Dr. Melynda Barnes, Ro, on why we should all be bullish about telemedicine

In this episode, we interview Dr. Melynda Barnes, Senior Vice President of Medical Affairs & Research at Ro. Ro is a patient-driven healthcare company that puts you in control of your health, building technology to make healthcare accessible, affordable, and maybe even enjoyable. Ro’s nationwide physician and pharmacy networks power three digital health clinics — Roman, Rory and Zero — providing a personalized end to end telehealth experience from diagnosis to delivery.

Ro has also launched a free telehealth triage service for people who are seeking guidance and information about the novel coronavirus (COVID-19).

Editor’s note: our episode with Dr. Barnes was recorded just weeks before the virus broke out in New York City. Where relevant, we’ve added additional editor’s notes in the transcript below to share more about how Ro and the team responded to this situation so promptly.

Prior to Ro, Dr. B. practiced medicine for over five years as a double board-certified Ear, Nose and Throat doctor (“ENT”) and a Facial Plastic and Reconstructive Surgeon. She joined Ro in November of 2018. Her role is to provide all of the medical and scientific expertise for all of Ro’s digital health clinics, including quality and safety.

Start —6:30 Childhood dreams and early career

• What did you want to be when you grew up? Dr. B. has a list of four things she remembers wanting to be when she grew up. The list was: 1. President 2. Baby doctor 3. Children’s book novelist 4. Olympic gymnast. In addition to her early aspirations, she traces her career path back to age eight, when she really loved going to the pediatrician, who she describes as “funny and smart.” Her mom bought her an anatomy book and she felt she was joining a secret society of people who knew how the body worked.
• Always expected to be a doctor: Dr. B. went to Stanford for undergrad, where she majored in Biology & Spanish Literature. There were no doctors in her family, but she always felt enthralled by both science and the human body. She pursued becoming an ENT because these providers work across populations, people, and conditions. She trained at Stanford and completed an extra year at Oregon Health Sciences to become board certified in facial plastics and reconstructive surgery. Her first academic job was at Yale, where she kicked off her practice.
• Exposure to the business side of things: At Yale, she enjoyed teaching residents and patients as she took care of them. She successfully ran for a position on the Board of Directors at Yale Medical Group, which is where she fell in love with the “other side of medicine,” such as the finance and network components. She found it fascinating to be in a room full of people not directly in medicine who were making a lot of healthcare decisions; she quickly recognized the value in being a clinician in this setting.

7:00–8:40 Making the transition away from the hospital setting — opportunistic or part of a plan?

• Transitioning away from the hospital setting: Dr. B. recalls that she knew she wouldn’t be solely a clinician for her entire career as early as the second week of medical school. It wasn’t that she didn’t like medicine, but because she saw how big medicine could be, beyond treating someone one-on-one. Joining Ro was perhaps opportunistic, but she always knew she would do something else.
• How she knew it was the right time: She knew that the time was right when she started to feel more excited by discussing how to improve clinical productivity than she did spending a day in the clinic. Dr. B. says she prefers spending time thinking about how Ro can address outreach to patients and access in healthcare, which she says feels really special. While working as a surgeon, most of her clinical colleagues loved to treat patients; that’s all they thought about. However, when she would leave the hospital, she was still thinking about these other problems, which told her that it was probably time for a switch.

8:45 —10:00 Biggest learnings in making the transition from hospital work to working with such a multifaceted team at Ro

• Unique understanding of the ideal physician/patient interaction: Clinicians have to be the advocate for the patient. Dr. B. says a lot of times clinicians know more about the patient journey than the patient themselves. Of course, physicians can’t understand the patient journey from the lens of having the disease or condition, but they can understand what the ideal interaction should look like with the healthcare system.
• Optimizing for patients: Dr. B. thinks of her role as embodying the spirit of the patient/physician relationship and incorporating this into all of Ro’s web interactions, making sure that Ro is always thinking about this relationship from the patient perspective, making this interaction the best it can possibly be for everyone involved.

