Josh Hix, Season Health, on making “food as medicine” accessible

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In this episode, we connected with Josh Hix, Co-Founder and CEO of Season Health. Season Health is a platform that connects members with healthy meal ideas and grocery options to help members and providers manage chronic conditions. Prior to starting Season Health, Josh co-founded the meal prep delivery service Plated, which led to an appearance on SharkTank, investments, and eventual sale to Albertsons grocery store. Josh Hix is a serial entrepreneur with several successful tech startups under his belt. Josh holds a Bachelor’s degree from the Georgia Institute of Technology and an MBA from Harvard Business School.

Season Health recently raised $34M in Series A funding led by Andreessen Horowitz. LRV Ventures, Company Ventures, Cityblock CEO Toyin Ajayi and other angel investors also participated in the round. Prior to this, Season Health raised $11M in seed funding.

We discussed:

• Leveraging Josh’s prior experience co-founding Plated to realize a vision of creating a consumer-grade software platform that connects food and medicine.
• Season Health’s mission to make nutritious food more accessible by shaping the increasingly digital food environment and partnering with payers to make food more affordable to improve health outcomes for patients with chronic diseases.
• Partnering with healthcare industry leaders Geisinger, CommonSpirit, and Cricket Health to scale Season Health’s offering and enrich scientific research linking nutrition with better chronic disease management.

Start to 5:59: Serial entrepreneurship experience paving the way for founding Season Health

• Early appearance on Shark Tank: Josh is a serial entrepreneur, perhaps most well known for co-founding Plated, a meal kit delivery company. Josh and his co-founder pitched Plated to the team of investors on ABC’s Shark Tank, including the legendary Kevin O’Leary and Mark Cuban. Having pitched to VCs before, Josh revealed the conversations with the SharkTank investors were fairly similar to discussions with other investors though the final clips included in the show created a punchier narrative for TV audiences. The experience of appearing on SharkTank also gave Josh deeper appreciation for the sacrifices entrepreneurs undertake to build and sell their business ideas.
• On the pivot to starting a healthcare company: Plated was Josh’s initial foray into nutrition, and he had long term aspirations to work on something more directly related to health and nutrition. After Plated was acquired, Josh spent time developing a concept for a healthcare solution that addresses gaps in the patient food experience. Josh brought on his future co-founder, Mustafa Shabib, who had previously been the Chief Technology Officer of Quartet Health, along with Dr. Andrea Feinberg, the former Geisinger Fresh Food Farmacy Chief Health Officer and Co-Founder. Pooling their various experiences, the team realized the opportunity to use technology to expand access to nutritious food to improve patient health outcomes.

5:59 to 23:23: Season Health bringing a new perspective to food as medicine

• Gaps in the food and healthcare industry prior to COVID: For a long time, clinicians understood diet and nutrition were key factors influencing the health outcomes of patients, especially for those with chronic conditions such as Type 2 diabetes. However, prior to COVID, to address nutrition, physicians at best referred patients to a dietician. The patient received guidance on which foods to eat and which to avoid, but faced challenges in implementing these guidelines due to a lack of care coordination and the endemic difficulties patients, especially those from socioeconomically disadvantaged backgrounds, faced to procure and prepare the foods dieticians recommended.
• Defining “food as medicine”: For Season Health, “food as medicine” refers to leveraging dietician-approved nutritional guidance to help patients with chronic diseases improve and maintain their overall health. The focus on chronic disease management is especially salient given the impact of food on many chronic illnesses such as diabetes and heart failure. Due to the long-term nature of these conditions, patients must consistently monitor their nutrition.

