Real Health Care Happens Between Doctor Visits w/ Wei-Li Shao, President, Omada Health

When you think about people's health journeys, oftentimes they are characterized by individual doctor visits, maybe intermittent hospital stays, but they're basically like quick hits or interactions with a healthcare system. But we all know healthcare is longitudinal, it's persistent, it should always be done. But our system's built on you know building events, right? Because 100 years ago we couldn't figure out a way to always be there to provide care. But now technology is there and we have the ability to do that. And Whaley spent 18 years at Eli Lilly building businesses across diabetes, oncology, and international markets before joining Amada in 2019. And he took the company public in 2025. Less than a year later, Omata posted its first profitable quarter on the back of explosive growth in its GLP1 programs. And we'll get into that, what that growth means for the business. But I also want to spend some real time on where Whaley's thinking about chronic care actually comes from, and on the parts of Omada's business that don't necessarily make the headline. So with that, Whaley, welcome to Healthcare Rounds. Yeah, thanks, Sean. Super uh glad to be here. Thanks for having me. Looking forward to the conversation, by the way. So we spent almost two decades at Eli Lilly, and that was across multiple diseased states and geographies before doing what you're doing now. And so it doesn't happen very often that we have somebody uh from who spent so much time in industry and then kind of going into in a new direction. So I'm curious, what is what's the one idea from all that time in pharma that might show up most clearly in how Omada is built today? Yeah, it's a great question. There are in so many different directions uh to go. And uh you're right, there's there aren't too many crossover pharmaceutical execs over into digital health and virtual care. And uh maybe for a different podcast we can talk about how that that that kind of journey was made and and why. But um the one thing from that journey that I think that uh is super applicable to your your question, John, is um, you know, I I spent um 18 years uh as mentioned with uh Eli Lilly and Company, and then spent you know, almost seven, eight years with another pharmaceutical company prior to that, uh Legacy Pfizer Company, uh Pfizer Pharmaceuticals as well. And through all of that, you know, I can I I remember this conversation I had um with um uh a boss I had at the time. This was probably about, I don't know, 10, 12 years ago. I was running one of the businesses in the United States, and I said, you know, why is it that uh uh we set all these business measures in our planning process, like number of prescriptions sold, market share, how much are we growing the category? Uh, but we say we're in healthcare. Where's our outcomes goal? Like how many patients are we gonna make better? And uh that conversation uh didn't go anywhere. And I realized in that moment that pharmaceutical companies, uh, and it sounds so simple when we think about it right now, John, is like pharmaceutical companies, what is it that they do for healthcare in the community and humanity? They discover innovative medicines. And their whole business model is about prescriptions, prescriptions, prescriptions, and prescriptions. And oftentimes, what I've discovered as I've moved into virtual and digital care is that the prescription is just one very, very small part of the total healthcare ecosystem. As we all know, and all our listeners know, there's PBMs, health plans, there's all sorts of stakeholders, and there's distribution arms, there's specialty pharmacy, there's so many, so many intermediaries. And then, of course, there's all the cottage style industry doctor's offices and then huge, massive um, you know, ACOs and health systems. Uh, but when you bridge over to the care delivery side, which is kind of where OMATA is and delivering true care services, the prescription becomes just one small element. And then everything else is what you work on is are they getting support in between the visits, which is where we specialize? Um, are they getting the education? What is their environment like? What are the barriers they have? How do we help them overcome? What are the simple changes you can make? Are you taking your medicines? Are you eating right? Do you have access to nutrition? Um, you know, what is your uh family like? Uh, what is going on in your family? What kind of coverage do you have? And so when you go into clinical services and clinical care, you realize, my gosh, what it is important what pharmaceutical companies do, but there's such a small portion of total clinical care delivered. And that was the big kind of like mind-blowing aperture change um as I pivoted from pharmaceuticals to uh digital and virtual care. You know, you you just made me think of uh of something that we do here at Darwin. We spend a lot of time working with industry and and specifically um how to work with large customers. So it just the way that you framed that just made me think about I came back from a meeting last week, we'll call it um uh an internal strategy session at a at a client. And the theme really was about well, how do we get this account team skilled, upskilled? Uh, how do we get them thinking how to work with a health system versus this sort of prescriber model? And I'm telling you, Waley, the the kind of struggle that was going on throughout the meeting, really, is the sense of the, I'm just gonna call it old school, um, prescribing, detailing docs, right, focusing on exactly what you said prescriptions, market share, volume, right? All these KPIs that pharma thinks about. And the challenge that they have, and I agree with you, by the way, once you get into the world of care delivery, it's an entirely different matter. Um, but the challenge is well, what else are you bringing to the table? And how do you have a conversation with, let's say, a chief medical officer? How do you how do you move the needle when working with a large