10:00–13:45 Context on Ro’s current offerings & how Ro determines what to launch next

Many of the conditions that Ro’s digital products address relate to those that patients can identify prior to diagnosis (e.g. hair loss, erectile dysfunction). This serves to benefit the relationship with the clinical team member.

Ro’s offering currently consists of the following:

• Roman: a digital health clinic for men
• Rory: a digital health clinic for women
• Zero: a digital health clinic for smoking cessation
• Plenity (to be released in the spring): the first and only FDA-cleared weight management product made from naturally derived building blocks
• Health Guide: medically-backed, approachable health content for patients

Editor’s note: Ro has since added its COVID-19 assessment: a free telehealth triage service for the novel coronavirus

More on the decision-making process:

• Patient safety: From the medical side, patient safety is number one. Ro always looks for conditions where the patient-physician interaction is safe to conduct virtually. Ro also thinks about the treatment that is appropriate for a given condition. For example with hair loss, a patient can identify that they have hair loss. A physician can examine and confirm the condition with a photo.
• Diagnostic criteria: Ro thinks about the diagnostic criteria, too— does the condition need to be diagnosed via blood work? What are the “look alike” conditions? How easy are those to spot? For treatment options, they’re also thinking about side effects. Can someone take the medication incorrectly? What would be the worst thing that happens to them? How easy would it be for a patient to identify this side effect?
• Pain point for patients: In general, Ro focuses on high pain point conditions where people can look and feel that condition, such as erectile dysfunction. High cholesterol, on the other hand, is exactly the opposite. A patient can’t “feel” high cholesterol in a way that will prompt them to go into the doctor’s office, or in this case, a virtual clinic.

Ultimately, Ro tries to walk through the following steps:

• Meet patients where they are by addressing an initial pain point (e.g. via conditions that Ro currently treats)
• Build trust to develop the relationship through their virtual clinics
• After these steps, Ro can address other conditions that may not be as apparent to the patient.

13:45 —15:16 How they manage the pipeline of conditions

• Keeping an eye out for what’s next: Ro is constantly evaluating new conditions, primarily through their Business Operations team. Technology is fast-paced and ever changing, and they want to incorporate these changes into their offerings. For example, as more diagnostic equipment becomes available to use in the home, that changes the “algorithm” of what is treatable at home.
• What types of tools are available: Imagine if people had tools at home that could take blood pressure, pulse, oxygen saturation, respiratory rate, temperature — those are all of the vitals right there. Ro looks at things like at home testing, where a patient can take their own blood or urine samples. This opens the spectrum of conditions that can be treated through the platform.
• In sum, Ro evaluates what’s available, what’s necessary, what’s the “algorithm” of diagnostic items that are needed — then they see what surfaces to the top.

Editor’s note: In the instance of COVID-19 triage, Ro identified that its telehealth platform would be uniquely suited to help the public health crisis. With telehealth triage, Ro can unburden hospitals and clinics, safely advise symptomatic patients, and provide trusted health information.

15:25–17:00 How think they about navigating traditionally “taboo” topics with their patients

• Ability to go deeper: Having a condition-specific platform allows Ro to hone in on all of the nuances of a given condition. Instead of superficially thinking about hair loss as “just cosmetic”, Ro can dive deep and understand the psyche of someone who is going through hair loss. What are the options and how do you present those? What tools does a physician need to treat someone with this condition?
• Building trust and safe spaces: Things are typically stigmatized because we as people feel uncomfortable talking about them in public. The doctor’s office should be the safe space where there is no such things as stigma — you should be able to say whatever you want to your physician, judgment free. Ro’s challenge is figuring out how to create the safe space virtually through language. How online visits, treatment plans, even their advertisements are written needs to make patients feel like Ro really understands them. When Ro can convey that, that’s how they build trust and eliminate the feeling of something being stigmatized.