Overview of Season Health: Season Health currently services providers, payers, and patients

• For providers: Season Health offers the ability to integrate clinically-vetted nutritional guidance into a healthcare system’s electronic health records (EHRs) so patients receive meal-level nutritional recommendations based on their clinical diagnosis. Season Health is the software platform on which providers share nutritional guidance with patients.
• For payers: Season Health supports payers based on their capabilities. For payers who lack dietician expertise, Season Health provides nutritional guidance from their national network of registered dieticians. Season Health can also facilitate payments from the payer to subsidize clinically-recommended and nutritional foods for the member.
• For patients: Season Health is a digital app that translates clinical nutritional guidance into suggested recipes that are personalized for each patient based on cost, time required to make the food, and cultural or dietary preferences. Season Health’s platform matches the recommended food with local grocery stores or food delivery companies so the patient can more easily purchase the food.

“Making [nutritional health] consumer-grade is a big part of the magic and making it all work.”

• Proving the value proposition to payers: Years of research including some claims data show that diet directly impacts the severity of many chronic conditions. In this way, maintaining a nutritious diet can reduce overall healthcare costs. Despite this knowledge, patients have struggled with implementing nutritional guidance because of challenges in accessing healthy food. Season Health works with payers to bring awareness to the healthcare savings potential of subsidizing nutritious food for patients with chronic conditions.

“Season is an app for patients where the nutritional requirements from their clinician is baked in…We are really that tool to help [patients] find food, whether it’s recipes in the grocery store or their weekly staples.”

• Creating a consumer-grade offering: Season Health borrows from Plated’s experience designing recipes that appeal to consumers based on their personal taste preferences, cultural background, and available grocery vendors all while taking into account the clinical nutritional needs of the patient. Josh brought on former members of Plated’s team to build an adaptive algorithmic model generating recipes for patients based on buying behaviors, and how patients rate foods they purchase. Through this, Season Health aims to continuously improve their personalized recommendations for members.
• Focus on chronic conditions: Currently, Season Health supports patients with diabetes and chronic kidney disease. Moving forward, Season Health plans on servicing patients across a wider disease profile including heart failure, certain types of cancer, and maternity. Season Health is also aware of the prevalence of comorbidities amongst patients across the disease profiles they service, and tailors nutritional guidance factoring in comorbidity status. Season aims to focus efforts on expanding and scaling its offerings for these disease burdens before tackling other diseases given the vast number of Americans who currently suffer from these conditions.
• Oriented around a value-based model: Season Health offers eligible patients living with the chronic conditions they currently treat a direct way to engage with their offering. However, most patients access Season Health through payers. Season Health aligns its payer contracts in a value-based way that accounts for health outcomes. While there may be modifications to the current commercialization model, Season is invested in continuing to orient its contracts around improvements in patient health and engagement metrics.
• Tracking key metrics: Season Health tracks member engagement, such as the number of times members log into the app, whether the member attends meetings with their dietician, and the food items purchased on the app. On the medical side, Season Health tracks clinical indicators such as A1C levels in diabetes patients, as well as claims data to gauge the efficacy of its program on the health of patients.

23:23 to 38:57: On crafting food that is available, affordable, and culturally competent

Addressing the accessibility of healthy food, Josh breaks down food access into two parts: the availability and affordability of food

• Availability: Food has become more available through increased digitization and the growing omnipresence of food delivery. Before COVID, the rise of digitally-native food platforms that delivered to consumers across America such as Plated ushered in a trend of consumers becoming more acclimated to receiving groceries and semi-prepared foods at their doorsteps. However, many households did not utilize food delivery. COVID vastly accelerated food and grocery delivery adoption across all population segments, including Medicare members who are also at greater risk of managing chronic conditions.
• Affordability: Delivered food is more expensive than food consumers purchase at their local grocery store. However, existing research shows clear linkages between good nutrition improving health outcomes and lowering the overall cost of medical care. This presents an opportunity for payers to subsidize the cost of healthy food as a way to manage the patient’s cost of care. In addition, scaling food delivery operations through technology enablement will likely also bring costs down.

“We all kind of just eat what’s around us. And so is it really that much of a surprise that in certain neighborhoods, where the food that’s most available is not healthy, that people have a greater than average disease burden?”

