Why I Co-Founded Ryse Health

When I was leaving WelbeHealth, I was intent on being thoughtful about my next full-time role. I told my wife, “I don’t know if I’ll end up at a 4-person company or a 40,000-person company, but the one thing I know I won’t do is start my own company.” And yet, here I am: co-founder of Ryse Health, a new startup helping patients manage type 2 diabetes and other chronic diseases. The obvious question that springs from that epic flip flop is “Why?”

The simple answer is because people need it. Every year, 1.7 million Americans die from chronic disease despite our country spending $1.1 trillion in treating those diseases. And the indirect cost of chronic disease is over $2 trillion. The scale of the chronic disease challenge we face is hard to fathom.

But are things at least getting better? Unfortunately, no. For instance, the number of diabetes-related deaths in the US grew from 72,000 in 2006 to 76,000 in 2014 to 102,000 in 2020.

Why did I choose these specific years to showcase this trend? Here’s why:

2006

Dr. Elliott Fisher coined the term Accountable Care Organization (ACO) in 2006. The theory was so compelling: if you provide Primary Care Physicians (PCPs) the right information and incentives, they’ll change how they practice, keeping patients healthier and out of the hospital, saving money in the process. Since then, public and private health plans and provider organizations have invested enormous energy in ACOs. There have been a few inspiring success stories, but most ACOs have generated minimal improvement in quality and cost. Multiple evaluations of Medicare ACOs have found that they failed to reduce costs. And in a rare window into private ACOs, Humana’s 2020 Value-Based Care Report revealed members served by physicians in value-based payment arrangements cost 0.4% less than those in fee-for-service. The ACO quality picture has also been mixed.

2014

Omada Health was founded in 2011, followed by Livongo in 2014. Both companies held out the promise that digital tools could transform diabetes care. By 2021, there were more than 350,000 digital health apps available. But despite a panoply of options, most Americans with chronic diseases haven’t used apps. Only 39% of people with diabetes have ever tried an app, and only 34% of those using medical apps are still using it 90 days later. Within a year, that number goes down to 16%. And even for the ~5% who started and continue to use digital health tools, it’s unclear how much benefit they’re getting.

“Gee, Richard. You seem pretty jaded.” No, I’m an optimist! But if we’re really going to solve colossal problems, we have to be clear-eyed about what’s not working, or at least not working as well as we had hoped. And everything I’ve written above leads me to ask, “What if?”

• What if PCPs weren’t forced to choose between trying to help patients with complex diabetes themselves, with limited resources and narrow appointment windows, or referring those patients to endocrinologists who would only see patients twice a year after a four-month wait for the first appointment?
• What if there was an endocrinology practice that would see a patient next week and keep working with that patient every week until the patient was on a good path?
• What if that practice had a team of dietitians, diabetes educators, and health coaches so the endocrinologist didn’t bear the full responsibility of supporting patients through difficult behavior change?
• What if that practice also had licensed clinical social workers to provide additional assistance for patients navigating complex emotional and behavioral issues that were a barrier to their diabetes care?
• What if, instead of giving patients technology disconnected from their local care team, that same practice used a technology stack custom-tailored to support rapid patient improvement?
• And what if, instead of forcing patients to choose between virtual and in-person care, patients could connect with their team in person, by video, by phone, or by chat?

That practice would look like Ryse Health. We’re lowering patients’ HbA1c by two points in their first 90 days, significantly reducing their risk of hospitalization and overall healthcare costs. And our patients are consistently telling us this is the best healthcare they’ve ever received, with one saying Ryse “restored my faith in the medical community” and another “I realized my life isn’t going to end with diabetes.”

We’ve still got a long way to go, but we’re on the road to get there. This is why I teamed up with Erin Kane, MD to start Ryse Health. Stay tuned for more.