Episode 41

Delivering Healthcare to the Home

with Dan Trigub

August 23, 2022

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Dan Trigub
CEO and Co-Founder, MedArrive

Dan Trigub is the Co-founder and CEO of MedArrive. Previously, he was GM and Head of Uber Health as well as the Regional Vice President of Healthcare Partnerships for Lyft. Dan was the Global Business Development Lead for eBay. He also co-founded OpenPlacement. Dan received a Bachelor’s in Economics from Vassar College.

McKinsey came out with a really good report about three months ago now saying that 250 billion dollars of care services will move into the home between now and 2025.



[00:00:30] Lynne Chou O’Keefe: Well, Dan, thank you so much for joining us at this episode of Day Zero, where we interview founders and talk about the founder’s story. And so, just here to join by Dan, the co-founder and CEO of MedArrive. Thanks so much, Dan, for joining us.

[00:00:47] Dan Trigub: Lynne, my pleasure. We’ve come a long way to this conversation today and always great to be with you. So, thank you for having

[00:00:52] Lynne Chou O’Keefe: We have, we have. That’s absolutely true down. So how about this? I’d love to start from the very beginning in terms of what inspires you to be an entrepreneur. Did you wake up one day and say, this is what I want to be? Talk a little bit about that journey.

[00:01:08] Dan Trigub: Yeah, happy to. And I’ve shared this story throughout my career. I think a big thing that defines me that tells people a lot about where I’ve come from in my beginnings, I’m a first-generation American, come from a family of immigrants. My parents, my sister, all immigrated from the former Soviet Union, now it’s the Ukraine of all places, and that’s a whole another conversation of what’s going on there. My family is all from the city of Odessa, which is on the black sea there, certainly been in the news for not-so-great things recently. But they came here and literally left everything, left everything that they knew as children, really for a better opportunity for their family and for their kids. And that really is that seed inside of me. It’s that really believing that, and I tell my kids this every single day, you can do anything. And I, for all the faults of our country, I still believe this is the best country in the world, and you can absolutely do anything you want if you simply just work hard. And that’s another thing I always tell my kids when they go to bed: work hard when you wake up in the morning. And so, I think that’s always been inside me and has really inspired me to want to build a better life for my family than what my parents had and having this unique opportunity to do so here. And so, I think every step in my journey to where I am today has led me here. And it started with building my core skillset in consulting and investment banking in my early days coming out of college really, started to spend a lot of my time in the healthcare vertical, spent a lot of time working on healthcare transactions at my investment bank. And then also through my family, actually my father-in-law, who I’ve known for 15 years, just as long as my wife. He built a very successful business. He was an entrepreneur himself. He built a very large home care business here in the bay area. Non-medical home care, helping folks with most of the activities of daily living private duty, literally from nothing to over 500 caregivers serving the greater bay area. And I really saw the opportunity within healthcare. The other thing I’d say, just as a side note, my parents came from a world where going to a hospital was an absolutely foreign concept unless it came to end of life care. And this idea of why would I go to a hospital where people are sick or where I can get sick, house calls was the norm. And they always saw physicians or doctors coming to them. And so, when they came here, they thought it was really odd going into a doctor’s office. And, that I think was a bug in the back of my head that always really showed that there’s a lot more opportunity to create a better infrastructure here. And so for all those experiences and doing a few other startups throughout my career up to this point, I think all those things really led me to want to do more, to have a bigger impact and really build something of my own and really have my hands on something where I can control my destiny, I could control the ultimate outcome.

[00:03:40] Lynne Chou O’Keefe: Yeah, absolutely. I mean, so amazing through your family influences, just being seeped in this industry for so long, and maybe tie in. I mean, the other interesting area that you were in is you were at Uber before. And so how did that all roll in into then MedArrive for you?