17:00–20:20 Launching allergy treatment on their existing platforms

At the end of February, Ro launched the 11th condition available for treatment on its platform: allergies. 50 million people in the United States suffer from allergies. Allergies treatment is available through both Roman and Rory.

• How it works: Allergies represents a huge step forward for Ro because it was simultaneously launched across Roman and Rory. Ro was especially proud of this release because it went live before allergy season actually hit. Allergy treatment represents Ro’s first foray into chronic conditions that are not stigmatized nor gender-specific. It’s something special to Dr. B., who, as a board-certified ENT, has treated hundreds of patients for seasonal allergies. Dr. B. shared an astonishing figure: over 80% of people pick the wrong allergy medication when they go to the drugstore.
• Current issues with allergy management: She explains why. When medications go over the counter, the FDA wants to make sure the medication is safe. So, the FDA will typically recommend two weeks to take a medication and if you don’t feel better, you should go to a doctor for the purposes of identifying if something else is causing your symptoms. Most people interpret that to mean they should only take the medication for two weeks, after which they will start feeling better. This is not the case! Patients should really be taking the medication beyond just a two week period to see if it works for them.
• Ro’s offering: The Ro product is a combination of nasal sprays and medications that attack allergies from different pathways in a very low-maintenance treatment regimen.

20:20 —22:15 How people use the Ro platforms in conjunction with their existing care teams

• Over 10% of Ro’s members discover Roman, Rory or Zero because of a recommendation from their physician. Doctors are telling patients to go online for one of the conditions that Ro treats.
• Ro views itself as a complement to existing treatments. They provide a nice end-to-end experience for patients, but people do need to go into their doctors for other things, like flu shots, physical exams, or colonoscopies.
• Ro’s objective is to free up the time for in-person clinics so physicians can spend more time with sick patients that need more than 7-minutes with their doctors. It also means that patients won’t have to wait days and days to get an appointment or wait for three hours in the waiting room when they are finally able to be seen.
• This value prop becomes evident looking at the coronavirus pandemic. Public health experts are worried that coronavirus fears will overcrowd and overburden our health system, making it more challenging and costly for people who need in-person or emergency care to find it. With telehealth triage, Ro can reduce strain on providers who are treating higher-risk and sicker patients.

22:15–24:30 What we can expect from the team in 2020

• What they’ve built to date: Ro has built everything from the patient application to the EMR to the pharmacy process, which is a massive undertaking. Each of those things could be businesses in themselves.
• Unlocking provider superpowers: Ro is optimizing its EMR to give providers “superpowers” — leveraging technology that not only meets the standard of in-person care, but supersedes it. For example, incorporating features like drug interaction trackers. It’s impossible for a human to remember every drug interaction, but a computer can.
• Continuing to offer a seamless journey: By owning every step of the pathway, Ro can really make the journey for the patient and the physician seamless. Working to improve that is one goal. Of course, there will be some new conditions coming out as well, such as Plenity and a partnership with Pfizer-Greenstone for generic offerings.

24:30 —27:45 Thoughts on collaboration between business and medicine

• Dr. B. says she’s seen a shift in appetite for business and medicine collaborating — over time, it has become more encouraged than she saw when her career in medicine first started. She appreciates being able to collaborate with her colleagues, who are at the top of their game in communications, marketing, product, engineering, among other fields that she claims to have never even heard of!
• Work with clinical folks! The one area where she sees an opportunity is among new health tech companies. There are a number of companies launching without any clinical presence on their initial team, which is unfortunate because the physician offers a lot in terms of patient and physician advocacy. Sometimes ideas may seem great on paper, but in a real life setting it doesn’t take off because of a mismatch between what patients and providers need and what the outside world thinks it can innovate.
• The opportunity for business and medicine collaboration is truly unlimited. It’s going to push in person providers to provide higher quality of care because industry will innovate on the delivery. In that setting, everyone wins.

