Lessons from Sonia Millsom, CEO of Oxeon, innovating at the forefront of value-based care and digital health

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Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.

This week, we’re super excited to get to know Sonia Millsom, CEO of Oxeon, a trusted healthcare firm, powering change through talent, entrepreneurship and investment. She is a veteran healthcare leader who has been at the forefront of value-based healthcare, with extensive experience growing mission-driven innovative companies, as well as serving as an adviser, board member and investor.

Prior to joining Oxeon, Sonia served as the Chief Commercial Officer at Maven Clinic, which achieved the first unicorn valuation in women and family health. Before joining Maven, she was Chief Growth Officer at Boston-based startup Iora Health, where she helped strengthen the organization’s revenue and oversaw an expansion that led to its $2.1 billion acquisition by One Medical. Sonia also held leadership roles at Best Doctors, Health Dialog and UnitedHealthcare. She is also a board member for Clever Care Plan, Quilted Health and Suvida Health. She is an advisor to a number of early stage startups including, Stellar Health, QHLTH and Flourish Fund. Sonia has a MPH from Columbia University and a BA from Boston College.

In this episode, Sonia shares her experiences across the ecosystem from the payer to provider sides, and from large public companies to small startups, all the while empowering diverse leaders in the healthcare space.

‎Pear Healthcare Playbook: Lessons from Sonia Millsom, CEO of Oxeon, innovating at the forefront of…

Sonia’s career in healthcare:

• Sonia was born in Hell’s Kitchen to immigrant parents. Her father is a physician, but regardless of occupation, she believes “immigrants are really the true entrepreneurs.” There’s no playbook on how to survive in America.
• Growing up, Sonia was always interested in the service aspect of healthcare and wanted to be an international lawyer. She didn’t end up pursuing that, but entered the Peace Corps instead — her career in healthcare began as a maternal child health volunteer in a rural North African village. For 2.5 years, she saw firsthand that the delivery system not working can have a deep impact on women and families’ health.

“How do we really bring change to the delivery system here in the United States?”

• After coming back to the US, Sonia got her MPH. She thought she would go back into the international system, but love created a detour — she met her husband, a domestic litigator, and ended up staying in the US (where they’ve been happily married for 23 years). Sonia has spent her career across various parts of the US healthcare ecosystem, and in the last 10 years, in PE and VC backed organizations primarily in the growth area. Questions she’s explored:
• When you come into companies at times of pivot, how are they thinking about their strategies? How do they move from commercial to Medicare? How do you think about go to market strategies, client success, biz dev, sales, marketing, and overall building a flywheel for sustainability?

Seeing firsthand how a large national carrier leverages resources to deliver healthcare locally

• Sonia’s UnitedHealthcare career started with employee benefits consulting, where she learned about underwriting actuarial components. In the payer space at UnitedHealthcare, Sonia was responsible for public sector and labor customers in the Northeast territory. She saw firsthand how a large national carrier leverages resources to deliver healthcare locally.
• Sonia met Jeannine Rivet at UnitedHealthcare, who recommended her for a program called Women Business Leaders in Healthcare. Jeannine was an executive at UnitedHealth Group, and Sonia shares that she’s been a mentor to her throughout her career.

VP of Business Development → Chief Growth Officer at Iora Health:

• Sonia had known Rushika Fernandopulle for years and jumped at the opportunity to work with him, but beyond that, she was ready to move on from working direct-to-payer to dive deep into care delivery. As her career developed, Sonia developed more risk tolerance to want to work in smaller and earlier stage organizations.
• Sonia shares that a go-to-market strategy isn’t always linear. When she joined Iora, their growth strategy was built around the commercial and ACA population. They were working directly with UnitedHealthcare as part of their Harken initiative, but when the Harken initiative decided to withdraw from the ACA exchanges, they pivoted quickly to leverage the very small Medicare presence they had at the time, recognizing the growing traction in the Medicare population.

“Our model naturally had the aspects of all of the value-based care scenarios there. We were thinking deeply about the consumer and patient experience, and then we had the economic model to drive real change. We knew that when you surround the patient with all of those additional resources, you can make an impact for the long-term.”

• They took down their Harken practices and focused on building more practices to serve Medicare beneficiaries. Sonia was responsible for all of Iora’s market entry — which markets they entered, how many practices they put down, all of their value-based contracting (working directly with payers) as well as direct-to-patient acquisition (convincing individuals to move to Iora’s practice).
• It was hard to do growth and patient acquisition at the same time. The “if you build it, they will come” mentality didn’t work. Sonia shares that they built a comprehensive go-to-market strategy that incorporated brokers, direct-to-patient acquisition through social media, incorporated the community and put all of those things together to drive growth. Now, there’s much more standardization to value-based care contracts, but Sonia shares that back then, they built their own term sheets and worked with payers very directly. “It was a lot of learning, candidly, between both us as a provider and with the payers.”
• Over 4 years, Iora expanded into 3 new markets, 30 new practices, and built revenue from $20 million to almost $350 million.

“Most importantly, it brought value-based care to a number of new markets, and the impact that we had on patients was really what was inspiring to me on a day-to-day basis.”

