Delivering Same-Day Healthcare

Healthcare’s long-overdue adoption of modern technology is among the few silver linings of the Covid-19 pandemic. While the need to reduce in-person interaction as much as possible has accelerated the digital transformation of nearly all enterprises, the healthcare industry has had perhaps the most room to grow, and has undergone a near-paradigm shift in the past seven months.

As we’ve featured on several Greymatter podcasts with startups including Grand Rounds, Notable Health and Cleo, this sea change in the way healthcare is accessed and administered has provided ample opportunity for startups that provide elements of telemedicine and digital health technology to grow.

Solv Health is among those that have swelled in popularity with consumers and healthcare providers alike. The company, which was founded in 2016, provides software that makes finding a doctor, booking an appointment (virtual or in-person) as straightforward and painless as reserving a table in a restaurant. Since Covid-19 first hit, Solv Health has played an instrumental role in helping healthcare organizations connect virtually with patients to provide telemedicine and same or next-day clinic appointments, as well as myriad administrative services such as contactless payments and digital paperwork. Solv is also now facilitating Covid-19 testing across its partner organizations – including urgent care clinics, hospital systems and even working with the City of Seattle and other state and local governments. The Solv platform handles everything from finding available testing capacity, to booking a testing appointment to integrations with labs, texting communications of the results and processing payment.

For Solv, the widespread shift to telemedicine meant the company went from hosting about 9,000 virtual visits in all of 2019 to hosting half a million since March of 2020. Solv is part of a major trend: In 2020, telemedicine adoption across the U.S. healthcare system has increased more than 40% as healthcare organizations quickly shift as many elements of patient care and administration as possible into a digital format. There’s reason to believe the trend is here to stay: In late July, Teladoc, one of the oldest and largest telemedicine companies in the world, merged with virtual chronic condition management company Livongo in an $18.5 billion deal.

Solv CEO and co-founder Heather Fernandez sat down with Greymatter to share her experience at the fast-growing startup as the company navigates its expanded role in modernizing healthcare. Additionally, Heather shares how the company is adapting to working remotely, and managing her own personal life as a mother of three.

You can listen to the podcast here:

Podcast Transcript

Heather Mack: Hey everyone. Welcome to Greymatter, I’m Heather Mack.

Today we’re diving back into our series focused on health technology startups. This sector is among those that has grown significantly during the coronavirus pandemic. We’ve been talking with the leaders of these startups to learn not only how entrepreneurs can adapt to sudden surges in business, but also how to do so while working remotely,

Our guest today is Heather Fernandez, who is the CEO and co-founder of Solv Health. The company provides a platform to facilitate a range of healthcare services – from appointment booking and virtual visits to digital paperwork and payments. Since the pandemic hit, Solv has seen a huge uptick in user growth, and has quickly expanded its services to keep up with demand.

Prior to Solv, Heather was on the early team at real estate tech startup Trulia, which was acquired by Zillow in 2015 for $2.5 billion.

Now let’s give Heather a chance to talk more about her experience as a CEO during this wild moment in time. Heather Fernandez, thanks so much for joining us.

Heather Fernandez: No, thank you so much for inviting me. I’m pumped to be here.

HM: Great. So before we get into all the specifics about your business right now with coronavirus and everything that is crazy about the world right now, can you first give us one minute company introduction-what is Solv?

HF: So, Solv is very simple. Solv is an app where consumers can get access to convenient, same-day or next-day health care. It’s powered by a network of doctors who are running our software to deliver a modern patient experience both in their office as well as virtually.

It’s worth saying our mission is also very simple – empower consumers to simplify their day-to-day healthcare needs and answer three really simple questions: One, where should I go for the problem I have? Two, when can I be seen? And three, how much does it cost?

HM: So you started the company in 2016. What was going on in the world that made you want to get into this field in the first place?

HF: Well, the biggest thing that led to the creation of Solv was the sale of Trulia to Zillow ( I was an early employee and part of the very early team at Trulia, and after almost a decade-long run, we were acquired by Zillow for $2.5 billion). During that time at Trulia I had three kids, I was incredibly heads-down trying to be a great mom and employee and team member and wife, and friend to the few people whom I still had time to maintain a relationship with. So the biggest thing that happened to me, personally, was I got to look up for the first time after a decade and really ask the question, ‘Where do I want to spend my time?’ It just so happens that I love to build. So through the process of really looking around – once I made the decision to leave the merged company – I found myself talking again to a number of startups. And my personal energy was really focusing me on working on something that mattered. It wasn’t just about building a big business, but about solving a really hard consumer problem.