27:45 —29:00 What has made Ro so successful in its cross-functional collaboration

• Dr. B. says that everyone at Ro maintains a level of humility — and they know where their lanes are. There are a lot of cross-functional teams and meetings. To be most effective, the company has started collaborating earlier in any given process.
• Instead of thinking of “medical” and “legal” teams as those who someone needs to get approval from, the teams get together at the beginning of the process when someone starts thinking about “What if we added x feature?” This way teams can collaboratively iterate as they go, instead of showing it to Medical or Legal at the end.

29:00–31:00 Talking through some of the team’s big challenges

• Launching a new vertical: Dr. B. describes launching Rory as a “Herculean effort” because it entailed launching a completely new vertical and brand within the company. With Rory, education is key. When Ro was launching Roman, initially tackling erectile dysfunction and viagra, the team benefited from 20 years of D2C marketing. Viagra and ED are mainstream topics, conditions, medications.
• However, that’s a big contrast from Rory or vaginal dryness, one of the symptoms that Rory addresses. These things aren’t very mainstream. Even women experiencing these conditions needed to be educated. With Rory, Ro had to go all the way back to the beginning and educate women about menopause and the symptoms they might be experiencing. Then they could build trust, but this trust had to start with educating patients about their own bodies. That was a challenge because it was a completely new process.

31:00–33:35 Why Ro bullish on the future on telemedicine and the role it will play in the growth of this area

• Telemedicine is broader than people think: Many people think of telemedicine as only the synchronous visits with a provider. But really every time you message your doctor and they message you back, you describe symptoms, they prescribe treatment: that’s telemedicine! There’s huge adoption already, it’s just in a different form than the way most people think about it.
• It’s a tool, not an end-state: Ro isn’t claiming that telemedicine is the only part of the future of healthcare, but they are claiming that telemedicine can alleviate a lot of the burden that currently plagues the healthcare system. How many other treatment modalities allow a physician in New York to treat a patient in Kentucky or Virginia or rural Georgia?
• It solves problems across the board: Telemedicine also addresses physician shortage and access for people in rural areas living hours from their doctors. It also addresses the single mother who is an hourly worker who can’t take off from work for fear of choosing between her healthcare and putting food on the table. With telemedicine, she can see her doctor in the middle of the night or on her lunch break when it’s convenient for her. Access, safety, quality, transparency are all things that telemedicine can address. That’s why Ro is laser-focused on it.
• Being the patient’s first call: For Ro, the goal is to be the patient’s first call, the industry standard for telemedicine. There are other players in the space, but for condition specific, end-to-end treatment from diagnosis to delivery — Ro is the only company that has built its own patient, physician and pharmacy applications (no small task!). Ro wants to lead the space. They will continue to push to add more capability, especially as the technology gets better.

33:45–36:30 How patients pay for Ro and why their approach encourages transparency

• How payment works: The physician’s visit is $15 and the patient pays for the cost of the treatment. Shipping is free. Ro does this because you can innovate a lot in a cash pay environment. There are many restrictions when innovating under insurance contracts.
• Why it’s a cash pay solution: On the physician side, $15 is less than most people’s co-pay. This lower cost improves access and that was important to Ro when they thought about getting it into the hands of everybody. The transparency with Ro — here’s what you pay for the visit, here’s what you pay for the medication — will help force transparency in the insurance world or in the in-person scenario where you get a bill and an explanation of benefits.
• Right now with traditional healthcare, it’s totally unclear who you’re supposed to pay for what.

36:30 — End Final advice

Here’s a direct quote from Dr. Barnes because her advice is fantastic:

“Go with your gut! Everything I have ever wanted has been on the other side of fear: what will colleagues say, what will my residency director say. I am the only person who has to wake up and be me every day. Let me have the freedom to explore it.”

Tactically, she gives two recommendations:

1. Write down your ideas and what you think is keeping you from making a given transition. Start networking with the people who are doing the things you like.
2. When you’re ready, take the leap! It is so worth it.

Big thank you to Dr. B. for sharing her time with us on The Pulse Podcast! Subscribe for our new releases on Twitter, Apple Podcasts or Spotify.