that's right. But it allows us to take care of populations at scale. Now, 10s to 20s, 1,000 people. And if you're in a risk-based business, scale is actually an advantage. It's an advantage. It takes away some of the volatility. That's exactly right. That's exactly right. Yeah. And as you thought about this, one of the things that I admire about you is that you're able to forge partnerships. I think one of Livongo's strengths and Glenn's strengths was that he finds win-win solutions. Sure. And that allowed the business to grow. And he was happy to cut other people in in order to make it successful. You know, we had a couple of conversations dealing with payers, dealing with insurers is not hard, not easy rather. How did you work with those insurers on this journey to value-based care so they understood what you were doing and they were willing to take risk with you because ultimately they're shifting the risk to you, but it's their population. They need to be confident that you can deliver services. Yeah, so partnership is everything for us. It's everything in rural markets. It's trust is really important in healthcare. So we partner not just with the payers, which I'll talk about in a second, but we partner with everybody that's in the county. We're looking around who are the hospitals, who are the people that give transportation rides or food banks. So we're looking across the whole ecosystem to leverage their resources. So we are truly in partnership. Our payer partners benefit not only because we are taking on the financial risk for that population, but we're bringing in and helping them serve in a population that is underserved. So it allows them branding and equitable, equitability, like in terms of who that population is, and we're coming in to bring and increase care in the counties that they're responsible for. So again, we come in ad care, don't compete with existing providers, but come in and ad care. I think your point on the care in the community is such an important point, right? Because there's, in healthcare, people sometimes forget that it's the social determinants of health, and there are community organizations that are out there that can be supported with these populations. I know you've talked to me about certain types of partnerships that you've been thinking about. What have been the sort of local community partnerships that have been most effective to date, or where do you think like you can leverage local communities to help these patients best? Yeah, a lot of it is, and this won't surprise you, but a lot of it is in the very simple thing. So it's in the interconnectedness of people. People, we deal with people who are over 65 in rural communities, so the rates of depression and loneliness are massive, massive. And so there are institutional, religious, foundational aspects in the community that people kind of withdraw from that just re-engaging helps that part of the chronic condition journey. And aside building your third business, you're also a mom, you're an author, you're a endurance athlete. How do you balance all these different priorities in your life? Chicken wire and duct tape, right? I mean, it doesn't look pretty when you're doing it, but you just kind of decide what's most important to you and do it. But do you think like that ability to balance these different parts of your life has allowed you to be as successful as you have been? I think that the old outage, like if you want something done, give it to the busiest person, you know, is true. And so I think that people who love their work, love their life, love their families, have a, you know, have a vivacity for living. And so I do think it's a privilege to get to have multiple lenses and multiple aspects. I think a lot about, you know, when you come home from work and, you know, you had a really great successful day and you gave your middle child the wrong sand, which you really like, you get an earful around like what's really important. It's super, I always say parenting is the most humbling sport I've ever invented. But I think that aspect is very real and very right in how you stay grounded in what you're doing. Well, thank you, Jenny. Thank you, Chris. Real pleasure to have you here today. Thank you. Thank you. Thanks.