[00:03:57] Dan Trigub: Yeah. So, and even prior to Uber, I actually worked at Lyft. I was doing essentially a very similar role at both. I was the first healthcare hire at Lyft. Back when Lyft was a few hundred employees at the time and in two and a half years on the healthcare team and helping to build that at Lyft. We built a half a billion dollar business around non-emergency medical transportation. Small side note, most people don’t know but the U.S. Government, CMS, spends $6 billion a year on transportation services for Medicare, Medicaid recipients. 80% of that volume, those rides, are what’s known as curb to curb ambulatory transportation, meaning these are people who can get in and out of a car on their own. And the vast majority, if not all, of that was going to taxis. So this was one of the last meccas, if you want to call it, for ride share to really disrupt traditional taxi services and within the healthcare vertical. I really saw the power at Lyft and Uber of a marketplace of technology, of a platform within a healthcare vertical. And even more interestingly, I saw the power for more underserved, vulnerable populations. We built tools where a health planner, a healthcare provider can order a ride on behalf of a Medicaid recipient, on behalf of a 90 year old woman who can’t get to her medical appointment that lives in the transportation desert. This was done all for them. They didn’t need an app. They didn’t even know anything about Uber and Lyft. And we built a very successful business that had some amazing stories of really helping some of our most underserved populations. I went over to Uber. We did it at a much larger scale. We did meal delivery and healthcare. We did pharmaceutical delivery as well. And again, that really showed me the power of a marketplace within healthcare. And that really inspired me to say there’s so much more we can do. And as a side note, Uber and Lyft are not healthcare companies. If you look at their stock price these days, they’ve got lots of other things to worry about in the healthcare division. Even though, you know, they’re continuing to do some work there, I fundamentally believe they can do so much more. But, it wasn’t the core focus, and you couldn’t blame Dara for not devoting more resources given, it’s a fraction of their P&L. I wanted to do more. And I wanted to build a platform within healthcare and really focus on these more vulnerable populations. And that’s really what inspired me to do what we’re doing today at MedArrive.

[00:06:09] Lynne Chou O’Keefe: That’s amazing. So talk to us a little bit about MedArrive and how you’ve built the business from the very beginning, and then over the last couple years,

[00:06:18] Dan Trigub: So it’s only been two years now, which is crazy. It feels like 20 years. And there’s been a lot of twists and turns, and ups and downs, and a lot of fortuitous interactions and connections. But, it’s been a great journey, and I think it all starts, first and foremost, if I was going to talk to any founder, if anyone was going to ask me what leads to the opportunity to build a successful business, it all comes down to people– and I truly believe it’s all about your co-founder; it’s all about the team you’ve built; and it’s all about the culture and infrastructure you’re building, and every single hire you make– that is what leads to success. Ideas are a dime a dozen. I’d rather have, part of my French, a shitty idea and a world class team than the inverse of that– the best idea in the world but a really crappy team. And that I think is really what has led to our opportunity to build this business and ultimately lead to some of the success we’ve had. So it all comes down to my co-founder, Ina. I was very fortunate, about two years ago, I was approached by Ina and actually our original investor in the business, an organization called Redesign Health, out of New York. They are adventure fund, but what’s unique about them is they have a full-time team of people who come up with ideas internally that they really perceive as opportunities in healthcare. And if they like it enough, they’ll seed fund it, hire the founding team, companies off to the races. And so Ina, my co-founder, was actually on that founding team of Redesign. She launched a few businesses in the healthcare vertical. And then given COVID and the need to bring high quality, low cost care into the home, she saw this unique opportunity, which at the time didn’t even have a name, which ultimately became MedArrive. Ina wrote the original business plan and approached me when I was at Uber and said, listen, I think you have a really interesting background here. And we ultimately found that our skill sets very well complemented one another. She has a deep operations background. She worked up blue Apron in the early days, ran their entire supply chain. And we really came together and said, listen, we think we have a great fit just between the two of us. And that was the most important thing. And ultimately also had a great business idea. And so we came together through that relationship, raised in seed capital, really defined what the business model was, and really refined what our go-to-market approach would be, had some early traction, started building a team, raising some more capital and ultimately got to where we are today. So, I think, again, we’re looking came down to those human interactions. The people, my co-founder and the early team, were able to build that, I think, were instrumental to getting us to where we are.