HM: Right. Tell us about the first few years, from launch to getting the company up and running.

HF: A lot of the lessons come from my time at Trulia. My Solv co-founder is Daniele Farnedi, who was my partner in crime at Trulia – he ran the technology team and I ran a lot of the go-to-market teams. The core of what we built at Trulia was an incredible consumer app and mobile experience focused on empowering consumers to make better real estate decisions. But probably 80% of our headcount and team at any time was really servicing the supply side of that market, which were real estate agents and brokers. We were empowering them with software and tools to deliver a better consumer experience. That sort of that paradigm of a marketplace is really what we were looking to bring to healthcare. So the first year was not ‘Let’s build Solv,’ the first year was, ‘Can we bring our talents into healthcare and solve a really hard consumer problem and build a business working with the innovators in the space?’ It was that broad. So year number one was figuring that out.

Year number two: We’d figured out the business model for Solv and, importantly, figured out the entry point. So many challenges in digital health are not around having good or bad technology, but around where you start within the category. Once we did that we were focused on building the early products, launching in our first market (which was Dallas, Texas) and really trying to validate some of the value prop both for the innovative providers we had on the platform. We were also trying to understand some of the consumer behavior.

HM: When did you really start to find a lot of traction?

HF: I’ll answer that on both sides of what we do (the provider side as well as on the consumer side). On the consumer side we realized very early that consumers have been disaggregating their care. There is this traditional notion of having one physician for your lifetime who is going to ensure you have all this preventative care, who knows your family – that’s great, but there are real challenges in the U.S. health system which means that hasn’t been the reality.

As a mom, I had become a frequent visitor to urgent care clinics in addition to our visits to our pediatrician, because it was how we got care in between. What we realized very early was I wasn’t alone, and that there was a massive consumer trend dating back 10 years wherein consumers were really optimizing around convenience and access, and this one particular, incredible category of urgent care has really been delivering on that need. Oftentimes, urgent care is working in partnership with a primary care physician or pediatrician. or within a health system, but it functions as a compelling entry point.

We came into this category as healthcare novices. We thought this category of urgent care was so interesting, but all we were seeing in the media was a telemedicine. Yet, the reality was telemedicine was an inconsequential percentage of overall healthcare visits at the time. Virtual care visits only made up 1, 2, or 3 percent of total visits. However, out of the billion ambulatory visits, roughly 150 million of them were within this convenient care category where urgent care was the biggest player. So, the first area where we got traction was really building up a consumer audience by using a lot of the tools that came from Trulia, so that we could help consumers identify where they should go, which clinic is near them, which one takes their insurance, and ultimately where they want to book an appointment.

HM: Yeah, that’s why some people have thought of Solv as the OpenTable of healthcare, right?
Yeah, that’s when people were thinking of Solv as the OpenTable of healthcare.

HF: That’s what was written about us in a few articles. Realistically, that’s a great analogy. It should be as easy for me to identify, ‘Where should I go to look at this mole on my neck?’ Or “Where should I go for my sore throat?’ as it is to say, ‘I want to go to Italian food for five people at eight o’clock.’ Well, in the world when we all used to go to restaurants, at least. But if we can make it that easy, then of course it is a win.

On that consumer side of the platform, we started really ramping up roughly in late 2017, which was about the same time as when the provider side was ramping up. What we were really able to catch was just this shift to online. Frankly, we started the company with a real focus on one market, thinking that we would go market to market. And very early on – within a year of operation – it became clear to us that this trend of doctors moving online; this trend that’s effectively a more consumer-centric trend within healthcare was really taking off. So it was important for us to actually work with providers across the country versus market by market.

HM: It’s crazy to think about how long it took telemedicine to get to where it is today. These companies like Teladoc have been around for more than 20 years, yet people were still barely using it until recently. Now we’re at a time when Teladoc merged with Livongo for something like $18 billion.

HF: $18.5 billion! I mean, it’s almost not even accurate to say how long telemedicine took because, yes, it started 20 years ago and it’s been a slow, slow build, and then COVID-19 happened. It’s a transformational moment in so many ways, which I think everyone universally has believed. Policymakers, health systems, plans, startups – everyone believed that this digital wave was coming, it just took way longer than anyone fathomed. And then you had this particular moment in time.

As one data point: Part of the Solv platform is telemedicine We launched it in 2018, and it became very obvious that telemedicine was a list on someone’s innovation board across every hospital system and provider group across the country, but no one was really acting on it because there was no incentive on the provider side. The plans had not fully pushed into that game, and even consumers weren’t demanding it.