customer? And and part of the answer is if all you're focused on is how many scripts are we getting, or what kind of pull through, how's that? I'm sure you heard that a lot. What kind of pull through are we getting from the field? I think largely missing the point. And I think that's that's why. And that is absolutely not the point of today's conversation. I just it just made me think of it like this is the struggle that the industry is having with their slice of the of the of the pie that they're very comfortable with, and like you said, that they're very good at and their purpose, right? But how do they how do they broaden that lens in such a way to get them thinking about those outcomes? It's a very different conversation with uh, let's say a pharmacy director, if if you're thinking about outcomes, right? Versus I'm thinking about pull-through and and our you know, formulary positioning or something like that. I my personal belief is there's a long way, but pharma can get there to be a, and again, we'll save that for a topic of a maybe another podcast for for you and me to talk about. Um, but it's just really interesting when you talk about your evolution and in that meeting, just thinking about, well, geez, pharma is really missing the bigger picture here. Um and so I guess that that leads to the follow-up question from that is did you have to unlearn anything from all those years in pharma? Did you have to unlearn anything, or is it just sort of like you you you you you took that perspective and now with Omada, um, you're building on that? You know, um, yes and no. I always I often tell people, um, you know, a lot of folks that are in pharma are like, hey, you know, is the grass greener on the on the digital virtual care side? So I talked to a lot of people in pharma. And I tell them basically in short form that uh, hey, listen, you think there's a lot transferable when you come into the care delivery health services side and virtual care, and you find out you're really wrong. Um, and then you find out after a year of doing the job, two years of doing the job, that there's a lot that's transferable. Um, it's just you've got to find those nexus points. I think that um one of the areas that I'm excited and anxious to partner with Pharma on uh is the area of persistence and adherence. Um, because when you think about people's health journeys, um, oftentimes they are characterized by individual doctor visits, maybe intermittent hospital stays. But they're basically like quick hits or interactions with a healthcare system. But we all know healthcare is longitudinal, it's persistent, it should always be done. But our system's built on billing events, right? Because 100 years ago we couldn't figure out a way to always be there to provide care. But now technology is there and we have the ability to do that. But the the challenge is that you know, healthcare, we know that the best healthcare delivered is not just in doctor's visits. Uh, very little actually gets done there. Uh the real healthcare is what you decide to do in between those doctor visits. And the reason I bring up persistence in adherence is because you know, we we we focus at Omada delivering a form of persistent, we call in-between visit healthcare. So we don't compete with your doctor visits, but we actually provide persistent daily health care through the convenience of the cell phone in your pocket. So healthcare is never more than six inches away from you, uh, given everybody's got their cell phone with them all the time. But the other thing that's in between doctors' visits oftentimes are drugs. And that's the persistence adherence, I think, intersection point that I would love to work more with pharma with. Because I can tell you from my 20 plus years of experience in pharma, from a business standpoint, they lose probably 60% of all of their patients, probably within 90 days of the first chronic prescription that is written. And for healthcare, that's bad, especially if it's the right patient, right time, and they need to be on that truck. But there's all sorts of problems that happen after the first prescription where pharma's not at, right? They don't have the ability to be there. But there are lots of healthcare organizations. Uh, mine happens to be one that can be there. And boy, if we can get the right patients on medications, not just from this from day zero, but stay on them through day 365, we can really bend the curve on outcomes and prevent hospitalizations and unnecessary healthcare resource utilization. I think that is a that's a that's a no-brainer. And from a pharma perspective, you know, if they're still in the old world with their KBIs, uh, every month of additional persistence or endurance is worth billions of dollars to them. So if you think about all the incentives align, and so gosh, wouldn't it be great to really create um you know uh a deep partnership across industries, across companies uh to really make sure that happens really well. And in fact, you know, that's what we're we're doing in GLP1s right now, um, uh, because we know in GLP ones this whole cycling on and off is is is the new yo-yo diet um, you know, from the from the 80s and 90s. They're just doing it with uh with drugs now. Well, it seems to me if we went back about 10 years, yeah, seems about right, 24, 2015, 2016 time frame, um, I had this uh this notion that I was really pushing of emphasizing care navigators from the pharma side. I thought it was like the greatest idea. You know, you're gonna have this whole quote unquote sales force of navigators. Um problem is, as you know, I don't need to tell you, you run into all kinds of um firewall um issues. And you know, are you consulting? What is the role of this person? Are you giving advice, compliance issues to kind of like wrapping the book? Right. Exactly. Transfer value issues. All things that that I think pharma struggles with because they want to bring value and then there is that issue. But but if you're working with a legitimate uh third party in a partnership like this, that's where I think you can get a lot of those things done. So we'll we're we're gonna get to GLP1s in a second, but I I I wanted to call attention to something that I just I think is is remarkable. And you know 24 peer-reviewed publications, is that right? Um, something along the lines. That's that's unusual. When I was doing kind of a background, of course I was aware of Amata, but just background for this conversation today and looking. I mean, and these are not slouch studies. This is not, you know, let's get a friend and publish something and just throw it up on our website. 