[00:08:42] Lynne Chou O’Keefe: Yeah. And maybe talk a little bit, Dan, about the business, how it started and where you are today.

[00:08:49] Dan Trigub: Yeah. So at a high level we fundamentally believe, like many other companies out there today, that clinical services are moving into the home. You ask me, what does a hospital look like in 10 years? I think fundamentally it might just be an OR and ER, and ICU, and the vast majority found everything else moved to the home. McKinsey came out with a really good report about three months ago now, saying that 250 billion dollars of care services will move into the home between now and 2025. There’s no question that this is the trend. And so lots of companies in this space. Now as a side note, it’s not a winner take all. It’s not one company that’s going to do everything and there’s lots of white space. So at the core of MedArrive, we believe in bringing high quality clinical care into the home. However, we have a much different approach and different tact at this market. At the core of MedArrive, we’re a three-sided platform. There’s three key stakeholders who we build and solve for. The first a patient or a health plan member. That is our ultimate user. And we design everything for the second component of our three-legged stools. What we call our demand partners are essentially our customers and those at the core. Our value based providers and payers. Those are our core customers today, Managed Medicaid Plans, MA plans, Medicare Advantage, and ACOs. We want to build tools for them to better serve those they care for into the home. So just to be clear, we’re not a consumer business. We’re not trying to build a consumer brand. We’re not trying to go D to C, build a beautiful app, put it in the app store, someone downloads it and gets on demand. I’ve worked at Uber and Lyft. It’s hard enough to get a Millennial to a bar on a Friday night. Trying to deliver on-demand healthcare, and oh, by the way, doing that margin positive and actually generating a profit and doing it with good SLAs and rural markets, is near impossible. So our approach was let’s build tools for payers, primarily, who have these populations that are mostly vulnerable and underserved. This isn’t designed for somebody who can afford for on demand concierge care, or knows how to use an app. We are primarily focused for populations that are Managed Medicaid as I said earlier, who are typically high ED utilizers. These are people going to the ED five, six times a month where the total cost of care is exorbitant. So we want to serve these populations. And then finally, the third piece of that three legged stools are providers who’s going into the home. And at the core of our providers are EMS professionals. So we are leveraging EMTs and paramedic who we believe are in the most under utilized resources in healthcare cost effective, highly clinically trained, skilled, and scoped, and everywhere. They’re in rural markets and large metropolitan areas to provide these valuable services into the home. And we’ve developed an infrastructure to tap into that labor pool. So that is the core platform. That is the core customer that we’re going after. And essentially, yes, we’re a technology company, but we’re just as much a service business. We’re a technology enabled service provider, and we bring all these three stakeholders together.

[00:11:41] Lynne Chou O’Keefe: Yeah, Dan, I mean, amazing though, as you think about your journey as an entrepreneur and what inspires you and how you started this, right? In terms of how your parents received healthcare, all the way to your familial influences to come to this moment, and this model and this solution for healthcare, and how necessary it is truly, it’s so integrated. So let’s talk about COVID in two ways, actually one is COVID. How that became almost like a wedge for your business, and then how you evolved from that. But then secondly, what it was like to build a company in COVID truly in the very beginning stages. So let’s first talk about the first, which is what that has meant for the business, and then maybe we talk about company building during COVID.