So, telemedicine was something we effectively had as part of our offering, but not something that we were aggressively trying to get out there. We thought that broader adoption would happen, but we thought it would take longer. If you look at the time from when we launched in 2016 to today, there have been over 14 million patient visits consummated on Solv. That includes in-person or virtual, but the vast majority were in-person. In all of 2019, we had 9,000 telemedicine visits. When we look at 2020 (realistically, mid-March through today), we’ve had 500,000 telemedicine visits.

HM: Wow.

HF: Yeah, so because of Covid, we went from having almost zero percent of our visits be virtual to suddenly 50 percent during the phase when it was the only way that people could actually access primary care. Now it’s normalized around 15 percent. That’s massive. If 15% of doctor visits across the country shift to digital, that represents a number of things around our ability to access populations, ensure high quality care, and consider it a core part of the care continuum. So it’s a pretty fascinating time to be in this space.

HM: Absolutely. Let’s talk more about the beginning of 2020. You probably had a different plan in place for the year. Then Covid happened, and you were able to meet this demand and really rapidly iterate. How did you do that? How did you get organized and delegate on who’s going to work on this project?

HF: I will say being overwhelmed with all of it, the way we are right now emotionally and physically and everything else, it’s helpful to feel like you’re part of the solution. I think that, in many ways, is what motivated the team itself in the beginning of the pandemic when we really saw it start to happen in the United States.

To paint a picture for you, unlike most startups, our job is to connect consumers with care. So our day-to-day is looking at what people’s symptoms are and what their chief complaint is, and then connecting them with providers. So we have a really good pulse of what’s happening across the country. Until the middle to end of February there was nothing, right? And then the last week of February we got a call from MultiCare Health System in Washington, which is an incredible partner to us. If you recall that first nursing home where the news broke in the United States where there was a COVID-19 outbreak, that was within a mile of their facilities.

So very quickly, it became very clear to us that this was going to spread rapidly and no longer be a problem that we’re reading about in the New York Times, but rather be one that we are facing day to day.

In effect, we had a head start in Seattle. We talked to them on a weekend and that following Monday, we opened a war room. We got on the phone with our team and went over everything from ensuring that we had the ability to triage patients to the right place first, to helping prevent infection among staff (because as we all know, healthcare staff across the United States were not prepared for the outbreak). Then we were enabling telemedicine, creating all the documentation, ultimately powering the high throughput testing across their sites.

At that point, we then proactively notified our partners (and our database across the country) with, ‘Here are the best practices based on our learnings, and now let’s partner with you.’ What that kicked off for us was the moment when telemedicine effectively just skyrocketed.

HM: Right. Were there other projects you had to stop working on?

HF: Oh yeah. We did all of this great end-of-year planning and first half-of-the-year planning. We effectively burned all of that. But what this really did is it enabled us to accelerate things that we were planning to do later in the year and into next year (namely telemedicine), like payments and then, increasingly, expansion to other specialties.So it’s not that we had to pivot to something, but more that all of these things were just accelerated in the Covid moment. There was very high incentive and adoption of the things that we wanted to do.

So, as I look back on that time it was certainly stressful for the team, but the team was very motivated, because we could see every day that we were enabling people to get care who otherwise wouldn’t. We were helping to keep essential workers and healthcare staff safe through our core technology, whether that’s telemed or SMS- based communications, and the reality is that that’s motivating.

HM: Where is Solv Health physically today as a company?

HF: We’re all over the place like everyone else. In February, we were mostly at our headquarters in San Francisco. We have an office in Denver, and then we have a handful of folks across the team that are distributed. Today, like everyone else we’re fully distributed. Based on what we were already seeing, we made the call in the first week of March to send everyone home, and then a month after that we made the call that we would be fully work-from- home through the end of 2020. We’re distributed even farther – we’ve got folks in Hawaii, Washington, D.C., and like everyone else, we’re figuring out the operational rhythms of this new world.

HM: What’s the hardest part about being distributed?

HF: We were already really well suited to be a distributed team. Everything’s in the cloud, our security measures are all in place. We’re a Slack- first organization, etc, so in some ways we were already equipped. The biggest reason why we had not been more distributed previously was that it was hard to imagine a hybrid situation, and having the same level of efficiency and engagement. Now, with 100% remote, in many ways everything works, right? The pieces that you lack in an entirely remote world – and the parts that I personally struggle with – are not productivity and efficiency. The areas I think of struggle are those meaty, strategic, cross-functional challenges that you want to work through are just harder on a four-hour long Zoom, whereas a four-hour long meeting in person is actually much easier.