• Shaping the digital food environment: Before the prevalence of food delivery, consumers’ choices about food were primarily determined by the food available within close physical proximity to where consumers lived. Food delivery has enabled a digital food environment where consumers have access to a wider range of food options. Season Health aims to improve the food environment for all stakeholders by exposing consumers to more nutritious choices while also influencing restaurants and prepared foods companies to adapt their offerings to align with healthier options that benefit consumers.
• Leveraging AI to develop personalized, culturally competent recommendations: Stemming in part from Josh’s prior work at Plated, Season Health utilizes big data and AI to generate food recommendations optimizing across several dimensions to capture consumer preference. These parameters include cost, time to prepare a recipe, cultural considerations and dietary restrictions. Awareness of the important role culture plays in shaping consumer taste preferences is a key driver for Season Health’s ability to ensure patients prepare and consume the food it recommends.

Collaborating to target food nutrition and insecurity: Season Health is working with Geisinger and Cricket Health to bring its nutrition services to more patients. Season Health is also collaborating with CommonSpirit Health to enhance research linking nutrition with chronic disease management.

• Geisinger: Season Health is dispatching its software platform and virtually-based dieticians to expand the reach of the Geisinger Fresh Food Pharmacy, a program that connects patients grappling with diabetes and food insecurity with food options and clinical nutritional guidance. Season aims to service more Geisinger patients across a greater geography and more disease burdens beyond diabetes.
• Cricket Health: Season Health is also working with Cricket Health, an industry leader in chronic kidney disease management, to design nutrition plans targeting chronic kidney disease care. Season Health will also engage its software platform to help Cricket Health patients mitigate issues of food insecurity and enable patients to access more nutritional foods to improve their overall health.
• CommonSpirit Health: Season Health is partnering with CommonSpirit Health to conduct clinical trials with CommonSpirit’s diabetes patients to measure the impact of diet on diabetes management. The outcome of this research will contribute to the existing literature on how diet impacts chronic kidney disease management.

“Our biggest competitor is the status quo — it’s just continuing to do nothing.”

• Working against systemic inertia: Payers and providers are overwhelmed, and have limited near-term incentives for updating their legacy nutrition programs. Payers tend to be risk averse, and may not prioritize improving the way nutrition has been traditionally dispensed in the healthcare system. However, the prevalence of diseases that are strongly influenced by nutrition, such as Type 2 diabetes, suggests there is a large gap in the way nutritional medicine is currently handled in the U.S. Season Health is focused on plugging in this gap by connecting a growing number of patients with nutritious food options to improve and maintain their health conditions.
• Even more opportunities in healthcare today: Healthcare is a massively complex and heavily regulated industry that harbors institutionalized inefficiencies that continue to drive up costs. Improved technology has not been consistently deployed across the industry, and the patient experience is still deeply unsatisfactory in many aspects. These dynamics create tremendous opportunities for innovation and disruption in healthcare to benefit all stakeholders.

38:57 to End: Advice from a serial entrepreneur

• Find what you truly want to do and can build a business around: Finding an area you are truly interested in, not simply because the certain trends may be favorable to starting a company in a specific sector, is critical. Being an entrepreneur is hard, and a problem you are internally driven to solve will be critical in helping you remain motivated during the difficult times (and there will be many.) The business should also have a clear path towards scaling, otherwise the end goal may not be economically sufficient to sustain the challenges you will encounter along the way.
• How to pick investors: The wrong investor will erode the value of a company, and this phenomenon happens more frequently than people think. When assessing investors, Josh looks for personality fit and values alignment. The best investors also know how to balance providing an opinion with deferring to the business team when opinions differ. Investors also can’t neglect the basics — they should show up on time to meetings having reviewed any relevant materials beforehand so they are prepared for the discussion.

“A lot of entrepreneurship is just doing the right things but doing them every single day.”