24 peer-reviewed publications. Most companies in your space, I can think of a couple of exceptions, but they're kind of grading their own homework, right? Um, so what was it for you or in your organization that said, you know, we're gonna commit to this higher level of rigor to demonstrate the work that we're doing has value and is making a difference? Um, rather than just, you know, kind of the uh marketing case studies. I'm sure Darwin, we've got our own share of case studies. What was it that's that that you said we need to put put some muscle behind this, put some real real evidence behind it? Um, because I I think it's it's uh we need to talk about that before we get into uh more details of Omana. Yeah, I I can't take credit for that. I mean, uh our co-founders uh had a tremendous amount of uh foresight. So Sean Duffy, our CEO and co-founder, and then Adrian James, the other co-founder. I mean, they, you know, these trials, these clinical studies, these analyses, uh they take a lot of time to execute and to run. I mean, you can't do these things in three months. Sometimes they say six, twelve, eighteen months to do. And then you got to do the analysis data lock, then you need to get it published. I mean, it could be a two, three-year affair. Um, and uh they had the foresight way back when. And as Sean would tell it, he basically, you know, he he was uh at Harbor for his uh uh MDMBA and uh he came from Silicon Valley, and when he would talk to his medical school friends about the exciting things of technology and trackers and wearables, you know, his medical school friends would be like, well, where's the evidence? Where is it published? Uh and then he'd talk to the his technology friends and be like, this stuff works, isn't it obvious? So I think he sat between that tension and that intersection between like a legacy, you know, not legacy, but you know, traditional healthcare ecosystem, which is very, very evidence-driven, which is great. And then technology, which is like create the evidence, but create the vision in the future first. And I think he took these two things and he said, hey, listen, there's going to be a clash of like uncertainty and incompatibility unless we adopted this approach from the get-go. And they did that. Uh, stemming back from 2013-14, we had our first trials uh and studies peer-reviewed and published. And I think that's what's seeped into our DNA. Uh, you can't get into a conversation about a new feature, uh a new service your clinical service is going to provide without our clinical product teams and our care deliveries teams saying, okay, well, where's the evidence and how are we publishing this? And how do we hold ourselves and our buyers and our competition to the same account? Uh and so just become part of our DNA. We all think that way. Um, and so, but but again, I think it stems back decades. So, really, my my next question was well, how does it affect how you operate day to day? You've actually answered that. It's part of your DNA. But is there any area of research, whether it's in you know diabetes prevention, hypertension, is there any area of research that you find is, let's say, the most interesting work that doesn't get a lot of attention? Yeah, I think um there's two kinds of most interesting work that don't get a lot of attention that I think people would find tremendously valuable and interesting. Some of the work that we do internally uh eventually gets published, but for the purposes of program and product development. So, you know, we we come up with a hypothesis, uh, we develop uh you know different uh ways to address the hypothesis using the technology we have or other technology we can use and care. And then we we create different arms, you know, like control arms in terms of to test those features and we test them internally, and then we end up shuttling and getting rid of certain features and and and knowing from our data that these are the features that actually make the difference. There's a lot of that data that goes into our program on product development that boy, I I wish everybody could see it because you'd see an equal number of things that didn't work or failures, uh, as you would uh the successes. Um so that's that's one one classification. I do I do feel like one day in the future uh we're just not there yet, that you know we'd be we'd be equally, if not more loud about our failures, uh, just so the system doesn't repeat uh what we've already done uh and can do better. Um the other the other form of evidence, um which I think eventually we're we're gonna come out and publish the stuff uh when we're at the right the right the right point how do we know that somebody's gonna respond to something? How do you predict somebody's behavior? How do you begin to understand if you do A, B, and C, that you get X, Y, Z result? Uh it's a less of a we do this and and and over the last 12 months, how has that been done? But it's more of this uh, you know, if the patient presents this way, we know they're gonna end up this way in 12 months. Uh but if we do A, B, and C, we can put them on a different track and actually uh uh uh study uh how right were we um over periods of time. And so um we we work a lot on trying to understand health signals uh and how they affect care. Uh we run a number of different uh what we call plays internally with our care delivery system. If we do this, then we get that. If we do that, we get this. And then when we see that signal, then we replicate it through our care delivery engine. Um that kind of stuff is the stuff people don't see uh that