The other thing that I really miss are the magic moments that aren’t scheduled, where you have that insight in-between meetings, or walking to go pick up lunch, and something that’s been on your mind or on your colleague’s mind is all of a sudden surfaced and it becomes very clear that issue is now an opportunity or a big priority. The serendipity is gone. So, once you talk to someone who’s sorting out how to get serendipity back, let me know, because that’s the one we’re still trying to work out.

HM: No one has figured that out yet and it’s what everybody wants. We’ve been doing a whole podcast series specifically on remote working and new tools, and literally that’s what every single person says that’s what they really want and no one’s figured it out yet. And I don’t think everyone’s going to start wearing VR headsets or anything.

HF: Yeah, exactly. An interesting thing that I personally enjoy about the fully remote thing – both with our own team as well as partners and customers – is everyone is forced to be a bit more real. The authenticity quotient has just gone up, because we have no other choice and there’s something kind of magical about that.

HM: Let’s talk about your customer base. What’s changed about the ways you’re interacting with them? Do they need anything from you that’s different?

HF: Let me highlight the biggest thing for you. You asked a question earlier about our roadmap, and I said how in many ways we have accelerated what we already planned to do. The thing that we did not plan to do however, (even though our core assets of the company happened to be really well-suited and now has become a much bigger part of what we do) is participation with cities and states as well as our partners in Covid-19 testing. So, if you think about our footprint: we’ve primarily had urgent care [centers] running our software across the country. A number to the tune of 200 million people across this country can book in a same-day or next-day appointment on Solv within five miles of their home. And that’s lot of how we thought about our growth, [in terms of] ‘How do we increase access by ensuring that we have a broad footprint so everyone can get the care that they need?’

It just so happens that 80 percent of those are running Covid-19 testing today, and so what happened was within the Solvhealth.com and Solv app, searches for Covid-19 testing started to really grow. Within the provider side (and particularly within this urgent care category), we were seeing more and more capacity of testing. We started talking to cities and states around how we could improve access and use our core technology to enable testing across those organizations. And that is very new. Take the city of Seattle as an example: We’re working with the University of Washington labs, the city of Seattle, and the fire department. The core Solv software enables the identification of the online booking with our core, high throughput workflow, as well as data fidelity and connectivity to labs for the testing.

So now they are doing 2,500 tests per day through Solv – something like 75 patients per hour. So it’s not just the core booking, but we realized our software (which we were already using across providers across the country), was incredibly relevant for this high throughput testing use case. So that’s been an incredible opportunity for us to really be part of the public health solution, and also scale the business that we’re growing. So to date we’ve facilitated roughly 700,000 COVID-19 tests on the platform. And we’re just at the beginning of that. If you look at the CDC guidance in terms of what is required for us to open up as a country, this looks like something that we can do that is sort of a very clear public health initiative, and then a clear growth initiative for the organization.

HM: Wow 700,000. That means Solv is being used from the point of finding where you can get a test, to booking it, going to get it, accessing results, paying for it or figuring out your insurance coverage.

HF: Yep. Different partners are using different components of the software, but think of it as: I’m going in through an entry point, whether that’s going straight through the Solv app, or Googling something and getting directed to a Solv partner, or starting with a provider who is a Solv partner. We’re providing the core access to the capacity as well as the software that manages the workflow, and that connection to the lab. That’s all Solv, and that’s our core software that we’ve been building and really iterating on since 2016. It happens to be a really good fit for this use case.

HM: That’s great. Something I found really interesting when I first heard about the company, was the fact that you had some non-traditional healthcare investors involved, and they are the ones that had been known for spotting real big enterprise and consumer software companies in general, like Benchmark (and Greylock) I’d love to hear about what the experience was like pitching investors.

HF: I didn’t start out meeting investors with a pitch. At the end of my other job, when Trulia was bought by Zillow, Daniele and I effectively started meeting with whoever would meet with us (including investors), while we were refining our hypothesis for what we could build. We were working with the investors and identifying who was interested in the space, and identifying who could be additive to us. I mean, it was an incredible opportunity for us to work with incredibly smart people like James Slavet and Sarah Tavel (who’s now at Benchmark), and Bill Gurley, as they are thinking about these problems in healthcare. So by the time we were actually fundraising, there was no one that we talked to who we didn’t already know.

I sometimes get asked to give advice to entrepreneurs. This is a hard one, but if you can ensure that the first time you’re meeting with an investor you’re not asking for money, you should figure out all of the ways to do that.