Leading payer contracts during Maven’s high-growth mode:

• Sonia came back to women’s health after meeting Kate Ryder, a female founder who saw early on an opportunity to drive a different experience for women and family health. Kate was starting to think about growth and scaling, the market was picking up, and Sonia came on as Chief Commercial Officer. Maven had previously been focused on the employer segment, and Sonia helped pivot Maven to think about the payer market and make their first move into Medicaid.
• At Maven, Sonia thought about how to create structure with payer contracts as well as how Maven could be integrated with payers’ care management programs. People become more engaged in their healthcare when they are starting a family, and people want on-demand access to a variety of specialists. Maven provides this, from mental health to lactation consultants to fertility to surrogacy. They wanted to create a much more virtual experience out of just care management and be available 24/7, something that was very unique in the market
• Sonia shares that in high growth mode, they doubled down on the employer side of the business, thinking systematically about segmentation on the employer side and then thinking about integrating into the payer market.

Sonia’s path to leading Oxeon as CEO:

• While Sonia was at Iora, she participated in a program Oxeon founded called Break Into the Boardroom, which helps place women onto healthcare company boards. It’s what helped her get her first board position at Clever Care Health Plan, and Sonia shares that it’s been fun to go from presenting to the board to being on the board side.
• Sonia was always familiar with Oxeon. Oxeon had helped place many executives in Iora’s leadership team. When Sonia left Maven about a year ago, Trevor Price, Oxeon’s founder, approached her about taking his place as CEO. Sonia joined to contribute her commercial growth expertise as Oxeon thinks about the next stages of growth and scaling.

“We are a founder-led organization, and we’re moving into becoming a multi-generational firm…

How do you take what’s amazing about what we have today — deep values and roots, which are such an important part of our culture and what we want to maintain — but shift and think about what’s happening in the market today?

How do you create sustainability for the long-term so that we can continue to do what we do and deliver on our mission?”

• Sonia shares that there’s a transition taking place organizationally as people get acclimated to her leadership style, but that she and Trevor are highly collaborative. In the last few months, Sonia has spent a lot of time on the road speaking directly to customers (or people who aren’t their customers) about why they work with Oxeon and what their experience has been.

Oxeon is a healthcare-focused search firm, venture studio and investment portfolio.

• Search firm: Oxeon does about 200 searches a year and has placed more than 1000 executives at innovative healthcare companies, including Iora.
• Trevor Price came from search, which is why he started Oxeon as a search firm. Early-stage companies don’t always have as much resources or capital for executive search fees, so Trevor pioneered a concept of taking equity in lieu of a placement fee.
• The traditional search model is commission-driven and in Sonia’s opinion, very transactional. Instead of capital, when Oxeon takes equity for their search work it has the effect of aligning all of the incentives — they’re vested in making sure that an amazing person ends up in that role. When it comes to the search, Sonia shares that they take their time to understand the founding CEOs as deeply as possible to think about what their value system is and what complementary skill set is required. In certain cases, they also build entire leadership teams, which is when they can see big impact. To date, where Oxeon places more than five executives, the valuation of the company increases 26.6x.

“60% of our founding teams are women, 35% are people of color, so our ability to really think about bringing in new talent and diverse talent is core to what we’re doing as an organization. Placing not just a CEO, but a number of leaders in the beginning, and making sure they’ve got the right chemistry… is part of what we believe is our secret sauce.”

• Oxeon has more than 25,000 conversations a year with healthcare executives, investors and entrepreneurs in their extensive network. They frequently hear about pain points for their customers. “I wish somebody was building a maternity company, I wish somebody would build a company that was thinking about substance use disorder…” They knew how to build a team and they knew how to bring investments, and thus the venture studio was born.
• Venture studio: Oxeon has launched 9 companies to date: 3 of them have exited and 6 are between seed and Series C. These companies range from maternity and midwifery to advanced illness and hospice care, but are all centered around a deep and value-based care thesis.
• Oxeon only incubates one or two companies a year, and past companies have primarily been based on the value-based care thesis. Sonia shares that this area of healthcare really requires strong financial acumen in order to be successful. Oxeon has a deep network with over 100,000 people, advisors and investors from all different types of healthcare. They have the ability to get to the problem statement quickly. They constantly triangulate between the leadership team, the investors, and an anchor client (or first customer) that sets that team up for success. The venture studio team continues to be a resource for their companies.
• Investment portfolio: Oxeon doesn’t take any outside capital, but they take equity for fees or take money off their balance sheet to put into select seed investments. Sonia shares that this has been an incredible value driver for the organization with over $100 million in capital returned directly back to employees.

“We’re focused on doing what we’re doing well in these three areas of the business, but doing them a little differently, better, and again, evolving it for the current point in time. Some of the things we built 10 years ago, we could be doing in a very different way.”

• Sonia believes that Oxeon’s macro environment is ripe for real innovation. There is opportunity to bring new ideas to the market and healthcare companies are trying to fix the real problems.

How to achieve effective leadership

Lead differently in different scenarios. Adapt to your environment.