is is core to the kind of care we deliver that you know one of these days, um, you know, we've got to be able to make that uh make that public. Well, why don't you give us, for those who don't know Omada, just sort of like we'll say the elevator uh pitch. Yeah. Um describe what it is that you do, and then we can get into a, once we have that kind of framed out, we can get into some more details about OMATA health. Yeah, so the the 32nd kind of who is OMATA and what is it we do is the best way to understand it is to start with a problem. Uh the problem is uh that um the way our healthcare system is delivered today, uh centered around events, doesn't work. People with cardiometabolic conditions are just getting worse. Most, if not every study shows that over the last 10 years and even most recently with better technology. Um and secondly, what the evidence does show us, even when we sit in patients' rooms, is that it's the day-to-day, it's the time and space between those doctor visits that really matter. In effect, 80-90% of all the outcomes uh that are generated from healthcare are delivered in between those moments. Uh, and so we took the reverse of that and said, okay, if that's where the outcomes occur, then we've got to create and pioneer a new form of care, you're leveraging technology that is evidence-based to basically help you uh participate and take care of yourself uh through behavior change uh every day or every other day for a few minutes or for an hour, whatever works for you to make small changes that end up racking up to big outcomes. Uh and so that's what we've done. We've used technology to scale that, and we use uh the signs of behavior change uh to make sure that happens. You know, we do that, of course, uh, people with that risk of diabetes, diabetes, hypertension, musculoskeletal conditions, cholesterol. High blood pressure. And then, of course, if you have one, you unfortunately generally have the others. And so multi-conditioned care. And so we've been doing that now for a decade and a half. And we have a little over a million people under active care today. And we think we've we've stumbled upon something that uh works. But the last thing I'll say, John, in describing that is that as simple as it does, as it sounds, right? Like this idea of like in-between visit care, uh, it's radical uh in the sense that would you compare to how healthcare is actually delivered today. So there's a lot of work to be done, but encouraged with uh the scene we've post as well. Well, a couple of observations. One, um over the last several months, shall we say, um we here at on healthcare rounds, I've been leaning into value-based care. Yeah, it's old, old story, right? But but where are we today? And I've been bringing on industry leaders, I've been bringing on academics, um, just recently had Elliot Fisher on, who's kind of like the the brain behind ACOs, right? And all of those models, I think, are really focused on payments, of course, but it's it's what's going on in the moment. And you can say longitudinally we're trying to improve um through a score. Are you controlling your difficult to control diabetics, let's say? And you can you can have carrots and sticks and everything associated with that, but everything is focused on that. It's event focused, it's on how many patients are you seeing or the are or and when you're seeing them. So that that's that's the first thing that it seems like you're everything else that's around that. And and what I mean by that is you're trying to create value for value-based care, and you probably don't think of it this way, um, by doing all of those things that that um bolster, I guess, those uh those individual events. The second thing is to a point, I feel like just about every person that I've had on uh recently has said primary care, primary care, primary care. We've got to get better at primary care. We have to get better at these visits, right? But what you're talking about when I look at the list of things that you're focused on and that we'll get into, that's primary care. These are, you know, right? I mean, for the most part, this is your the expectation is that primary care doctor is helping to manage that hypertension hypertension or helping to manage um the difficult undiabetic. Yes, there may be specialists involved. So I just I think it's interesting the intersection. This is this conversation is not designed to be about value-based care. I think probably our listeners are getting tired of hearing me talk about it. But but the effect, in other words, what we're trying to get to is improved outcomes, really at lower costs. Seems to me that that's that's really what you're all about, and and really emphasizing primary care too. Yeah, you're exactly right. And I love the way you you frame that. Uh the tension between kind of what what people talk about and then kind of what is needs to be done. There's a there's a delta between there, as you just kind of uh pointed out. And it's understandable because you know, we as humans, we tend to think about solutions based upon what we have experienced and what we could conceive is possible. And if you can't conceive of a new form of care that is there every day, persistently, longitudinally, uh, and is not event-based, then you then you automatically focus on what happens in the existing legacy primary care doctor's office. But that's also the definition of insanity. Because, you know, it's like doing the same thing over and over again and expecting a different outcome. But we've known for decades that the primary care doctor is is important, it has a role to play. But uh, you know, trying to stuff more into a 15-minute visit it's it's insanity, it's ludicrous. And putting more payments into that visit to do things that they don't have time to do when patients can't find a primary care doctor, you know, one third of Americans don't have one. And then if you do want one, the one you probably want probably doesn't have an appointment for months. This is nonsensical and doesn't make sense. And so we've got to break the paradigm, and it's very, very