HM: That’s great advice too for entrepreneurs

HF: So, when we were first raising money, there were certain types of investors who really leaned in. But those who had been longer-term healthcare investors had a lot of skepticism around our approach. And that’s okay, because they gave me great advice, and now they are great supporters of what we do and continue to give me great advice. But it was very clear to me that coming from a non-traditional background we effectively have to prove it before the more traditional healthcare investors were going to take a look at us and say, “Actually, you can improve access and outcomes within this health care ecosystem and now we can see it.”

HM: Has anything about those conversations changed now with investors?

HF: Well, they’re a lot easier! Like I said, we’ve seen 14 million consumers in front of a provider in some form, and we’ve had incredible growth to telemedicine. One data point that we collect from consumers is, ‘Where would you have gone if you did not book through Solv?’ this is direct Roughly 15 to 20% would have gone to an emergency room, so putting on your cost savings hat, we’ve been impactful in directing consumers to the appropriate site of care where they can get quality care but at a lower cost, and to the tunes of multiple hundreds of millions of dollars of spend saved. That makes our conversations with healthcare investors, payers and other sort of larger entities (who previously wouldn’t have paid attention to what we’re doing), that makes them all pay attention. We’re now at 6 million web visits to Solv per month.

Once you have proven that there is a real customer side value proposition (which is the Solv operating system enabling the online booking, the workflow, the telemedicine digital payments, digitizing the intake, all of those components) and you’ve monetized it and you’ve proven it – plus you also have a big and growing consumer audience where you’re actually connecting them to care – more people start paying attention.

HM: Right. But at the same time, there are several other telemedicine platforms out there, not just the big ones like Teladoc or American Well, but a lot of other little startup solutions and point solutions. What’s the most differentiating aspect of Solv?

HF: We don’t pay $1 for our consumer acquisition. There are incredible startups that are working in telemed against very specific use cases that have gotten a ton of traction. Obviously, looking at a lot of the direct-to-consumer drugs space has been really interesting; another area is working specifically with payers against a specific population [like chronic illnesses] where that’s going to drive demand to you. Then there’s a whole other group of companies that are just broadly telemedicine. I think it’s a hard category to win in because you are now competing for patients with traditional providers.

But there’s something important with the shift to telemedicine with Covid. With Solv, it’s not a third party physician whom a consumer has never had a relationship with. They are going to the same primary care physician or urgent care doctor, but now they are just visiting them through a different modality. We’re actually enabling that. As you think about the consumer demand generation, we’ve been building that over the past four years. So we’ve built an audience that is looking for access to care, without us having to pay anything for them to do it.

HM: Wow, I see. So you don’t have to pay for anything for customer acquisition on the consumer side.

HF: Right. This is, again, one of the Trulia learnings. If we build a website and mobile app that’s going to help consumers answer some questions – which happened to be really hard to answer in healthcare – we’re going to be able to build a significant organic audience who’s going to come to us seeking that care. That’s something that we started doing from the very beginning.

At Trulia, we built that consumer audience, but of course they were not going to transact. There is a key difference there. There are lots of people who look at houses all day long – thank you all very much, because that was a great business we were able to build from all the people who are looking all the time at the really cool new kitchen, or what their neighbor’s house was worth, or their boss’s – it was great. It was a top of the funnel search where ultimately the unit of value was the lead that was sent to the agent. But that real estate agent would then make 3% on a transaction, so they could be fairly infrequent; It made more sense to build this big audience of people looking.

In healthcare many people take the same approach, but the equivalent is symptom search, When you hear that 1 in 18 searches on Google are healthcare-related, that’s really attractive from a consumer technology standpoint. However, the way we approached building a consumer audience was not, ‘Let me acquire all these people at the top of the funnel who want to know like, what the green bruise versus the black bruise means.’ There are lots of people who do that very well. Ours [audience] is people who want care now. So conversion to actual appointments on Solv is incredibly high because we’re not looking at the symptom level, we’re looking to fill the need when they have it.

HM: Yeah, there are a lot of things that are the same and different from your time working at Trulia and working at Solv. For starters, they are both fast-growing companies in really complex industries.

HF: Yes, and they are in categories with very large incumbent players, similarly heavily regulated, quite opaque for the consumer in all scenarios, tons of online traffic associated with each category. In terms of our approach, what was the same at Trulia was to work with the innovators who are really trying to deliver a better consumer experience; powering them with software – which ultimately will lead to higher ROI them making more revenue. So we brought that mental model to Solv.