[00:12:29] Dan Trigub: Yeah. So, a couple things, one I’d even take the story back, even pre COVID. And I talked about the delivery model of care in the former Soviet union where my parents grew up. Well, even historically in the U.S., healthcare was really delivered in the home. And, house calls, doctors on demand was not a novel concept in the early days of our healthcare system in the U.S.. And frankly, the only time people usually went to the hospital was for end of life care. And that was really the original inception of hospitals and why they were created. Now a lot has certainly changed over the last century when it comes to delivering care into the home. And so COVID was really an accelerant to really shifting expectations. And the other tailwind even pre COVID was the whole shift of on demand services, models like Uber and Lyft and Amazon, and really shifting consumer expectations of services meeting people and goods meeting people where they are. And so, COVID was really the accelerant that really continued to move that trend forward and enable a service, a platform like MedArrive, to thrive. The other key trend during COVID was telehealth services. I think at the peak of COVID, we saw around 60% utilization in telehealth services. Today, telehealth utilization is still around 20, 30%, certainly a lot more than it was pre COVID. And it’s here to stay. But as we like to say at MedArrive, there’s no humanity in telehealth. It’s all virtual. There is no human context. And one of the founding visions of MedArrive was always to be that bridge between onsite clinical care and pure telehealth service. And we want to be that physician extender into the home. We want to be the eyes and ears of a specialist, of a provider, through telehealth with our network of providers. EMTs and paramedics cannot prescribe. They can’t diagnose. They can’t do HCC coding. But they can do all that with physician oversight through telemedicine. And so that is a core component of our infrastructure. So I think a lot of these trends, telehealth, consumer expectations services coming into the home, and COVID really allowed us to build this model and do it at a much quicker pace than we could have pre COVID. And originally, one of the first use cases for us was actually talking to large health plans and then saying, okay, listen, I like your model. I like what you’re doing, but you’ve got to prove it to us. We have home bound populations and really underserved rural markets who can’t get to a vaccine site to get a COVID vaccine. Can you deliver vaccinations into the home, and oh, by the way, your cost to do that relative to a hospitalization for COVID is well worth it. The ROI on that program makes a ton of sense for a plan. And so, we use that as an early use case for MedArrive and actually got great traction there. We got MSAs with large health plans. We executed on that. We proved ourselves. And now, we’ve been expanding, moving away to much more higher value use cases. We’re longitudinal care where we’re seeing people multiple times, not just for one visitor for a vaccine. And then, last thing I’d say is, Scan Health Plan was one of those first customers. And now Scan is an investor, given how well that program went. So, COVID really changed a lot for us, and it allowed us to get to where we are today. On the team front, It’s a very interesting time to be building a business. And I think, today we have just under 40 corporate employees. I think they live in about 13, 14 different states across the country. There is no doubt in my mind, you can build a very successful business that is fully remote, and there are ways, there are tools, there are ways to build culture to build that sense of belonging, to build that sense of mission and culture. You can do that remotely. And frankly, we can hire much better talent. We can now hire talent from all across the country and more diverse talent. And that I think is extremely important, especially within healthcare. And especially when you’re building a tool to serve vulnerable populations. I’m proud to say that about 60% of our workforce today is female. And over 30% of our workforce today is from underrepresented minority groups. And we can always get better at that. And I firmly believe that our team, our corporate staff, has to look and come from the communities that we serve because ultimately, I can’t pretend to understand their needs as well as people from those communities. And you can do that even better in a remote first environment. And I think that’s been really core to how we’ve thought about building our team during COVID.

[00:16:35] Lynne Chou O’Keefe: Yeah, Dan, I would always say you’ve been so thoughtful about your team, your culture, and it really impresses me every time in a board deck. You have a couple slides on culture and team and how you’re building that in a remote workplace that is really distinctive in how you’re building your team and what you guys are tackling.

[00:16:54] Dan Trigub: So Lynne, culture has been so important to us at MedArrive and fundamental to the team we’ve built. It really came from my experiences of both working at Uber and Lyft. It’s well documented. It’s no secret. The early foundings of both companies and the cultures and the communities they built in the early days. I fundamentally believe that the only reason Lyft exists today, because it should have been all of Uber’s market, frankly, but the only reason is the culture and the community and the infrastructure they built in the early days with the people at Lyft. And one thing I say as a great example of that, when I was at an all hands at Lyft versus Uber, and they did all hands frequently, I believe at Lyft, we did them monthly, at Uber I think it was biweekly. I never once met an Uber driver at an Uber all hands. And in Lyft all hands, I would meet a Lyft driver almost every single time and hear about the stories and hear about the impacts that those drivers were having on the platform. And I fundamentally, again, that comes down to that core, those core tenants that seeped throughout the entire organization. And that’s really been important to us at MedArrive, and how mission is critical to how we reach our employees and get them excited about their work. The other thing I am very proud about is our corporate employees go into the field. They go on actual visits into some of the poorest, most underserved communities. As an example, in Houston, they spend a bunch of time out there going into the homes of the people that we impact and that we touch. Not only does it give them a sense of what we’re actually doing aside from running spreadsheets and writing code all day, but it also truly lets them experience the pain points of our platform, where are the opportunities for improvement? And on the last quick example I’ll give you, I never appreciated Lyft as much as I did. Until after I signed up and became a Lyft driver, and did a few rides on the platform, and truly saw how the app works, how the experiences as me as a driver, the human interaction I’m having with the person in the backseat. And I think that is so important when you’re building a business, and especially in those early days, because that those early days set the foundation. They set the tone for the future and for all new hires, and when we become a thousand people, all those things really make a big difference.