hard because we raise people and educate people in a legacy system. But we've got to break that paradigm. That's why I say it's a it's a simple concept to try to help somebody on a daily basis, leveraging technology. We can do it, we've shown who've done it, we've published it, but it is radical uh when in comparison to what is currently done today. And so you're right to link it to value-based care. And in fact, we do we do business and have partnerships uh with some of the most innovative value-based care organizations. Um, and they've begun to basically break their own paradigm and say, gosh, we have a segment of patients that we know we can't get them into a visit every day if we tried, even if we thought it would work. We can only get them in two, three times a year, but they just need more care. And so they call us up and we partner with them. We work with their primary care network, and and not surprisingly, we see results uh from from how that how that partnership works. And then on the patient side, I would imagine that people are hungry for this kind of um we'll we'll say non-intrusive, really. I mean, yeah, you've got your phone in your pocket, right? I mean, they're hungry for that better care because of the level of frustration, survey after survey keeps coming back, frustration with the health system. Well, I can't think of a time that I've been doing this that people say, yeah, you know, it's the greatest health system in the world. I love the health care I get from my doctors, right? So I would imagine the feedback that you get from patients is also um very comforting, right? That that you're moving the needle there. It it is. And and it's um, but we've also learned a lot, John. So I'll give you an example of one of the things we found that doesn't work that we don't do. So, you know, back it was probably like 24, 36 months ago, it was all about like nudging. Like if you just nudge people on their phone, then they'll change the behavior. Well, you could we found not maybe not surprisingly that you can nudge the crud out of somebody. Um, and it doesn't move the needle. Um, and so the broader learning there is not just about nudges, it's about how you blend technology with human. And there's a raft of other digital health virtual care providers out there that are totally moving AI, totally moving towards technology and removing human. We don't believe that's the answer. But we also don't believe that it has to be 100% human. There's a co-intelligent approach where you get the best intelligence from AI and you get the best empathic intelligence from human. Because I tell you, over the last 15 years we've been doing business, when you talk to our millions of members that we have served, they, when you ask them, what is it that was special about OMADA that made the difference? Do you know what they say? They don't talk about our app, they don't talk about the communities that have, we don't talk about the integrated devices and how we don't they talk about the human care team, their coach, or their diabetes educator, or their hypertension specialist, or their doctor that they use through us. They talk about that person who saw them, understood them, and helped them and didn't judge them. Our healthcare system today, uh not unintentional, judges people, right? When you give them a diagnosis and say, Congratulations, you are now diabetic. That comes with all sorts of stigma. Uh you are now diagnosed with clinical obesity. Uh oh, guess what? I kind of knew already before coming in, and we all know the baggage and stigma uh in esteem that comes with the self-esteem issues that come with being obese and overweight. And so, in a judgment-free care way, and so not it's not just about providing support, it's how do you do it in the right way? How do you do it in a co-intelligent way? We're using human and AI in a way that's blended so that the number of the patient feels seen and heard and cared for so that uh they can honestly say this is a great care experience. I'll tell you why healthcare systems need to really understand this. Because if you are in, if you see, if you're, let's say, a health uh health system or health plan and you have Medicare Advantage, which basically almost all do, their payments for stargatis, one of the major ones is called HOS or Health Survey. And it has nothing to do with like, did your did your blood sugar go up or go down, or did you take this prevention thing or not? It's like, do you essentially feel better about your health plan? Did they provide value to you? It's a totally qualitative question that has billions of dollars on the hook. And guess what? If you don't provide exceptional health care, which we define as visit plus in-between visit care, are you gonna are you gonna be able to have that question reliably come back and say we love you? I would argue that that would be a challenging expectation. Well, it seems to me that you're you're you're filling a gap that you know when people talk about the old days when they had their doctor and they had these long conversations with their doctorations with my doctor, right? And I could trust my doctor. And um, I think I've even talked about here on healthcare rounds about um how I appreciate the relationship that I have with my primary care doctor, which you know sometimes gets strained, just not enough, not enough time in the day. People want that. So when you say it's the one thing that care team, it's like coming back to relationship, coming back to that trust, right? Which is, you know, name your institution. Trust is in an all-time low, right? That's right. It's bringing that that trust back to the relationship. And that's, you know, that's immeasurable because when I think about the times that I've had, and I haven't had any serious health challenges. So I'm, you know, knock on, I don't have any wood in front of me, but I haven't had anything serious. But when I think about when I've made real changes in my own health, there has been this thing in the back of my mind. I think about my relate, this is gonna sound crazy, but the conversation I had