A really interesting thing is the fact that we had these economic crises with both companies in the categories that we were operating in. So the 2008 crisis in the economy was specifically set off by the real estate industry, and then of course, in 2020 this healthcare and economic crisis with the pandemic.

When I think back to Trulia then, I can’t recall how much traffic we had at the time, but clearly our paying customers we’re going to make far less revenue. People were unable to buy houses.
However, we were still growing because what we realized was that in that moment – again, on both sides of the marketplace – there became a trend really focused on deals and price cuts, people wanting to know what was happening across the country and where they could have more value. We started surfacing foreclosures as part of our core search experience, because what we realized was people would continue to look, but what they were looking for and how they engage was changing, and we were really able to take advantage of that to scale our consumer audience. With that, we could continue to build our customer audience – the brokers and real estate agents – and that really took us through that period.

Fast forward to today, we’re now in an economic situation that’s much worse in many ways. But we’re in healthcare. Similarly, the trend that became very obvious to us again (starting with the consumer side) was, an audience of people who are saying ‘I need to get care, and telemedicine is how I’m going to do it,’ Then we could identify the customer side (in this case providers), who wanted to deliver that to them. And now we are also doing that with COVID testing.

So in many ways in both scenarios we were able to identify, ‘how does what we have service the new needs on both sides of our market today, and how is that different than it was two months ago?’ These have both been interesting experiences. I hope that it’s not causation from our companies…that’s a joke, obviously.

HM: Yeah, if you start another company, I wonder what sector it will be in that will experience another huge economic upheaval.

HF: Definitely us.

HM: Getting back to remote work. Are you hiring remotely?

HF: We’re certainly open to looking at a more distributed team. Like many organizations, we’re trying to figure out what remote work and flexible work looks like at Solv in the new world. The one thing that’s very clear is that we won’t go back to how we were doing it before.But yes, we’re actually hiring basically for every role, and so anyone who’s interested please reach out. That’s sales, engineering, customer success, product, marketing – we’re effectively hiring across the organization. And it’s a whole new challenge trying to recruit in a much more distributed way and then onboard, that’s the new challenge for all of us.

HM: What do you hope the rest of 2020 is going to look like (or even getting into 2021). Do you have a road map?

HF: Is this a company question or is it a Heather personal question?

HM: Company. A personal roadmap is way too hard. I don’t know who has one of those. But how do you create a company roadmap knowing that you have to have a lot more flexibility than before?

HF: Yeah, as I mentioned we’re not doing anything that is outside of the vision of the company and where we want it to go. So whether that is accelerating the shift to digital – not just telemedicine, but really digitizing all of the upfront experience as well as post-experience – that was already in the roadmap continues to happen. Clearly, COVID-19 testing is a new dimension. We think of it as a new service, and we’re also working with new partners. But ultimately it’s a lot like we started: answering the question of ‘Where should I go for the problem I have? When can I be seen? How much does it cost?’ To enable the consumer to have access to high-quality, same-day next day care. It’s all consistent with our core mission of what we’re doing.

It’s probably the element that has the least uncertainty, but what is very clear is continued work with state and local governments to enable access to testing will continue to be a priority. As the testing landscape shifts – think antibody testing and vaccine distribution and all the stuff that frequently happens as we enter flu season – this is all consistent with our core plan, it’s just the unexpected element. It’s right around the corner. These are seasonal businesses in a non-pandemic world. So, thinking about the scenario where we don’t have it under control and we’re launching into flu season, we may see telemedicine go back up to 50% depending on what’s happening in the country. I like to remain optimistic, I think that there is going to be more testing and there’s going to be different types of testing that become more available, because I’m an optimist at heart. Ultimately, I think we’re equipped to be effective no matter what happens.

HM: Now, before you were working in startups you worked in communications, including working as a Deputy Press Secretary for senator John McCain during his presidential run in the year 2000. You’ve mentioned in the past how this experience really helped you learn some of the key lessons that would shape how you thought about approaching entrepreneurship. Can you share a little bit more about that?

HF: Absolutely. First let me clarify that, as you said, it was John McCain’s 2000 presidential run, which was the Straight Talk Express John McCain, not the 2008 campaign, which I was not involved in.

[Working on that campaign] was an incredible training ground to be an entrepreneur. Every time I talk to someone who comes from politics (and then specifically from campaigns in my startup life) I’m immediately attracted to them. I certainly didn’t know it at the time, but I think fundamentally so much of what I learned came from that experience. First, he assembled basically a band of misfits. John McCain in 2000 was not beloved by most Republicans. It was not conventional wisdom that he was going to come anywhere close to winning. So he sort of brought together this band of misfits who really didn’t give a shit about what other people thought, but they believed in the candidate and in the mission, right? So that was lesson one: When you are the underdog, finding the organization – the team that’s going to stand with you against conventional wisdom – is the most critical component.

