Lessons from Vik Bakhru, Chief Health Officer of Circulo: Building a new Medicaid model centered around the patient
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.
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This week, we’re excited to learn from Vik Bakhru, Chief Health Officer at Circulo Health. Circulo is building the Medicaid insurance company of the future to provide tech-enabled, world-class care to the nation’s most underserved populations.
Vik is also currently a member of the clinical advisory board at Bright Health and a practicing Staff Physician at UCSF Medical Center. Prior to Circulo, Vik was the Chief Operating Officer and Chief Financial Officer at SameSky Health (formerly Consejosano) for almost 4.5 years and COO of First Opinion.
Vik’s incredible career from medicine to business school to startups:
“It really started with a fascination around finding ways to have an impact on populations and groups of individuals that need more support than they’re getting from our current healthcare ecosystem.”
- Early in his career, Vik started the Foundation for International Medical Relief of Children, a nonprofit building pediatric clinics in the developing world. Vik explains that his decision to pursue an MBA was largely driven by not understanding how to best manage the team. After an MBA student from Wharton Healthcare Management who had joined the board pointed out some management mistakes, Vik went to pursue his MBA through Wharton’s Healthcare Management Program (plug for HCM Alums!), branching out to the non-clinical realm.
- Early on, Vik learned that he really enjoys solving problems in the 0 to 1 space, especially within the healthcare ecosystem to battle challenges, diseases, and problems patients face. Through his coworkers at SameSky Health, Vik eventually found his way to Circulo to develop a technology-first healthcare product catered to underserved individuals.
Circulo is the Medicaid Insurance Company of the Future
- Vik shares that Circulo’s vision is to be the Medicaid insurance company of the future providing tech-enabled, world-class care to the nation’s most underserved. Circulo focuses on the member experience, understanding and addressing their needs through accessible technology.
- As of 2021, there are over 82 million Americans enrolled in their state’s Medicaid and CHIP programs. This number is up by 11.85% from 2020, when close to 74 million were enrolled in Medicaid or CHIP. For a variety of reasons, individuals who need benefits might still be ineligible for Medicaid and the legal documents surrounding benefits are often incomprehensible — that’s why Circulo has focused on the member experience in both a health insurance context and a direct service delivery context.
- Through inorganic growth, Circulo acquired a company called Huddle Health to bring a fundamentally different primary health experience to not only those covered by Medicaid, but also uninsured individuals in adjacent spaces.
- Vik believes that Circulo is still in an exploration phase, figuring out exactly what combination of highly integrated experiences, directly managed experiences, or owned experiences will have the most impact in the member’s daily life.
- Circulo has been approaching this mission market-by-market, starting with Ohio and New York. Vik believes Circulo can play an important role in that ecosystem, and they’ll see how long it takes to realize some of that impact.
Lessons on building new solutions in Medicaid
Understand your member’s needs and the economics in how you’re serving your members.
- Vik believes that understanding a member’s needs requires cultural competency, engaging with the right tone, words, cadence, timing, and starting the relationship off on the right foot. When it comes to the user journey, it’s important not to place more burden on the members you’re aiming to serve and prioritize building a trusted relationship.
“It’s not about [the member] fitting into the mold that I already have. It’s around creating a flexible mold that fits the needs of each individual at the moment in time where you’re lucky enough to encounter them, because the timing won’t be up to you as the provider, it’ll be based on the presence of certain needs.”
- Vik shares that oftentimes, some of these needs will be more severe medical issues that prove especially difficult to confront with Medicaid. Forming partnerships with multi-specialty groups in a fee for service environment can be challenging — understand the economics involved in how you’re serving, so that you can bring the most relevant partners together and deliver the most impact.
The best touch point is to meet members in their communities.
“Go to the places where members work, live, and engage with their own community… It isn’t necessarily an app that you build, and deploy and hope that it’ll be adopted. Certainly, there are pathways to achieve that that are important and should be in tandem with some of your local community based efforts. Similarly, understanding the needs of a community before you plop down is also crucially important and deserves a decent amount of attention.”
- Vik believes that doing user research and building frontline communication is paramount, and that takes time and relationship building. Work with existing community based organizations that have a deep understanding, and importantly, have the trust of the community that you’re trying to serve.
Beyond physicians, understand the role of a multidisciplinary team within healthcare.
- Vik describes a core question that Circulo uses: how do we huddle together? How do we huddle together with our members, understand their needs, and then deliver according to those needs, the various services that might be required?
- These needs might require social workers, nutritionists, physical therapists, or other healthcare services that the communities Circulo aims to serve haven’t had frequent access to.
“The income lines in our country and therefore the income inequality really determine what is available to you.”
Being aware of your risks when contracting with payers
- Vik acknowledges that the contracting process with payers can be high-risk to your company, considering the legal challenges, the red tape, and stakeholders involved. From cybersecurity to the 10 million limit, there are tactical strategies to payer contracting, but they’re dependent on your company’s use case.
- Be careful with resource allocation, especially when it comes to your first deal.
“Don’t be afraid to ask the question, why is this important?”
Building a medical team within a startup
There’s not one way to do it — your team should be custom built for the individual you’re trying to serve.
- Vik shares that the needs you’re trying to serve will inevitably change over time, require a variety of skill sets, and differ within the community; therefore, your medical team is going to have to flex in certain ways.
“Start with lowest common denominator thinking and ultimately get more specialized over time. So ideally, you’re starting with individuals who have the broadest certifications and licenses possible.”
- Clinical services have state by state licensing requirements, and so figuring your geography out first is critical to building your medical team, whether that’s driven by your first customer, population density, etc.
- Vik believes the next step is to build a medical team with the broadest possible certifications — for example, if you’re a women’s health platform, you can start with a family practice doctor.
- Figure out what your service is vs. what someone can achieve in a health system setting, so you can understand how to partner appropriately and offer the right scope of services to be able to deliver value to your users. “The value to your user that you provide may not be the surgery itself, it might be all the things leading up to that hopefully mitigate the need for surgery.”
Create a member centered ecosystem within your startup, and hire based off of that.
- Vik believes that the decision to bring on medical expertise in a startup depends on what the members need and what services you provide. As you work towards your first product offering, that might not necessarily be hiring a C-level health director.
“What’s your user journey? What services are you providing? And how are those services regulated in the market that you’re hoping to bring them to fruition? That will drive some of the decision making around whether you need a CMO, CHO, Chief Clinical Officer, or candidly, maybe not that lead position, but someone who’s staffing.”
The Chief Health Officer is the core patient advocate, unclouded by financial incentives
- Vik shares that the primary Chief Health Officer role should be focused on patient safety, ensuring products and services are appropriate and meeting the health needs of the company’s patients. Vik believes that having served in a clinical context offers an important perspective to how the company might be able to innovate.
- Vik shares that he will not allow his judgment to be clouded by some of the financial considerations and really understanding what’s best for the patient. You need the Chief Health Officer in your organization, who is really thinking intentionally about that member experience. In some ways, it’s actually a product role, and it hybridizes the medical and clinical aspects.
Founders without a medical background can still thrive with curiosity and an ability to learn.
- Vik shares that for most founders who may not have a clinical background, it is most important for them to anchor on the member experience.
- With that we will leave you with an inspirational quote from Vik to leave you pondering!
“If we start with always what has been, and we can’t really capture and envision what could be, we lose out on the possibility to innovate.”
Interested in learning more about Circulo? Learn more on their website, Twitter, and LinkedIn.
If you have suggested guests or topics, please email vivien@pear.vc!