with my doctor, that I'm almost like accountable to this guy. Like I I bring it back to, I've brought it back to that relationship, and I bet you you see some of that in those scores. You see some of that where people are saying, all right, you know, I'm willing to make a change, not just for me, not just for my kids, but I know I've got a call with my coach. And I really like this coach, and this coach cares about me. Right? Yeah, yeah, yeah, yeah. John, look, you, you, you, you, you may, to use your words, you may think it sounds great. It's not. This is exactly what I'm talking about. We we often say inside of Omada that trust is the currency for change. If there's no trust between Omada's care team, our coach, and the patient or member, then when that when that coach provokes you to set a new goal, to push you just a little bit out of your comfort zone, that member or patient is being like, be like, uh, you don't know me. How can you ask me? I can't do that because this, but when that coach says, but I think you could do a lot of you enter in a judgment-free zone, you get behavior change. And so it's not crazy. That is, that's why we say trust is the currency for positive health care change. You don't have that, in the absence of it, you find that things don't move forward. You can't set goals. We know that when you have trust, you can then engage in behavior change. And behavior change, right? There are several components. One is you need to learn, you need to be educated. So there's a huge part of learning and multimodal learning activities. The second one is community. You have to know that you're not alone, and you have to know that the others just like you that you can that can empathize with your journey because it's tough and you will have moments that are very, very hard. The third one is you need tracking, uh, you need real-time feedback. And so, devices, you need to know that if if I've set a new goal and I've tried to do something differently this week, that it shows up somewhere because you can't wait a year just to shed five pounds. That's too far away. You need to get some feedback that what you did is making a difference. And so devices information is so important. Uh, and the last one um is essentially uh goal setting. You've got to be able to set a goal. Uh, and oftentimes that's the first thing and the hardest thing to do. But when you have somebody who's working with you with technology as well as with a human touch, you tend to set a goal because you know somebody's got your back through the tough times and hard times. Think about how hard that is to recreate in three 10-minute primary care business. Completely impossible. Impossible. But I will tell you, but I will tell you, it's kind of funny. I will tell you that when I was a child, my pediatrician, I still remember his name is Dr. Farrow. We would have the doctor's office visit, then he would bring us into his office, and I would sit in front of his big, huge walnut desk, I presume. He would sit there, he would slow down, he'd talk to me and my mom and my dad about whatever was going on with me. He'd give us, give me like a freaking lollipop and some bubblegum or something like that, and we would have a conversation about what needed to happen. That was the good old days, man. Dude, that stuff is gone. But boy, with technology and a commitment to persistent long-term care that's that's available to you every day, we can actually get that done too his way, just in a different, more scalable form. Because Dr. Farrow, he doesn't exist anymore, and he can only see about 15 patients a day. Yeah. Have you ever used a personal trainer? Yeah. I used to be one actually in college. Oh, okay. So there you know. It it reminds me of I've had loads of personal trainers in my life on and off. And the model that you're describing it describes the best personal trainers that I've had. The non-judgment, the checking in, the pushing you with specific goals. Um you cannot, I you can't accomplish, I believe, the your personal training goals just by an app on your phone and and a personal trainer that's not interested or that's not helping you out. So it just kind of reminds me, I know we're talking about two different things, but it reminds me of uh it's a great analogy. The best, the best personal trainers that I've had have are apply those same principles. Yeah, it's a it's a great analogy uh because they have positive accountability, right? And and every week, maybe you're doing two and a half more pounds on a bench press or squat or something like that. Then last time, and you can see that progress, and it speaks to the accountability and you know that you made improvements. And in fact, we have exercise specialists. Uh, we introduced them last year into our program. So we have a care team space inside the chat where an exercise specialist can actually come in with your coach as well as your diabetes educator and talk to you about movement and actually, you know, quote unquote prescribe a plan for movement, because movement is so core uh to uh uh uh the key behaviors uh around getting your cardiometabolic health important. Uh and uh and yeah, we're seeking to replicate as much of that that you just said. So Way Lee, I wanted to talk a little bit about um because everybody's talking about them, GLP once. And I never heard of it that I never heard about Well, um you said that uh publicly you've said that they're not just weight loss drugs anymore. I think that we can accept that. Um what as these molecules keep improving and as we start seeing different ways that GLP ones are being used, does that change any way the coaches are interacting with people? Or I'm just I'm curious, in this particular category where you've got a potential, you know, it makes me think of like um Enbril or Humera, totally different um drugs, but we think of these like the eight-legged monsters, right? When they were first coming out. That's what's happening with these GLP ones. So, how does that affect um your coaching? How does that affect how you approach these patients? I'm just really curious as to