Second, remember [Steve] Forbes was also running in that primary. Our headquarters was a little shack with holes in the walls in Northern Virginia in Old Town. It was not anything to look at. I don’t recall there being many windows. But we were there 16 to 18 hours per day, seven days a week, and to get to the office I used to have to walk by the Forbes campaign headquarters, which was like brick and beautiful glass. I have a recollection of there being workout machines in the windows, and I just remember thinking like, ‘Wow, they’re spending so much money.’ So, that second thing I learned was spending more money doesn’t mean you win. Especially at a startup, recognizing that there is a scrappiness that comes from not being over-funded is a great thing to learn.

The third main lesson was around the Bush campaign, who we were running against in the primary. They started spreading this rumor about McCain’s POW years – which in many ways was so much of the narrative that made him great and made people love him – but they took that and turned it and said being a POW for that long would of course make someone crazy. So it became this narrative in the media that he was not stable to be president. And we did the coolest thing (I take zero credit because I was the Deputy Press Secretary; a very junior person looking at all these senior people), but they basically released all of his medical records. There were about a dozen giant binders of medical records and they just made them entirely open to the media to pour through them. So that was my lesson on radical transparency. There’s an element of taking the narrative and then just being really transparent about who you are. Of course, there’s a lot of stuff in those medical records, but that really shut down the story that he was unfit and that really helped us in that race. We ended up winning New Hampshire in that primary.

Another fun story on that campaign was we had The Wall Street Journal editorial board on the Straight Talk Express bus one day. He [John] kicked them off because there was this kind of punk reporter (that’s how I remember him) named Jake Tapper from Salon.com. and he loved Jake. So John said to WSJ, ‘We don’t have space, you guys are off. Jake, you’re on.’ And I just remember thinking that there was something so unconventional about that – doing what he thought was the right thing versus the thing you’re supposed to do. It was really an amazing experience.

HM: Yeah. That’s the perfect segue for this next question. I’ve had a lot of CEOs on Greymatter lately who’ve talked about how this moment in time is really changing the way that they’re approaching their role – basic things like how often they hold their all-hands meetings to what kind of mental health support they provide, or just getting better at making decisions very quickly so that the team can feel a little bit more peace of mind. How has the role changed for you during this time?

HF: It’s an interesting question. I think the role of the CEO feels very different right now. Between the uncertainty of what’s happening across the country with COVID-19, and then add to it the appropriate and righteous anger around racial injustice in the country, and what feels like social injustice while we are all in our homes and unable to socialize with the people that we love and do things to distract us. The moment is very intense, right? And in some ways it feels like the role of the CEO is in part to acknowledge that and where there are statements to be made where you decrease the uncertainty. The importance of us doing that is just so much more important. Even minor things like how we decided fairly early on to continue the work from home through the end of 2020. It certainly wasn’t clear that the world wouldn’t be back, that San Francisco wouldn’t be back open and people wouldn’t be going back to offices later in the year. But it was just so clear people needed to have some certainty versus this every day, every week, every month update that was incremental. In areas where you can provide certainty, I’d become much more biased to give it. In areas where I may not have the final answer, but I can disclose the progress, I’m much more inclined to be proactive about that. I try to add some sort of normalcy or stability in these pretty volatile times.

There are also just a number of tactical things that we’re doing differently, like proactively monitoring vacation time so we can reach out individual by individual to say, ‘Hey, you haven’t taken a vacation. You should schedule the time off.’ They are little things, but thinking of that as the company as a whole to make sure that self-care is a priority. We’re doing things like enabling a wellness monthly benefit for the meditation app. We’re a startup of just 55 people, but we’re doing things that signal that self care is critically important right now in order for us to continue doing the important work that we’re doing. You’ve got to take care of yourself. Probably the other big difference is that as a leadership team, we’re talking about it probably every other week, getting a sanity check on how the team is doing and what needs to happen in order to ensure that our team is healthy so we can continue to perform.

HM: Yeah, and it’s also important for you. You’re a parent, you have three kids.

HF: I do.

HM: Are you homeschooling all of them? I hope you have a co-teacher.