• Sonia has worked at a wide range of companies, from publicly traded companies to much earlier startups, and notes that team chemistry varies in different environments.
• Sonia shares that places like UnitedHealthcare, a publicly traded company, is incredibly metrics driven. There’s usually a playbook of what you’re doing, and you need to be able to execute on that playbook in order to build sustainability.
• At places like Iora in the early days, there is no playbook. Sonia shares that you need someone who has creativity and ability to adapt pretty quickly. The path is never linear.

Sonia’s three key points of leadership:

1. Leverage data to make informed decisions.

“I always tell my team: you have to be really comfortable with the gray because it’s not going to be clearly defined. You have the responsibility for driving that and defining it. For me, what that means for the leadership style is one being very data-driven.”

2. Have diversity of thought and skill sets around the leadership table.

You have to have trust and respect to be able to debate and have the right conversations.

3. Have the ability to take in as much external information as possible.

“It’s really the triangulation of data, the voice of the customer (thinking outside in), as well as diversity, that drives high performance and brings a team together in a way that’s very trusting and respectful. It brings the most innovation to really be empowered and do amazing things.”

Empowering female founders and leaders:

1. Back it up with data. In 2018, BCG did a study looking at 350 early stage companies that found that women delivered twice as much value for dollars invested than all-male teams. Sonia shares that this kind of data helps empower diversity decisions. “We have to look at the performance of some of these companies and understand that when we have diversity, and we have women led companies, we actually see better outcomes.”
2. Offer leadership opportunities. Sonia acknowledges that she sits in the role she has today as a result of someone like Rushika from Iora, who trusted her abilities and gave her a big opportunity early in her career.
3. Deploy capital. Sonia advises a number of female-founded companies and often shares insights from her career. She knows firsthand how important it is to put women on boards to help empower the next generation.
4. Take chances. Now sitting in executive search, Sonia shares how often she sees PE firms or VCs thinking about pattern recognition when it comes to leadership — people who’ve done it before, the same names over and over again. There may be a different candidate who hasn’t done it before but actually has all the skill sets and just needs an opportunity. “Take a bit of a chance and invest in them in a very different way.”

Go-to-market strategy

Selling to employers or to payers depends on the market segment and it depends on your product.

• Ask yourself: what’s the population you’re serving and the problem that you’re trying to solve? Maven was focused on providing flexibility for families across their entire health curriculum; mental health has been a big focus for many employers that gave Maven a lot of market share.
• Employer vs. payer market: Sonia shares that the employer market can be easier to start with. Payers are complex, and the decision making process is deep, so your product has to have strong clinical value. Sonia shares that the best opportunity in the payer market might be to integrate with something that they’re already offering, while employers are more willing to try something new.
• Sonia shares that over the years, she’s seen employers become less focused on a particular area and move on to something else. In the case that this happens and you’ve got a great entrenchment in the employer market, it’s important to try to shift to the payers so that you can get deeper into the healthcare ecosystem. It’s a natural evolution for many of these organizations from an operational perspective depending on the type of payer clients they’re serving.
• Your go-to-market strategy has to be comprehensive in terms of how you’re approaching large groups or the middle market or smaller groups. These different market segments can be very challenging, but the priority is to get in there quickly to build your market brand awareness. Make decisions based on your service offering, your sales force, and your growth officer, finding the area where your business model can initially gain the most traction. It’ll be easier to shift markets later on.

Sonia’s predictions for innovation in value-based care:

• Sonia still has a huge passion for women and family health. With 50% of the burden taking place in Medicaid, it’s still a place that has a lot of opportunity for improvement.
• One of the historic issues with Medicaid is churn, people coming on and off plans because they don’t maintain eligibility. Eligibility for a mom and a baby is not on a continuous basis, which makes it harder for payers or providers to take on risk or think about value-based care initiatives. Oregon recently passed a law allowing continuous coverage up to the age of six, and Sonia believes action in this direction will make a huge impact.
• Sonia also highlights the need to focus on maternal and infant mortality; the US has the highest rate of maternal mortality of any developed country.
• Sonia is also very excited by vertical integration. She references Walgreens’ partnership with Village MD, which has value-based care around primary care and acquired Summit, which has local resources and deep integration into the delivery system. She believes integrations like this will have a ripple effect on overall health delivery systems and interesting local geographic innovation.

Sonia’s lens to making career decisions:

1. What subject matter area are you interested in learning about? Sonia made choices to experience the employer side, payer side and provider side to see things across the healthcare ecosystem.
2. What area of functional expertise are you interested in? Sonia was interested in the growth stage, thinking about business development, marketing, client success and all of the components.
3. What’s best for you at this phase of your life? Sonia shares her experiences turning down new opportunities at UnitedHealthcare in order to avoid relocating her family. She chose to work at companies based in Boston in order to prioritize her family life.

The unifying factor across every choice was to stay mission-driven. Sonia shares that it’s important to evaluate these three buckets to place yourself in a position to learn and grow, and she emphasizes that it’s okay to take risks.

“Life begins at the end of your comfort zone. Don’t be afraid to put yourself in an uncomfortable situation — that’s when you’ll grow the most.”

Interested in Oxeon or joining their team? Learn more on their website, LinkedIn, Instagram and Twitter.