your mindset around this massive category of drugs that has so much potential. Yeah, my gosh. I mean, what hasn't changed? Look, I mean, GLP ones for weight loss, especially you know, the the the current generation GLP1s that we're in, uh, you know, single and dual agonists, and then we get the triagonists coming, uh, and the clinical data look just absolutely spectacular. I mean, these these molecules, these drugs are game-changing. Uh, and I think they're gonna bend uh a number of curves, but they can't do it alone. Here's what we've learned there is a way to pair a GLP1 uh kind of behavior change lifestyle uh support program uh and get amplified weight loss, uh, you get better persistence. And then should you decide to go off your GLP1 alongside uh your clinician, uh clinician's guidance, you can actually keep the weight off uh uh over the long term, because we know that the exact opposite happens when you're not prepared for it. Uh and in fact, you in many, many cases, in certain cases, you can actually be worse off than when you were before GLP1 because of all the loss in lean mass, you gain it all back uh in fat. And so um, while they're powerful, the GLP1s, uh, we've we've understood that if you combine it with the right kind of support, so what have we had to do? Number one is that the titration journey uh associated with GLP1s can be difficult for some people, gastrointestinal side effects, so on and so forth. And helping somebody on a daily basis manage that as opposed to lose confidence in their GLP1 or actually just like decide with their clinician not to get up to the effective dose, so not get the maximum effect, helping them through that per portion of their journey with a coach and also a specialist to help them understand like how do we how how can you um uh uh uh work with the nausea with your food and things like that to get over that piece. That's that's one thing we've learned and uh has been helpful and important. The other one is uh actually getting not just focused on weight loss, but weight health. So um it is very much possible the case, and I think it's happening far too often, where people, your appetite goes down, but your eating habits don't change. And so you actually end up getting malnourished, you lack lock, you lack micronutrients. And in fact, there was this incredible uh Wall Street Journal article that came out last week that showed uh looking at over 400,000 uh people retrospectively, that one in five of them actually were lacking significantly micro and macronutrients from their diet because their appetite went way down, but they didn't consume healthier food. And so food quality and nutrition quality and nutrition density, uh, when you work with us uh in our program, that's something we focus on big time because we don't just want the weight loss, we want the weight health to go up. Uh so that's important. The other one is the preservation of lean mass. We know that up to 35%, one-third of the weight that you lose is actually in lean mass. A lot of that, most is it, is from muscle. Losing muscle is bad, not only from an injury prevention standpoint, but muscle also is the chief engine of burning calories and keeping the weight off. And so we've now had to incorporate exercise specialists into our program to help you move and gain lean mass while at the same time losing fat. And in fact, what we've shown is you can you actually can double the percent of fat loss relative to lean mass. You can actually preserve your lean mass if you do it thoughtfully during that period of time. And so those are just a few ways in which we've had modify our program and evolve our program as people's needs have changed, as people have come into our programs on GLP1s for weight loss. Uh, and so you know, we we've got you know well over 150,000 plus people uh that are on GLP1s uh on our evolved or modified program. Um and um, you know, we're pleased with the results and uh think that uh other companies, including ourselves, if if we just do it right, we can get the return on investment from these drugs because that's what it is at the end of the day. That uh with a thoughtful execution of GLP ones, we can truly bend the curve of disease. Billions of dollars on the hook for for um for the United States and healthcare resources if we can do that together. So, Whaley, we're coming we're coming up. On time. I feel like we're just getting started in the conversation. I do too. So have you back. I hope you're you'd be willing to come back at some point in the future and let us know how you're progressing. I don't mean to put you on the spot, but I want to go back to where we started this conversation in the world, you know, the at Lily and prior to that being, was it pharmacia? I'm trying to remember the pharmacy. Yeah, all nell, all now part of Pfizer. Yep. Right, all Pfizer Pfizer, like so many companies. Um part of Pfizer. Um but I'm just curious, again, I'm not trying to put you on the spot. I'm curious with everything that you just said, all the things that you're learning, and you're in a partnership with Lily, if I'm if I'm not mistaken, a distribution. Right. What do the Lily people say? Like when they see exactly what you're saying, when they when and when they under when they're starting to get um, for lack of a better term, sort of real-world evidence around what you're learning. I'm just curious, has the mindset shifted? Um in you know, um in your eyes, has the mindset shifted a little bit from just prescriptions, market share volume to understanding the contribution that their GLP1 portfolio is having on human health? Yeah, I think so. I think so. Um I think you could see it in their behavior. Uh I can think you could see it in the rhetoric uh externally. Um and um I certainly have a lot of friends in pharma, not just at Lilly, but across the industry. I mean, you spend if you spend one time in so much time in a particular industry, you you make a lot of friends and you get to know a lot of people. And I think things are evolving. I mean, look, you know, when I started, uh pharmaceutical industry was one of the