HF: It would be really hard to be a parent of toddlers right now, and I’m lucky in that my kids are six, nine and 12. So they’re right in between where I don’t need to manage the day-to-day every second of the day. During the school day we create a calendar of what needs to happen. My six and nine-year-old boys are probably 70% compliant – which is good enough, we’re all happy with that – and my 12 year old girl is in middle school and she’s been a delight, and I think just as a family team we’ve been very focused on supporting each other through this. Being very honest, it would be very much harder to do if I had a toddler. That’s physically taxing in a different way.

A friend of mine made this comment to me a couple of months ago and I’ve really reflected on it because it’s so true. The macro of this moment feels pretty stressful, right? And pretty overwhelming based on all the stuff that we’ve discussed. But there is an element of the micro of the moment, and for me particularly with my family, which really is a silver lining. In the past five months I’ve had dinner with my kids every single night except for one night, which was my wedding anniversary to my husband of 16 years. So there are silver linings to all of this.

HM: That’s great. What advice do you have for entrepreneurs today?

HF: For health tech specifically, this moment in time is an incredible opportunity. When you think about one of the biggest impediments to progress (when you think about the consumerization wave) it’s really around incentives. Who’s going to get paid and where? And how does the payer play into that, and what happens to the fee schedule? All of that is so complex in healthcare. This particular moment with the shift to digital is going to enable new models to get traction. I would say to the health tech entrepreneur that there are some incredible models that have worked historically and that’s great, but you can really press past that because of the opportunity in this moment. I truly believe that a number of really compelling companies are going to come out of this because they will be able to start on an entirely different playing field. New models of primary care, new models of digitized health…. I think my advice is just do it. Do it, because I really think this particular unique movement is going to transform the next 20 years.

For entrepreneurs in general, I would say don’t believe the hype about how you’re supposed to be or feel or how successful you’re supposed to be as an entrepreneur. I remember when I started. We raised the funds when I was 40. I was a 40-year-old mom with three kids. I’m not conventional in my profile. People who care about me said, ‘I think it’s going to be really hard for you and I’m worried.’ And they were right. They care about me. But I think there’s an element that we get to define what success looks like. So many of the narratives around entrepreneurs who are successful are just not true. It’s not just a young man. The average age of entrepreneurs (especially in digital health), is much older than that 22-year-old in the hoodie, right? Experience and your network and your maturity is going to enable you to succeed. If you have conviction and enough of the elements of magic – and it really does take some magic and luck to get it all started – go for it.

HM: Yeah, that’s great. Before we wrap up, we like to give the opportunity for you to give little shout outs. If there’s anybody on your team who’s really stepped up in the last few months and really made it possible for you to get through what is a good time for business, but a challenging time nonetheless.

HF: Gosh, I mean we have such an incredible team I find it really hard to highlight just a few people. I do want to highlight the early team who joined us when we were still pre-product – and who are still there today – and played a huge role in ensuring not only that the product was and is successful, but also ensured that culturally, as an organization, we’re true to who we say we want to be. I want to thank our customer success team who all of a sudden, we’ve been onboarding different types of providers within a telemedicine product (which was getting so little traction before Covid). I want to thank our product team and those who are focused on our Covid testing and the research, and how much empathy they’re building for that end user as we’re building up a product. I would love to name one person but I can’t; I just feel very grateful for the entire organization I get to be a part of.

HM: Thank you to the entire Solv team.
One more thing: as everyone is sheltering in place and there are fewer options for things to do, what are you doing to keep your sanity (or just be entertained or to learn more at this time)?, Do you have recommendations for a book, movie, podcast, show or anything else?

HF: Yes, Dolly Parton’s America is a ten-part podcast and it is fantastic; I highly recommend it. I’m of the school of appreciating a good, solid distraction which has nothing to do with my day-to-day whenever I can, and Dolly Parton’s America is incredible. Everyone should listen to it. As you might imagine, there is also a lot of X-men and Avengers and various other movies in my life, but the part that is for me is Dolly Parton.

HM: Yeah. No, that’s great I’m the same way too.

HF: Exactly, when you don’t get to physically separate yourself between work and home, I think it is very useful to build in whatever sort of unnatural transition for you to move from one to the other, and that’s at least been a strategy for me.

HM: Great. Great. Well, thank you so much for joining us on Greymatter. This was really interesting.

HF: Thank you.

HM: Ok, everyone, that concludes this episode of Greymatter. You can subscribe to our podcast on Soundcloud dot com slash Greylock hyphen partners, or you can find new episodes and blogs on our website Greylock.com. You can also follow us on twitter @greylockvc. I’m Heather Mack, and thanks for listening.

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