[00:19:05] Lynne Chou O’Keefe: That’s amazing, Dan. Definitely at Define, we and spouse trying to use our own solutions that we partner with and really try to go ground up, if you will, and just that’s really inspirational in terms of your approach to team build culture. So in closing and to wrap up, what are some advice you would give on new entrepreneurs that are maybe building their own businesses today?

[00:19:30] Dan Trigub: Yeah. So I think a couple key things come to mind. The first and foremost is believing in the mission, the core of the business, and believing in the impact it can have and not doing it for the quote unquote, “wrong reasons,” not doing it for that big exit one day, not doing it because it’s the cool thing to do, or you want to have a good dinner conversation and even more so if you’re doing anything in healthcare. As my friends at Kaiser Permanente used to tell me at corporate T-T-T, Things-Take-Time. And that was literally executives at Kaiser telling me when they were trying to work with me as a vendor. And so healthcare, it’s not building the next social media app. It’s not building a viral platform where “if you build it, they will come,” you spend some money on marketing and the funnel will fill instantly. It’s a long haul, and you have to be in it for that long haul. And you have to be in it for the mission and at the core of what you’re doing. That’s first and foremost. The second, third thing, and fourth thing– people. It’s having the right people around you. And I’m rarely ever the smartest person in the room, and with my team when I’m on calls. I have been so blessed with the group I’ve been able to build at MedArrive. You can’t over invest in people, especially in the early days. And then the last thing I’d say is, one of my mantras is just relentless pursuit, and I firmly believe in that. I think it’s the relentless pursuit and the mindset that it will happen. And, I played sports my entire life, played sports in college, and I have a lot of sports analogies. And in sports, athletes, especially at the highest level, always talk about visualizing– visualizing yourself holding the trophy, visualizing yourself making the game winning play. And if you do it in your mind, it’s a lot easier to do when in reality. And I think that relentless pursuit and that mindset is extremely important because, if it was easy, a lot of people would’ve done it already. If it was easy, this, your business, would’ve already been built by now. And so, I think those are some of the key things that I’ve taken with myself and with our team. And actually, you know what I’d say, sorry, one more. It’s also taking care of yourself, physically and mentally. I burnt out at Uber and Lyft. You know, I was working, and I worked in investment banking prior to that, I was working a hundred hour weeks. And when you’re young in your twenties, that’s certainly somewhat sustainable, and you can do that. But you have to take care of yourself physically and mentally. I used COVID as an opportunity to get back into the best physical shape I’ve ever been in my life. No question in my mind that’s led to my success and my ability to execute and work at this type of level. You have to have a good mind and a good body, I think. And I think good things will happen.

[00:22:02] Lynne Chou O’Keefe: Dan. It’s just so inspirational from the beginning of your journey, what inspires you, to what you’re building, and how you’re changing the healthcare system, to just how you approach culture team building, and the tenants of being an entrepreneur. Thank you so much for joining us here at Day Zero, and thank you for your time and the inspiration.

[00:22:24] Dan Trigub: Lynne, thank you. And thank you and Define for being a key member of that team and the people around us at MedArrive and look forward to the next time we can have a conversation like this.

[00:22:32] Lynne Chou O’Keefe: It’s all you guys for sure. Thanks again, Dan.

[00:22:36] Dan Trigub: Thanks Lynne.

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