least trusted industries in the entire nation. It was right down there with like, you know, tobacco companies uh and gas companies. It is like the worst. And and the industry has made tremendous gain over the last period of time, some of it fueled by you know what the industry did from a great standpoint, from a COVID standpoint, uh, but also most recent with GLP ones. But I think the but there's still more to go, I think. Um, but I think um uh you mentioned earlier there are realistic constraints as to what pharmaceutical companies can do from a compliance and legal standpoint. Um and I think it's all about how do we how do we foster the right partnerships. Uh you're right, we we have a partnership with Lily. Uh we're looking to do partnerships with other companies. We we have an open-door policy on that. We don't favor one or the other. Uh we we we favor our our members and our patients. Um and um and I think that um you know the companies that are more innovative uh and want to try new things and and find kind of the nexus points where you know uh clinical care also benefits financial performance, uh, not just financial performance alone. Um I think the dialogue's changing. I'm optimistic. Um, but there's a lot more way to go. What I would love to see uh are deeper partnerships um, you know, in the area of persistence adherence, uh, like we talked about in the in the up top, because I think that's just the most obvious area where um it it benefits them, benefits the member, uh, and it's something that we can do uh we think uh pretty well. Um and I think that's just a natural evolution of it. Um what I would like to see uh tackled, and maybe this is a plea to all of my uh PBM and health plan and pharmaceutical friends that I hope are gonna listen to this episode is is is I've got a plea. Is look, I think if we all work together, we can make GLP ones for uh obesity or weight loss far more accessible and affordable. There's tremendous price dislocation in the marketplace. You know, as of July 1st, Medicare recipients are paying $50 out of pocket. That's fantastic, it's incredible. Uh in cash pay, if you don't have coverage, you're paying maybe $250, maximum $300. That's great. From when it was $1,300 a month down to $250, $300 is great. Uh, but the commercially insured employer market uh is still paying a significantly higher price. Um and we've got to work together to create uh accessibility, affordability for everyone, um, and then make sure that that affordability around the medicine comes with the kind of care that can ensure not only great outcomes for the individual person, but then benefit the total system as a whole. We've got to lower healthcare costs down. Uh, and if we work together, this is the golden opportunity. We can all see it. We can bend all of those curves, uh, cardiovascular curves, metabolic curves, diabetes, obesity, maybe even cancer and Alzheimer's or dementia curves. We can bend all those curves. Uh, but we've got to like get out of our lanes and we've got to start saying, okay, how do we get this from a cooperative standpoint? Uh, each of us doing a part that we do exceptionally well, uh, because there's enough financial gain for all of us there if we just think about it a little bit differently. Well, I I couldn't have said it any better to sum it up, Wayley. I mean, this is this has uh been a fabulous conversation. And when I think about these, just let's focus on pharma as we're wrapping this up. If you look at their mission statements, not a single one of them says, let's uh maximize uh shareholder, well, maximize shareholder value. They're all trying to do that, right? But it's not let's sell more drugs, let's discover more drugs. There's always this tie-in to health care, to human health, to making life better for people. I mean, you see this in mission statement after mission statement, and it it really feels like your organization can be one of those that can help pharma come along and help them achieve those objectives without bumping up into compliance and other kinds of issues. Of course, the compliance folks will always find something, right? They'll always find something to look at. They keep us out of hot water. Let's go to that. They keep us out of the hot water and they're necessary partners. But you're right, John. I mean, look, it's also reverse the reverse is true as well. We we can't we can't bend uh bend the curves by ourselves. We need partners. We need pharma. Uh you know, we we dream of a day where pharma needs us too. Uh, and help plans need us, uh, and and and pbms need us. I mean, we have partnerships with all three of those uh those stakeholders. Um But um I we can't do it alone. We we like to think that they can't do it alone. Um, and I think that's where you know things have got to evolve. Um and I think there's a way, there's a way there, uh regardless of the compliance and regulatory things, there's definitely a path toward all this stuff. Well, and you said this early in the conversation and health systems, right? Absolutely. I mean that their their goal is to look at the uh you know the the total patient, the total patient experience every step along the way in the journey. And if you can help them with that, then uh all the better. Whaley, thanks again um for spending some time, as I said. Yeah. I'd love to have you come back in a while and just see how you're progressing as an organization. Um this has been a lot of fun, and I and I'm I'm sure people are gonna uh appreciate listening to it. Yeah, yeah. We'd love to come on back and uh appreciate the opportunity, John. Great. And uh well, that'll do it for another episode of Healthcare Rounds. Thanks for joining us. Um, if this episode made you think differently about what's really driving healthcare, um share it with a colleague who needs to hear it. And if you're not already following the show, now's the time. If you're listening on Spotify, we'd especially love it if you'd follow us there in a rating or review on the Apple Podcasts or uh on YouTube, certainly goes a long way too. I'm John Marchica, and we'll see you next round.